Suicide, Mental Health, and Life's Anchor

Despite our best stated efforts, suicide continues to be a major problem. It is not a matter of economic status, or being marginalized socially, as it has become very clear with the recent suicides of Kate Spade and Anthony Bourdain. It's a problem for youth and the middle aged. In a 2009 report by the American Counseling Association, the group cited the third leading cause of death for age group 15 to 24, and college students was suicide. The rates have only increased, despite the greater efforts by primary physicians to identify major depressive disorder . The Center of Disease Control reported an increase from 2015 (44,193 deaths) to 2016 (44,965 deaths) of 777 completed suicides. As with major depression, a history of trauma and substance abuse is greatly associated with people who attempt and complete suicide.

The increase in completed suicides means that more people have been affected by the suicide - family, friends, co-workers - leading to the American Psychological Association calling suicide a national crisis. While there are a number of factors involved in thinking, planning, and completing a suicide, we need to focus on protective factors. An important protective factor are the attachments in a person's life. From anecdotal information from people who are recovering from substance abuse, their sense of attachment improves with sobriety, suggesting that the cycle of addiction likely affects our sense of important attachments. The sense of attachment is also significantly impacted by trauma and Adverse Childhood Experiences (ACE's). A possible symptom for PTSD is a sense of detachment and inability to experience closeness.

I conduct many interviews with people who have been traumatized or are chronically depressed because of life events or chronic pain, and suicidal ideation is often cited as part of their recent history. When asked "What has kept you from trying?" they almost always cite a single family member or the effect on their children. They serve as an emotional anchor in this life, even among the most traumatized. A spouse or partner has only an inconsistent impact on deferring suicide. And no one has ever made a reference to their job or co-workers. But among a larger percentage of discharged service people, their sense of honor to those who died in active duty keeps them alive. Again, the attachment.

The question then is "How do we increase attachment?" There are several ways to do it, and I will suggest three. The first is Touch. Touch includes hugs or simply a hand on a person's shoulder. Young children are the template, since they often look for their parents to give or get a hug unconditionally. Next, let them know that you love them, and/or that you value their existence. I honestly tell my patients when they return to their next session after a period of suicidal thinking that I am very happy that they are still here and that they are important. Next, review memories of happy, uplifting times and fortify hope based on those memories. You can cite areas of their life that are related to preferences and their improvements, such as "Imagine how video games will be in three years?" If you know them well, reminding them of the times spent together and that you are sure those times will happen again. The three recommendations are built over time and with repeated efforts. The repeated efforts will establish the sense of value.

For more information, refer to the blog post published in Psychology Today (https://www.psychologytoday.com/us/blog/emotional-fitness/201210/10-ways-build-positive-attachment).