Why do only humans commit suicide?

Why do only humans commit suicide?

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Why is it that only humans commit suicide?

Many animals do 'brave' things to protect their children or family, and some male spiders sacrifice themselves so that they can impregnate the females. However, humans commit suicide without necessarily any intention to help their offspring. Why?

Animals can hurt themselves to save their life for example foxes and tigers falling in traps are known to chew their paws to escape from the trap. Thus one can argue that all living creatures want to live and to escape death as well as losing freedom.

looking at how animals live, an animal can always use its capabilities to escape danger or problems as well as to look for food for survival. In humans who commit suicide sometimes it is because there is no "exit". for example some people commit suicide due to being unable to pay their loans it is the feeling of distress losing all hope and the fact that it is hard to escape from problems in a human society that lead to this thinking.

so a person doing so is trying to escape the problems instead of facing them. further, the fact that humans have the concept of "responsibility" and being held accountable by members of the society all these lead to this thinking as the only escape

Why You Should Stop Saying ‘Committed Suicide’

It’s an expression that many people still lean on, both in the news (take one look at headlines after the deaths by suicide of Parkland, Florida, students and the father of a Sandy Hook shooting victim) and in outside conversations.

While the term may seem innocuous, it’s actually laden with blame and stigma. So much so that reporting guidelines outlined by mental health and media organizations strictly advise against using it.

“The term ‘committed suicide’ is damaging because for many, if not most, people it evokes associations with ‘committed a crime’ or ‘committed a sin’ and makes us think about something morally reprehensible or illegal,” said Jacek Debiec, an assistant professor in the University of Michigan’s department of psychiatry who specializes in post-traumatic stress and anxiety disorders.

The phrase “committed suicide” also ignores the fact that suicide is often the consequence of an unaddressed illness (like depression, trauma or another mental health issue). It should be regarded in the same way as any physical health condition, said Dan Reidenberg, the executive director of Suicide Awareness Voices of Education.

“You don’t ‘commit a heart attack.’ Instead, you might hear someone say they ‘died from a heart attack.’ Dying by suicide is the same. . When attaching the word ‘committed,’ it further discriminates against those who lost their battle against a disease,” he explained.

Reidenberg added that the best phrase to use is “died by suicide,” since it sends the message that the death was caused by the mental health condition. It’s the preferred language in media stories, and it’s worth using in everyday discussions as well.

Why This Matters In The Long Term

It might sound like nitpicking to focus on just two words. However, word choices ― whether intentional or unintentional ― have much broader implications.

Using sensitive mental health vernacular is crucial to eliminating negative stereotypes attached to mental illness (and the consequences of those stereotypes) now and in the future. Research shows that when stigma is present, people avoid seeking help ― help that could be life-saving.

“The fact that we are having problems with choosing words when speaking about suicide reflects our deeper problems with understanding mental health in general,” Debiec said.

“The language [we use] reflects our system of values, both conscious and unconscious,” he continued. “Using a judgmental or degrading language prevents us from recognizing mental health problems, seeking help and providing help.”

“Using a judgmental or degrading language prevents us from recognizing mental health problems, seeking help and providing help.”

Simply put, “committed suicide” conveys shame and wrongdoing it doesn’t capture the pathology of the condition that ultimately led to a death. It implies that the person who died was a perpetrator rather than a victim. And you don’t have to live with a mental health condition to understand how that could be damaging.

“Words have consequences,” Debiec said. “I would encourage people who think that language around mental health is not important to think about their own experiences when they felt that somebody’s judgment or words unfairly and deeply hurt them.”

It’s time that we start looking at suicide as a dangerous byproduct of a health condition that can ― and should ― be prevented. That, of course, requires treatment. But it also includes paying attention to our words so that those living with a mental health issue feel they won’t be alienated for speaking up and seeking support, Reidenberg said.

He noted that suicide is a leading cause of death in the United States. “Suicide is a serious public health crisis. More people die by suicide than by homicides and car accidents and breast cancer,” he added. “Suicide is a real issue that must be taken seriously all of the time.”

Reidenberg said he hopes that more people will be more compassionate about suicide, and not just after a high-profile suicide but every single day.

“Let’s keep working to prevent tragedies from happening, celebrate those who are still alive . and do all that we can to break down the stigma surrounding mental health and suicide,” he said. “It is only by talking about these that we will get people to open up before a tragedy happens.”

Dropping the phrase “committed suicide” as part of this effort may be a tiny step ― but at least it’s one that’s forward.

Top 10 Reasons to Not Commit Suicide

There have been countless numbers of suicides going on in the past few years so I've decided to share my thoughts on why you should not kill yourself. Don't even try to kill yourself. It really is not worth it. Trust me.

Anyone considering suicide, remember, you're not alone. Confidential help is available.

In the U.S. you can contact the National Suicide Prevention Lifeline for free by phone at 1-800-273-8255 or by online chat at There a counselor will listen to you, understand how your problems are affecting you, provide support, and share resources that may be helpful.

Outside the U.S., please seek out the available resources in your country.

All organisms' purpose in life is to reproduce and die. We are supposed to fight for our lives because only the strongest make it. That goes for the birds, fish, dogs, cats, humans, and every other organism on the planet. Except humans are so ignorant that they care about love and friendship. When in reality our friends and family wont be there for us after we die. Our superior intelligence has blinded us to the truth about life. The animals know quite well about what they need to do, but they are not caught up in the prison of love and emotions. Have a nice day!

Unless you believe in re-birth. You can be re-born after you die, heck if you get lucky, you'll get the opportunity to start your OWN life all over again.

But yes, suicide is quite risky.

Precisely. There's always a vast selection of opportunities, and always something to live for.

Life is the most precious thing you can grasp, don't let go of it.

I've seen a lot of this on YouTube.

Your friends and family will end up grieving for you, and the memory will stick with them for their whole life. Don't cause them the pain.

This is very true! Suiciding is wrong and it will transfer your pain onto your family and friends.

Everybody has parents and adults have children. I agree.

Exactly, it's not like people just aren't gonna care.

Most people commit suicide because they get bullied in school. Getting bullied in school won't effect you that much in the future.

Yes. It's true. I have so much to live for. I want to become a YouTuber, travel around the world, adopt a puppy & so many things other people do. I will never commit suicide EVER!

Who knows? Maybe tomorrow, you'll be the wealthiest person alive!

Even when the going gets tough, there's always a future.

Even if you don't know it, you could be making someone's life a whole lot better, brightening their day just by being there.
And even if it's not happening now, it may happen later in life.
But only if you stick around too see it happen.

What if you have someone that's going through something, like depression or autism or something that changes their life dramatically, and then all of a sudden the person they care about most dies?

Somebody might need you so that they can relieve their urge to torture somebody!

Hell is a real place. Do not commit suicide. Instead, give your life to Jesus Christ. Serve Him. Repent of sins. Read a KJV Bible.

Yes, in religions, this can be very true.

I'm very sorry, but this is true!

It may not be temporary, but even if you do die, no one can reverse that, which is a scary and sad thought.

If you kill yourself, then the effect is that everyone else will have to go through the pain. If you kill yourself, what do you think will happen after you die? Don't kill yourself no matter what happens in your life. I don't care what you believe in because it doesn't matter if you commit suicide. Please, just think before you act. Since I'm a Christian, which doesn't mean you have to be, I believe there is a hell. You will go to hell if you do not give you life to Jesus and believe that he died on the cross for your sins. Please think about this.

I don't want to commit suicide because people will be sad and I won't be able to do anything about it. People do care about you and I know that positive remarks don't fix depression but I just want to say that people do love you no matter who you are.

Do you really want to do that. ?

Biggest reason there isn't 55 grains of lead and copper lodged in my head

Many people feel suicidal and they could feel worse than you, like you aren't the only one feeling like that. People don't have to feel offended by this

True. If you kill yourself, you're only hurting yourself and the ones that love you and care for you. So very true.

It may not always feel like it, but there is someone who cares about you. Trust me.

The only reason I don't do it is because I don't want people to be sad.

If you don't know who loves you then you haven't met them yet.

Now, why would you want to give them that kind of satisfaction?

If you fail it. You might be feeling worse than you already are. That's like, the only reason I'm still alive, trying to find a 100% method.

Sometimes, you don't succeed in killing yourself. Rather, you end up seriously injuring yourself instead.

If you fail to suicide you might end up with disabilities or end up with brain damage.

Yeah true or sometime nothing bad happens at all.

For a while, I was suicidal. But then I thought to myself, "It's not worth it." No matter what, there is one person who loves you in the world. I can assure you of it. Even if you feel alone.

If you want to die, dye your hair.
If you want to hang, hang in a local park.
If you want to end, end a really good series.
I know this won't help everyone, and if anybody wants me to delete this for (almost) any reason, I will. But if you are considering suicide, please know that.
you matter. Please don't leave us.

Ya'll were born for a reason. People say "I was born to die" but that's not true. Making a difference and leaving your mark on the world is something that all of us have potential to do. There is real, true value in simply living. Passing the burden of pain onto others because you want life to end is selfish. Get up, get a life. People need you whether you realize it or not.

Why do people kill themselves?

Suicide refers to when someone harms themselves with the intent to end their life. The reasons that people attempt suicide are varied and complex, but they often involve severe emotional or physical pain that a person finds unbearable.

It can be difficult for people to understand why someone would want to harm themselves. However, suicide is one of the leading causes of death in the United States, according to the National Institute of Mental Health (NIMH).

This article will look at some of the reasons that a person might consider suicide, the link between mental health and suicide, and the role of suicidal thoughts.

It will also discuss some ways to help someone who is contemplating suicide and some of the support resources available.

Suicide refers to when a person intentionally ends their own life. Sometimes, people use the term “commit suicide” to describe this. However, the word “commit” implies criminality, which can reinforce harmful stigma.

There are many potential reasons that a person may consider suicide. Often, it is the result of long-term difficulties with thoughts, feelings, or experiences that the individual feels that they cannot bear any longer.

Among other things, a person contemplating suicide may feel:

  • sadness or grief
  • shame
  • worthlessness
  • intense guilt
  • rage, or a desire to seek revenge
  • that they are a burden to others
  • that they have no worth or value
  • that life is not worth living
  • that they are trapped, either physically or emotionally
  • that things will never get better
  • intense physical or emotional pain

Many factors can contribute to a person feeling this way. It may be due to events happening in their life. Mind, a charity in the United Kingdom, list the following examples of scenarios that may lead to suicide:

  • the loss of a loved one
  • bullying, discrimination, or abuse
  • the end of a relationship
  • a major change in life circumstances, such as divorce, unemployment, retirement, or homelessness
  • receiving a diagnosis of a life changing illness
  • problems with money
  • being in prison
  • pregnancy or pregnancy loss
  • questioning one’s sexual or gender identity in an environment that is not accepting of this
  • certain cultural practices, such as forced marriage
  • surviving a traumatic event

However, suicide does not always occur because of a specific life event, and not everyone who experiences these events will consider suicide. People respond to adversity in different ways.

According to the NIMH, suicide is more prevalent among certain groups. These include people who:

  • are aged 15–24 years
  • are over the age of 60 years
  • have a mental health or substance abuse disorder
  • have a family history of mental health or substance abuse disorders
  • have a family history of suicide
  • have experienced family violence or abuse, such as physical, sexual, or psychological abuse
  • are in prison
  • have a severe or chronic illness
  • have access to firearms or other weapons

Males are more likely to die by suicide than females. However, females are more likely to attempt suicide. Attempted suicide occurs when a person tries to end their life but does not die as a result of their actions.

This may be due to a difference in preferred methods. According to the NIMH, for example, males are more likely to use lethal methods that are difficult to treat.

Mental health conditions are a significant risk factor for suicide. SAVE estimate that around 90% of people who die by suicide have a mental health condition.

Some examples of conditions that may contribute to suicidal thoughts or intent include:

  • substance abuse disorders
  • depressive disorders
  • borderline personality disorder
  • bipolar disorder
  • anxiety-based disorders
  • psychosis

However, it is important to note that although mental health conditions can increase the risk of suicide, they are also very common. Additionally, according to the U.K. charity Samaritans, not everyone who considers suicide has a diagnosed mental health condition.

Social isolation, a lack of support, and untreated or mistreated mental health conditions place people at higher risk of suicide, while having appropriate access to healthcare and support lowers this risk.

Some people exhibit warning signs that they are considering suicide. SAVE state that it is important to take notice if someone is:

  • talking about wanting to die
  • talking about feeling trapped, feeling hopeless, or being in unbearable pain
  • talking about being a burden to others
  • planning or looking for ways to harm themselves, such as acquiring firearms or other weapons, stocking up on medications, or searching online
  • withdrawing from family and friends
  • using drugs and alcohol more often
  • eating or sleeping more or less than normal
  • acting in an anxious, agitated, or reckless manner
  • experiencing severe mood shifts

However, not everybody exhibits these warning signs when they are considering suicide. The best way to find out for certain whether or not someone is considering suicide is to talk to them.

Some people believe that talking about suicide can cause others to experience suicidal thoughts. However, research has shown this is not true.

For example, one 2014 review found that talking about suicide does not increase the risk of it. In fact, it may even decrease the risk by allowing people to share any thoughts and feelings that they are struggling with.

Although talking to someone about their thoughts of suicide may feel intrusive, it could save their life. Some examples of ways to start a conversation include:

  • “How have you been feeling?”
  • “Do you ever feel so bad you think about suicide?”
  • “Have you been having suicidal thoughts?”

Samaritans recommend listening to what the person has to say without judgment, using a technique known as active listening. This involves:

  • focusing on the other person, with no distractions
  • asking open-ended questions
  • giving someone time to articulate what they want to say
  • repeating things back to them, to show understanding

Experiencing suicidal thoughts does not always mean that a person will kill themselves. Samaritans state that around 1 in 5 people think about suicide at some point in their lives. Often, this is in response to a temporary feeling or situation.

In many cases, people who experience thoughts about suicide do not act on them. However, if a person has suicidal intent, it means that they have made a decision and intend to act on these thoughts.

This is an important distinction to make, as having suicidal intent indicates that someone needs immediate help.

If someone intends to end their own life, it is important to act quickly. SAVE recommend:

  • Asking the question: Ask the person if they have a plan to end their life. If so, ask them how and when they plan to do it.
  • Calling for help: If a person is in immediate danger, call 911, go to an emergency room at a hospital, or contact the National Suicide Prevention Lifeline (800-273-8255). Hard-of-hearing or deaf people can contact Lifeline by dialing 711 and then 1-800-273-8255, or they can use their preferred relay service.
  • Taking their reasons seriously: While talking to the person, do not try to convince them that their problems are not that bad. Instead, listen to them, acknowledge how they feel, and reassure them that it is possible to get help.
  • Not keeping their plan a secret: Although trust is important, keeping a person’s planned method of suicide a secret can put their life at risk. It is essential to let medical professionals or caregivers know how they intend to end their life, so that they can remove any sources of danger.

People can also use these steps to help others online. The following social media sites, as well as some others, have ways to report suicidal content:

People who consider suicide do not always want to die. Often, people consider suicide because they feel hopeless and cannot think of a way out of their current situation. Intervention can help a person regain a sense of hope or show them another perspective.

It is a common misconception that people who talk about or attempt suicide do so for attention and, therefore, do not need help. However, any suicidal thoughts or behaviors indicate severe distress. As a result, it is important to take them seriously.

Even if a person does not intend to kill themselves, talking about suicide or acting in a self-destructive manner can indicate that they need mental health support.

There are many reasons that a person might consider suicide. Some people consider suicide due to specific events or life experiences, while others may do so because of a physical or mental health condition that causes them unbearable pain.

The reasons that people take their lives are not always clear, but having open conversations about suicide can help alleviate a person’s pain.

3. Bullying

Most people experience bullying to some degree while growing up and going through school – it’s an inevitable part of life. Bullying can have a profound effect on the way people think and how they feel. Most people that are bullied end up feeling extremely depressed, worthless, and hopeless to change their situation.

Unfortunately in many cases, bullying goes completely unrecognized until the victim can’t take it anymore and sees suicide as the only way to escape the pain that they are experiencing. Some kids view bullying others as a way to fit in and/or prove themselves in regards to social hierarchy. Kids that get bullied are often viewed as being either physically weak and/or socially weak to not come up with witty responses.

Additionally, now there is a phenomenon called “cyber bullying” in which people fall victim to being bullied online. This happens on social media sites, comments sections of websites, and various blogs that aim to ruin people’s reputations and make people feel ashamed. When a person is bullied online and/or has privacy exposed online, they may view a ruined reputation as the end of the world and feel helpless to change their situation – which could lead to suicide.


The study of suicide methods aims to identify those commonly used, and the groups at risk of suicide making methods less accessible may be useful in suicide prevention. [6] [5] [10] Limiting the availability of means such as pesticides and firearms is recommended by a World Health Report on suicide and its prevention. The early identification of mental disorders and substance abuse disorders, follow-up care for those who have attempted suicide, and responsible reporting by the media are all seen to be key in reducing the number of deaths by suicide. [11] National suicide prevention strategies are also advocated using a comprehensive and coordinated response to suicide prevention. This needs to include the registration and monitoring of suicides and attempted suicide, breaking figures down by age, sex, and method. [11]

Such information allows public health resources to focus on the problems that are relevant in a particular place, or for a given population or subpopulation. [12] For instance, if firearms are used in a significant number of suicides in one place, then public health policies there could focus on gun safety, such as keeping guns locked away, and the key inaccessible to at-risk family members. If young people are found to be at increased risk of suicide by overdosing on particular medications, then an alternative class of medication may be prescribed instead, a safety plan and monitoring of medication can be put in place, and parents can be educated about how to prevent the hoarding of medication for a future suicide attempt. [10]

Media reporting of the methods used in suicides is "strongly discouraged" by the World Health Organization, government health agencies, universities, and the Associated Press among others. [13] Detailed descriptions of suicides or the personal characteristics of the person who died contribute to copycat suicides (suicide contagion). [14] [15] Dramatic or inappropriate descriptions of individual suicides by mass media has been linked specifically to copycat suicides among teenagers. [15] Writing for the New Yorker about celebrity suicides, Andrew Solomon wrote that "You who are reading this are at statistically increased risk of suicide right now." [16] In one study, changes in how news outlets reported suicide reduced suicides by a particular method. [15]

Media reporting guidelines also apply to "online content including citizen-generated media coverage". The Recommendations for Reporting on Suicide, created by journalists, suicide prevention groups, and internet safety non-profit organizations, encourage linking to resources such as a list of suicide crisis lines and information about risk factors for suicide, and reporting on suicide as a multi-faceted, treatable health issue. [17]

Method restriction, also called lethal means reduction, is an effective way to reduce the number of suicide deaths in the short and medium term. [18] Method restriction is considered a best practice supported by "compelling" evidence. [15] Some of these actions, such as installing barriers on bridges and reducing the toxicity in gas, require action by governments, industries, or public utilities. At the individual level, method restriction can be as simple as asking a trusted friend or family member to store firearms until the crisis has passed. [19] [20] Choosing not to restrict access to suicide methods is considered unethical. [15]

Method restriction is effective and prevents suicides. [15] It has the largest effect on overall suicide rates when the method being restricted is common and no direct substitution is available. [15] If the method being restricted is uncommon, or if a substitute is readily available, then it may be effective in individual cases but not produce a large-scale reduction in the number of deaths in a country. [15]

Method substitution is the process of choosing a different suicide method when the first-choice method is inaccessible. [5] In many cases, when the first-choice method is restricted, the person does not attempt to find a substitute. [15] Method substitution has been measured over the course of decades, so when a common method is restricted (for example, by making domestic gas less toxic), overall suicide rates may be suppressed for many years. [5] [15] If the first-choice suicide method is inaccessible, a method substitution may be made which may be less lethal, tending to result in fewer fatal suicide attempts. [5]

In an example of the curb cut effect, changes unrelated to suicide have also functioned as suicide method restrictions. [15] Examples of this include changes to align train doors with platforms, switching from coal gas to natural gas in homes, and gun control laws, all of which have reduced suicides despite being intended for a different purpose. [15]


Suffocation, as a classification of suicide method, includes strangulation and hanging. [21] [22]

Suicide by suffocation involves restricting breathing or the amount of oxygen taken in, causing asphyxia and eventually hypoxia. This may involve the use of a plastic suicide bag. [23] It is not possible to die simply by holding the breath, since a reflex causes the respiratory muscles to contract, forcing an in-breath, and the re-establishment of a normal breathing rhythm. [24] Therefore, inhaling an inert gas such as helium, nitrogen, and argon, or a toxic gas such as carbon monoxide, is used to bring about unconsciousness. [25] [26] As of 2010 [update] , organizations supporting a right to die used death by helium inhalation more often than drug overdoses, largely owing to its reliability. [27]

Suicide by strangulation is self-strangulation that may involve the partial suspension of the body rather than the full suspension used in hanging. Self-strangulation involves tightening a ligature around the neck. This compresses the carotid arteries, preventing the supply of oxygen to the brain, resulting in unconsciousness and death.


Hanging is a common method of suicide. [22] [21] Hanging involves the use of a ligature such as a rope or cord attached to an anchor point with the other end used to form a noose placed around the neck. The cause of death will either be due to strangulation or a broken neck. About half of attempted suicides by hanging result in death. [4] People who favor this method are usually unaware that it is often a "slow, painful, and messy method that needed technical knowledge". [28]

Hanging is the prevalent means of suicide in impoverished pre-industrial societies, and is more common in rural areas than in urban areas. [29] It is also a common means of suicide in situations where other materials are not readily available, such as in prisons.

Hanging was the most common method in traditional Chinese culture, [30] as it was believed that the rage involved in such a death permitted the person's spirit to haunt and torment survivors. [31] [32] In the Chinese culture, suicide by hanging was used as an act of revenge by women [33] and of defiance by powerless officials, who used it as a "final, but unequivocal, way of standing still against and above oppressive authorities". [30] Chinese people would often approach the act ceremonially, including the use of proper attire. [30]


Suicide by poisoning, also called self-poisoning, is usually classed as a drug overdose when drugs such as painkillers or recreational drugs are used. The use of pesticides to self-poison is the most common method used in some countries. [2] Inhalation of poisonous gases such as carbon monoxide may also be a cause of death by suicide. Poisoning through the means of toxic plants is usually slow and painful. [34] [ better source needed ] The mass suicide of members of a cult led by Jim Jones in 1978 resulted from poisoning ("Drinking the Kool-Aid"). [35] [ better source needed ]


As of 2006 [update] , worldwide, around 30% of suicides were from pesticide poisonings. [37] The use of this method, however, varies markedly in different areas of the world, from 0.9% in Europe to about 50% in the Pacific region. [36] In the US, pesticide poisoning is used in about 12 suicides per year. [38] Poisoning by farm chemicals is very common among women in rural China, and is regarded as a major social problem in the country. [39]

Method restriction has been an effective way to reduce suicide by poisoning in many countries. In Finland, limiting access to parathion in the 1960s resulted in a rapid decline in both poisoning-related suicides and total suicide deaths for several years, and a slower decline in subsequent years. [40] In Sri Lanka, both suicide by pesticide and total suicides declined after first toxicity class I and later class II endosulfan were banned. [41] Overall suicide deaths were cut by 70%, with 93,000 lives saved over 20 years as a result of banning these pesticides. [2] In Korea, banning a single pesticide, paraquat, halved the number of suicides by pesticide poisoning [2] and reduced the total number of suicides in that country. [40]

Drug overdose

A drug overdose involves taking a dose of a drug that exceeds safe levels. In the UK (England and Wales) until 2013, a drug overdose was the most common suicide method in females. [42] In 2019 in males the percentage is 16%. However self-poisoning accounts for the highest number of non-fatal suicide attempts. Overdose attempts using painkillers are among the most common, due to their easy availability over-the-counter. [43] Paracetamol is the most widely used analgesic worldwide and is commonly used in overdose attempts. [44] Paracetamol poisoning is a common cause of acute liver failure. [45] [44] In the United States about 60% of suicide attempts and 14% of suicide deaths involve drug overdoses. [4] The risk of death in suicide attempts involving overdose is about 2%. [4] [ verification needed ]

A drug overdose is often the first-choice method of members of right-to-die organizations. A poll among members of Exit International suggested that 89% would prefer to take a pill, rather than use a plastic exit bag, a carbon monoxide generator, or slow euthanasia. [46] [47]

Carbon monoxide

A particular type of poisoning involves the inhalation of high levels of carbon monoxide (CO). Death usually occurs through hypoxia. Carbon monoxide is used because it is easily available. A nonfatal attempt can result in memory loss and other symptoms. [48] [ self-published source? ] [49]

Carbon monoxide is a colorless and odorless gas, so its presence cannot be detected by sight or smell. It acts by binding preferentially to the hemoglobin in the bloodstream, displacing oxygen molecules and progressively deoxygenating the blood, eventually resulting in the failure of cellular respiration and death. Carbon monoxide is extremely dangerous to bystanders and people who may discover the body, so "Right to Die" advocates like Philip Nitschke recommend against it. [50] [ self-published source? ]

Before air quality regulations and catalytic converters, suicide by carbon monoxide poisoning was often achieved by running a car's engine in an enclosed space such as a garage, or by redirecting a running car's exhaust back inside the cabin with a hose. Motor car exhaust may have contained up to 25% carbon monoxide. However, catalytic converters found on all modern automobiles eliminate over 99% of carbon monoxide produced. [51] As a further complication, the amount of unburned gasoline in emissions can make exhaust unbearable to breathe well before a person loses consciousness.

Charcoal-burning suicide induces death from carbon monoxide poisoning. Originally used in Hong Kong, it spread to Japan, [52] where small charcoal-burning heaters (hibachi) or stoves (shichirin) have been used in a sealed room. By 2001, this method accounted for 25% of deaths from suicide in Japan. [53] It has become the second most common suicide method in Hong Kong and is a growing trend in other countries. [52] Nonfatal attempts can result in severe brain damage due to cerebral anoxia.

Other toxins

Detergent-related suicide involves mixing household chemicals to produce poisonous gases. [54] [ better source needed ] At the end of the 19th century in Britain, there were more suicides from carbolic acid (a disinfectant) than from any other poison since there was no restriction on its sale. Braxton Hicks and other coroners called for its sale to be prohibited in 1893. [55] [56]

The suicide rates by domestic gas fell from 1960 to 1980, as changes were made to the formula to make it less lethal. [5] [57]


In the United States suicide by firearm is the most lethal method of suicide resulting in 90% of suicide fatalities, [4] and is thus the leading cause of death by suicide as of 2017. [60] Worldwide, firearm prevalence in suicides varies widely, depending on the acceptance and availability of firearms in a culture. The use of firearms in suicides ranges from less than 10% in Australia [61] to 50.5% in the U.S., where it is the most common method of suicide. [62]

Generally, the bullet will be aimed at point-blank range. Surviving a self-inflicted gunshot may result in severe chronic pain as well as reduced cognitive abilities and motor function, subdural hematoma, foreign bodies in the head, pneumocephalus and cerebrospinal fluid leaks. For temporal bone directed bullets, temporal lobe abscess, meningitis, aphasia, hemianopsia, and hemiplegia are common late intracranial complications. As many as 50% of people who survive gunshot wounds directed at the temporal bone suffer facial nerve damage, usually due to a severed nerve. [63]

Gun control

Reducing access to guns at a population level decreases the risk of suicide by firearms. [64] Fewer people die from suicide overall in places with stricter laws regulating the use, purchase, and trading of firearms. [65] [66] Suicide risk goes up when firearms are more available. [67] [68] [69]

Gun control is a primary method of reducing suicide by people who live in a home with guns. Prevention measures include simple actions such as locking all firearms in a gun safe or installing gun locks. [20] Some stores that sell guns provide temporary storage as a service in other cases, a trusted friend or family member will offer to store the guns until the crisis has passed. [19] [20] When a person is going through a crisis, red flag laws in some places allow family members to petition the courts to have firearms temporarily removed and stored elsewhere.

More firearms are involved in suicide than are involved in homicides in the United States. A 1999 study of California and gun mortality found that a person is more likely to die by suicide if they have purchased a firearm, with a measurable increase of suicide by firearm beginning at most a week after the purchase and continuing for six years or more. [70]

The United States has both the highest number of suicides and firearms in circulation in a developed country and when gun ownership rises so too does suicide involving the use of a firearm. [71] [72] A 2004 report by the National Academy of Sciences found an association between estimated household firearm ownership and gun suicide rates, [73] [74] though a study by two Harvard researchers did not find a statistically significant association between household firearms and gun suicide rates, [75] except in the suicides of children aged 5–14. [75] Another study found that gun prevalence rates were positively associated with suicide rates among people aged 15 to 24, and 65 to 84, but not among those aged 25 to 64. [76] Case-control studies conducted in the United States have consistently shown an association between guns in the home and increased suicide risk, [77] especially for loaded guns in the home. [78] Numerous ecological and time series studies have also shown a positive association between gun ownership rates and suicide rates. [79] [80] [81] This association tends to only exist for firearm-related and overall suicides, not for non-firearm suicides. [80] [82] [83] [84] A 2013 review found that studies consistently found a relationship between gun ownership and gun-related suicides, with few exceptions. [85] A 2016 study found a positive association between gun ownership and both gun-related and overall suicides among men, but not among women gun ownership was only strongly associated with gun-related suicides among women. [86] During the 1980s and early 1990s, there was a strong upward trend in adolescent suicides with a gun, [87] as well as a sharp overall increase in suicides among those age 75 and over. [88] A 2014 systematic review and meta-analysis found that access to firearms was associated with a higher risk of suicide. [89]

A 2006 study found an accelerated decline in firearm-related suicides in Australia after the introduction of nationwide gun control. The same study found no evidence of substitution to other methods. [90] Multiple studies in Canada found that gun suicides declined after gun control, but methods like hanging rose leading to no change in the overall rates. [91] [92] [93] Similarly, a study conducted in New Zealand found that gun suicides declined after more legislation, but overall suicide rates did not change. [94] A case-control study in New Zealand found that household gun ownership was associated with gun suicides, but not overall suicide. [95] The authors attributed this finding to the highly stringent firearm storage laws and very low prevalence of handgun ownership in New Zealand. A Canadian study found that gun ownership by province was not correlated to provincial overall suicide rates. [96] A 2020 study also found no significant correlations between provincial firearm ownership and overall provincial suicide rates. [97]

Jumping from height

Jumping from a dangerous location, such as from a high window, balcony, or roof, or from a cliff, dam, or bridge is an often used suicide method in some countries. Many countries have noted suicide bridges such as the Nanjing Yangtze River Bridge (China), and the Golden Gate Bridge (US). Other well known suicide sites for jumping from include the Eiffel Tower (France), and Niagara Falls (Canada). [98] Nonfatal attempts in these situations can have severe consequences including paralysis, organ damage, and broken bones. [99]

In the United States, jumping is among the least common methods of suicide (less than 2% of all reported suicides in 2005). [100] However, in a 75-year period to 2012, there had been around 1,400 suicides at the Golden Gate Bridge. In New Zealand secure fencing at the Grafton Bridge substantially reduced the rate of suicides. [101]

In Hong Kong, jumping is the most common method of suicide, accounting for 52.1% of all reported suicide cases in 2006 and similar rates for the years prior to that. [3] The Centre for Suicide Research and Prevention of the University of Hong Kong believes that it may be due to the abundance of easily accessible high-rise buildings in Hong Kong. [102]

Less common methods


Self-inflicting a wound with a sharp instrument as a suicide method is usually to the wrists but can also be to the throat (or belly in harakiri). This is a relatively common method to the wrists, and the ready availability of knives is a noted factor. [103] A fatal self-inflicted wound to the wrist is termed a deep wrist injury, and is often preceded by several tentative surface-breaking attempts known as hesitation wounds, indicating indecision or a self-harm tactic. [104] For every suicide by wrist cutting, there are many more nonfatal attempts, so that the number of actual deaths using this method is very low. [105]

Wounds from suicide attempts involve the non-dominant hand with damage often done to the median nerve, ulnar nerve, radial artery, palmaris longus muscle, and flexor carpi radialis muscle. [106] [104] Such injuries can severely affect the function of the hand, and the inability caused to carry out work or interests increases the risk of further attempts. [104]


Suicide by drowning is the act of deliberately submerging oneself in water or other liquid to prevent breathing. It accounts for less than 2% of all suicides in the United States. [100] Of those who attempt suicide by drowning in the US, about half die. [4]

Fasting and dehydration

A classification has been made of Voluntary Stopping Eating and Drinking (VSED) which is often resorted to in terminal illness. [107] [108] This includes fasting and dehydration, and has also been referred to as autoeuthanasia. [109]

Fasting to death has been used by Hindu, Buddhist, and Jain ascetics and householders, as a ritual method of suicide known as Prayopavesa in Hinduism Sokushinbutsu historically in Buddhism, and as Sallekhana in Jainism. [110] [111] [112] Cathars also fasted to death after receiving the consolamentum sacrament, in order to die while in a morally perfect state. [113] This method of death is also associated with the political protest of the hunger strike such as the 1981 Irish Hunger Strike in which ten prisoners died.

The explorer Thor Heyerdahl refused to eat or take medication for the last month of his life, after he was diagnosed with cancer. [114]

Death from dehydration can take from several days to a few weeks. This means that unlike many other suicide methods, it cannot be accomplished impulsively. Those who die by terminal dehydration typically lapse into unconsciousness before death, and may also experience delirium and deranged serum sodium. [115]

Terminal dehydration has been described as having substantial advantages over physician-assisted suicide with respect to self-determination, access, professional integrity, and social implications. Specifically, a patient has a right to refuse treatment and it would be a personal assault for someone to force water on a patient, but such is not the case if a doctor merely refuses to provide lethal medication. [116] But it also has distinctive drawbacks as a humane means of voluntary death. [117] One survey of hospice nurses found that nearly twice as many had cared for patients who chose voluntary refusal of food and fluids to hasten death as had cared for patients who chose physician-assisted suicide. [118] They also rated fasting and dehydration as causing less suffering and pain and being more peaceful than physician-assisted suicide. [119] [108] Other sources, however, have noted very painful side effects of dehydration, including seizures, skin cracking and bleeding, blindness, nausea, vomiting, cramping and severe headaches. [120]

By transportation

Another suicide method is to lie down, or throw oneself, in the path of a fast moving vehicle, either on the road or onto railway tracks. Sometimes a car may be driven onto the railway tracks. [121] Nonfatal attempts may result in profound injuries, such as multiple bone fractures, amputations, concussion and severe mental and physical handicapping. [122]

Rail and metro

On railway tracks above ground, somebody may simply lie down or stand on the tracks, as the speed of an approaching train prevents its easy stopping. This type of suicide may cause trauma for the train driver. [101]

Jumping in front of an oncoming subway train has a 59% death rate, lower than the 90% death rate for rail-related suicides. This is most likely because trains traveling on open tracks travel relatively quickly, whereas trains arriving at a subway station are decelerating to stop and board passengers.


Data gathered to 2014 showed that there were 3,000 suicides and 800 trespass related accidents on the European railways each year. [101] In the Netherlands, as many as 10% of all suicides are rail-related. [123] In Belgium where rail service is frequently interrupted due to a high level of suicide by rail, families are expected to cover the substantial cost of rail network standstill. [124]


Trains on Japanese railroads cause a large number of suicides every year. Suicide by train is seen as something of a social problem, especially in the larger cities such as Tokyo or Nagoya, because it disrupts train schedules and if one occurs during the morning rush-hour, causes numerous commuters to arrive late for work. However, suicide by train persists despite a common policy among life insurance companies to deny payment to the beneficiary in the event of suicide by train (payment is usually made in the event of most other forms of suicide). Suicides involving the high-speed bullet-train, or Shinkansen are extremely rare, as the tracks are usually inaccessible to the public (i.e. elevated and/or protected by tall fences with barbed wire) and legislation mandates additional fines against the family and next-of-kin of the person who died by suicide. [125] As in Belgium, family members of the person who died by suicide may be expected to cover the cost of rail disruption, which can be significantly extensive. It has been argued this prevents possible suicide, as the person who is considering suicide would want to spare the family not only the trauma of a lost family member but also being sued in court however there is insufficient evidence to support this assertion. [126]

North America

The Federal Railroad Administration, in the U.S., reports that there are 300 to 500 suicides by train per year. [127] They also reported that those suicides on railway rights-of-ways were by people who tended to live near railroad tracks, were less likely to have access to firearms, and were significantly compromised by both severe mental disorder and substance abuse. [128]

Reducing rail-related suicides

Railway-related suicides are rarely impulsive, and this view has led to research on behaviour analysis using CCTV at known hotspots. [129] Some behaviour patterns are implicated such as station-hopping, platform switching, standing away from others, letting a number of trains go by, and standing close to where trains enter. Surveillance cameras are viewable by railway staff. [129] Media reporting has been linked to increased rail suicide attempts. [129]

Public access to rail tracks may be restricted by the erection of fences. Fencing on both sides of the rail lines are carried out. Other preventive measures are landscaping to create tree and bush hedging as a natural fencing, and the installation of prohibitive signage. Fencing and landscaping have shown significant reductions in suicide attempts, and signage a lesser reduction. Sometimes vegetation along the tracks can obscure the view of the train driver and the removal of this is also advocated. [101]

The installation of platform screen doors in many stations and countries has significantly decreased the numbers of suicides, notably in Hong Kong. In Japan the use of calming blue lights on station platforms is estimated to have resulted in an 84 per cent reduction in suicide attempts. [101]

On the London Underground the presence of a platform drainage pit has been shown to halve the number of deaths from suicide attempts. [101]

Uncommon methods


There have been documented cases of gay men deliberately trying to contract a disease such as HIV/AIDS as a means of suicide. [130] [131] [132]


Suicide by electrocution involves using a lethal electric shock, and is a rarely used method. [133] This causes arrhythmias of the heart, meaning that the heart does not contract in synchrony between the different chambers, essentially causing elimination of blood flow. Furthermore, depending on the current, burns may also occur. In his opinion outlawing the electric chair as a method of execution, Justice William M. Connolly of the Nebraska Supreme Court stated that "electrocution inflicts intense pain and agonizing suffering", adding that it is “unnecessarily cruel in its purposeless infliction of physical violence and mutilation of the prisoner’s body.” [134] Contact with 20 mA of current can result in death. [135]

Car crashes

Some suicides are the result of intentional car crashes. This especially applies to single-occupant, single-vehicle accidents [136] although head-on collisions with heavier vehicles are becoming more common [137] as road traffic safety measures like traffic barriers and impact attenuators limit damage potential from traditional targets like trees, boulders, and bridge abutments. Even single vehicle collisions may affect other road users for example, a car that brakes abruptly or swerves to avoid a suicidal pedestrian may collide with something else on the road, and the driver could be harmed.

The real percentage of suicides among car accident fatalities is not reliably known as they may be under-reported as accident causes are often unknown. A study in Europe suggests that more than 2 per cent of crashes result from suicides. [138]

Some researchers believe that suicides disguised as traffic accidents are far more prevalent than previously thought. One large-scale community survey in Australia among suicidal people provided the following numbers: "Of those who reported planning a suicide, 14.8% (19.1% of male planners and 11.8% of female planners) had conceived to have a motor vehicle "accident". Of all attempters, 8.3% (13.3% of male attempters) had previously attempted via motor vehicle collision." [139]

Self-immolation is suicide usually by fire. This method of suicide is rare due to its being long and painful. If the attempt is intervened severe burns, and scar tissue will prevail with subsequent emotional impact. It has been used as a protest tactic, by Thích Quảng Đức in 1963 to protest the South Vietnam's anti-Buddhist policies by Malachi Ritscher in 2006 to protest the United States' involvement in the Iraq War and by Mohamed Bouazizi in 2011 in Tunisia which gave rise to the Tunisian Revolution. [ citation needed ] and historically as a ritual known as sati where a Hindu widow would immolate herself in her husband's funeral pyre. [140]

Indirect suicide

Indirect suicide is the act of setting out on an obviously fatal course without directly carrying out the act upon oneself. Indirect suicide is differentiated from legally defined suicide by the fact that the actor does not pull the figurative (or literal) trigger. Examples of indirect suicide include a soldier enlisting in the army with the intention and expectation of being killed in combat, or provoking an armed law enforcement officer into using lethal force against them. The latter is generally called "suicide by cop".

Evidence exists for suicide by capital crime in colonial Australia. Convicts seeking to escape their brutal treatment would murder another individual. This was felt necessary due to a religious taboo against direct suicide. A person completing suicide was believed to be destined for hell, whereas a person committing murder could be absolved of their sins before execution. In its most extreme form, groups of prisoners on the extremely brutal penal colony of Norfolk Island would form suicide lotteries. Prisoners would draw straws with one prisoner murdering another. The remaining participants would witness the crime, and would be sent away to Sydney, as capital trials could not be held on Norfolk Island, thus earning a break from the Island. There is uncertainty as to the extent of suicide lotteries. While surviving contemporary accounts claim that the practice was common, such claims are probably exaggerated. [141]

Animal attacks

Some people have chosen to indirectly bring about their death by suicide by being attacked by predatory animals. In some cases, the person has been killed for example, a few people have been killed and eaten by crocodiles. [142] [143]

Several creatures, such as spiders, snakes, and scorpions, produce venom that can kill a person. For example, Cleopatra supposedly had an asp bite her when she heard of Marc Antony's death. [144]

Ritual suicide

Ritual suicide is performed in a prescribed way, usually involving fasting, and often as part of a religious or cultural practice.

Seppuku, also known as harakiri, is a historical Japanese ritual suicide method involving inflicting a severe wound to the belly. For example, Yukio Mishima died by seppuku in 1970 after a failed coup d'état intended to restore full power to the Japanese emperor. [145] The ritual was seen in the Japanese culture of the time as a means of saving face.

Volcano jumping

Jumping into a volcanic crater is a rare method of suicide. Mount Mihara in Japan briefly became a notorious suicide site during the Great Depression following media reports of a suicide there. Copycat suicides in the ensuing years prompted the erection of a protective fence surrounding the crater. [146] [147] [148]


There have been suicide attacks by aircraft, including Japanese Kamikaze attacks in the Second World War, and the terrorist initiated September 11 attacks in 2001.

Towards the end of the 20th century, one or two pilots in the US died by suicide by aircraft each year. [149] The pilot was usually flying alone at the time, and was using alcohol or drugs about half the time. [149] [150] However, in the rare case of a pilot engaging in murder–suicide, the number of innocent people is sometimes very high. On 24 March 2015, a Germanwings co-pilot deliberately crashed Germanwings Flight 9525 into the French Alps to kill himself, killing 150 people with him. [151] [152] Suicide by pilot has also been proposed as a potential cause for the disappearance and following destruction of Malaysian Airlines Flight 370 in 2014, [153] with supporting evidence being found in a flight simulator application used by the flight's pilot. [154]


There have been several documented cases of suicide by skydiving, by deliberately failing to open a parachute, or removing it during freefall. [155] [156]

Leenaars and the Multidimensional Model of Suicide

Antoon Leenaars is a leading proponent of multidimensional, evidence-based models of suicide. They are also sometimes referred to as “ecological models”.

Leenaars, along with Shneidman before him, is a leading researcher of psychological autopsies – a term that Shneidman first coined. He is also a leading authority on the analysis of suicide notes. These investigations are extremely effective in understanding, retrospectively, why someone has taken his or her life.

When Leenaars undertakes a suicidal analysis, he employs idiographic (specific) and nomothetic (general) elements. This is essential to capture a more complete illustration of the lost life. He draws on resources such as personal documents, interviews with survivors, official government reports, suicide notes, and any other available sources.

He interprets both intrapsychic and interpersonal features to decipher what drives an individual to suicide:


  • Unbearable psychological pain
  • Cognitive construction rigid thinking, tunnel vision
  • Indirect expressions ambivalent thoughts toward living, contradictory feelings
  • Inadequate adjustment cannot cope with problems, losses and weakened ego


  • Interpersonal relations frustrated relationships
  • Rejection/aggression loss or abandonment, aggression turned inward
  • Identification/egression strong attachment to another that is not met, need to escape (Leenaars, 1996).

For Leenaars, suicide is a “multidimensional malaise”, or a combination of “biological, psychological, intrapsychic, interpersonal, social, cultural and philosophical” elements, as opposed to the simple escape from pain(Leenaars, 1996, p.221). In his view, a penetrating investigation into the person’s lived experiences gives us much more of the “why” someone died by suicide (Leenaars, 1996).

Stages of Suicidal Behavior

  • Stage 1 (Ideation): At this stage, the person starts developing a feeling of depression and loneliness, but fear of death still overpowers such thoughts.
  • Stage 2 (Planning): This is the stage when the person’s dark thoughts are now asking him/her to plan for suicide.
  • Stage 3 (Auto-pilot): This is the most crucial stage as the person has now lost his/her conscience and is now ready to commit suicide at any instant.

Wrapping It Up

Now, when you are able to relate to the signs of a suicidal person, it’s time to help him by inculcating the value of life and a few reasons why they need to look life in a better way.

Check these top reasons to not to commit suicide and help your close one.

The Complexities Behind the Act of Suicide

I am a 78-year-old retiree, living in Australia. I notice that there have recently been a few articles about the contentious subject of suicide in Psychiatric Times. My first wife died from suicide about 40 years ago, and my second wife died 3 years ago after a short illness.

Some people do commit suicide, and this has surely happened since humans first walked the earth. This is not a treatise on the causes or possible reasons for suicide, but the complexities behind the act have puzzled me for many years. In particular our seeming abhorrence and our obvious dismay, regret, and great sadness that anyone should even contemplate the need to end their life, by whatever means has taxed my understanding and the meaning of my life.

What follows below is my considered opinion.

I ask the question-why is suicide considered such a bad thing? Now I am not advocating that anyone should commit suicide. I am just trying to pick apart the emotional clutter that accompanies this very personal and private act. The only answers I get are that it is a waste of a (usually) young person’s life that they were loved that they had unlimited potential, now never to be realized that they had a future to live for . . . etc, etc.

This is partially correct but is not a real answer. The person concerned-the person now deceased-obviously had a different view of life. I am not discussing his or her view-I have no idea what that was. I am discussing our view-that of the outsider-the ones left behind.

Why are we “outsiders” (I deliberately use this word because we are “outside” that person’s inner world) affronted because someone considers living-in their current situation-to be so bad, so threatening, so limiting as to be not worthwhile continuing? Are we discomforted because this rejection, this dismissal of all we have striven for (in “our” world), may reflect poorly on us, those left behind, regarding the way we have organized the world? Are we disturbed by the confronting prospect of having to admit that we make mistakes and that the way in which the economy, our legal, welfare, and education systems are set up may actually cause distress, that we are not always fair or just in our dealings? Do we feel guilty that we have developed a financial system that promotes the massive imbalance between the very wealthy and the very poor and the disadvantaged?

We have to recognize that we are all, all, party to the ills of the world. We created them. If we look with even a modicum of insight, we should see in ourselves the cause of these shortcomings and see ourselves reflected in the eyes of the distressed. And we should be dismayed.

Is this why we consider suicide a “bad thing” and are so shocked when it occurs?

It is needful to remember that we, each one of us, have our own experiences of life. These are our own. No one can see the world through our eyes with the same imagery and emotional response. No one can see the world through our eyes with our life experiences and our interpretations of those experiences-these are our own.

So, I ask the question again-why is suicide considered such a bad thing? Obviously for the person concerned the prospect of death is more alluring than continuing living as currently experienced. What is “wrong” with that? It is their choice.

Then, for some to say that only God can decide when or where a person dies is surely a gross over assumption-how do they know? What special insight do they possess? Is it not possible, because (I assume) God gave us free will that God may have already decided to allow a person who wants to die, to die?

Furthermore, to declare (as some authority figures do) that most people who commit suicide suffer from a mental “illness” or disorder is surely wrong. It is also highly presumptuous on the part of the person making such a declaration-how do they ACTUALLY know! This is categorizing a person, who now has no recourse or ability to refute the presumption. This is putting a label on someone. And what about those “outsiders” left behind to live with the event-the family and friends?

Are they to be made to suffer further pain with the stigma provided by so called experts who provide the “knowledge” that their son, daughter, friend, brother, sister “must have been mentally deranged” to have committed such an act. This implies that no “normal” person would ever do such a thing! What about self-sacrifice when there is loss of life? Isn’t this an act of suicide? But if it saves the life of others it is considered “noble”! (“There is no greater love than this, that a man should lay down his life for his friends,” English King James Bible: John 15:13).

Research on completed suicides is notoriously difficult. It is always referring to an historic act-something that has already happened. Police, the coroner’s, autopsy, psychiatric and psychological, and counselling reports are analyzed and carefully combed through to try and establish some reason or motive for the suicide. This is fraught as it is impossible to know what was actually going through a person’s mind at the precise moment they took their own life. At that moment they made a choice. Why? We can never know.

Shall we now look at what suicide actually is? Someone taking his or her own life-right? It seems that the “act” is only considered suicide if it results in the quick death of the person concerned. But what about those who commit suicide in the “long term”? Those who drink or drug themselves to death over a number of years, what about them? They may suffer from abuse, or from unbearable pressures associated with their domestic arrangements or at work. They may determine that the easiest and most “socially acceptable” way of easing this pressure or pain, is to get drunk or to get “stoned” on a regular basis. It may take some time but in possibly 5 or 10 years they will be dead. The emotional (and economic) “cost” of this (“long-term suicide”) far exceeds that of any number of “quick” suicides.

To get back to the “mental illness or disorder” accusation. Disordered from what? What are these people supposed to be disordered from? From “normal”? As far as I can discover, there is no accepted definition of “normal.” Possibly those considered “disordered” react to life’s trials and tribulations differently from those around them. Are they wrong? Or are we “outsiders” just being intolerant and lacking in understanding or compassion? Maybe these people are just eccentric-God knows there are enough odd-ball people in the community! Some behavior may be considered maladaptive or possibly antisocial by “outsiders” but not by the people concerned-otherwise they wouldn’t act the way they do!

Similarly, why should anyone “live” according to another’s expectations?

The Scottish philosopher David Hume (1711-1776) wrote the essay, “Suicide,” wherein he said, “I believe that no man ever threw away Life while it was worth keeping.”

What follows is a warning relating to antidepressant drugs, with which you will be familiar:

US FOOD AND Drug Administration Product Information Warning

Patients with major depressive disorder, both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality), whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs. Although there has been a long-standing concern that antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients, a causal role for antidepressants in inducing such behaviors has not been established. Nevertheless, patients being treated with antidepressants should be observed closely for clinical worsening and suicidality, especially at the beginning of a course of drug therapy, or at the time of dose changes, either increases or decreases.

Consideration should be given to changing the therapeutic regimen, including possibly discontinuing the medication, in patients whose depression is persistently worse or whose emergent suicidality is severe, abrupt in onset, or was not part of the patient’s presenting symptoms.

From the above it is apparent that psychopharmaceutical medications are not always the answer! Finally, I give you a quote from the Indian sage Jiddu Krishnamurti (1895-1986), who said, “It is no measure of health to be well adjusted to a profoundly sick society.”

There we have it-in a nutshell!

From the Editor:

As anticipated, the commentary “The Complexities Behind the Act of Suicide” by Andrew Campbell-Watt in the March 2019 issues of Psychiatric Times generated a wide range of feedback. Our intent in publishing this commentary was to give voice to the author, a 78-year-old man who has reflected on the suicide of his first wife for over 40 years-a person deeply affected by a suicide who was compelled to share his personal perspective after deliberating on the meaning of suicide for decades after the loss of his wife. As clinical psychiatrists, understanding how individuals grieve, process, and in some cases make peace with the suicide of a loved one can only serve to enhance our own empathy for our patients and any person whose life has been impacted by suicide.

Many factors can shape a person’s understanding of the reasons, experiences, and circumstances that ultimately converge on an individual’s decision to take their own life. As Mr. Campbell-Watt states, often we will never know the personal deliberations that occurred in the moments before a completed suicide. As psychiatrists, it is our ethical and professional duty to intervene to prevent a person from suicidal actions. Often, days, weeks or months after our intervention to prevent a suicide the person involved is grateful for our intervention, especially when the circumstances, experiences, symptoms or substance abuse issues have been thoughtfully addressed and that great healer “time” has enacted its gift. However, this is not always the case, and a subset of individuals will continue to attempt suicide until they succeed.

Suicide is, indeed, a complex act. We encourage a healthy and respectful discussion on the many facets of suicide, some of which may invite us to explore beyond our personal beliefs and opinions. We will post follow-up letters to the editor to encourage this discussion and exploration.

John J. Miller, MD
Editor in Chief, Psychiatric Times

From Our Readers: Nancy B. Graham, MD

The commentary in the March, 2019 issue on suicide written by Andrew Campbell-Watt was profoundly disturbing to me as a psychiatrist. I do not know what professional or educational credentials Mr. Campbell-Watt possesses to qualify his writing knowledgeably on this topic in this newspaper. Obviously, much of our psychiatric work is devoted to deciding when people might be a danger to themselves and to try to prevent their suicides.

He asks why suicide is such a bad thing. There are many reasonable answers to that question, but I suspect he would accept few of them.

First, suicide has been considered an evil, selfish act throughout thousands of years in all Judeo-Christian cultures. Only in so-called pagan cultures (e.g. the Greeks, the Romans, the Japanese samurai society) would suicide be an acceptable or even noble act.

Next follows the reality that practicing psychiatrists have all seen suicidal patients stop wanting to die when their mental illness was treated or their social or emotional or physical needs were met. Many of our patients, after nearly dying from a suicide attempt, no longer have any wish to die. In fact, people who survived leaps off the Golden Gate Bridge have usually said they regretted their decision to die on the way down. The wish to die is generally a transient wish linked to certain changing circumstances.

Third, Mr. Campbell-Watt does not consider the traumatic and permanently life–altering effect of suicide on the family and friends of the deceased. This act is never a solitary affair and grieving people are forever left with unanswered questions, never fully quenched pain, and a great hollow inside. Most patients who have tried to kill themselves have told me they weren’t thinking of their loved ones when they acted, because their pain was so great. Is that not then, though understandable, a profoundly selfish act? The rate of suicide, by the way, is greatly increased in the children of parents who killed themselves. What a wonderful legacy to give your kids!

He also conflates suicide and dying to save another life. Suicide is performed only to end one’s life-that is the purpose and method of “escape.” Sacrificing one’s life for another is NOT suicide. The person dying does not do the act to die but to save life. How different are the motivations though each person dies!

In the end suicide is exactly what the word means – “murder of self.” Murder-just contemplate that word. How much better is the suffering person trying to murder himself than the one who murders another? He is taking a life he never gave himself and slaughtering that life, admittedly out of pain. But there is help for pain. Pain is a momentary thing, even if it lasts some years. All pain comes to an end naturally in time. If the sufferer endures the pain, he may be restored to health, partially or fully. As long as he lives, there is hope, yet suicide takes away hope. Even those who, as Mr. Campbell-Watt, puts it, commit “long-term suicide” by abusing their bodies still have the opportunity to change for the better and live a full life. Again, drug abuse or other destructive habits are not an active attempt to kill oneself but to feel better.

The commentary’s author does not mention that slippery ethical slope at the top of voluntary, adult suicide to the mud-slicked bottom of involuntary killing of various people. It’s not so far from there to “helping” the elderly, the chronically sick, the handicapped, the “deformed,” and the unwanted on to their reward. Ask the Netherlands how involuntary euthanasia is working out for them after they allowed voluntary suicide. Read about the patients who pin notes on their chests saying, “Do not kill me” when they go in the hospital. Follow the news stories about the babies and children whose parents decide they should die because of their poor health. Once it seems expedient for some people to move on, it is much easier to see how others should, too.

Finally he asks why “anyone should live according to another’s expectations.” Killing oneself is not living at all and has nothing to do with others’ expectations. Incidentally we all live according to some social expectations, and those who don’t end up in prison or dead society dictates that we shall not rob others, we shall not rape others, we shall not kill others, we shall not abuse others. Those are very good rules. Total personal autonomy is not only antisocial and harmful-it is impossible.

Nancy B. Graham, MD
Richmond, KY
April 6, 2019

From Our Readers: Alicia Vaughn

I read your piece in Psychiatric Times with great interest. Many of the questions you raise have puzzled me, too. While I did find some of your ideas disturbing, Dr. Nancy Graham’s letter was equally troublesome, to me. Respectfully, may I suggest to both of you that Is suicide such a bad thing? is the wrong question? Is it wrong, evil, and selfish? only compounds the problem and obfuscates the way forward.

As someone who has lived with suicidal thoughts for much of my life, these questions have worked against my efforts to remain alive. Guilt and shame-and their unholy offspring, stigma-encouraged my parents to keep secret my first suicide attempts just as strong religious traditions in my part of the country continue to fuel the difficulties I face in managing my mental health issues.

You ask many questions about suicide but curiously, you leave the one area that would seem of most interest to readers of Psychiatric Times unexplored. Where I live, firearms, drugs and other means by which I could commit suicide are readily available. As long as I don’t disclose my intentions to anyone, ending my life is a relatively straightforward endeavor. It’s when I decide to try to stay alive, and begin to navigate the American health care system-a process euphemistically referred to as getting help-that complexities arise.

Perhaps it’s different, where you live, but the central issue in the United States is that if I commit suicide while in the care of a mental health professional, that person can be held liable for my death, a fact of which I’m sure not a single Psychiatric Times reader is unaware. It’s no surprise to me that among clinicians who assume those risks are countless “outsiders” who are decidedly “affronted” by the idea of suicide.

This peculiar dilemma and its infuriating collection of resultant complexities have shaped the psychiatric care available to me more than anything having to do with the “complexities behind the act” of suicide itself, or even my own needs, as a person experiencing suicidal thoughts.

Please picture this. I’m at a psychiatric clinic, sitting across from a caring, well-trained and experienced outpatient provider. The moment I utter the “s” word, all efforts to see my “circumstances [and] symptoms. thoughtfully addressed” as Dr. Miller describes, are immediately suspended to allow for thorough risk assessment. From this point forward, my relationship with my doctor will split its focus between the treatment of my symptoms and the management of the threat I pose to his or her livelihood. Every decision he or she makes now must balance what might be best for me against what can be defended in court.

So there we are, this doctor and I, in the same room, with the same goal: keep me from dying by suicide. To effect that outcome, what does this clinician really have to offer me?
He or she can try to alleviate the symptoms of my depression, but that may or may not affect my suicidal thoughts. What about drugs specifically developed to reduce the likelihood of suicide? There are none. What about this doctor’s specialized training in treating suicidal clients? There’s very little to be had, I’m told. Does he or she have access to a knowledge base of relevant research? What research is currently underway, I wonder, apart from that aimed at improving risk assessment so as to better indemnify those individuals who care for patients likely to succumb to suicide?

As far as I can tell, my outpatient provider has little choice but to rely on assumption, anecdote and personal experience in place of evidence-based medicine. The bewildering statements Dr. Graham offers throughout her letter: the wish to die is generally a transient wish. pain is a momentary thing. killing oneself has nothing to do with others’ expectations. evince the familiar dismissive, accusatory approach favored by the majority of my 28 years’ worth of health care providers.

While Dr. Graham’s truisms might not be true, they do make suicide is wrong easier to accept. Rolling them out again and again also makes it easier to convince me that attempting suicide means I’m petulant, short-sighted and selfish. Those three in turn justify the ever-present implication that a doctor’s duty includes the application of additional guilt and shame-maybe even a little intimidation-because the “standard of care” requires I be made to understand that suicide is wrong, lest attempts to investigate my motivations, validate my feelings or accept that ultimately, my personal autonomy in this context is absolute might be mistaken for approbation. To trade condemnation for productive efforts at meaningful change might accidentally reward me, the wrongdoer.

What I’m getting at is that getting help often proves far from helpful. The Is it so bad? / Is it wrong? debate devalues the humility required to ask the questions that need asking, and the courage required to answer them with enough honesty to facilitate actual improvement. Absent that humility, my doctor and I are left in a sadly adversarial situation, full of bullying and empty assurances (even if they’re born of genuine empathy for the worried human being charged with my care) that yes, I feel better now.

While I appreciate Dr. Graham’s sincere belief that her patients regret their actions, all she can really know is what they report to her, and if suicide is wrong is in the room, what they say might speak less of their genuine experience than of the guilt and shame engendered by her (hopefully) unspoken but plainly apparent contempt for those who, even “admittedly out of pain,” attempt to end their lives.

I’ve had 28 years to wonder why doctors resort to such negative tactics. I don’t know that I ever arrived at an answer, but at some point, that question turned into a different one: What is it reasonable for me to expect from someone who assumes the risk of treating me in return for (I kid you not) $60 per visit? Who in their right mind (pardon the expression) would accept that risk?

Once I arrived at those questions, it upset me less that most outpatient providers won’t accept me as a patient, not with my history of medically-serious attempts, multiple hospitalizations and failed medication trials. I understand now that the risk I represent is just too great.

I’ve also spent the last 28 years evaluating and re-evaluating the risk my family and I take, every time I seek help. How profoundly will another pointless hospitalization jeopardize our financial future? How likely is it that a doctor on my insurance company’s panel will have the training and experience to help me avert a sixth attempt instead of intensifying my feelings of helplessness?

It has been several years since my last serious struggle with suicidal thoughts. These days, I am not involved in any efforts to end my life. Should thoughts of suicide arise in the future, will I try to get help? Not if the resources available to me are the same ones available to me at the present time. The risk that such help will not prove helpful and that the cost will only add to the stressors driving my suicidal thinking is just too great.

I feel a great deal of empathy for you, Mr. Campbell-Watt I can’t help but imagine that you are a lot like my own husband-hurt and confused, with as genuine a desire to understand your wife as my husband has to understand me. My suicide is not yet an historic act, however, and the questions which matter to me do so in an immediate and concrete way.

So I ask you, and Dr. Graham, Dr. Miller, and all Psychiatric Times readers: If it’s too risky for me to seek treatment, and too risky for psychiatrists to accept me as a patient, is that so bad? Is that wrong?

Alicia Vaughn
April 19, 2019

Response from the author:

Re: The Complexities Behind the Act of Suicide

I have read with great interest the responses, so far published, to my original contribution to your publication. I am responding to clarify a few points. With our [Australian] health system (including mental health) there is none of the apparent adversarial attitude described so eloquently by Alicia Vaughn, who responded to my commentary. All health needs are very well addressed in Australia-including mental health needs. Our “Medicare” system is very generous.

Any patient with mental health issues, in the “public system” (with no private health insurance) may be referred by his health professional to any psychiatrist for up to 10 consultations, who may “bulk bill” (ie, charge a government set fee) or charge what he or she likes. The “gap” in any payment may be ultimately covered by the government-provided “safety net.”

Should a patient with mental health issues present him or herself at a public hospital emergency department (to my knowledge very few private hospitals have EDs) he or she will be charged accordingly: Medicare patients charged nothing private health insurance patients invoiced for payment by their insurer.

Briefly summarized, since 1984 Australians have had the benefits of universal health care: Medicare. If one is a “public patient” attending a “public hospital,” treatment is free-no matter what. (For example, my second, late wife, endured many years of renal dialysis before receiving, over the years, two kidney transplants. We did not pay a cent apart from heavily subsidized medication-normally about $40.00 per prescription pensioners only pay $7.00 per prescription.)

As I understand it, if a mental health patient attends a public hospital to see a psychiatrist (patients need to be referred by their physicians) the psychiatrist may “bulk bill.” If the patient is a pensioner and holds a government provided “Health Care Card” the patient will not pay anything. The psychiatrist may, of course, charge what he or she likes, but Medicare will only reimburse the set fee-the patient pays the “gap” amount. Medicare set fees are arrived at in consultation with the requisite medical health provider associations: the Australian Medical Association (AMA) or the Royal Australian and New Zealand College of Psychiatrists (RANZCP). A safety net is available but needs to be applied for that covers most of any gap fees the patient is unable to meet, thus preventing the patient from going into long-term debt.

Private health insurance in Australia is encouraged (but can be expensive). A tax rebate may be applied for to reduce the overall cost to the private patient. A privately insured patient may attend any hospital (public or private) and will be charged accordingly.

Moreover, as I understand it, there is no requirement for a psychiatrist, or any health care provider, to report suicidal ideation to any government authority. Suicide-or attempted suicide-while actively discouraged, is not a crime in Australia. The Australian government has many programs in place to help prevent suicide, particularly aimed at young people and the the First People-the Indigenous population-who have extremely high suicide rates.

In answer to my question “Can an Australian psychiatrist be sued if one of his patients, under care, commits suicide?” A lawyer told me that in his opinion, “Potentially the answer is yes. However, before the psychiatrist would be found liable, he or she would have to show that either contact with the patient was the direct cause of what eventually happened or that the therapist knew or should have known that the person was in crisis. This is always the difficult part in these types of cases. It is not so much getting sued as being held liable. The problem here would be proving that the therapist knew or should have known that this person was going to harm himself and that is very difficult to establish.”

Andrew Campbell-Watt
April 25, 2019

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Mr Campbell-Watt reports no conflicts of interest concerning the subject matter of this article.

People who kill themselves usually believe that they are in an unbearable situation from which they cannot escape and that things won't ever get better.

The problem with research into the reasons for suicide is that those that successfuly killed themselves can no longer explain their motives, and those that survived might – consciously or unconsciously – have planned not to die, so their motivations might not be motivations to die but motivations to affect others or to relieve tension (similar to non-suicidal self-injury).

A close friend who only accidentally survived a suicide attempt (because, not being a physician or apothecary, she had unknowingly chosen sleeping pills that cannot kill you, no matter how many you take) had been abused as a child, consequently lost all self-worth, felt she would never experience love and happiness, and finally tried to end her misery when she was 21. Her survival was followed by another, successful, suicide, which to me shows that her first attempt was earnest.

This is the only person I know who wanted to die and told me her reasons, between the two attempts. More abstractly, her reason was the one stated at the beginning of my answer: not simple depression or hopelessness. We all go through such phases, but we know they pass, so we bear them and wait for better times. This person had been depressed and miserable for so long, that she could no longer imagine things changeing for the better. Unable to bear the idea of having to endure another eighty years of unhappiness, she ended it.

There is some research into reasons for suicide, which, as far as I know, does not emphasise this point and thus fails to explain why some people kill themselves in a moment of hopelessness, while others don't. For example, Brown, Comtois and Linehan (2002) interviewed women who attempted suicide and compared their motivations to women who performed non-suicidal self-injury. Their abstract summarizes (my emphasis):

Overall, reasons given for suicide attempts differed from reasons for nonsuicidal self-injury. Nonsuicidal acts were more often reported as intended to express anger, punish oneself, generate normal feelings, and distract oneself, whereas suicide attempts were more often reported as intended to make others better off. Almost all participants reported that both types of parasuicide were intended to relieve negative emotions. It is likely that suicidal and nonsuicidal parasuicide have multiple intents and functions.

Some old people who ask physicians for assisted suicide report that they don't want to burden their families. I think it is a true reason for some people, while others would probably rather want to live, if they could stop being debilitated by old age. Again, the underlying reason is that these people feel they cannot change their situation to the better. Borderline women might feel the same, since their emotional instability, inability to have functioning relationships, fear and depression, are not momentary but have usually been there for all their adult lives, often as effects of some trauma such as childhood abuse.

Adolescents, who are often thought to be more self-centered and less socially concerned in their motives than old people, also report more self-centered reasons to kill themselves. In their study of adolescent suicide, Boergers, Spirito and Donaldson (1998, my emphasis) found that

Consistent with prior research, the most frequently endorsed motives for self-harm were to die, to escape, and to obtain relief. More manipulative reasons for overdose (such as making people sorry) were endorsed less frequently. Adolescents who cited death as a reason for their suicide attempt reported more hopelessness, socially prescribed perfectionism, depression, and anger expression.

With the restriction that we don't know who of the suicide attempters really wanted to die, nevertheless for most of them the primary reason was to end a life they had no hope of changing to the better.

Because what does it mean that you feel you are not perfect enough? For adolescents it usually means that you feel you are so ugly no one will ever love you, or that you are introverted and cannot make friends and have been outside the ingroup for so long that you no longer believe that anyone will ever love you. It does not matter if other, less pretty people, can be happy, or if other loners can make loner friends, the important aspect is that you feel you are not good enough to be loved by those that you want to love you and that nothing you ever do (makeup, bringing home good marks) can change that, because in truth, for example, it is not actually you who are unlovable but your parents who are unable to love you because of their own mental disorders (and that is how some of them are passed on through the generations).

Studying successful suicides, Cavanagh, Carson, Sharpe and Lawrie (2003) found that

mental disorder was the most strongly associated variable of those that have been studied. . Suicide prevention strategies may be most effective if focused on the treatment of mental disorders.

This is of course a very global result, but it shows that people don't usually kill themselves because they experience dire circumstances or a bad phase in their lives, but only if their long term mental well-being is destroyed.

Linehan, Goodstein, Nielsen and Chiles (1983) have studied the reasons why people do not kill themselves. The primary reasons for living, if suicide was contemplated, were:

Survival and Coping Beliefs, Responsibility to Family, Child-Related Concerns, Fear of Suicide, Fear of Social Disapproval, and Moral Objections.

Besides fear (of dying and death and the judgment of God and men) and responsibility for family and children, the main reason to keep people alive was their belief that they could survive and cope! If we turn this around, the main reason to die (besides having no responsibility and not being afraid, or overcoming those concerns) is the belief of not being able to cope.

What makes you kill yourself, in sum, is that you can no longer take it and believe you cannot change it. Very simple – and horribly tragic.