Suicide involves a decision by someone to take their own life. Mental illness may be involved in that decision. Our lifestyles may expose us to the risk of cancer, but we can’t contract cancer the way we bring about suicide.
Suicide remains a divisive subject among mental health professionals. Suicide prevention measures consume a vast amount of mental health resources. Yet, I know of many psychiatric colleagues who believe doctors cannot prevent suicide.
Some healthcare professionals and managers think that adopting into suicide research the techniques used in cancer research might improve our ability to predict suicide. I instead think the opposite; the reason we have made little progress in predicting suicide may be because we have banked too much on these techniques, trying to predict suicide as if it were a disease. We have not paid enough attention to the fact that suicide is the immediate and direct outcome of a decision by the victim, unlike cancer and other diseases.
Our approach to suicide studies also translates into difficulties with the way we manage suicide risks. The link between mental illness and suicide is often over-emphasized, and this may be because society finds it hard to accept that someone of a sound mind can take their own life. When someone expressing suicidal thoughts has been diagnosed with a condition like depression, attention is immediately focused on the mental illness while other suicide factors are ignored.
I am always surprised by how little attention is paid to the reasons, justification, or rationale for a person’s suicide when managing the patient in life or their after-suicide inquiry. In life, we base our risk assessment on what the person admits to and the severity of their illness. This approach again ignores the fact that even in depression, the reason someone takes their own life is rarely” because I am depressed” and instead because they have decided for reasons known to them that their life is not worth living. Depression may be an essential factor in that decision, but so are other factors.
Our suicide management and prevention strategy should pay greater attention to the patient’s rationale for suicide, how suicide makes sense to them, and why it may not. After all, suicide is not an automated act but rather a decision, however long or short the victim had taken to make that decision.
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