First a disclosure: The title of this piece is stolen, word for word, from a journal article by a friend of mine, Dr. Susan Walen, who wrote courageously about her own close brush with suicide several years ago (Sue has a way with words, not to mention brilliant wit).
Facing the facts
But I thought that phrase also captured something broader about suicide that deserves attention. Consider the following:
- Suicide is the 11th leading cause of death in the U.S., killing 33,000 people per year (more by far than homicide or AIDS). Yet federal research funding, at $37 million annually, falls far behind that for health threats that kill fewer people (for example, AIDS research funding is around $3 billion).
- Most people who die by suicide have never received treatment, and most patients who die by suicide while in treatment had denied feeling suicidal at their last contact with their treater (One wonders how much of this might be driven by stigma).
- While large randomized studies of depression, anxiety disorders and other mental health conditions number in the hundreds, only 45 randomized trials of suicide-focused treatments have been conducted (most show high levels of effectiveness).
A bleak situation, you might say. Is no progress being made on this terrible cause of unnecessary deaths?
Progress in suicide research
I recently had the honor of sharing the podium with some distinguished suicidologists at a conference in Houston (co-sponsored by The Menninger Clinic) called “Understanding Suicide: More than Just a Theory.” What emerged over the course of a full day of presentations was that we have learned a great deal about suicide in recent years, inspiring hope that suicide is both understandable and preventable. A few examples:
- We now know that nonfatal suicide attempts, far from being a sign that a person doesn’t really want to die, are experiences that actually make it easier for someone to inflict damage on his or her body, greatly increasing risk for death by suicide. This is key information for treatment development.
- Recent years have seen a virtual explosion of research findings on how suicidal people think differently about themselves and circumstances compared to people who don’t become suicidal. Again, important grist for the therapeutic mill.
- The apparently common sense step of having a patient sign a “contract” agreeing not to commit suicide is apparently not helpful and may actually be detrimental to effective treatment. We now teach mental health professionals that their efforts are better invested in development of a safety plan, created collaboratively with the patient.
- Speaking of collaboration, if forced to select a single common thread woven throughout the conference, it would be that what most contributes to despair and thoughts of suicide is feeling alone, cut-off and uncared for, and that what clinicians must consider job one, even before commencing treatment for an individual’s disorder, is establishing an understanding, accepting and caring therapeutic relationship.
The last of these may seem like an example of “science proving the obvious,” but it serves to remind us that science and art are not mutually exclusive properties of the therapeutic endeavor. High tech and high touch both are our allies. Indeed, as with any tenacious killer, we welcome all the help we can get.