Skip to main content

Warning Signs and Suicide Hot Lines Won't Fix This

A psychiatrist remembered his first days on his ER rotation. He dealt with a woman who had tried to kill herself. She was homeless, had been taking meth so she wouldn't sleep ever since she had been raped on the street. The supervisor asked what the young doc intended to do. "Prescribe antidepressants?"

They both knew how stupid that sounded.

In the 80s and 90s, they thought they had this suicide thing figured out. As the number of prescriptions for Prozac rose, the suicide rate was falling. It was widely claimed by people who flunked logic that this was epidemiological evidence that Prozac prevented suicide. Just get more people into treatment. This kind of error is common enough to have its own name: post hoc ergo propter hoc. Or maybe there was some economic incentive behind that sloppy thinking...

For a hundred years, suicide rates and unemployment rates rose and fell in tandem. The top chart is the unemployment rate 1927-2006. The bottom is the suicide rate in the same time frame for different cohorts; yellow shows the total.

The correlation holds without reference to how many people are on antidepressants. Prozac didn't prevent suicide; Eli Lilly was just lucky enough to introduce it at the start of a boom. One good recession and that so-called progress was blown to bits. The much heralded fall in rates reversed, even as prescriptions continue to rise.

Now as suicide rates skyrocket (up over 15% since the start of this millenium), we are not more sick. We are just more desperate. We are especially more desperate in rural areas, the fly-over states, where people have poor education, limited opportunity, less health care, fewer social assets, and fewer community resources to cover the non-existent safety net.

And things keep getting worse. States with more rural population have been the most restrictive about extending ACA. Wage stagnation has stressed farm and ranch families who have long held outside jobs to support their primary vocation. The tariff wars are finishing off the process of pushing them off the land since the last time a president wrecked havoc on farm communities with the grain embargo of the late 70s.

Shitty life, shitty suicide.

I could turn to climate change, to school violence, to the trauma of live shooter drills to which we subject our children, to fear-mongering, to the rise of white nationalism... Babies in cages.

Victor Frankl said, Those who have a why to live can bear with almost any how

Almost any how. Almost.

For that matter, how many of us have lost our why?

As I said to my therapist the other day, my life is great right now, except for the existential despair.

Sure, it's a good idea to keep an eye on friends who show warning signs. But getting them hauled off to the hospital in handcuffs (that's how it's done when the police do a welfare check) does nothing to stem the tide. If you think the hospital and a bunch of pills will fix it, you need to know that the most dangerous time in the life of someone who is suicidal is the week after discharge. In the long haul, involuntary hospitalization does not decrease the suicide rate.

What does? Something much harder.

Suicide happens when pain exceeds resources for coping with pain. 

There it is. That is the key.

To prevent suicide, decrease pain and increase resources.

Like I said, something much harder. The psychiatrist in ER knew that he wasn't going to do a damn thing for that homeless woman who had to take meth to stay awake so she wouldn't get raped again. And finding her a safe place to sleep at night never makes it to those lists that go around during #SuicidePreventionMonth.

This post seems so drear. Is that a problem? Do you want a good news story for Suicide Prevention Month? Okay.

It was over a decade ago and I was in bad shape. Really bad shape. And then my printer went out. So I had to go outside of the safety of my home, talk to strangers, and buy a new printer. And then it wouldn't install. It was brand new, it cost more than I wanted to pay, it wouldn't install, and I was in bad shape. On top of all that, which had me teetering on the precipice, now I had to make a phone call.

On the other end of the call was a young man at a call center in Mumbai. He knew what was wrong with my printer. He was able to send me the patch over the internet. It took an hour to download. And during that hour, we talked about Mumbai. We talked about the little I knew about Indian cinema, and he taught me some more. He talked for an hour. At the end of the hour, the printer worked.

He saved my life that day.

I already have a safe place to sleep tonight. But it was a dangerous time for me. So that's what it took. 

You want to save a life? Reduce pain or increase resources. If you can manage to provide a why or fix the how, that would be great. But don't diminish the power of taking somebody to the movies or washing the dishes.

That's my story and I'm sticking to it.

charts from CDC and NIMH and in the public domain
photo of Indian call enter in the public domain


Popular Posts

Loony Saints - Margaret of Cortona Edition

Every once in a while, Prozac Monologues reaches into my Roman Catholic childhood's fascination with saints, especially the ones who today might be assigned a diagnostic code in the DSM.  Twice, Lent Madness has introduced me to new ones that I share with you.

A few years ago it was Christina the Astonishing.

Today it's Margaret of Cortona.  If you're a Lent Madness regular, you'd expect Margaret to be a shoe in for the first round of voting, where her competition is a stuffy old bishop/theologian, because Margaret became a Franciscan and, more significantly, her story features a dog.  Lent Madness voters are suckers for dogs.

Anosognosia and Amador

Anosognosia. It means lack of insight. But from the mouth of Xavier Amador, it’s his ticket. He tells you he knows why your son or daughter won’t take meds. And you are desperate for the answer, aren’t you. Because schizophrenia is a terrible disease and your beloved child is sick and won’t take the meds. The meds would make everything alright. So you are desperate and Xavier Amador throws you a lifeline, a promise that once you understand this unpronounceable word, you can learn how to get your child to take the meds.

He must be right, right? Because he is a psychologist and he can pronounce it. And then the kicker, he also loved somebody with schizophrenia, and he says he got him to take the meds. So NAMI invites him to give the spotlight lecture, and for the rest of the convention, parents hear every other presentation through the filter of this new word that they cannot pronounce.

Here is how you pronounce it:

But really, why bother? It means lack of insight. But you have heard o…

Introducing Allen Frances

Allen Frances was the editor of the DSM-IV, first published in 1990.  He is now the fiercest critic of its next major revision, the DSM-5.  For over three years, he has been blogging weekly to this end at Psychology Today.  This week I will summarize his steady drumbeat.  I hope soon to publish an open letter to him.

Frances' complaint in a nutshell is that the DSM-5 creates fad diagnoses and changes criteria of older diagnoses to medicalize a whole range of normal behavior and miseries.  The link lists these problem diagnoses and a number of the following points, in an article published all over town last December.

These issues have been discussed widely, in public and private circles.  I am not qualified to address each point, though I did give a series over to one of them, the bereavement exclusion.  The best of the batch, if I do say so myself, is Grief/Depression III - Telling the Difference, which got quoted in correspondence among the big boys.