Life and death decision

Only a small minority of suicides ever actually leave a note to say goodbye, and a smaller number again ever offer a reason. Often these notes raise more questions than they answer — doing little to ease the pain of those left behind. The majority of these deaths go unreported, too, yet they have a profound impact on family, friends and colleagues and the wider community.
In the end all that we are left with are memories and that simple, searing question: Why?
It is difficult to know who’s at risk, but we’ll have to find a better means to identify them: among young people, Ireland now has the highest rate of attempted suicide in Europe, according to the World Health Organization, and it is second in the world only to New Zealand. It’s a crisis that many medical experts believe has now reached epidemic proportions.
In Ireland in 1998 no fewer than 634 people committed suicide. Statistically that’s the equivalent of losing four Boeing 737s full of passengers within 12 months. Nationwide there are more than 12 suicides, on average, every week — even more than the number who die in our all too frequent traffic accidents. And worse still, for every death, there are at least 50 unsuccessful attempts. Suicide is now the leading cause of death in young Irish males between the ages of 15 and 24. Every day at least one young person successfully takes his or her own life.
So why are Irish statistics so disturbingly high, particularly among young men? While the youth suicide figures might at first seem to be related to the everyday student difficulties related to finance, or academic pressures brought on by exams, recent studies have shown that private issues involving relationship difficulties, family breakdown, or addiction problems can often play a decisive role.
Dr. John Connolly is a psychiatrist at St. Mary’s Hospital in Castlebar, Co. Mayo. In his role as honorary secretary of the Irish Association of Suicidology, he has been a member of this grassroots organization’s effort to highlight the growing problem of suicide in Ireland since 1996.
“We’re an independent, all-Ireland voluntary organization and a registered charity,” he said. “Our aim is to raise awareness among the public about suicide and its prevention. We also promote related research, we produce annual publications, and we apply pressure to the Department of Health to address this tragic problem.”
The organization’s yearly conference on suicide in Ireland certainly helps to keep the issue in the public realm, and its specialist conferences throughout the year address many important related topics, such as bullying or exam stress.
“Suicide was decriminalized here in 1993,” Connolly said. “We were the last country in Europe to do so. Even today we don’t yet have a national strategy on suicide prevention [although one is finally in development]. But in the context of the overall health budget of the country, we spend something less than 7 percent on our mental health. And that figure has actually been falling in recent years.”
One area that raises particular concern among medical professionals — and lately the general pubic — is that of the binge drinking that young Irish people are now regularly indulging in at the weekend. Over the last 10 years there has been a 40 percent increase in alcohol consumption among the young. In the same period, there has also been a 70 percent rise in suicide levels. Remarkably, Irish teenagers are now at the top of the world’s drinking league. They binge drink high levels of alcohol at the weekend and often end up feeling hung over and depressed — which can trigger suicidal feelings.
“There does seem to be a direct relationship — in a very cruel way — between the amount of alcohol consumed in any one country and their suicide levels,” Connolly said. “Adults will have to lead by example now in terms of the Irish drinking culture. Parents should try to educate themselves, as a matter of urgency, about the links between suicide, depression and drinking.”
To assist the public in that prevention effort, the Irish Association of Suicidology has released a booklet that addresses common myth’s about suicide, which include the following:
? those who talk about suicide are the least likely to attempt it;
? if someone is going to kill himself or herself, there is nothing you can do about it;
? if someone has a history of making “cries for help” then he won’t do it for real;
? only clinically depressed make serious attempts at suicide;
? once a person is suicidal, he is suicidal forever;
? if someone is going to commit suicide, he will not tell anybody and prepare it well in advance;
? talking about suicide actually encourages it;
? suicide is painless.
Connolly is careful to note the effect of recent Irish societal changes: “The cultural shifts that occurred during the Celtic Tiger phase were enormous in terms of the amount of disposable income suddenly available to young people, for example — and the decline in religious practices has been quite drastic in some areas. Of course, the scandals within the Catholic Church have also had a major impact, and the fall-off in attendances has been particularly marked among the young. I am not advocating a return to religious practices necessarily — there is a secular morality that works well in most modern societies — but obviously one does need to have a context or outlet for one’s spiritual life. In Ireland, we throw out our old values before establishing new ones, it was a kind of amputation.”
Traditionally, of course, Irish society has displayed a markedly low tolerance for what it terms “whingers” — to wit, anyone with an issue that requires more than a few minutes’ worth of superficial discussion. This may in part explain the lingering stigma surrounding issues of mental health and the practice of psychiatry in Ireland — the result is that many of our young people are still reluctant or unwilling to seek professional counseling to address their concerns.
“We need to make our mental health services more accessible and user friendly,” Connolly said. “We don’t have a residential psychiatric unit for adolescents in the entire country. Teenagers are treated within the adult services, which is less than ideal. And teenagers in the highest risk ages — between 15 through 18 — often end up in the general adult psychiatric hospital.”
Add to this mix the frequently adversarial nature of parent-adolescent relationships in Irish families, where parents and offspring commonly view the other as “the enemy,” and a most unfortunate and destructive dynamic is set in motion.
American psychologist Michael Riera has studied adolescents in the U.S. for more than 15 years. A household name in his field, he reminds us that although parents and teenagers have dissimilar worldviews and interpret events in different ways, most teenagers generally don’t want an adversarial relationship anymore than their parents do. Recognizing that your adolescent is not “the enemy” is a crucial first step toward a deeper understanding of the issues that he or she is facing. Relax, he suggests, and you’ll be less likely to take the erratic behavior of your teenager so personally. This has important implications for the level of communication that will occur between you both: it is much better to let communication arise between you, he suggests, than to try to force it. Give it time. When all is said and done he or she needs you as an ally, not an enemy.
There is light on the horizon: “The Department of Education is now introducing the SPHE program — the Social, Personal Health Education program,” Connelly said. “It’s a new program that helps to prepare students for the challenges they’ll meet as citizens. It may well have a big impact. To date Irish schools have focused almost exclusively on academic achievement rather than what you could term citizenship, but that is slowly changing. We have to teach young people about how, where and when to seek help. They have to learn who they can turn to.”
Although there are entire studies devoted to it, at root the recent spike in suicide rates among young Irish people is in many ways still quite mysterious. The study and the response of our medical experts is ongoing. The good news is that most teenagers develop their own ways of coping with the stresses of modern life, some more effectively than others. But those who fare best are those who feel comfortable enough to turn to others for advice and support. As a matter of urgency now we need to help the young to feel comfortable and welcome to do so.