suicide

barefootlady, ADN, RN · Jul 4, 2005

I am sorry for your pain .

Editorial Team / Admin · Jul 4, 2005

Please do not take the suicide personally. Believe me, you are not responsible. Patients will "find a way" if truly suicidal. It may happen again in your career along with many other events of which you have no control. So, please talk with someone face to face and deal with the grief you have now. Go back and continue your work and you will do fine. Let it go.

beesnest · Jul 4, 2005

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IMO, very selfish, but they are not thinking clearing or they would never do it. The turmoil left behind is life-long for the survivors.SJ

Would we call someone selfish who chooses not to go through another round of chemo, or undergo some experimental treatment that might save their life? No- we would respect their right to die peacefully, and on their own terms.

Most of people in psychiatric wards have already been through the wringer four or five times. We have an obligation to help them as much as we can, but if they don't want that help I don't think we should judge their choices.

Thunderwolf, MSN, RN · Jul 4, 2005

Would we call someone selfish who chooses not to go through another round of chemo, or undergo some experimental treatment that might save their life? No- we would respect their right to die peacefully, and on their own terms.
Most of people in psychiatric wards have already been through the wringer four or five times. We have an obligation to help them as much as we can, but if they don't want that help I don't think we should judge their choices.

This is a tough one. As an ex-psych nurse, the issue of "choice", "making a choice" or "choosing" for suicide is tough for me. My borderlines of old were great to argue the point that it was "a choice" to suicide. Where I have issue with this is that a "real choice" will always allow you to "choice otherwise". If you are dead, no more choices...so, by definition, suicide is not a choice but it is a violent, desperate act. Along with this line of thinking, when a person is suicidal...the person's "realm of choices" has been greatly narrowed by the tunnel vision that accompanies suicidal thinking. When the person is not suicidal, choices open with suicide not being the option that it once was. This approach has been helpful most of the time in encouraging them to wait out the impulse till they see their "choices" more clearly. Now regarding medical end of life/terminal patients, the issue is a little more easier for me. If no hope for recovery, hopeless medical decline and suffering, and fruitless treatment results are expected, I believe that "choice" becomes more relevant. Death by suicide vs suffering a disease of increasing pain and suffering, leading to death, without hope of improvement...well, we are left with only two choices which don't allow much room for choice otherwise. In this case, I believe the person's request or decision should be honored and respected. Just my thoughts.

beesnest · Jul 4, 2005

1)If you are dead- no more choices

2)The person's perception has been greatly narrowed by their illness

Those are the points that I saw in your argument, but I believe both those conditions are met in mental AND physical illness. Could you clarify what you meant?

Thunderwolf, MSN, RN · Jul 4, 2005

In a medical health state of terminal illness without hope of improvement (because the body has reached beyond it's threshold for recovery) "and death IS the outcome as a result" with continued pain and suffering, there is no hope but release...ie suicide.

In a mental health state of illness of decline, death is NOT the outcome of the mental illness in and of itself...although there can be great suffering. There IS hope for recovery or periods of recovery "without death being the expected outcome" of the illness.

Now the issue of hope.

A mental health patient may not "see" hope for themselves at that period of time in his/her suffering, but the majority of others may. Time, which the mental health patient has, simply proves it out. When the patient is eventually feels better, the patient begins to experience and see it for him/herself...something others saw as well but earlier despite the suffering.

A terminal medical patient doesn't have the time or the capacity to heal to health because death IS the expected outcome at this point in the illness. Not only does the patient not see hope in continued suffering, but others quite often see little hope as well and are pretty much on the same page as the patient.

I guess, this is what I mean.

beesnest · Jul 4, 2005

Gotcha, thanks.

I guess I think that it is a continuum in mental health. For example the 15yo who wants to kill herself because she can't date the "cool" guy? No issues with intervention there.

The 90yo who just experienced the death of their spouse of 70 years? The depressive who has been fighting for 20 years, without ever really feeling any improvement, and has just lost his spouse? I think leaving the choice up to them ultimately, but offering unconditional support would be more appropriate.

On another thought...how many borderlines would actually complete suicide if they knew we wouldn't stop them? It would certainly eliminate a lot of acting out and threats that take time away from other patients.

Thunderwolf, MSN, RN · Jul 4, 2005

beesnest, gotcha back.

I do believe in the continuum of health. Let's say, however, that a chronic depressive has treatment failure. Was ECT tried? Let's say it was, and little improvement. But, does depression in and of itself cause death? No, the person's suicide if it presents itself, but not the illness. The terminal medical patient doesn't have that. The illness Will cause demise, regardless. This is the difference I'm trying to make.

I agree, borderlines love attention that crying wolf provides. Benign neglect, setting boundaries and consequences of behavior, discussing only healthy options of coping, and attention GIVEN when healthy behavior is demonstrated seems the best way to go. Unfortunately, borderlines do have suicides too, often accidently.

Gompers, BSN, RN · Jul 4, 2005

I agree, borderlines love attention that crying wolf provides. Benign neglect, setting boundaries and consequences of behavior, discussing only healthy options of coping, and attention GIVEN when healthy behavior is demonstrated seems the best way to go. Unfortunately, borderlines do have suicides too, often accidently.

My high school boyfriend was borderline (which of course I didn't realize until years later in nursing school, then it all made sense). He threatened suicide at least once a month, which is why I stayed with him for 2 years - I was convinced he'd kill himself if I left, which was his constant threat. Of course, he's still alive today (and more screwed up than ever). I do worry sometimes that he'll do something crazy one day...

But from what I understand, more often than not, the people who actually go through with suicide are those who you never suspected. Like with the borderlines, it's a very manipulative way to get attention...they WANT you to know it's on their mind so you can talk them out of it, again and again. Meanwhile, if someone is either very depressed or very psychotic, they're not going to be talking to you about it - it's all pent up inside of them.

We can't predict the future, and we can't read people's minds, and that sucks. I'm so sorry you are going through a hard time right now. Nursing is such a wonderful profession, but man, sometimes the things we go through emotionally...most people have no idea. We take on such mental burdens sometimes. When most people come home from work, they complain about office politics, rude customers, etc...but we nurses usually can't vent the same way. We'd horrify our families with our stories. Find a good friend within the profession, or even a counselor, so that you have someplace to go for support and to help ease your mind.

Please take care.