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.

National Study Finds Highest Rate Of Suicide On Wednesdays

By ARIELLE LEVIN BECKER

The Hartford Courant

July 11, 2009

Nearly a quarter of suicides in the U.S. occur on Wednesdays, about twice as many as almost every other day of the week, a new study has found.

The study, published in the journal Social Psychiatry & Psychiatric Epidemiology, contradicts earlier findings that suicides are more common on Mondays and left experts puzzling over what may be behind Wednesday's grim distinction.

Is it something about the middle of the week? Job stresses piling up, potentially overwhelming people who already see their problems as insurmountable?

"It may be just that it feels like there's no way out on Wednesday, [it's] too long to wait for the weekend," said Theodore Mucha, medical director at the Institute of Living at Hartford Hospital. Like other experts, he cautioned that his explanation was just a guess.

Researchers Augustine J. Kposowa and Stephanie D'Auria at the University of California, Riverside, examined data from U.S. death records from 2000 to 2004, focusing on adult suicides.

They found that 24.6 percent of suicides occurred on Wednesdays. The next-highest rates were 14.4 percent on Saturdays and 14.3 percent on Mondays. The fewest suicides occurred on Thursdays — 11.1 percent.

Kposowa and D'Auria also found that more suicides occurred in summer and spring than in fall or winter, contrasting with traditional thinking that winter months bring more risk of suicide.

Other parts of the study were consistent with previous research, showing that men are more likely to take their lives than women, and people who are divorced, white, educated or living in non-metropolitan areas have a higher risk of suicide.

The day of the week findings represent something new.

"This really does tell us something different," said Nina Heller, a social work professor at the University of Connecticut. "What it doesn't yet tell us is the why of that."

Heller said she had been "scratching my brain" since learning of the study, trying to think of a reason for the Wednesday peak in suicides. Maybe, she said, people who are already suffering from a mental illness and struggling to get through the week see Wednesday as a halfway point. "Perhaps they can't push any further," she said.

People who take their own lives often have lost perspective, becoming so despondent they lose track of things that might help them get through the day, said Charles Atkins, attending psychiatrist at Waterbury Hospital.

"One of the obvious speculations about Wednesday is that it's work-related, that people have become so caught up in the stress of the work week that whatever it is that's going on or is on their plate seems unsurmountable and suicide seems like a way out," he said.

Other national studies have indicated that working Americans typically list their jobs as their top source of stress, which Atkins said may lend weight to the idea that the Wednesday suicide peak could be related to the work week.

Kposowa also pointed to workplace stress as a potential explanation and believes changes in Americans' work and family life may be behind the shift in suicide's concentration from Mondays to Wednesdays.

Increased economic competition worldwide has threatened job security for many workers, heightening stress, frustration and even feelings of betrayal, said Kposowa, a sociology professor. "Individuals work harder and harder, but seem to be losing ground; they have little or nothing to show for their labor — especially among those who depend on others for wages," he wrote in an e-mail. "It is highly likely that the middle of the week (represented by Wednesday) is when these stressors and feelings of hopelessness are at their highest."

People may have once viewed Wednesday as the day you got over in order to look forward to a relaxed weekend, he said. But perhaps many Americans now see the next weekend as too far away.

Kposowa suggested that suicide prevention hot lines examine which days of the week call volumes are highest and consider placing more staff on Wednesdays, Saturdays and Mondays. Mental health workers might also consider scheduling more patient appointments on Wednesdays, he said.

Several mental health workers said they had not noticed a link between Wednesdays and an increased risk of suicide. More than 25,000 people kill themselves in the U.S. each year, an average of slightly more than one per day in each state, so trends that might be apparent from thousands of cases would not likely be noticed by individual mental health workers or programs.

A Courant analysis of Connecticut figures showed a different day distribution: from 2001 to 2004, no day stood out as sharply as Wednesday did in the national study. Most suicides — 16.7 percent — occurred on Tuesday, while 16.4 percent occurred on Monday and 14.5 percent on Wednesday. Thursday had the lowest occurrence, 12.1 percent. The data showed 966 adult suicides, a small fraction of the 131,636 in the national sample.

Seasonal suicide variations in Connecticut did reflect the national findings, with most occurring in summer and spring and fewer in winter and fall.

The seasonal figures contradict previous findings, but they didn't surprise Michael Levinson, director of clinical services at the Capitol Region Mental Health Center. He works nights in an emergency room and has gotten used to seeing more psychiatric emergencies in the spring.

"We always sort of look forward to spring gritting our teeth," he said.

While traditional thinking has focused on winter, with its cold weather and lack of sunlight, as a more common season for suicide, Levinson has a theory about why it may not be so: People think it's normal to be depressed in the winter. "Spring is the time of year when people are supposed to be rejuvenated and outside and enjoying themselves, and if you're not, it makes you feel comparatively worse than everybody else, which may make you feel more hopeless," he said.

Courant staff writer Matthew Kauffman contributed to this story.

The United Way's hotline for suicide prevention is available 24 hours a day and can be reached by dialing 2-1-1 The Capitol Region Mental Health Center's mobile crisis team, which serves the Hartford area, can be reached at 860-297-0999