The “myth” of holiday suicides rates
I thought the old saw that suicides increase during the holidays–the result, it was assumed, of isolation and despair deepened by the camaraderie ostensibly being enjoyed by everyone else–was an Urban Legend that I was the last to catch on to.
Apparently not. This story by Jim Nichols of the Cleveland Plain-Dealer is a good myth-buster, with some explanations as to how the legend got going, why it remains so durable, and why it’s not true. Nichols quotes Pat Lyden, executive director of the Suicide Prevention Education Alliance of Northeast Ohio, who says the misconception is rooted in a pervasive public misunderstanding of what triggers suicides–and, more importantly, what does not.
“Untreated mental illness, such as depression, bipolar disorder [commonly called manic depression] and anxiety disorder, are the main causes of suicide,” said Lyden, whose nonprofit organization teaches youths about warning signals.
“People, I think, expect more suicides at Christmas because they see people who have the blues, or who have loneliness,” she speculated. “But the blues and loneliness are not the same as major illness. This particular illness affects the brain, in the same way other diseases affect the heart or the pancreas or other organs.”
What remains unexplained, however, is why, according to statistics from the National Center for Health Statistics, December has the lowest suicide rate of any month of the year. Are the holidays in some way an antidote to despair? Is there a lesson there? Or just another myth waiting to be born?
on December 29th, 2008 at 5:26 pm
Are the holidays in some way an antidote to despair? Dream on. Christmas is when DUIs and domestic violence reports peak.
http://www.naplesnews.com/news/2008/dec/26/holidays-usually-season-when-domestic-violence-dui/?partner=RSS
on December 30th, 2008 at 9:55 am
David: I wonder if “despair” it the right word to describe those who commit or contemplate suicide. Is it really a lack of hope (I looked it up to make sure)? I’m not sure. Anguish? Maybe. Pain (an all over ambient kind)? Better. Fatigue (of a deep, deep, tired of hurting kind)? Sometimes. A desire for non-existence with no readily identifiable source of that desire? Probably.
Despair suggests both a logic (the person has done a hope calculus and finds the answer to be zero) and a sense of prognostication about the future (there will be nothing good in the future) that doesn’t quite ring true to what I have read about those who experience severe mental illness and from what I have learned from those I know who suffer from it.
I’m not trying to be picky, just trying to continue the theme you raise in the post of properly characterizing mental illness.
on December 30th, 2008 at 9:59 am
One quick, entirely unsubstantiated theory on why suicides are low in December. December is a busy month. It occupies people with shopping, “to do” lists, parties, and get togethers. This business is an antidote to suicide. Isolation, lots of down time (not loneliness, rather, just being alone), that’s the time to really worry about suicide.
on December 30th, 2008 at 10:08 am
I think it was Voltaire who said that if you don’t want to commit suicide, always have something better to do. (And he always did.)
I have no doubt there are many precisazioni that could and should be made about suicide, and the holidays. I was using general terms for a quick description–but knowing about the complexity and sensitivities surrounding mental illness and suicide (not to mention holidays), it is hard to imagine a way to convey these things briefly, or without requiring lengthier explanations.
I think mental illness of the sort that leads to the abyss covers a wide range phenomena, and comes from many things. (As does domestic violence and drunk driving.)
This is worthy of another post, certainly, and one that I think might take off from Kathleen Norris’ new book on “acedia.” I am a “Cloister Walk” fan, and haven’t read the new book, but I see she’s gotten some tough reviews–perhaps rightly, for all I know–about conflating, or not sufficiently differentiating, between acedia as a spiritual problem and clinical depression. Maybe they overlap. Maybe they are the same. Maybe they are wholly different. Maybe she explains all that. But it’s a contentious point.
on December 30th, 2008 at 10:39 am
Depression is something of cause for me, especially as an academic. Every semester I assume that I have at least a few severely depressed students in my classes. I know that this has been the case on several occasions. One of the problems with depression is that paralysis is a common symptom. As a professor, it is hard to differentiate paralysis with slackerdom or exploitation of the professor. However, borrowing the motto “first, do no harm” I assume that any student who comes to me after missing many classes or failing to hand in assignments and asks for a second chance should actually get that second chance. Am I a pushoever? Probably. Am I fooled by students? Almost certainly. But I would rather be fooled nine times out of ten than refuse the second chance to the one student who is severly depressed. The first book I bought when I was hired by Morgan State was Lay My Burden Down: Suicide and Depression among African Americans.
FWIW, Darkness Visible by William Styron is valuable quick read to give one a sense of what it is like to experience suicidal depression. After reading the book I wondered what it must be like for those not as introspective as Styron who experience severe depression. It struck me that it must seem like a curse from the gods.
on December 30th, 2008 at 11:41 am
Kay Redfield Jamison’s _Night Falls Fast: Understanding Suicide_ says that epidemiological studies show that April is actually the only month with a significant spike in suicide rates (cue T.S. Eliot jokes here). Some theorize that it’s because being depressed during the winter feels “right,” while being depressed as things grow warmer and brighter around you is unbearable. Some theorize that it simply has to do with changed cicadian rhythms.
Andrew Solomon’s _Noonday Demon_ does some exploration of how the ancient concept of acedia might be connected to more modern concepts of depression.
on December 30th, 2008 at 11:52 am
Bless you, Joe, for being humane to the point of being a pushover. I wish I had more professors with your approach.
on December 30th, 2008 at 4:06 pm
Kurt Vonnegut wrote in “Time Quake” that one of the reasons he didn’t commit suicide when he suffered bouts of depression was because he read that children of suicides often take that same route.
Talk, group and drug therapy can help those who have chronic recurring depression over the bad patches. But medical solutions are a crap shoot, and I think most people who are able to work through depression weave themselves a lifeline that has some kind of philosophical or spiritual strand. Like Vonnegut, who believed that he was saving his son every time he didn’t give in to his urge to suicide.
Prayers of the faithful that acknowledge that there are those for whom the holidays are not a happy time, full of joyful associations, can go a long way toward strengthening that lifeline some folks need to get from Thanksgiving to New Year’s.
on December 30th, 2008 at 6:04 pm
“But I would rather be fooled nine times out of ten than refuse the second chance to the one student who is severly depressed. ”
As one who has been clinically diagnosed with depression, I only asked for professorial assistance once in college. I needed to conceal the depression, so asking for any help was a last resort. Incidentally, I had a couple of classmates cwho committed suicide. I wonder how many lives you saved by your policy? I suspect several.
on December 30th, 2008 at 8:42 pm
These are kind affirmations. Did I mention that I FAIL (for the course, not the assignment) any student that I catch cheating? In some ways the rationales for both policies are the same. I cannot see into the souls of my students, so they catch a break on the depression side and everyone gets treated equally on the cheating side. Since I cannot tell who has a good sob story to tell when it comes to cheating, I go nuclear on everyone. I also make clear that it’s not personal, and that I would welcome anyone who fails for cheating in future sections of the course. But cheating is probably best left to another thread.
on December 30th, 2008 at 11:18 pm
Mr. Pettit – have been working in behavioral health for 20 years. What got me started was my family history of depression (thankfully, no suicidal history). Agree – Wm. Styron’s book is one of the best in laying out the emotional abyss that you feel.
Keep in mind that clinical depression is a disease – usually with multiple causes – genetic, family history, substance abuse, stress, medical – closed head injury. Simply, the brian synapses no longer work – your brian short circuits. It is no different than if a student had heart disease and could not function without oxygen and medication. Unfotunately, you can test and see heart disease; even today, there is not definitive test for depression. You must track and know the symptoms and behaviors and there is still an unspoken stigma against mental illness (reference some of the blog comments).
Because of the events happening on college and high school campuses in the past 10 years, administrations are now asking for clear cut ways to identify, encourage, and track depressed students. Best practice is to have college policies that encourage students to get help rather than punitive policies; training for faculty and dorm supervisors to identify and then an active campus counseling center with MD staff to track and treat students (again, with privacy and confidentiality). Best practice also encourages parents, faculty, and incoming students to self-identify so that treatment is made available. Not unlike society in general, if your campus approach is to help rather than punish/expel and you clearly have resources in place to treat and to track – then, faculty can be encouraged to confidentially work with the counseling staff and dorm admin to identify students who are not showing up for class; or seem pre-occupied or confused in terms of assignment completion. Some say this is a “police” state environment – our experience is that it is a best practice that removes stigma and treats deprression just like you would a student with a coronary issue.
on December 31st, 2008 at 9:54 am
Bill, with great respect for your desire to help those with depression, I’d argue that depression IS different from having coronary disease.
Meds in the Prozac family don’t work quickly–usually it takes six weeks for the drugs to kick in–and even when the meds work, the side effects can be as depressing or limiting as the disease (nausea, vomiting, fatigue, etc.). If the meds don’t work, friends and co-workers often tend to think he’s just an oversensitive whiner.
In addition, depression often tends to be cyclical, which often reinforces the notion among family and the patient himself that it’s just a “bad mood” thing that can be controlled with willpower. Ergo, when the depression hits, the depressive is just not trying hard enough to fight it.
In truth, the outward behaviors can sometimes be controlled with non-medical treatments (prayer, yoga, exercise, talk therapy) or meds for specific symptoms like anxiety, sleeplessness and migraines, which often accompany depression. All of that takes a fair amount of self-awareness and a need for “alone time” that is sometimes misread as selfishness.
Sadly, a known history of depression does often result in behaviors that require separate medical intervention (drug abuse, alcoholism, cutting, etc.), and that make depressives poor risks for insurance companies. Admitting having been treated for mental illness on an insurance application is a sure way to get turned down, or to be offered coverage beyond your means, or with all sorts of caveats about treatment options.
Moreover, once doctors make a diagnosis of depression or know about a family history of it, many will blow off legitimate physical ailments as psychosomatic, even though most depressives learn to clearly distinguish between the “normal” set of depression symptoms and others that are not normal. My guess is that many menopausal women have probably had similar experiences–in your late 40s and early 50s, just about everything is waved away as a “female” problem, and you often have to insist on diagnostic tests.
Finally, the media attention on depression tends to focus on celebrity suicides and disaffected kids who mow down their classmates a la Columbine. There has been a lot of education about depression–but most depressives cringe whenever they hear it.
While massive medical intervention such as you suggest sounds great, there are many practical reasons why depressed students themselves would resist participation in this type of program.
on December 31st, 2008 at 10:39 am
The contributions of depressives to the world has been enormous. Among them have been Abraham Lincoln and Winston Churchill, both very funny men. Churchill called his depression his “black dog” that followed him around. Who knew.
Kay redfield Jamison has another non-rechnocal book about depressives, “Touched with Fire”, which is abput depression and artists and writers. One wouldn’t expect to find in her list of depressives those funny men Mark Twain and Charles Dickens, nor the eminently cheerful musician Handel.not to mention Noel Coward or Irving Berlin. One of my godsons (another musician) is a depressine, and he complains that even people who care about him will tell h to buck up, distract himself, whatever. But he says clinical depression just isn’t controllable at will any more than cancer is.
on December 31st, 2008 at 10:46 am
Qualification: none of this is to say that will power and the lpve others can’t help sometimes. Styron tells how, when he told his friend Art Buchwald.that he was going to kill himsel Buchwald told him simpyl, “this is not acceptable”. This turned the tide for Styron and he got professional help. (If I’m npt mistaken, buchwsld, that very funny man, was also a depressive.)
on December 31st, 2008 at 12:16 pm
Jean – agree with your comments completely. The best practice is never medication alone – our experience shows that the majority of depressives do not do well on their firsts medication; it usually takes 2 or 3 tries and, yes, the physical/mental improvement may not happen for weeks. We always try to do both counseling and medication – if possible, with family or friend support included.
Depression is a difficult disease to manage – my experience is that it does re-occur all too frequently and again learning how to self-manage, learning the indicators, trusting some valued counselor/friends can off-set the blackness.
You are also correct about insurance companies, managed care companies – what we find is that most counselors will respect the patient by using a code such as adjustment disorder or even anxiety which is more acceptable in our society. We actually intervene with counselors with this diagnosis knowing that 50% of more are actually depression and need a more comprehensive approach. One of the biggest, growing stumbling blocks is the increased use of anti-depressants by primary care physician who merely prescribe and forget – this is the opposite of a truly comprehensive approach. It also makes anti-depressants one of the top 3 drugs that most corporations re-imburse for.
I used coronary illness as an example – studies/experience indicates that 40% of more of all coronary patients are also clinically depressed. It is not that simple of an illness.
on December 31st, 2008 at 1:15 pm
Here is one sense in which depression should be treated like heart disease; namely, the willingness of academics, employers, and others to find alternative ways for individuals to complete responsibilities because of limitations impsoed by their illness. Most profs would have no problem cutting a student some slack if that student were being treated for an easily recognizable disease (e.g. heart disease). They seem much less willing to do so for depression.
on December 31st, 2008 at 1:51 pm
Joe, I assume it’s none of my business why students are absent, and this puts me in conflict with department policy, which is to dock grades by a certain percent for every absence unless the absence is documented with a doctor’s note, emergency room slip, obituary or the like.
When a student has been absent more than twice, I send him an e-mail requesting a conference ASAP so we can make a plan to get him through the class. Usually the kid is grateful for the concern, and I don’t think most of them are giving me a load of bull, given the number who admit they’ve been over-imbibing at one of the local taverns that has cheap pitcher nights on Wednesdays. Many of them are dealing with parental problems. Many are having financial problems or their work schedules have been changed. Some are having a medical crisis. Some are depressed. Some are sick of college. When I can offer coffee and encouragement or referrals, I do.
Ann, yes, depressives have a good sense of the ridiculous–depression makes no sense–and sometimes have a humorous streak that runs to farce, irony and black humor. Count Jonathan Winters and Groucho Marx among my favorite depressives.
on December 31st, 2008 at 4:15 pm
Jean –
Yes, depressives can have a very keen sense of the ridiculous. I’d say a keen sense of reality in some cases. One important point about depression that many people do not know is that it is an •Affective• Disorder, not a cognitive one , as are schizophrenia and some other psychoses. A person can be horribly depressed and from his or her conversation wouldn’t know it. No voices, no living in alternatve universes of their own making, no bizarre behavior, except maybe not getting out of bed for three days or some such reduced activity.
A family friend was a severe depressive. As my mother said, our friend could tell you exactly and in great detail what her problems were and what she needed to do about them. But sometimes she was simply eotionally paralysed, like a paraplegic who cannot walk. It is an awful, awful illness.
Last I read a majority can be helped a significant amount. But there is still a sizeable portion for whom little can be done. Sadly even children become depressed, and adolescents. In the latter cases it often presents as irritability rather than the down feeling of adults. Since irritability is common in adolescents anyway, parents easily can be mistaken about what is really happening.