updated 11:40 AM EDT, Tue August 21, 2012
Film director Tony Scott left notes in his car and office before plunging to his death, a coroner's official said.
STORY HIGHLIGHTS
- Most people who commit suicide are losing a battle against major depression, psychiatrist says
- These suicides can haunt and hurt most of all, Dr. Charles Raison says
- Depression-related suicides cast a long shadow over relatives and friends, Raison says
- Talking about suicide with someone can decrease the chance of it happening, he says
Editor's note: Dr.
Charles Raison, CNNhealth's mental health expert, is an associate
professor of psychiatry at the University of Arizona in Tucson.
(CNN) -- I got a terrible shock when I heard the news that the famous director Tony Scott had apparently committed suicide by jumping off the Vincent Thomas Bridge in San Pedro, California.
Not because I knew Scott,
and certainly not because it is a rare thing for people who seem to
"have it all" nonetheless to kill themselves.
No, I got a shock because I knew the bridge.
For the better part of a
decade, I trained and then worked as a psychiatrist in Los Angeles. For
several of those years, I did psychotherapy with a young woman who drove
over that same bridge every day. The bridge became almost a third
person in our work together, because she talked about it constantly.
Dr. Charles Raison
Every morning and then
again every evening she faced huge anxiety as she approached its yawning
span because it was all she could do not to stop her car and throw
herself off it. Just seeing that bridge made all her pain and despair
intensify, and it came to represent everything that was wrong with her
life.
On the other hand, it's a
beautiful structure, in an industrial sort of way, and it also seemed
beautiful to her because it was always there, silently waiting, always
offering an easy out. When things were really bad, she'd drive 20 miles
out of her way just to avoid that bridge and the terrible temptation to
jump or crash her car off the side.
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Fortunately, my patient
avoided Scott's fate. She came to grips with a history of abuse and her
depression eased. She married and left Los Angeles. I also left Los
Angeles, but a few years ago, I returned to the San Pedro area to give a
talk and crossed that bridge with a mixture of relief and distress.
It is that strange
mixture of relief and distress that characterizes many of the responses
to Scott's apparent suicide that have been posted on CNN.com.
Many comments come from
family members of people who have committed suicide, some defending the
loved one's decision, others decrying it as the ultimate selfish act.
Although I've spent my life battling suicide, I find myself empathizing
with both points of view.
Perhaps the first thing
to say about suicide is that people make suicide attempts for all sorts
of reasons. Sometimes people want to die, or half want to die.
But just as often in my
experience, suicide attempts are a cry for help, or a way to punish
people they are upset with, or a means of controlling a situation. I've
known more than a few married people who kept a husband or wife from
walking out on them, at least for a while, by making a suicide gesture.
On the other hand, people really only kill themselves for three reasons.
Occasionally people will
commit suicide because they are facing some incurable condition that
promises a brief future filled with nothing but pain.
Although many mental
health clinicians will disagree vociferously with me, I have seen
suicides that I felt were in this sense justified. For example, I knew a
grand old fellow who, in the midst of unbearable physical pain from
inoperable cancer, took his life when he had a life expectancy of two to
three months.
Occasionally people will
commit suicide because they are psychotic and believe they must die for
some reason that makes no sense to anyone else. I had a patient once
who made a very serious suicide attempt because she believed that if she
died, the mysterious private investigators who were stalking her would
leave her family alone.
These types of suicides are heartbreaking, because they are so futile and can often be prevented by appropriate treatment.
The vast majority of
people who choose methods of suicide that are almost guaranteed to
succeed -- like a gun to the head or a plunge from a high bridge -- do
so because of they are losing a battle against major depression. These are the suicides that haunt and hurt worst of all, and that almost to a person are the most tragic.
I hate suicide.
I've been fortunate that
suicide does not run in my family. But it runs in lots and lots of
families and I've known -- and known of -- more people who have killed
themselves than I can easily count.
There was the shy kid
who shot himself in high school, the young punk who drove his car off a
particularly bad curve, the wonderful hard-working father of the class
valedictorian, and various in-laws across a couple of marriages.
And those are just
people from my personal life. Like any psychiatrist who deals with the
severely mentally ill, my life is littered with memories of folks who
threw themselves off high buildings, hanged themselves in dark closets
or slit their throats in dusky gardens.
But as much as I hate
suicide, I also understand it. One of the things people have repeatedly
posted in comments responding to Scott's death is that you can't weigh
in on why someone might commit suicide unless you've really had your
life torn apart by an episode of major depression.
I agree.
Severe major depression
is probably the most unbearable pain a human being can withstand for any
protracted period of time. Many people who died of cancer have written
eloquently about how the crushing pain from their tumors paled in
comparison to the pain they felt when depressed.
With all other pain,
most people can maintain some sense of separation between themselves and
the pain. As horrible as it is, the pain is in their arm, or leg, or
belly or head. But there is still a "them" that is separate from the
misery.
Depression is different.
Because it is at its essence a perceptual disorder, it causes one to
see the entire world as pain. It feels painful inside, but it also feels
painful outside.
When a person is
depressed, the entire world is disturbed and distressed, so there is
nowhere to escape. And it is this fact that makes suicide so seductive,
because it seems to offer the one available escape option.
There are at least two
reasons why suicide in response to major depression is so horrible and
so tragic. First, although our treatments for depression are far from
perfect, they are nonetheless effective enough to help the vast majority
of depressed people feel well enough to forgo killing themselves.
And even when treatment
is not particularly effective, depression often passes on its own
accord. It is not an incurable cancer that offers a guaranteed
foreshortened future of unbearable pain. Because of this, depressed
people kill themselves over something that would have lifted had they
just been able to hang in there.
The other reason
depression-driven suicides are so tragic and terrible is because they
cast such long shadows on families and other loved ones.
Children especially
suffer. They grow up wondering why, and whether they could have done
something, and whether they'll have to struggle with the same urges.
I think of people I have
known in this situation, and I have to think of something else to keep
from tearing up as I write this. More than once I've "guilted" acutely
suicidal patients into not killing themselves for the sake of their
children and have done so with a clear conscience.
We may or may never know
why Scott apparently killed himself, but we can be sure that his family
and friends will spend many years wondering what they might have done
to have protected him. This is part of the painful legacy left by
suicide, and my heart goes out to them.
In fact, even
psychiatrists have a difficult time predicting when someone is at
heightened risk for suicide. In part, this comes from the fact that many
people who really want to kill themselves keep their mouths shut about
it and just go do it. In part, it comes from the fact that suicide is
often an impulsive act driven by acute and unpredictable increases in
anxiety and despair that one cannot predict in advance.
For families and friends
worried about the suicidal potential of a loved one, there are a few
useful pieces of advice I can offer from the research literature, such
as it is.
First, older men are more likely by far than other people to kill themselves.
Second, people who kill
themselves often will tell someone ahead of time. Any such
communications should be taken with utmost seriousness, and all efforts
should be made to keep the person safe and get him or her to appropriate
treatment immediately.
Third, even over the
suicidal person's objections, the means for committing suicide should be
removed from the environment. Guns should be taken out of the house.
Pain pills should be taken elsewhere.
Fourth, studies
conducted over the last 20 years suggest that the biggest short-term
risk for depressed people to kill themselves is the development of
unbearable anxiety. If a loved one with depression begins to pace the
floors or do other things suggesting that they are becoming consumed
with terror, panic or dread, the risk for suicide shoots up.
Finally, it is not true
that talking about suicide increases the likelihood it will happen. In
fact, studies suggest the opposite.
So if you have a loved
one with depression who is struggling with the will to live, one of the
best things you can do -- over and above getting them immediate health
care -- is to check in with them regularly and honestly and act if their
drive to die intensifies.
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