How I Stayed Alive When My Brain Was Trying to Kill Me, Revised Edition

To give and receive are one in truth.

—A COURSE IN MIRACLES

The World Health Organization reports that “close to 800,000 people die by suicide every year, which is one person every 40 seconds. There are indications that for each adult who died of suicide there may have been more than 20 others attempting suicide.”³

Suicide Awareness Voices of Education (SAVE) notes, “Suicide does not have one single cause. Certain factors like substance abuse and untreated depression can lead to higher risk of suicide just as having a trusted group of friends can help.”⁴ According to the Centers for Disease Control and Prevention (CDC), “Many people who die by suicide are not known to have a diagnosed mental health condition at the time of death.” The CDC goes on to report that many factors contribute to suicide among those with and without mental health conditions: relationship problems, crisis in the past or upcoming two weeks, problematic substance use, physical health problem, job or financial problem, criminal legal problem, or loss of housing.⁵

According to the American Foundation for Suicide Prevention (AFSP), “Suicide most often occurs when stressors and health issues converge to create an experience of hopelessness and despair.”⁶ The Jason Foundation reports, “Approximately 40 percent of youth suicides are associated with an identifiable precipitating event, such as the death of a loved one, loss of a valued relationship, parental divorce, or sexual abuse.”⁷

Suicide can happen to anyone in any family at any time. If someone you know is suicidal, the American Association of Suicidology (AAS) reminds us, our ability to recognize the signs and our willingness to do something about it could make the difference between life and death.

I compiled the following list of risk factors and warning signs—many of which are symptoms of depression—from the websites of the AAS, AFSP, SAVE, Jed Foundation, Trevor Project, Jason Foundation, and the CDC; as well as from a report by doctors Christopher W. Drapeau and John L. McIntosh, entitled, “U.S.A. Suicide: 2016 Official Final Data.” No one of these risk factors or warning signs on its own indicates a suicidal person. The people most at risk for attempting suicide are those who exhibit or have experienced several of the following.

SITUATIONS

Previous suicide attempts. Four out of five people who die by suicide have made at least one previous attempt. Half of all children who have made one suicide attempt will make another, sometimes as many as two a year until they “succeed.”
Family history of mental disease, suicide, violence, depression, or substance abuse.
Lack of cohesion in the home, high levels of violence and conflict, a lack of parental support, and alienation from and within the family.
Prolonged stress, such as harassment, bullying, relationship problems, or unemployment.
Stressful life events, like rejection, divorce, financial crisis, other life transitions, or loss.
Changes in gender roles and expectations, issues of conformity and assimilation, and feelings of victimization. The AAS notes, “Being LGBT is not a risk factor in and of itself; however . . . minority stressors such as discrimination and harassment are directly associated with suicidal behavior.”
In some cultures (particularly Asian and Pacific), suicide may be seen as a rational response to shame.
Exposure to another person’s suicide, or to graphic or sensationalized accounts of suicide.
Situational stressors exacerbated by changes in family structure, such as death, divorce, remarriage, moving to a new city, or financial instability.
Serious physical health conditions involving pain or traumatic brain injury.
Access to a firearm. The AAS writes, “Although firearm access does not cause suicidal thoughts, it makes it more likely that suicidal individuals will die.”⁸ In 2016, firearm suicides ranked first in suicide methods—22,938 of 44,965 suicides; or 51 percent.⁹ Surprisingly, even when a child has made one attempt with a firearm, parents often fail to remove guns from the home.
Experienced violence and trauma in the form of physical, sexual, domestic, or child abuse.
Experienced poor parent-child communication or neglect.
Experiencing unusual stress due to combat, traumatic situations with employment, or traumatic life events and/or major life changes (such as death of a friend, spouse, or family member, separation, divorce, the end of a relationship, job loss, problems at work, impending legal action, impending loss, loss of honor, failing academic performance or impending exams).
Youth with high levels of exposure to community violence.
Recent imprisonment or upcoming release.
Medical condition; chronic pain; long-term illness.
Barriers to accessing mental health treatment.
Co-occurring substance abuse and mental disorders.
Unwillingness to seek help because of the stigma attached to mental and substance abuse disorders and/or suicidal thoughts.
The influence of significant people—family members, celebrities, peers who have died by suicide—through direct personal contact or inappropriate media representation.
Life events commonly associated with elderly suicide are: the death of a loved one; physical illness; uncontrollable pain; fear of dying a prolonged death that damages family members emotionally and economically; social isolation and loneliness; and major changes in social roles, such as retirement. The widowed, divorced, and recently bereaved are at high risk, as are depressed individuals and those who abuse alcohol or drugs. (Depression is not a normal part of aging.)
Many children who die by suicide are anxious and insecure and have a desperate desire to be liked and to do well. Their expectations are so high that they demand too much from themselves and are constantly disappointed. A traumatic event that may seem minor viewed from an adult perspective—being jilted, failing a test, getting into an accident—can be enough to push a child over the edge into a severe depression.

BEHAVIORS

Threatening suicide; seeming preoccupied with death; or talking about being a burden to others, having no reason to live, or feeling hopeless and helpless. For example, “Nothing matters anymore,” “What’s the use in living?,” “No one will miss me if I’m gone,” or “It’s never going to get any better.”
Talking about feeling trapped, like there is no way out, or being in unbearable pain.
Talking or writing about death, dying, or suicide, when these actions are out of the ordinary.
For teens and young adults—running away, rebellion, difficulty tolerating praise or rewards, poor concentration, or poor school performance.
Crying for no apparent reason.
Experiencing an inability to feel good about themselves or express joy.
Withdrawing from family, friends, or social activities.
Losing interest in hobbies, work, or school.
Increasing drug or alcohol use or use of other medications. Teens may try alcohol or other drugs to relieve depression. Unfortunately, the drugs themselves have a depressant effect by lowering inhibitions against self-injurious behavior. In any age group, drug and alcohol use can cause people to die by rash, impulsive acts that they might not do sober.
Showing marked changes in behavior and attitude that have no apparent reason or last for a significant period of time: for example, a shy person becomes a thrill-seeker, or an outgoing person becomes withdrawn, unfriendly, and disinterested.
Behaving recklessly; taking unusual risks and acting impulsively.
Breaking the law; fighting (with parents); getting in trouble at school.
Self-mutilation: the Jason Foundation notes, “Self-mutilation or self-harm behaviors include head banging, cutting, burning, biting, erasing, and digging at wounds. . . . Because most self-mutilation behaviors are not suicide attempts, it is important to be cautious when reaching out to the youth and not to make assumptions.”
Failing to take prescribed medicines or follow required diets.
Acquiring a weapon or seeking to access potentially lethal means, such as guns, knives, pills, high windows, or poisons.
Putting affairs in order, writing a will, making final arrangements, giving away prized possessions, or visiting or calling people to say good-bye. Young people making such arrangements often give away treasured items, such as a favorite book or a CD collection.

PHYSICAL CHANGES

Change in eating or sleeping habits; sleeping too much or too little; loss of appetite; sudden weight gain or loss; unexplained fatigue or apathy.
Lack of energy and loss of interest in life.
Change of sexual interest; loss of sex drive.
Sudden change in appearance.
Loss of interest in personal appearance.
Increased frequency of minor illnesses, complaints of aches and pains.

THOUGHTS AND EMOTIONS

Depressed mood—most of the day, every day, deepening depression.
Becoming suddenly cheerful after a period of depression.
Dramatic mood and personality changes—one minute high, next minute low.
Mental diseases, particularly depression and bipolar disorder. According to the Jason Foundation, “One in ten youth suffer from mental disease serious enough to be impaired. . . . 60 percent of those who complete suicide suffers from depression.”
Experiencing rage, uncontrolled anger, or talking about seeking revenge.
Anxiousness; irritability; restlessness.
Thoughts of death, punishment, or the option of suicide.
Deep sadness or guilt; feelings of shame, humiliation, or worthlessness.
Having trouble working, concentrating, or making decisions.
Talking about or feeling helpless, hopeless, or worthless.
Inability to see beyond a narrow focus.
Loneliness—lack of support from family and friends.
Rejection—feeling marginalized or socially isolated.

To help remember the warning signs of suicide, the AAS recommends using this mnemonic, which I suggest you write down and keep accessible: IS PATH WARM?

I	Ideation
S	Substance Abuse
P	Purposelessness
A	Anxiety
T	Trapped
H	Hopelessness
W	Withdrawal
A	Anger
R	Recklessness
M	Mood Changes