We Know the Answers to Our Suicide Crisis, But Prefer to Deny Them

    Supporting people in living is the best solution to self-inflicted death. Isn’t that simple?

    Nearly all of us in the liberal-progressive community endorse the science around climate change, which we regard as undeniable. We fear the disastrous consequences of a powerful lobby’s rejection of this reality. But the overwhelming mass of educated Americans bear a striking resemblance to climate deniers when it comes to mental health and addiction. And the consequences are real and tragic, as witnessed by our suicide and drug-death epidemics.

    In 2018, several prominent people, including Kate Spade and Anthony Bourdain, took their own lives. The standard response to the deaths was to recommend instantly reaching out for psychiatric help and calling hotlines.

    An important component in standard treatment approaches is searching for and uncovering repressed trauma memories and PTSD as a source for “suicidality.”

    The CDC report on suicide rightly portrays it as a complex and human action, which too many others insist on reducing to a simplistic medical problem. 

    But standard responses to suicide aren’t working. Quite the reverse. The Centers for Disease Control issued a report,  “Suicide Rising Across the US: More than a mental health concern.” The alarming phenomenon it presented: “The US suicide rate increased 25 percent from 1999 to 2016, even though the rates of psychiatric diagnosis and treatment also greatly increased.” 

    While experts reported with depressing predictability that depression, leading to suicide, was a medical “disease,” the CDC found instead that, “suicide is rarely caused by any single factor. In fact, many people who die by suicide are not known to have a diagnosed mental health condition at the time of death.”

    The New York Times writer Benedict Carey was driven to present “How Suicide Quietly Morphed Into a Public Health Crisis,” a piece that reeled under the confusion:

    The rise in suicide rates has coincided over the past two decades with a vast increase in the number of Americans given a diagnosis of depression or anxiety, and treated with medication.

    The number of people taking an open-ended prescription for an antidepressant is at a historic high. More than 15 million Americans have been on the drugs for more than five years, a rate that has more than tripled since 2000. 

    But if treatment is so helpful, why hasn’t its expansion halted or reversed suicide trends? [Our emphasis.]

    “This is the question I’ve been wrestling with: Are we somehow causing increased morbidity and mortality with our interventions?” said Dr. Thomas Insel, former director of the National Institute of Mental Health and now president of Mindstrong Health, which makes technology to monitor people with mental health problems.

    “I don’t think so,” Dr. Insel continued. “I think the increase in demand for the services is so huge that the expansion of treatment thus far is simply insufficient to make a dent in what is a huge social change.”  

     

    Thus the neuroscientist and psychiatrist who headed the National Institute of Mental Health from 2002-2015, during the simultaneous meteoric rises in suicides and depression diagnoses and treatment, interprets that failure as proof that we should redouble our efforts to diagnose and treat more people. In doing so, he expresses an obligatory mantra familiar to those who follow the addiction field: “People deny their disease because of the stigma they unfortunately attach to itdenial they must be encouraged or convinced to overcome before being pushed into treatment.”

    In fact, research shows that young people who self-label their mental conditions are more likely to become depressed, and less likely to feel that they are capable of changing. As opposed to the suggestion that the best way to have helped Anthony Bourdain was to uncover his life traumas with him, the best therapeutic approachper Martin Seligman’s and Angela Duckworth’s positive psychology models, as well as reams of datais to direct the suffering person’s attention to their purposes in life, to their sustaining values, relationships and goals, and help them to plan forward in fulfilling these positive visions.

    This unquestioned acceptance of dysfunctional medical, disease panaceas is regularly rehashed at the Times. As the CDC made clear that most suicides can’t be traced to a mental disorder, the Times’s psychiatric expert Richard Friedman declared: “Suicide is a medical problem that is almost always associated with several common and treatable mental illnesses.”

    The Times consistently purveys the mythical narrative, also disproved by research, that our crisis of opioid-related deaths is due to people receiving painkiller prescriptions who become addicted and die, even as painkiller prescriptions declined dramatically over the past five years while drug deaths continued to accelerate.

    The CDC report on suicide rightly portrays it as a complex and human action, which Friedman and too many others insist on reducing to a simplistic medical problem. 

     

    Stanton’s Brother

    Stanton’s older brother killed himself at age 59. Stephen (not his real name) was—like Spade and Bourdain—a person with some social advantages, but deeper underlying discontents, none of which in Stephen’s case comprised mental illness.

    Stephen was an insecure person who accomplished quite a bit but who never felt comfortable in his own skin. He received a PhD in physics from a prestigious university, but didn’t land a position in academia. Instead, he worked at a variety of software companies over a spotty career. He married and had two children, then divorced and had a second marriage, which was substantial and loving.

    This experience was so painful to Stephen that he preferred to die instead.

    In his late 50s, he had a meaningful family life and friendships, as did Bourdain and Spade. Unlike them, Stephen had not created a secure professional identity.  Meanwhile, a financial investment he had made in real estate had failed.

    Stephen finally took a trial job lasting six months. At the end of this period, he was informed that he wasn’t to be given a permanent position. He went home and gassed himself in his family garage.

    Although he was economically challenged, Stephen wasn’t in real danger of losing his middle-class position (his wife worked). He was in danger of doubting himself and losing his tenuous hold on self-respect. This experience was so painful to Stephen that he preferred to die instead.

    Stephen had friends and family and access to psychiatrists and mental health workers, as did Spade and Bourdain (although we don’t know what life issues Spade and Bourdain faced). He had no obviously diagnosable mental disorder. But he had lost his way financially, and then existentially, in his sense that he deserved to live.

     

    There Are Answers, But They’re Complex and Resisted

     In its report, the CDC—the respected health protection agency of the United States—detailed the needed steps for preventing suicide. Encouragingly, they are the opposite of focusing on trauma or drugs to cure a disease. 

    CDC Guidelines: How to Prevent Suicide

     * Identify and support people at risk.

    * Teach coping and problem-solving skills to help people manage challenges with their relationships, jobs, health or other concerns.

    * Promote safe and supportive environments. This includes safely storing medications and firearms to reduce access among people at risk.

    * Offer activities that bring people together so they feel connected and not alone.

    * Connect people at risk to effective and coordinated mental and physical healthcare.

    * Expand options for temporary help (including financial help) for those struggling to make ends meet.

     

    Stephen could have been helped by a financial consultation and career guidance, which seems simple enough. Many people at risk of suicide require practical assistence to improve the conditions of their lives and renew their sense of purpose. Yet the CDC’s economic, skills and community solutions for suicide are generally ignored.

    Despite the headlines generated by celebrities who take their own lives, people experiencing economic insecurity or poverty are at greater risk.

    Just as increasing socio-economic pressures and inequalities make addiction anything but “equal-opportunity”and entail that meaningfully impacting addiction on a large scale would require far-reaching social changeso too with suicide.

    Despite the headlines generated by celebrities who take their own lives, people experiencing economic insecurity or poverty are at greater risk. One study found: “the hazard ratios of suicide showed an increasing trend as socioeconomic position decreased. After adjusting for gender, age, geographic location, and disability level, Medicaid recipients had the highest suicide hazard ratio.”

    It’s as though the suicides of people in more vulnerable socio-economic groups—like their addictions—are less deserving of care and concern.

    We know the steps that would reduce suicide, but will we take them? It seems that instead, we prefer to ritualistically repeat our favored mantras.


     

    Screenshot of Anthony Bourdain via Vimeo

    This article is an adaptation of an excerpt from Chapter 11 of Stanton Peele and Zach Rhoads’ book, Outgrowing Addiction: With Common Sense Instead of “Disease” Therapy, published by Upper Access Press in May 2019.

    • Stanton Peele & Zach Rhoads

      Dr. Stanton Peele is a psychologist who has pioneered, among other things, the idea that addiction occurs with a range of experiences and recognition of natural recovery from addiction. He developed the Life Process Program for addiction and has authored many books since the 1975 publication of Love and Addiction (co-authored by Archie Brodsky).

       

      Zach Rhoads is an author and educational consultant working with families in Vermont. He is also an addiction coach in Dr. Stanton Peele’s Life Process Program. He hosts the podcast FSDP Presents on behalf of Families for Sensible Drug Policy.

      Their book Outgrowing Addiction: With Common Sense Instead of “Disease” Therapy was published by Upper Access Press in May 2019.

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