​COMPLEXITY OF SUICIDE IS “THE TROUBLE WITH SUICIDE”
Suicide – otherwise fatal human suicidal behaviour – is believed by some to be more prevalent in N Ireland’s ‘deprived areas’. This may or may not be statistically correct. NISRA¹ admits that it may take up to three years to register a death as being a suicide. Hence our suicide statistics are an unreliable guide to the incidence here of self destruction. Unfortunately the ‘deprived areas’ argument is unhelpful regarding reduction of suicide here. Why?
Because the vast majority of residents of ‘deprived areas’ do not engage in suicidal behaviour. The issue then becomes how to identify the exceptional case, i.e. the vulnerable person living anywhere who may be at risk of death or serious injury by suicidal behaviour and to ‘intervene’ by offering and/or providing life-saving support to that individual.
Unfortunately, nowhere in the world, least of all in our local dysfunctional society has it been discovered how to locate, identify and engage with this individual other than in the even more exceptional case where a person is found ‘in the act of taking their own life’ and actively prevented from self-destruction. The fact is that in the vast majority of cases, death by suicide is thought about, planned and executed in secret.
Edwin Shneidman², PhD is considered to be the father of the science of suicidology. He described fatal suicidal behaviour as “the psychological drama that plays itself out in the suicidal mind . . . Suicide is an exclusively human response to extreme psychological pain, a lonely and desperate solution for the sufferer who can no longer see any alternatives”.
Understanding this is the beginning of wisdom regarding suicide prevention, intervention and postvention. Hence education, including study and research, as opposed to “training”, is the way ahead. Unfortunately here educational courses in suicidology are effectively non-existent. Modules are thought to be available at both universities in the context of students’ perceived occupational requirements. For example, courses in medicine, law, nursing, policing, social work and the like may offer short modules that focus upon specific occupational roles.
However what is not readily available for interested lay persons is access to educational courses in suicidology, as opposed to short ‘training courses’ (e.g. ASIST, SafeTalk, etc.), for community and voluntary sector employees and volunteers. Such courses at introductory / pre-certificate, full certificate, diploma, degree and master’s degree levels should be available so as to encourage the development of research into the suicide phenomenon where we live. Without such educational provision we, as a society, will continue to flounder in unaddressed confusion, as the incidence of suicide at all ages increases to our extreme detriment as individuals, families, communities and neighbourhoods.
REFERENCES 1 NISRA Northern Ireland Statistics and Research Agency. 2 Shneidman, E.S. (1998) The suicidal mind. London: Oxford University Press    [Originated by Philip O’KeeffePhD©2017]

​Draft Article for “The View” ed. Brian Pelan – Oct 2016
 
“You just don’t wake up one day and become a racist” a commuter says to his passenger, a fellow commuter in “The Commute”, a recent television programme. I immediately thought this fits with my take on suicide, namely, an individual’s pathway to death by suicide does not emerge overnight: it’s a dynamic if dysfunctional response to their unbearable ongoing psychological, social, biological predicament.
 
Research by Joiner (2005) identified an essential factor that’s present in each suicidal death, namely the victim’s ability to kill themselves, or ‘acquired lethality’: the soon-to-be-deceased must have taken the time to learn how to do it. Shneidman (1971) and Maris (1981) had suggested that each victim’s death by suicide might represent the tragic conclusion to a lifelong journey, long or short, that morphed into a fatal trajectory.
 
On a positive note, this scenario suggests that multiple opportunities may exist, for the person at risk, and for their relatives, carers, friends, neighbours, colleagues and clinicians to intervene and influence the potential victim’s deadly intentions and terminal destination. It’s like if everybody else did something different, then this person would not, or could not or might not take their own life. Does this matter? Nothing matters more since failure to act upon such opportunities can be fatal for the vulnerable individual at risk.  
 
Each death by suicide is as unique as an individual’s fingerprint. Learning to recognise and act upon the ‘signs of suicide’ represent important objectives for awareness-raising efforts by suicide-prevention organisations and individual helpers. Almost fifty years ago Shneidman (1971) listed some high-profile ‘markers’, or indicators for suicide ideation or suicidal behaviour, including conspicuous instability, depression and problems in relationships, especially early ones. These days, most if not all that’s written about suicide prevention includes schedules of signs, or symptoms, for suicide risk. A fairly random Google search for ‘signs of suicide’ identified 25 of these in four categories: behavioural, physical, cognitive and psychosocial: there’s nothing simple about suicide.
 
Regrettably professionals and volunteers in suicide prevention work will be relatively ineffective without considerable expertise in understanding, recognising and acting upon these signs. I would argue that developing and maintaining such expertise demands focused education and training in suicidology and psychotherapy, initially to certificate / diploma / master’s level and then by continuous professional development. Two day courses with occasional refreshers will not do. It seems self-evident to me that what you don’t understand you’ll find very difficult to change.
 
Unfortunately there are many combinations of suicide ‘symptoms and signs’. Research has not identified, and may not ever identify conclusively, which individual ‘symptom’ or group of ‘symptoms’ might accurately predict a death by suicide. To date neither blood test nor brain scan can conclusively confirm a person’s propensity towards suicidal behaviour in the short, medium or long term. This is because suicidal behaviour’s neurobiology represents a most serious problem in both psychiatry and general medical practice that remains to a large degree unclear. Perhaps the best that can be done by experienced helpers for an at-risk individual is appropriate, compassionate engagement, offering genuine, empathic, non-judgemental support, including when available and appropriate, expert psychological guidance.
 
To sum up. Suicide is a highly complex, perhaps the most complex, human behaviour. Each incidence of suicidal behaviour, I would argue, is a unique phenomenon unlike any other. Yet medicine, including psychiatry, currently expends scarce research resources in a desperate if futile search for similarities, commonalities and degrees of sameness in suicide-related cases. Why futile? Because of that idiosyncratic ‘unique factor’.
Better perhaps to emulate a leading local legal organisation that acknowledges individual differences by aspiring to treat every client as an individual.
(601 words)
REFERENCES
BBC (2016) The Commute. BBC TV Channel 1 N Ireland. 29 Sept 2016
Furczyk,K.,  Schutová, B., Michel, T.M., Thome, J. and Büttner, A. (2013) The neurobiology of suicide - a review of post-mortem studies. Journal of Molecular Psychiatry, 2013, 1:2
Hawton, K. and van Heeringen K. (Eds) (2000) The international handbook of suicide and attempted suicide. Chichester, England: John Wiley and Sons, Ltd 
Joiner, T.E., (2005) Why people die by suicide. Cambridge, MA: Harvard Univ Press
Maris, R. (1981) Pathways to suicide. Baltimore, MD: John Hopkins University Press
Shneidman, E.S. (1971) Perturbation and lethality as precursors of suicide in a gifted group. Life Threatening Behaviour, Spring, 1971, 1, 1
Valley Behavioural Health System (US) Website accessed on 6 Oct at: http://www.valleybehavioral.com/suicidal-ideation/signs-symptoms-causes]
van Heeringen, K., Hawton, K. and Williams, J.M.G. (2000) Pathways to suicide: an integrative approach. In K. Hawton and K. van Heeringen (Eds) The international handbook of suicide and attempted suicide, pp. 224-234. Chichester, England: John Wiley and Sons, Ltd 
BIBLIOGRAPHY
 
Brent, D.A. and Mann, J.J. (2006) Familial pathways to suicidal behaviour – understanding and preventing suicide among adolescents. New England Journal of Medicine. 355,26: 2719-2721
 
Byng, R., Howerton, A., Owens, C.V. and Campbell, J. (2015) Pathways to suicide attempts among male offenders: the role of agency. Sociology of Health and Illness. 37(6): 936-51
 
Gray, L-A. (2013) Can school stereotypes be a pathway to suicide? Huffington Post. Nov 27 2013
 
King, C., Senior, J., Webb, R.T., Millar, T., Piper, M., Pearsal, A., Humber, N., Appleby, L. and Shaw, J. (2015) Suicide by people in a community justice pathway: population-based nested case-control study. British Journal of Psychiatry. 207:175-176

“. . . . suicide might be better understood as a phenomenon centred in the individual. In other words, the motives for suicide can be found in the individual viewed as a unique human being whose personality contains the real reasons for wanting to die. Suicide research is not enough; we must work seated at the suicidal individuals’ bedside, trying our very best to feel what that person feels and how these feelings lead the wish to die.”...
Click "Read More" to view embedded document

Well over a century after Durkheim’s major study (‘Suicide’ Durkheim 1897/1951) there is disagreement about the effectiveness of preventive efforts. When this ‘disagreement’ is examined, there are two main reasons:
a)      Suicide’s extreme complexity; and
b)      Suicide’s relative rarity.
...
Click "Read More" to view embedded document

“. . . . suicide might be better understood as a phenomenon centred in the individual. In other words, the motives for suicide can be found in the individual viewed as a unique human being whose personality contains the real reasons for wanting to die. Suicide research is not enough; we must work seated at the suicidal individuals’ bedside, trying our very best to feel what that person feels and how these feelings lead the wish to die.”...
Click "Read More" to view embedded article

Interviewed recently on RTE about her divided GAA loyalties regarding support for Tipperary, where she was reared or Dublin, where she currently resides, Mary Hanafin, former Irish Minister for Education, revealed her linguistic shortcomings by saying she was somewhat “schizophrenic” about this vital issue (*). Again, in a satirical piece about the Irish President’s GB visit, and the high profile presence alongside him of a Northern Ireland politician, a local writer referred to the latter gentleman as “your (i.e. Official Ireland’s) schizophrenic sibling” (**). Perhaps you, dear reader, are reasonably comfortable with the use of psychiatric language when discussing the GAA and/or Irish politics: I’m afraid I’m not.
Click "Read More" to view embedded article

Caine and Able. I haven’t misspelled our legendary fraternal ancestors’ names. “Caine” refers to Dr Eric D Caine, a New York university professor while “Able”, meaning “having sufficient power, skill, or resources to accomplish an object” (*), may in time describe Dr Caine’s “new paradigm” (**) for reducing human suicidal behaviour...
Click "Read More" to view embedded article

I never cease to be amazed at the stupidity of some Irish opinion formers. What I mean is how loose their tongues are at those precise times when a closed trap would suit them, and us, much better. Everyone knows that a family suicide is a most challenging experience for anyone to face. Yet several recent examples – and unfortunately there are plenty out there – reveal a carelessness born of arrogance and ignorance, where ‘celebrity’ influencers, publicly and with aforethought, ‘let rip’ with crass and offensive sound bites about human suicide.
Click "read more" to view embedded document...