Tag Archives: Suicide

Anthony Bourdain and Suicide

By Dr David Laing Dawson

We are Borgs, if you will pardon the Sci Fi reference.

At our best we carry in our heads a sense of the thoughts and feelings and wellness of others as well as our own. I am not talking about empathy here but rather that a piece of our consciousness is devoted to the existence of others; that an awareness of others, even when they are not present, is an important part of consciousness.

This ability allows us to experience empathy but it is wider than that. When conscious, at our best, we are aware of not just what we see and hear and of ourselves, but of the people in our lives and our connections to them. And that circle of people can include a few family members or stretch to the refugees of South Sudan.

At our best.

In a psychotic illness that awareness can become strangely distorted, with one or many of these relationships over interpreted, imbued with magical power or ominous threat. This is easy to observe, from a stated conclusion that the people on television talk to me or the police are watching me and putting drugs in my orange juice.

What is not so easy to observe is the effect of clinical depression. But depression, the illness depression, diminishes and eventually eliminates that social form of consciousness; the awareness of others, our connections to them, the presence they maintain in our minds, is lost in depression. Consciousness, in depression, is reduced to simply the self, and the self in depression is a malfunctioning body of limited worth and a sense of dread. Others are gone from our shrinking cloud of consciousness.

Anthony Bourdain killed himself in a hotel room in Paris and I watched CNN last night. He left grieving friends, colleagues, fans, and an eleven year-old daughter. Oddly, with what I have written above, Anthony made a career out of connecting with, engaging with others and sharing their lives and cuisines.

Apart from remembering, paying tribute to Anthony Bourdain last night, much of the focus was on suicide. The number of a suicide hot line was displayed throughout. But we have had these help lines available for 30 years and, as CNN reported, the suicide rate continues to climb. And as I recounted in a previous blog, the numbers of people brought to emergency rooms for assessment of “suicide ideation” has been growing by 14 percent year after year. Yet actual numbers of completed suicides persist and grow.

The focus on suicide itself is wrong. This focus, this de-stigmatization and “talk about it” approach obviously has not helped and may even be a contributing factor.

Suicide is the product of despair, dread, pain, anxiety coupled with the cognitive impairment of depression I have described above. It is this cognitive impairment that allows the severely depressed person to not realize the damage his death by suicide will do to his daughter or son, sister, brother.

We are often bewildered by seemingly successful people with loving partners and family who kill themselves. But depression, the illness depression, renders success hollow, and gradually eliminates loved ones from consciousness. In depression one’s sphere of consciousness has deflated to the agony of self. And at that point we seldom call a hot line or seek out help.

For prevention of suicide we need to focus on depression. The recognition of depression and the cognitive deficit that develops with depression, and the treatment of depression.

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On Adolescent Suicide

By Dr David Laing Dawson

Adolescent suicide is a tragic event. It can have a devastating and life long impact on others: parents, siblings, teachers, relatives, counselors, friends.

Five Woodstock, Ontario  teens have taken their own lives since January this year. A very high number for a small community.

If this were a cluster of deaths from respiratory causes we would surely investigate with a team comprised of a respirologist, an epidemiologist, and the public health officer.

Thus our first step here should logically be an investigation by an epidemiologist, a  psychiatrist, and the public health department. Let us first see if these deaths are a result of undetected, untreated mental illness, if the teens know one another in real life or through social media, if they are all browsing the same toxic websites, or if each has been the target of bullying or something worse, or a combination of these. Let us try to understand before rushing into awareness programs, school assemblies, more crisis lines.

There are several good reasons to not rush to “talking about it” as the answer. These are teenagers, not adults. We know from anti-smoking programs, when we gathered our high school students into the auditorium to talk to them about the horrors of smoking and showed them videos of cancer-ridden lungs and COPD sufferers gasping for breath, the number of teens taking illicit puffs at the local smoking pit increased. Increased. Not decreased, increased.

We are also living with the paradox of contemporary times when kids are inundated with suicide awareness programs, when every school counselor and nurse asks every troubled kid the question, when each community has an advertised crisis line, when the question “do you ever think of harming yourself?” is asked on countless questionnaires and surveys, when our teens are communicating with each other around the clock, when information on any and every subject is as available as the nearest smartphone, and when we are in the midst of public discourse about assisted suicide. It is in these times, not in the 50’s, 60’s, or 70’s ( when the word suicide would only be said in the same whisper as syphilis), that clusters of teens are committing suicide.

Or so it seems.

But what I am trying to say is that we should investigate these phenomena before we rush to “solutions”, especially with teenagers. They are not adults. They often do things just because they have recently learned those things are possible to do. They are often more intrigued when adults bend over backwards to warn them of danger.

The adolescent brain has lost some of the intuitive avoidance and fear of the child’s brain. It is developing some reasoning and analytic processes to replace these. But it does not have the breadth and depth of experience of the adult brain, nor the ability to consider the distant future and the effect on others. The adolescent brain tends to live entirely within its present context.

“Would you swim with sharks?” When a child is asked this question he or she will answer with an emphatic NO. An adult will also offer a very quick negative, though with some adults and a few adolescents the questioner may need to add that ‘sharks’ is meant in a literal sense. But the teenager. Ah, the teenager. He or she asked that same question will ponder it. You can see and sometimes hear the analytic reasoning kicking in: “Well, humans are not the sharks’ natural prey, so….and though I am not a good swimmer….and depending on…”

So far, with teens, my own informal survey has resulted in answers of “yes or maybe or I’d consider it” 100 percent of the time.

I am not saying we should downplay suicide and it’s tragic consequences. I am saying that we should treat an increase, a cluster of suicides like any other serious outbreak of illness. We should study it without pre-judging. And when teens are involved we should take into account their contrary minds.

The Woodstock cluster may be a problem of inadequate resources; there may be a contagion factor at work;  there may be a local stigma about seeking help; there may be some cyber bullying occurring; the means to kill oneself may be too readily available; there may be untreated mental illness involved; they may all have been fans of the same toxic Web site; they may know one another, or not; they may be using or misusing the same drugs; they may be all attending the same counselor; or this cluster might be simply a statistical anomaly…

We should help family and friends cope with these tragedies, but we should investigate before we plan a preventive intervention.

 

On Mental Illness – Let’s Not Wring Our Hands But Actually Do Something

David Laing DawsonBy Dr David Laing Dawson

The last few days, thanks to our local newspaper and the television, I have been bombarded with mental health news. This could be a good thing. Heightened awareness, increased sensitivity, decreased stigma, having a public conversation about it, making politicians and lawmakers aware.

But it has almost all been over-inclusive wringing of hands, bemoaning the state of the nation, the suicidality of our youth, the stresses of modern life, the bad behavior and instability of our classrooms, the internet vulnerability of our children, the dramatically increased use of marijuana which is now, they say, ten times more powerful than the stuff we toked in the 60’s while singing “Puff the Magic Dragon.”

As is so often the case these days the words and phrases “mental health”, “mental health issues”, “addictions”, “behavioural issues”, “stress”, “anxiety”, “mental illness”, “addiction issues”, are used interchangeably.

The most egregious of these misnomers often comes in the form of “He is known to suffer from mental health.”

Am I too concerned with semantics here? I don’t think so. Because I think all this fraught hand wringing, vague euphemisms, contradictory word usage, broad generalizations, and statistically implied causal relationships can only lead to two kinds of unhelpful responses:

  1. The news itself, defined so broadly, so all inclusively, so vaguely, and with such a sense of urgency, becomes just another stress to bear.
  2. Money is found, a program is announced, some general response that will allow the politicians to appear to be doing something to “solve the problem” and boast in the legislature or town council, while knowing it will do nothing to help specific individuals who actually suffer from specific mental illnesses.

At least response number two will help alleviate the damage of response number one. But response number two is all too often some general manipulation of optics, some appearance of action to “eliminate crime”, or to provide a telephone number to call for those who are stressed or “experiencing suicidal thoughts.”

Okay. There are social, political, and economic factors that contribute to mental illness and disability. And we could and should gradually ameliorate these through social and political programs that reduce poverty (minimum wage, disability pension, and social assistance increases), increase the availability of affordable housing, make day care more affordable and accessible, ensure we have an educated population, help youth transition from childhood to full independence (support, training, internships, money management programs), stop sending young men and women to war and trauma, ensure some of the profits from alcohol and gambling go to alleviate the damage done by alcohol and gambling, fund and evaluate specific targeted programs to reduce the social cost of addictions, and to counter the misogynist messages our young men are now acquiring through social media, pervasively available pornography, and hateful song lyrics.

But there are a number of specifically identifiable and specifically treatable mental illnesses that we could target in a far more specific and effective way. These are:

Anxiety Disorder

Obsessive Compulsive Disorder

Depression

Bi-Polar Disorder

Schizophrenia.

These specific disorders (not withstanding the researchers’ and clinicians’ ongoing search for more clarity, specificity, and causality) can be very specific causes of disability, distress, failure, and suicide.

But we can identify them; we have the tools to detect them; and we have the tools to treat them. And doing this, providing funds and creating programs to do this, would be far more effective than hand wringing.

Take suicide for instance. There are a large number of social factors (loss, divorce, alcoholism, poverty, unemployment, debilitating illness, aging, trauma) that increase the risk of suicide. Some of these we can do nothing about. We can chip away at others through legislation and social programs.

But there are some specific causes of suicide (actual suicide, not threats and thoughts) for which we do have the tools to detect, intervene, and treat.  And these are the mental illnesses listed above.

(I think I must point out here that the proliferation of hot lines, crisis lines, help lines, phone numbers to call over the past twenty years, has NOT changed the actual completed suicide rate in any jurisdiction I know of.  But there have been studies demonstrating that helping and teaching family doctors in the detection and treatment of depression has lowered the rate of actual suicide.)

So what we should focus on are specific programs for early detection and comprehensive treatment of the mental illnesses listed above. Or better targeted funding for the services that do that now, and the linkages between them.  These linkages are crucial in order to move from suspicion, to detection, through assessment, to expert treatment: Parent and teacher to counselor and social worker to family doctor and pediatrician to mental health program with psychologists and psychiatrists.

Editor’s Note Dr David Laing Dawson has been practicing psychiatry for many years. He is a former professor of psychiatry in the Faculty of Health Sciences at McMaster University in Hamilton, ON and the former chief of psychiatry  at the Hamilton Psychiatric Hospital. He is the author of Schizophrenia in Focus, Relationship Management of the Borderline Patient and The Adolescent Owner’s Manual. He has also written and directed a number of films on mental illness.