Spectators of Suicide.

The most common cause of death for men aged 20 to 49 in the UK is suicide. The most common cause of death for women aged 20 to 34 in the UK is suicide. The World Health Organisation estimates that, globally, there are approximately 800,000 lives lost to suicide each year. It's probably higher than that as, due to stigma and legal issues in some territories, many suicides are not registered as such.

Most people know, an average of, one hundred and thirty five other people. Which means that each year over one hundred million people, worldwide, are affected by suicide. Some very deeply. I am one of them. I have lost four friends to suicide since 1999. Stuart, Angela, Rob, and Simon - who all fell into the age groups outlined above.

You may also observe a 75% male/25% female split and though my friends were real people with fascinating lives rather than statistics, this figure is roughly equal to the one that is reflected across the UK as a whole.

It is also estimated that there are twenty attempted suicides to every "successful" suicide (and if ever a word needed to be put in quotes that's it) which would mean three million suicide attempts globally every year. Something, you must agree, of a pandemic. So why is suicide so rarely spoken about in a way that interrogates it? Why are so many myths about suicide allowed to linger? Why do people kill themselves? And, most importantly of all, is there something we can do to prevent them?

It was another Thursday evening with Skeptics in the Pub - Online (host:Brian Eggo from the Glasgow branch of Skeptics) and we were joined by Rory O'Connor, Professor of Health Psychology at the University of Scotland, who has spent twenty-five years studying and researching suicide. He's President of the International Association for Suicide Prevention and a Past President of the International Academy of Suicide Research as well as leading mental health and wellbeing research groups in Scotland.

He's even, this year, written a book, When It is Darkest. Why People Die by Suicide and What We Can Do To Prevent It, about the subject and that book would provide both the title and the background for his Skeptics talk. One which, despite the subject matter, attracted roughly the same number of online attendees as normal (a few hundred).

Suicide, the Prof began by telling us, is not, for the most part, something that happens because somebody wants to die. What they want to do is put an end to what has become an unbearable pain. But we've all had times when we've felt like the pain, often emotional pain, we are experiencing will never end. When it is hard to see the light at the end of the tunnel. 

A rough estimate has it that 97% of us have, at one point or another, thought about or considered committing suicide. But most of us, thankfully, don't. What happens with those who go through with it? Studies suggest there is no definitive single reason but, instead, a variety of contributory factors.

Social context and developmental circumstances play into it. If you are experiencing economic turmoil or living through a war or famine the chances of you taking your own life are increased. If your mental health situation is particularly poor that could push you in that direction and if you have been affected by other suicides, or have even read reports about them, this can be a factor. 

Genetics can confer vulnerability towards suicide (though never, it is worth stressing, an inevitably to it). All, or several, of these factors can combine to make a person feel trapped in a miserable and helpless situation and, in some cases, that sense of entrapment can lead to suicidal thoughts. To try and understand how in some circumstances that can then lead to actual attempts to commit suicide, Rory and his team have conducted disciplinary research with organisations like the Samaritans and the NHS.

The slides came quickly and often and I didn't always get a chance to fully take them in but it was interesting to see a few myths about suicide dispelled. Some people think that to ask people if they're suicidal may plant the idea in someone's head so shy away from it. There's no evidence for this being the case and, in fact, not asking is worse because it's possible that the person is question may not get the help, possibly life saving, that they need.

A trickier one to act upon is the belief that an improvement in someone at risk's mental state means the suicide risk has lessened. That could be the case - sure - but it could also mean that they have a found a 'solution' to their problems, and the motivation and executive function to plan it, and are preparing to act upon it. When people become less fearful of death, it is easier for them to make the ultimate sacrifice.

It's a difficult situation to read for anyone concerned but to be able to predict, and hopefully help, those most at risk of suicide it is important to be able to identify who they are. The factors that most clearly move a person from thoughts of suicide to attempts are, Rory repeated, a sense of entrapment in life. Or a sense of defeat.

But when assessing how high a suicide risk a person is, it is worth bearing in mind that there are other indicators to be observant of. Suicidal ideation, previous attempts at suicide, a sense of being a burden on others, and an impulsive nature. I recognise some of these signs in the behaviours of at least two of the friends I mentioned earlier.

Rory and his team showed people four statements and if they agreed with most of them, that was a worry....

(1) I often have the feeling that I would just like to run away

(2) I feel powerless to change things

(3) I feel trapped inside myself

(4) I feel I'm in a deep hole I can't get out of

All of these feelings, understandably, will lead to a person feeling unduly stressed. Normally when we're stressed, cortisol (a steroid hormone - known as 'the stress hormone') is released and this triggers in us the fight-or-flight response and allows us to defend ourselves against these negative feelings. So is it possible that those who attempt suicide have, in some way, inferior levels of cortisol or are, for some reason, unable to produce it when required?

When Rory and his team monitored people under laboratory conditions, they found that to be the case. They also discovered that those who had suffered childhood trauma had reduced ability to produce cortisol. I would have been interested to hear a little more about cortisol and how childhood trauma somehow reduces our supply, or control, of it but these talks run quite strictly to a forty-five minute timescale and there simply seemed not to be time.

Perhaps one for another day. Next, Rory spoke about the pandemic and if that had changed the picture at all. With the caveat that the studies cited only go up to the middle of last summer, observations have been made that, in general, and this may come as a surprise to many, anxiety levels were decreasing for many with high anxiety (I totally get this, Western society before the pandemic could be a horrible and cruel place as surely as it could a beautiful and kind one - and when people spoke of getting back to 'normal' it always felt like they were missing an opportunity to try and create a new and fairer society).

Suicidal ideation was, however, worryingly, increasing. Although there was no evidence, by that point at least, of an increase in actual suicide. Coming out of the pandemic into a world of increasing inequality means, of course, we are not in the all clear and the figures quoted at the top of this piece surely prove we never were.

Not if we genuinely care about our fellow human beings. We already knew, deep down, that if people regularly talk of being trapped or of being a burden, or if their behaviour is becoming increasingly unpredictable, that they are 'not in a good way'. We also know, deep down, that 'not in a good way' is often not far from suicidal but we can feel helpless when presented with these scenarios.

Many of us will have worried deeply about a friend or family member being suicidal, I know I have and I am fairly certain people have worried about me being so in the past, but have been unsure what to say or what to do. While the assertation that suicide prevention is about identifying who is at risk and offering useful help is self-evident it doesn't necessarily mean there are many of us gifted with the mental and emotional tools to do much.

Rory's final words (before we returned for the Q&A) were to tell us there is something we can do. We can ask people how they are and listen to what they say (if someone tells you they're suicidal, don't tell them they're not) and we can challenge mental health stigmatisation whenever we encounter it.

I'm as guilty as anyone when it comes to using words like nutcase, crazy, mental, and loon and I am also guilty of not asking people how they are often enough. The first of my friends to take his own life was Stuart. Stuart was funny, intelligent, and handsome. He loved cricket, he loved music festivals, and he had studied at Bristol University. When he died, he was twenty-five years old and his mental health had been suffering for a while. He had become difficult to be around and had withdrawn from almost all social life. I knew he was in a bad way. I had no idea that on a lovely warm day in the middle of the summer he'd lay down on a train track on the outskirts of Birmingham and wait for a train to end his life. Maybe if I'd asked him I would have done.