Humiliation, feeling trapped, as well as feelings of hopelessness often play a central role in suicide.
How can one determine that a person is on a suicidal path. Sadly, there is no foolproof way of determining if a person will kill themselves. But happily, there are some fairly good predictors that indicate that a person is in danger.
A few months ago a 24- year-old girl was brought to hospital in critical condition having taken a mixture of pain killers and sedatives. On arrival, she was in a deep coma and was transferred to the intensive care unit where she remained on life support for the next 24 hours. Slowly she came round and we were asked to see her as was the hospital policy — all attempts at suicide had to be evaluated by a psychiatrist. At first she was clearly tired from her experience and could hardly talk to us about the events that led to the incident.
By the third day she was moved to the general ward and was able to give an account of herself. She had broken up with her boyfriend of six months and thought it best to die. Life without him was not bearable and death was her only option, she said. Pressed a little further, she agreed that the heavy drinking preceding the overdose may have made things look worse than they really were, and she certainly had no wish to die now that she was safe. She was in fact keen on going home to be with the rest of the family.
The family agreed that her’s was an impulsive action, totally out of character and that she was ordinarily a good girl with many friends, loved parties, and seemed to perform below her intellectual level. It was later clear that the girl suffered from Attention Deficit Hyperactivity Disorder and depressive illness. She was treated, got better and is back on track. Her case is different from that of the 65-year-old businessman who shot himself through the abdomen. The bullet ripped through his liver and just missed the heart. He had clearly planned the suicide very carefully. He had chosen to commit suicide on a night when both his wife and daughter were out on late evening Bible study. To prepare for death, he downed a number of whiskies. We saw him five days after major surgery, and he had a very long story to tell. In essence, he had became depressed and found life impossible.
Losing weight
He was losing weight, his diabetes and hypertension were out of control. He did not sleep well at night, had lost interest in sex, and his wife of 40 years did not seem to care as she had become completely swallowed in church activities. He lost interest in his business. He felt unable to supervise his construction team, even paying salaries at end month was too much for him. He began to feel useless, worthless and empty. His only companion was whisky.
His friends at the club begun to avoid him because when drunk as he frequently was, he was a nuisance. He kept repeating the same story about his conquest of women at university and how hot he once was.
Some said he was depressed, others thought he was demented, while others argued that he was plain stupid. His rather youthful physician had failed to diagnose a straightforward case of depression in a man with uncontrolled diabetes and hypertension.
Ten days after he shot himself, the man died of a huge blood clot in his lungs. The church, which had taken too much of his wife’s time, had nothing to do with his funeral, claiming that the man chose to die.
The man was in fact not in a position to exercise choice. He had a severe depressive illness which was neither recognised nor treated. A young priest, recently returned from the US, spoke at his funeral. He moved the gathering to tears. He spoke of suicide being a leading cause of death in men aged 20 to 29.
He pointed out that men were four times more likely to kill themselves than women.
Untreated depression
He went on to give other causes of suicide, including untreated depression, explaining the role played by alcohol in precipitating the event.
The role of physical illness, isolation, and recent loss or bereavement were further causes of suicide. Humiliation, feeling trapped, as well as feelings of hopelessness often play a central role, he said.
Those charged with criminal offences were at high risk as were those abusing drugs and alcohol. The list, he concluded, was long and he was not sure what in the end had caused the man to choose death, but what he was certain about was that depression must have played a role.
These two cases illustrate the complex nature of suicide and emphasise the fact that no two cases of suicide are the same in spite of the fact that depression and alcohol seem common denominators.
The rich and poor kill themselves, but a history of depression, previous attempts at suicide, recent major loses, family history of suicide coupled with drug and alcohol abuse rank high on causes of suicide.
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