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SUICIDE AMONG PERSONS

WITH MENTAL ILLNESS

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On the order of 1% of the general population kill themselves. However, persons suffering from certain mental illnesses are particularly susceptible to suicide ideation and suicide attempts. Their suicide rate may be 10 or 20 times higher than for the average citizen. Unfortunately, not a great deal is known about effective methods of combating suicide, because it is considered unethical to conduct studies on such matters.

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Severe depression:

Elderly persons who are terminally ill, for whom the quality of life has shrunk to zero, are often not depressed when they seek assistance in ending their life, or when they commit suicide. However, suicide is otherwise generally associated with severe depression.

One study showed that only 3% of persons who completed suicide had been receiving adequate antidepressant therapy. 7 There is a common belief that patients who are recovering from severe depression -- particularly after a week or two of antidepressant treatment -- are at high risk for suicide.

It is generally accepted that abuse of alcohol or other drugs, coupled with depression, greatly increases the likelihood of suicide. 8

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Bipolar Disorder:

This is sometimes called Bipolar Affective Disorder, Manic Depressive Illness, or Manic Depression. It is a type of disorder in which the individual suffers extremes in mood: periods of deep depression alternating with periods of extreme excitement or mania. Symptoms often first appear in the late teen years. 

Among persons with bipolar disorder, 

bulletThe highest risk for attempted suicide is shortly after the onset of symptoms.
bulletAbout 20% of those whose disorder is not treated commit suicide at some time during their lifetime.
bulletAbout 25% to 50% will attempt suicide at least once.
bulletAbout 19% will die by suicide. 4
bulletMen and women commit suicide at equal rates. This is different from persons who do not suffer from Bipolar Disorder. In the general population, four times as many men as women commit suicide.
bulletCreative individuals, such as artists, writers, musicians, composers, etc. appear to suffer disproportionately from mood disorders, and suicidal ideation.

Fortunately, medication will alleviate symptoms in about 80% of cases, thus greatly reducing the risk of suicide.

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Borderline Personality Disorder:

Persons with borderline personality disorder (BPD) "display poor control or dyscontrol of their emotional states. It is characterized by impulsivity, self-destructive behavior, problems with anger, lability of emotions and stormy interpersonal relationships." 3

bulletAbout 10% will end their life through suicide.
bulletAbout 75% have made at least one suicide attempt; almost 50% have made at least one severe attempt.
bulletAbout 80% have engaged in self-mutilation. This usually takes the form of cutting or burning their skin -- often on their forearms.
bulletSince many persons with BPD repeatedly self-mutilate as a reaction to relatively minor stressors in their life, they are often dismissed as attention seekers. Their suicidal ideation may not be treated seriously.
bulletDialectical Behavior Therapy (DBT) has been shown to reduce suicide attempts, incidences of self-injury, and inpatient hospitalization. DBT combines cognitive behavioral therapy with skills training.

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Schizophrenia:

Schizophrenia is "the most persistent and disabling of the major mental illnesses." 6 The term means "split-mindedness;" it refers to a disruption of the balance among the four mental functions: thinking, feeling, perception and behavior control. Many incorrectly confuse it with split or multiple personality, a disorder that is either non-existent or phenomenally rare. Schizophrenia effects about 1% of the population. Symptoms, such as delusions, hallucinations, illusions, and thought disturbances, usually first appear between the ages of 16 and 30. A predisposition to schizophrenia appears to be caused by a chemical and/or structural defect in the brain. It is then triggered by an external stressor. Long term, about one in four recover fully; another one in four require long-term care; the rest make a partial recovery.

bulletAbout 10% of persons diagnosed with schizophrenia will die an unnatural death - usually by suicide.
bulletAbout 40% are known to have attempted suicide. 5
bulletThey are not generally driven to committing suicide as a result of their internal voices or delusions. One expert, Dr Jock Cleghorn, estimated in 1992 that only 2% of suicides by persons with schizophrenia did so in response to their voices. They usually kill themselves because of a collapse of their support network, the loss of their job, loss of accommodation, death of a beloved relative, etc.
bulletRisk factors include: having a good educational background, having high performance expectations, being recently released from hospital, and going through an upswing in the disorder, having a sudden change in mood from gloomy to cheerful.

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Iatrogenic (physician induced) disorders:

During the 1980's and early 1990's, many mental health therapists used various experimental recovered memory therapies to reconstruct what were believed to be their patients' long-suppressed memories of childhood sexual abuse. About 17% of the patients who had recovered images of sexual abuse, eventually concluded that they had been the victims of Satanic Ritual Abuse (SRA). These images coalesced into what felt like memories of real events from the past. It was only in the 1990's that a consensus grew that these therapeutic methods were quite unreliable and that most of the memories that they created were of events which never actually happened. Over a decade of police investigations have produced a total lack of hard evidence that SRA exists. Belief in Satanic Ritual Abuse has now largely collapsed.

During the same period, some mental health therapists started to diagnose many of their patients as suffering from Multiple Personality Disorder (MPD; a.k.a. Dissociative Identity Disorder - DID). They seem to exhibit many discrete personalities, called alters, who appeared within the single individual. Belief in the widespread existence of MPD faded rapidly during the late 1990's. Many, if not most, therapists believe that alters are actually created by the therapist and patient during therapy without either being aware of the process.

False memories of Satanic Ritual Abuse, and invalid diagnosis of MPD/DID have been responsible for many suicides. Unfortunately, statistics are not available that would give an indication of how many physician-induced suicides have actually occurred. 

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References:

  1. "Facts about Bipolar Disorder and Suicide," American Foundation for Suicide Prevention, at: http://www.afsp.org/about/manicdep.htm  
  2. http://www.schizophrenia.com
  3. Barbara Stanley, "Suicidal behavior in borderline personality disorder: The scope of the problem and psychotherapeutic approaches," at: http://www.afsp.org/education/bpd.htm 
  4. Leonardo Tondo et al., "Lithium and suicide risk in bipolar disorder," at: http://www.afsp.org/education/tondo.htm
  5. "Pamphlet #23: Schizophrenia and suicide," World Fellowship of Schizophrenia, at: http://www.world-schizophrenia.org/publications/
  6. "Pamphlet #1: No family is immune," World Fellowship of Schizophrenia, at: http://www.world-schizophrenia.org/publications/
  7. Isometsa, et al., American Journal of Psychiatry, (1994) 151: Pages 530-36, as quoted in Reference 8
  8. "Ask the expert: Depression and suicide," at: http://www.mhsource.com/expert/exp1121597b.html.    

Copyright 2000 by Ontario Consultants on Religious Tolerance
Originally written: 2001-FEB-6
Latest update: 2001-FEB-11
Author: B.A. Robinson

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