On Tuesday, I attended a lecture at UC Irvine Medical Center called “Spirituality and Suicide Prevention.” The speaker was a psychiatrist named Aaron Kheriaty. Dr. Kheriaty is the director of UC Irvine’s unique Psychiatry and Spirituality Forum.

As is the case for Kheriaty, my interest in this topic is not merely professional. A few years ago, within a short period of time, three Christian young people that I knew died by suicide. It was the third death that convinced me to take my own depressed teenager to the doctor. I’m glad I did.

Here are my notes from what was an excellent lecture:

Mark Twain: Man is the only animal that blushes, or needs to.

Man is also the only animal that takes its own life, buries its dead, performs funeral rites. (Lemmings do not commit mass suicide during migration as is commonly thought.)

Suicide is a self-contradictory act; it is excercising autonomy in order to eliminate autonomy.

Artistic Expression of Suicidal Ideation:

“Amsterdam” by Coldplay

“Come on, oh my star is fading
And I see no chance of release
And I know I’m dead on the surface
But I am screaming underneath

And time is on your side, its on your side, now
Not pushing you down, and all around
No it’s no cause for concern

Stuck on the end of this ball and chain
And I’m on my way back down again
Stood on the edge, tied to the noose
Sick to the stomach

You can say what you mean
But it won’t change a thing
I’m sick of the secrets
Stood on the edge, tied to the noose
And you came along and you cut me loose
You came along and you cut me loose
You came along and you cut me loose”

John Donne : “Whensoever any affliction assails me, methinks I have the keys of my prison in mine own hand and no remedy presents itself so soon to my heart as mine own sword.”

Statistics and Research:

There is one suicide every 17 minutes in the United States; over 30,000 each year. Suicide is the third leading cause of death among the young. Teen suicide has tripled in the last 45 years. 1-of-10 college students has thought about suicide in the past year ; 1-of-5 high school students have.

CDC reports: The suicide rate rose 8 percent between 2003-2004; this represents the highest increase in 15 years.

Researcher Emil Durkheim says the suicide rate is a key measure of social connectedness. He found that religious institutions, when flourishing and healthy, act as a deterrant. Religious communities counter individualism. Results confirmed in other studies.

His Hypothesis:

1. social support
2. religious communities forbid suicide (Dutch study controlled for social cohesion–religion still protects)
3. sense of meaning, purpose, hope, reason for living

Case Studies:

Patient 1: 25 year old male, panic disorder, depression, doesn’t believe in God. “I don’t see anything wrong with suicide.” Solution to serious debt problem. Mother had actually given her permission at one point if he feels suicide is the only way out.

Patient 2: 22 year old male, depression. Doesn’t want to go to hell. Social ties at church weakened by his depression. Conscience acts as preventive because he believes suicide is morally wrong.

Patient 3: 43 year old woman, post-traumatic stress disorder from years of sexual abuse by both parents. “If it weren’t for Jesus, I would have killed myself a long time ago.” Social connections lost amidst ugly church split. Very traumatic for patient. Still, faith gives her meaning and purpose and appears to be one of the few healthy, mature elements of her life.

Neelman and Lewis conducted 37,688 interviews in Europe and the U.S.; found four religious variables that lower suicide rates:

1. religiosity (personal belief)
2. religious service attendance
3. religious affiliation
4. religious upbringing

Religiosity was strongest factor in lower rates; attendance the weakest.

Religion in mentally ill: study of 155 psychotic patients; 43 percent had attempted suicide. Of those who hadn’t 25 percent noted the protective role of religion (religious coping, ethical norms); 10 percent cited religion as an incentive for suicide attempt–either patient thought they would be better off after death or had experienced loss of faith or anger with God. Only 3 of the 155 patients who had attempted suicide did so in context of delusional thinking.

2004 American Journal of Psychiatry published study of suicide rates in those with religious affiliation vs. those without:

Less attempts, less impulsivity, less aggression, less substance abuse , more reason to live and objections to suicide in those with religious affiliations than in those without. (Aggression and substance abuse are suicide predictors on their own.)

Views of Suicide within various relgious traditions:

Judeo-Christian: suicide serious sin; breaks 6th commandment.

Eastern–Hindu, Buddhist: discouraged, not right means to free self from suffering.

Islamic: as grave or graver a sin than homicide (suicide bombers, etc., abhorrent from orthodox teaching).

Advised medical professionals to involve members of clergy from patient’s religious community in dealing with them, and/or with family after suicide. Most hold much more nuanced positions on eternal destiny than commonly thought (eg. Catholic).

Enlightenment era: possibly worst treatment of suicide victims took place in 17th century France.  Bodies dragged through the streets, head down, then hanged from guillotine, and thrown in a sewer.

Older thinkers opposed suicide: Locke, Rousseau, Kierkgaard; newer appear ambivalent–A. Camus

Social Effects of Suicide:

Suicide appears to be contagious. Those vulnerable to suicidal thoughts are influenced by suicides of famous people; may romanticize it.

Symbolic Places: Mt. Fuji was leading site in world. Now, Golden Gate Bridge, San Francisco. 1200 people have jumped. One every two weeks. Zero jumps off adjacent Bay Bridge. 26 have survived. Takes 4 seconds to hit water. Final thoughts of survivors:

K.B., 28 years old: realized that everything he thought wasn’t fixable in his life was fixable, except the fact that he had jumped.

K.H., 18: realized that he really didn’t want to die.

E.S. Schniedman, preeminent suicide researcher: the suicidal person can be described as someone who cuts their throat and cries for help in the same breath.

John Donne: “No Man is an Island.” Social isolation contributes to suicide. Often when suicidal person is preparing to take their life, they will isolate. Something to watch for in at risk people.

Last journal entry of one Golden Gate Bridge suicide victim: “I’m going to walk to the bridge. If one person smiles at me on the way there, I will not jump.”

Researcher Aaron Beck studied 9000 hospitalized patients over 10 year period. The key factor in suicide attempts and ideation: HOPELESSNESS. A foreshortened sense of the future. Give some hope; reduce risk. Other studies replicated his findings (J. Fawcett w/ outpatients).

Neurophysch studies indicate that the thinking of suicidal patients is constricted, inflexible, rigid; they cannot see options; they are unable to separate the future from the present. Hospitalization alone does not help. Hospitalized patients who attempt suicide soon after release often have denied suicidal thoughts.

Prevention [in addition to proper medical treatment]:

1. Appeal to sense of responsibility to God and family—patients often have distorted view of what impact will be on survivors; help them understand their loved ones will not get over it quickly.
2. Discuss afterlife; what do they think will happen to them.
3. Spiritual practices: meditation, prayer, contemplation (no studies yet on effectiveness).

Hope, Despair and Spirituality within the Christian tradition:

Hope is a theological virtue: one of three highest–love, faith, hope.

To be without hope is to be separated from God; it is the definition of damnation.

Dante’s Inferno: Inscribed over hell are these words: “Abandon all hope, ye’ who enter here.”

Despair is a state proper only to the damned; to be without hope is to be in hell.

Religion may foster hope grounded in the past (Psalms) and the future (Prophets). It also provides meaning in suffering (Christ).

Hope and Acceptance: Job–“Though he slay me, yet will I trust in him.” Acceptance of death/mortality key element in most religions.

Kheriaty concluded with the story of close high school friend named Matthew: 27 years old, bi-polar, Air Force Academy graduate, varsity track athlete, medically discharged from Air Force after diagnosis: “Our pilots don’t have bi-polar disorder.”

Four suicide attempts, last spoke to him two weeks before death. Successful on 4th attempt because he used a gun. Mother psychiatric nurse; tried to get him to take meds; wouldn’t. Afterwards mother consoled Kheriaty: “You did everything you could.”

Kheriaty ended with a poem by Gerald Manly Hopkins that I was unable to find online. Here’s the snippet I caught:

“I say that we are wound with mercy round and round…”

Amen

Points to Remember:

Kindness means everything; Instill hope in the despairing; Preach the Gospel. In other words: Faith, hope, love … and the greatest of these is love.

The UCI Psychiatry and Spirituality Forum meets monthly. This event was attended by medical professionals, clergy and at least one journalist : )

[© cas 2007, all rights reserved]