Dying by their own hand

By Jason Ferguson


This is the first in a series on suicide, who it affects, how it affects them and where people can turn to for help.

By the time you read the first few paragraphs of this story, someone, somewhere will have committed suicide.

The World Health Organization tells us close to 800,000 people die due to suicide every year, which is one person every 40 seconds. Many more attempt suicide. Suicide occurs throughout the lifespan and is the second leading cause of death among 15-29-year-olds globally.

Suicide is a phenomenon that reaches all genders, age groups, walks of life and countries. It takes from all. Virtually everyone knows someone who has committed suicide or attempted suicide. You  may not know it, but you probably also know someone who is contemplating suicide.

There were a handful of suicides in Custer County last year and undoubtedly several more attempted and contemplated. Suicide was the ninth leading cause of death in South Dakota in 2017, with someone dying by their own hand every two days.

In the United States, 44,193 people die by suicide each year. For every completed suicide, 25 are attempted. Suicide costs the U.S. $93.5 billion annually through direct medical expenses as well as indirect costs such as lost wages resulting from premature death and injury (in the case of attempted suicide).

No complete count of suicide attempts is kept in the U.S. However, the Centers for Disease Control gathers data from hospitals on non-fatal injuries from self harm. In 2015, for example, nearly 500,000 people visited a hospital due to self-harm. Surveys suggest that at least one million people in the U.S. each year engage in intentionally inflicted self-harm.

So why do people commit suicide? That’s as tricky to answer as trying to answer how to prevent suicide.

“There are a variety of reasons. It’s individualized,” said Stephanie Schweitzer Dixon, executive director of the Front Porch Coalition, a Rapid City agency devoted to suicide prevention. The group serves families and friends who have lost someone to suicide through its volunteer Local Outreach to Suicide Survivors (L.O.S.S.) first responder team. “There is almost always mental illness and/or substance abuse problems going on with the individual.”

Suicide is not simplistic. There’s no single cause, no magic pill for prevention. Suicide occurs when stressors exceed coping abilities of someone suffering from a mental health condition, although depression is the most common condition associated with suicide and it is often undiagnosed and untreated. Conditions like depression, anxiety and substance abuse problems, especially when unaddressed, increase the risk for suicide. However, most people who actively manage their mental health conditions lead fulfilling lives.

“A lot of people struggle with addiction. A lot of people have mental health problems and do OK. They get help,” Schweitzer Dixon said. “If they don’t get help and the illness is severe, they can struggle and have thoughts of suicide.”

Schweitzer Dixon said over 90 percent of people who die by suicide have had or are struggling with a mental disorder or substance abuse. By the time it gets to the point of wanting to die, having a plan for suicide or making an attempt to commit suicide, the affliction from which they suffer has reached critical severity, and many of those people feel they don’t have enough help or support to get them through rough times. A feeling of hopelessness has set in.

What they don’t realize, Schweitzer Dixon said, is that in most cases, they do have a support system to help them through troubled times.

“The (mental) illness is so severe it clouds their ability to understand the support for them,” she said. “It has to be treated.”

Schweitzer Dixon said mental health problems are an ever-growing issue in society that must be addressed head-on instead of being stigmatized.

“Until society realizes the importance of getting help for and treating mental health as important as physical health, the problem isn’t going to get any better,” she said. “It’s going to get worse. We have to break the stigma of mental health or the problem will continue.”

While the stigma of mental health has gotten somewhat better, she said, it’s nowhere where it needs to be.

“People still don’t want to take medication, don’t want to go to counseling, don’t want to get that help,” she said.

Dr. Steve Manlove, a former Custer resident and practicing psychiatrist for 31 years, agrees that depression plays a big role in suicide, saying suicide attempts are almost always connected to depression and feelings of hopelessness. The feeling of social isolation—which is accompanied by depression because depressed people typically do not engage as much socially—can lead people down the suicide spiral.

“People might not feel good. They might feel upset or have a crisis in their life, for instance, a breakup, but not everybody feels they need to kill themselves,” he said. “What’s interesting to me is, why doesn’t everybody who is depressed commit suicide? It’s only certain people. People who might be more dangerous in an acute setting might not have coping skills or a support system in dealing with it. This is especially true in kids.”

Teenagers or younger children who commit suicide begin to feel like nobody understands them, Manlove said, or have feelings of abandonment.

“They are beside themselves, don’t know what to do, and suicide feels like a better option than dealing with those feelings,” he said.

Not everybody who commits suicide has a poor support system, however, he cautions, but it’s a major factor that isn’t considered as much.

“I think the straw that breaks the camel’s back is that people feel isolated, so to speak,” Manlove said. “Lots of people lose money and they’re depressed. Most people don’t commit suicide in that setting. A lot of people who break up with  a boyfriend or girlfriend don’t commit suicide. Most have the ability to put the brakes on, gain perspective and think of other alternatives.”

Warning signs of suicide can be conveyed by an at-risk person both through their words and their actions. Someone contemplating suicide will talk about being a burden to others, feeling trapped, experiencing unbearable pain, having no reason to live or killing themselves. Behaviors can include increased use of alcohol and drugs, looking for ways to kill themselves, such as searching for materials and means, acting recklessly, withdrawing from activities, isolating from family and friends, sleeping too much or too little, visiting or calling people to say goodbye, giving away prized possessions or aggression.

People who are considering suicide often display depression, a loss of interest, rage, irritability, humiliation and anxiety.

While males are four more times more likely than females to die by suicide, females attempt suicide three times as often as males.

“Men are more likely to be violent in general and are more likely to have weapons,” Manlove said. “Women (attempt suicide) by less violent means.”

Manlove said suicide is also common with elderly people who watch friends and loved ones die and they themselves are nearing death.

Suicide can also come in clusters, Manlove said, pointing to a time he was practicing in Custer when one child committed suicide and a young acquaintance of the child talked to him about how much of a relief it must have been for the child who had hung themself to have all their pain go away.

“That was a scary kid. That was a kid in danger,” Manlove said. “He was viewing it as a positive alternative because everything goes away.”

Children who see someone commit suicide are more likely to consider it an option, Manlove said.

“Maybe even there was a big funeral, accolades, people really miss them,” he said. “(They think) ‘Nobody cares about me now, then maybe they would think about how much I was suffering.’”

Younger people who commit suicide frequently don’t have the perspective to realize how final suicide truly is, Manlove said. As people mature they can see themselves in the bigger picture.

“There is more ability to cope with the situation and get perspective on it,” he said. “(They think) maybe there is something else I can do.”

Younger people are not educated about what depression may feel like and that there are lights at the end of the tunnel. Like Schweitzer Dixon, Manlove said depression is truly a brain illness and needs to be treated as such—not as a shortcoming or something to be embarrassed about.

“They think they are a horrible person and nobody likes them,” he said. “It’s no less of a biological problem than a broken arm.”