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.

Why you need crime scene cleanup services

By Alex Thomson

Crime scene cleanup or trauma scene cleanup after the death of someone either violently or naturally is by and large the responsibility of the victim’s family. Even till few years ago, there were a handful of cleaning companies that specialized in trauma cleaning service. But today this niche service has emerged as a lucrative business and there are many companies who provide this service.

Trauma cleaning service requires special experience, skills, equipment and expertise to deal with different types of bio-hazardous waste and dispose them efficiently with the minimum possible emotional stress to the victim’s family.

The most traumatic form of death is violent death and leaves the victim’s family feeling both victimized and traumatized. Coming to terms with the unnatural death of a loved one is in itself an uphill task for the bereaved family, and to top it they have to deal with other practical matters like making funeral arrangements, dealing with insurance issues, contacting surviving family and friends and locating wills. Furthermore, in case of violent crimes the police and the media are also involved. This can really overwhelm any family. Here is where trauma cleaning service comes to your rescue. They lighten one of the heaviest burdens, that is of dealing with the horrid murder cleanup. They will take care of the crime scene cleanup, ensuring that the scene is restored to its pre-incidental state as far as possible and in the most quick and efficient manner thus allowing you to deal with other important matters. Most service providers work discreetly and protect the confidentiality of the sufferer and family.

Most of the times, the crime scenes are so ghastly that they can induce additional emotional trauma in victim’s friends and family. By hiring professionals for cleanup, you can reduce this emotional stress. Immediately after death the nature begins its process of breaking down the body. Unattended death scene and dead bodies can be dangerous as it gives rise to blood borne pathogens, mold spores and bacteria. You may try to clean the area by yourself but the exposure may result in flu-like diseases or direct attack on the respiratory system. So it is advisable to leave this job to professionals who specialize in bio fluid and blood remediation.

The total cost involving a trauma scene cleanup will depend on a number of factors. One of the most major factors is that how many technicians will be needed for the job, how long will the job take and the quantity of hazardous material that needs to be treated and disposed of. It can range anywhere in the range of $100 to $1000 per hour. Some people might call this business as capitalizing on death but it is still essential and indispensable in case of a death.

Crime Scene Cleanup: What It Involves

A crime scene cleanup service is not without its complications. Crime scene cleaning encompasses restoring the crime scene to its original state. When a crime is usually discovered, crime scene cleaners are not called until after officers of the law, like the crime scene investigators, have done their jobs first and have given the go ahead for the cleaners to come in. If you intend to hire a crime scene cleanup company, you must make sure that they are well equipped and fit right to get the job done. A crime scene presents challenging conditions.

The Use Of Protective Gears:
Crime scenes can very well involve the use of hazardous or deadly substances. For safety reasons then, it has become imperative that crime scene cleaners use protective clothing, in addition to protective tools and gadgets. You must see to it that they have all the necessary protective gears and gadgets. The protective clothing can consist of disposable gloves and suits. A disposable gear is preferred nowadays since it offers the best protection against contamination. You use it one time and get rid of it. That way, the dangers of contamination is virtually brought down to zero percent. Protective clothing extends to respirators and the use of heavy-duty industrial or chemical-spill protective boots.

Among the gadgets that a crime scene cleaning company must have are special brushes, special sprayers, and wet vacuum. These special tools ensure added protection against getting into contact with the hazard could very well be present in the crime scene. There is large, special equipment such as a mounted steam injection tool that is designed to sanitize dried up biohazard materials such as scattered flesh and brain. You would also need to check if they have the specialized tank for chemical treatments and industrial strength waste containers to collect biohazard waste.

Of course, any crime scene clean up must have the usual cleaning supplies common to all cleaning service companies. There are the buckets, mops, brushes and spray bottles. For cleaning products, you should check if they use industrial cleaning products. A crime scene cleaning company must have these on their lists:

1 - Disinfectants including hydrogen peroxide and bleaches - The kinds that the hospitals used are commonly acceptable.

2 - Enzyme solvers for cleaning blood stains. It also kills viruses and bacteria.

3 - Odor removers such as foggers, ozone machines, and deodorizers

4 - Handy tools for breaking and extending such as saws, sledgehammers, and ladders

Established crime scene operators also equip themselves with cameras and take pictures of the crime scene before commencing work which. The pictures taken may prove useful for legal matters and insurance purposes. You never know which.

Needless to say, a specially fitted form of transportation and proper waste disposal is also needed. These requirements are specific. As you can imagine, crime scene cleaning is in a different category on its own. A home cleaning or janitorial service company may not be able to cope up with the demands of a crime scene. A crime scene cleanup service requires many special gears and tools that a home cleaning or a janitorial service company does not usually have or does not require. Crime scene cleaning if not done correctly can expose the public to untold hazards.

What Else To Look For In A Crime Scene Cleanup Company
You may also want to hire a company that has established itself. An experienced company with a strong reputation is always a plus but it could be expensive too. You will do well to balance your needs with what is your budget. There are several companies that offer specific prices such as for death scene clean up categories and suicide clean up categories. Most companies own a website and have round the clock customer service as receptionists.

When looking for a suitable crime scene cleaning service, among the first things you need to do is to scout for price quotes. Crime scene cleanup services usually provide quote after they have examined the crime scene and then they give you a definite quote. Factors that are usually considered include the number of personnel that will be needed to get the job done. It also includes the amount of time that might be needed. The nature and amount of the waste materials that need to be disposed will also be factored in. You can be sure that the more sophisticated equipments needed the more expensive it will get.

Crime Scene Cleanup And Your Insurance
For homeowners, the best approach is always to make sure that crime scene cleanup services clauses and provisions are written down on the contracts or policies. The inclusion of crime cleanup services clauses is very common and has become standard clause in most homeowner’s policy. Make sure that you are covered for this unforeseen event. Make sure that your policy directs the crime scene cleaning company to transact directly with the homeowner insurance company. A crime scene cleaning service is usually a standard clause in many homeowners’ insurance clause. These companies often do the paperwork in behalf of clients.

If for some reason you do not have such coverage by any policies relating to crime scene cleanup on your home, there are ways to keep your expenses controlled.

Finding the right company can be very taxing, especially that you have to deal with the emotional stress stemming from the crime itself, especially with a crime scene involving death.

There are many crime scene cleanup companies in operation nowadays. There are reliable professionals that you can hire and prices are relatively competitive. As of recently, crime-scene cleanup services can cost up to $600 for an hour of their service. A homicide case alone involving a single room and a huge amount of blood can cost about $1,000 to $3,000.

In recent years, crime scene cleaning has come to be known as, "Crime and Trauma Scene Decontamination or CTS. Basically, CTS is a special form of crime scene cleaning focusing on decontamination of the crime scene from hazardous substances such as those resulting from violent crimes or those involving chemical contaminations such as methamphetamine labs or anthrax production. This type of service is particularly common when violent crimes are committed in a home. It is rare that the residents move out of the home after it has become a scene of a crime. Most often, the residents just opt to have it cleaned up. That is why, it is very important to hire the best crime scene cleaning company out there. The place needs to be totally free from contamination of any kind. You have to make sure that the company is able to remove all traces of the violent crime that took place. This includes cleaning biohazards that are sometimes invisible to the untrained eye.

Legally speaking, federal laws state that all bodily fluids are deemed biohazards and you should make sure that the cleanup service company you hire understands this and includes it in the cleanup. These things appear as blood or tissue splattered on a crime scene. You must be able to hire a company that is equipped with special knowledge to safely handle biohazard materials. The company must have the knowledge what to search for in any give biohazard crime scene. For instance, the company should be able to tell clues such that if there is a bloodstain the size of a thumbnail on a carpet, you can bet that there is about a huge bloodstain underneath. Federal and State laws have their own laws in terms of transport and disposal of biohazard waste. Make sure that the company you hire has all the permits necessary.

It will also be a huge plus if you could hire people who not only has the special trainings but also who have the nature to be sympathetic. If you are close to the victim and have the cleaning done at the behest of the victim’s relatives, it would matter that the cleaners tread the site with some level of respect. It is a common site that family members and loved ones are often there at scene. In general, when looking for a suitable crime scene cleaners, you would take into considerations the kind of situation that the crimes scene presents and the demands that it require. Crime scene cleaning companies handle a wide variety of crime scenes and prices may vary from one to the other crime scene and one to the other company.

Each type of scene requires its own particular demands not only to make the crime scene look clean and neat on the surface but to make it germ free, and clean inside and to make it free from all deadly and infectious substances. The cleanup cost for biohazards may vary depending on degree of the bio hazard(s) on the scene. There may even be a category that changes the cleanup pricing which usually involves decomposing bodies and carcasses. Likewise, a cleanup of chemical hazards vary, depending on the amount of chemical hazards as well as the grades i.e. how hazardous the substance is in terms of human contact. Prices are also determined by the number of hours and personnel that it would to get the crime scene cleaned. In addition, the "gross factor" from crime scene involving death and gore needs to be taken under consideration regarding the chemicals that will be used as opposed to those crimes' that do not have gore involved.

Custodian’s stress-disorder suit restored

Meghann M. Cuniff / Staff writer

A custodian who sued her school district after being forced to clean up the bloody scene of a student’s suicide had her lawsuit reinstated Tuesday by the Washington Court of Appeals.

Debbie Rothwell, who still works at Lakeside High School in Nine Mile Falls, suffers from post-traumatic stress disorder, according to a lawsuit filed in May 2007 by her lawyer, William Powell, of Spokane. The 16-year-old student shot himself in the head inside the school’s main entrance in 2004. The lawsuit was dismissed in January 2008 by Spokane County Superior Court Judge Greg Sypolt, who ruled the incident was covered by the Industrial Insurance Act.

But the Court of Appeals, in a 2-1 ruling, disagreed and reinstated the suit.

“There are people who do clean up the mess after one of these horrible murders or suicides happen,” Powell said Tuesday, referring to private professionals. “But the superintendent in this case chose not to do that. He should have known better.”

Along with former Superintendent Michael Green, now superintendent of the Woodland School District in Western Washington, the lawsuit names the Nine Miles Falls School District, Stevens County Sheriff Craig Thayer, two sheriff’s detectives and an unidentified man as defendants.

None was available for comment. Like most civil suits in Washington, the complaint seeks unspecified damages.

Rothwell’s complaints center around her task of cleaning up the suicide scene, then being asked to move a backpack she later learned belonged to the victim and contained a suspicious device that authorities detonated using a robot.

She stayed at work until after 4 a.m., cleaning the mess of blood, brain and bone alone, becoming “emotionally distraught and physically ill” before returning to the school less than four hours later at Green’s orders to serve cookies and coffee to grieving students and keep the media from the school, according to the suit.

At issue in the court decisions was whether Rothwell’s claim of post-traumatic stress disorder fell under the industrial injury act, which prohibits lawsuits based on industry injury or occupational disease.

Judges John A. Schultheis and Dennis J. Sweeney ruled it didn’t because it wasn’t the result of one work order. Her trauma grew over several days, according to their written opinion. Judge Teresa C. Kulik dissented.