Suicide recently received national attention of the President of the United States, the U.S. Department of Health and Human Services (DHHS), the Surgeon General, the Center for Disease Control and the Substance Abuse and Mental Health Administration (SAMSHA). The amplified concern related to the increased prevalence of suicidal thoughts and behaviors resulted in the aforementioned entities compiling a Treatment Improvement Protocol (TIP). TIP was complied to provide research based information for substance abuse counselors’ preparation and utilization with clients and/or family members presenting with suicidal thoughts or ideations (U.S. Department of Health and Human Services, 2009). Suicide as a growing concern is further exemplified by statistics. The National Center for Health Statistics (2006) reported an annual increase in deaths by suicide every year totaling over 33,000 people United States dying by suicide every year. This is equivalent to 91 suicides per day, one suicide every 16 minutes or 10.95 suicides per 100,000 population.
Suicide dates back to early civilization with the most frequent method identified as hanging. Suicide is generally precluded by surmounting distress and pain rendering feelings of disdain with little to no hope of managing or recovering from the mental anguish. TIP researchers comprised of “distinguished panel of experts” succinctly defined of suicide, suicidal behaviors, suicidal thoughts, and nonsuicidal thoughts and behaviors. “Suicide is a deliberate act of self-harm with at least some intent to die that results in death. Suicide attempt is a deliberate act of self-harm with at least some intent to die that does not result in death. Such acts have a wide range of medical seriousness. Suicidal ideations are thoughts of attempting suicide. Such thoughts have a wide range of specificity, intensity, and frequency. Suicide plans are a severe form of suicidal ideations that include identifying a method or scenario to attempt suicide” (TIP, 2009, p.1-3). Behaviors identified as nonsuicidal thoughts and behaviors were characterized as “death ideations are thoughts of dying but without ideas for suicidal behavior per se. Nonsuicidal self-injurious behaviors are self-directed acts of self-harm without intent to die. Broadly these acts tend to have intrapersonal (e.g., manage emotions) or interpersonal (e.g., communicate distress) motivations and include a variety of behaviors (cutting, piercing, burning) and a wide range of medical seriousness” (p. 1-3).
Incidences of suicide have impacted the legal profession resulting in the loss of valuable members.According to Carroll (2006) some statistical data suggest that lawyers are more at risk for suicide than other professions or vocations (as cited in Schiltz). Results from National Institute of Occupational Safety and Health study (1992) indicated male lawyers in the United States are twice as likely to commit suicide in comparison to their counterparts in general population (Jones & Crowley, 2006). Overall males (17.7%) are four times more likely to die as a result of suicide than females (4.5%). Male are more susceptible to suicide from age 20-21 with occurrences reportedly stable until age 70 when the risk increases throughout later life. Females’ susceptibility is reportedly steady with a tendency to peak during the forties (National Center for Injury Prevention and Control [NCIPC], 2007). Similarly, suicide was identified as the third leading cause of death among lawyers insured by the Canadian Bar Insurance Association 1997 study (Weiss, 2009). Summary findings from the Canadian Bar Insurance Association study reported suicide rate was approximately 69 deaths per 100,000 population or nearly six times the suicide rate in the general population. From a multicultural perspective in the U.S. suicide is highest among white males, American Indians and Alaska Native males. Lower incidences of suicide are purportedly among African American and Hispanic or Latino females (NCIPC, 2007). The latest data from NCIPC reported a total of 32, 637 death by suicide in 2005.
Suicidal behaviors often co-occur with substance abuse or other diagnosable emotional and psychological disorders. Suicidal behaviors and substance abuse disorders co-occur more often than not (Kessler, Borges, & Walters, 1999; Wilcox, Conner & Caine, 2004). Nearly 90% of adults who commit suicide had a diagnosable psychological disorder (Halgin and Whitbourne, 2008). Although psychological disorders are not associated with all suicides, Halgin and Whitbourne reported that nearly 90% of adults who commit suicide have a diagnosable psychological disorder. The authors also stated that the most frequent co-occurring are major depression, schizophrenia and alcohol-related disorders (as cited in Duberstein & Conwell, 2000).
Among lawyers, judges and law students, depression has been reported as a major concern and a predisposing risk factor for suicide. Within the legal profession, “about 19% of lawyers experience depression at any given time compared with 6.7% of the general population“(Weiss, 2007). Other contributory factors to higher suicide rates within the legal profession include, but are not limited to personality characteristics associated with lawyers such as perfectionism and competitiveness, co-occurring with depression (Weiss). Alarming statistical data among lawyers is best illustrated in Table 1.
Halgin & Whitbourne (2008) purported, “For some people, depression is so painful that their thoughts turn recurrently to ideas about escaping from the torment that characterizes every day” (p. 267). Nevid, Rathus, & Greene (2006) and others suggested that “the risk of suicide is greatly elevated among people with severe mood disorders, such as major depression and bipolar disorder” (p. 280; Bostwick & Pankratz, 2000; Bruce et al., 2004); thus, it is critical that the signs and symptoms of depression are clearly recognized to help avert a possible suicide.
Symptomatology of depression includes the following: “depressed mood or loss of interest or pleasure in nearly all activities (i.e., changes in appetite or weight, sleep, and psychomotor activity; decreased energy; feelings or worthlessness or guilt; difficulty thinking, concentrating, or making decisions; or recurrent thoughts of death or suicidal ideation, plans, or attempts” (DSM-IV-TR, 2000, p. 349). These diagnostic criteria or signs and symptoms manifest different in each individual. Diagnosis of clinical depression, it is not necessary for an individual to exhibit all the signs or symptoms: “the diagnosis is typically made if at least a few signs are evident, particularly a mood of profound sadness that is out of proportion to the person’s life situation and a loss of interest and pleasure in previously enjoyable activities (Davison & Neale, 1994, p. 226). According to the American Foundation for Suicide Prevention (1995), about 15% of the population will suffer from clinical depression at some time during their lifetime; 30% of all clinically depressed patients attempt suicide; 15% of them succeed over a lifetime. Individuals diagnosed with a mental disorder are between seven and 10% at greater risk of committing suicide (Cavanagh, Carson, Sharpe, & Lawrie, 2003).
Carroll (2006) stated that “depressed individuals may be more prone to use addictive substances to deal with feelings of sadness and isolation” (p. 70). “While approximately 10% of the population suffers from alcoholism, the number jumps to almost 20 percent in the legal profession, or one in five lawyers” (Sweeney, p.3). Substance abusers are 10 times more likely to commit suicide than the general population (Louisiana State Bar Association, Lawyer Assistance Program). The American Foundation for Suicide Prevention (1995) reported that alcohol is a factor in about 30% of all completed suicides. Over 60% of all people who commit suicide suffer from an affective disorder. If one includes alcoholics who are depressed, this figures rises to over 75% (American Foundation for Suicide Prevention, 1995).
Table 1: Statistics Regarding Depression, Alcohol Abuse and Suicide Among Lawyers
- Research conducted at Campbell University in North Carolina indicated that 11% of the lawyers in that state thought of taking their own life at least once a month.
- According to a 1991 Johns Hopkins University study of depression in 105 professions, lawyers ranked No. 1 in the incidence of depression.
- Male lawyers in the United States are two times more likely to commit suicide than men in the general population (National Institute for Occupational Safety and Health, 1992).
- One in four lawyers suffer from elevated feelings of psychological distress, including feelings of inadequacy, inferiority, anxiety, social alienation, isolation and depression.
- Higher rate of depression among law students than any other professional student body (Tennessee Bar Association, 2007).
The highly alarming statistics presented illustrate the urgency to address suicide within the legal professional and to encourage seeking assistance to promote wellness. What Are The Signs To Be Aware Of?
Throughout the literature, circumstances precipitating and contributing to suicidal thoughts and behavior are coined risk factors. On the other hand, factors in an individuals life that prevent, reduce or alleviate risk factors: thus, decreasing suicidal thoughts and behaviors are protective factors. Risk and protective factors also vary individually, but should be identified when suicidal thoughts or ideations are suspected or assessed. As listed by the Desk Manual on Mental Illness for LAP Directors, here are some signs to observe, question and assess.
1. A deepening depression or expressions of utter despair or hopelessness. Such feelings may indicate a downward spiral, especially if combined with the use of alcohol or harmful drugs.
2. Pre-suicidal comments or statements. Often suicidal people will actually make suspicious comments about suicide or death or despair or hopelessness. These statements can be missed or even ignored if the listener is confused or embarrassed.
3. Putting affairs in order and making final arrangements. A pre-suicidal person may suddenly finish a Will, give away prized possessions or put their affairs in order for the first time in a long time. Sometimes, they will make direct or even vague statements that they are not going to be around.
4. Unexplained cheerfulness. A suicidal person may suddenly appear cheerful after a long period of being down. Their depression may suddenly be replaced by a strange elevated mood. It seems that a decision to commit suicide can serve to remove the burdens or the perception of the burdens on a suicidal person. Having decided on a solution, the suicidal person may feel a lessening of their pain.
5. Serious risk taking. Driving at high speeds is a perfect example. There are many, many unexplained single occupant car accidents where someone appears to have driven into a barrier or off the road.
6. Other self-destructive behavior. These may include severe bouts of drinking or drug abuse or even walking the winter streets without hat, coats or boots.
Protective factors may consist of the following: access to and participation in counseling or clinical intervention; family, church or community support; effective stress management, conflict resolution or problem-solving skills; values or cultural characteristics that scowl against suicide; or children or other responsibilities (Center for Disease Control, n.d.). Understanding suicidal tendencies or behaviors is critical in obtaining professional help for the individual at risk. Dispelling misunderstandings or myths is essential to preventing suicide and accessing professional help (See Table 2). Efforts to increase awareness and provide accurate information about suicide has proposed Ten Commandments of Suicide as listed in Table 3. Table 4 encapsulates some suggestion on how to respond and seek professional help when suicidal behaviors are present in an individual.
Table 2: Some Myths and Facts About Suicide
1. Myth: People who talk about suicide are just seeking attention and won’t really try to kill themselves.
Fact: Studies show that 75% of those who commit suicide talk about it or display other warning signs before attempting it.
2. Myth: Suicidal people are intent upon dying.
Fact: The majority of suicidal people are not intent upon dying. Often, they simply see no other viable option. The warning signs they give are desperate calls for help before they take this final option.
3. Myth: Talking about suicide and a person’s suicidal feelings will only encourage that person to commit suicide.
Fact: Talking about suicide may be the only thing that can save the person’s life. It can give them a sense of connection and hope. It shows the person that someone cares and find them important enough to listen to and help.
4. Myth: Improvement in emotional state means lessen risk of suicide.
Fact: The fact is that people often commit the act after their spirits begin to rise and energy level improves; this appears to be especially true of depressed patients.
Most people have suicidal thoughts or feelings at some point in their lives; yet less than 2% of all deaths are suicides. Nearly all suicidal people suffer from conditions that will pass with time or with the assistance of a recovery program. There are hundreds of modest steps we can take to improve our response to the suicidal and to make it easier for them to seek help. Taking these modest steps can save many lives and reduce a great deal of human suffering (Schimelpfening, 2004).
Table 3: The Ten Commandments of Suicide
I. The common purpose of suicide is to seek a solution.
II. The common goal of suicide is the cessation of consciousness.
III. The common stimulus in suicide is intolerable psychological pain.
IV. The common stressor in suicide is frustrated psychological needs.
V. The common emotion in suicide is hopelessness-helplessness.
VI. The common cognitive state in suicide is ambivalence.
VII. The common perceptual state in suicide is constriction
VIII. The common action in suicide is egression
IX. The common interpersonal act in suicide is communication of intention.
X. The common consistency in suicide is with lifelong coping pattern.
Source: Davison and Neale (as cited in Shneidman, 1987, p. 167).
Programs Offering Assistance to Lawyers Who Are Suicidal
Inquire if your state has a Lawyer Assistance Program and record the number. These are programs that offer confidential assistance to lawyers, judges and law students who are dealing with issues related to substance abuse, chemical dependency, mental disorders and/or mental health related concerns, etc. Please contact the American Bar Association’s Commission on Lawyer Assistance Programs if you are uncertain if your state has such a program.
Table 4: What You Can Do To Help Save a Life
1. Take it seriously
2. Remember: Suicidal Behavior is a cry for help
3. Be willing to give and get help sooner than later
5. Ask: “Are you having thoughts of suicide?”
6. If the person is acutely suicidal, DO NOT LEAVE THEM ALONE
7. Urge professional help
8. No secrets
9. From crisis to recovery
Source: Tips from Suicide Prevention Resources (2004) on “How to Help a Suicidal Person” by Nancy Schimelpfening
– by Barbara A. Scarboro and Towanda C. Garner*
*Towanda C. Garner, M.A., LCAS, Certified QPR Gatekeeper Instructor, is employed with the North Carolina Lawyer Assistance Program (LAP) as the Piedmont Coordinator. Dr. Barbara A. Scarboro, NCC, LPC, LCAS, ICAADC, CCS, NCLSC, Department of Human Development & Psychological Counseling, Appalachian State University, Boone, NC is a LAP Board Member.Posted by