Washington - If you tried to create a profile of someone at high risk of committing suicide, one likely example would look like this: a middle-aged or older white male towards the end of a successful career, who suffers from a serious medical problem and chronic depression and substance abuse, who recently completed treatment for either or both those psychological conditions and who is going through a difficult period, personally or professionally.
In short, that person would look a lot like Robin Williams, the 63-year-old actor and comedian who, authorities said, hanged himself in his San Francisco Bay-area home this week.
While certainly not the only group susceptible to suicide, older white males with that cluster of characteristics have been on psychologists’ radar at least since federal statistics released last year showed an alarming spike in their suicide rate between 1999 and 2010. The suicide rate for white men increased by nearly 40 percent, to 34.2 every 100 000 people.
“This is certainly the demographic, middle-aged or older Caucasians,” said Dost Ongur, associate professor of psychiatry at Harvard Medical School. “And certainly men with medical problems.”
Williams has said he suffered from heart problems.
Men account for only about 20 percent of suicide attempts, but represent about 80 percent of completed suicides, statistics show, almost certainly because they choose more lethal methods: guns and leaps from high places instead of drug overdoses, Ongur said.
Beyond the mechanics of suicide lay a variety of risk factors that predisposed men, particularly middle-aged men, to suicide, experts said.
“Men are much less likely to seek help than women are,” said Michelle Cornette, executive director of the American Association of Suicidology. And “apart from seeking help professionally, (men) utilise their friendships in different ways. Men are less likely to disclose to a male friend that they are struggling psychologically”.
At the same time, ageing may take a larger toll on the male psyche. Older men who value their self-reliance may find themselves less able to cope as they age, when they are no longer in their prime physically, sexually and at work.
“I often refer to them as being developmentally unsuccessful, because they’re not equipped to handle the challenges of getting older if they are so tied into their masculinity… and making a lot of money,” said Christopher Kilmartin, a psychology professor at the University of Mary Washington.
“Things aren’t the way they used to be,” Ongur said. “The power you knew, the control you knew, aren’t the same.”
When depression, addiction and medical problems are added to the mix, the risk of a suicide attempt increases significantly. Williams was grappling with “severe depression”, according to his publicist – a condition that creates hopelessness and despair, frequent precursors to suicidal ideation. Substance abuse suppresses inhibition and can lead to an impulsive act.
Ironically, when depression is lifting or someone is released from rehab or treatment, they were also vulnerable to a suicide attempt, said Nadine Kaslow, a psychology professor and vice-chairwoman of the department of psychiatry and behavioural sciences at Emory University School of Medicine. In recent months, Williams had gone through rehab again. In July, the Oscar winner spent a few weeks at the Hazelden addiction treatment centre in Minnesota, participating in a programme designed to reinforce sobriety.
“After working back-to-back projects, Robin is simply taking the opportunity to fine-tune and focus on his continued commitment, of which he remains extremely proud,” his representative told the Los Angeles Times.
During rehab, people often felt safe and protected, Kaslow said, “but when they come out, they may be overwhelmed by the world around them”.
A toxicology report that would reveal whether Williams had any chemicals in his blood at the time of his death will be released in two to six weeks.
One thing most older men won’t know is the feeling of having a television series cancelled. Williams recently lost his latest television project, The Crazy Ones, which didn’t attract enough viewers to earn a second season on CBS.
But the wind-down of a successful career and the loss of self-esteem are common problems for older men, especially if they are also having financial problems.
As men looked back on their lives, they might become more reflective, asking themselves whether they focused on what really mattered to them, and what they were going to do next, Kaslow said.
“Has the career been worth it, or did I sacrifice my family … I think that is part of what happens for people,” she said.
An emerging area of interest for many mental health experts is the impact of feelings that the person who attempts suicide has begun to feel he is a burden to his family and friends, who, he believes, would be better off without him.
Recent studies had shown a solid association between those sentiments and suicide, Cornette said, stronger even than the power of depression. While depression and suicide had been more thoroughly studied, many were paying attention to the newest risk factor, she said. In the end, she said, “regardless of what we end up learning from the police, no one but this guy’s therapist, and maybe his friends and family, knew all these risk factors.
“It’s speculation on our part.”
– Washington Post
In no particular order, here are the 10 best and worst things you can say to a person with depression, and the reasons why you should and shouldn’t say them.
The Worst
l Depression isn’t real. This is just ignorant. Depression is a serious illness that can affect every aspect of life. To belittle it in this way can be extremely offensive.
l Just get over it. People don’t enjoy being depressed. If they could just “get over it”, then they would.
l You have a mental illness? Then you must be crazy! Again, this is extremely ignorant. Mental illnesses are just like physical illnesses – you treat them and get better. Having depression does not make someone “crazy”.
l I know how you feel. This is okay if you have suffered from depression and you actually do know how the person feels. But if you haven’t, it can be really annoying.
l We all have bad days now and then. Depression is far more than just a “bad day”. It is a serious illness that can be life-threatening.
l You can’t be depressed – there are so many people in the world who are worse off than you. This is equivalent to saying “you can’t be happy, because there are so many people in the world who are better off than you”! Everyone is entitled to their happiness, in the same way that everyone is entitled to their pain.
l It’s all in your head. This just isn’t helpful, and can come across as very dismissive.
l Look how lucky you are. Again, depression is an illness. “Lucky” people can suffer too. It is possible to be conscious of how “lucky” you are but at the same time feel miserably suicidal.
l Just think positively. Even the most positive people in the world can fall victim to depression. Over a four-year period, I went through countless bouts of depression that almost led me to suicide, but there’s no way that you can read my story and deny that I’m a very positive person. Anyone can fall victim – positive people included.
l Stop feeling sorry for yourself. Depression is an illness. It can develop for a myriad reasons, and certainly doesn’t imply that the sufferer is just wallowing in self-pity.
The Best
l I love you. People with depression often don’t love themselves, and thus find it impossible to believe that anyone else can. So if you do love someone who happens to suffer from depression, it can do wonders for them when you reiterate it.
l I’m here for you. This is what people with depression need – your support.
l Is there anything I can do to make you feel better? Again, the best thing you can offer them is your support.
l Would you like to talk about what you’re going through? Being willing to listen is great – just make sure you don’t pressure them into talking if they’re not ready to.
l I don’t quite understand what you’re going through, but I’m here to support you anyway. If you don’t understand, then that’s okay. Just say so and be there for them – instead of acting like you do.
l I’m sorry you’re in pain. This is warm and compassionate and shows you’re on their side.
l I've suffered from depression myself. If this is actually true – and you’re comfortable saying it – then this can be a great disclosure to make, as it helps the sufferer realise that they’re not alone.
l Have you made an appointment to see a doctor? Such a response implicitly acknowledges the person’s pain and also encourages them to seek help – both very good things.
l This must be very hard for you, but you’re going to get through this. Reinforcing a positive message can give the sufferer hope.
l Is there something we can do together to take your mind off it? Try to encourage them to take part in joyful activities. – Source: Anonymous writer (Sadag)
Warning signs of suicide
l Talking or joking about suicide.
l Depression.
l Preparing for death or writing goodbye notes.
l Giving away prized possessions.
l Changes in personality.
l Drastic changes in sleeping and eating habits.
l Loss of interest in appearance.
How to help a loved one
l A person who is suicidal needs to know you care. Listen to them. Ask questions. Help them discuss their feelings.
l Learn all you can about depression.
l You might be your loved one’s only source of information. Let them know you care. Remind them that they shouldn't feel ashamed or guilty. Avoid telling them things like “Snap out of it”. Let them know their feelings are caused by an illness that can be treated.
l Invite them out. Realise they might not want to go at first. If they say no, ask them again later or offer to stay in and spend time with them.
l If you are worried they might be suicidal, ask them about it and help them get help. A straightforward, caring question about suicide will not cause someone to start having suicidal thoughts. If they are thinking of suicide, don’t promise secrecy. Tell someone you trust.
l Talk to the person about attending a support group meeting if there is one in their area. It can help them to learn that they’re not alone.
l Make sure they do not have access to things that can cause injury, like guns, alcohol or drugs.
l DO NOT take responsibility for making your friend or family member well. You are not a therapist.
l If the person is in immediate danger, take the person to a hospital, casualty or to a clinic. – Source: Sadag
BY LINDSAY ORD
The South African Depression and Anxiety Group (Sadag) has noted an increase in the number of calls to its helpline from older white males seeking help, in the past 18 months.
“They call feeling helpless and hopeless, and very serious about ending their lives,” says Cassey Chambers, operations director of the group. “We have had to provide serious crisis intervention in those cases to get them help.”
Men find it more difficult to acknowledge that they are suffering with depression or are not coping.
“They are brought up with the motto ‘cowboys don’t cry’, so talking about depression or emotions is seen as a sign of weakness,” says Chambers.
“But this doesn’t mean that they don’t suffer from depression, it just means that they don’t speak out about it or are unwilling to get help – until it is too late, when they feel like ending their lives.”
Zane Wilson, founder of Sadag, said the group received calls, e-mails and SMSes daily from people who were considering taking their own lives.
“There are 23 completed suicides in South Africa, and a further 230 attempted suicides every 24 hours,” she said.
Women are five times more likely to attempt suicide, with men more likely to succeed, because of the methods they use.
Lori Barausse, a co-ordinator and facilitator of the Survivors of Loved Ones’ Suicides support group in Durban, says in the 3.5 years of her involvement with the group, she has seen a higher percentage of men of 50 and older commit suicide than women.
“From the stories I have heard in the group, many were depressed, but had never been diagnosed with mental illness,” she said.
“They had not sought help, mainly because of the stigma and a sense of pride. They also felt if they had a diagnosis of mental illness, they would not be accepted by their communities or workplaces.
“One of the triggers that made them go over the edge was financial problems. I certainly hope that the tragic death of such a talented brilliant actor will place a huge spotlight on the importance of accepting and dealing with mental illness which is a real killer in today’s society.”
Chambers said looks could be deceptive.
“Robin Williams always looked so happy, always had a smile on his face – how could he have been so down that he thought suicide was the only solution for him? Depression can affect anyone, it doesn’t discriminate against race, age, or gender.”
Comedian Mel Miller urged people with depression to seek help.
“Depression is the unseen killer,” he said. “If you had measles, you would know and see it and would do something about it. If you had a headache you would take a pill, why don’t we do the same if we are feeling depressed?
“We need to dispel the ‘cowboys don’t cry’ attitude. If you are feeling down or depressed, get help, seek a professional, they can help.”
l Sadag’s suicide crisis line: 0800 567 567 or 0800 70 80 90. For more information on depression and suicide, visit www.sadag.org
l SOLOS: suicideprevent@gmail.com 083 652 0117
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