About suicide - out loud and openly

Myths and reality about suicide

The seriousness and complexity of resolving the problem gives rise to myths and prejudices. Non-specialists have a simplified opinion regarding suicide and try to explain it by mental disorders.

As studies show, individuals who commit suicide are absolutely healthy people who find themselves in acute psychotraumatic situations. Among those who discussed the possibility of death in their personal diaries are well-known, quite successful personalities: I. S. Turgenev and M. Gorky, Romain Rolland, Napoleon, John Stuart Mill, Thomas Mann, Anthony Trollope.

A person finds himself faced with depression of such magnitude that it seems that all previous life experience is not enough to get out of it. A crisis can occur suddenly, combining several types of different emotions. They provoke anxiety, followed by hopelessness. Self-confidence is lost, the strength to overcome troubles disappears. There is a feeling of loss of meaning in life.

The basis of suicidal behavior is conflict, and it includes:

• objective requirements of the situation;
• awareness of one's importance by the subject;
• assessing opportunities to overcome difficulties;
• the individual's actual actions regarding the situation.

Refuting myths with reality:

1. “Suicide occurs due to mental deviation from the norm”: in fact, about 85% of people who committed suicidal acts were healthy individuals.
2. “Suicide cannot be prevented”: the crisis has some duration, and the need to commit suicide is temporary; a person who has received support during a difficult period of life changes his decision.
3. “There is a category of people prone to suicide”: in reality, suicide is committed by individuals of various psychotypes; the outcome depends on the individual assessment of intolerance and the severity of the situation.
4. “There are no signs confirming the intention of suicide”: this is preceded by behavior that is unusual for a person, which will attract the attention of people from the immediate environment of the suicidal individual.
5. “A person who declares a desire to commit suicide will never do it”: many, on the eve of planned actions, informed relatives and work colleagues about their intentions, but they did not attach serious importance to this.
6. “The decision to kill oneself comes suddenly”: as analysis shows, suicidal actions are the result of prolonged mental trauma; a crisis can last for weeks or months.
7. “Suicide attempt is not repeated”: in fact, the risk of re-attempting is very high; the highest probability is in the first couple of months.
8. “Suicidal tendencies are inherited”: the statement has not been proven; If there have been cases of suicide in a person’s close circle, the likelihood of them being committed by family members increases.
9. “Educational activities help reduce suicide rates”: Research has shown that messages about death activate suicide. In fact, it is necessary to talk about ways to resolve conflicts.
10. “Alcohol reduces suicidal feelings”: drinking alcohol has the opposite effect, as it increases anxiety, increases the significance of the conflict, which makes the likelihood of suicide closer.

About suicide - out loud and openly

We often complain about the high mortality rate from road accidents, but at the same time we are silent about the fact that fewer people die from all automobile, air, railway and water transport accidents combined than from suicide. Yes, the murder rate is of great concern, but few people know that twice as many Russians take their own lives voluntarily.

Out of drunkenness

However, we can talk about voluntariness here very conditionally. It is no secret that the suicide rate clearly correlates with the alcoholization of the population. Suicide is often committed in a state of alcoholic intoxication or alcoholic psychosis, when a person throws himself out of a window or stabs himself under the influence of frightening hallucinations experienced in a state of acute delirium (delirium tremens).

Many suicides occurred during times of stagnation, but in 1987, thanks to Gorbachev’s Prohibition Law, these figures dropped significantly. But in the mid-1990s, Russians started drinking again and began committing suicide again, just like in 1982. In recent years, there has been a significant decrease in the suicide rate, however, these “optimistic” rates are significantly among the highest in the world.

Alcohol abuse in Russia explains a lot, but not all suicides happen due to drinking. A special large group includes suicides committed in a state of depression.

Depressed

In many ways, the level of such depressions is associated with industrialization in the most developed countries of the world. People live in an unnatural urban environment, their lives are poisoned by constant stress associated with a permanent flow of negative information, the career demands of a plankton-office society, a completely new way of life in which a person’s life depends less and less on his actions.

In the new world, we do not have time to psychologically adapt to the rapid updates of the social environment, where fundamental changes occur not only in the scientific and technical sphere, but also in moral principles and family values. A resident of such a society is not sure of the future and, moreover, is not sure of the value of his past and present life. Instincts hysterically stall when we try to replace family values ​​with corporate career values, and green forests with a palisade of concrete high-rises.

Take a look at how suicide rates have changed over 30 years:

Youth suicide

WHO experts note: the real numbers of suicides in the world are higher than the official ones, since in some cases the true cause of death is replaced by a “more socially acceptable” death from natural causes. There are many suicides among the missing.

In the USSR, statistics on suicide were taboo, the people were zombied with a bright future, and an optimistic and foolish ideology completely excluded the very concept of suicide.

The first publications of Goskomstat appeared only in 1989. The numbers had the effect of a bomb exploding - the Soviet regime had something to hide! If in tsarist Russia the suicide rates did not exceed the European average, then after the October Revolution the mortality rate from suicide reached a terrifying level.

In 1926 in Moscow and St. Petersburg it was 42 men and 20 women per 100 thousand population. Very high suicide rates were observed in 1937 and 1947. There was a relative decline during the Khrushchev thaw, but then the statistics darkened again. In 1984, already 39 people per 100 thousand people committed suicide - it was worse only in Hungary, where the suicide rate remains traditionally the highest to this day.

Suicide has become terribly younger throughout the world. It is now one of the top three causes of death in the 15 to 34 age group. And until recently, the main share of suicides occurred among the elderly... If for the elderly, suicide is only a plea for death, for the young it is a plea for help, said the outstanding Polish psychiatrist Antoni Kępiński. “A plea for help that no one heard…” added writer and lawyer Ravil Aleev.

To God without an invitation

Suicide rates also largely depend on religious upbringing. “To commit suicide is to violate the rules of politeness by appearing before God without invitation,” Lord Denning used to say. It is said not without bitter humor, but the semantic load is quite serious: a person whose existence is given meaning by religious views resorts to suicide much less often.

Many religions condemn suicide as the greatest of sins, and in Muslim countries alcohol consumption is also sharply limited. Suicide is very rare among Muslims, there are many more suicides among Christians, even more among Buddhists, and the highest rates are among atheists.

Men and women

Suicide is also unevenly distributed by gender. In the world, the number of completed suicides among men is 4 times higher than among women. But at the same time, women are 4 times more likely to commit suicide attempts. This difference is due to a number of factors:

1) Men all over the world, and especially in Russia, are much more alcoholic.

2) Peculiarities of male thinking, conditioned by both cognitive dimorphism and gender-social norms, give rise to more persistent, thoughtful suicidal thoughts. Men choose more “successful” methods (hanging, firearms), while women resort to more “gentle” ones that less often end in death (opening veins, drug poisoning).

3) Women more often resort to staged suicide attempts in order to manipulate other people. Such attempts rarely end in death.

4) No matter how hopeless a woman’s life may be, she is often held accountable by her children.

Suicides are inherited

Singles are much more likely to commit suicide compared to married people. Particularly severe depression develops in those who have lost a partner - such people commit suicide three times more often than married people.

Suicidal tendencies are believed to have a strong genetic correlation. In addition, the example of a loved one who committed suicide also plays an important role. It gets stuck especially deeply in the brains of children. In this sense, a suicide kills not only himself, but often his descendants. 6% of those who committed suicide had one of their parents who committed suicide. Each suicidal person is surrounded by, on average, six people for whom his suicide is a severe mental trauma.

The highest rates of suicide are recorded among representatives of the Finno-Ugric group (whether residents of Udmurtia, Hungary or Finland). It is important to note that many Russians have direct Finno-Ugric roots. This factor can also be considered genetic. Not all suicides can be prevented, but most can! WHO recommends the following government measures to prevent suicide:

• decreased access to means of suicide (certain drugs, firearms, pesticides and potent poisons);

• monitoring of mentally ill people (severe endogenous depression, schizophrenia, etc.), persons with addictions to alcohol, illegal drugs, psychotropic medications;

• providing the population with medical and psychological forms of support;

• responsible approach of the media to the presentation of information (the very exaggeration of the problem, especially with examples from the lives of show business stars, prominent scientists, writers, etc., can serve as reinforcement for suicidal thoughts of young people).

Find time to talk

One of the days of September (10th) was declared by the World Health Organization as Suicide Prevention Day. It is clear that a problem of this magnitude cannot be significantly affected in one day.

You, dear reader, should remember that only a small number of suicides occur without warning. We are often inattentive to our loved ones; in the hustle and bustle of our days, we do not have time to analyze the alarming harbingers in their behavior and statements.

Meanwhile, about 80% of suicides explicitly or indirectly warn friends and family about their terrible intentions. Therefore, all threats and statements of this nature should be taken seriously. Take time to talk to a friend if you are concerned about their state of mind. Sometimes it is easier for someone contemplating suicide to pour out his soul to a stranger, or even a complete stranger - do not distance yourself from such a person, listen and support.

Remember that most people who cultivate thoughts of suicide in their souls do not have the ultimate intention of dying; until the last minute they are torn apart by internal contradictions.

The author's opinion may not coincide with the position of the editors

Causes of suicidal behavior

A combination of external and internal factors provokes suicide attempts.

Prerequisites for suicidal behavior are:

• biological reasons: decreased serotonin levels in the blood, disruption of the hypothalamic-pituitary axis;
• heredity;
• psychological reasons: low stress resistance, egocentrism, dependence on the opinions of others, emotional lability, inability to fulfill the need for safety and love;
• medical factors: alcoholism, drug addiction, mental disorders, oncological pathologies, AIDS, somatic diseases with disability, death.

Potentiating factors that increase the risk of suicide:

• religious factors: suicide in some cults is regarded as purification and sacrifice; in some movements, self-death is seen as a gesture of romanticism;
• intrafamily factors: children and adolescents from single-parent, asocial families, brought up in conditions of violence, humiliation, alienation;
• influence of society: conflict atmosphere in communication with peers, problems of love relationships.

The immediate causes of suicide attempts are:

• stress: death of loved ones, accidental observation of suicide, rejection by the team, acquaintances, condition as a result of rape;
• the availability of means of suicide for a specific condition increases the risk of their use.

Problem overview

Every year, about 800,000 people take their own lives, and many more attempt suicide.
Every suicide is a tragedy that impacts families, communities and entire countries, leaving a lasting impact on those living. Suicide occurs throughout the life cycle and in 2016 it became the second leading cause of death among young people 15-29 years old globally. Suicide does not only occur in high-income countries; it is a global phenomenon in all regions of the world. In fact, more than 79% of global suicides occurred in 2021 in low- and middle-income countries.

Suicide is a serious public health problem; however, with timely, evidence-based, and often low-cost interventions, suicide can be prevented. A comprehensive, cross-sectoral suicide prevention strategy is required to ensure an effective national response.

Types of conflicts

Conflicts underlying suicidal behavior can be classified:

• conflicts based on professional activity and social interaction, including interpersonal conflicts, individual adaptation difficulties;
• regulated by the specifics of personal and family relationships (unrequited love, betrayal, divorce, illness or death of loved ones, sexual failure);
• in connection with antisocial behavior: fear of criminal liability, shame;
• due to health conditions: physical, mental illnesses, chronic diseases;
• due to financial difficulties;
• other types of conflicts.

A suicidal situation is created by the interaction of conflicts of various types. The loss of life values ​​is accompanied by individual assessment, judgment, and worldview. There is no personality structure specific to suicidal behavior.

Individuals with psychopathic character traits are the most vulnerable. In difficult conditions, against the background of an age crisis, with the sharpness of certain qualities, a person comes to maladjustment.

Classification of suicidal behavior

Of the many classifications of suicidal behavior, attempts related to goals and reasons are of interest.

There are three types of suicidal actions:

• True: carefully planned actions, which are preceded by the formation of appropriate statements and behavior; the decision is made on the basis of long thoughts about the meaning of life, purpose, the futility of existence; signs of suicidal behavior dominate; other emotions and character traits remain in the shadows, and the goal of dying is achieved.
• Demonstrative: suicide attempts resemble theatrical action and can be a way of dialogue with loved ones. The signs of demonstrative suicidal behavior are that they are produced with the viewer in mind, and their goal is to attract attention, to be heard, and to receive help. Death is possible due to poor judgment.
• Masked: suicidal behavior of minors involves indirect methods of suicide - extreme sports, high-speed driving, dangerous travel, use of psychotropic substances; More often than not, the real goal is not fully realized.

Signs characteristic of the adult population

A sign of suicidal behavior in adults is anger directed inward. It can also be indicated by heavy losses, poor state of affairs, lack of hope and options for help. Another symptom is an all-consuming feeling of hopelessness, as well as, in fact, an attempt to leave life.

Recognizing the signs of suicidal behavior can save a person's life. Loss of energy, a constant feeling of boredom, fatigue, long-term disturbances in sleep and appetite, nightmares with pictures of disasters, evil creatures, death of people - all this is included in the list of common symptoms.

Other signs: increased self-criticism, pronounced feelings of guilt, failure, shame, fear, anxiety, uncertainty, deliberate impudence, aggression. Depression manifests itself in the form of melancholy, as well as insomnia, anxiety, resulting in “tiredness of life.”

Signs of suicidal behavior in adults:

• planning a murder, voicing an intention to commit an action against oneself or another person;
• the presence of a murder instrument - a pistol or the like, and access to it;
• loss of connection with reality (psychosis), auditory hallucinations;
• use of psychotropic substances;
• conversations about methods and objects of causing physical harm;
• persistent desire to be alone;
• giving away personal items;
• aggression or inadequate calm.

Any statement regarding suicide should be taken seriously. When observing signs of suicidal behavior, it is necessary to find out as quickly as possible whether the person has weapons, medications to carry out the planned actions, whether the time of this act has been determined and whether there is an alternative to it, another way to relieve the pain.

If you cannot provide assistance, you must report the threat to the police and hospital. It is recommended to be present with the person who needs support and ask others you can trust to do this. The person should be convinced that he needs professional supervision from specialists.

Signs of suicidal behavior in children and adolescents

Suicide attempts are preceded by isolation and depression. As for the signs of suicidal behavior in children, this is accompanied by a loss of interest in games, entertainment, and food. They prefer loneliness, refuse friendly events, activities that brought them pleasure, and visits to kindergarten.

Depressive manifestations look like disorders of physical activity: body pain, sleep disturbances, appetite, and digestion appear. Boys are more likely to experience irritability, while girls are more likely to be tearful and depressed. Death may be perceived as a dream or a temporary phenomenon.

The child's suicidal behavior is expressed in his drawings and made-up stories. Children can talk about the advantages and disadvantages of this or that method of dying. They may discuss the dangers of medications, falling from heights, drowning, or suffocation. At the same time, the child has no interests in the present or plans for the future. Sluggishness of movements, deterioration in school performance, insomnia, loss of appetite, and weight loss are observed.

Among the signs of suicidal behavior in adolescents there are frank statements and phrases: “I don’t want to live,” “I want to die,” “life is over.” This obsession continues with the desire to watch films or read books about committing suicide, and search for information on the Internet. Art of any kind contains themes of death.

Other signs of suicidal behavior in adolescents:

• leaving home;
• instability of emotions, aggressiveness, rudeness;
• indifference to one's appearance;
• alienation from relatives and friends, although relationships may be stable, school attendance may be regular;
• dangerous hobbies;
• drunken driving;
• demonstrative contradiction to others;
• behavior that poses a danger to health and life.

Dangerous symptoms include:

• past suicide attempts;
• suicide intentions in the family;
• presence of depression, schizophrenia, bipolar disorder.

WHO activities

The WHO considers suicide a public health priority. In 2014, WHO's first report on global suicide, Preventing Suicide: A Global Imperative, was published to improve public health understanding of the importance of suicide and suicide attempts and to place suicide prevention at the top of the global public health agenda. It also aims to encourage and assist countries in developing and strengthening comprehensive suicide prevention strategies through a multisectoral public health approach.

Suicide is a priority in the WHO Mental Health Gap Action Program (mhGAP), launched in 2008, which develops evidence-based technical guidance to scale up services and care in countries in the area of ​​psychological, neurological and addiction disorders. In the WHO Mental Health Action Plan 2013-2020. WHO Member States have committed to achieving the global target of reducing national suicide rates by 10% by 2020.

In addition, suicide mortality is one of the indicators of Sustainable Development Goal target 3.4: by 2030, reduce premature deaths from noncommunicable diseases by one third through prevention and treatment and promoting mental health and well-being.

Diagnostics

Identification of signs of suicidal behavior in children and adolescents is carried out by a psychiatrist and clinical psychologist. After parents complain about the child’s emotional state - lethargy, depression - the doctor assumes the presence of depression and suicidal tendencies.

Examination methods:

• conversation: the psychiatrist clarifies the time of manifestation and severity of symptoms, their duration;
• questionnaires, testing: a variety of techniques are used, including direct questions about thoughts and attempts at suicide (Eysenck’s “Self-Assessment of Personal Mental States” questionnaire);
• projective methods: used for children of primary school age, adolescents who are not aware of suicidal tendencies (Luscher test, tests using drawings, “signal”, method of unfinished sentences).

As a result of a comprehensive examination of personality activity, signs of suicidal behavior in children are identified, including hysterical, sensitive, excitable, accentuated, and emotionally labile traits. The combination of depression, instability, and impulsivity is an indication of a significant risk of suicide attempts.

Who is at risk?

Although there is a clear link between suicide and mental health problems (most notably depression and alcohol use disorders) in high-income countries, many suicides are committed impulsively in moments of crisis, when the ability to cope with stressful life situations, such as financial problems, is lost , relationship breakdown or chronic pain and illness.

In addition, suicidal behavior is strongly associated with conflict, natural disasters, violence, abuse or loss, and feelings of isolation. Suicide rates are also high among the most vulnerable groups who experience discrimination, such as refugees and migrants; indigenous people; lesbian, gay, bisexual, transgender and intersex (LGBTI); as well as prisoners. The strongest risk factor for suicide is a previous suicide attempt.

Complications of suicidal behavior

Suicidal behavior that does not result in death is complicated by specific diseases. These include various injuries, cuts, severe injuries, damage to the arms, legs, ribs, larynx, esophagus, and disruption of the liver and kidneys.

After suicide attempts, such people need hospitalization, and the damage can lead to disability and restrictions, leaving a heavy psychological imprint on their future life. There is a risk of social maladjustment.

Methods of suicide in different countries have a certain degree of prevalence:

• hanging: the leading method worldwide;
• firearms: in the USA it accounts for 60% of popularity; in Canada - 30%;
• poisoning: drug overdose, in the USA - accounts for 18% of all suicides;
• Road accidents with a single victim: about 17%;
• farewell notes with laying hands on oneself: 15-25%.

Methods of suicide

It is estimated that about 20% of suicides worldwide are the result of self-poisoning from pesticides, with the majority of such cases occurring in rural and agricultural areas of low- and middle-income countries. Other common methods of suicide include hanging and the use of firearms.

Understanding the most common methods of suicide is important for developing prevention strategies that have been shown to be effective, such as limiting access to means of suicide.

Tasks of a specialist, consultant

Crisis services approach suicide differently. Some aim to find the client's whereabouts and prevent the murder. They can independently transmit client information to medical and police services. In order to prevent suicidal behavior in minors, a special professional approach is required.

The tasks of the hotline consultant are as follows:

• recognize signs of suicidal thoughts and tendencies;
• assess the degree of danger of behavior;
• show sensitive care for the client.

Principles of conversation with the client:

• do not neglect suicidal statements;
• express interest in the personality and fate of the interlocutor;
• questions should be asked calmly and sincerely, actively listening;
• carefully determine the patient’s ideas and plan of suicidal action;
• find out whether similar thoughts were present in the past;
• find out the causes and conditions for the formation of suicidal thoughts;
• encourage the interlocutor to express feelings in connection with a painful area.

Prohibited actions during first aid:

• do not enter into direct confrontation with the client when he declares suicidal intentions;
• do not show your shock at what you heard;
• do not enter into a discussion about the admissibility of an action;
• do not resort to argumentation, given the client’s depressed state;
• not guaranteeing what cannot be achieved (family help);
• do not judge, show sincerity;
• do not offer simplified schemes, such as: “you just need to rest”;
• do not focus on negative factors, try to consolidate optimistic trends.

The priority action in helping a suicidal client is to maintain a conversation with him or her for as long as possible. In further work, the client should be allowed to speak out, express his feelings, promise to be helpful in the conversation, help structure the origins of the problem in his mind, and lead him to the idea that such situations occur quite often.