Monday, August 11, 2014

On the Passing of Robin Williams: A Psychiatric Nurse Explains Suicide

Oregon psychiatric nurse Shauna Hahn shares the following insight into suicide:

RIP Robin Williams.

On the heels of another suicide, the hanging death of a local mother, I feel compelled to share something about the science of suicide. Too often, I have heard or read comments suggesting that the suicide victim was selfish or did not consider her own family, etc. How I educate patients about this serious topic is to liken suicide to having a heart attack. For example, we know the risks for Coronary Artery Disease: smoking, obesity, hypertension, hyperlipidemia, yet a heart attack doubtless feels surprising to its sufferer. Suicide is a lot like this. We know the risks: depression, substance abuse, risk-taking, history of other aggressions, etc yet the great deficiency in serotonin (a happy neurotransmitter or brain chemical implicated in both depression and anxiety) actually happens quite precipitously.

How do we know this? We can measure levels of serotonin metabolites in the cerebral spinal fluid and we find that, in individuals who have completed suicide, their levels are much lower than in individuals simply struggling with depression. And there is no difference in serotonin metabolites of the lightly depressed versus the seriously depressed. These dangerously low levels of serotonin mean that not only do we have despondency and despair but also poor impulse control. What a lethal combination.

Individuals who have survived high lethality suicide attempts (jumping off the Golden Gate bridge, shooting themselves in the head) mostly remark that they "did not know what they were thinking" and allude to being "not in [their] right mind." Obviously, individuals affected by mental illness have serious problems thinking clearly.

Kant believed that suicide was *the* philosophical problem. (He was very punitive and unforgiving in his view). Certainly, I empathize with individuals not being able to "understand" suicide, but what I would definitely encourage would be to at least try.

Do not judge men by mere appearances; for the light laughter that bubbles on the lip often mantles over the depths of sadness, and the serious look may be the sober veil that covers a divine peace and joy. - Edwin Hubbel Chapin, 1845

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