Psychiatrist: sometimes a minor thing can provoke to commit suicide

PAP: In media we can find comments and stereotypical views on suicide, such as a disbelief that a strong, uncompromising man of decided character could attempt to take his own life. Do certain personality traits really make some of us, but not others, potential suicide victims?

Agnieszka Gmitrowicz: I would never try to explain why someone committed suicide, if I had not known and could not diagnose that person earlier. The problem of suicide is very complex, and each person has a different story of life. Of course, various risk factors have been identified. Suicide is usually does not happen without warning. Very often it is a process that can be represented as a graph. On one axis we can mark risk factors and genetic determinants of personality, and on second axis we can put stressors, situations in life that cause stress. If a certain accumulation occurs, which means that a person who has a predisposition (susceptibility) accumulates negative experiences and crises, the risk of suicide significantly increases, especially if a trigger event (like humiliation) occurs. This process may also lead to extinction of suicidal thoughts. 30 percent young people have suicidal thoughts. This is associated with an identity crisis, with maturation. It does not always lead to a behaviour that threatens life or health. However, a few percent of the people, and in some countries even 10 percent, make suicide attempts knowingly and intentionally.

PAP: Which traits are considered a predisposition to commit suicide?

AG: The studies of psychologists and psychiatrists have certainly shown that there is a portrait, a set of personality traits that may contribute to suicidal behaviour. These are impulsive, aggressive, people with low self-esteem, people with chronic feelings of hopelessness or lack of purpose in life. We can create a long list of risk factors. A high risk group are young people engaged in self-harm (which is associated with impulsivity and aggression), people who are easily provoked, people with limited cognitive abilities, suffering from "tunnel" vision (inability to see another way out of the situation), "black and white" thinking (all or nothing), and those unable to see the positive qualities or phenomena, and the only negative. There are also people who are not able to remember the good events, and remember only the difficult ones. Studies of identical twins have shown that there is a high compatibility between them in terms of suicide attempts, even above 12 percent. It is not known whether this compatibility results from the occurrence of similar disorders such as depression (vulnerability), or from the same negative effects of family environment. There are many more factors. Also, many factors may be true for a person without developing a suicide process because, for example, the person is a Christian, believing that suicide is a sin, or there are other protective factors, such as support from family, friends, good social skills, assertiveness, problem solving skills, good communication of needs. In contrast, in another person, despite the lack of susceptibility and a number of protective factors, an intense stressor (for example, loss of loved ones during a disaster), may suddenly exceed ability to adapt and lead to suicide.

PAP: Is it possible to predict who is a potential suicide victim?

AG: Without a careful analysis of the process occurring in a particular person it can not be certain, that someone will definitely do or not do it. Even a person who has a history of suicide attempts, with correct drug therapy or psychotherapy may abandon further attempts. I have seen many such patients. On the other hand, in more than 90 percent people after suicide attempts an examination showed a mental disorder. Most common are depressive disorders. Which means that we can not say that a particular personality or a crisis situation determines suicidal behaviour, because if we take into account that a large proportion of suicide victims have various mental disorders, including depression, the importance of risk factors is distributed differently.

PAP: You mentioned stresors, circumstances which may lead to suicide. There are studies that show that more people kill themselves when struggling with a serious illness or after a pessimistic diagnosis. Can health (except for mental illness) be the reason for suicide?

AG: Diabetes, asthma, cancer, are without a doubt diseases that cause thinking that life is meaningless and hopeless. If there is a feeling of hopelessness, meaninglessness, even in someone who is not mentally ill, it is a signal indicating a high risk of suicide. The life of chronically ill people, who do not receiving proper support, falls apart. Besides, there is more social consent to acts of suicide, if the victim is terminally ill. But we should not generalize. I know people who had previously had suicidal thoughts and depression, and learned that they suffered from cancer, After the diagnosis of these thoughts ceased. They just felt that what had happened before had a different importance and a completely changed attitude to life.

PAP: Can something like that happen so suddenly that the environment does not expect it, or under the influence of a trivial event that pushes a healthy person over the edge?

AG: First we must answer the question what a healthy person means. Just because someone functions works in accordance with a standard, with social norms, does not mean that the person is healthy. Little can be said about a person only on the basis of the fact that he or she walks down the street normally, behaves just like the others, and dresses like the others. We must always ask our patients about suicidal tendencies, because some people simply do not make such intentions public. Of course, it happens that an external situation suddenly converges with the current inner condition, and the stressor becomes difficult to bear. Sometimes it can be seemingly insignificant: a text message, something on the news. Environment is not always aware. So-called ordinary situation may be unusual for someone, and sometimes even paradoxically present a special burden, because the person should behave as if nothing had happened, while something very difficult, burdensome psychologically and sometimes physically is going on inside.

PAP: What are suicidal thoughts of young people associated with, a storm of hormones at puberty?

AG: Puberty is associated with identity disorders, with uncertainty, ambivalence, low self-esteem. A young person struggles with the change of roles in life. This leads to a crisis, it is even called a crisis of adolescence. And every crisis can activate or provoke suicidal thoughts. That\'s why the suicide rate among young people is very high in relation to all other causes of death. In Poland in 2010, in the age group 15-19 years the rate was 18 percent, similar level as deaths in traffic accidents.

PAP: What should family or friends do when they suspect that a loved one is planning a suicide?

AG: First of all, to accompany this person all the time, monitor and listen. We should not say: "Get a grip". Also, this should not be kept secret, because the broadest possible support network will be needed to protect that person. The family should go with such a person to a specialist, psychiatrist or psychologist (with clinical experience). If suicidal thoughts and plans are verbalized, the person must see a psychiatrist. In my medical practice I have many patients who come to see me themselves when they are in suicidal crisis. They do not agree to these thoughts, and fear that they might do something themselves and burden loved ones, so they ask for help. Then I examine thoroughly all aspects of mental health. If depression is diagnosed, it should be treated strictly in accordance with established psychiatric standards. Thus we remove the cause of suicidal thoughts. The situation is similar with other disorders such as schizophrenia, anorexia, abnormal behaviour, sleep disorders and mental distress and anxiety.

Interviewed by Urszula Rybicka

PAP - Science and Scholarship in Poland

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