Leow Suicide

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obody can ever predict how another person

will react to the more troubling or difcult

things in lie. Dierent people handle dierent

situations in dierent ways this is an undeniable

act o lie, no matter how old you are.

But there are usually some clear advance warning

signs that a riend may be in trouble and that

suicide may be something he is considering. Since

suicidal wishes could become a prevalent and

potentially lethal problem in depressed patients, it

is important or therapists to understand why the

patient is considering such a drastic action in the

rst place.

The therapist will then be in a better position to

select appropriate and eective techniques to deal

with the particular problem. However, no anti-

suicidal strategy is o any use unless the therapist is

rst able to detect and assess the degree o suicidal

intention.

Risk indicators

Clues to suicide plans may be detected in overt

behaviour such as secretiveness, a sudden decisionto make a will or verbal statements. For example,

a suicidal individual may say, I dont want to go on

livingor I want to end it all.

Other statements suggestive o suicidal intent

include: Im not going to put up with it anymore, Im

a burden to everyone, things will never get better

and my intent is indirect and may be pieced together

only in retrospect. Other indications are: I guess I

wont be seeing you again or I want to thank you for

trying so hard to help me.

FEATURE

Gently tipping the balanceBy Dr Leow Chee Seng, Certied Stress Consultant Professional (US)

When contemplating suicide, the individual is attempting to take back controlof a situation they feel they have no control over. Thus, the best cure is helpingthem regain this control.

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FEATURE

A depressed patient leaving on a weekend pass

rom a hospital or upon retiring or the night, may

say goodbyeinstead ogoodnight.

According to the Diagnostic and Statistical Manual

o Mental Disorder (DSM-IV-TR), mental disorders

that could lead to suicidal impulses include

conduct disorder among children, delirium,

dementia, substance-induced mental disorders,

amphetamine-induced disorders, schizophrenia,

a major depressive or manic episode, anxiety

disorders, dissociative disorder, sexual and gender

identity disorders, borderline personality disorder

and premenstrual dysphoric disorder.

Researchers have noted that some individuals lean

towards suicide more than others. The characteristics

associated with such at-risk adolescents include the

ollowing:

A previous suicide attempt;

Suicidal gestures (cutting o ones hair, sel-

inicted cigarette burns, other orms o sel-

abuse);

A tendency to be socially isolated (having no

riends or only one riend);A record o school ailure or truancy;

A broken home or a broken relationship with a

signicant other (amily member, boy/girlriend);

Talk o suicide, either ones own or that o others;

A close riend or relative who was a suicide victim;

Not living at home;

Preoccupation with death or dying;

A recent signicant loss or the anniversary o one;

Sudden disruptive or violent behaviour; or

Being more withdrawn or uncommunicative and

more isolated rom others than usual

The most common external causes or more

accurately, external catalysts o suicidal behaviour

include bullying, peer pressure incidents, amily

crises and health problems.

Usually, these are situational in nature and have an

escalating history that leads the individual to eel he

has no other way out. In their minds, the situations

had reached breaking point and they see no other

way out except death, or the threat o death.

Depressive fantasy

When external orces become unbearable enough

or a person to contemplate suicide, depression osome sort is always involved. The depression causes

the individual to make irrational decisions based on

unstable emotions.

This type o suicidal tendency is oten accompanied

by ater-death antasies in which the now dead

individual, ater taking his or her own lie, gets to

view the reactions and grie o those let behind.

In these antasies, the people who have caused the

psychological pain eel punished by the suicide.While grieving, they demonstrate great remorse or

having driven the person to take his own lie. In this

type o suicide (or suicide attempt), the individual

is attempting to take back control o a situation he

eels he has no control over.

In killing himsel, he is taking back control, getting

in the last word. And, i the real lie situation has let

the individual eeling totally helpless, the idea o

going out o control and teaching other people a

lesson in the process can be strangely appealing.

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Suicidal urges that are brought on by external

circumstances include an unwanted pregnancy

without a support system, abuse in the amily or

relationship, sexual assault, sexual harassment,

bullying, peer rejection and romantic rejection.

The individual is intrigued by the antasy that he

would be getting back at somebody whom he eels

has hurt him and that this other person will see

the error o his ways and eel tremendous guilt as a

result o the suicide.

Because such impulses are oten eeting in nature

and happen in a moment o extreme emotional

stress, the suicide attempts are more likely to ail,

be repeated and escalate in severity with each

repeated attempt.

Under these circumstances, the suicide attempts

are oten dismissed as cries or attention, which can

be a atal mistake on the part o the people close to

the suicidal individual.

Since the root cause here is a deep and wounding

sense o helplessness being ignored or having

others dismiss the attempts as attention-seeking

it can ultimately lead to the person successully

taking his own lie.

When the external causes are addressed and dealt

with, and the persons sense o helplessness is

overcome, the suicidal urges all but disappear.

Biological causes

Internal causes o suicidal behaviour are much more

complex and harder or the average person to see

than external causes. The most common internal

causes o suicide or suicidal

behaviour include clinical depression, psychiatric

disorders or chemical imbalances.

Essentially, all suicide attempts come down to

something inside the suicidal person but those

without external catalysts are oten biological in

nature. Severe depression, which is believed to be

caused by a combination o external actors and

internal chemistry, is one thing that almost every

suicide or suicide attempt has in common how

that depression came to be is the only dierence.

Some people suer rom depression because o

chemical imbalances and to outsiders, their lives

seem great or at the very least average with

nothing outstanding that would indicate a reason

or this person wanting to die.

Tipping to positive

It is important or riends and therapists to play or

time until the dangerous period has passed.

The strategy used is to involve the patient himsel

in the therapy process such that he decides to stick

it out until he sees where the therapy is going.

This can be done by stimulating an interest in his

therapeutic approach.

Involvement o patients in the treatment plan helps to

treat the decision to commit suicide as the outcome

o the struggle between the patients wishes to live

versus his wishes to die. As in a declaration o war, an

irrevocable decision may be made on the basis o a

margin o a single vote, as it were.

Initially, thereore, the therapists eorts should

be directed towards shiting the votes in avour o

living. On top o it, the therapist should maintain

continuity between sessions.

FEATURE

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Once the patient has agreed to weigh the pros

and cons o suicide, the therapist would elicit the

reasons or living and reasons or dying. Although

patients might orget their reason or living, wecan guide them by asking them to think o happy

moments.

The next step is to draw two columns on a sheet o

paper. The therapist and patent can then list reasons

in avour o living that were valid in the past. The

therapist proceeds to ascertain which o the past

reasons or living are valid in the present or, at the

very least, might be valid in the uture.

It is interesting to note that the suicidal patient hasoten nullied these positive actors in his lie which

he has either orgotten, ignored or discounted their

value.

The therapist should also recognise that it may

be quite painul or the patient to reconsider his

decision to kill himsel. The patient may have

undergone enormous turmoil beore arriving at

his decision to terminate his suering by suicide;

and reopening the question may mean that he will

have to go through another period o turmoil and

prolong his plan.

Being alertWhen dealing with depression, hopelessness and

ear, it is difcult to know where the bad eelings

end and the real risk begins. I your riend exhibits

two or more o these warning signs in a short period

o time, it is best that you try to help.

This does not mean you should take the weight o

their world upon your shoulders, but it does mean

you should alert other people to the possible risk.

Go to your other riends, your at-risk-riends amily, atrusted teacher or counselor. Just like your riend who

does not have to go through a difcult time alone you

do not need to try to save your riend on your own.

It is impossible to know or sure i a person who seems

sad or who has changed or the worse is at a real risk

o committing suicide. I you ear your riend may

attempt suicide, you should get some outside help

and guidance rom people who are better able to get

your riend the help he or she really needs. OH!

FEATURE

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