Occasionally people will commit suicide because they are psychotic and believe they must die for some reason that makes no sense to anyone else. I had a patient once who made a very serious suicide attempt because she believed that if she died, the mysterious private investigators who were stalking her would leave her family alone.
These types of suicides are heartbreaking, because they are so futile and can often be prevented by appropriate treatment.
The vast majority of people who choose methods of suicide that are almost guaranteed to succeed -- like a gun to the head or a plunge from a high bridge -- do so because of they are losing a battle against major depression. These are the suicides that haunt and hurt worst of all, and that almost to a person are the most tragic.
I hate suicide.
I've been fortunate that suicide does not run in my family. But it runs in lots and lots of families and I've known -- and known of -- more people who have killed themselves than I can easily count.
There was the shy kid who shot himself in high school, the young punk who drove his car off a particularly bad curve, the wonderful hard-working father of the class valedictorian, and various in-laws across a couple of marriages.
And those are just people from my personal life. Like any psychiatrist who deals with the severely mentally ill, my life is littered with memories of folks who threw themselves off high buildings, hanged themselves in dark closets or slit their throats in dusky gardens.
But as much as I hate suicide, I also understand it. One of the things people have repeatedly posted in comments responding to Scott's death is that you can't weigh in on why someone might commit suicide unless you've really had your life torn apart by an episode of major depression.
I agree.
Severe major depression is probably the most unbearable pain a human being can withstand for any protracted period of time. Many people who died of cancer have written eloquently about how the crushing pain from their tumors paled in comparison to the pain they felt when depressed.
With all other pain, most people can maintain some sense of separation between themselves and the pain. As horrible as it is, the pain is in their arm, or leg, or belly or head. But there is still a "them" that is separate from the misery.
Depression is different. Because it is at its essence a perceptual disorder, it causes one to see the entire world as pain. It feels painful inside, but it also feels painful outside.
When a person is depressed, the entire world is disturbed and distressed, so there is nowhere to escape. And it is this fact that makes suicide so seductive, because it seems to offer the one available escape option.
There are at least two reasons why suicide in response to major depression is so horrible and so tragic. First, although our treatments for depression are far from perfect, they are nonetheless effective enough to help the vast majority of depressed people feel well enough to forgo killing themselves.
2-3
