- 1Suicide risk is a complex mutation system, and suicide prevention should abandon “solution-oriented” and turn to “process-oriented”.
- 2Not all suicides have psychological or psychiatric problems.
- 3People can change from “low suicide risk” to “high suicide risk” in a very short period of time (such as a few hours).
- 4Don’t look for “suicide high-risk groups”, but capture everyone’s “suicide high-risk moments”.
- 5It is difficult to prevent suicide by “spotting the suicide warning signs”.
- 6Therapies that “directly reduce suicidal thoughts and behaviors” are more effective. Treatments that “indirectly reduce suicidal thoughts and behaviors by reducing mental illness” were less effective.
- 7Environmental approaches to suicide prevention are useful.
- 8Increasing the “will to live” is more important than reducing the “desire to die”.
- 9The focus is to improve the quality of life, create and build a “life worth living”.
psychologist who studies suicide in the military
Psychologist Craig Bryan (Craig Bryan) had an unusual experience — the military.
He served as a military psychologist at Lackland Air Force Base in Texas for more than four years and was deployed to Joint Base Ballad in Iraq for six months.
Craig Bryan, Psy.D. (right) enlisted in 2009 and served in Iraq | health.osu.edu
He provides psychotherapy to service members, neurocognitive assessments to service members with head injuries, and expert opinion to medics and commanders. At the same time, he inevitably faced countless cruel tragedies-from war, from trauma, from… suicide.
Soldiers have so easy access to guns and ammunition that when they decide to commit suicide, they often do so . It was a drastic approach with little redemption.
On one occasion, four soldiers shot themselves at an Iraqi base within a short period of time. Their brains are dead, but their bodies and organs are still alive on life support systems. Because of their organ donation agreements, they were placed together in the intensive care unit, waiting for a plane to fly them back to the United States for organ transplants.
That day, Brian stood in the intensive care unit, looking at the four suicide victims lying side by side, and his heart was filled with sadness, frustration, doubt and anger. What kind of life did they lead? Why choose death? What happened at that moment in that day? How has their life changed compared to the previous week, the previous month? If the situation changes a little bit, is it possible for them to choose to survive?
It was also on that day that Brian realized that current suicide prevention programs were clearly not good enough . It’s time to change our perspective again to understand and intervene in suicide.
People without mental illness can commit suicide
The current suicide prevention is based on the ” psychological/mental illness model “. To put it simply, it is believed that almost all people who commit suicide have mental illness, and mental/mental illness leads to suicide. Recognizing the warning signs of mental illness and treating it can prevent suicide.
The “Mental/Mental Illness Model” Doesn’t Explain All Suicides
But Bryan encountered several cases of suicide at the Iraqi base that could not be explained by mental illness .
Pilot A, knowing that he was going to be disciplined again by the army, was depressed and called his girlfriend in the United States to confide. The girlfriend expressed frustration that he had “fucked up again”, said she “can’t go on like this” and hung up. A continues to call his girlfriend, but the girlfriend doesn’t answer. He sat in the room by himself and thought, what’s the point, I screwed everything up. He takes out the gun, loads it, and raises it to his head… At this moment, a friend just comes to A. The friend immediately took his gun, reported the incident and took him to the hospital. A said that if the friend hadn’t come, he must have died, everything happened too fast.
A had no previous suicidal thoughts, no suicide plans, no psychological disorders, no mental illness, no history of drug or alcohol abuse. He did have some “warning signs”-due to the punishment, he had obviously increased stress and poor sleep in the previous week, blamed himself, and worried about his future. However, these reactions are normal responses to stress. A does not prevent him from functioning or socializing properly with others. If the previous A stood in front of a psychiatrist, the doctor would not think that he had a mental or mental illness, and would not even diagnose him as an adjustment disorder.
Brian also noticed that “it just happened”, it happened so fast. A went from “low suicide risk” to “high suicide risk” in a very short period of time .
Later, when Brian was practicing law in Utah, the United States, he also encountered a case of “it just happened”.
During a heated argument with his wife, Client B “felt completely overwhelmed and just wanted it to stop” so he grabbed a pistol and pointed it at his head, only narrowly stopping before pulling the trigger .
B and his wife had a tense relationship at the time, but he had no previous mental or mental illness, nor had he had any suicidal thoughts or plans. He felt “emotionally overwhelmed” during the argument, but again this is a normal human reaction, not a psychological or mental illness.
Suicide after feeling ’emotionally overwhelmed’ after quarrel | Tu Chong Creative
Examples of such ” emotional overwhelm, so impulsive suicide ” are also very common in Chinese scholar Wu Fei’s “Floating Life and Observing Justice”.
A young man named Fang Lin, his younger sister had a quarrel with her brother-in-law. He took her back to her natal home and advised her, “If he doesn’t come to beg you to go back within two weeks, he will really divorce him. If you go back with him easily , your status in the family is even lower. We can’t let people look down on our family so much. If there is anything, I will support you from behind.” However, the brother-in-law not only delayed the deadline, but also came to the door with an arrogant attitude. And the younger sister just followed back. Fang Lin was sad and angry, “No matter how poor our family is, we shouldn’t be bullied like this.” He committed suicide by drinking pesticide that night.
A woman named Jiaolan is usually outgoing and loves to talk and laugh. During the years when her father-in-law’s sister-in-law was ill, Jiao Lan and his wife took care of her until she died of illness. Jiao Lan believes that because her father-in-law’s sister-in-law has only two daughters, and she and her husband have contributed so much, her husband should be eligible to hold a banner at the funeral. However, the son-in-law of the deceased suspected that she was using this to seize the family property and scolded her in the street. Jiaolan ran home in a fit of rage and drank the pesticide, but fortunately was sent to the hospital for gastric lavage and rescued.
This survey of suicides in a county in North China shows that many suicides are not mentally ill. They often act soberly, violently, and without thinking because they have suffered setbacks in the power game. towards suicide.
Again, this is not saying “suicide is a normal response” – suicide is definitely an extreme choice. Nor is it to say that “mental illness/psychiatric illness does not increase suicide risk” – of course illness can significantly increase suicide risk, and it is important to detect and treat it promptly.
The point here is that perfectly normal people can also experience intense emotional pain, and that this emotional distress may already be driving them towards suicide .
Unhappy things in life are often eighty-nine. We will be rejected by our loved ones, we will have fierce arguments with our family members, we will be depressed and painful when we are blamed by our superiors, we will feel panic and despair when facing unemployment or debt… These strong emotional disturbances are a natural, normal and ordinary part of life. But these pains may overwhelm a normal person at a certain moment and become “the last straw that breaks the camel’s back.”
Some pains may become “the straw that breaks the camel’s back”｜Pichong Creative
People who “do not have mental illness, but commit suicide because of severe emotional distress” are the hard-to-catch part of the current “suicide prevention system”.
Suicide is like an equation with multiple solutions, like X+Y+Z=100. There are many solutions that satisfy this equation, X=50, Y=50, Z=0. X=10, Y=10, Z=80. X=100, Y=100, Z=-100… These are the “correct solutions” to the equation. The same is true for suicide, there are many “risk factors” that promote suicide, and many “protective factors” that prevent suicide. For each specific case of suicide, mental illness may or may not be in the “solution” of suicide.
Brian also often encountered situations where a person committed suicide without warning. In utter shock, his family looked back for signs of psychological or mental illness, sometimes finding some, sometimes finding nothing. Bereaved family members sit in front of therapists and cry, not knowing what they are missing and what they should be doing. Many people believe that the suicide of a loved one comes so unexpectedly, with little warning .
Why are warning signs of suicide so hard to spot?
Can suicide be prevented by “recognizing the warning signs of suicide”?
Existing suicide risk screening methods are far from accurate enough.
Let’s first look at a typical list of suicide warning signs——
suicide warning signs
- 1talking about suicide or wanting to die
- 2Find a way to end your own life
- 3alcohol or drug use
- 4social withdrawal, isolating oneself, away from others
- 5despair
- 6Sleep changes, sleeping too much or too little
- 7anxiety
- 8feeling trapped with no way out
- 9irritable
These warning signs do exist, but the problem is,
- 1These warning signs will also appear in people who do not commit suicide. Most of the people who have warning signs do not commit suicide in the end.
- 2These warning signs do not necessarily appear in a suicidal person, and even if they do appear, they do not necessarily attract the attention of those around them.
Since suicide is an inherently low-probability event, this means that “most people who are caught in suicide screening will not commit suicide.”
Let’s make a very ideal assumption—assuming that according to the suicide warning screening, 99% of people who really want to commit suicide can be found, and at the same time, there is only a 1% chance of misjudging people who will not commit suicide .
Sleep changes are warning signs of suicide, but they can also appear in people who do not commit suicide｜图虫创意
According to the “China Health Statistical Yearbook 2021”, the suicide mortality rate of urban and rural residents is about 3.8~8.65/100,000-a bit overestimated, let’s say 10/100,000, which means that for every 1 million people, 100 people will die Suicide, 999,900 people will not commit suicide.
So the screening will find 99 of those 100, and 9,999 of 999,900. A total of 10098 people, only 99 of them will really commit suicide, the correct rate is less than 1% . In other words, although a suicidal person is likely to have warning signs in advance, very few of those who have warning signs will actually commit suicide.
For “low-probability events”, the result of large-scale screening is that the number of people with warning signs is too large to take effective interventions, and some suicides will always be missed. Screening for warning signs of suicide is certainly better than doing nothing, but not by much.
A 2017 study in JAMA: Psychiatry found that screening patients admitted to emergency rooms for suicide risk did not reduce the rate at which patients attempted suicide in the following year .
A 2013 paper in the journal Psychiatric Services analyzed 200,000 psychological status questionnaires from 84,418 individuals. During the follow-up period of the study, there were 709 suicide attempts and 46 suicide deaths. The researchers asked these people whether they had suicidal thoughts in the previous two weeks. Those who answered “almost every day” had a 0.3% risk of suicide and death in the next year; The risk of dying by suicide within a year is 0.03%.
People who think about suicide every day have a tenfold higher risk, which is easy to understand. But if you look at the data from another angle, it means that 99.7% of people who “think about suicide almost every day” are still alive after one year. And for every 3,000 “people who have never thought about suicide”, 1 person will not survive the second year .
The study also found that among the 46 people who died by suicide, 13 said they “thought about suicide almost every day” in the past two weeks, 12 said they “thought about suicide more than half of the days”, and 12 said they “thought about suicide for a few days.” “, while 9 people (accounting for 20%) always answered that they “never thought of committing suicide” when they were surveyed.
Do you really have no suicidal thoughts, or are you unwilling to reveal your true thoughts? It could be both. People who commit suicide impulsively may not have had any suicidal thoughts before. And a large part of people who have suicidal thoughts are unwilling to tell others.
A 2017 paper in the journal “Suicide and Life-Threatening Behavior” compared several survey methods in the military. Among the same population, 5.1% reported suicidal thoughts when they were completely anonymous, while in the real-name health assessment, 5.1% reported suicidal thoughts. , only 0.9% reported suicidal thoughts.
I have never thought of committing suicide. Is it true that I have no suicidal thoughts, or do I not want to reveal my true thoughts? There may be both.
A 2018 paper in the “International Journal of Environmental Research and Public Health” surveyed 14,322 people, 719 of whom had had suicidal thoughts in the past year, and half of these people had never told others that they had suicidal thoughts ( 348 people).
There are many reasons why people are reluctant to disclose their suicidal thoughts: For those who are determined to die, disclosure may cause additional humiliation or harm to themselves, and it may also hinder their own plans. For those who still want to live, disclosing may harm their interpersonal image, which is not conducive to their future career development, and they may not want to die in a few days, so why tell others about their temporary mood swings.
How to spot a person’s “high suicide risk” moments?
The fluctuations in suicidal thoughts are indeed very large.
A 2017 study in the “Journal of Abnormal Psychology” attempted to track changes in people’s suicidal thoughts over a short period of time. The participating researchers were all at high risk of suicide. The men were asked about their “thoughts in that moment” an average of 2.5 times a day and found that on most days, the suicidal desire fluctuated wildly. Feelings of hopelessness, loneliness, seeing yourself as a burden to other people… these feelings also vary greatly.
These people were questioned 2.5 times a day for 28 consecutive days. Different colored lines represent different people, and suicidal thoughts vary from person to person
A person may have been normal yesterday, suddenly have extremely strong suicidal thoughts at noon today, and at night, the suicidal thoughts disappear without a trace.
In 2018, Bryan published a paper in the journal Suicide and Life-Threatening Behavior, analyzing the social media content of 315 service members in the year before their death. Of these soldiers, 157 died by suicide and 158 by other causes. The results showed that suicides and non-suicides had different “patterns of change in social media content” —
1. Simply comparing “social media content”, there is no difference between suicides and non-suicides . Both express negative thoughts and describe stressful events.
2. Suicides have a typical temporal pattern: Post negative thoughts while describing stressful events. These two topics appear consecutively and may be posted on the same day or just one day apart.
In contrast, nonsuicides also posted about their negative thoughts and stressful events, but the two themes did not appear consecutively. “Negative thoughts” of non-suicides more often appeared consecutively with “physical ailments and discomfort”.
In other words, “stressful events” and “negative thoughts/negative cognitions” of suiciders are strongly correlated . Non-suicides are not.
3. The closer to the date of suicide, the more obvious this temporal pattern of the suicide is.
The most important “suicide marker” is not a distinction between people, but a specific change in the individual over time – more and more frequent mentions of “stressful events” and “negative thoughts”. “ .
You can use the analogy of a balance beam athlete. Before the athlete falls off the balance beam, in order to restore balance, the athlete will move more frequently and with greater range. However, each athlete has different movement habits. If we only focus on the frequency and range of movements, we may not be able to predict which of a group of athletes is about to fall off the balance beam. However, if the frequency and range of an athlete’s movements suddenly increase significantly compared with his own before, this is a “warning sign”, and it can be predicted with confidence that this person is in a “high-risk period of falling off the balance beam.”
“Stressful events” and “negative thoughts” are mentioned more and more frequently at the same time, which may be in a high-risk period | Tu Chong Creative
Traditional questionnaire screening has a hard time capturing these naturally occurring fluctuations, nor can it pinpoint a person’s most dangerous moments. If a person’s suicide risk spikes within hours, is there a way to detect and stop him at that moment?
But how can a person suddenly become “high risk of suicide” within a few days or even hours?
Not a continuous change, but a sharp point mutation
The suicide risk in the traditional imagination is a “continuum on a single dimension”——
- 1Many people basically don’t want to die, this is the “low suicide risk group”.
- 2Some people want to die a little bit, this is the “medium suicide risk group”.
- 3A small group of people who want to die very badly is the “high suicide risk group”.
Starting from the continuous model, the suicide risk is considered to be a “gradual change” rather than a “mutation” process. A person has to slowly accumulate a lot of stress before changing from low risk to medium risk, and then slowly accumulate a lot of stress to change from medium risk to high risk.
But when Brian talked to some suicide survivors, he noticed another pattern that resembled the ” butterfly effect “: a relatively small change that produced a tiny nudge that just happened to push the person past a certain point. “Tipping point”, which eventually leads to dramatic change – where people decide they have “enough”.
First, several studies have found that suicide risk is not distributed on a continuum, but more closely divided into distinct categories . A 2017 paper in Psychological Assessment surveyed 1,773 people, and a 2018 paper in the same journal surveyed 2,385 people. Both found that suicide risk was made up of two subgroups—the “low-risk group.” ” and “High Risk Group”. The two groups did not differ significantly in symptoms of mental illness such as depression and hopelessness, but did differ significantly in factors associated with suicide risk, such as “how strongly suicidal thoughts are.” In other words, two people with similar levels of depression may have a low suicide risk and a high suicide risk.
Secondly, interviews with suicide survivors often show extremely rapid state transitions . An emotional impulse or an emotional fluctuation may jump directly from “low suicide risk” to “high suicide risk” in a short period of time.
A 2007 paper in the Journal of Affective Disorders found 112 people who had attempted suicide, and a quarter of them committed suicide impulsively — they attempted suicide impulsively without planning ahead. In addition, the majority of those who attempted suicide (63%) believed that their entire suicide process was ups and downs and fluctuating; only a small number of people (22%) believed that their suicide process developed linearly and gradually became more severe.
The researchers found that the transition from “low suicide risk” to “high suicide risk” was not linear but exponential. The vast majority of people suddenly made up their mind to commit suicide in a short period of time, and then immediately started to execute it— all 30 people took action within 3 days of “decided to commit suicide”, of which 18 people (accounting for 60%) Suicide occurred within 5 minutes of making up the mind.
The critical point of the state transition of suicide risk is “a fierce debate of ‘survival vs death’ in the heart”. If the conclusion of “survival” is drawn, it will quickly return to the state of “low suicide risk”, but if the conclusion of “death” is drawn, then the person is likely to form a suicide plan within the next few hours, and commit suicide.
And it is likely to be extremely small factors that play a role at this critical critical point.
In normal times, a little change in pressure may not matter. But at the critical moment, a hug or a scolding may push a person to take a completely different path .
This is also in line with the fourth characteristic of the cusp mutation model – small changes in conditions may lead to very different results.
\Schematic diagram of the “cusp mutation model” of suicide risk
Suicide is likely to be a complex dynamic system in which there are sometimes sudden, discontinuous catastrophic changes. The change is so dramatic, so irrational, so unpredictable, so sweepingly changing the way the entire system works. There are few signs to predict when catastrophic change will occur. This unpredictability is the source of its destructive power .
Can we prevent suicide if we can’t predict when someone will commit suicide?
At this time, the fifth feature of the cusp mutation model is used-increasing a certain factor can promote a person from a low suicide risk to a high suicide risk, but reducing this factor does not necessarily promote a person from a high suicide risk Transition to low suicide risk.
Just like stepping on the gas pedal can quickly accelerate the car, but to slow the car down in a few seconds, it is not enough to let go of the gas pedal, we have to step on the brakes hard.
To prevent suicide, we need to find the “suicide brake”.
Brian began asking suicide survivors “what are your brakes?” When you are in intense pain, what methods work for you, and what methods are helpful? How do you face a new round of crisis and keep yourself from committing suicide? Did you do something differently?
Focus directly on reducing suicide, not reducing suicide by reducing mental illness
Existing suicide intervention methods are only moderately effective in reducing suicidal thoughts and behaviors .
This conclusion comes from a meta-analysis published in Psychological Bulletin in 2020, which included 1125 controlled studies over the past 50 years, and concluded that “short-term, cheap interventions and long-term, expensive interventions have similar effects. , or just as bad” conclusions that “fundamental changes are needed in suicide interventions”.
For suicide, the effect of many current interventions and treatments is unsatisfactory, possibly because their design idea is “reduce suicide by reducing mental illness”.
But if you want to reduce suicide, the best design idea is to directly add “suicide brakes” to people. That is, therapies that directly focus on reducing suicide are more effective.
The first brake is to increase the willingness to live, that is, to make people “want to live more”.
“How much you want to live” and “how much you want to die” are certainly related, but they can also vary independently. Some people “don’t want to live too much, and they don’t want to die too much”, while others “want to live very much, but they also want to die very much”.
Suicide is because of “wanting to die”, but also because of “lack of reason to live”.
A 2005 paper in the “American Journal of Psychiatry” asked 5,814 patients to assess their “will to live” and “will to die” and found that as long as there is at least some willingness to live, it can offset many wills to die and significantly reduce suicide. risk .
A 2016 paper by Bryan in the Journal of Affective Disorders similarly found that suicidal behavior was primarily driven by a “less desire to live” rather than a “very much desire to die.” Decreased “willingness to live” will greatly increase the risk of suicide. In contrast, changes in “death wishes” had less dramatic effects.
Just like Nietzsche’s famous saying, “A man who knows what he lives for can endure any kind of life.” To prevent suicide, it is necessary not only to reduce the “willingness to die”, but also to increase the “willingness to live”. Only by looking forward to “a meaningful life worth living” can we resist the impermanence and pain that will inevitably appear in life.
Worrying about puppies is also a kind of living will | Tu Chong Creative
The second brake is to teach people to persist in using effective new strategies in the face of setbacks.
A 2010 study in the “American Journal of Psychiatry” found that, compared with others, those who had attempted suicide had a characteristic—the ability to reverse learning (reversal learning), that is, cognitive rigidity and inflexibility. It is difficult to forget the outdated old experience, and it is more difficult to learn new experience to adapt to the current environment.
Successful reversal learners can: quickly adapt to unexpected changes in the environment, and quickly identify current successful strategies in an uncertain environment; even if they encounter occasional setbacks, they can persist in newly learned successful strategies.
When the rules have changed silently, can you discover new methods in repeated setbacks and stick to them?
People who have attempted suicide are significantly weaker at this point. One of their characteristics is that ” even if they know that it is an effective strategy, as long as it doesn’t work once, it is enough to make them give up ” – they know that exercise will obviously improve their mood, but they were told by the coach when they went to the gym last time In other words, I never want to go to the gym again. Obviously, most of the time, my friends will patiently accompany me, but when I was looking for a friend last time, the other party happened to have no time, so I never contacted my friend again.
Only by being able to tolerate occasional setbacks can you stick to and benefit from a long-term strategy. Only when you realize the rewards that patience can bring in the moment, you will not act impulsively and desperately.
This is the third brake.
The third brake is to teach people how to slow down their decision-making in times of extreme pain.
A 2016 paper in the American Journal of Geriatric Psychiatry found that people who had committed suicide had a decision-making style that favored high-risk, high-reward, rather than low-risk, low-reward. Ordinary people are more inclined to choose the strategy of “small wins and small losses, long-term profits”, but people with a history of suicide are more willing to choose the strategy of “big wins and big losses, long-term losses”. Especially those who have used highly lethal violence to commit suicide are more inclined to choose “gambling big” and “a stud”.
Suicide survivors need to learn to change their decision-making style, learn to not pursue “immediately end the pain” when the future is full of uncertainty and they are in extreme pain, but let themselves slow down , do something else, and divert their attention , relieve negative emotions, endure uncertainty, and wait for things to turn around.
Therapies that can do this relatively well include dialectical behavior therapy, cognitive behavioral therapy for suicide prevention, crisis response plan, etc. What these “suicide-centered” therapies have in common is that they all aim to directly reduce suicidal thoughts and behaviors.
For example, Dialectical Behavior Therapy (DBT) focuses on teaching four core skills:
- 1Mindfulness: Being aware of what is happening to you in the present moment without judgment or self-blame,
- 2Pain tolerance: the ability to bear negative emotions such as pain and stress,
- 3Emotional management: identify, influence, and change your own emotions,
- 4Effective Interpersonal: Interact effectively with others
These four skills all point to allowing a person to calm down and make better decisions when they are most emotionally disturbed .
Mindfulness makes people calm down when their emotions are most troubled｜Pichong Creative
Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP) is very similar to DBT, while strengthening the skill of “reforming a dead end idea”:
There are many horny thoughts: “Things will never get better” (desperation, no way out), “I’m a drag on others, people are better off without me” (thinking I’m a burden), “I don’t deserve to live” ( self-hatred) and so on.
The therapy teaches people to replace these negative thoughts with more balanced, objective thoughts (such as “I made mistakes, but it doesn’t mean I’m a failure, and it doesn’t mean I deserve to die”). Also teach them to build new beliefs, “The future may be difficult, but it is not completely hopeless, sometimes things may turn out better than expected, and sometimes we do get what we want”-with such beliefs, people will be more confident . Willing to slow down, gather more information, and wait for a turning point .
A 2014 paper in the American Journal of Preventive Medicine showed that patients who received cognitive suicide prevention therapy were 50 percent less likely to attempt suicide again, compared with patients who received routine follow-up and referral.
A Crisis Response Plan (CRP) is an easy way. Users should remember and practice “what to do when overwhelmed and overwhelmed”:
- 1Recognize the “warning signs” of a personal emotional crisis,
- 2Use some simple strategies to reduce stress, or divert attention,
- 3Think of reasons worth living,
- 4seek help from friends, family or others who will support you,
- 5Go to professional support or crisis services.
The specific content of these five steps can be written on a small card and put in your wallet to carry with you. In a moment of emotional excitement, taking out this card is equivalent to stepping on the brakes heavily.
In one of Bryan’s studies, published in the Journal of Affective Disorders in 2017, 97 people who had committed suicide were randomly assigned to either a “no-suicide protocol” or a “crisis plan.” The “No Suicide Agreement Group” uses a commonly used strategy at present, guiding patients to promise not to commit suicide and sign a “safety agreement”. At six months, 19 percent of the no-suicide protocol group attempted suicide again, compared with 5 percent of the crisis response plan group.
During suicide interventions, Brian spends an entire class discussing “reasons worth living” with patients . Although many suicidal people will say “I don’t have any reason to live”, with support and help, most people can find at least one reason-the most common reasons include family, friends, pets, and hope for the future. hope.
Family and friends are also “reasons worth living” | Tuchong Creative
Next, each patient should write his reasons on a small card and take it with him, and read it from time to time no matter whether he is calm or depressed.
This is to remind them of the meaningful, happy, positive parts of life. Continuing to strengthen and expand these parts, the pillars of life will become more and more diverse, thick and indestructible .
They will still experience life’s ups and downs…but at the lowest point, they learn to trust that “hope” and “reasons to live” must exist somewhere and that they can still “build meaningful lives” .
The “brakes” that directly target suicide are effective, but there is also a line of thought in suicide prevention.
Prevent suicide like you reduce traffic deaths
Maybe there is no need to be obsessed with “finding suicidal people first, and then intervening with this group of people”.
Even if you don’t know who is most likely to commit suicide, you can still prevent suicide. Just like even if you don’t know who will be in a traffic accident, you can still reduce the number of traffic accident deaths.
Most of the focus of suicide prevention is now on “reducing human wrong thoughts and behaviors”. We do risk screening, we encourage people to be on the lookout for warning signs of suicide, and if they have warning signs, go to psychotherapy, take medication, call a suicide prevention hotline.
If the same idea were applied to traffic accident prevention, we would endlessly train people to pay attention to the warning signs in the environment, constantly screening drivers for “Have you speeded recently? Are you drunk? Are you looking at your phone while driving?” ?”, arrange for the driver involved in the accident to take a safe driving course.
These work, but they are not enough.
A complex system needs to ” promote safety on the basis of knowing that humans will make mistakes .”
Not only to change the thinking and behavior of individuals, but also to change other parts of the system to ensure that if something goes wrong in one part, people in the system can still be protected by other parts.
Many studies have proved that “restrictive means” can be said to have an immediate effect on reducing suicide.
A 2005 review in the Journal of the American Medical Association (JAMA) reviewed various strategies for suicide prevention and found that one of the most effective strategies is to “reduce the means of suicide and limit the means of suicide .” To put it simply, add various obstacles to the road to death: control guns, restrict the prescription of lethal drugs, replace highly toxic pesticides with less toxic pesticides, replace gas with less poisonous natural gas, and build high bridges Guardrails prevent bridge jumps…
In the UK, as the proportion of carbon monoxide in the gas supply fell from 12% to 0%, the suicide rate fell by almost 30%, and women who would have killed themselves with gas did not use other methods to kill themselves.
After Sri Lanka banned the most toxic pesticides, the suicide rate fell by almost 50%. When Samoa banned paraquat, the suicide rate fell by almost two-thirds. The rural population who would have committed suicide with highly toxic pesticides did not commit suicide by other methods.
Since 2006, when the Israeli army banned soldiers from bringing army-issued guns home on weekends, the suicide rate among soldiers has dropped by 57 percent. Much of this decline is because service members who would have shot themselves at home did not commit suicide by other means.
New Zealand’s Grafton Bridge (Grafton Bridge) removed the old fence in 1996 to prevent suicides by jumping from the bridge. As a result, the number of suicides by jumping from the bridge went from one to three per year. A new and improved fence was installed in 2003, and the number of suicides by jumping off the bridge dropped to zero immediately. The data also showed that after the addition of fencing on the Ellington Bridge in Washington, D.C., the number of bridge-jumping suicides fell from 4 per year to 0.2 per year, and there was no increase in the number of suicides by jumping off the nearby Taft Bridge .
People who would jump off this bridge are not going to another bridge.
…
Psychotherapy that focuses directly on suicide can reduce suicide rates by an estimated 15% to 22%.
And “restricting the means of suicide” can reduce the suicide rate by about 30% to 60% .
Beyond psychotherapy, there are many, many approaches to suicide prevention that have great potential.
For example, making the world more “worth living” .
A 2006 paper in the “Journal of Clinical Psychiatry” showed that in each state in the United States, the higher the proportion of residents with health insurance, the lower the suicide rate . For every 1% increase in the population with health insurance, the suicide rate decreases by 1-2%. The risk of suicide decreased, possibly because of easier access to medical care and also because of lower medical-related anxiety.
A 2019 paper in the American Journal of Preventive Medicine showed that, in every state in the United States, higher minimum wages were associated with lower suicide rates . For every $1 increase in the minimum wage, the suicide rate fell by 1.9 percent. The risk of suicide fell, possibly because of less financial stress.
Therapy is important of course, but it won’t pay your bills, it won’t give you a job, it won’t give you a house, it won’t give you health insurance, it won’t protect you from cyberbullying or violence from the people around you… The problem of suicide must go beyond the “personal responsibility perspective”. It is important to realize that suicide is not just a “suicide” problem. Suicides are not so much the problem as individual “fire alarms” . They gave their lives to tell others that the world is still full of painful fires.
