6 reasons why people commit suicide

by Alex Lickerman, MD

Though I’ve never lost a friend or family member to suicide, I have lost a patient.

I have known a number of people left behind by the suicide of people close to them, however. Given how much losing my patient affected me, I’ve only been able to guess at the devastation these people have experienced. Pain mixed with guilt, anger, and regret makes for a bitter drink, the taste of which I’ve seen take many months or even years to wash out of some mouths.

The one question everyone has asked without exception, that they ache to have answered more than any other, is simply, why?


Why did their friend, child, parent, spouse, or sibling take their own life? Even when a note explaining the reasons is found, lingering questions usually remain: yes, they felt enough despair to want to die, but why did they feel that? A person’s suicide often takes the people it leaves behind by surprise (only accentuating survivor’s guilt for failing to see it coming).

People who’ve survived suicide attempts have reported wanting not so much to die as to stop living, a strange dichotomy but a valid one nevertheless. If some in-between state existed, some other alternative to death, I suspect many suicidal people would take it. For the sake of all those reading this who might have been left behind by someone’s suicide, I wanted to describe how I was trained to think about the reasons people kill themselves. They’re not as intuitive as most think.

In general, people try to kill themselves for six reasons:

1. They’re depressed. This is without question the most common reason people commit suicide. Severe depression is always accompanied by a pervasive sense of suffering as well as the belief that escape from it is hopeless. The pain of existence often becomes too much for severely depressed people to bear. The state of depression warps their thinking, allowing ideas like “Everyone would all be better off without me” to make rational sense. They shouldn’t be blamed for falling prey to such distorted thoughts any more than a heart patient should be blamed for experiencing chest pain: it’s simply the nature of their disease.

Because depression, as we all know, is almost always treatable, we should all seek to recognize its presence in our close friends and loved ones. Often people suffer with it silently, planning suicide without anyone ever knowing. Despite making both parties uncomfortable, inquiring directly about suicidal thoughts in my experience almost always yields an honest response. If you suspect someone might be depressed, don’t allow your tendency to deny the possibility of suicidal ideation prevent you from asking about it.

2. They’re psychotic. Malevolent inner voices often command self-destruction for unintelligible reasons. Psychosis is much harder to mask than depression — and arguably even more tragic. The worldwide incidence of schizophrenia is 1% and often strikes otherwise healthy, high-performing individuals, whose lives, though manageable with medication, never fulfill their original promise.

Schizophrenics are just as likely to talk freely about the voices commanding them to kill themselves as not, and also, in my experience, give honest answers about thoughts of suicide when asked directly. Psychosis, too, is treatable, and usually must be for a schizophrenic to be able to function at all. Untreated or poorly treated psychosis almost always requires hospital admission to a locked ward until the voices lose their commanding power.

3. They’re impulsive. Often related to drugs and alcohol, some people become maudlin and impulsively attempt to end their own lives. Once sobered and calmed, these people usually feel emphatically ashamed. The remorse is usually genuine, and whether or not they’ll ever attempt suicide again is unpredictable. They may try it again the very next time they become drunk or high, or never again in their lifetime. Hospital admission is therefore not usually indicated. Substance abuse and the underlying reasons for it are generally a greater concern in these people and should be addressed as aggressively as possible.

4. They’re crying out for help, and don’t know how else to get it. These people don’t usually want to die but do want to alert those around them that something is seriously wrong. They often don’t believe they will die, frequently choosing methods they don’t think can kill them in order to strike out at someone who’s hurt them—but are sometimes tragically misinformed. The prototypical example of this is a young teenage girl suffering genuine angst because of a relationship, either with a friend, boyfriend, or parent who swallows a bottle of Tylenol—not realizing that in high enough doses Tylenol causes irreversible liver damage.

I’ve watched more than one teenager die a horrible death in an ICU days after such an ingestion when remorse has already cured them of their desire to die and their true goal of alerting those close to them of their distress has been achieved.

5. They have a philosophical desire to die. The decision to commit suicide for some is based on a reasoned decision often motivated by the presence of a painful terminal illness from which little to no hope of reprieve exists. These people aren’t depressed, psychotic, maudlin, or crying out for help. They’re trying to take control of their destiny and alleviate their own suffering, which usually can only be done in death. They often look at their choice to commit suicide as a way to shorten a dying that will happen regardless. In my personal view, if such people are evaluated by a qualified professional who can reliably exclude the other possibilities for why suicide is desired, these people should be allowed to die at their own hands.

6. They’ve made a mistake. This is a recent, tragic phenomenon in which typically young people flirt with oxygen deprivation for the high it brings and simply go too far. The only defense against this, it seems to me, is education.

The wounds suicide leaves in the lives of those left behind by it are often deep and long lasting. The apparent senselessness of suicide often fuels the most significant pain survivors feel. Thinking we all deal better with tragedy when we understand its underpinnings, I’ve offered the preceding paragraphs in hopes that anyone reading this who’s been left behind by a suicide might be able to more easily find a way to move on, to relinquish their guilt and anger, and find closure. Despite the abrupt way you may have been left, those don’t have to be the only two emotions you’re doomed to feel about the one who left you.

Alex Lickerman is an internal medicine physician at the University of Chicago who blogs at Happiness in this World.

Appeals panel agrees that failure to read document doesn't null contract

KEITH ARNOLD, Daily Reporter Staff Writer
A Franklin County appellate panel was unable to conclude that the Franklin County Municipal Court's determination in a breach of contract suit between a specialty home-cleaning service and the next of kin of a Grove City man who died in his home was against the manifest weight of the evidence in a recent decision.

"Upon our review of the record, we find no error in the trial court's determination that an enforceable contract existed between the parties," 10th District Court of Appeals Judge Patrick McGrath wrote for the 3-0 court.

The appellate court's holding overruled Nancy Buffington's claim that the trial court was mistaken to find that the contract between her and the cleaning service was enforceable and, therefore, obligated the woman to utilize the company's services per the agreed terms.

Buffington's father died in his home on Nov. 10, 2005, case summary provided. The man's body was discovered one-and-a-half to two days after his death. Approximately one week later, the personal belongings were removed from the home and it was listed for sale.

On Jan. 14, 2006, Buffington contracted for the services of Aftermath Inc., which provides biological remediation and cleanup services. According to the contract, the woman agreed to pay for cleanup services concerning an unattended death in the Grove City home.

Aftermath's complaint alleged that after the firm rendered services, appellant refused to pay the amount due under the contract. After a trial to the bench, the trial court concluded that a valid written contract existed between the parties and that the company was entitled to payment for the services rendered in accordance with the contract. The court awarded damages in the amount of $6,189.36 to Aftermath.

The panel noted Buffington signed both a site cleanup agreement and a fee agreement for non-insurance-related jobs. Additionally, the court rejected the woman's claim there existed no evidence that she understood or agreed to biological remediation of her father's home.

"... As noted by the trial court, appellant's stated failure to read the documents prior to signing them is of no consequence as it is well-established that the failure to read the terms of a contract is not a valid defense to enforcement of the contract," as in Haller v. Borror Corp. (1990), 50 Ohio St.3d 10, 14.

"Further, appellant's argument that she was 'mistaken' equally fails because 'relief for a unilateral mistake of material fact will not be provided where such mistake is the result of the negligence of the party seeking relief,'" as in Hikmet v. Turkoglu, 10th Dist. No. 08AP-1021, 2009-Ohio-6477, and Marshall v. Beach (2001), 143 Ohio App.3d 432, 437.

Fellow 10th District Judge Susan Brown and John Connor joined McGrath to form the majority.

The case is cited as Aftermath Inc. v. Buffington, 2010-Ohio-19.

Date Published: January 19, 2010