by S. Todd Stop MD
©July 2007
To question what it means to be human may not sound like a public health issue. However, suicide, as narrowly defined, is a behavior that is distinctive only to humans. Therefore, to scrutinize what it is about humans that accounts for this uniquely human tragedy may bring us to a better understanding of the phenomenon of suicide and contribute to minimizing its occurrence in our communities.
It is clear that other creatures will engage in behavior that results in the self-imposed death of the individual. A scorpion will sting itself, a spider may lose its life upon mating, a mammal may die defending their young against impossible odds, and higher animals may die of starvation after the loss of a mate or die as a result of self-injury upon captivity.
However, as far as science can determine, none of these examples represent actions by otherwise healthy individuals that are chosen with the specific purpose of ending the life of the individual. So what singularly human capacities make such a decision possible?
It is generally accepted that humans enjoy intellectual powers that provide us with unique perceptions. This includes the ability to conceive of life span, life expectancy, and mortality – most notably our own. People understand abstract concepts like taboo behavior, popularity, ethics, and cultural norms. We inevitably construct some sort of self-image of ourselves by measuring how we perform against the norms that regulate the societies in which we live. Unfortunately, when our own self-assessment leads us to perceive ourselves as falling far short of our own expectations or society’s expectations, mental anguish is a frequent outcome and the mechanisms of mental illness frequently follow. Self-awareness of the factors that influence our behavior provides the basis for widely embraced and successful forms of psychological treatment, such as Cognitive Behavioral Therapy and Dialectical Behavioral Therapy.
To maintain a healthy mental state, one must have an adequate supply of socially acceptable coping mechanisms (rational arguments, self-confidence, meaningful employment, a sense of humor, spiritual beliefs, etc…) with which to manage the negative or positive self-perceptions one encounters, to greater or lesser degrees, during life. One theory considers that the abyss of suicide in an otherwise healthy individual represents a breakdown of these coping mechanisms relative to one’s negative self perceptions and/or world perceptions.
A recent article in the New England Journal of Medicine points out that it is possible to detect in young people when the failure of coping mechanisms begins to push a young person towards a sense of hopelessness. There are even indications that physical, genetic factors may in some instances influence our ability to develop and exercise adequate coping skills.
Herein lays the public health message. Prominent risk factors for suicide include Native American and White ethnicity, residence in a rural community, access to firearms, substance use disorders, male gender, sexual assault victimization and recent personal loss. “Red flag” trigger factors include recent exposure to personal tragedy, intoxication, loss of interest in favorite pastimes, ease of access to a suicide method or legal problems. If you or someone you know displays such behavior and admits to thoughts of suicide when you ask, call or have them call 1-800-273-TALK immediately. For a local number to access emergency mental health care for thoughts of suicide, call your local Behavioral Health Department.
Self-perceptions are naturally distorted by our own biases. Recognizing early when those perceptions – guided or misguided as they may be – are leading us to thoughts of hopelessness may be all the incentive we need to seek professional counseling services. Such services can and do save lives.