Michael Abrahams | Why do people become suicidal?

Whenever someone dies by suicide, one of the most common reactions is to ask the question “Why?”. Most of us have never thought of taking our own lives. Persons who do, or attempt to do so, are sometimes judged harshly, and deemed to be crazy, selfish or “sinful”. I remember when the famous actor and comedian Robin Williams died by suicide, someone on my Facebook page was full of condemnation, insisting that he would be going to, or was already in, Hell. Rather than judging, it is more helpful to try to understand why someone would consider the act, as this will assist us in identifying those at risk.

One of the most significant risk factors is mental illness, especially depression. An analysis of 65 studies found that 31 per cent of people with major depression have attempted suicide. Other conditions that increase risk are anxiety disorders, bipolar disorder, borderline personality disorder (BPD), post-traumatic stress disorder (PTSD), eating disorders, and schizophrenia.

Traumatic stress is another significant risk factor. For example, in the United States of America, the suicide rate of war veterans is 1.5 times higher than that of the general population. Other types of trauma, such as rape and other forms of sexual assault, also contribute. And the effects of trauma are greater when it occurs in childhood, because the developing brain of a child is more vulnerable to being affected than that of an adult.

MAJOR RISK

Therefore, childhood trauma, often referred to as adverse childhood experiences (ACEs), is an established major risk factor for suicidal ideation. ACEs are typically placed in three categories: abuse (physical, emotional, and sexual), neglect (physical and emotional) and exposure to dysfunction in the home (domestic violence, mental illness, drug abuse, incarceration of a family member, and divorce or separation). A score of 1 is given for each ACE, and there is a dose-response relationship between the ACE score and suicidal risk. In other words, the higher the ACE score, the greater the risk of being suicidal. So, if a person’s ACE score is 0, the risk of their attempting suicide is 1 per cent. With a score of 3, it rises to approximately 10 per cent. At a score of 7, it increases to about 20 per cent. In other words, the more a child is traumatised, the more likely they are to attempt suicide. In addition to the ACEs mentioned above, there are others, including severe poverty, homelessness, hunger, bullying, racism, losing a parent or caregiver, surviving a major accident, natural disaster or illness, community violence and war.

Substance abuse is another risk factor. Alcohol, recreational drugs and mind-altering prescription drugs may contribute, as they can cause those who are already suicidal to be more impulsive. People sometimes become suicidal after experiencing failures, such as academic failure or a failed business or relationship. Another cause is loss, such as of a loved one, job, relationship or social status. The shame and humiliation that result from bullying have driven people to suicide too, and cyberbullying has significantly magnified these effects. It is one thing to be bullied privately or in front of a few witnesses, but cyberbullying on social media platforms has the potential to be seen by countless people, some of whom may even join the bullying, exponentially increasing the effects of the trauma.

Financial problems, such as severe debt, have been known to push people over the edge. Physical ailments can also take people to that dark place. For example, people experiencing chronic pain sometimes see suicide as a way out of their misery. Indeed, more than half of such persons have depression or anxiety symptoms. Illnesses such as cancer, especially when terminal, and chronic and incurable diseases, including potentially lethal ones such as HIV/AIDS, unsurprisingly push some people over the edge.

BECOMING DEPENDENT

Losing one’s independence, becoming dependent on others, and feeling like a burden can make one want to leave the planet, as can social isolation and loneliness. A common state of mind, regardless of the reason for being suicidal, is a feeling of hopelessness. When someone gives up hope that things will get better for them, leaving this world can appear to be a reasonable option. It is also essential to appreciate the role childhood trauma plays in many cases of suicide or suicide attempts. It has already been mentioned, but it is also at the root of several of the other risk factors listed above, including mental and physical disorders, drug abuse, job insecurity, financial issues and dysfunctional and toxic relationships, which are likely to end in messy break-ups.

It is important to note that one of the most significant risk factors for suicide is a previous attempt. Sometimes it may not have been a serious one, but instead a cry for help. In any case, any attempt ought to be taken seriously.

Armed with this information, it is incumbent upon us to do what we can to protect our fellow human beings at risk and the loved ones they would leave behind. A good start is to destigmatise mental illness. We must understand that our mental health is as important as our physical health. A no-brainer is to treat our children better and minimise the trauma they are exposed to. We do not have to beat them to discipline them, and we must understand how unkind words or the absence of a parent can adversely affect a child. We must be mindful of how we treat others. Everybody has a story, and some are horrific. You do not have to throw words at people you do not like, whether in person, on social media platforms or in other spaces. Many are on the edge, and just an unkind word or gesture can shove them over. So, please be kind.

If you know people, including family, friends, co-workers, neighbours, or others who have any of the aforementioned risk factors, check in with them from time to time, even if they appear okay. You just might save a life.

Michael Abrahams is an obstetrician and gynaecologist, social commentator, and human-rights advocate. Send feedback to columns@gleanerjm.com and michabe_1999@hotmail.com, or follow him on X , formerly Twitter, @mikeyabrahams