The suicides this week of celebrity chef, author and CNN host Anthony Bourdain and fashion designer Kate Spade brought up more questions than we can answer.
The tragic deaths of these two wealthy, successful and famous people prompts us to ask ourselves: Why did they take their own lives? Why do so many other people do the same thing? Can anything be done to prevent suicides?
As a physician who is frequently the first line of defense against depression that in the worst cases can lead to suicide, let me address a few of these questions:
Why have U.S. suicide rates climbed so dramatically, up 30 percent in half of our states, with 45,000 suicides in 2016 alone?
I believe that the anger, meanness and contagiousness of social media help to spread depersonalization. This is compounded by the isolation inherent in smartphone technology. Devices connect us with other devices, but leave us disconnected from each other.
Have you ever seen two teens sitting back to back texting each other? I have. True, this is the natural path from Alexander Graham Bell forward, but touching, or hugging, or looking someone in the eye is too frequently lost.
We have to communicate better and care more about each other. And while we are at it, it wouldn’t hurt to diffuse our anger over political differences.
And sadly, when the suicide of famous people makes news, as horrible at it is, some depressed people may decide to copy the action.
Does a patient's history play a role in suicide?
Yes, it does. Kate Spade’s sister reports that Kate had a long history of depression.
Anthony Bourdain has reported being depressed himself. And he also had a history of opioid addiction, which can increase the risk of suicide.
People with a history of depression are more likely to be at risk for impulsive suicide.
What are the signs of severe depression or impending suicide?
Patients who are severely depressed don’t function well. They can feel very sad, have trouble with work and personal relationships, and have difficulty sleeping, eating and getting out of bed in the morning.
Don’t be afraid to ask someone you know and care about how they are feeling. According to the Suicide Prevention Resource Center, in 2016 over 10 million Americans thought about suicide, 2.8 million had a plan and 1.1 million attempted it.
As a primary care physician who screens all my patients for depression, I ask each of them questions to determine if they are depressed. If so, I ask about suicide. If I encounter a patient thinking about suicide I urge immediate psychiatric care. If I encounter someone with a suicidal plan, I mandate it.
What can you do about the problem of suicides?
What if you are not a physician, or if the person who is suicidal is not your patient? The answer is that you can be on the lookout for telltale signs, just as a physician is.
National suicide hotlines aside, you can always call 911. I did that once for a friend, and he has never stopped blaming me for it. On the other hand, he said he was calling me to say goodbye for the last time.
Another friend, very dear to me, came to have lunch with me many years ago and I never saw him again after that. It turned out I was part of the goodbye circuit. After this experience I became vigilant in looking for clues, whether in my role as a physician, or my role as a friend.
Is suicide selfish?
My religious beliefs and those of many of my readers have taught me that life is precious and we must do our best to cherish every second, whether it is filled with pain or joy. That is easy to aspire to, but obviously difficult to attain – especially if you are in pain from an illness.
As a physician, working with thousands of dying patients over many years has taught me to cherish life while I and my family are in good health. As a writer, I was taught early on by a prominent professor that all great writing occurs in the shadow of the fluttering of the wings of death. This is true for all great art.
Survivors of a family member who commits suicide frequently ask: How could the person be so be so selfish to inflict so much pain? The answer, unfortunately, is that the suicidal patient isn’t thinking of it that way.
It isn’t a matter of selfishness so much as being caught by a quicksand of negative thoughts that drag the patient deeper and deeper until he or she no longer sees a way out. As a medical professional, it is my job to reach an arm in and grab onto the person before it’s too late. As a caring friend or family member, it’s your responsibility too.