# Frequently Asked Questions about Suicide



## David Baxter PhD

Frequently Asked Questions about Suicide
National Institute of Mental Health
December 1999

*What should you do if someone tells you they are thinking about suicide?*
If someone tells you they are thinking about suicide, you should take their distress seriously, listen nonjudgmentally, and help them get to a professional for evaluation and treatment. People consider suicide when they are hopeless and unable to see alternative solutions to problems. Suicidal behavior is most often related to a mental disorder (depression) or to alcohol or other substance abuse. Suicidal behavior is also more likely to occur when people experience stressful events (major losses, incarceration). If someone is in imminent danger of harming himself or herself, do not leave the person alone. You may need to take emergency steps to get help, such as calling 911. When someone is in a suicidal crisis, it is important to limit access to firearms or other lethal means of committing suicide.

*What are the most common methods of suicide?*
Firearms are the most commonly used method of suicide for men and women, accounting for 60 percent of all suicides. Nearly 80 percent of all firearm suicides are committed by white males. The second most common method for men is hanging; for women, the second most common method is self-poisoning including drug overdose. The presence of a firearm in the home has been found to be an independent, additional risk factor for suicide. Thus, when a family member or health care provider is faced with an individual at risk for suicide, they should make sure that firearms are removed from the home.

*Why do men commit suicide more often than women do?*
More than four times as many men as women die by suicide; but women attempt suicide more often during their lives than do men, and women report higher rates of depression. Several explanations have been offered: (a) Completed suicide is associated with aggressive behavior that is more common in men, and which may in turn be related to some of the biological differences identified in suicidality. (b) Men and women use different suicide methods. Women in all countries are more likely to ingest poisons than men. In countries where the poisons are highly lethal and/or where treatment resources scarce, rescue is rare and hence female suicides outnumber males. More research is needed on the social-cultural factors that may protect women from completing suicide, and how to encourage men to recognize and seek treatment for their distress, instead of resorting to suicide.

*Who is at highest risk for suicide in the U.S.?*
There is a common perception that suicide rates are highest among the young. However, it is the elderly, particularly older white males that have the highest rates. And among white males 65 and older, risk goes up with age. White men 85 and older have a suicide rate that is six times that of the overall national rate. Why are rates so high for this group? White males are more deliberate in their suicide intentions; they use more lethal methods (firearms), and are less likely to talk about their plans. It may also be that older persons are less likely to survive attempts because they are less likely to recuperate. Over 70 percent of older suicide victims have been to their primary care physician within the month of their death, many with a depressive illness that was not detected. This has led to research efforts to determine how to best improve physicians' abilities to detect and treat depression in older adults.

*Do school-based suicide awareness programs prevent youth suicide?*
Despite good intentions and extensive efforts to develop suicide awareness and prevention programs for youth in schools, few programs have been evaluated to see if they work. Many of these programs are designed to reduce the stigma of talking about suicide and encourage distressed youth to seek help. Of the programs that were evaluated, none has proven to be effective. In fact, some programs have had unintended negative effects by making at-risk youth more distressed and less likely to seek help. By describing suicide and its risk factors, some curricula may have the unintended effect of suggesting that suicide is an option for many young people who have some of the risk factors and in that sense "normalize" it—just the opposite message intended. Prevention efforts must be carefully planned, implemented and scientifically tested. Because of the tremendous effort and cost involved in starting and maintaining programs, we should be certain that they are safe and effective before they are further used or promoted.

There are number of prevention approaches that are less likely to have negative effects, and have broader positive outcomes in addition to reducing suicide. One approach is to promote overall mental health among school-aged children by reducing early risk factors for depression, substance abuse and aggressive behaviors. In addition to the potential for saving lives, many more youth benefit from overall enhancement of academic performance and reduction in peer and family conflict. A second approach is to detect youth most likely to be suicidal by confidentially screening for depression, substance abuse, and suicidal ideation. If a youth reports any of these, further evaluation of the youth takes place by professionals, followed by referral for treatment as needed. Adequate treatment of mental disorder among youth, whether they are suicidal or not, has important academic, peer and family relationship benefits.

*Are gay and lesbian youth at high risk for suicide?*
With regard to completed suicide, there are no national statistics for suicide rates among gay, lesbian or bisexual (GLB) persons. Sexual orientation is not a question on the death certificate, and to determine whether rates are higher for GLB persons, we would need to know the proportion of the U.S. population that considers themselves gay, lesbian or bisexual. Sexual orientation is a personal characteristic that people can, and often do choose to hide, so that in psychological autopsy studies of suicide victims where risk factors are examined, it is difficult to know for certain the victim's sexual orientation. This is particularly a problem when considering GLB youth who may be less certain of their sexual orientation and less open. In the few studies examining risk factors for suicide where sexual orientation was assessed, the risk for gay or lesbian persons did not appear any greater than among heterosexuals, once mental and substance abuse disorders were taken into account.

With regard to suicide attempts, several state and national studies have reported that high school students who report to be homosexually and bisexually active have higher rates of suicide thoughts and attempts in the past year compared to youth with heterosexual experience. Experts have not been in complete agreement about the best way to measure reports of adolescent suicide attempts, or sexual orientation, so the data are subject to question. But they do agree that efforts should focus on how to help GLB youth grow up to be healthy and successful despite the obstacles that they face. Because school based suicide awareness programs have not proven effective for youth in general, and in some cases have caused increased distress in vulnerable youth, they are not likely to be helpful for GLB youth either. Because young people should not be exposed to programs that do not work, and certainly not to programs that increase risk, more research is needed to develop safe and effective programs.

*Are African American youth at great risk for suicide?*
Historically, African Americans have had much lower rates of suicides compared to white Americans. However, beginning in the 1980s, the rates for African American male youth began to rise at a much faster rate than their white counterparts. The most recent trends suggest a decrease in suicide across all gender and racial groups, but health policy experts remain concerned about the increase in suicide by firearms for all young males. Whether African American male youth are more likely to engage in "victim-precipitated homicide" by deliberately getting in the line of fire of either gang or law enforcement activity, remains an important research question, as such deaths are not typically classified as suicides.

*Is suicide related to impulsiveness?*
Impulsiveness is the tendency to act without thinking through a plan or its consequences. It is a symptom of a number of mental disorders, and therefore, it has been linked to suicidal behavior usually through its association with mental disorders and/or substance abuse. The mental disorders with impulsiveness most linked to suicide include borderline personality disorder among young females, conduct disorder among young males and antisocial behavior in adult males, and alcohol and substance abuse among young and middle-aged males. Impulsiveness appears to have a lesser role in older adult suicides. Attention deficit hyperactivity disorder that has impulsiveness as a characteristic is not a strong risk factor for suicide by itself. Impulsiveness has been linked with aggressive and violent behaviors including homicide and suicide. However, impulsiveness without aggression or violence present has also been found to contribute to risk for suicide.

*Is there such a thing as "rational" suicide?*
Some right-to-die advocacy groups promote the idea that suicide, including assisted suicide, can be a rational decision. Others have argued that suicide is never a rational decision and that it is the result of depression, anxiety and fear of being dependent or a burden. Surveys of terminally ill persons indicate that very few consider taking their own life, and when they do, it is in the context of depression. Attitude surveys suggest that assisted suicide is more acceptable by the public and health providers for the old who are ill or disabled, compared to the young who are ill or disabled. At this time, there is limited research on the frequency with which persons with terminal illness have depression and suicidal ideation, whether they would consider assisted suicide, the characteristics of such persons, and the context of their depression and suicidal thoughts, such as family stress, or availability of palliative care. Neither is it yet clear what effect other factors such as the availability of social support, access to care, and pain relief may have on end-of-life preferences. This public debate will be better informed after such research is conducted.

*What biological factors increase risk for suicide?*
Researchers believe that both depression and suicidal behavior can be linked to decreased serotonin in the brain. Low levels of a serotonin metabolite, 5-HIAA, have been detected in cerebral spinal fluid in persons who have attempted suicide, as well as by postmortem studies examining certain brain regions of suicide victims. One of the goals of understanding the biology of suicidal behavior is to improve treatments. Scientists have learned that serotonin receptors in the brain increase their activity in persons with major depression and suicidality, which explains why medications that desensitize or down-regulate these receptors (such as the serotonin reuptake inhibitors, or SSRIs) have been found effective in treating depression. Currently, studies are underway to examine to what extent medications like SSRIs can reduce suicidal behavior.

*Can the risk for suicide be inherited?*
There is growing evidence that familial and genetic factors contribute to the risk for suicidal behavior. Major psychiatric illnesses, including bipolar disorder, major depression, schizophrenia, alcoholism and substance abuse, and certain personality disorders, which run in families, increase the risk for suicidal behavior. This does not mean that suicidal behavior is inevitable for individuals with this family history; it simply means that such persons may be more vulnerable and should take steps to reduce their risk, such as getting evaluation and treatment at the first sign of mental illness.

*Does depression increase the risk for suicide?*
Although the majority of people who have depression do not die by suicide, having major depression does increase suicide risk compared to people without depression. The risk of death by suicide may, in part, be related to the severity of the depression. New data on depression that has followed people over long periods of time suggests that about 2% of those people ever treated for depression in an outpatient setting will die by suicide. Among those ever treated for depression in an inpatient hospital setting, the rate of death by suicide is twice as high (4%). Those treated for depression as inpatients following suicide ideation or suicide attempts are about three times as likely to die by suicide (6%) as those who were only treated as outpatients. There are also dramatic gender differences in lifetime risk of suicide in depression. Whereas about 7% of men with a lifetime history of depression will die by suicide, only 1% of women with a lifetime history of depression will die by suicide.

Another way about thinking of suicide risk and depression is to examine the lives of people who have died by suicide and see what proportion of them were depressed. From that perspective, it is estimated that about 60% of people who commit suicide have had a mood disorder (e.g., major depression, bipolar disorder, dysthymia). Younger persons who kill themselves often have a substance abuse disorder in addition to being depressed.

*Does alcohol and other drug abuse increase the risk for suicide?*
A number of recent national surveys have helped shed light on the relationship between alcohol and other drug use and suicidal behavior. A review of minum-age drinking laws and suicides among youths age 18 to 20 found that lower minimum-age drinking laws was associated with higher youth suicide rates. In a large study following adults who drink alcohol, suicide ideation was reported among persons with depression. In another survey, persons who reported that they had made a suicide attempt during their lifetime were more likely to have had a depressive disorder, and many also had an alcohol and/or substance abuse disorder. In a study of all nontraffic injury deaths associated with alcohol intoxication, over 20 percent were suicides.

In studies that examine risk factors among people who have completed suicide, substance use and abuse occurs more frequently among youth and adults, compared to older persons. For particular groups at risk, such as American Indians and Alaskan Natives, depression and alcohol use and abuse are the most common risk factors for completed suicide. Alcohol and substance abuse problems contribute to suicidal behavior in several ways. Persons who are dependent on substances often have a number of other risk factors for suicide. In addition to being depressed, they are also likely to have social and financial problems. Substance use and abuse can be common among persons prone to be impulsive, and among persons who engage in many types of high risk behaviors that result in self-harm. Fortunately, there are a number of effective prevention efforts that reduce risk for substance abuse in youth, and there are effective treatments for alcohol and substance use problems. Researchers are currently testing treatments specifically for persons with substance abuse problems who are also suicidal, or have attempted suicide in the past.

*What does "suicide contagion" mean, and what can be done to prevent it?*
Suicide contagion is the exposure to suicide or suicidal behaviors within one's family, one's peer group, or through media reports of suicide and can result in an increase in suicide and suicidal behaviors. Direct and indirect exposure to suicidal behavior has been shown to precede an increase in suicidal behavior in persons at risk for suicide, especially in adolescents and young adults.

The risk for suicide contagion as a result of media reporting can be minimized by factual and concise media reports of suicide. Reports of suicide should not be repetitive, as prolonged exposure can increase the likelihood of suicide contagion. Suicide is the result of many complex factors; therefore media coverage should not report oversimplified explanations such as recent negative life events or acute stressors. Reports should not divulge detailed descriptions of the method used to avoid possible duplication. Reports should not glorify the victim and should not imply that suicide was effective in achieving a personal goal such as gaining media attention. In addition, information such as hotlines or emergency contacts should be provided for those at risk for suicide.

Following exposure to suicide or suicidal behaviors within one's family or peer group, suicide risk can be minimized by having family members, friends, peers, and colleagues of the victim evaluated by a mental health professional. Persons deemed at risk for suicide should then be referred for additional mental health services.

*Is it possible to predict suicide?*
At the current time there is no definitive measure to predict suicide or suicidal behavior. Researchers have identified factors that place individuals at higher risk for suicide, but very few persons with these risk factors will actually commit suicide. Risk factors include mental illness, substance abuse, previous suicide attempts, family history of suicide, history of being sexually abused, and impulsive or aggressive tendencies. Suicide is a relatively rare event and it is therefore difficult to predict which persons with these risk factors will ultimately commit suicide.


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## Enigma

That's very interesting.

I was wondering, is suicide illegal?  I mean, if one survives, will they get put in prison?  (I'm thinking on the lines of self-murder).  Stupid question, I know, but I've heard people talking about it as well.


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## David Baxter PhD

Technically, in Canada suicide is still a crime, as is assisting or encouraging suicide. On the other hand, I've never heard of anyone being prosecuted for attempting suicide.

I think if you're at the point where you are trying to kill yourself, I doubt that worrying about going to jail is among the priority list of things on your mind...


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## Cat Dancer

I wonder about the effects of suicide on family and friends, if one had any friends?


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## ThatLady

Having had a family member suicide, I can tell you that the effects on the family are devastating. Emotions of grief, guilt, shame, anger, blame...all kinds of things go through the minds of those whose loved one takes his/her own life. Often, it leaves lasting scars on those who are left behind.


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## Cat Dancer

Not relief?


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## ThatLady

Not relief at all, hon. Not in any way. All the things I mentioned, and regret...lasting regret. Not something I'd want to leave as a legacy to my family.


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## Cat Dancer

but what if someone is really, really suffering? People seem to think that people who have cancer or something like that are better off not suffering. Why is it different with this?


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## ThatLady

The difference, as I see it, is that people who are suffering with a cancer (or some other disease) for which there is no possible cure are doomed to continue to suffer until they die in suffering. Their deaths are rarely quick, and usually very painful.

For those of us who suffer from depression, there is treatment. If I am any example, there is cure. We CAN get well, and be happy, productive members of society. Death, in this case, is a permanent solution to a temporary problem...to borrow an oft-used phrase.


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## Jon

Having watched my grandmother and an aunt die of cancer, etc. it was difficult to watch their suffuring, but during that time our families were brought closer together.  A suicide does the opposite.  As ThatLady said 



> ... the effects on the family are devastating...



I have seen the same.  

Suicide is NOT the answer IT is a permanent way to surrender.  Never give up.  Time has a miraculous way of fixing things when you put your feet on the right path.  The fact you are here tells me you have turned the right direction, the next step is to start walking forward one step at a time.


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## foghlaim

leaving out possible depresson and\or  terminal illness... 
* 
"Is there such a thing as "rational" suicide?"
* 
been thinking on this for a while and i think there has to be... 
just because it's not the "norm" doesn't make it necessarily irrational.. 
hmm.. (just thinking out loud..)


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## Misha

That raises many issues.... euthanasia for one.  
But is it "rational" to commit suicide, say if there were a nuclear holocaust and you would inevitably die a slow and painful death?
It becomes an ethical issue.  If the above situation is warrented, are then not the suicides of cancer patients.... and perhaps the "murders" of sick children are justified as well.  
And I could even rationalize a suicide not as a result of depression but because of depression.  Is the illness of depression not also slow and painful?
Perhaps then all suicide is justified.  
Or perhaps I'm just making a point.


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## Daniel

> Is the illness of depression not also slow and painful?
> Perhaps then all suicide is justified. Or perhaps I'm just making a point.



In reality, there is a lot of difference, including the often-mentioned fact that depression is treatable.  My former ethics professor put it this way: "If one of your friends had depression, would you help him suicide?"  The answer is, obviously, no.


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## ThatLady

As I read your hypothesis, foghlaim, you're musing as to whether there is such a thing as "rational suicide" when not in the face of terminal illness or depression. I cannot imagine a case where suicide would be rational, except one in which an individual had a painful, debilitating, inescapably terminal illness. In any other situation, it would seem to me that suicide would be a permanent solution to a temporary problem, as has been stated.


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## foghlaim

okay one step further... no problems,(temp or otherwise)  no depression, no teminal illnes's.. 
 does there have to be a reason.??


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## ThatLady

I would think there would have to be some reason for a person to take their own life. It requires an active intent to do so, and something would have to motivate that intent.


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## foghlaim

so you're saying  there would have to be a reason then..  but could that reason (if there were one) be rational.


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## Daniel

> But is it "rational" to commit suicide, say if there were a nuclear holocaust and you would inevitably die a slow and painful death?



Sure, but as your example indicates, the kind of dire circumstances required for a rational suicide don't befall most people.  Some other examples of potentially rational suicide:

- Trying to avoid the pain of burning to death by jumping from a burning building, e.g. the World Trade Center tragedy
- Trying to avoid chronic, severe torture. (For example, at least one American prisoner of war tried to kill himself at the "Hanoi Hilton.")
- Freud's physician-assisted suicide related to his terminal mouth cancer


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## Misha

I think what my point was is that we never know what is going to be permanent, degenerative, and debilitating. 
The World Trade Center is an excellent example, but IF those people knew the day before that the disaster would occur, would it be justified to kill themselves then?   Does there not remain the possibility that at least some of those that jumped from the twin towers might have survived?  Is it not possible that cancer be cured?  And that depression be permanent?  
The thing about trying to "rationalize" a suicide in any situation is that one simply does not KNOW.  And if knowledge is the precurser of rationale, there can not be rationale.


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## Daniel

> Is it not possible that cancer be cured?


Yes, but not always.  



> And that depression be permanent?


All states of mind are temporary, especially one's mood.

One could argue that if we were really rational, we could endure anything by just taking one second at a time.


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## Misha

So then are we really rational enough beings to justify an ethical leap like suicide?


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## Daniel

> So then are we really rational enough beings to justify an ethical leap like suicide?



Yes, especially in very dire circumstances (terminal illness with unrelieved pain, torture, etc.).  But most suicides are clearly more impulsive than anything else, so it's rare for a suicide to be deemed rational or morally good.    For example, it's not uncommon for a suicide to be triggered by a minor setback like being dumped by boyfriend/girlfriend.


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## ThatLady

Jumping out windows to escape the Twin Towers fires was not an effort at suicide, in my opinion. It was an irrational act based on fear of the fire. There just wasn't any other place to run and the fight/flight mechanism took over. I doubt those people ever thought about the results of jumping out the window. The only thing they thought about was getting away from the fire.

Some cancers can be cured, and new research is producing new treatments daily. However, if you have a stage 4, incurable cancer right now, there isn't much hope that a magical cure will erupt tomorrow. Furthermore, the pain and suffering are probably taking a terrific toll on your strength and your will. I can understand a person's wish to just pass on at that point.

A person can justify anything they're of a mind to justify. That doesn't necessarily mean that their justification is rational.


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## Into The Light

we all come with a strong survival instinct. suicide goes against this survival instinct. i am not sure it can ever be a rational choice, other than maybe in a situation of war and torture.

i still sometimes wonder about the point of my life and why i am here. however, my instincts to survive are far greater than these doubts. it's these instincts that even in our deepest moments of wanting to die still make us want to live, and make us reach out for help. suicide goes against our basic survival instincts. i really cannot see it ever being rational choice in a case where you are not ill or suffering.


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## David Baxter PhD

foghlaim said:


> leaving out possible depresson and\or  terminal illness...
> *Is there such a thing as "rational" suicide?"*
> 
> been thinking on this for a while and i think there has to be...
> just because it's not the "norm" doesn't make it necessarily irrational..
> hmm.. (just thinking out loud..)



It doesn't make it rational either.

Other than to avoid a painful and certain death, as in terminal illness or, as suggested, the 9-11 "suicides", I have never seen a case of contemplated suicide that did NOT involve distorted thinking. This has nothing to do with whether or not it is the "norm". It has everything to do with the reasons for thinking about suicide to begin with versus the reasons for living.

Try putting those in two columns: "reasons for living" and "reasons for giving up".

Then post them or ask someone you know to comment on the two columns.

I can guarantee you that this will show clear evidence of distorted (irrational) thinking.


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## Halo

David I just wanted to say that I really liked your idea of the two columns. I will remember that one.


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## foghlaim

from the various responses above it would _appear_ that there *isn't* such a thing as rational suicide.  Good to know.


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## Daniel

A corroborating quote:



> "In my 30 years of research, I've never seen a rational suicide," said Dr. Donna Cohen, newly elected president of the American Association of Suicidology and a professor at the University of South Florida.
> 
> San Francisco Chronicle, July 25, 2005


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## Daniel

Three in Four Americans Support Euthanasia  (Gallup Poll - May 2005)


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## healthbound

ThatLady said:


> There just wasn't any other place to run and the fight/flight mechanism took over. I doubt those people ever thought about the results of jumping out the window. The only thing they thought about was getting away from the fire.



Couldn't the above points also be made about someone who is suicidally depressed (replacing the words, "the fire" with "depression")?

But, maybe I'm confused about what we mean by "rational".  When I look it up in the dictionary it says:


> Main Entry: ra?tio?nal
> Pronunciation: 'ra-sh&-n&l
> Function: adjective
> 1 : having reason or understanding
> 2 : relating to, based on, or guided by reason, principle, fairness, logic, a legitimate state interest, or a consideration of fact <age distinctions are not subject to strict scrutiny, but they must have a rational relationship to a legitimate state interest ?In re J. M., 642 Atlantic Reporter, Second Series 1062 (1994)> ?ra?tio?nal?i?ty /"ra-sh&-'na-l&-tE/ noun ?ra?tio?nal?ly adverb



Can't someone use logic and consider the facts...then, make a decision to suicide based on those facts...understanding what the choices and consequences are?

Why would suicide _never_ be rational?  It's not a socially or legally accepted option, but it is an option.  If one consciously chooses it...why is it irrational?


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## Daniel

> Can't someone use logic and consider the facts...then, make a decision to suicide based on those facts...understanding what the choices and consequences are?



Yes, but most of the time the logic is compromised due to depressed, demoralized thinking.   Even when people aren't depressed, they often underestimate their ability to overcome problems.  Suicide, for the most part, is a savage god, not a rational enterprise.


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## healthbound

I've never read Savage God (or any other publication about suicide, actually).  From what I can tell, it is a book about a variety of experiences with suicide?  How does it explain that suicide is not a "rational enterprise"?


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## Daniel

It's been over 5 years since I read "The Savage God," but here is a quote from the book on the tunnel-vision nature of suicidal thinking:



> Once a man decides to take his own life he enters a shut-off, impregnable but wholly convincing world where every detail fits and every incident reinforces his decision.



Similarly, another book on suicide, "The Suicidal Mind," explains that a suicidal person typically does not fully understand the consequences of committing suicide:



> In suicide, the diaphragm of the mind narrows and focuses on the single goal of escape to the exclusion of all else--parents, spouse, children.  Those other persons in the life are not forgetten; they are simply not within the narrow focus of the suicidal lens.  Suddenly they are just not in the picture. (pg. 60)


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## David Baxter PhD

Daniel said:
			
		

> most of the time the logic is compromised due to depressed, demoralized thinking. Even when people aren't depressed, they often underestimate their ability to overcome problems.


That is exactly right. As I said earlier, in 30 years, I have never seen a case where that was NOT true.


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## ThatLady

healthbound said:


> Couldn't the above points also be made about someone who is suicidally depressed (replacing the words, "the fire" with "depression")?



The fight/flight mechanism is not triggered by rationality. It's triggered by chemical changes in the body (adenalin, et al). It happens without rational thought, so it can't be termed "rational".




> Can't someone use logic and consider the facts...then, make a decision to suicide based on those facts...understanding what the choices and consequences are?
> 
> Why would suicide _never_ be rational?  It's not a socially or legally accepted option, but it is an option.  If one consciously chooses it...why is it irrational?



In my opinion, the terminal cancer (or, insert terminal disease here) who is suffering can, in fact, make a rational decision to choose death over continued suffering and deterioration. In this case, I would not consider suicide (I prefer the term euthanasia) to be a permanent solution to a temporary problem. The terminal illness is, in fact, permanent unto death.


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## healthbound

> The terminal illness is, in fact, permanent unto death.


But so is some depressions?  My sister's depression was terminal.  I am still trying "life", but I wonder if mine is too.  I now know it's cyclic.  What if I'd rather not live with such an illness that destroys my body and mind?

I don't know if I'm crossing the lines here...perhaps my questions cross over to romanticizing, but these are most definitely things I think about on a daily basis.


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## ThatLady

healthbound said:


> But so is some depressions?  My sister's depression was terminal.  I am still trying "life", but I wonder if mine is too.  I now know it's cyclic.  What if I'd rather not live with such an illness that destroys my body and mind?
> 
> I don't know if I'm crossing the lines here...perhaps my questions cross over to romanticizing, but these are most definitely things I think about on a daily basis.




No, healthbound. Your sister's depression wasn't terminal. While it is a disease, just like cancer is a disease, it can't kill you by using the cells of your body against you like cancer can. It can't cause your heart to stop beating, or your kidneys to stop functioning. What it CAN do is disrupt your thinking to the extent that YOU bring about your own demise. That's why it's so important to get treatment.

No amount of treatment can save someone who's dying of stage 4 cancer, or renal failure, or inoperable heart disease. Treatment can, however, save those who are suffering from depression from themselves


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## Cat Dancer

Who decides what is rational? Can't we rationalize anything? Justify anything? Does that make it the right thing to do? Just because I might think I have a good reason to commit suicide? 

What about the people left behind? What about their pain? 

What about the moments, the hours when things are okish and the thoughts go away? Isn't it worth it to live for that? 

With a terminal illness you don't have a choice. With depression or bipolar or ocd or other mental illnesses you DO have a choice. You can choose to get treatment. You can choose to live. Or at least that's what I always thought or wanted to believe. Is that true?

This whole discussion is causing some extremely distressing feelings in me. I am trying so hard to hold on to life. I believe in hope. I believe things can get better, but maybe I'm wrong? Maybe I'm doomed? This is scary. 

Aren't we supposed to be looking for reasons to live? Isn't life hard for everyone? Don't we all struggle and suffer and hurt? 

So many painful thoughts and fears are going through my mind.


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## David Baxter PhD

Janet said:
			
		

> Who decides what is rational? Can't we rationalize anything? Justify anything? Does that make it the right thing to do? Just because I might think I have a good reason to commit suicide?
> 
> What about the people left behind? What about their pain?
> 
> What about the moments, the hours when things are okish and the thoughts go away? Isn't it worth it to live for that?
> 
> With a terminal illness you don't have a choice. With depression or bipolar or ocd or other mental illnesses you DO have a choice. You can choose to get treatment. You can choose to live. Or at least that's what I always thought or wanted to believe. Is that true?


It's not only true but very eloquently expressed, Janet.


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## David Baxter PhD

healthbound said:
			
		

> But so is some depressions? My sister's depression was terminal. I am still trying "life", but I wonder if mine is too. I now know it's cyclic. What if I'd rather not live with such an illness that destroys my body and mind?


Your sister's depression was only terminal because she chose to make it terminal by giving up. It didn't need to be that way. That, and the sister she left behind to struggle with all this, is the real tragedy of suicide.


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## Cat Dancer

I want to apologize for what I wrote about being distressed. I was really emotional when I wrote that. I feel better now. I am so sorry. I guess it is a case in point about not going by how you feel in a moment, but trying to look at the other moments, the overall picture.

I DO believe in hope. And those moments when things are ok are what I live for and they're worth it to me. I guess I get really scared sometimes.

Very sorry.


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## ThatLady

Janet, to me, you epitomize hope! You're so willing to work for what you want in life, and you never give up! You're an example to all of us in so very many ways. :hug:


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## healthbound

> Who decides what is rational? Can't we rationalize anything? Justify anything?


Perhaps I was hung up on the particular word, "rational".  I also question who decides what is rational and what isn't.  Suicide is very a very subjective decision.  And because of that, I was just saying that perhaps it is a rational decision for the sufferer at the time (ie: with logical reason -- maybe to stop the unbearable pain).  Even because of a lack of awareness or education about what is happening for a depressed person, they may not know any other options.

It doesn't mean it is the best decision.  It doesn't even mean it's the "right" one.  It just means that I think that many people who do end up taking their own lives DO think long and hard about it and then make the decision based on consideration of the facts surrounding their own pain and personal circumstances .  I think this falls under the definition of rational (again, whether it's "right" or "wrong" is a whole other issue).

I want to make it extremely clear that I do NOT think that suicide is a healthy choice.  And I absolutely DO think that is IS giving up.

The question was, "Is there such a thing as "rational" suicide?"  foghlaim also preceded the question with "leaving out possible depresson and\or terminal illness...".  I was just giving my opinion that part of me does think it does exists even for a depressed person.  But then again, I also want to make it clear that I don't know everything and that I've been affected by my sister's suicide and I am battling my own desires too.  So, I'm fully aware that there's a huge probability that I am distorted.  But, regardless they are my thoughts.

There is absolutely another side of me that believes that anyone who goes to the extreme of taking their own life is not fully conscious or aware of the bigger picture.  But then again, I haven't thought too much about those with terminal illnesses, I have only thought a lot about those with depression.

This is a topic that has many variables, potential exceptions and opinions.  I'm genuinely sorry if any of my comments have caused any upset.  That definitely wasn't my intention.


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## healthbound

Or maybe I'm just confused about my perception of a paradox:

-a depressed person who suicides is can NOT be rational
-a depressed person who suicides IS making a choice

It seems confusing to me.


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## ThatLady

I see why you're seeing a paradox, healthbound. Perhaps, the definition of "rational choice" will help you differentiate:

Rational choice is a process in which individuals weigh the costs and benefits of each possibility and in which the choices made are those within the opportunity set that maximizes net benefits.

Admittedly, rational choice theory is something that is used mainly in economics; however, it can be applied just as well to human behavior. If we look at the above definition, we see that the costs and benefits are weighed and choices made based on what will give the most benefit. A person who suicides actually receives the least benefit. Had they made the choice to check themselves into hospital for treatment, they would have made the choice that would have gleaned the most benefit. However, due to their illness, they were unable to arrive at that conclusion. Their mind would not/could not think rationally.

Does that make any sense?


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## Halo

I am going out on a limb here and am going to admit that this whole thread is completely over my head 

Too complex and too much for me or maybe it is that I just don't have the brainpower after working all day to sit down and really _try_ to comprehend what is being written.  Ya, that sounds more like it.

My opinion, there is no such thing as rational suicide and if one is seriously considering taking their own life then their thoughts are distorted and they are not thinking rationally at all.


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## healthbound

A bit.

Can they be said to have really made a "choice" then?  How can I be rational (think I'm making the best possible choice) and yet be irrational at the same time (be operating with distorted perceptions and criteria)?

Maybe I still don't get it.  I feel horribly sad.  Am I in control?  Or am I out of control?  Am I responsible for my life or am I not?  Am I capable of making choices?  Or am I not?  Do I or don't I know what's best for me?

It's other people's perception that I'm suffering, but not as much as someone with a terminal illness.  But it feels like a terminal illness to me.  Regardless of whether it actually is or not, does it even matter if that's my perception?

Or even one step further...how do you know that I'm not feeling the same as a person who is terminally ill?  (Dramatic, I know.  And again, I mean no disrespect.  I'm just trying to work through some of my own thoughts and feelings).

I feel horrible.  Please quarantine if you think it's most appropriate.


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## ThatLady

You absolutely CAN feel just as badly as someone with a terminal physical illness, healthbound. You can feel as hopeless as they do. The difference is, your situation is not hopeless. There is hope for you with medication and therapy. It may seem, at times, hopeless; however, it isn't. I know. I recovered completely, and my daughter has recovered, as well.

For people with a terminal physical illness, no amount of medication, therapy, dreams or wishes can save them. In the case of cancer, if chemotherapy and radiation have been tried post surgery, and the cancer returns or refuses to abate, they are doomed. There is no way out for them. All doors are closed. Barring some kind of miracle, they must suffer until the end.


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## foghlaim

I would like to throw something in to this discussion..... if it makes any sense, great, if not, someone remove it. 
​actually TL. maybe this is a question you may?? be able to answer..

given that suicide isn't rational or doesn't seem rational to most ppl... ( I'm going with Isn't Rational..(for now)).

I'm wondering if\when some one suicides.. 





> It doesn't mean it is the best decision. It doesn't even mean it's the "right" one. It just means that I think that many people who do end up taking their own lives DO think long and hard about it and then make the decision based on consideration of the facts surrounding their own pain and personal circumstances .


 Assuming those left behind know this about the person, that they did think long and hard about it..

Does that person have to be viewed as a person who gave up? in that person's mind they were making a rational decision, weren't they?

 Don't we all make decisions based on the info we have at that moment in time. Maybe we hadn't enough info or maybe the info we had wasn't good sound info, but it was what we had at the time, and we believed we were doing what was best, AT THAT time.
 Can we not accept that the person who suicide'd believed they were doing what's was best for them and in doing so (accepting where that person was at)  make the grieving process a little easier to go thru, (if that's possible).??   I think this is the question i was trying to formulate TL.  (not sure if i have put it together properly).


those of us here on this forum have so much info available to us now...not only that but we have eachother as well. I know that i wouldn't be here if not for this forum, i didn't have much info on what was available (resources etc)  to me in the past. 
Suicide still is and i think will always be on my mind.. 
 It's damn hard not to rationalise suicide, because i know it can be done.. like some one said somewhere on this thread (i think) we can rationalise anything.  For me these past few weeks, have been hard cause i did rationalise it,, part of me is hanging on to that rationalisation,, but coming here everyday and reading everything and anything and even starting this thread.. has\is  helped\helping.

I know this thread is and has been hard for some ppl to read..(even me)  and I do apologise for causing upset,fear,  insecurity etc.
 But my hope is that this thread will continue to help me figure out a few things and maybe help others do the same.   Right now today i believe that suicide is not rational.


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## David Baxter PhD

> Assuming those left behind know this about the person, that they did think long and hard about it..
> 
> Does that person have to be viewed as a person who gave up? in that person's mind they were making a rational decision, weren't they?


The person who attempts/commits suicide may well see it at the moment as a rational decision. But that is part of the pervasive distorted thinking that characterizes that individual at the time. By any objective standpoint, the thinking is irrational, distorted, blinkered, etc. Even many/most people who survive a suicide attempt will later see that clearly. And those left behind never have any doubt that the decision was irrational, distorted, and unnecessary. I would say that the most common comment you will hear from family emmbers, friends, and loved ones is that the act was unnecessary, that it didn't have to be that way. I have never *ever* heard anyone say, "S/he made a considered and valid decision and it was the right one for him/her".

Make no mistake about this. This is not conjecture. This is based on my work with survivors and with grieving loved ones.


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## ThatLady

I think, in your scenario, fog, the person was making what he/she THOUGHT was a rational decision. However, due to the effects of mental illness/depression (as Dr. Baxter pointed out), it's not possible for that person to think rationally. The mental illness causes distortions in thought. Because of those distortions, rationality is just not there to be used.


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## foghlaim

> the person was making what he/she THOUGHT was a rational decision.





> The person who attempts/commits suicide may well see it at the moment as a rational decision.


So.. if it can be accepted that the person *thought* it was a rational decision, then 





> Can we not accept that the person who suicide'd believed they were doing what's was best for them and in doing so ( accepting where that person was at) make the grieving process a little easier to go thru, (if that's possible).


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## ThatLady

No, fog, it doesn't make the grieving process easier for those left behind. Those left behind CAN think rationally. They KNOW it was a bad decision, based on irrational thinking caused by mental illness. They KNOW things could have been different if the mental illness had been treated. Because they know these things, their grief is far more difficult for them. They tend to feel a lot of guilt, which is difficult to overcome. Even though it's not their fault, they still feel that guilt.


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## Daniel

> Can we not accept that the person who suicide'd believed they were doing what's was best for them and in doing so ( accepting where that person was at) make the grieving process a little easier to go thru, (if that's possible).



As TL says, the answer is definitely no.    Grief is a pretty basic emotion.


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## Lana

What a fascinating discussion.  Personally, I don?t think any suicide is rational, be it due to a terminal illness or depression (which, incidentally, has a very high mortality rate in a mental heath world)  I think what makes euthanasia justifiable (rather then rational) is that we can relate to pain, to what it?s like to hurt all the time, we can sympathize and empathize.  We see the wound and we nod in understanding, ?Oh yes, that must hurt?  However, with depression, it is more difficult to be totally sympathetic and empathetic?we can?t see the wound, just the symptoms.  I think that is the crux of the issue.

Physical pain can be controlled by medications, whereas emotional pain is much more difficult to control and/or medicate.  I suspect that this ability to define pain and be able to relate to it, makes it seem that one persons decision to end their life is more valid/rational then the other.  But that?s not true.  Physical pain impairs judgment and distort thoughts as  much as psychological pain.  But, we don?t have the same ability to relate to the psychological pain and can, unintentionally dismiss the pain brought on by depression.  That?s what makes mental health issues difficult to live with?it?s too easy to invalidate the pain that it causes to those suffering from it.  And that is why an average person would rather have cancer then suffer from a mental illness.

In the end, all suicide is not rational, extremely hurtful to family and friends, irrevocable, guilt bearing, and traumatizing for survivors.  No one in their rational mind would wish that on anyone, not even on their worst enemy.


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## ThatLady

Unfortunately, Lana, in many terminal illnesses there comes a time when medication will no longer handle the pain. These people reach a point where there's nothing we can do but watch them suffer and wait. It's at that point that one can understand the choice, made by the patient, to end the suffering. They can no longer be treated. Not for the illness, and not for the pain caused by the illness. It's for things like this that Advance Directives (such as Living Wills or Healthcare Powers of Attorney) are made. Even then, there is often a long period of suffering before a natural death occurs. Euthanasia is a hotly debated topic amongst those who deal directly with these situations, as I do.


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## Lana

Hi TL;
I?m not debating euthanasia, but was focusing on the ?rational suicide? thought brought up earlier.  To me, euthanasia and suicide are two very different things.  

I feel that both, terminally ill people and people suffering from depression are susceptible to distorted thinking.  I don?t think that being terminally ill means that all decisions are rational. I also think that I cannot possibly know what goes on in the mind of someone that suffers from depression.  All I know is that for someone to consider ending their life, it has to be pretty bad and I don?t want to invalidate their hurt by saying ?well, your thoughts are distorted, your decisions are not rational, and you?re not terminal?you can be treated?  

Thing is, chronic depression is for life, so I imagine that it would be a very difficult choice to accept that or find other, alternative means of coping (or not coping) I just think that the suffering, for both types of people, is very real and I feel a tremendous amount of compassion.  I wish there was some way of helping?and I feel that validating the person, and acknowledging that they?re hurting, is a small tiny step that I can do?at least for now.


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## Into The Light

i think suicide is the result of hopelessness. a person who wants to commit suicide is completely overwhelmed with hopelessness. they _cannot see_ any other way out of their situation and pain. however, bystanders who observe them seem to be able to see that things are not hopeless for the depressed person. others can see solutions for him/her, whereas he/she cannot.

i am convinced that the depressed person has blinders on because they are so overwhelmed. this is where they need help from others to pull them out of their despair, and to show them there IS hope. life for a depressed person certainly isn't easy, and it can feel near impossible, but there is always hope. depression is treatable.


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## Daniel

> Thing is, chronic depression is for life...



If that were the case, then the suicide rate would be at least three times what it is now.  Depression, even chronic, recurrent depression, is not a lifetime event.


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## ThatLady

I've got to go with Daniel here. Depression is not, necessarily, a life sentence. It can be treated, and it can be vanquished. You can learn new ways to cope with difficulties, and through that learning can get past the depression. I've done so, and have known others who have done so.

Terminally ill people can be depressed, and that can destort their thinking. However, it doesn't always happen. There are some terminally ill people who are accepting of their illness (even though they certainly don't like it!) and realize that their time on earth is coming to an end. All they wish is to die with dignity and without undue pain. Under those conditions their thinking is often surprisingly rational.


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## foghlaim

> This is a topic that has many variables, potential exceptions and opinions.


 I agree.. and i want to say thanks everyone who posted their views opinions ect. 
I think the general consensous here is that either: (a) a person who is suffering from a terminal illness can in some cases can make a rational decision to suicide.. or (b) if a person (not terminally ill) makes a decision to suicide based on info  (or personal circumstance) available at the time, to that person a rational decision.. then they must have been depressed and therefore the decision was\is irrational.

maybe because there are so many variables ect..ect..I know i could ask more questions or more opinions.. but for now i will hold my own counsel. (if that's the correct phrase?) 
So i'm gonna watch this space for now and maybe learn from what others think and say on this.  


(just in case anyone thinks i'm pro-suicide.. I'm not)


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## Lana

Daniel said:


> If that were the case, then the suicide rate would be at least three times what it is now.  Depression, even chronic, recurrent depression, is not a lifetime event.



I stand corrected.


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