Despair, NOT Depression is at the Root of Most Suicides
We must all think Mental Anguish, NOT Mental Illness
By Dr. Uchennaa Umeh aka Dr. Lulu
Every time we hear news about a suicide, it never fails, the reported cause is nearly always mental illness, especially depression. We seldom hear any news reports mentioning mental anguish or emotional distress. Every now and again substance abuse is mentioned as a confounding factor, but for the most part, mental illness is nearly always to blame. However, a closer look at the statistics shows that only 42% of people suffering from mental illness die by suicide, and often those are folks who did not receive any treatment. In actuality, 80-90% of people suffering from mental illness do not die by suicide. When someone is diagnosed with mental illness and is appropriately treated, they often get better. However, underdiagnosis, misdiagnosis or no diagnosis at all, leads to poor or no treatment, causing some affected patients to resort to substance abuse, etc.
My talk will mostly highlight the fact that mental anguish and despair following major life’s trauma(s) (NOT mental illness and depression) are the leading causes of suicidal ideation and subsequent suicides. A classic example was in 2008 when following the dotcom bubble burst, a record 10,000 men died by suicide. These men never had any prior mental illnesses, however, they were faced with a total loss of their life’s savings (major trauma) and many felt trapped, disappointed, desperate and unable to cope with the loss (despair), leading them to make the ultimate decision to end their lives. Now even though these losses led to reactive depression (secondary depression from a primary problem), no dose of antidepressants would have made a significant enough difference in the root cause (financial devastation) of their acute stress.
It is important to note that antidepressant prescription use has more than quadrupled in the past few years. So, if depression is the major cause of suicide, and if antidepressants work, then how do we explain the sustained rise in the rates of suicides across all ages, all ethnicities and all works of life. As a doctor and a US Air Force Veteran, and an immigrant, I am at very high risk of suicide for reasons way more than mental illness. Veterans, for the most part, receive the short ends of the sticks with regards to appropriate treatments of their PTSD, doctors are increasingly dealing with burnout in a system that is very antagonistic to any sort of declaration of fatigue or mental illness or mental anguish, so they continue to work themselves to the bone with unsustainable hours and enormous responsibilities at home and at work, eventually, those that cannot cope anymore with the mental anguish, take their lives (this is why Physicians have the highest rates of suicides in the US). Immigrants also face a great deal of hostility and hardship in America. We generally come from a background with severe taboos surrounding any mental illness. It is generally regarded as a show of weakness. However, it is part of real life, and suicides in our immigrant youth, as well as youth in Nigeria, is on the rise because of extraneous circumstances ranging from poor governance to poor socioeconomic climates, intolerance to nonconforming sexuality, unrealistic social media expectations, to religious invalidation, paucity of medical facilities, lack of family support, etc. All these, coupled with the absence of jobs and infrastructure cause the youth to become restless, turn to substance abuse and once helplessness and hopelessness ensue, the rest is history.
As a pediatrician, my focus is on suicide in children and youth. Thiers are somewhat different in the sense that their issues often stem from abuse at home, bullying at school, poor parental involvement or lack of parental validation of their feelings, sexual assault or another extreme form of child abuse. 8 out of 10 kids who call the suicide hotline mention issues in school as a reason. It is safe to assume then that these children do not have mental illness, but mental anguish. ACEs refers to Adverse Childhood Experiences, recent studies have shown that children who were subjected to ACEs before the age of 18, often have a shortened lifespan as a result of peculiar medical illnesses that develop, including suicidality. I shall discuss ACEs in detail and review the numbers and what is being done about ACEs in today’s American child. It is arguable that many children who die by suicide do not believe that the particular act they are engaging in will not lead to their deaths, but kids as young as 4-5yrs of age, do understand the concept of death.
If time permits, we can touch on the fact that suicide is now the second leading cause of death, second only to accidents, and we shall explore the fact that most accidents (especially overdoses) are possibly suicides.
So, how come I never had a prior diagnosis of mental illness (depression) before and after my period of suicidality a few years ago? Why didn’t anyone ask me what happened? Why did they all assume I had depression? Did they not know that I had just gotten a divorce? Did anyone ask me if I was overwhelmed about becoming a single mom of three sons? Did they know that I had just sold my beloved practice and sold my beloved home (that I designed from scratch) in a short sale and made absolutely NO money out of? Was is a concern that I had just discovered after nearly 15yr of owning my practice that my ex-husband had not paid taxes in nearly 5yr, so I suddenly owed the IRS over $320K. Did they care that the IRS had just taken every single penny I had from every single bank account to offset the debt? Is it not normal to be utterly sad and disappointed when stuff like that happens? How is it possible that the only diagnosis they could come up with was depression and mental illness? What about despair? What about mental anguish? Did the well-meaning doctor ever think for a moment that after having to file bankruptcy, it was somehow ok to feel not ok about things? How about the fact that I am a Black woman, a Nigerian woman, and we are not supposed to feel or show any pain? Do they know that I am not supposed to accept the diagnosis of depression, because that means weakness? And by the way, that divorce and mental illness are considered taboos where I come from?
Did anyone care to consider the fact that the antidepressants that I had been given (changed twice and dose increased several times) were indeed, making me more suicidal? As a physician in the United States, do they know that even voicing out the word “depression” could mean severe repercussions to include losing my job and source of livelihood, even though it is perfectly normal for someone to be really sad considering what I had just been through?
Why does Big Pharma feel a need to push an agenda that is obviously not entirely accurate? I knew for a fact that I did have depression, but it was secondary. Reactive at best. My kind of depression was not the root cause of my suicidality. My mental and emotional anguish over a failed marriage, financial crisis, single motherhood, stress over work as a Lt. Col and commander in the US Air Force, bankruptcy, extreme disappointment, self-loathing, shame and “overwhemness” were my root causes. Did anyone care to put that together? How many kinds of antidepressants can fix that? What dose of an SSRI would it take to get me better? If I had acted on my suicidal thoughts, would the news report have been “she died by suicide from depression and mental illness or from despair and mental anguish”? Here’s my main question: Why do we think that in spite of the dramatic increase in prescriptive antidepressants in the past few years, suicide rates have continued to soar in all ages and across all races? Does that mean that the antidepressants don’t work? And if they do work, then could it be that the diagnoses of mental illness, particularly depression are inaccurate? Are we therefore possibly over-diagnosing them? Are we aware that by diagnosing everyone with mental illness, the stigma increases? Should we be looking into this phenomenon as a possible case of misleading the masses? If so, when?
While researching for my next book, I noticed a peculiar trend; most news reports about suicide linked victims to mental illness. It is nearly always depression. While it is true that personal mental illness and a family history of mental illness are often risk factors for suicide, they are only one of many underlying causes of suicide. I pondered on that and the fact that when I was suicidal between November 2013 and May 2014, I had never been diagnosed with mental illness before. I was however readily diagnosed with severe depression by the well-meaning Captain that I was assigned to, at Joint Base San Antonio, Lackland.
You see, she missed the fact that even though I was suicidal, it was from mental anguish rather than mental illness. In July of 2000 when my friend Ngozi as a second-year surgical resident died from a single self-inflicted bullet wound to her head, she also didn’t have mental illness, rather she had severe mental anguish stemming from a culmination of a bad relationship, a stressful surgical residency, and our medical system that punishes doctors who cry for help from what I call “overwhelmedness”. That Sunday morning while her family was at church, she did the unthinkable, with one single shot. I can only imagine how lonely and possibly afraid she had been that morning. How helpless she must have felt. How alone, how trapped, how much pain she must have been in, how much anguish.
In my case, I had discovered that I owed the IRS money, thanks to my ex-husband and former practice manager, who messed up my beloved practice and left me alone to clean. It was Thanksgiving week, that day, the morning air was crisp, the streets were less crowded, my car radio was playing a jazzy tune from 88.3 FM. I inserted my ATM card into the slot, waited a few minutes, and no money came out, instead my card returned to me. I inserted it again, certain it was an error, already composing the words I would have for the operator when I called and complained about the machine being out of money. Again, no money. That’s when I panicked thinking only one thought, identity theft! I couldn’t wait to get home and tell the family.
As it turned out, I owed back corporate taxes to the IRS to the tune of $329,000! Somehow my ex-husband and former office manager had neglected to pay taxes for my practice, and since I was sole owner and proprietor, the IRS took every single penny I owned from every single bank account that I owned. I felt all kinds of emotions during the days that followed. Mostly sad, but also anger, self-pity, pain, and disappointment. There was a lot of moping around and not eating, I was devastated. I became actively suicidal. The day I voiced my intentions to my wife, she calmly canceled all her appointments for the week and attended to my every need. If she was freaked out, she didn’t show it. She pleaded, offered options and suggestions and she also took me to see the doctor who promptly placed me on antidepressants, with side effects of suicidal ideation.
So, here’s my dilemma. There was no doubt that I was experiencing depression, reactive depression. No doubt I was suicidal. However, after the third change in dose of my SSRI, my mood did not improve, my suicidality remained the same if not worse because my life’s stressors remained largely unchanged. I would drive up and down the highway, looking for a chance to drive off-of-it, wondering what if? I eventually weaned myself off the SSRI, and with the help of my supportive spouse and family, I began my road to rebuilding. The more I was able to plan out my future, the better I felt. I eventually paid some of the debt and filed bankruptcy, which is stressful enough, but because it was part of my recovery plan, it didn’t hurt as badly. The lingering question I have is, what dose of antidepressants would it have taken to change my financial situation?
When the financial crisis of 2008 hit, a record 10,000 men died of suicide in the following weeks and months. These were men who never had any mental illness recorded before the fact. So, how many milligrams of an SSRI would it have taken to “fix” their mental anguish? When children and teens take their lives because of incessant bullying, how many kinds of antidepressants would it take to change their reality?
Prescription antidepressant use has quadrupled in the past few years, depression is often blamed for most suicides. If antidepressants work, as Big Pharma would like us to believe, why then are suicide rates on the rise across all races, ages and works of life? Why are African American children and teens attempting and dying by suicide more than other races? Why do LGBTQ+ youth have the highest rates of suicide of all youth? Why do Native American/Alaskan Native youth have the highest rates of suicides of all youth? Why do Indigenous Australian youth lead the pack in suicides in the land down under? Why would Ngozi with a promising future suddenly kill herself during her second year in surgical residency?
Until we begin to look at other myriad reasons for suicide as bonafide players in the game, suicide rates will not come down any time soon. I had the pleasure of interviewing Canadian Emergency Psychiatrist and Suicidologist, Tyler Black, MD, recently for an episode of my podcast, and he confirmed my suspicions. We must be very careful in throwing mental illness at suicidal persons. If someone has an overwhelming traumatic life event, a prescription of antidepressants might be more detrimental to them. There is no doubt that mental illness (especially when undiagnosed or untreated) is a risk factor for suicide, but so are other factors. Less than 50% of suicide deaths had mental health issues, and many were complicated by a lack of family support, substance abuse or a sudden super-imposed life trauma.
We must find out what the underlying cause of the behavior is and tackle it specifically. Excessive diagnosis of mental illness could worsen the stigma of both suicidal behavior and mental ill-health.