Suicide rates in the US have surged to a 30-year high at the same time that US antidepressant use has skyrocketed. While correlation is not the same as causation, this concurrence naturally raises questions from people comfortable challenging authorities—including mental health authorities. Does it help all people to view being suicidal as a symptom of mental illness for which standard psychiatric treatment is the most effective remedy? Or, for some people, could being suicidal be regarded—and cared for—in other ways?
First, a closer look at both US suicide rates and standard treatment realities. Then, some options for anti-authoritarians who have been failed by mental health authorities.
US Suicide Rates and Treatment Realities
In 2016, the National Center for Health Statistics reported that the overall US suicide rate had increased by 24% from 1999 to 2014, with the US suicide rate surging to a 30-year high. The American Foundation for Suicide Prevention states that in the US in 2015, there were 44,193 reported suicides and that this number is likely higher because stigma surrounding suicide leads to underreporting; and it also noted that for every completed suicide, 25 attempt suicide.
A US sub-population with an especially large increase in suicide and with high antidepressant use is middle-aged women. The suicide rate for women age 45 to 64 increased by 63% from 1999 to 2014, and by 2008, 23% of women 40–59 years of age were taking antidepressants (with more recent estimates of antidepressant use in this population stating, “the figure is one in four”).
The correlation between psychiatric treatment and suicide is not an encouraging one. In 2014, a large Danish study published in Social Psychiatry and Psychiatric Epidemiology reported that people who received psychiatric medication were 5.8 times more likely to commit suicide than people who did not receive psychiatric medication; and people who had spent time the previous year in a psychiatric hospital were 44.3 times more likely to commit suicide than those not psychiatrically hospitalized. Again, correlation is not the same as causation, as psychiatrically treated people may also be more severely at risk of suicide to begin with. However, an editorial accompanying the Danish study concluded that these study findings suggest that “psychiatric care might, at least in part, cause suicide . . . Perhaps some aspects of even outpatient psychiatric contact are suicidogenic.”
Among young people in the US, suicide is the second leading cause of death among those aged 15-34 and the third leading cause of death among those aged 10-14; and among students in grades 9-12, 17% seriously considered attempting suicide and 8% attempted suicide one or more times in the previous 12 months. Mental health authorities tell us that the problem is that treatment is not available enough; however, among those 18 years of age and younger in the US, the number taking antidepressants more than tripled between 1987 and 1996; further increased by 50% between 1998-2002, and increased by 26% between 2005-2012.
Antidepressants for young people, according to the US Food and Drug Administration, are suicidogenic. Based on placebo-controlled trials of nine different antidepressants, the FDA in 2004 ordered warning labels of increased risk of suicidality (suicidal thinking and attempts) for children using antidepressants; these warnings were updated in 2007 to also include increased suicidality risk for adults aged 18-24 using antidepressants. A cautionary note: If you abruptly stop taking antidepressants or lower the dose too quickly, one of many possible withdrawal adverse effects is feeling suicidal.
Overwhelming pain is associated with suicidality, and antidepressants and other psychiatric drugs can help some people blunt their emotional pains; but antidepressants can also create painful physical adverse effects and/or remove inhibitions against acting on suicidal thoughts. And for many critically-thinking anti-authoritarians, these drugs cannot blunt painful realities of trauma, loss, alienation and oppression in their occupation, schooling, family and other aspects of their lives. There is a significant association between suicidality and being a member of an oppressed US sub-population (such as Native Americans), as well as with poverty, unemployment and other painful states.
Other standard treatments besides antidepressants—such as the “no suicide contract”—can appear ludicrous for suicidal anti-authoritarians. In the no suicide contract, the patient agrees not to attempt suicide and to seek help if unable to honor the commitment; and signing such a contract is sometimes a requirement for release from a psychiatric hospital. Despite a lack of empirical support for the effectiveness of these contracts in preventing suicide attempts, they have been widely used by mental health professionals. To even mild anti-authoritarians, it is obvious that these contracts serve only to meet the anxiety-reduction needs of hospital staff, will not prevent suicide, and increase skepticism for mental health authorities.
Many critical thinkers have little faith in standard mental health treatments for subjective and objective reasons. Their own subjective experience may well have been that such treatments have failed them, their family or friends. And the objective facts (of an increasingly suicidal US, at the same time increasing numbers of Americans are taking antidepressants) trigger incredulity of the claims and recommendations of mental health authorities.
Options for Suicidal Anti-Authoritarians
Feeling suicidal is much about being overwhelmed by pain and becoming hopeless that your pain will ever diminish, and people overwhelmed by their suicidal impulses may need to be watched. Nowadays, society uses psychiatric hospitalizations to guard against suicide, however, a 2012 study reported that 6% of all suicides occur in hospitals. At one time, suicide watches were comprised of friends and family (effective for a suicidal Abraham Lincoln), but that was in an era when suicidality was not seen as a symptom of mental illness.
Today we often hear mental health authorities such as the National Alliance on Mental Illness proclaim, “Research has found that about 90% of individuals who die by suicide experience mental illness.” While for some suicidal people, the idea that they are mentally ill reduces their self-blame, for many others, the idea that they are mentally ill makes them feel more hopeless—an impetus to attempt suicide.
Some anti-authoritarians challenge the idea that their suicidality is evidence of mental illness. David Webb, author of Thinking About Suicide, is one of those anti-authoritarians. Webb attempted suicide several times and was psychiatrically treated. He ultimately concluded that it was unhelpful to view feeling suicidal as a consequence of mental illness, and he came to believe that the “mental illness approach” medicalizes what he views as a “sacred crisis of the self.”
For Webb, “Contrary to the assumptions behind the mental illness approach, it is possible to see thinking about suicide as a healthy crisis of the self, full of opportunity, despite its risks.” For Webb, taking the opportunity to ask questions about the self that is in crisis “has the potential to open up possibilities for a deeper experience of the self, which for some, such as myself, can be a pathway out of suicidality.”
There is little controversy that it is helpful for people who are suicidal to be open about their feelings. However, if being suicidal is viewed as a symptom of mental illness, Webb notes, “talking about your suicidal feelings runs the very real risk of finding yourself being judged, locked up and drugged.” So, many critically-thinking suicidal anti-authoritarians don’t reach out.
Suicidal teenagers and young adults—the group for whom suicide is the second leading cause of death—are people whom I have worked with for over thirty years, often after unsuccessful treatments in which their suicidality was viewed as evidence of mental illness. Many of these young people are anti-authoritarians, and so for them, similar to Webb, the idea that they are experiencing a crisis of self rather than a mental illness opens them up for dialogue.
For many young people, the healthy crisis of self can involve their sexuality, religion, family role, and other aspects of their identity. Many sensitive and critically-thinking teenagers become suicidal because of overwhelming pain from authoritarian school. On several occasions, I’ve seen school failure and the threat of not graduating high school make a teenager suicidal. Teens’ pain of failure is exacerbated by their parents’ anxiety over failure, and teens become hopeless that all of life will be as miserable as high school. They are then routinely told that they are suicidal because they are mentally ill, and that makes some of them even more hopeless. The pain of their school misery and suicidal thoughts are rarely validated as a common emotional experience of many sensitive anti-authoritarians experiencing a healthy crisis of self. That validation, from my experience, can both reduce their pain and increase their hope—and open them up for dialogue.
For many people, especially anti-authoritarians, it is often counterproductive to focus on the symptoms of one’s pain as evidence of mental illness. Society itself stigmatizes mental illness, so how can one expect a person overwhelmed by emotional pain not to self-stigmatize once they’ve been labeled as mentally ill? And this stigma creates more pain and more hopelessness.
In contrast, what’s helpful for many suicidal people is validation that their pain is evidence of their soul and their humanity. For anti-authoritarians such as Webb, it is helpful to view feeling suicidal as a “genuine and authentic human experience that is to be honored and respected.”
As noted, overwhelming pain and hopelessness are associated with suicide, and when we are overwhelmed by our suicidal impulses, we may need to be watched to keep from acting impulsively. But a suicide attempt is not always an impulsive action, and we cannot be watched forever. Long-term, reducing suicidality is about reducing overwhelming pain and increasing our hope that our misery may not be a permanent condition. And suicidal anti-authoritarians, including Webb, have found anti-authoritarian options which reframe their pain and suicidality, and increase their hope—and prevent them from committing suicide.
Bruce E. Levine, a practicing clinical psychologist, writes and speaks about how society, culture, politics and psychology intersect. He is the author of Get Up, Stand Up: Uniting Populists, Energizing the Defeated, and Battling the Corporate Elite . His Web site is brucelevine.net
In the seventh grade, I used to put my head down on my desk, close my eyes and repeat my mantra: “I wish I was dead.” It was a kind of prayer that my inner suffering could end. My home room teacher suggested that my parents send me to a child guidance counselor, who in addition to running a small clinic in an old house, was a psychology prof at the local University. He turned out to be a very caring and patient person.
He arranged to see me in the evenings three nights a week. For the first month I never said a word. He took to reading to me from a weekly science digest he subscribed to – he had been told I had an interest I science. And he offered me cigarettes, and we both smoked. Over the next couple of years he got me interested in Freud, and I read all of Freud’s books, and we tried to analyze my dreams. Suicidal thinking just faded away….
Later in life I became an alcoholic and drug addict. I found AA and again a non drug treatment cured me of my recurrent depressive thoughts. A few years ago I wrote the poem below that expresses some of my idea about the possible value of painful feelings:
If you don’t hurt
Then you may be
Sicker than you realize.
If you don’t cry
May be frozen.
If you have not screamed yet
Then your sanity
Has become a disease.
Thanks for your insights Dr. Levine. I work with my fellow alcoholics now who come to a treatment center up the road from where I live in the country. My observation is that various drug treatments have been more of problem for them than a cure.
Once I accepted my “mental illness” I would frequently be consumed with the idea that I must commit suicide. It wasn’t always that I wanted to. I believed I was a moral monster fundamentally incapable of any goodness and dangerous to all I came in contact with. I could only be as morally responsible as the pills I took. If I lost the pills, ran out of my prescription, my Medicaid expired, or the pills quit working I was terrified of running around murdering people. The “doctors” assured me I would.
Since I was doomed to commit random acts of violence why not commit the ultimate violence on myself beforehand? Surely this would be less reprehensible than mass murder.
My son & myself are survivors of the psychiatric system. The progressive pathologizing of our emotions, & medicating them, is causing untold damage. It’s clearly more about money than people. Any doubt I had was dispelled by the joke that is the DSM V. There’s little support to be found for people unwilling to take meds. Interpersonal types of therapy, supportive recovery environments, & alternative treatments, i.e. trauma informed bodywork, cost too much. Take a pill & go away. I despair for future generations if this trend is not reveresed.
My heart goes out to you and your son, Margo. I really want to bring back “moral treatment” from the 19th century. Some Quakers had the idea of building a nice house in the country for people who had lost touch with reality. Folks could come and go as they chose.
The workers treated the residents like equals. They were very kind and showed them unconditional love and acceptance.
About 90% of the “patients” recovered completely. Including people in the grip of bad psychosis. None of the Quakers running the place were doctors or therapists either.:)
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