Elena (name changed to protect her identity) was born in 1957 to a teenage mother. Her early years were a nightmare of abuse and neglect. She was not quite 15 when she first attempted suicide.
She survived the attempt, left home, and became the first person in her family to attend college. Still, she suffered crippling episodes of depression. Throughout the next thirty years, she sought treatment through counseling, medication, religion, holistic therapies and psychiatric hospitalization.
None of it helped. By her late 40s, she was plagued with physical and financial problems as well as clinical depression. She averaged 1 to 2 suicide attempts per year.
A few days after her 52nd birthday, Elena committed suicide with an overdose of muscle relaxants. At the time of her death, she was taking anti-depressants and was under the care of a psychiatrist and a psychologist.
Severe Mental Illness is Not Always Treatable
Despite the information provided in mental health public service announcements, severe mental illness does not always respond to treatment. Consider the following risk factors from the website StopASuicide.org:
- 90% of people who complete suicide have one or more diagnosable psychiatric disorders;
- A person with a mood disorder such as clinical depression or bipolar disorder are 12 to 20 times more likely than the general population to take their own life;
- A person with an anxiety disorder is 6 to 10 times more likely than the general population to take their own life;
- Of the people who complete suicide, 20 to 40% have made one or more previous attempts; and
- Around 30% of the people who complete suicide are receiving psychiatric treatment at the time of death.
Suicide Prevention Effectiveness (or Lack Thereof)
Most researchers who have performed literature reviews on the topic of suicide prevention express frustration at the lack of quality research on suicide prevention effectiveness. For instance, in spite of their popularity, suicide hotlines have never been proven to reduce the rate of suicide in a community.
Similarly, communities with a higher rate of the use of psychotropic medications like antidepressants do not have lower — or higher — suicide rates than communities with fewer individuals whom are using such medications.
Consistently, researchers have found that the most effective method of suicide prevention is removing the suicidal person from the means to carry out his or her plan; however, this solution is a temporary one at best.
Switzerland Weighs in on Physician Assisted Suicide and Mental Illness
In 2006, the Swiss Federal Supreme Court ruled that those with "incurable, permanent, severe psychological disorders" had the right to end their lives. The court was careful to draw a distinction between people with short-term psychiatric conditions that were likely to respond to treatment and people with long term severe mental illness for whom treatment had proven ineffective.
The Concept of Terminal Mental Illness
According to U.S. Legal, a terminal illness is defined as "an active and progressive illness for which there is no cure and the prognosis is fatal."
Think back to Elena for a moment: Her illness was certainly active; it haunted her almost every day of her life. It was also progressive and each episode of clinical depression was worse than the one preceding it. Her illness was impervious to multiple modes of treatment from faith healing to traditional Western psychiatry. And several physicians predicted Elena's mental illness would end in death by suicide. Eventually, it did. Elena's depression seems to meet all the criteria for a terminal illness.
Just like a cancer patient can take every recommended treatment and still not achieve remission, some people with severe mental illness can try a host of remedies and still not achieve relief from their symptoms, symptoms so painful their ultimate result is predictably self-destruction.
For People with Mental Illness
This article looks at severe mental illnesses that do not respond to treatment – fortunately, this type of mental illness is the exception rather than the rule.
Estimates suggest that depression is 80% to 90% treatable with a combination of medication and talk therapy, though symptoms may reoccur and the patient may need to undergo another round of treatment.
Bipolar disorder, too, can usually be well managed with education, mood stabilizers, and therapy.
It's a sad fact that many mentally ill people who commit suicide never seek any type of treatment at all due to their fear of being stigmatized – the equivalent of women dying of breast cancer years ago because they were too embarrassed to go to a doctor.
If you are considering suicide, talk to a counselor, social worker, psychologist or psychiatrist. If you think you can't afford to seek psychiatric treatment, go to your community mental health center and see if they will treat you on a sliding scale, or call the National Suicide Hotline, 1-800-273-8255 for the location of a crisis center near you.
Don't make the assumption that your symptoms can't be managed just because they haven't been managed yet.
For Suicide Survivors
Those who have lost a loved one to suicide are frequently haunted by questions about why their loved one chose to leave them. If you are able to accept the view of some mental illnesses as terminal, you may find some comfort in realizing that often there was no "choice" – only unbearable, intractable pain that could have had no other reasonable outcome.
For additional support and information, check out the Alliance of Hope for Suicide Survivors.
Sources:
Appel, Jacob M. (2007). "A Suicide Right for the Mentally Ill? Swiss Case Opens a New Debate" on MedScape Today. Accessed 8/24/10.
Bertolote, Jose M. (2004). "Suicide prevention: At what level does it work?" on World Psychiatry. Accessed 8/24/10.
"Depression out of the Shadows: Statistics" on PBS. Accessed 8/24/10
"Suicide and Mental Illness" on StopASuicide.org. July 2007. Accessed 8/24/10.
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