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Psychotherapy.co.za : Articles : Articles : Self Help : Show Entry

 Suicide - The final say
Submitted By DavidvdW | Added on: 2011 May 17 | Total Visits: 13075 | Printable version

Suicide

The final say

Jenny Perkel
Cape Town Clinical Psychologist Jenny Perkel writes informatively about suicide, its predisposing factors and the implications for those left behind.

Jenny Perkel is a clinical psychologist in private practice in Cape Town. She is the author of Babies in Mind and Streets of Jewels. Visit her website at www.babiesinmind.co.za or contact her on jenny@perkel.co.za.


Carmen was 30 years old. She was beautiful, intelligent and successful and surrounded by people who loved her. But a few months ago she took a fatal overdose that left her friends, colleagues and family reeling with shock. “Why did she do it?” they all asked. Well, she’s not around to answer their question. By ending her life she had the final say. And those who knew her and cared about her are left behind with their unanswered questions, and a large dose of confusion, pain, regret, guilt and anger.

It’s hard when you’re the one left behind to make sense of it. With outrage you might say, “Suicide is selfish!” or “Suicide is wrong!” But truthfully that doesn’t capture what it really means when someone was suffering to such an extent that she couldn’t bear to go on living.

Depression and its link to suicide

It’s very hard to live with a depressed person, especially if that person is yourself. If you hate someone enough you might want to kill him. If you hate yourself enough, killing yourself might seem like a good option.

Steven had been depressed for years. He had tried overdosing on his antidepressants twice before and his life had almost ground to a halt because his depression left him feeling incapacitated and unable to do the simplest things. He struggled to sleep because his mind was constantly tormented with thoughts about how bad and worthless he was. He had no motivation or desire to do anything, from being with friends to working or even getting up out of bed. Nothing he did brought him any pleasure at all, and this is how he had felt for a very long time. His third suicide attempt was successful. His ‘struggle with life’ was over.

Most psychiatric disturbances, especially depression, are associated with a risk of suicide. Despair, grief, loneliness, shame, terror and a range of other feelings can become so unbearable and overwhelming that it can make you long for escape. You might think that escape from your own mind is not possible except, perhaps, through death. When your mind is fraught with crazy-making thoughts and feelings, you might long for the illusion of death-induced ‘peace’.

The good news is that depression is usually treatable. Psychotherapy with a trained clinical psychologist or an experienced mental health practitioner is crucial. In addition, consultation with a psychiatrist is necessary if the depression is accompanied with suicidal ideas or thoughts about dying. Anti-depressants, which should be prescribed and monitored by a psychiatrist, are hugely effective and have saved many people from the brink of suicide. Occasionally, however, despite therapy and antidepressants, people still commit suicide. In a cruel twist of fate, some even die by overdosing on their own antidepressants - the ultimate ‘attack’ on any attempt at getting well and leading a healthy, normal life.

Is the past to blame?

With genetics as the backdrop, a trigger in the here and now almost always links to something from childhood that might lead to suicide. Often, these links are unconscious so it is hard to understand what is so traumatic, for example, about getting depressed after giving birth to a baby. The way the current circumstances fit into your own past and the unique complexity of your own mind could bring about suicidal feelings.

Life-stressors can precipitate depression with suicidal feelings but they are part of a bigger picture. Early life experiences and childhood relationships have a huge impact on the developing mind. If, for example, you had a mother who constantly made you feel unwanted, you will probably develop in your mind an internal representation of a rejecting mother. You will carry that internal rejecting mother with you wherever you go throughout childhood, adolescence and adulthood. You will feel rejected by people in your life and you will probably recreate situations where you will be unwanted. You might attract rejecting people to you because they are familiar to you. Psychologists refer to these ‘little people’ or images we carry around in our minds as ‘internal objects’. These internal objects have a profound impact on our mental state throughout life.

Trudie Rossouw, a London based psychoanalyst who previously lived and worked in Cape Town, says that killing oneself is actually an attempt to murder or get rid of the bad, destructive internal objects inside of one’s own mind. If you have felt tormented and persecuted your whole life by your internal objects (representations in your own mind of traumatic babyhood and childhood relationships and experiences), you might long to get rid of those internal objects and suicide might feel like the only option. It isn’t. Psychotherapy with a qualified and skilled therapist for a substantial period of time will alter your internal objects.

Effects on those left behind

Once the person has died, it is the people left behind that might need the psychotherapy because they are left with the pain and the mental anguish. Suicide is the final devastating act of rage and violence. Those who are left behind are often left feeling angry and betrayed. “How could she have done this to me?” or “Why didn’t he tell me he was feeling suicidal?” and even “He was only thinking of himself”.

In fact, suicide is often partly an attack on the people in one’s life. It can be an attack on one’s parents, teachers, ex-girlfriend, husband, and even one’s own children. It can also be an attack on one’s therapist. “You should have been there and you weren’t!” These are the words that a suicidal person might want to say to certain people in her life. But even if she had managed to say them, she might still have killed herself.

It’s normal to feel enraged with a loved one who has committed suicide. You have been made to feel guilty and responsible. You didn’t do enough. You might have turned your life completely upside down and made massive sacrifices, but still it was not enough. You will be thinking, “If only I had done more, he might be alive today”. You can carry this guilt for years and years after the person has died. He has left you with that - a parting ‘gift’ of guilt and remorse for you, wrapped in the colourful paper of his self-sacrifice:  His own death. “There! Take that! Carry it around with you for the rest of your life and don’t ever forget that I killed myself because you did not look after me properly!”

Consciously or unconsciously and to some extent, your guilt and suffering might have been partly the suicide victim’s intention. “Look what you’ve done to me. I couldn’t live without your love.” Perhaps he lost sight of the fact that each person is responsible for his own life. Some people have had childhood experiences that have left them with a seemingly cruel and unfair psychological vulnerability. But everybody has choices, including the choice of whether to live or to die. If he made the choice to die, you probably couldn’t have changed that.

This life of ours can be unspeakably, brutally hard. For some people, their own mental anguish can be relentless and unbearable. This is probably directly linked to their experiences early in life. If your girlfriend takes her own life because you broke up with her, this has less to do with you than you might think. Abandonment and rejection possibly felt intolerable for her because of childhood experiences or relationships, and it was just triggered by you. If it were not you who left her in her adult life, it would have been someone else. Her unconscious would probably have recreated abandonment in some form by someone. In the end, she got the upper hand by abandoning you. Not only was this an attack on you, but it was also an attack on her own parents (the people who gave her life), either in the real world or in the convoluted realms of her own mind.

Even more tragic, says Cape Town clinical psychologist Tanya Wilson, is the legacy left with the children and grandchildren of those who commit suicide. Because of the taboo, the shame and the silence around suicide, a child’s imagination can run wild with negative, destructive images about self-induced, violent death. There can be a danger of trying to identify or make a connection with the lost parent (or relative) through suicide. In that way, the child might feel that she can get the person back or hold the person inside of herself if she feels what he felt. Alternatively, a child might not allow herself to go anywhere near her own emotional pain, in case she should encounter the dangerous and frightening suicidal potential that has already been acted out in her family.

Tanya Wilson explains that all children are susceptible to thinking magically and omnipotently about things in their lives. Because they characteristically can (and should) see themselves as the centre of the universe, when something bad happens they must have caused it. If a child’s father commits suicide because of the torment of his own mental illness, his child will believe that it was her fault. She grows up feeling she has the power to destroy people. People will try to convince the child that she had nothing to do with it and isn’t to blame, but then she is left with the horrible realization that she is powerless and the world doesn’t, in fact, revolve around her at all. Perhaps the child part in all of us is in this same dilemma when someone commits suicide. “There must have been something I could have done. It was my fault. If it had nothing to do with me, I must be quite small and insignificant and really not very important in this world.”

Shedding some light on the darkness of suicide is important because it’s real and it happens every day in this country and around the world. No-one likes to talk about it, probably because it feels so horrifying and shameful. But silence brings even more complications and so it makes sense to talk and think about suicide and the effect that it has on those of us left behind. Even though in his own life the suicide victim had the final say, the rest of us can still talk and we are still alive.

Triggers for suicidal depression

  • birth of a child
  • divorce or ending of a relationship
  • stages in life such as adolescence or middle age
  • physical or terminal illness
  • infertility
  • loss of a parent
  • loss of a spouse or loved one
  • any significant life change
  • any kind of mental illness
  • immigration
  • change in career or loss of employment
  • poverty
  • unemployment

Suicide statistics

  • 2 South Africans kill themselves every hour
  • 20 South Africans attempt suicide every hour
  • 10% of all non-natural deaths in South Africa are due to suicide
  • 2 million people commit suicide worldwide every year
  • there has been a 60% increase in suicide in 45 years
  • suicide behaviour is dramatically higher in HIV positive patients
  • 45% of fatal suicide victims had high levels of alcohol in their blood
  • males are 5 times more likely than females to commit suicide
  • the average age of people committing suicide is 36

About the author

Jenny Perkel is a clinical psychologist in private practice in Cape Town. She is the author of Babies in Mind and Streets of Jewels. Visit her website at www.babiesinmind.co.za or contact her on jenny@perkel.co.za.


References

Clark,  L. (30 May 2004) South Africa Suicide Rate High and Growing. Sunday Tribune.
Rossouw, T. (2007). Exploring the Inner World of a Patient suffering from Manic-Depression. Psychoanalytic Psychotherapy in South Africa.


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