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V.F. Wojciech, from the book “What do we know about suicide?”
Suicide is understood as “an act with a fatal outcome that was deliberately initiated and carried out by the deceased subject himself, subject to the latter’s knowledge or expectation of such an outcome, and the outcome is considered by the subject as a tool in achieving the desired changes in self-awareness and social environment.” In this somewhat complicated definition, three points are highlighted - awareness of actions, understanding that they lead to death and the desire of the suicide to influence others.
There are completed suicide, parasuicide, self-harm, suicidal thoughts, often realized in the form of an accident, and unconscious, auto-aggressive behavior. Suicide is a deliberate act, but there are many cases when there is no sufficient reason to speak unequivocally about suicide. It could simply be an accident, an accidental overdose of medication, etc. If a person survives suicide, then this is regarded as an attempt or parasuicide. Suicide attempts can be divided into three groups: those in which the individual “really wants to die,” those in which he “lost the chance of survival,” and those in which he “definitely expected to survive.”
Some authors highlight indirect suicide or self-destructive behavior. There are people who are suicidal, but their environment does not recognize this. Some subjects may consider their lives to be unnecessarily bland or unbearable due to insurmountable obstacles, and their behavior may then border on suicidal behavior. Karl Menninger described “chronic suicide,” by which he meant “indirect self-destructive behavior that undermines health.” American researcher N.B. Tabachnik defines self-destructive behavior as the commission of “any action (over which a person has some real or potential volitional control) that contributes to the individual’s advancement in the direction of earlier physical death.” Any behavior that shortens a person's life is defined as "partial", "semi-intentional", "semi-intentional", "latent suicide", "unconscious suicidal behavior" or "suicidal equivalent".
People often kill themselves slowly without realizing their intentions to commit suicide. They deny that their actions are aimed at self-destruction or harm to themselves. And yet their way of life is a movement towards self-destruction. The same mental forces that drive a person to jump off a skyscraper underlie dangerous habits such as alcohol or drug abuse, ignoring serious illnesses, overeating, excessive work, or chronic smoking. Although indirect suicide is less obvious to others, its results are nevertheless also lethal. Another place to look for disguised suicides is the roadway. The machine is the perfect instrument of self-destruction. Many deaths reported as accidents are often disguised suicides (auticide). 40% of victims of transport accidents have alcohol in their blood. It remains controversial how “accidental” these accidents were.
Experts believe that inattention, speeding, misjudgment and drunk driving are often the result of conscious or unconscious self-destructive behavior. A study conducted by the Center for Suicide Prevention in the United States found that 25% of accident victims surveyed were depressed or reported feeling helpless. Before the accident, they had fantasies of death and self-destruction. According to experts, approximately 25% of drivers who die in car accidents themselves intentionally or semi-intentionally contribute to these accidents through their recklessness and excessively risky behavior.
Road accidents are especially common among teenagers. Researchers found that young men who had frequent accidents spent most of their time on the street, had a violent and uncontrollable character, and saw themselves as a “tough guy.” When under emotional stress, they easily consumed alcohol or drugs and then drove carelessly and impulsively, showing more interest in power and speed than in driving safety.
Other forms of semi-intentional suicides. By definition, suicide is the deliberate taking of one's own life. There are people who want to die, but are not ready to consciously fulfill this desire. Suicides disguised as accidents are not as rare as is believed. Those people who are accident prone may consider themselves cautious and yet, strangely enough, behave in self-destructive ways. For example, stabbing themselves or “accidentally” taking too many pills.
Some people are not sure that they want to die, but they are also not sure that they want to live. This ambivalence manifests itself in the so-called “deadly games,” which include Russian roulette. In such games, the outcome depends on external forces, and the decision is made as if for the players. Playing with death also occurs during other risky competitions, such as car racing or skydiving.
The suicidal equivalent may be camouflaged by considerations of idealism or altruism. Martyrs give their lives in the name of God or the Fatherland. Long before death, they may unconsciously want to die. Then an opportunity arises that allows them to do this with honor and nobility. As a result, because of their selfless courage, they evoke not contempt, but reverence from their descendants.
Suicide attempt
A suicide attempt, which indicates a person's intent, is a powerful predictor of subsequent completed suicide. There is nothing more dramatic and painful than a cry for help from a suicidal person who has committed suicide. Some suicide attempts are not taken seriously. For example, a girl takes sleeping pills, confident that her attempt will be discovered. Or a man cuts himself in such a way that it cannot possibly end in death. Often family and friends take it easy. This also applies to cases where a person who tried to poison himself seeks to justify his behavior. Often people react to these events with an irritated remark: “She just wanted attention.” The point is that every suicide attempt should be taken seriously, no matter how harmless and frivolous it may seem. The most vulnerable are people who have attempted suicide in the past or have had close contact with someone who has attempted or accomplished this. Statistics show that 12% of those who make a suicide attempt, no later than two years later, definitely repeat it and achieve what they want. Four out of five suicide victims had attempted to do so in the past. After the first failed attempt, many conclude: “I’ll do it better next time.” And they remember this when they are in a state of crisis.
Suicidal behavior in depression
Suicidal attempts are one of the most dangerous consequences of depression, manic-depressive psychosis, and schizophrenia. According to statistics, from 40 to 60% of all suicides on the planet are carried out by patients with depression.
Men commit suicide 4 times more often than women. This is due to psychological characteristics. If women talk more about their fears and negative emotions, and try to share them with others, then men, on the contrary, are not inclined to tell anyone about their experiences. As a result, suicidal thoughts and tendencies in men remain unrecognized. And they learn about them only when nothing can be returned. In addition, men are more likely than women to abuse alcohol, so they have a higher risk of developing alcoholic depression and suicide on this basis.
The most predisposing time for suicide is the early morning hours. This is due to hormonal fluctuations occurring at this time. Most people who attempt suicide in the early morning hours suffered from insomnia all night, sad and painful thoughts filled their minds, and in order to get rid of all this they decide to commit suicide.
Why do people with depression attempt suicide?
With depression, in addition to a decrease in mood, symptoms such as a feeling of self-doubt, decreased self-esteem, and a gloomy and pessimistic vision of the future appear. People with depression may also experience persistent thoughts about their own worthlessness. Even the successes achieved during life against the background of depression seem unimpressive.
The patient may consider himself guilty of almost all mortal sins. Against the background of illness, a person suffering from depression begins to think that he himself is the source of misfortune for his family and friends, and his death will free his relatives from the heavy burden of caring for him.
Depression and suicide are closely related. Ideas of a meaningless existence that are common in depression can contribute to thoughts of suicide. At first, thoughts appear in the minds of patients about how good it would be for everyone if an accident happened to them. Gradually, an irresistible attraction to suicide and obsessive ideas about committing suicide join in.
The danger of suicide is especially high when depression is combined with a chronic somatic or neurological disease (stroke, diabetes, cancer, HIV infection ). Quite often, such people cannot lead a normal life and are forced to cause a lot of inconvenience to loved ones and burden them. So thoughts come to mind on how to make everyone happy...
Suicide can also occur as a result of the development of reactive depression; a sudden life catastrophe literally shatters a person’s life into smithereens, and instead of starting all over again, overcoming the difficulties that have arisen, the person chooses to take a step into nowhere.
Attempts to commit suicide are a common occurrence among creative people suffering from manic-depressive psychosis or dysthymia. At the peak of high spirits, such people create masterpieces, become famous, and when a depressive streak sets in in their lives, they can attempt suicide.
When is the risk of suicide highest for depression?
The likelihood of committing a suicide attempt is not the same for all patients with depression. Against the background of a mild course of the disease, even if suicidal thoughts appear, in most cases they do not turn into actions.
The risk of suicide attempts is also reduced during severe bouts of depression. Although thoughts of suicide quite often haunt patients with severe depressive disorders, severe motor retardation and inability to do anything act as a defense mechanism that prevents a person from committing suicide.
The most dangerous periods in terms of suicide attempts are the periods of “entry” and “exit” from severe or moderate depression.
As depression progresses (the onset of severe depressive disorder), patients are haunted by obsessive thoughts about their own worthlessness, suicidal thoughts, and in order to punish themselves, not to disturb others, and simply not seeing any prospects in the future, such people can commit suicidal acts. As depression progresses, motor retardation does not yet reach the same severity as at the peak of a depressive disorder, and patients with depression may attempt suicide.
When patients with depressive disorder start taking antidepressants, the effect of treatment does not occur immediately. Initially, some disinhibition of the patients occurs, motor activity appears, although a negative assessment of oneself and suicidal thoughts still persist. That is why, during the period of recovery from depression (in the first two weeks from the start of treatment), many patients are capable of committing suicide.
What manifestations help to suspect suicidal thoughts and suicidal tendencies?
You can suspect the presence of suicidal thoughts, suicidal tendencies in patients with depression and not only by the following signs:
Suicidal thoughts can slip into statements - “if only death would take me sooner”, “I don’t want to live, I want to take my own life once and for all.”
Constant conversations about the futility of existence, about one’s own helplessness, and burdening others with their problems.
Progression of depression - loss of usual interests, insomnia, severe melancholy.
Some people who carefully plan suicide begin to put things in order in advance - they draw up a will, finish a book (finish a report) so that after their departure there are no unresolved issues.
If a person does not spontaneously commit suicide, but systematically prepares for this, then he can say goodbye to loved ones - call them, write. Sometimes it is a sudden call that helps loved ones understand that something is wrong in the behavior of a person with depression, that he is preparing for something fatal.
How to prevent suicide attempts if you are depressed?
In many cases, you can suspect the presence of suicidal thoughts in a person suffering from depression in advance. To do this, you need to regularly communicate with a patient with depression, take an interest in his affairs, and express your support to him. After all, people with depression are often pushed to commit suicide by loved ones. And not even themselves, but their behavior, indifference, absorption in their own worries.
If the following statements apply to your friends, then you should seek help from a specialist psychologist, psychotherapist or psychiatrist.
A person’s appetite has changed, he is rapidly losing weight or gaining weight. He feels constant anxiety. He withdraws from friends and family. He can't concentrate. What he used to really like no longer interests or pleases him. He is tormented by a feeling of hopelessness or guilt. His mood and behavior changed dramatically: before he was very calm, but now he is extremely excited; Previously, he loved to be in companies, but now he avoids all communication.
For the most part, people who are depressed or thinking about suicide do not talk and do not want to talk about their feelings. They feel unwanted. They have lost hope and do not express their emotions, believing that their experiences will fall on the shoulders of others. Some are afraid of being ridiculed. This is understandable because those who talk about suicide are often not taken seriously or what they say falls on deaf ears. Such a reaction can lead to irreparable consequences. Therefore, if your acquaintance, friend or relative brings up such a topic, you need to take it seriously and find time for a deep and compassionate conversation. It is necessary to convince this person that he has someone to turn to. That relatives, friends, a psychologist are undoubtedly ready to listen to him. Often the opportunity to talk can ease the pain, and although it is difficult to start such a conversation, it is still necessary. Also, one should not lecture and point out all the reasons why a person is obliged to live. Instead, you need to listen more and try to convince him that depression and suicidal tendencies are treatable.
But the most terrible and, probably, stupid thing, in my opinion, is the suicide of young people who have not yet faced truly serious problems, but who know how to exaggerate the magnitude of their, sometimes far-fetched, grief.
Therefore, let's be more attentive to each other, because this is important, let's not be so callous and selfish? Maybe we should listen to the worries and problems of people close to us? After all, suicide is one of the consequences of depression that can be noticed and prevented in advance. And our helpers in the fight against suicidal tendencies are attention, support and love.
For help, advice and adequate treatment of depression, neuroses, suicidal thoughts, contact a psychiatrist at the Krasnoselkup Central District Hospital. Do not be afraid of condemnation, all treatment takes place on an anonymous basis, without registration, since these conditions are considered borderline in psychiatry. You will be surprised how effective this is and you will smile about your experiences in the past!
Psychiatrist-narcologist
Kolobova Yulia Viktorovna
Suicidal threat
Some suicidal people are quite clear about their intentions. There may also be direct statements: “I can’t stand this. I don't want to live anymore. I want to commit suicide." More often, with serious intentions to commit suicide, statements are veiled: “You don’t have to worry about me,” “I don’t want to create problems for you,” “I want to fall asleep and not wake up,” “Soon this pain will be over,” “ They will be very sorry when I leave them.” Regardless of whether these dangerous statements take the form of open statements or hints, in any case they should not be ignored. Sometimes nonverbal behavior can be an indicator of suicide. Preparation for suicide depends on the person’s personality and external circumstances. It often consists of what is commonly called “getting your affairs in order.” This could be drawing up a will, reviewing insurance, writing necessary matters or long belated letters for loved ones, resolving disputes and conflicts with relatives and neighbors. A teenager may sentimentally give away valuable personal items. The final preparations can be made very quickly, and then suicide will immediately follow.
