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Leow Suicide

Leow Suicide

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Published by Dr Leow
I have a friend who intent to suicide.How can we help him/her? Learn more from this article. For more information, please login www.yaleconsultant.com or write to me at drleow@yaleconsultant..
I have a friend who intent to suicide.How can we help him/her? Learn more from this article. For more information, please login www.yaleconsultant.com or write to me at drleow@yaleconsultant..

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Published by: Dr Leow on Feb 28, 2010
Copyright:Attribution Non-commercial


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obody can ever predict how another personwill react to the more troubling or difcultthings in lie. Dierent people handle dierentsituations in dierent ways – this is an undeniableact o lie, no matter how old you are.But there are usually some clear advance warningsigns that a riend may be in trouble and thatsuicide may be something he is considering. Sincesuicidal wishes could become a prevalent andpotentially lethal problem in depressed patients, itis important or therapists to understand why thepatient is considering such a drastic action in therst place. The therapist will then be in a better position toselect appropriate and eective techniques to dealwith the particular problem. However, no anti-suicidal strategy is o any use unless the therapist isrst able to detect and assess the degree o suicidalintention.
Risk indicators
 Clues to suicide plans may be detected in overtbehaviour such as secretiveness, a sudden decisionto make a will or verbal statements. For example,a suicidal individual may say,
“I don’t want to go onliving” 
“I want to end it all.” 
Other statements suggestive o suicidal intentinclude:
“I’m not going to put up with it anymore”, “I’ma burden to everyone”, “things will never get better” and “my intent is indirect and may be pieced together only in retrospect”. Other indications are: “I guess I won’t be seeing you again” or “I want to thank you for trying so hard to help me.” 
Gently tipping the balance
By Dr Leow Chee Seng, Certied Stress Consultant Professional (US)
When contemplating suicide, the individual is attempting to take back controlof a situation they feel they have no control over. Thus, the best cure is helpingthem regain this control.
SEPT/OCT 2009 • OH!
A depressed patient leaving on a weekend passrom a hospital or upon retiring or the night, maysay
instead o 
 According to the Diagnostic and Statistical Manualo Mental Disorder (DSM-IV-TR), mental disordersthat could lead to suicidal impulses includeconduct disorder among children, delirium,dementia, substance-induced mental disorders,amphetamine-induced disorders, schizophrenia,a major depressive or manic episode, anxietydisorders, dissociative disorder, sexual and genderidentity disorders, borderline personality disorderand premenstrual dysphoric disorder.Researchers have noted that some individuals leantowards suicide more than others. The characteristicsassociated with such at-risk adolescents include theollowing:A previous suicide attempt;
Suicidal gestures (cutting o one’s hair, sel-
inicted cigarette burns, other orms o sel-abuse);A tendency to be socially isolated (having no
riends or only one riend);A record o school ailure or truancy;
A broken home or a broken relationship with a
signicant other (amily member, boy/girlriend); Talk o suicide, either one’s own or that o others;
A close riend or relative who was a suicide victim;
Not living at home;
Preoccupation with death or dying;
A recent signicant loss or the anniversary o one;
Sudden disruptive or violent behaviour; or
Being more withdrawn or uncommunicative and
more isolated rom others than usual The most common external causes – or moreaccurately, external catalysts – o suicidal behaviourinclude bullying, peer pressure incidents, amilycrises and health problems.Usually, these are situational in nature and have anescalating history that leads the individual to eel hehas no other way out. In their minds, the situationshad reached breaking point and they see no otherway out except death, or the threat o death.
Depressive fantasy
When external orces become unbearable enoughor a person to contemplate suicide, depression o some sort is always involved. The depression causesthe individual to make irrational decisions based onunstable emotions.  This type o suicidal tendency is oten accompaniedby “ater-death” antasies in which the now deadindividual, ater taking his or her own lie, gets toview the reactions and grie o those let behind.In these antasies, the people who have caused thepsychological pain eel punished by the suicide.While grieving, they demonstrate great remorse orhaving driven the person to take his own lie. In thistype o suicide (or suicide attempt), the individualis attempting to take back control o a situation heeels he has no control over.In killing himsel, he is taking back control, gettingin the last word. And, i the real lie situation has letthe individual eeling totally helpless, the idea o going out o control and teaching other people alesson in the process can be strangely appealing.
SEPT/OCT 2009 • OH!
Suicidal urges that are brought on by externalcircumstances include an unwanted pregnancywithout a support system, abuse in the amily orrelationship, sexual assault, sexual harassment,bullying, peer rejection and romantic rejection. The individual is intrigued by the antasy that hewould be getting back at somebody whom he eelshas hurt him – and that this other person will seethe error o his ways and eel tremendous guilt as aresult o the suicide.Because such impulses are oten eeting in natureand happen in a moment o extreme emotionalstress, the suicide attempts are more likely to ail,be repeated and escalate in severity with eachrepeated attempt.Under these circumstances, the suicide attemptsare oten dismissed as cries or attention, which canbe a atal mistake on the part o the people close tothe suicidal individual.Since the root cause here is a deep and woundingsense o helplessness – being ignored or havingothers dismiss the attempts as attention-seeking– it can ultimately lead to the person successullytaking his own lie.When the external causes are addressed and dealtwith, and the person’s sense o helplessness isovercome, the suicidal urges all but disappear. 
Biological causes
Internal causes o suicidal behaviour are much morecomplex and harder or the average person to seethan external causes. The most common internalcauses o suicide or suicidalbehaviour include clinical depression, psychiatricdisorders or chemical imbalances.Essentially, all suicide attempts come down tosomething inside the suicidal person but thosewithout external catalysts are oten biological innature. Severe depression, which is believed to becaused by a combination o external actors andinternal chemistry, is one thing that almost everysuicide or suicide attempt has in common – howthat depression came to be is the only dierence.Some people suer rom depression because o chemical imbalances and to outsiders, their livesseem great – or at the very least average – withnothing outstanding that would indicate a reasonor this person wanting to die.
Tipping to positive
It is important or riends and therapists to “play ortime” until the dangerous period has passed. The strategy used is to involve the patient himsel in the therapy process such that he decides to stick it out until he sees where the therapy is going. This can be done by stimulating an interest in histherapeutic approach.Involvement o patients in the treatment plan helps totreat the decision to commit suicide as the outcomeo the struggle between the patient’s wishes to liveversus his wishes to die. As in a declaration o war, anirrevocable decision may be made on the basis o amargin o a single vote, as it were.Initially, thereore, the therapist’s eorts shouldbe directed towards shiting the votes in avour o living. On top o it, the therapist should maintaincontinuity between sessions.
SEPT/OCT 2009 • OH!

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Helen Winslow Black added this note
A great sadness has touched my school community and I have had to talk to my children about depression and suicide. How do we do this? This post is for beautiful Salve and her emerging butterfly of a daughter: together you will find the courage to rediscover joy.

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