Ok.  Back to it then.

We’re back; time to pick-up the conversational thread from Suicide Ain’t Painless.

When we last convened on the topic, we agreed that in our society talking about suicide is about as etiquitte savvy as asking an obese, 40+ woman, “Wow! You’re like huge! How much weight have you gained since high school? And what year was that again?”

We’d come to consensus on the realization that there is a relational onus to create space in discussions, healthcare, families, treatment, and ideology for people to pause, breathe and heal enough that they can bear their circumstances without suicidal measures.

This post will identify the most common reasons people suicide in categorical terms, as well as metacognitive dialogue from the various point-of-view of suicidal ideation.

Before we do that, however, with all this talk of suicide, I expect you might have a question for me.

And that’s good. That’s appropriate.

So ask me.

Ask me if I am thinking about hurting myself or taking my own life.

It’s the perfect question to pose if you are concerned, and it won’t make me catch suicidal ideation like strep throat if you ask me.  Were I considering suicide, you’re asking me could create the space I need to realize it is possible to continue living my life differently.

Thank you for your concern.

I am not suicidal or in any way considering hurting myself. I am, however, very concerned about suicide.

In 6 reasons Why People Commit Suicide, Alex Lickerman, MD, enacapsulates a succinct list of the most common categories of why people choose to end their lives.

Dr. Lickerman asserts that in general, there are six reasons people attempt to/end their own lives.

1. They’re depressed. Clinical depression may lead to feelings of intense sorrow, unrelenting pain, self-loathing and hopelessness. Physical symptoms may further complicate the condition and include changes in sleeping and appetite patterns, lethargy, nhedonia (loss of pleasure in daily rhythms and routines) and impaired concentration. Another common aspect of clinical depression is recurring thoughts of death or suicide. The cumulative weight of all these complications distort perspective and pace. People begin to feel that the pain is too much to bear, that their lives have been reduced to feelings of loss and pain and/or it would be better for their family and friends if they were gone.

The metacognitive soundtrack of clinical depression might perseverate on the following refrains: “Life is too painful to go on living.” “I can’t keep on living this way.” “Anything, nothing would be better than living this way.” “I can’t imagine living this way.” “I’m tired, I’m done, there’s nothing left for me besides pain.” “It would be better if my children didn’t have to see me like this.” “Caring for me like this is too much of a burden on my wife.” “I can’t stand it anymore, it hurts too much.” “Pain is all that is left  for me.” “It would be better for everyone if I end it.” “I should have never been born.”

People may attempt to mask depressive symptoms due to shame or despair. If you or someone you care about feels intense sadness during the majority of each day, especially in the mornings, it could be clinical depression. As a primary symptom of clinical depression is recurring thoughts of death or suicide, such situations/persons are at increased risk of suicide. Interventions strategies and treatment are available for clinical depression.

2. They’re psychotic. Unlike depression, psychosis is difficult to mask. Psychotic individuals are tormented by dark, inner voices that compel them to hurt/destroy themselves. These voices may so command a person’s perceptions that s/he feels unable to do anything other than obey their malevolent edicts. When asked, psychotic patients may honestly report what the voices demand they must do, and if they are considering suicide as an option to quiet them.

The metacognitive soundtrack of a psychotic might perseverate on the following refrains: “You must die. “You must kill yourself.” “You are worthless and must die.” “I command you to die for me.” “I order you to kill yourself.” “I demand your life.” “Your life is already over; you’re life is forfeit to me.” “You must sacrifice your life as penance for your sins.” “You must sacrifice your life to prove you love me.” “You must sacrifice your life to serve me.” “I will only love you if you kill yourself.” “I will reward you beyond imagination if you kill yourself for me.”

Like depression, Psychosis is treatable and intervention available.

3. They’re impulsive. Acute stress and drug and/or alcohol use may induce intense feelings of despair/pain that compel people to impulsively kill themselves. These situations may arise without previous indications of depression or suicidal ideation, and often operate outside of a premeditated plan or prior intent. Because the onset of impulsive activity is acute and unpredictable, it is difficult to foresee the likelihood that acute stress, drugs and/or alcohol use could lead a party to suicide.

Similarly, outside of an impaired or altered lens, it is difficult to render the metacognitive soundtrack of an impulsive suicidal ideation.  This script is purely hypothetical: “Oh my God, I never realized how bad it all is.”  ”Shit. Nothing makes sense. This is all a perverted joke.” “I can fly! Oh, my God, I can fly!”

4. They’re crying out for help, and don’t know how else to get it. Even though we are a society that does not talk much about suicide, it is keyed into the fabric of how we triage resources. Attempts of suicide are a certain measure to alert the world an individual is in distress and in need of intervention. Young adults and adolescents may choose suicide attempts as a means to call for help that instead becomes lethal; for example, jumping from a height too high to survive, taking a dosage of a medication that was not believed enough to end life but does, and cutting a vein or artery more deeply than intended.

The metacognitive soundtrack of crying-out-for-help suicidal ideation is also difficult to template.  Its hypothetical script could read: “Then they will know,” “If I do it, then they will help me, ” “They won’t know I am serious unless I do this.” “They won’t believe how bad it is unless I show them.” “This is the only way to get their attention.”

5. They have a philosophical desire to die. Outside of depression, psychological illness, impulse or desperation, some people reflectively plan to die in a strategic-end-of-life-plan. Terminal illness, medically progressive diseases, duty (in the line of service, protection or combat) and financial impetus are examples of reasons people intentionally plan suicide. What distinguishes this category from the others is that people who philosophically choose to die operate outside of mental disorders or acute emotional features.

The metacognitive soundtrack of the philosophical-desire-to-die converses differently and in flat notes of certainty without the sharps of desperation. Such utterances may sound clinical and objective: “I don’t want to suffer and die slowly in pain while my family wastes away with me by my bedside.” “I have lived a full and happy life. I am lucky to have enjoyed such longevity and experienced all in life that I have. I want to quit before I get sick in mind or body.” “I don’t want to use up my life savings in a futile attempt to prolong a life that is at the end. I want to be able to leave behind financial security for my family.” “I am no longer able to perform the tasks that make me the most happy. I am no longer able to contribute in a meaningful way. The quality of my life has decreased in a trend that can only progress and continue.” “It is my duty to do this so that others might live.” “Not him, me.” “I can buy them more time.”

6. They’ve made a mistake. Sadly, there are many too many recent ways that people, especially young people accidentally kill themselves. Many of these situation involve experimentation with oxygen deprivation to induce a high that goes too far. Some argue that texting while driving that results in fatal car incidents or driving while impaired could also be categorized as cases of suicide by mistake.

I can only imagine what the metacognitive soundtrack these situations impart: “What would happen if I tried it?” “Just one more second.” “I will just answer quick.” “I couldn’t be hurt.” “Mascara won’t run from the front of my face or down my shirt.”

It helps me to know that there are categorical reasons people choose suicide. It unveils some of the myths around suicide to know that there are indicators for suicide that are as consistent as risk factors for tooth decay. Decay, is at the core of suicide. Instead of an erosion of tooth enamel, it’s a striping away of hope. Depression, psychosis, impulse, desperation, philosophical intentionality, and mistakes all create conditions that make suicide more likely. A person who attempts suicide may or may not have actually desired to die. The context of each death by suicide is as individual are are people. That said, there is enough commonality to suggest that most every condition that increases the likelihood of suicide is treatable. Intervention and help is available.

Ready help and intervention strategies will be the focus of the next post in this series.

For now, I respectfully close with these final thoughts:

1. If you or someone you know is seems clinically depressed, or seems unusually low or disconnected from the joys of daily life, it’s time to for you to talk to someone, or you to talk to that person. Asking someone if he is considering hurting himself does not make it more likely that he will do so. It can, in fact, it could create the space for ready help to rush in. Furthermore, if you have come to believe that suicide is the only way you are able to escape the pain in your life that makes you feel overwhelmed and joyless, I assure you that there are services available to assist you. 911, local emergency rooms, and suicide hotlines are all direct patches into the network of resources in your area. People you know and love, as well as people called to intervention work are literally standing in line to support you during this time. Even if you can not remember a face of love in your daily life, I promise you that you are an adored child to the One above, and He seeks to prosper and not to harm you. There are ready alternatives to hurting yourself, friend. You have years of light, and love ahead of you. Consider all the lives you can touch if you choose to seek help and live on.

Live on.

Live on.

2. Liability demands I state this part crystal clearly:  I am not a physician or therapist. I cannot offer medical or psychological advise or treatment. If you are concerned about your situation or the situation of a loved one, I encourage you to consult your doctor or area mental health resources for treatment advise or referral services.

3. Suicide leaves the house left in shambles. I will never be able to think about its impact the same way since G surrendered his own life.

As such, I commit to work hope, exercise prayer and Praise the Light of the World.

My focus will be on education, treatment and prevention.

My face will look up to my Portion Deliverer as I research, write and cling unto my Rock.

I will be still, and know that He is God.

There is nothing too big or scary for my God.

I reject the outgrown chains of my history and shame.

Darkness will have no victory in this circumstance or over G’s community.

Nothing will turn me away from the Face of Love.

Well it goes like this
The fourth, the fifth
The minor fall and the major lift
The baffled king composing Hallelujah
Hallelujah
Hallelujah
Hallelujah
Hallelujah