When Hopelessness Sets In, Warns Psychiatrist Aaron Beck, Suicide Can Be Close Behind
A leading expert in the field is Dr. Aaron T. Beck, 64, professor of psychiatry at the University of Pennsylvania School of Medicine. A graduate of Brown and the Yale medical school, Beck has conducted decades-long suicide studies and conceived of a "cognitive therapy" seeking to reverse depressive moods through reason and problem-solving. With correspondent Giovanna Breu, he discussed what we know now about suicide.
What kind of person commits suicide?
People who have a negative image of their lives. The critical factor is a sense of hopelessness that is characteristic of people who may have gone through severe stress such as disappointment in their careers or a breakup of a relationship. They exaggerate their problem or its consequences.
Was Donald Manes an example of that?
We don't know what was going on in Mr. Manes' mind, but if he assumed that he would always be miserable, that would be irrational. We've seen a whole raft of politicians in Pennsylvania indicted, and it wasn't the end of their worlds. Public figures sometimes believe they have let down their country or community, their associates or family, and they can't go on. Sometimes they romanticize the act of suicide.
Are there personality traits that identify people as suicide risks?
There is no single profile. In general they don't like to feel bad and they look for quick fixes to avoid feeling bad. They have less control over their angry feelings and violent impulses. They also have low serotonin, a neural biochemical substance in the brain that has a dampening effect on impulses, like shock absorbers on a car. Other factors include a low capacity for solving problems—and alcoholism.
Is a suicidal tendency a family trait?
The idea may seem silly, but people do inherit the temperament that, when combined with other factors, could lead to suicide. We know this from a study of adopted children in Denmark who were reared apart from their biological parents. Among 57 adoptees who committed suicide, there were 12 suicides among all their biological relatives. A control group of 57 nonsuicidal adoptees had only two suicides among relatives.
What about identical twins?
There is some evidence that when one twin commits suicide, the other twin, even when raised apart in a separate adoptive household, has a higher probability of suicide.
Are multisuicide families common?
Not really. Inheritance is not a major factor. Yet if someone in a family has made a serious attempt or committed suicide, that may dignify the act. It can legitimize a particular form of behavior ordinarily considered to be antisocial.
How many suicides are recorded each year in the U.S.?
We know of about 25,000 to 30,000, but it could run as high as 60,000, since many are hushed up or recorded as accidents. Other countries such as Hungary, Austria, Denmark and Switzerland have substantially higher rates.
How do suicide rates vary between the sexes and among various groups?
Men commit suicide three times more frequently than women, but women make nonfatal attempts at least three times more frequently than men. Catholics are far less likely to commit suicide than other religious denominations in this country. Ethnic groups here in the U.S. tend to show suicide rates similar to those of their countries of origin. This tells us that social factors have an important role in suicide rates.
Can suicide ever be a rational act?
I know of an AIDS victim deserted by family and friends who was dying with no one to take care of him. That seemed like a rational suicide, but I think such instances are rare.
Can one suicide trigger others?
Yes. You see this in cluster suicides, where there is a series of suicides among young people in a particular area. There's an element of imitation. Publicity given to one suicide tends to promote others. When a celebrity commits suicide, there is a measurable increase in the national suicide rate. After Marilyn Monroe's death was reported as a suicide, the U.S. suicide rate increased by 12 percent for a month.
What should we look for in people we suspect might be thinking of suicide?
Some kind of unexplained change in their personalities. They tend to be more serious. They don't respond to gratifications as they once did. They talk about morbid topics for no reason. Significantly, they may have crying spells and appear unusually sad.
Should family or friends try to help them by "talking out" their problems?
It's important for them to know there's someone around who cares. But discussions of feelings have to be kept to a minimum because suicidal people tend to feel worse if they dwell on their sad feelings. Criticism by a family member is especially harmful. An English study of women hospitalized for depression showed that those who went home to a critical husband were far more likely to be rehospitalized. It is a myth that if you give the depressed patient enough love, things will get better. Love is not enough.
What is the system of treatment that you call "cognitive therapy"?
Depressed and suicidal people start off by not seeing any solution to their problems. At our Center for Cognitive Therapy, we try to define the problems for them and generate a variety of probable solutions or approaches. Most psychological problems center on incorrectly appraising life's stresses, reasoning on the basis of false assumptions and jumping to self-defeating conclusions. You help patients to apply reason and logic to their problems so they can confront them consciously, here and now. You don't have to extinguish totally the wish to die. You just have to lobby to swing the vote the other way. If you intervene properly, you can save lives.
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