Tag Archives: suicide contracts

More on Depression and Suicide

By Dr David Laing Dawson

Let me take my most recent blog a little farther.

For mental health workers: Stop asking the suicide question. It is a question that produces about 50% false positive, 49% genuine negative, and 1% false negative answers. It misleads and distracts. And, clearly, even with thousands of mental health professionals asking that question over and over again, the actual completed suicide rate is increasing (it does not work), while the statement “I want to die” has become legitimized as a replacement for, “I am not happy with my life at this moment.”

The question also distracts and misleads. The answer to this simple question becomes the criteria for holding or not holding, for acting or not acting, for caring or not caring. It also, in hospitals and emergency rooms, becomes a cover-my-ass question before discharging from care.

Rather, spend the time to be with. To look, listen, and attend. Depression is visible. It is not a hidden illness. It is visible. If you don’t believe me watch Anthony Bourdain’s last television special.

Agitated Depression, a combination of despair and high anxiety, is very visible and a high risk for suicide. The pain of agitated depression is hard to sit with, be next to. The diminution of conscious awareness is apparent. Being there and listening one can experience the loss of attachment to others and to a future and to the pain of being in that person’s skin.

Flat, blunted depression is airless. The eyes have no life, the voice no lilt; the entire arousal system is diminished. It is difficult to sit long with this person without feeling his or her lonely shrinking consciousness.

Offer help and treatment in a safe environment. And by treatment I mean medical psychiatric treatment, not a CBT course starting next month. Hospitalization is needed if the risk is severe, and definitely when the person is in a state of agitated depression, or if he or she not once in the course of an hour spoke of anything beyond tomorrow, and no one’s name caused a glimmer of light to appear in his eyes.

Offer treatment, help, hope and hospitalization. Severely depressed people accept help when it is offered.

Do not “contract for safety”. It is, again, a bizarre “cover-my-ass” approach that is obviously paradoxical. It means, at face value, that the counselor believes the risk of suicide is high and at the same time that eliciting a promise to not kill oneself (at least before the next appointment) is a sufficient response to that risk.

We treat heart failure to prevent death.

We should treat depression to prevent suicide.

Advertisements