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Why Can't We Say 'Suicide'?
Medpage Today ^ | May 3, 2022 | Arthur Lazarus, MD, MBA

Posted on 05/06/2022 11:43:36 AM PDT by nickcarraway

Ignoring this illness is not sustainable

Iconic singer Naomi Judd died at age 76, one day before she was to be inducted into the Country Music Hall of Fame.

Her daughters, Wynonna and Ashley Judd, shared a statement confirming her death: "Today [April 30, 2022] we sisters experienced a tragedy. We lost our beautiful mother to the disease of mental illness."

An exact cause of death was not disclosed, and no additional information was forthcoming. However, the late Grammy-winning legend had been open about her mental health struggles and descent into debilitating depression and suicidal ideation. It was the focus of her 2016 autobiography, River of Time.

Five years ago, I attempted to schedule a follow-up appointment with a neurosurgeon who had operated on my spine. I clicked on his name online, but I received an error message: "Page not found." Subsequently, I discovered that my doctor had taken his life. I read his obituary on the internet: "Dr. Eugene William Strickland [a pseudonym] passed away suddenly. He was 55 years old. He is survived by his loving family."

There was no mention of suicide or the circumstances surrounding Strickland's death.

Why are we afraid to say the word "suicide?" Usually, it is for the benefit of the family, out of respect for their privacy. But the real reason is that mental disorders remain the most stigmatized of all illnesses, and suicide encapsulates mental aberrations to the extreme. I never considered my specialty (psychiatry) to have a mortality rate until one of my supervisors reminded me that our patients die by suicide and sometimes kill others by homicide, acts which can be prevented more often than not.

One of the first things I learned as a resident -- and even prior to that as a medical student during my psychiatry clerkship -- was that asking patients about suicidal ideation is an essential component of the mental status examination. I would have flunked my psychiatry boards had I not asked the question -- "Have you ever had thoughts of harming yourself?" -- to the patient I was assigned to interview.

It is unfathomable that a myth persists that asking patients if they are suicidal will precipitate the action, despite abundant research that has shown asking about suicidal thoughts or attempts will not "put the idea" in someone's head. On the contrary, acknowledging and talking about suicide may reduce, rather than increase, suicidal behavior.

The difficulty that clinicians seem to have in initiating discussions about suicidal ideation has less to do with patient characteristics than it does with clinician anticipatory anxiety about learning that a patient is positive for suicidal ideation. Another one of my supervisors commented, "Art, the only thing worse than a suicidal patient is one who doesn't show for their appointment." It got me thinking that cherry-picking patients by avoiding those who are suicidal is not a bad idea. Then I realized it was not a sustainable strategy, nor is it even desirable if a psychiatrist really wants to learn his or her craft. It behooves clinicians to become comfortable asking "the question" and to become aware of interventions for the prevention of suicide in their practice.

Reading accounts of people who have died suddenly and mysteriously, without explanation, typically invokes suicide as a cause of death. The unwillingness to acknowledge a suicide reminds me of a bygone era when cancer was referred to as the "C" word, and the diagnosis was whispered and discussed in muted tones owing to its perceived incurability. Neither cancer nor suicide is incurable, however. Knowing the risk factors and recognizing the warning signs for suicide (and cancer) are common preventive measures. But suicide cannot be prevented unless we inquire about self-injurious thoughts and behaviors in our patients.

It is more correct nowadays to refer to individuals as having completed suicide rather than having committed suicide. What's the difference? The former notation indicates that suicide is usually a contemplative event as opposed to an impulsive act. Most individuals who complete suicide have thought about it over a period of time, once again providing clinicians and others an opportunity to intervene. Warning signs -- verbally or behaviorally -- precede most suicides. Only when those signs are not recognized or well-hidden does it seem like the suicide was sudden or a shock.

Contrary to the theme song from "MASH," suicide is not painless, and it brings on many changes -- to loved ones left behind. And what about the fate of patients under the care of the approximately 400 physicians who die each year by suicide? How do they cope with the loss? Patients are rarely privy to the circumstances surrounding the suicide deaths of their physicians, which often leave them confused and unable to obtain closure, possibly making it difficult to move on with their treatment.

Finding another physician I could easily entrust with my spine wasn't easy for me. In fact, after consulting a half dozen neurosurgeons, I still haven't found one.

If you or someone you know is considering suicide, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

Arthur Lazarus, MD, MBA, is a psychiatrist.


TOPICS: Heated Discussion
KEYWORDS: suicide
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1 posted on 05/06/2022 11:43:36 AM PDT by nickcarraway
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To: nickcarraway

I wonder how many suicides occurred due to lockdowns.


2 posted on 05/06/2022 11:46:37 AM PDT by EEGator
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To: nickcarraway

We lose an average of 20 veterans EVERY DAY to suicide.

Its an epidemic that is ignored for the most part except for those of us in the veteran community.

Saying it out loud highlights the issue. Hiding it behind soft labels like “mental health issues” helps no one, especially those currently dealing with the problem.


3 posted on 05/06/2022 11:52:27 AM PDT by airborne (Thank you Rush for helping me find FreeRepublic! )
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To: airborne
Saying it out loud highlights the issue. Hiding it behind soft labels like “mental health issues” helps no one, especially those currently dealing with the problem.

Reminds me of the George Carlin routine about "Shell Shock".

4 posted on 05/06/2022 11:53:28 AM PDT by dfwgator (Endut! Hoch Hech!)
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To: nickcarraway
"Iconic singer Naomi Judd died at age 76, one day before she was to be inducted into the Country Music Hall of Fame."

I'm surprised she wasn't inducted a long time ago. The Judds' heyday was 25-35 years ago.
5 posted on 05/06/2022 11:56:07 AM PDT by Steve_Seattle
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To: nickcarraway

How ironic that a Dr. Arthur Lazarus is writing about suicide.
In the New Testament Bible, Lazarus was raised from the dead four days after his entombment.


6 posted on 05/06/2022 11:58:42 AM PDT by lee martell
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To: EEGator
One of the great and tragic secrets in the nation are the suicides of men in their ‘50s and 60s, almost exclusively White males. No one is talking about this, no one cares. My oldest and dearest friend committed suicide back in January. He was 64.
7 posted on 05/06/2022 11:59:41 AM PDT by jmacusa (America. Founded by geniuses. Now governed by idiots. )
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To: jmacusa

I’m very sorry to hear that.


8 posted on 05/06/2022 12:03:09 PM PDT by EEGator
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To: nickcarraway

Because everyone is now a victim and not responsible for their choices/actions.


9 posted on 05/06/2022 12:09:02 PM PDT by Codeflier (I am just going to assume you are a Democrat if you call me a Putin supporter and ignore you.)
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To: lee martell

Big doings in Bethania that day!


10 posted on 05/06/2022 12:09:36 PM PDT by one guy in new jersey
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To: nickcarraway

Having dealt with suicide in my own family, I have to say that one aspect the writer is missing is privacy.
Cause of death by car accident or heart attack is often referred to as “sudden” in a public publication.


11 posted on 05/06/2022 12:11:04 PM PDT by nuconvert ( Warning: Accused of being a radical militarist. Approach with caution.)
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To: EEGator

Or due to something in the vaccine. There’s been a rash of suicides in my small town. Lots of young people.


12 posted on 05/06/2022 12:11:51 PM PDT by RoosterRedux
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To: nickcarraway

Suicide is a big problem.
More broadly: mental illness is a big problem.

I’m convinced that this country, partly on purpose, and partly through misguided policies, has been manufacturing mental illness for at least 30 years. One aspect: the COVID policies of isolation, fear, and masks — those things manufactured mental illness in many people. Also: “Perversion is normal” and “Everyone gets a trophy” and “Everything is racist”. All of these things manufacture mental illness.

We see the sad fruit of this today. It is with us already.

But jump ahead 20 or 30 years and see how much worse it will be. I’d say we’re on a slippery slope and the angle is about 85 degrees. The damage has been done, and the sadness will increase without let up.


13 posted on 05/06/2022 12:12:27 PM PDT by ClearCase_guy (It's hard to "Believe all women" when judges say "I don't know what a woman is".)
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To: nickcarraway

How about, it’s none of our business.


14 posted on 05/06/2022 12:14:20 PM PDT by Robert DeLong
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To: RoosterRedux

Suicides, ODs, and relapses are all up.
I lost two friends via relapse during lockdowns.
The last two years have been terrible for people with substance abuse and mental health issues.
Behavior in general seems worse to me as well.
Fewer people interact in a kind way in the stores around me at least.
I know that’s a insignificant number of interactions statistically speaking...


15 posted on 05/06/2022 12:18:15 PM PDT by EEGator
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To: nickcarraway

Suicide Ideation is huge fad among young people who are constantly talking about their “mental health”. University medical clinics are overwhelmed with kids wanting therapy and most of all drugs. When they can’t get treatment, they call their parents and threaten suicide.

Oddly, many suicides are a result of kids stopping their medication. I have Depression and I refused the drugs out of fear that it would swing the pendulum too far. I have a friend who was so worried about his obesity that they put him on anti-anxiety drugs. Guess what they do to your weight?


16 posted on 05/06/2022 12:27:11 PM PDT by AppyPappy (Biden told Al Roker "America is back". Unfortunately, he meant back to the 1970's)
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To: nickcarraway

It was ridiculous to read that the other day. Changing the wording doesn’t change that she killed herself.


17 posted on 05/06/2022 12:31:06 PM PDT by Trillian
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To: EEGator

I know of one. Coworker’s nephew, only 14 years old.


18 posted on 05/06/2022 12:32:00 PM PDT by subterfuge (I'm a pure-blood!)
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To: EEGator

I’m assuming suicides in our WOKE military are hidden...

The solution to happy citizens is to divide the country.

If none of us had to deal with white liberal ‘elites’ and their violent pets and WOKE insanity our world would be better. Suicide rates would drop like a lead balloon. And so would theirs. ( *Note to white liberal ‘elites’ - divide the country and before the ink is dry all guns could be confiscated, abortion would be legal until the child is a year old, every illegal in the world could come to YOUR country and no one would object. And
badda bing badda boom - all the deplorables would be GONE) forever from your half.

Stop the misery - negotiate a divorce.


19 posted on 05/06/2022 12:32:43 PM PDT by GOPJ (Biden's motto "America Last". If YOU object you're labeled 'domestic terrorist' and put on a list.)
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To: nickcarraway

Suicides will be gradually going down now that the Clintons no longer have an empire to protect.


20 posted on 05/06/2022 12:35:06 PM PDT by Tell It Right (1st Thessalonians 5:21 -- Put everything to the test, hold fast to that which is true.)
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