6 reasons why people commit suicide

by Alex Lickerman, MD

Though I’ve never lost a friend or family member to suicide, I have lost a patient.

I have known a number of people left behind by the suicide of people close to them, however. Given how much losing my patient affected me, I’ve only been able to guess at the devastation these people have experienced. Pain mixed with guilt, anger, and regret makes for a bitter drink, the taste of which I’ve seen take many months or even years to wash out of some mouths.

The one question everyone has asked without exception, that they ache to have answered more than any other, is simply, why?


Why did their friend, child, parent, spouse, or sibling take their own life? Even when a note explaining the reasons is found, lingering questions usually remain: yes, they felt enough despair to want to die, but why did they feel that? A person’s suicide often takes the people it leaves behind by surprise (only accentuating survivor’s guilt for failing to see it coming).

People who’ve survived suicide attempts have reported wanting not so much to die as to stop living, a strange dichotomy but a valid one nevertheless. If some in-between state existed, some other alternative to death, I suspect many suicidal people would take it. For the sake of all those reading this who might have been left behind by someone’s suicide, I wanted to describe how I was trained to think about the reasons people kill themselves. They’re not as intuitive as most think.

In general, people try to kill themselves for six reasons:

1. They’re depressed. This is without question the most common reason people commit suicide. Severe depression is always accompanied by a pervasive sense of suffering as well as the belief that escape from it is hopeless. The pain of existence often becomes too much for severely depressed people to bear. The state of depression warps their thinking, allowing ideas like “Everyone would all be better off without me” to make rational sense. They shouldn’t be blamed for falling prey to such distorted thoughts any more than a heart patient should be blamed for experiencing chest pain: it’s simply the nature of their disease.

Because depression, as we all know, is almost always treatable, we should all seek to recognize its presence in our close friends and loved ones. Often people suffer with it silently, planning suicide without anyone ever knowing. Despite making both parties uncomfortable, inquiring directly about suicidal thoughts in my experience almost always yields an honest response. If you suspect someone might be depressed, don’t allow your tendency to deny the possibility of suicidal ideation prevent you from asking about it.

2. They’re psychotic. Malevolent inner voices often command self-destruction for unintelligible reasons. Psychosis is much harder to mask than depression — and arguably even more tragic. The worldwide incidence of schizophrenia is 1% and often strikes otherwise healthy, high-performing individuals, whose lives, though manageable with medication, never fulfill their original promise.

Schizophrenics are just as likely to talk freely about the voices commanding them to kill themselves as not, and also, in my experience, give honest answers about thoughts of suicide when asked directly. Psychosis, too, is treatable, and usually must be for a schizophrenic to be able to function at all. Untreated or poorly treated psychosis almost always requires hospital admission to a locked ward until the voices lose their commanding power.

3. They’re impulsive. Often related to drugs and alcohol, some people become maudlin and impulsively attempt to end their own lives. Once sobered and calmed, these people usually feel emphatically ashamed. The remorse is usually genuine, and whether or not they’ll ever attempt suicide again is unpredictable. They may try it again the very next time they become drunk or high, or never again in their lifetime. Hospital admission is therefore not usually indicated. Substance abuse and the underlying reasons for it are generally a greater concern in these people and should be addressed as aggressively as possible.

4. They’re crying out for help, and don’t know how else to get it. These people don’t usually want to die but do want to alert those around them that something is seriously wrong. They often don’t believe they will die, frequently choosing methods they don’t think can kill them in order to strike out at someone who’s hurt them—but are sometimes tragically misinformed. The prototypical example of this is a young teenage girl suffering genuine angst because of a relationship, either with a friend, boyfriend, or parent who swallows a bottle of Tylenol—not realizing that in high enough doses Tylenol causes irreversible liver damage.

I’ve watched more than one teenager die a horrible death in an ICU days after such an ingestion when remorse has already cured them of their desire to die and their true goal of alerting those close to them of their distress has been achieved.

5. They have a philosophical desire to die. The decision to commit suicide for some is based on a reasoned decision often motivated by the presence of a painful terminal illness from which little to no hope of reprieve exists. These people aren’t depressed, psychotic, maudlin, or crying out for help. They’re trying to take control of their destiny and alleviate their own suffering, which usually can only be done in death. They often look at their choice to commit suicide as a way to shorten a dying that will happen regardless. In my personal view, if such people are evaluated by a qualified professional who can reliably exclude the other possibilities for why suicide is desired, these people should be allowed to die at their own hands.

6. They’ve made a mistake. This is a recent, tragic phenomenon in which typically young people flirt with oxygen deprivation for the high it brings and simply go too far. The only defense against this, it seems to me, is education.

The wounds suicide leaves in the lives of those left behind by it are often deep and long lasting. The apparent senselessness of suicide often fuels the most significant pain survivors feel. Thinking we all deal better with tragedy when we understand its underpinnings, I’ve offered the preceding paragraphs in hopes that anyone reading this who’s been left behind by a suicide might be able to more easily find a way to move on, to relinquish their guilt and anger, and find closure. Despite the abrupt way you may have been left, those don’t have to be the only two emotions you’re doomed to feel about the one who left you.

Alex Lickerman is an internal medicine physician at the University of Chicago who blogs at Happiness in this World.

Detecting and Preventing Suicide among Teenagers

Melissa Ridenour

According to both the American Academy of Child and Adolescent Psychiatry and the Center for Disease Control, suicide is the third leading cause of death for youth ages 15 to 24. Teen suicide affects everyone. Family and friends feel a guilty sense that if they had only done something different, the suicide could have been prevented. Therefore, it’s important to understand its causes, how to detect potential suicidal vulnerability, and how to help prevent it.

Causes of Teen Suicide
As teens grow up, they often feel stress, self-doubt, confusion, social and interaction problems with friends, peer pressure, concerns about succeeding, and pressure to meet parental expectations. Some teens suffer from clinical depression as well. Most teenagers experience such feelings to a certain degree at some point in their growing years. Those who are overwhelmed with such feelings and are unable to deal with them are more at risk for suicide.

There are several causes for teenagers to potentially want to take their own lives. Anxiety or depression left untreated can be a contributing factor. Feelings of hopelessness, helplessness, and worthlessness can cause teenagers to contemplate ending their lives. Other contributing factors are lack of success in school, bullying at school, violence at home, divorce, death of a loved one, rejection by peers, and the suicide of a friend.

According to the Center for Disease Control, such pressures of life make it too difficult for some teens to cope. As a result, sometimes overwhelmed teens welcome suicide as an escape from the pressure and pain.

Detecting Teen Depression and Potentially Suicidal Teens
According the American Academy of Child and Adolescent Psychiatry, parents should be on the lookout for specific signs in their children that could be indicators for a potential suicide risk. Such indicators include withdrawal from family and friends, as well as a lack of interest in activities the teens formerly enjoyed. Parents should look for any change in eating and sleeping habits or in hygiene and personal appearance.

In addition, parents should watch for personality changes and rebellious or violent behavior. Difficulty concentrating, decline in the quality of school work, and persistent boredom and malaise are possible signs as well. Persistent complaints of stomach aches, headaches and fatigue could be symptoms of emotional problems that can be signs of potential suicidal tendencies.

Equally important signs to watch for include statements from teens that they are bad and that they feel terrible inside. Other verbal hints include such statements as, “I won’t be a problem for you much longer. It’s no use. Nothing matters anyway.” Such statements from teens are clear indicators that they may be at least contemplating suicide.

If teenagers start giving away cherished possessions or throwing away favorite belongings, a way of getting their affairs in order, parents should consider such behavior an indicator of the risk for suicide. In addition, parents should watch for any signs of hallucinations or bizarre or strange thoughts.

Teen Suicide Prevention
According to the American Academy of Child and Adolescent Psychiatry, if teens threaten to commit suicide, parents should take the threat seriously and immediately seek professional help from a qualified mental health professional. Parents should not hesitate to ask their teens if they have suicidal thoughts. Such a question will not put the idea into children’s heads, but will, instead, assure teens that someone cares and open up an opportunity for discussion about it.

Parents should determine if their teens are suffering from depression and, if so, get medical treatment for the depression. Counseling is a good preventive strategy for depressed or potentially suicidal teens as well. Counseling can provide teens with coping strategies for dealing with their life problems. Frequently, once teens learn how to cope with problems, their suicidal desires dissipate.

It is essential for parents to treat their teens with understanding, compassion and respect. Parents should demonstrate unconditional love, offer emotional support, and make their teens feel important, loved and wanted. Parents should demonstrate to their teens that overcoming their problems and life challenges is possible and that they will help them with such challenges.

Resources
Related information can be found in the articles, “Coping with a Bully: How to Stop Bullying” and “Strategies for Dealing with a Bully Dilemma”. The article, “Dealing with Grief” provides related information about dealing with the death of a loved one.

Appeals panel agrees that failure to read document doesn't null contract

KEITH ARNOLD, Daily Reporter Staff Writer
A Franklin County appellate panel was unable to conclude that the Franklin County Municipal Court's determination in a breach of contract suit between a specialty home-cleaning service and the next of kin of a Grove City man who died in his home was against the manifest weight of the evidence in a recent decision.

"Upon our review of the record, we find no error in the trial court's determination that an enforceable contract existed between the parties," 10th District Court of Appeals Judge Patrick McGrath wrote for the 3-0 court.

The appellate court's holding overruled Nancy Buffington's claim that the trial court was mistaken to find that the contract between her and the cleaning service was enforceable and, therefore, obligated the woman to utilize the company's services per the agreed terms.

Buffington's father died in his home on Nov. 10, 2005, case summary provided. The man's body was discovered one-and-a-half to two days after his death. Approximately one week later, the personal belongings were removed from the home and it was listed for sale.

On Jan. 14, 2006, Buffington contracted for the services of Aftermath Inc., which provides biological remediation and cleanup services. According to the contract, the woman agreed to pay for cleanup services concerning an unattended death in the Grove City home.

Aftermath's complaint alleged that after the firm rendered services, appellant refused to pay the amount due under the contract. After a trial to the bench, the trial court concluded that a valid written contract existed between the parties and that the company was entitled to payment for the services rendered in accordance with the contract. The court awarded damages in the amount of $6,189.36 to Aftermath.

The panel noted Buffington signed both a site cleanup agreement and a fee agreement for non-insurance-related jobs. Additionally, the court rejected the woman's claim there existed no evidence that she understood or agreed to biological remediation of her father's home.

"... As noted by the trial court, appellant's stated failure to read the documents prior to signing them is of no consequence as it is well-established that the failure to read the terms of a contract is not a valid defense to enforcement of the contract," as in Haller v. Borror Corp. (1990), 50 Ohio St.3d 10, 14.

"Further, appellant's argument that she was 'mistaken' equally fails because 'relief for a unilateral mistake of material fact will not be provided where such mistake is the result of the negligence of the party seeking relief,'" as in Hikmet v. Turkoglu, 10th Dist. No. 08AP-1021, 2009-Ohio-6477, and Marshall v. Beach (2001), 143 Ohio App.3d 432, 437.

Fellow 10th District Judge Susan Brown and John Connor joined McGrath to form the majority.

The case is cited as Aftermath Inc. v. Buffington, 2010-Ohio-19.

Teen depression and suicide risk linked to late bedtimes and chronic sleep deprivation

A report from the Jan. 1, 2010 issue of the journal Sleep found a surprising link between the typically late bedtimes of teenagers and teen depression and suicide.

Parent-set bedtimes affect teen's mental state

Adolescents with parent-set bedtimes after midnight had a 24% increased incidence of depression and a 20% increase in suicidal thoughts compared to teens with a bedtime before 10 pm.

Most of the teens in the study reported adhering to the bedtimes their parents set for them, showing that it's up to parents to give appropriate guidelines for avoiding sleep deprivation.

Length of Sleep Matters for Adolescents

The length of sleep matters, too, according to the researchers. Teenagers who reported getting less than five hours of sleep a night had a 71% higher risk of depression and a 48% higher risk of suicidal thoughts than adolescents who got 8 hours or more of sleep.

The AASM (The American Academy of Sleep Medicine) recommends nine or more hours of sleep a night for adolescents.

The study was conducted by James E. Gangwisch, PhD, assistant professor at Columbia University Medical Center in New York, N.Y and colleagues and looked at over 15,000 teenagers' sleep habits and mental states. The teens in the study ranged from 12-17 years old.

Other studies indicate more benefits from increased teen sleep.

In previous studies, shorter sleep durations in children and teens have been linked to higher rates of obesity, school performance and general social well-being. And adolescents who don't get enough sleep due to insomnia are far more likely to develop mental health problems, including substance abuse.

Why you need crime scene cleanup services

By Alex Thomson

Crime scene cleanup or trauma scene cleanup after the death of someone either violently or naturally is by and large the responsibility of the victim’s family. Even till few years ago, there were a handful of cleaning companies that specialized in trauma cleaning service. But today this niche service has emerged as a lucrative business and there are many companies who provide this service.

Trauma cleaning service requires special experience, skills, equipment and expertise to deal with different types of bio-hazardous waste and dispose them efficiently with the minimum possible emotional stress to the victim’s family.

The most traumatic form of death is violent death and leaves the victim’s family feeling both victimized and traumatized. Coming to terms with the unnatural death of a loved one is in itself an uphill task for the bereaved family, and to top it they have to deal with other practical matters like making funeral arrangements, dealing with insurance issues, contacting surviving family and friends and locating wills. Furthermore, in case of violent crimes the police and the media are also involved. This can really overwhelm any family. Here is where trauma cleaning service comes to your rescue. They lighten one of the heaviest burdens, that is of dealing with the horrid murder cleanup. They will take care of the crime scene cleanup, ensuring that the scene is restored to its pre-incidental state as far as possible and in the most quick and efficient manner thus allowing you to deal with other important matters. Most service providers work discreetly and protect the confidentiality of the sufferer and family.

Most of the times, the crime scenes are so ghastly that they can induce additional emotional trauma in victim’s friends and family. By hiring professionals for cleanup, you can reduce this emotional stress. Immediately after death the nature begins its process of breaking down the body. Unattended death scene and dead bodies can be dangerous as it gives rise to blood borne pathogens, mold spores and bacteria. You may try to clean the area by yourself but the exposure may result in flu-like diseases or direct attack on the respiratory system. So it is advisable to leave this job to professionals who specialize in bio fluid and blood remediation.

The total cost involving a trauma scene cleanup will depend on a number of factors. One of the most major factors is that how many technicians will be needed for the job, how long will the job take and the quantity of hazardous material that needs to be treated and disposed of. It can range anywhere in the range of $100 to $1000 per hour. Some people might call this business as capitalizing on death but it is still essential and indispensable in case of a death.

Crime Scene Cleanup: What It Involves

A crime scene cleanup service is not without its complications. Crime scene cleaning encompasses restoring the crime scene to its original state. When a crime is usually discovered, crime scene cleaners are not called until after officers of the law, like the crime scene investigators, have done their jobs first and have given the go ahead for the cleaners to come in. If you intend to hire a crime scene cleanup company, you must make sure that they are well equipped and fit right to get the job done. A crime scene presents challenging conditions.

The Use Of Protective Gears:
Crime scenes can very well involve the use of hazardous or deadly substances. For safety reasons then, it has become imperative that crime scene cleaners use protective clothing, in addition to protective tools and gadgets. You must see to it that they have all the necessary protective gears and gadgets. The protective clothing can consist of disposable gloves and suits. A disposable gear is preferred nowadays since it offers the best protection against contamination. You use it one time and get rid of it. That way, the dangers of contamination is virtually brought down to zero percent. Protective clothing extends to respirators and the use of heavy-duty industrial or chemical-spill protective boots.

Among the gadgets that a crime scene cleaning company must have are special brushes, special sprayers, and wet vacuum. These special tools ensure added protection against getting into contact with the hazard could very well be present in the crime scene. There is large, special equipment such as a mounted steam injection tool that is designed to sanitize dried up biohazard materials such as scattered flesh and brain. You would also need to check if they have the specialized tank for chemical treatments and industrial strength waste containers to collect biohazard waste.

Of course, any crime scene clean up must have the usual cleaning supplies common to all cleaning service companies. There are the buckets, mops, brushes and spray bottles. For cleaning products, you should check if they use industrial cleaning products. A crime scene cleaning company must have these on their lists:

1 - Disinfectants including hydrogen peroxide and bleaches - The kinds that the hospitals used are commonly acceptable.

2 - Enzyme solvers for cleaning blood stains. It also kills viruses and bacteria.

3 - Odor removers such as foggers, ozone machines, and deodorizers

4 - Handy tools for breaking and extending such as saws, sledgehammers, and ladders

Established crime scene operators also equip themselves with cameras and take pictures of the crime scene before commencing work which. The pictures taken may prove useful for legal matters and insurance purposes. You never know which.

Needless to say, a specially fitted form of transportation and proper waste disposal is also needed. These requirements are specific. As you can imagine, crime scene cleaning is in a different category on its own. A home cleaning or janitorial service company may not be able to cope up with the demands of a crime scene. A crime scene cleanup service requires many special gears and tools that a home cleaning or a janitorial service company does not usually have or does not require. Crime scene cleaning if not done correctly can expose the public to untold hazards.

What Else To Look For In A Crime Scene Cleanup Company
You may also want to hire a company that has established itself. An experienced company with a strong reputation is always a plus but it could be expensive too. You will do well to balance your needs with what is your budget. There are several companies that offer specific prices such as for death scene clean up categories and suicide clean up categories. Most companies own a website and have round the clock customer service as receptionists.

When looking for a suitable crime scene cleaning service, among the first things you need to do is to scout for price quotes. Crime scene cleanup services usually provide quote after they have examined the crime scene and then they give you a definite quote. Factors that are usually considered include the number of personnel that will be needed to get the job done. It also includes the amount of time that might be needed. The nature and amount of the waste materials that need to be disposed will also be factored in. You can be sure that the more sophisticated equipments needed the more expensive it will get.

Crime Scene Cleanup And Your Insurance
For homeowners, the best approach is always to make sure that crime scene cleanup services clauses and provisions are written down on the contracts or policies. The inclusion of crime cleanup services clauses is very common and has become standard clause in most homeowner’s policy. Make sure that you are covered for this unforeseen event. Make sure that your policy directs the crime scene cleaning company to transact directly with the homeowner insurance company. A crime scene cleaning service is usually a standard clause in many homeowners’ insurance clause. These companies often do the paperwork in behalf of clients.

If for some reason you do not have such coverage by any policies relating to crime scene cleanup on your home, there are ways to keep your expenses controlled.

Finding the right company can be very taxing, especially that you have to deal with the emotional stress stemming from the crime itself, especially with a crime scene involving death.

There are many crime scene cleanup companies in operation nowadays. There are reliable professionals that you can hire and prices are relatively competitive. As of recently, crime-scene cleanup services can cost up to $600 for an hour of their service. A homicide case alone involving a single room and a huge amount of blood can cost about $1,000 to $3,000.

In recent years, crime scene cleaning has come to be known as, "Crime and Trauma Scene Decontamination or CTS. Basically, CTS is a special form of crime scene cleaning focusing on decontamination of the crime scene from hazardous substances such as those resulting from violent crimes or those involving chemical contaminations such as methamphetamine labs or anthrax production. This type of service is particularly common when violent crimes are committed in a home. It is rare that the residents move out of the home after it has become a scene of a crime. Most often, the residents just opt to have it cleaned up. That is why, it is very important to hire the best crime scene cleaning company out there. The place needs to be totally free from contamination of any kind. You have to make sure that the company is able to remove all traces of the violent crime that took place. This includes cleaning biohazards that are sometimes invisible to the untrained eye.

Legally speaking, federal laws state that all bodily fluids are deemed biohazards and you should make sure that the cleanup service company you hire understands this and includes it in the cleanup. These things appear as blood or tissue splattered on a crime scene. You must be able to hire a company that is equipped with special knowledge to safely handle biohazard materials. The company must have the knowledge what to search for in any give biohazard crime scene. For instance, the company should be able to tell clues such that if there is a bloodstain the size of a thumbnail on a carpet, you can bet that there is about a huge bloodstain underneath. Federal and State laws have their own laws in terms of transport and disposal of biohazard waste. Make sure that the company you hire has all the permits necessary.

It will also be a huge plus if you could hire people who not only has the special trainings but also who have the nature to be sympathetic. If you are close to the victim and have the cleaning done at the behest of the victim’s relatives, it would matter that the cleaners tread the site with some level of respect. It is a common site that family members and loved ones are often there at scene. In general, when looking for a suitable crime scene cleaners, you would take into considerations the kind of situation that the crimes scene presents and the demands that it require. Crime scene cleaning companies handle a wide variety of crime scenes and prices may vary from one to the other crime scene and one to the other company.

Each type of scene requires its own particular demands not only to make the crime scene look clean and neat on the surface but to make it germ free, and clean inside and to make it free from all deadly and infectious substances. The cleanup cost for biohazards may vary depending on degree of the bio hazard(s) on the scene. There may even be a category that changes the cleanup pricing which usually involves decomposing bodies and carcasses. Likewise, a cleanup of chemical hazards vary, depending on the amount of chemical hazards as well as the grades i.e. how hazardous the substance is in terms of human contact. Prices are also determined by the number of hours and personnel that it would to get the crime scene cleaned. In addition, the "gross factor" from crime scene involving death and gore needs to be taken under consideration regarding the chemicals that will be used as opposed to those crimes' that do not have gore involved.