Line #150 UsefulNotes/Suicide


1	This is a {{Useful Note\|s}}. Its purpose is to explain how things work in RealLife so that you can compare it to how it's used in fiction. Media as a whole has the unfortunate habit of [[BetterToDieThanBeKilled romanticizing]], [[SuicideIsShameful stigmatizing]], [[SuicideAsComedy playing for laughs]], or otherwise inaccurately portraying suicide, so this page will help you better understand who might die by suicide or why they might do it.
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3	We would be remiss [[OurLawyersAdvisedThisTrope if we didn't remind you]] that Website/TVTropes does not employ any medical, law enforcement, or mental health professionals, and this is absolutely not the place to be if you or someone you know is ''actually'' suicidal and wants to learn what to do. That being said, this is quite an extensive page, and we do hope you learn something. In fact, many lives could have been saved had people understood suicide correctly and not been laboring under [[TheCoconutEffect misconceptions wrought by popular culture and media]]. If nothing else, suicide is not easy to write convincingly without the risk of being [[{{Wangst}} melodramatic]] or [[{{Narm}} unintentionally funny]], and this page can help with that as well.
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5	Part of the problem with an in-depth analysis, though, is that no two people are alike, and what applies to one person may not apply to another. Some of the things you read in this page may even seem a little self-contradictory, but it's just a way of emphasizing that not everything applies to everyone. Bottom line: ''(a)'' learn all the facts, ''(b)'' remember that there is no magic solution that applies to every case, and ''(c)'' knowing what's wrong is only half the battle -- someone who's suicidal needs to seek professional help (and if the professional is controlling or abusive, ''keep looking'').
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7	[[foldercontrol]]
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9	[[folder:Causes]]
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11	We have to start by talking about UsefulNotes/{{depression}}, which is one of the single most common reasons behind suicide, although by no means the only one.\
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13	Most cultures have a negative view of depression, but how negative that view is can vary significantly between cultures. Western societies tend to view it as an illness or condition that requires professional treatment and support. Eastern societies tend to trivialize it and may not bother to treat it at all, creating a serious social stigma around it. Some cultures may even glorify suicide and thus amplify the stigma of seeking treatment for depression; UsefulNotes/{{Japan}}, for instance, with its elaborate tradition of [[{{Seppuku}} ritual suicide]], has the ninth-highest suicide rate in the world. But any way you look at it, depression is stigmatized so much that sufferers are reluctant to seek help for it. They may even insist that they feel normal and [[DontYouDarePityMe refuse help if offered]]. In fact, persistent refusal of help is as much a warning sign as directly asking for it.\
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15	It is ''extremely'' important for family and friends of someone who is suicidal need to be as supportive as possible. If a person is suffering from depression -- and is thus already under considerable mental stress -- ignoring or dismissing their problems, once discovered, can reinforce feelings of worthlessness already caused by the social stigma and make the sufferer feel even more suicidal than before.\
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17	[[{{UsefulNotes/BipolarDisorder}} Bipolar]] depression, the low mood phase of Bipolar Disorder, is especially deadly. People with Bipolar might be up to ''three thousand'' percent as likely to attempt suicide as the general population. Getting professional help for Bipolar Disorder is therefore as important as getting professional help for heart disease or cancer - if untreated it is often progressive and lethal.
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20	Signs of depression include:
21	* Widespread changes in brain activity -- clinically speaking, becoming agitated (constant irritability, stress, and anxiety) or lethargic (mentally and physically). Either way, it leads to an inability to feel "normal".
22	* Over-general memory, or the inability to pinpoint specific periods of happiness or depression, leading to [[AccentuateTheNegative understatement of the former and overstatement of the latter]]. It's not necessarily caused by depression, but it correlates with it strongly.
23	* Disruption of normal sleeping patterns -- usually [[TheInsomniac insomnia]], but sometimes [[{{Sleepyhead}} hypersomnia]] (excessive sleeping) or [[TheNightOwl changes in sleep cycles]].
24	* A weakened immune system, which can manifest in interesting ways, such as taking longer to heal than normal.
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26	Depression can be exacerbated by actual bad things happening to someone. One way to think of depression is as an inability to cope with other pain or trauma. But this just reinforces the importance of a person's family and friends being as supportive as possible, because dismissing these feelings as the result of something external to the sufferer will again reinforce that person's feelings of worthlessness. Financial loss is actually a particularly nasty exacerbator, as not only is it bad in and of itself, but it also often leaves a sufferer unable to afford treatment for their depression.\
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28	It's tempting to solve the problem with medication. Drugs are actually pretty good at treating depression, as they can correct the chemical imbalances in the brain that can lead to depression, but they're never a solution in and of themselves. A balanced treatment of depression involves therapy first, and medication second. Even without the physical recovery of a suicide attempt, getting over depression can take anywhere from months to several years.\
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30	While depression is the most common cause of suicidal thoughts, there are several other mental illnesses that can lead to suicide:
31	* Anorexia nervosa, which may not be the most common cause of suicide, but is the mental illness most ''likely'' to lead to suicide if you have it. Most anorexics suffer from [[ThePerfectionist extreme perfectionism]] and can be driven to suicide out of failure to meet their unreasonably high standards.
32	* Schizophrenia, which if untreated (or badly treated) also causes suicide at a higher rate than depression. Even the ''treatment'' for schizophrenia can lead to suicide; schizophrenia medications can have horrifically nasty side effects, including crippling sedation, massive weight gain, NMS, and tardive dsykinesia (in LaymansTerms, [[BuffySpeak very bad medical things]]). Sufferers are often left with the choice between not taking the meds (and risk getting sectioned or becoming a [[CrazyHomelessPeople bag person]]) or taking the meds and dealing with all the side effects. Suicide may appear to be the best possible option here.
33	* Post-traumatic stress disorder and complicated grief, although that's at least in part because depression is often co-morbid to both.
34	* Borderline personality disorder, as the labile moods and extreme mood swings, lack of a "self" to temper irrational thoughts, predisposition to feel hated and "evil", and extreme impulsivity all tend to lead to chronic suicidal ideation and spur-of-the-moment attempts.
35	[[/folder]]
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37	[[folder:Common Misconceptions]]
38	Now we get into what Hollywood gets wrong about suicide -- about who would do it, why they would do it, and how to help them.
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40	!!!Who might commit suicide
41	* Misconception: '''Only men are serious when they attempt suicide; women [[AttentionWhore just do it for attention]].''' A downright dangerous line of thought -- ''every'' attempt at suicide should be seen as a cry for help. This misconception derives mostly from stereotypes of the HystericalWoman who always throws invented problems at you. Sadly, this line of thought can be seen even in older professional handbooks, and media has been persistent in perpetuating the DoubleStandard. It is true that [[LiesDamnedLiesAndStatistics statistically]], women attempt suicide more often than men and men succeed more often than women, but this can be chalked up to a few factors which are also rooted in traditional gender mores:
42	** Women tend to be more subject to physical and emotion trauma, which can exacerbate existing depression or [[DrivenToSuicide drive someone to suicide]];
43	** Women tend to be diagnosed more often with personality disorders that have a manipulative component to them (like {{narcissist}}ic personality disorder or borderline personality disorder), meaning that while a big chunk of them might ''actually'' just be doing it for attention, there's an equally higher proportion of men doing the same thing who fly under the radar; and
44	** Women tend to use less violent methods of suicide like drugs or knives, which also tend to be less successful; they're more elegant and leave less of a mess, and societal norms have taught women to care more about such things. When men do it, more often they try to make it count -- they like to use [[AteHisGun firearms]].
45	* Misconception: '''Old people don't commit suicide.''' In fact, in many countries (including most Western countries), elders commit suicide at a much ''higher'' rater than younger people. Contrary to conventional wisdom, it's not due to age or health, but mostly due to longstanding depression (fighting it for that long can be ''exhausting''). Financial stress is also a bigger factor for older people, as they need to earn a living to support themselves -- and likely also spouses, children, or parents. Health and age can definitely be factors, however - people who have a weak or nonexistent support network who are beginning to accept that they can no longer care for themselves, or people who fear being placed in assisted living may have every reason to try and kill themselves, while people who have seen all of their friends and loved ones die or deteriorate to the point where they're no longer the person they remember may try to end it out of the belief that there's nothing left for them.
46	* Misconception: '''Teenagers aren't serious about suicide.''' Teenagers are often seen as the ultimate contrarians, [[AttentionWhore desperate for attention]] and to make you sorry for ignoring them. That's ''occasionally'' true -- but many teenagers are genuinely suffering, and they might be even ''more'' susceptible to trauma and depression than adults because they take things so seriously. Bullying is a serious and common cause of suicides among teenagers, and while there is a temptation to see bullying and hazing as mostly harmless and a way to toughen up young people, take a look at some teen suicides -- a lot of bullies go ''way'' too far. Teenagers can also suffer from depression and mental illness just like adults do, but with less opportunity to diagnose it. All of this adds up to a dangerous refrain -- if they're not taken seriously because they're teenagers, their suicidal thoughts could be exacerbated, they will be disinclined to open up to adults, and they may feel the need to prove that their feelings are real -- [[GoneHorriblyRight sometimes fatally]].
47	* Misconception: '''All right, but preteens ''definitely'' aren't serious about suicide.''' Even preteens can be genuinely suicidal. Again, it doesn't matter how old you are, depression or mental illness could manifest itself. And serious, over-the-line bullying can be an issue even for pre-teens.
48	Bottom line: ''anyone'' can commit suicide, and no one should be dismissed out of hand just because of the group they belong to.
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50	!!!Why someone might commit suicide
51	* Misconception: '''All suicides are caused by a traumatic event.''' This line of thinking derives from media's love of DrivenToSuicide, where a single and severe emotional trauma provides a clear reason for someone to commit suicide. But there are many other reasons one can commit suicide:
52	** A [[TraumaCongaLine long string of lesser humiliations or disappointments]], or even a not-so-long string if they all seem to pile up on each other;
53	** [[CosmicPlaything Bad luck with genetics]], including a family history of depression; or
54	** A mental disorder like anorexia or bipolar mania that doesn't show any outward signs of depression.
55	* Misconception: '''Well, then, nobody can be {{driven to suicide}}, and all suicidal people are [[InsaneEqualsViolent crazy or psychotic]].''' This is HollywoodPsychology in action. While mental illness is a frequent factor in suicide, it ''is'' possible to be DrivenToSuicide. You see it where someone has suffered UsefulNotes/{{abuse}} so severe that it has entirely destroyed their self-concept or their will to live. You see it where someone suffers chronic pain and can't stand it anymore. You see it where someone suffers immense financial loss from which they have no realistic prospect of recovery. There ''is'' a proverbial "edge", and you can be driven over it.
56	* '''What?! So then what am I supposed to think?''' As [[MathematiciansAnswer unhelpful as it is]], ''both'' are true -- suicide can be caused either by trauma or mental illness. In fact, it's common for suicide to be caused by ''both'' trauma and mental illness, if only because someone who is depressed to begin with is more likely to commit suicide after suffering trauma.
57	* Misconception: '''Well, regardless, suicidal people are [[AxCrazy dangerously violent]].''' The vast majority of suicidal people are not violent toward others. In fact, most suicide attempts happen in privacy or isolation at least in part because the sufferer doesn't want anyone else to get hurt. This is a dangerous line of thought, because treating suicidal people as violent is likely to alienate them further and exacerbate the problem. The few who ''are'' violent will likely be outwardly so and will not be shy about showing people that they will harm anyone who tries to stop them.
58	* Misconception: '''{{Suicide is shameful}}.''' This is a very pervasive stereotype, and also one of the most untrue. We've just gone through a bevy of reasons why people might commit suicide, ranging from depression to mental illness to serious trauma. The best way to prevent it is to get suicidal people the help they need -- and telling them that they're being "selfish" or "inconsiderate" is ''far'' from the right way to do that. Suicidal people often believe the opposite -- that it would be selfish of them ''not'' to die, because they believe they're TheLoad on society and the world would be better off without them.
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60	!!!How someone might commit suicide
61	* Misconception: '''All suicides are planned for a long time.''' It's often totally impulsive. Impulsive suicide is especially common among severely traumatized people (especially from a single event like a rape or an accident), people who self-medicate with drugs (they tend to crash eventually), and sufferers of bipolar disorder. It's difficult to deal with this sort of thing, because it means you're not suicidal ''all'' the time, and you don't know when the impulse will strike. Survivors have also been known to [[HappilyFailedSuicide regret the attempt]] almost as soon as it was underway.
62	* Misconception: '''All suicides are intentional and planned.''' It's entirely possible for a suicidal person to kill themselves without specifically intending to kill themselves. The gist of it is that they've [[NotAfraidToDie stopped caring whether they live or die]]. This can manifest itself in everything from unsafe sex and sexual practices (''e.g.'' unprotected casual sex, EroticAsphyxiation or other "edge play" without a SafeWord), to dangerous use of drugs or alcohol (''e.g.'' drinking until blackout, intentionally going near overdose range, using dirty needles), to extreme levels of self-harm resulting in death, or even to unsafe driving or work practices. Suicidality for these persons can be thought of as a spectrum of self-preservation -- turns out the world can be a pretty dangerous place. This also factors into how suicide can often be impulsive. And this doesn't even get into the SuicideDare, or even a ''suicidal'' dare -- ''i.e.'' do something stupid and dangerous and nominate yourself for a Website/{{Darwin Award\|s}}.
63	* Misconception: '''All suicides leave [[SuicideNote suicide notes]].''' Most suicides ''don't'' leave notes. It's an especially stupid misconception because it perpetuates the notion that if they didn't leave a note, then [[NeverSuicide it wasn't really suicide]]. In most countries, less than 10% of suicides leave notes -- in the U.S. it's more common, but that's largely attributed to PopCulturalOsmosis.
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66	[[folder:Signs and Symptoms of Depression and Suicidal Thoughts]]
67	* '''Persistent feelings of sadness or worthlessness''' ''[-("Persistent" meaning at least two weeks -- obvious sign of depression)-]'' A common description by sufferers is that they feel [[EmptyShell "empty" or "hollow" inside]]. It's an issue when expressed by teenagers, who ''always'' seem to be "empty" inside; this symptom is dismissed as [[EmoTeen typical moodiness]] when it really shouldn't.
68	* '''Persistent lack of interest in previously enjoyed activities''' ''[-("Persistent" meaning at least two weeks -- obvious sign of depression)-]'' There's a spectrum here -- it can range from just not participating in their hobbies, to actively disposing of things related to their hobbies, to outright retreating into their homes and not leaving the house. An extreme sign is when the person is ''trying'' to enjoy themselves but cannot even feel anxious about their lack of enthusiasm.
69	* '''Intensely elevated mood for no apparent reason, combined with a general feeling of invincibility or grandiosity''' ''[-(obvious sign of bipolar mania)-]'' An extreme sign would be someone acting as if they are on a constant cocaine or methamphetamine high without actually taking it, and taking risks like walking into traffic or gambling away all their money thinking they can't lose. It's related to the "risk-taking" element below.
70	* '''Frequent breakdowns and crying episodes''' ''[-(known but exaggerated)-]'' This is rarely witnessed firsthand, despite common media depictions (the RuleOfPerception means that if a person is depressed, you have to see it on screen). In RealLife, depressed people will more often actively seek out quiet and isolated places during such episodes, either because they don't want attention or because they want someone to notice that they're missing. In fact, such a desire to be found can be unconscious, as this would both validate their feelings and give them "proof" that someone cares about them. It happens to both males and females, despite [[MenDontCry societal perceptions to the contrary]].
71	* '''[[HairTriggerTemper Unusual or constant anger, irritability, or irrational rage]]:''' This is more common in male sufferers (many cultures view anger and violence as a more acceptable outlet for men [[MenDontCry than crying]], but there's also an element of how the male brain is wired -- men are hormonally less prone to crying episodes), but it can also be common as a result of mixed states in bipolar disorder, or in bipolar people who are heavy drinkers or stimulant users.
72	* '''[[TheStoic Absolute lack of displayed emotion]]:''' This is also more common in male sufferers of depression, but it's also highly common in victims of abuse or other PTSD sufferers, and far more rarely, it's one of the cardinal "negative" symptoms of schizophrenia. An extreme case is where a person becomes totally incapable of expressing emotion, even in a legitimately emotional situation, or if they [[ElectiveMute outright lose the ability to speak]] -- this is a ''major'' sign of something being very wrong.
73	* '''[[{{Sleepyhead}} Sleeping too much]] or [[TheInsomniac inability to sleep]]''' ''[-(known but may not be recognized as a symptom in itself)-]'' This is frequently due to the chemical imbalances that cause major depression. Bipolar mania or mixed states can also produce insomnia.
74	* '''[[ImHavingSoulPains Frequent unexplained aches or pains]]''' ''[-(little known and overlooked)-]'' This is due to the immune system shutting down. A variant of this is when minor injuries or illnesses take too long to heal, such as a cold persisting for a month or scrapes and bruises lasting for days. Those with no medical experience often cannot connect this to depression.
75	* '''Feeling cold in inappropriate weather''' ''[-(little known and overlooked)-]'' This is one of the most frequently overlooked symptoms, as wearing sweaters in warm weather is not uncommon in some places, and even the sufferer themselves may not realize that it's a symptom. It's also a possible explanation for why the EmoTeen always wears black -- it's warmer because dark colors absorb and retain heat better.
76	* '''Changes in appetite and subsequent weight gain or loss''' ''[-(little known and overlooked)-]'' Again, this is related to the chemical imbalances in the brain, which affect a person's appetite. Sufferers will often notice this and try to hide it (or [[SadClown joke about it]]) or even force themselves to eat normally -- as such, it's difficult to ascertain from the outside. Extreme weight loss, being dangerously underweight, and extreme attempts to suppress appetite are also primary symptoms of anorexia, and sudden unintentional weight ''gain'' in someone with anorexia can also inspire suicidal thoughts out of disgust at their "lack of control" over their body.
77	* '''[[DeathSeeker Sudden loss of care for dangerous activities]]''', beyond what can be explained by apathy or experience, particularly getting into physical altercations or reckless driving. It's related to the above feeling of invincibility described as a symptom of manic episodes of bipolar disorder. Some sufferers will take up dangerous hobbies, or even if they're already experts will start throwing safety precautions out the window. It's important to distinguish this from an expert at something dangerous just being confident (or cocky) and knowing how to do it right without the safety features -- a sufferer will thinking nothing will happen even if they do it ''wrong''. It shows that they don't care if they live or die.
78	* '''Changes in consumption of alcohol, recreational drugs, work hours, or forms of escapism:''' This is a more recently recognized sign, and it appears to be more common among high-stress and high-income professionals like athletes, entertainers, musicians, doctors, lawyers, law enforcement officers, and high-level business and finance workers. Much like with eating and sleep patterns, this could go either way -- either you lose total interest in your work or you start working like a maniac, or either you become [[TheAlcoholic an alcoholic]] or you stop drinking entirely and begin self-recrimination. The key is that such changes either way are not connected to any apparent reason or obvious triggering event.
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80	A few things to remember about these symptoms:
81	* Everybody's different. Not everybody will have the same symptoms, and certainly few people are going to have ''all'' of them. These are just the major signs, and there may be more symptoms that are harder to detect.
82	* Many of these symptoms -- particularly those involving weight gain, temperature control, sleep cycle, or the immune system -- could also be symptoms of a serious thyroid problem. Persons who suffer from such symptoms should absolutely see an endocrinologist or oncologist to rule out a thyroid problem, which can be fatal in and of itself.
83	* Depressed people are good at hiding or denying their symptoms. A lot of suicide and depression involves appearances and self-imposed pressures -- depression stems from both an inability to express emotions and the underlying (if warped) desire to protect their loved ones from "wrong" or "unsafe" emotions. In fact, seeing what a depressed or suicidal person really looks like can be a huge shock for someone who only knows the TV version of it, and naturally such people will want to prevent that shock.
84	* There are some things that depressed or suicidal people will only admit to professionals. Part of it is that friends and family members, while often well-meaning, are too emotionally involved -- they need to talk with someone who understands what they're going through, either one-on-one or with a group of fellow sufferers.
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86	[[/folder]]
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88	[[folder:Statistics]]
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90	If you're looking for good numbers, [[LiesDamnedLiesAndStatistics keep looking]]. Suicide statistics and official reports of deaths from suicide are often very skewed and inadequate. Deaths from suicide itself tend to be undercounted. Accidental suicides are often listed as just accidents, particularly when they arise from car or work accidents. Risky behavior might occasionally be thought of as bravery or heroism rather than suicidal behavior. Stress deaths should also attributed to suicidal behavior if they arise from overwork.
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92	But at the same time, many deaths that are officially suicides should really be considered ''homicides'', especially when it involves [[DrivenToSuicide severe bullying]] or extended UsefulNotes/{{abuse}}. They could also include:
93	* Cases of SuicideByCop or other deaths in police custody called suicides that are actually the result of PoliceBrutality or negligence;
94	* Murders that are [[NeverSuicide set up to look like suicides]];
95	* Suicide pacts and kinks GoneHorriblyWrong;
96	* Knowing that a person is suicidal and encouraging them to do so or [[LeaveBehindAPistol providing the means for them to do so]].
97	[[/folder]]
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Context UsefulNotes / Suicide