- A root cause of suicide is feeling trapped. Chronic mental and physical pain are significant contributors.
- Since mental and physical pain share similar brain circuits, they both create much misery.
- Modern medicine largely assumes that illnesses are caused by identifiable structural problems; it is wrong.
- There are ways out of chronic pain obviating the need to escape by suicide.
I recently received the letter below from a close friend, a movement, dance, and rhythm specialist who uses creative tools to calm the nervous system. When you feel stressed, your body is in a flight-or-fight state and pain sensation is heightened. Feeling safe creates a profound shift in body chemistry that slows nerve conduction, lowers brain inflammation, and lessens or resolves pain.
Most medical and surgical interventions for chronic pain have little data to support their use and are largely ineffective. As patients become increasingly frustrated and inflamed, pain worsens. This is particularly true with spine surgery, as major surgeries are performed on normally aging spines. Research documents that degenerative changes of the spine are not a source of chronic back pain.1 The success rate of a fusion or artificial disc is less than 30% at two-year follow up.2 Far from resolving pain, operating in these circumstances creates many problems. Patients are bounced around, repeatedly disappointed, become increasingly frustrated, feel trapped, and, for too many, the only way out seems to be suicide.
Sad news today. I received a phone call from someone that I have successfully worked with. He has transformed himself from being bed-bound with 'a broken back' to full potential. He wouldn't phone unless there was an emergency, so I took the call. He was uncontrolled, crying, but eventually calmed down. His sister was living with 'a broken back' that was fixed with multiple rods and screws. She was in unbearable pain for years post multiple surgeries from what I can gather. She refused all help, such as our approach, and relatives in general. She jumped in front of a train in France 4 days after her daughter's 4th birthday and was killed. She was described as being under unrelenting stress and pain.
A sharp reminder of why we do this.
We plod on, in my case with a heavy heart and I remind myself that if only one person hears that is enough.
Disability, surgery, and suicide
Early in my career as a spine surgeon, two patients committed suicide. They had experienced no improvement in their pain after surgery. I had sent one to a pain clinic; the other one walked out of my office and shot himself that afternoon. This was in the era when I was zealously performing fusions for back pain and was frustrated when I couldn't find reasons to perform surgery. I was viewed as their last hope.
Here are some of the issues around suicide.
- I eventually learned that when my patients were complaining of pain, they were often referring to mental pain in the form of repetitive unpleasant thoughts (RUTs). There is a clearly documented association between rumination and suicide.
- Mental and physical pain are processed in similar regions of the brain, and unpleasant thoughts and emotions hurt. What is particularly problematic is that many disability systems won’t allow treatments for a “mental health diagnosis.” What is being overlooked is that mental pain and physical pain are the same problem. The data is overwhelming.
- Until I learned to help people with mental pain, it was nearly impossible to resolve the physical pain, with or without surgery. This was true even for surgical problems.3
- Both types of pain fire up the immune system, including immune cells in the brain. A sensitized brain magnifies everything, and life caves in on people.
- It is my belief that RUTs are a driving force in most chronic disease states— mental or physical. You are trapped by your thoughts, there is not a protective withdrawal response as there is with physical pain. We have no protection against them, and suppressing them creates even more havoc.
- Failed surgery in any field of medicine is devastating. You are offered a chance at a cure or significant improvement and commit to a risky and expensive procedure. You have a lot of hope, and then it is dashed. We know that repeatedly dashing hope induces depression.4
- With failed surgery, there is the additional, and often legitimate, burden of anger, anger at the surgeon who did not deliver on the implied relief. If you knew that the success rate of a given procedure was less than 30%, would you go through with it?
- Learning to deal with anger is always the tipping point of healing.
Dealing with suicide head-on
I have dealt with almost every aspect of suicide. More than 20 medical colleagues of mine have died by suicide, including my fellow spine fellow. I almost committed suicide myself in 2002. I have an employee whose husband shot himself while talking to her on the phone. I have helped pull many colleagues back from the brink of going through with it. A whole group of us tried to help a fellow spine surgeon and we failed. He walked out of my operating room and went out and shot himself. I have had numerous face-to-face conversations with patients who have threatened to kill themselves if I did not do the surgery that they wanted. Fortunately, I was much better at understanding how trapped they felt, and each one eventually healed and went on to thrive.
A common denominator in suicide is feeling trapped. The feeling includes:
- Mental pain, often from RUTs (repetitive unpleasant thoughts)
- Physical pain
- Distressed relationships
- Financial crises
- Lack of opportunity
- Being stuck in any form of disability system
John Sarno, a pioneering physiatrist, recognized the impact of chronic pain on people's lives and used the term “rage” to describe the feeling.5 Additionally, people feel trapped by:
- Not feeling heard
- Being labeled
- Not having the true nature of chronic pain explained to them
- Being given the diagnosis of medically unexplained symptoms (MUS)
- Scattered medical care
- Not knowing when or whether the pain will end.
Research documents that the impact of chronic pain on a person's life is equivalent to having terminal cancer—except is it actually worse. As bad as cancer is, at least you understand the problem.6
Understand the problem, know the solution
Chronic pain, mental or physical, is consistently solvable by first understanding the nature of it. The current definition, put forth by leading researchers in Chicago, is “…….chronic pain is an embedded memory that becomes connected with more and more life experiences and the memory cannot be erased.”7 Reprogramming your brain around these circuits works. Extreme measures are not necessary.
If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.
1. Jensen MC, et al. Magnetic resonance imaging of the lumbar spine in people without back pain. NEJM (1994); 331:69-73.
2. Carragee, EJ et al. A Gold Standard Evaluation of the ‘Discogenic Pain’ Diagnosis as Determined by Provocative Discography. Spine (2006) 31: 2115 – 2123
3. Perkins, FM and H Kehlet. “Chronic pain as an outcome of surgery: A Review of Predictive Factors.” Anesthesiology (2000); 93: 1123 – 1133.
4. Blum, Deborah. Love at Goon Park. Perseus Publishing, New York, NY, 2002.
5. Sarno, John. Healing Back Pain. Warner Books, New York, NY, 1991.
6. O’Connor AB. Neuropathic pain: quality-of-life impact, costs, and cost effectiveness of therapy. Pharmacoeconomics (2009); 27: 95- 112.
7. Mansour AR, et al. Chronic pain: The role of learning and brain plasticity. Restorative neurology and neuroscience (2014); 32:129-139. doi: 10.3233.RNN-139003