Suicidality is a very serious issue, with more than 10,000 people taking their own lives each year in Germany alone. The number of unreported cases will certainly be much higher. Thus, the number of suicides significantly exceeds the number of traffic fatalities per year.
What is suicidality?
Suicidality, or a suicidal tendency, describes a mental state in which the thoughts, fantasies, and also actions of the person affected are directed toward bringing about his or her own death. This state can be persistent, repeated or only exist in crisis situations. In suicidality, a distinction is made between suicidal ideation (no actual desire to commit suicide) and urgent suicidal ideation, which conceals specific suicidal intentions and plans. Suicidality is not a disease, but a symptom of an underlying problem. A psychological problem has become so acute that only despair and hopelessness prevail. Those affected find their lives unbearable and therefore want to end them. There is no possibility of changing the current life for the better in acute suicidal tendencies. Suicide appears to the affected person as the only way out. Treatment of suicidality is among the most difficult challenges facing the health care system.
Causes
There are many different causes of suicidality. These include:
- Depressive disorder
- Alcohol or drug dependence
- Suicide attempts in the past
- Suicides in the family or close environment
- Personality disorders
- Neurotic disorders
- Schizophrenia
- Isolation and loneliness, for example in old age.
- Occupational stresses
- Unemployment or other reasons leading to a high level of hopelessness and lack of perspective
- Violent environment
- Financial problems
- Slights
- Loss of self-esteem
- Dependence on other people
- Traumatic or stressful experiences such as the loss of a loved one, for example, through death or divorce
- Serious or incurable illness
Suicidality can occur because of one event, but it can also result from a sequence of different events. How the stresses are experienced individually is fundamentally very different.
Symptoms, complaints and signs
A typical symptom of suicidality is the person’s thinking or talking about death or dissatisfaction in relation to life or problems. This should generally be taken very seriously and understood as an alarm signal. It is a common misconception that people who plan to take their own lives do not talk about it. Most suicidal people talk about the fact that they are tired of life or that their life seems meaningless to them. In the antecedents of suicidal acts, there is often a fundamental change in mood and behavior. It is often observed that they react more emotionally and tend to have strong emotional outbursts, for example, fear, sadness, outbursts of anger, feelings of shame and guilt. The affected person then falls into a depressive state. He believes that he can only escape this by committing suicide. A deep hopelessness has set in. Suicidal people often withdraw and communicate less. On the other hand, it is also often observed that people who have decided to commit suicide suddenly seem “relieved,” so that they are more communicative and open-minded than before. Giving away property or putting affairs in order may be an indication of suicidality.
Diagnosis and course of illness
Several considerations play an important role in the diagnosis of suicidality. These include:
- Constriction, aggression reversal, and suicidal fantasies.
- Risk factors include mental illness and disorders, especially depression and schizophrenia (acute phase)
- Addiction
- Psychosocial crises such as separation or death of a loved one.
- Barely any social relationships
- Previous suicide attempts or suicides in the family.
- Hopelessness, despair, anxiety, joylessness, insomnia.
- Resignation
- Discharge from psychiatric institution
These factors are very serious and so is the suicidality. Here, the sooner the risk is recognized, the better, because the longer the condition lasts, the more the desire to commit suicide can also solidify.
Complications
Suicidality, with its complications, must be considered on a case-by-case basis. Furthermore, it can itself be understood as a complication of depression. Suicidality carries the risk of not being recognized or understood. Not infrequently, depression in particular is not apparent to those around it and leads to an increase in psychological stress due to the failure to provide help. The same applies to suicidality, which in such cases often only becomes apparent with a (successful) suicide attempt. In addition, this form of mental suffering can be very acute, which lowers the inhibition threshold for committing affect acts – autodestructive and suicidal acts – and thus makes intervention by third parties or therapists de facto impossible. Suicidality further leads to complications in medical treatments. For example, an unwillingness to live in the affected person may mean that he or she refuses medication or food intake. This results in higher risks (accepted by the suicidal person), which have legal and emotional consequences for doctors and relatives. Complications can also arise from suicide attempts that were unsuccessful. Mutilation, brain damage, and the like occur and often mean a prolongation of perceived suffering for those affected.
When should you see a doctor?
People who are thinking about ending their lives on their own should seek medical or therapeutic help. If there is a persistent listlessness toward life or a sense of futility is worrisome. If thoughts of one’s own uselessness or superfluousness arise, these should be shared with other people. If emotions can no longer be felt by others, if wishes and dreams disappear, or if hopelessness sets in, the perceptions should be discussed with a doctor. If the affected person comes to a point in his life where he believes to be a burden for the close environment, he should openly address his concerns. If the affected person frequently deals with ways to end his or her own life, help is needed. If concrete plans emerge about how one’s own death will take place, there is an acute need for action. If self-injurious acts take place, a suicide note is written or the affected person begins to cancel existing contracts, there should be increased vigilance. If a person expresses clear actions that lead to his or her own willful demise, an emergency service must be alerted. Otherwise, there is a failure to render assistance, which is punishable under the law. A compulsory order is instructed in the case of a hardened suspicion of suicidality.
Treatment and therapy
To explore the reasons for suicidality and initiate appropriate treatment, this can only a specialist. Here, the therapy depends on the corresponding trigger of the suicidal intentions. Frequently, the affected person must be treated in a closed psychiatric ward, which is often done against his will in order to protect him. In the case of depression, antidepressants or mood-stabilizing substances are used. In manic-depressive states, the clinical symptoms are usually severe, so that the combination of different medications is required. In the case of suicidality resulting from the life situation, psychotherapy or sociotherapeutic measures are useful. A good relationship between the physician and patient is always important for successful therapy.
Prevention
There is basically no suicidal instinct. Before people harbor such intentions, a lot has usually happened, and this is precisely where it is important to intervene and help. If there is an emergency, help must be sought immediately and the emergency physician must be called without delay. It is important to let him know that the person is suicidal. Those who recognize signs of suicidality and act can save lives. In principle, it is wrong to reproach or reproach the other person, to downplay or trivialize the situation. Instead, the other person’s situation should be taken seriously, as it seems hopeless right now.The affected person should not be left alone in the situation, but should receive support and sympathy.
Aftercare
Suicidality is a phenomenon that should be taken very seriously, and therapy should be accompanied by close follow-up care. Contacts for this are psychiatrists or psychologists as well as the general practitioner. The reason for the suicidal tendency plays an important role in the follow-up care. It is important to know whether a single traumatic event is the reason for suicidal intentions or whether depression is the cause of these thoughts. It is important to have a social network that the person affected can always turn to when problems arise or there is other need to talk. Relatives and friends can also provide this to a certain extent. It is often advisable to visit a self-help group. Here, those affected can offer a valuable exchange of experiences and helpful tips in a protected setting. Hobbies and social contacts in leisure time are also well suited to accompany suicidality aftercare. Those who feel anxiety and restlessness can also reduce this with relaxation methods. These are best learned in a course so that they can then be practiced regularly at home on one’s own. There is a wide range of options: progressive muscle relaxation, autogenic training or fantasy journeys, for example. Yoga can also help. Through the combination of physical and breathing exercises, relaxation and meditation, it has a holistic effect on body, mind and soul.
What you can do yourself
Expressions of a desire to commit suicidal acts can be extremely stressful for the social environment and lead to situations of excessive demands. For this reason, extreme caution should be exercised when dealing with this sensitive topic. In the case of a suicidal intention, the person concerned is well advised to seek professional help. Working with a psychotherapist is advisable. Often, the person concerned is unable to overcome the emotional low on his or her own. It is always advisable to openly discuss one’s thoughts and emotions with confidants. However, if the desire to end one’s own life solidifies, professional help is needed. As soon as the desire for suicide develops into concrete plans, action must be taken. Under no circumstances should the affected person be alone or stay in areas and situations where the hopelessness seems to become even greater. In an emergency situation, the affected person can alert the emergency services himself or establish contact with a pastoral care service. In addition, it can be perceived as pleasant and helpful if there is an exchange with other formerly suicidal persons. Here there is a maximum degree of empathy, so that the affected person finds a good interlocutor who has experienced his stressful situation himself and can point out ways out.
