Recently a former neighbor and friend commit suicide. His obituary stated that he died unexpectedly after a long illness. A kind and generous man, it has left many sad, confused, hurt, angry, devastated, guilty and wondering if there wasn’t something more that could have been done. This post is dedicated to D, his family and friends and to the hope that it can help someone else struggling with a chronic condition.
The link between chronic conditions and higher rates of suicide can’t be ignored. It needs to be a conversation that those affected -medical providers, those with a condition, caregivers, family and friends-need to have. To aid in this discussion, the post below outlines why people with chronic conditions are more at risk, what the signs are, what you can do to help yourself or someone else who may be contemplating suicide as a way of coping and physician assisted suicide.
Why those with chronic conditions are more at risk
• Physical symptoms, which can decrease mobility and function, as well as create sleep irregularity, chronic pain and memory lapses. Note that with the opioid addiction epidemic raging, and the crack down on physicians writing prescriptions, there is now an increased risk of suicide among people with chronic pain.
• Loss of meaning and purpose: Not being able to work, take care of one’s self or perform daily functions can quickly erode sense of self worth and meaning.
• Loss of hope that they can feel better.
• Long-term injury and illness creates isolation and loneliness. Due to reduced capabilities and/or appearances, people are inclined to reduce or eliminate opportunities to socialize and be with others. In addition, family and friends can often withdraw for a host of reasons-don’t know how to be around someone who has an illness; out of sight out of mind; it’s scary to them etc. People fear being abandoned by family, society or both.
• Perception of being a burden. Whether it’s financial or their daily care needs, feelings of being a burden for family and significant others can lead to the erroneous conclusion that “everyone would be better off without me.” Guilt is a very negative emotion and it’s easy for someone in this position to think they are ruining the lives of those that love them the most.
• “It’s all in your head:” When family, friends, work colleagues or even medical providers say this, not only does it cause people to withdraw but it also considerably reduces self image.
• They don’t necessarily look sick so people are clueless to how they are feel or are doing.
Recognize Signs of Suicidal Thoughts.
• Unrelenting low mood, pessimism, hopelessness, desperation
• Withdrawing from people, events etc.
• Increased alcohol and/or drug use
• Impulsiveness and unnecessary risk taking
• Talking about suicide or wish to die
• Giving away prized possessions; sudden interest in firearms, obtaining other means of killing oneself such as poisons or medications
• Unexpected rage or anger.
If Someone is Suicidal: Take comments about suicide seriously. Many don’t want to die but they also don’t know how to continue to live in their current situation.
• Do not leave them alone.
• Seek immediate professional help,
• Take the person to an emergency room to the nearest hospital.
• Contact the person’s medical provider.
• If the above options are not available, call the Suicide Prevention Lifeline at 1-800-273-TALK (8255), or text HOPELINE at 741741 with the word “start” to get the assistance that you need.
If You are Feeling Suicidal: You are not alone. Whether you realize it or not, there are ways to help you feel better and recognize that your life has value and meaning not only to you but also to others.
• Share your suicidal thoughts with someone-family member, friend, therapist, medical provider, clergy, teacher, coach. Call the Suicide Prevention Lifeline at 1-800-273-TALK (8255), or text HOPELINE at 741741 with the word “start” to get the assistance that you need.
• If you can’t voice your plans and thoughts, put them in writing, text or e-mail and give them to someone you can trust.
• If the first person you reach out to doesn’t seem to understand, tell someone else or call the suicide crisis line.
• If you are dealing with significant symptoms and pain, let your care provider know. If current treatments aren’t helping, ask for a referral to a palliative care program, or pain program.
• Don’t act on your feelings. Thoughts and actions are two different things. Just because you may think about suicide doesn’t mean you need to act on it.
• Avoid drugs and alcohol
• Create a safe environment by removing items you could use to hurt yourself such as guns, knives, razors, pills etc.
• Take hope that you can live through these feelings and you can get help with problems that currently seem insurmountable.
What can be done
• Learn what you can about their condition, join a caregivers’ support group.
• Be their advocate and help them seek out the best possible care. Keep in mind that if symptoms such as pain and sleep deprivation can be controlled, suicidal thoughts are significantly reduced. Palliative care programs specialize in how to eliminate pain and suffering. Chronic pain clinics can also be helpful.
• Just because you can’t see it doesn’t mean it’s not real. Believe them when they tell you how they feel.
• Reassure them they are not a burden: Let them know what they mean to you.
• Let them do for themselves as much as possible.
• Include them in social activities.
• Recognize signs of depression and suicidal thought. See above
• Ask them if they are considering suicide. You will not make someone suicidal by asking this question.
• Talk to their care provider or the local chapter of a condition specific organization. Thinking that suicide is a passing fancy is risky.
For those living with a chronic condition, please read Healing the Whole Person: Ways to Increase Well-Being When Living with a Chronic Condition, which outlines specific ways to achieve healing and hope regardless of your diagnosis. This page is continually being updated and it’s better for you to go to the page than to try and summarize it here.
Physician Assisted Suicide
Now available in some states, the physician assisted suicide (PAS) movement was started for those with terminal illness. However, as time has passed, those with disabilities and chronic conditions have started discussing this as an option. It’s important to note that those who receive proper pain and symptom management, generally do not opt for suicide. “Kill the pain, not the person” is the underlying belief of palliative care, which is a good specialty to check out if pain and other symptom management is not being adequately controlled.
Working in AIDS, PAS was something we discussed a lot. One woman explained that she was saving pills as she wanted to spare her family seeing her at end stage AIDS. However, her choice at the end of her life was something none of us could have predicted. Her oldest child was in the military and her mother’s dying kept her stateside and out of the Gulf War. Now she was doing everything she could to live so she could keep her child safe. In fact, one of the hospice nurses had to tell her daughter to give Mom permission to let go and die. This was the ultimate sacrifice a mother could make for child. It also taught me that Dr. Kubler-Ross was right that you need to “Live until you die and live fully.”
Sometimes the purpose in our life is to receive, to let others care for us. In doing so we give more than we realize. We help others understand about their capabilities, explore their feelings or in the case of my friend, you can even save a life.
I’m concluding this post with part of an article written by a physician with Parkinson’s Disease, as it highlights both the problems those with chronic conditions encounter but also how they can find meaning in their lives.
”Now in the tenth year of a battle that will continue for as long as I live, I have watched as huge swaths of my abilities have calved like chunks of ice falling from a glacier into the sea. My circle of friends has shrunk, the role I used to play in family life has diminished dramatically, and my medical career is over. The physical word I am capable of navigating has become a fraction of what it once was. My mental processes have slowed to a veritable crawl. My ability to express myself is profoundly compromised... Control over my body is a formidable, ongoing struggle of mind over matter. As the disease progresses, my sense of myself erodes in parallel and I mourn those bits and pieces as I would the loss of a loved one.”
“However, there is one aspect of the self that even my disease cannot touch and that is the soul. Though not religious in a traditional sense, I remain spiritually whole, comfortable in the knowledge that my life still matters both to the patients I treated, the family I have raised, and the family I have, by second marriage, adopted. And that is where hope lives; not a naıve hope that I will, by some miracle, have my former self restored, but hope that tomorrow, and the day after, can still be days from which a measure of joy and meaning can be derived. And from hope springs optimism that, even with great limitations, there is life to be lived.” “Finding Hope in the Midst of Despair: My Decade With Parkinson’s Disease and Lewy Body Dementia” by Dr. Thomas B. Graboys. “Life in the Balance.”