6 reasons why people commit suicide

6 reasons why people commit suicide

Though I’ve never lost a friend or family member to suicide, I have lost a patient.

I have known a number of people left behind by the suicide of people close to them, however. Given how much losing my patient affected me, I’ve only been able to guess at the devastation these people have experienced. Pain mixed with guilt, anger, and regret makes for a bitter drink, the taste of which I’ve seen take many months or even years to wash out of some mouths.

The one question everyone has asked without exception, that they ache to have answered more than any other, is simply, why?

Why did their friend, child, parent, spouse, or sibling take their own life? Even when a note explaining the reasons is found, lingering questions usually remain: yes, they felt enough despair to want to die, but why did they feel that? A person’s suicide often takes the people it leaves behind by surprise (only accentuating survivor’s guilt for failing to see it coming).

People who’ve survived suicide attempts have reported wanting not so much to die as to stop living, a strange dichotomy but a valid one nevertheless. If some in-between state existed, some other alternative to death, I suspect many suicidal people would take it. For the sake of all those reading this who might have been left behind by someone’s suicide, I wanted to describe how I was trained to think about the reasons people kill themselves. They’re not as intuitive as most think.

In general, people try to kill themselves for six reasons:

1. They’re depressed. This is without question the most common reason people commit suicide. Severe depression is always accompanied by a pervasive sense of suffering as well as the belief that escape from it is hopeless. The pain of existence often becomes too much for severely depressed people to bear. The state of depression warps their thinking, allowing ideas like “Everyone would all be better off without me” to make rational sense. They shouldn’t be blamed for falling prey to such distorted thoughts any more than a heart patient should be blamed for experiencing chest pain: it’s simply the nature of their disease.

Because depression, as we all know, is almost always treatable, we should all seek to recognize its presence in our close friends and loved ones. Often people suffer with it silently, planning suicide without anyone ever knowing. Despite making both parties uncomfortable, inquiring directly about suicidal thoughts in my experience almost always yields an honest response. If you suspect someone might be depressed, don’t allow your tendency to deny the possibility of suicidal ideation prevent you from asking about it.

2. They’re psychotic. Malevolent inner voices often command self-destruction for unintelligible reasons. Psychosis is much harder to mask than depression — and arguably even more tragic. The worldwide incidence of schizophrenia is 1% and often strikes otherwise healthy, high-performing individuals, whose lives, though manageable with medication, never fulfill their original promise.

Schizophrenics are just as likely to talk freely about the voices commanding them to kill themselves as not, and also, in my experience, give honest answers about thoughts of suicide when asked directly. Psychosis, too, is treatable, and usually must be for a schizophrenic to be able to function at all. Untreated or poorly treated psychosis almost always requires hospital admission to a locked ward until the voices lose their commanding power.

3. They’re impulsive. Often related to drugs and alcohol, some people become maudlin and impulsively attempt to end their own lives. Once sobered and calmed, these people usually feel emphatically ashamed. The remorse is usually genuine, and whether or not they’ll ever attempt suicide again is unpredictable. They may try it again the very next time they become drunk or high, or never again in their lifetime. Hospital admission is therefore not usually indicated. Substance abuse and the underlying reasons for it are generally a greater concern in these people and should be addressed as aggressively as possible.

4. They’re crying out for help, and don’t know how else to get it. These people don’t usually want to die but do want to alert those around them that something is seriously wrong. They often don’t believe they will die, frequently choosing methods they don’t think can kill them in order to strike out at someone who’s hurt them—but are sometimes tragically misinformed. The prototypical example of this is a young teenage girl suffering genuine angst because of a relationship, either with a friend, boyfriend, or parent who swallows a bottle of Tylenol—not realizing that in high enough doses Tylenol causes irreversible liver damage.

I’ve watched more than one teenager die a horrible death in an ICU days after such an ingestion when remorse has already cured them of their desire to die and their true goal of alerting those close to them of their distress has been achieved.

5. They have a philosophical desire to die. The decision to commit suicide for some is based on a reasoned decision often motivated by the presence of a painful terminal illness from which little to no hope of reprieve exists. These people aren’t depressed, psychotic, maudlin, or crying out for help. They’re trying to take control of their destiny and alleviate their own suffering, which usually can only be done in death. They often look at their choice to commit suicide as a way to shorten a dying that will happen regardless. In my personal view, if such people are evaluated by a qualified professional who can reliably exclude the other possibilities for why suicide is desired, these people should be allowed to die at their own hands.

6. They’ve made a mistake. This is a recent, tragic phenomenon in which typically young people flirt with oxygen deprivation for the high it brings and simply go too far. The only defense against this, it seems to me, is education.

The wounds suicide leaves in the lives of those left behind by it are often deep and long lasting. The apparent senselessness of suicide often fuels the most significant pain survivors feel. Thinking we all deal better with tragedy when we understand its underpinnings, I’ve offered the preceding paragraphs in hopes that anyone reading this who’s been left behind by a suicide might be able to more easily find a way to move on, to relinquish their guilt and anger, and find closure. Despite the abrupt way you may have been left, those don’t have to be the only two emotions you’re doomed to feel about the one who left you.

Alex Lickerman is an internal medicine physician at the University of Chicago who blogs at Happiness in this World.  He is the author of The Undefeated Mind: On the Science of Constructing an Indestructible Self.

Image credit: Shutterstock.com

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  • http://www.eleventhhourllc.com LauraNP

    Dear Alex,
    Suicide is much more complicated. There are not merely 6 reasons people kill themselves. As a health care provider who is trained in risk assessment, there are risk factors and protective factors for people, and only after careful, in-depth data collection of these factors, can you assess a persons risk for suicide.

    • http://happinessinthisworld.com Alex @ Happiness in this World

      LauraNP:
      I’m not arguing suicide isn’t complicated, just that this organization is useful for thinking in the broadest sense about the reasons people attempt it. The schema implies nothing about an individual person’s risk.

  • http://www.pacificpsych.com/ pacificpsych

    I think your article is excellent. I might have added severe real life difficulties, such as suffering from a physical illness (not in a detached philosophical sense) and financial stress to the list of psychological conditions.

    If I were to single out the two most important factors contributing to suicide, they would be:

    1) Loss of hope.

    2) A sense of isolation.

  • http://paynehertz.blogspot.com Payne Hertz

    As someone with a chronic pain condition who can’t go five minutes without thinking of suicide, I can definitely say it is physical pain that does it for me. On the rare occasions my pain is mild or tolerable, thoughts of suicide are cleansed from my brain as if by psychic bleach.

    I don’t believe that most suicidal people are insane. They are just in severe pain, either physical, psychological, or both, and need a bit more to deal with it that than a good talk. Under some circumstances suicide can be a rational choice. The argument that allowing suicidal persons the means to self-deliverance should be prohibited because “effective treatment options are available” is completely unrealistic and unjustified. I can tell you from personal experience and that of thousands of chronic pain sufferers I’ve read or spoken to to that effective treatment most definitely is NOT available for everyone in anything but theory.The same stereotype that attaches to chronic pain patients of being weak, whiny and manipulative also applies to those with psychological disorders.

    I believe society has a duty to do all it can to help. but it also has a duty to respect the right of all people to make the choice for themselves whether they consider continued suffering to be worth enduring or not.

  • ange d’andre

    Stating that schizophrenia affects 1% of the world’s population might be correct, but unless hard numbers are used, one could easily gloss over the devastating effects to
    the sufferers and their families. 1% of a city of 50,000 equals
    500 individuals whose lives are haunted by demons, who feel
    that people shun them, who are frightened, who feel alone. It is very important that facts be stated in the clearest way.

  • Molly Ciliberti, RN

    Having lost my father, a grandfather and four extremely close friends to suicide I appreciate your blog. When you are so depressed that you cannot see any way out and the pain of living is so great you can do the unthinkable not to die but to just not hurt any more. They do not want to hurt those they love and genuinely think you will be better off without them. They do not know that the pain of loosing them to suicide never goes away and the hurt is forever. Please if you feel like taking your own life, talk to your loved ones and let them help you find a better way of handling your pain.

  • Lisa

    One day, I was one of those 500 people in a city of 50,000 who was frightened, alone and haunted by an evil command voice who told me to kill myself. Reason #2 Pcyhosis.

  • Anonymous

    I think about suicide on all the time on a daily basis. Sometimes it’s because I want to know what happens when you die. My mother died recently and I always think to my self what it was like for her to die. I like to believe that people have souls, or energy that is our consciensness that remains after death and want to know what it is like. I also pick up on other peoples energy and how they feel when around me. Today for instance, I could feel that everyone I was around could only tolerate me but did not enjoy my company. Then it leads me to think to my self, why? Is it because they think my life choices are wrong, and I could be doing better for my family but I lack the initiative to take control and better our young lives? Is it because they think I am a piece of crap that won’t and can not change? It seems that I care too much of what others think, but it does take a toll. I can not begin to explain my feeling because I do not know how. If you ask anyone who really knows me they will tell your that I am a selfish asshole and everything is always my way or the highway. I dont know why my wife married me or what lala land she was in when we decided that were going to do it. It should have been a sign to her when there was not a happy person at our wedding not go forward with it. There is not only 1 to 6 reasons people commit suicide, there are many. I have not yet to do it but I feel it will come soon. The only thing that stops me is the thought of my daughter growing up with out a father that commited suicide. The thought of suicide is dramatically increased with the consumption of alcohol, but it never seems to go away. Will my life decisions continue to adversely affect the people around me, should I leave and get away from everyone altogether, or there is the other thing that will surely take me away. Then I start to think of the money it will cost to take my carcass to its resting place, knowing how much it cost after burying my mother. I am drunk now and I can not stop thinking about this so I had to tell someone because my wife will not listen to me. She uses it against me when we argue about who is the biggest loser and tells me how nobody really likes me and thats why I don’t have any friends. Am I weak? I act tough and put on a tough guy show but it’s not. I am caloused and don’t care about anything or think about my future or the future I make for my family. I will show them.

    • http://twitter.com/motek42 Cigal Shaham MD MSc

      It sounds like you have schizoaffective disorder. You should seek medical help immediately!!!! You do not have to continue to feel like this.

  • Sarah Stanfield

    My response to #3.  Impulsivity often accompanies my depressive brain fogs (not substance related), and hospitalization or other 24-hour supervision is the only way for me to feel safe in that situation.  For me, depression alone usually isn’t sufficient to drive me to become suicidal until I reach that foggy, impulsive state.

  • Sarah Stanfield

     Please, please remove this comment.  I did not know it would post under my own name.

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