Educate me on suicidal depression

Factual Questions
1

I have a friend who’s a psychiatrist. He told me once that there are two kinds of suicidal people: those who want to commit suicide and those who need attention.

He said people who truly want to commit suicide tell no one. They set their affairs in order, go to a quiet place, and do the deed. They usually succeed.

The others do something loud, messy, often spur of the moment, and are usually unsuccessful. They aren’t really trying to end their lives, they’re trying to get help.

A couple of days ago another friend of mine set her affairs in order, made plans to commit suicide, and changed her mind at the last minute. Instead, she called a friend, who came to her aid and convinced her to check herself into a hospital.

Hearing about all of this after the fact, I am of course extremely relieved she did reach out to someone. I am also curious: was she one of those who would have gone through with it, or were her preparations part of a cry for help?

The factual question part of this OP: Are there really two kinds of suicides, the one meant to succeed and the one meant to fail? Or is it not that simple?

Moderators: I think this is a question with a factual answer. If you don’t agree, feel free to move this.

2

I don’t think there’s any ‘factual’ when dealing with human psychology. That said, I think there is something to the ‘cry for help’ suicide scenario. There is a popular, if morbid meme in mental health circles (from the consumer side) concerning slashing wrists. Draw a line across the wrist perpendicular to the arm and say ‘This way to get attention’, then draw a line from the wrist to the elbow and say ‘This way to get to heaven’. Ghastly little ditty, but funny in the day room :slight_smile:

Sounds like your friend was serious, but came to her senses. I have occasional suicidal thoughts, but I use them for catharsis, and to remind myself that whatever is frustrating me is not that serious. I’ve never made an actual attempt, I’m too cowardly, and deep down, for all it’s frustrations and disappointments, I like being here.

3

Your friend sounds pretty jaded for a psychiatrist. I would not want someone that saw the world is such black & white terms to be treating me or anyone I cared about.

4

IANAP, but I volunteered for a year on a suicide hotline, called The Samaritans. From the training I got and the many calls I received, I believe this is a huge over simplification of the types.

There are many, many different actions of people seriously contemplating suicide. Some brood alone and contact nobody, but most exhibit signs of needing help, either directly or more subtely.

Sure there those who either threaten or try suicide (hoping it won’t work) who need help. Many times their actions actually do suceed, but in any case they certainly need professional help.

Many who are serious exhibit all sorts of actions, too many to even list. Some brood, plan it, and actually carry it out without letting anybody know, but the majority exhibit many signs that they need help, or are going to try it. That is why the suicide hotlines are so helpful. Some who called us had psychiatric problems and just needed to talk, and we spent all the time they needed even though they were not really planning suicide.

Then there were those who really were planning it, and called either out of curiosity, or because they were going to do it. The main thing we did was never, ever, try to talk them out of it, as they would likly hang up. Our only methodology was to let them they could talk as long as they wanted. We would only sympathize with them (never saying “I know how you feel”) and try to get them talking. It is amazing how, if they really talk it out at length, they then never do it, or ask how to get professional help. We had a long list of doctors or agencise that we could refer them to.

Many people would call several times over a long period of time. Some were really suicidal, others not, but all felt better that they could talk to an anonymous person about all their troubles. So many said they could not, or were afraid to talk to family or friends, as all they got was lectures, rather than realy sympathy.

Some were silent callers. Pretty weird, the phone would ring, we’d tell them who we were and ask if they were planning suicide. Then they never talked. We would never hang up, but every few minutes we’d say, “We are still here and want to help. If you feel like talking, please go ahead, but you don’t have to.” Sometimes this went on for an hour and they’d hang up, sometimes they eventually would get the courage to start talking.

The very first thing we would ask, and most people are afraid to do it, is whether they are planning to kill themselves. If the said yes, or maybe, then we asked if they had the means to do it at hand, a gun, poison, etc. If so, then we would urge them to stay on the line and talk about their problems. After a while we would ask if they wanted a referraal to a pro, but most said they did not, and some would talk for hours.

The amazing thing to all of us was how effective it was to let these people talk it out. Many, many finally told us they gave up the idea, or wanted to talk to a pro and we gave them referrals.

We were absolutely taught never, ever to call police if we knew who they were. If we ever did this when they did not want it, the word would get around and people who needed us would no longer call. We told them at the begining that we would never do this if they did not want it, but did ask early on if they would like an ambulance or the police to come and help. We never told them not to do it, as that was why they called us as they knew we would not do what their families might, and they did not want to hear.

The very worst thing that could happen is that somebody actually did kill themselves while still on the phone. Thank God that never happened to me. Nevertheless, i finally burned out after a year (one night a week) and quit, as it was just too depressing, despite being to help many people.

5

Your friend is simplifying an enormously complex issue, and perpetuating many myths regarding suicide, and therefore it is frightening that he is a psychiatrist.

6

Tough response to compose (I’m post-call), but I’ll try.

I don’t think I’d agree with the former “usually don’t tell anyone” assessment. I don’t have my textbooks handy here, but ambivalence about committing suicide is very common. People who contemplate suicide quite often attempt to reach out to someone - a friend, a healthcare worker - before attempting (or immediately after the attempt).

I’ve only had one client in fifteen years who actually prepared for his suicide without telling anyone at all (including making extensive preparations so that he would not be thwarted in his plans).

As for the latter, your friend might be referring to people with severe coping skills deficits (such as found in borderline personality disorder). The self-injurious behavior may be a way to reach out for help or to punish someone else for a transgression (“see what you made me do”); it reflects a lack of tools to deal with whatever stressor is occurring.

The important thing is - I take them both seriously. The therapeutic intervention can be different, but it’s still a serious matter.

7

According to Andrew Solomon’s The Noonday Demon: An Atlas of Depression:

So I agree that the OP’s friend oversimplifies a complex issue and may actually be wrong, and I’d add that it’s possible that other psychiatrists are subject to the same misconceptions. And I would recommend the quoted book to the OP; the chapter on suicide is very informative and even-handed, mixing valuable research with the author’s own personal experiences. So are the other chapters.

8

This is what is called a false dichotomy. It is entirely possible for someone to sincerely want help but not know how to ask for or accept it. True attention-seeking behavior rarely gets to the point of actual preparation but this is often indistinguishable from the desperation of genuine suicidal intention. And sincere ideation is often followed by a sort of calm complacency; once a patient has accepted the idea of taking his or her own life, there’s really no hurry about it. So someone might be sincerely contemplating suicide, but then change their mind once the initial anxiety of self-murder is past and they reflect upon the finality of the solution. Others may be asking for help but never feel that anyone has really connected with them, and follow through even though the entire act is really just an extension of a hysterical crisis rather than genuine intent. And then there are suicides that are not a result of Major Depressive Disorder but instead a result of any of a number of schizophrenic manias or delusions, Post-Traumatic Stress Disorder, adverse drug reactions, et cetera that are not depressive disorders at all.

I’d agree with ASAKMOTSD and Kolga: it sounds like the psychiatrist known by the o.p. has some pretty severe detachment issues (and practice malfeasance) if he’s willing to classify all suicidal patients into two simplistic categories.

Stranger

9

Hear hear.

10

Well, we are hearing this third hand, probably quite a while after the original conversation. Perhaps the psychiatrist didn’t mean to literally divide all suicidal people into 2 mutually exclusive categories. I think “not all suicidal behavior is the same,” “there are at least 2 different types of suicidal people,” and “there are at least 2 important aspects to suicidal behavior, actual suicidal intent and attention seeking” are all valid statements. My sense of the original conversation is that the psychiatrist was trying to make the points above, and was taken a bit too literally.

11

Very true, on all points. It was a casual conversation, several years ago, and in the OP I was trying to describe what I understood of what he told me. I believe my friend is a complete professional at work (although I’ve never worked with him - you could say my knowledge of his skills are also third hand). He does tend to be somewhat sarcastic in his sense of humor at home.

In fact, I’m very glad I started this thread, because the clarifications on what is truly a complex issue have been very enlightening. Thanks everyone for your input.

12

IANAP either, but I was depressed and suicidal, so here’s an anecdote from the other side. I’ve attempted suicide twice so far and my experience would agree with the “it’s not so black and white” camp.

The first time, I took a box of over-the-counter sleeping aids, not knowing anything about drugs and lethal doses, and the next day I was simply shaken awake and dragged to the hospital very tired. I had every intention of succeeding, but I failed because I didn’t do my homework beforehand. It was a spur-of-the-moment thing and had happened despite the psychiatric treatment I was receiving at the time. Suicide was very much a last resort – I begged for help, received it, and only when that didn’t work did I make my attempt.

After the botched attempt, I extensively researched suicide methods through books, discussion groups, websites, chat rooms, etc… I swore that if I ever attempted suicide again, it would be with a surefire, redundant chain of methods. Part of the reason I felt the need to go “all out” the next time was precisely because of the notion that if I didn’t succeed, I was just an attention whore – misconception or not, I bought into it as well.

In fact, the kind of medical/judicial/psychological attention you get from a suicide attempt really is not fun. And nothing makes you feel more like a loser than being depressed enough to try and kill yourself and fail at that too. This is really not the kind of thing I, at least, would ever want to go through more than once – and that’s already once too many.

My second time was a lot like your friend’s and kinda shows the gray area that your shrink refuses to believe in. Following another rejection (this was almost ten years later), I tried again. This time, as soon I got home, all logical thought ceased and I just broke down and started crying uncontrollably. I was so overwhelmed with emotion I couldn’t even write a note – instead, I grabbed a Sharpie and scribbled random shit on my arm – and everything I had ever learned about effective suicide methodology amounted to jack diddly shit. Without thinking, I grabbed my knife and started cutting into my arm (not something I would regularly do, mind you, but also considered a very common sign of “s/he’s just seeking attention”). When that didn’t do anything, I became even more desperate, emptied out my first aid kit and downed everything I could find and washed it all down with a twelve-pack and a bottle of liquor. Then I tied a plastic bag around my head and went to bed to die. At no point through this did I think, “Ha-hah! Now they’ll pay attention!” or anything along those lines.

Five minutes later I felt an intense mix of panic and nausea. I dashed to the bathroom to vomit, but nothing came out. As I was washing my hands (out of sheer force of habit), I saw myself in the mirror and at that point I just lost it. I still hadn’t regained my faculties and very little rational thought was involved; it wasn’t so much a “Oh, oops. I seemed to have made a mistake. I had better ask for help.” as much as a “Noooooooooooooooooooooo! Not like this! Arghhhhhhhhhhhhhhhhhhh!” I ran to a friend and broke down again and started sobbing and begging for help – one of the only times I opened up to another male, and the first and only time I ever cried in front of another guy (meaning this would not be something I’d do just to seek attention). Anyway, the rest is history.

When I was released from the ER and mental institution a few days later, they told me I had taken an “extremely lethal dose” and that I’d be dead if not for my friend. So, again, I had intended 100% to succeed and die, but not even half an hour later I became 100% certain that I wanted to live. Mind you, this second time I had also restarted psychiatric treatment for 2-3 months prior, so it’s not like I was too afraid to ask for help the normal way.

Make of that what you will, but like so many books and people will tell you, when somebody speaks of suicide, whether it’s “just talk”, “just seeking attention”, or “just an attempt”, the point is they need help. This is not something normal people do, and even if somebody is simply so desperate for attention that they have to fake suicidal ideology to get it… that in itself should indicate something serious.

That’s all I’ve got. End of story :slight_smile:

13

Wow, that was a really interesting… um… reply, Reply (sorry, you must hear that all the time). :smiley:

Seriously, though, while I am sorry to hear that, it was a very interesting post. Yours, too, KlondikeGeoff. I’ve never heard an account of working on a suicide hotline. Fascinating stuff.

14

Oh gosh, Reply, I’m so sorry to hear of all the travails you have gone through. I do hope you are doing better now, but as you did not say, i think we would a like to know how you are coping now. Have you recieved any help that worked for your depression? I understand there are some meds now that are pretty effective in helping with clinical depression.

In any case, I do hope you are able to get along OK now. You wrote a really fascinating account of your troubles, and I can’t imagine how awful it must be to come to that point.

You seem exceedingly brave to be able not only to continue your life, but also to share this with us.

15

Any time that you try to assign causation or reason to suicide (or suicide attempts), you’re ultimately engaging in an exercise of meta-narrative. The human mind rarely follows along neat causal tracks, and reasons or emotions are transformed into something different – something more concrete than the underlying reality – when they pass through the filter of language. Even when we have a suicide note, or even entire journals explaining why, “why?” is neither easy nor certain.

Some time ago, I stumbled across this short essay. I can really only speak from personal experiences, but as far as that goes, it’s the closest thing I’ve ever read to a real understanding of why people kill themselves:

16

Thank you both for your concern. And KlondikeGeoff, please understand that I don’t mean to ignore your inquiry, but out of respect for the OP, I would prefer not to hijack this thread. I posted only to give an example and I don’t want the thread to veer off-track,

17

Even if a person is talking about suicide for the purpose of seeking attention, in your opinion, someone must give that person immediate attention – preferably professional. People do talk about it before they do it. Some may not and others do.

But what happens if a person actually begins to go through some of the motions of committing suicide just to get attention? There is still great danger to that person because she or he may accidentally go too far and actually kill himself.

The psychiatrist who told me that over forty years ago took his own life.

Don’t keep a gun in the house if you are depressed. Just don’t. But if you are ever seriously thinking about it, go to a safe place – preferably an emergency room, but at least a friend’s house before you see a doctor.

Medications turned my world right side up, but therapy still helped to give me insight into how to live a with much more satisfaction and emotional intelligence.

18

That’s what I thought at first, but on review it makes a little more sense after you realize he basically said it’s a way for crying out for help and not a cynical way of saying they’re whiny and should be mocked, he’s just saying they’re two very different issues that are equally serious and should be handled differently.

I have to somewhat I agree, I was in the “attention” crowd I guess, I legitimately DID want to die when I had my spur of the moment reactions, but when I look back, the way I carried them out WAS a cry for help, even if I was actually, legitimately telling myself I wanted to die. Call it a subconscious defense mechanism or whatever, but I think there’s something to the statement, even if it is a little simplified.