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Understanding and Overcoming the Myths of Suicide: Page 2 of 2

Understanding and Overcoming the Myths of Suicide: Page 2 of 2

Diagnostic myths

Friends and family who have been surprised by a suicide often consider it to be deeply selfish. This is understandable because the bereaved are often convinced that the decedent did not consider the impact of his or her death on those left behind. However, those who die by suicide certainly do consider the impact of their deaths on others; but to them, death is a positive rather than a negative outcome. This is wrong, but nevertheless, it is the view of the person who attempts suicide.

Still another reason to question whether selfishness is involved in suicidal behavior involves the associations of various aspects of psychopathy to suicidal behavior. In its description of psychopathy, DSM-IV includes aggressive behavior and reckless, out-of-control disregard for others and for rules and norms. Another aspect of psychopathy—evidently to be emphasized more in DSM-5 and included in Hervey Cleckley’s classic 1941 book, The Mask of Sanity5—describes psychopaths as controlled, callous, sometimes charming con men. They also demonstrate marked emotional detachment (ie, low anxiety; fake or shallow emotions; immunity to guilt and shame; and incapacity for love, intimacy, and loyalty).

In the current DSM, psychopaths are considered out of control but not necessarily unfeeling. Cleckley psychopaths are very much in control and very much unfeeling, except, that is, when it comes to themselves. One cannot be a Cleckley psychopath and not be selfish—it is part of the core of the syndrome; but on the basis of DSM, one can be a psychopath and not be selfish. In short, one group is selfish to the core; the other, less so.

If selfishness is key to suicidal behavior, it stands to reason that the group more prone to suicidal behavior should be the Cleckley psychopaths, but it is not. Genuine suicidal behavior is quite rare in this group.

Seasonal myths

Another common myth that even some professionals harbor is that death by suicide peaks around the winter holidays. In fact, far from peaking, the winter holidays represents a low point in suicide rates,6 possibly because it is a time of togetherness.

My research group hypothesized that seasonality and suicidality are associated at least partly because of seasonal fluctuations in togetherness.6 Consider a large college campus in this regard. Campuses provide numerous activities for belonging; anyone who doubts this should check out a nearby university’s online master calendar. Universities offer many social, cultural, academic, athletic, and other events—many of them free of charge. Perhaps partly as a function of this high level of belonging inherent in these events, suicide rates of college students are relatively low compared with their same-aged peers not at college.6

Opportunities for togetherness are thus high on college campuses, but they are not uniform throughout the calendar year. During a standard academic year (the fall and spring semesters, roughly from September to May), most schools are clearly in session, and chances for social engagement abound through classes, dormitory and apartment life, sports, and so on. However, summer activities continue but they ebb considerably. Therefore, it is conceivable that students’ sense of belonging may be lower during the summer than during active semesters. We found that suicidal ideation was higher in the summer months than during the regular academic year, and we reasoned that this association might be partly explained by fluctuations in opportunities for socializing.6

Slow suicide myths

A final collection of myths involves the notion of slow suicide, by which a person engages in unhealthy behaviors despite knowing that these behaviors may ultimately lead to death. Genuine suicidal behavior involves a rather clear intent to die, not to do something else like smoking or taking drugs because they like it. Consider, for example, smoking. By the logic of smoking as slow suicide, we should have witnessed a most remarkable decrease in the suicide rate in the past half century, as smoking rates plummeted; alas, we have not. People know smoking puts them at risk, but they smoke anyway—not because they intend to die—but because they like it. They are willing to take the risks because of how much they enjoy smoking. Addicts continue to use drugs even though they have been told and understand that continued use might kill them; but because they like “doing” drugs, the risks do not matter.

Therapeutic implications

I articulated these perspectives in Why People Die by Suicide1 and Myths About Suicide,2 which encompass risk assessment, therapeutics, and suicide prevention. In addition to marked warning signs, such as talking about suicide and planning for it, the books discuss clinically severe agitation, insomnia, and nightmares (these latter 3 are themselves not considered acute risk factors in some clinical settings). Noting a patient’s fearlessness of death, perceived burdensomeness, and accelerating alienation may improve risk assessment.

Myths About Suicide concludes with the following excerpt:

We need to get it in our heads that suicide is not easy, painless, cowardly, selfish, vengeful, self-masterful, nor rash; that it is not caused by breast augmentation, medicines, “slow” methods like smoking or anorexia, or as some psychoanalysts thought, things like masturbation; that it is partly genetic and influenced by mental disorders, themselves often agonizing; and that it is preventable (eg, through means restriction like bridge barriers) and treatable (talk about suicide is not cheap and should occasion treatment referral). And once we get all that in our heads, at last, we need to let it lead our hearts.

Therapeutic regimens and prevention protocols that target and acknowledge these factors should be given serious consideration.

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