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Suicide and Its Discontents

What does a suicide attempt tell us about future risk?

During the four seconds Kevin Hines penetrated the air on his plunge from the bridge to the Golden Gate Strait below, he decided, “I don’t want to die.” Suffering a crushed vertebrae and other injuries, Hines is one of the very few who have survived a suicide attempt jumping from the Golden Gate Bridge. Since then, he has traveled the country lecturing on suicide prevention.

Suicide is an increasing health care concern. Death by suicide occurs every 40 seconds. Rates in the U.S. have continued to increase every year in this century. Risk factors include social isolation, financial stress, lack of access to community, religious, and medical resources. The COVID-19 pandemic has exacerbated these hazards. The holiday season now is a time for some when suicidal ideation increases even more.

The world has recognized this problem. World Suicide Prevention Day is declared every September 10. The Saturday before Thanksgiving (this year it was November 21) is signified as International Survivors of Suicide Day, for those family and friends grieving. However, prediction and prevention of suicide remain elusive.

Some of our frustration may be related to the paradoxes enveloping attempts to actively address suicide risk. One of the primary indicators that clinicians consider in attempting to predict suicide is a history of a previous attempt. Indeed, many believe that “if you’re going to do it, you’re going to do it,” and expect the survivor of a suicide attempt to continue to try to end their life. Yet many patients have experienced what happened to Kevin Hines—a relief at surviving and renewed consideration of a productive future. Some studies have indicated that as many as half of individuals who survived a serious suicide attempt, felt more encouraged afterward and never attempted again. That has been my experience for some patients with whom I have consulted.

“Joe” drove out to a secluded area of the woods and fired a gun into his right temple. He was surprised that, except for some blood trickling and severe head pain, he was still alive. He remained in his car for another hour waiting to die. When he attempted to exit the car to relieve his bladder, he fell to the ground, completely paralyzed on his left side. Miraculously, “Joe” was found and taken to a hospital. Despite his handicap, he continues living a hopeful life.

“Peter” proceeded to a remote area and overdosed with multiple pills. Accidentally discovered, “Peter” was hospitalized in a coma that persisted for four more days. Cognitive retention, much less survival, were in doubt. “Peter” recovered with full mental and physical functioning and gratefully returned to his work, family, and friends with renewed optimism.

It is important to note this contradiction: Suicidal behavior in one individual may predict further suicide activity, while in another, the behavior may provide protection against future self-destruction. Perhaps this is related to the intention and severity of the initial attempt. In any event, we must continue to be vigilant in our efforts to rein in the tragedy of suicide, especially in the current worldwide upheaval we are all currently enduring.