Inevitable Suicide

Abstract

The author suggests that a new paradigm may be needed which holds that some suicides may be inevitable. The goal of this paradigm would be to diminish the sense of failure and inadequacy felt by many psychiatrists who experience the suicide of a patient and to increase understanding of the unique biopsychosocial profile of those whose suicides appear to be inevitable. The author stresses that this proposed paradigm should not be misconstrued as therapeutic nihilism but rather should serve to stimulate efforts to treat this patient population more effectively. Risk factors that place individuals at high risk for suicide are reviewed, including presence of a mental illness, genetic predisposition, and factors such as a history of abuse, divorce, unemployment, male gender, recent discharge from a psychiatric hospital, prior suicide attempts, alcohol or other substance abuse, a history of panic attacks, and persistent suicidal thoughts, especially if coupled with a plan. The author notes that, in those suicides that appear to have been inevitable, risk factors are not only numerous but at the extreme end of profound pathology. The example of Ernest Hemingway is used to illustrate how such a combination of risk factors may have contributed to his eventual suicide. Psychiatrists, like other doctors, may have to acknowledge that some psychiatric disorders are associated with a high mortality rate as a natural outcome. This could lead to heightened vigilance, a more realistic view of what can and cannot be achieved with therapy, and efforts to improve the quality of life of patients at high risk for suicide with the goal of reducing this risk and prolonging their lives. (Journal of Psychiatric Practice 2012;18:221-224).

Skepticism towards the Swedish vision zero for suicide: interviews with 12 psychiatrists

“…The VZ was considered to be unachievable also because of limitations of contemporary psychiatry: current clinical methods are not effective enough to save every person at risk of suicide. This, too, is consistent with the existing literature [ 33 ]. A related concern was that the VZ will contribute to the general public underestimating the severity of psychiatric illnesses or overestimating the ability of healthcare to treat these illnesses.…”

Epigenetic Modulation of Mood Disorders

“…Both unipolar depression and bipolar disorder present clinically severe conditions characterized by recurring episodes of depressive symptom categories, and in the latter periods of mania, with a life-long lasting prevalence [29-31]. It has been suggested that whereas mood refers to the underlying or longitudinal emotional state, affect pertains to the external/visible expression of the individual observed by others [32]. Unipolar depression and bipolar disorder, of the depressive disorder spectrum of mood disorders, present severe illnesses and are leading causes of disability and suffering among a large population of afflicted individuals [33].…”

Sociodemographic characteristics of adult Saudi patients with mood disorder subtypes

“…Mood disorder, also known as mood affective disorder, is a group of conditions characterized by disturbance in a person's mood, ranging from elevated (mania or hypomania) to depressed moods (major depression). [1] In fact, mood disturbances may also oscillate between mania and depression, such as in bipolar disorder. [2] Other subtypes include dysthymia (milder form of major depression), cyclothymiacs (milder form of bipolar disorder) and adjustment disorder (abnormal reaction to a life stressor).…”