Why are we against suicide?

Posted

Specializes in Psychiatry. Has 3 years experience.

I know the title is a bit harsh. I'm finishing up my psychiatric rotation and will be doing my capstone in a psychiatric facility next semester. I fell in love with psych nursing but one thing has not been answered adequately for me:

Why are we against suicide?

I can understand if it someone who is new to the darkness of feeling suicidal, someone who is going through a "situational crisis", etc, but what about those that have had a lifetime of pain and suffering? Those that are homeless, have no family, friends, are addicts. What is the rationale for stepping in, hospitalizing them and encouraging them to keep on truckin'?

If they have no religious reason to stick around, then who are we to basically judge their coping as unhealthy, put them on a 1:1, and force them to keep going?

Why is suicide viewed this way in our culture?

MrChicagoRN, RN

Specializes in Leadership, Psych, HomeCare, Amb. Care. Has 30 years experience. 2,589 Posts

Why WOULDN'T we try to keep them safe in the hope that life can and will get better?

If they are homeless, or without families are they less worthy of keeping alive than the middle class guy or gal?

Depression is a treatable illness. Many thousands have crawled back from the abyss, even though it may take years.

Life is short, and no one gets out of here alive. Death comes soon enough.

We help keep them alive because they have worth and value as human beings and deserve every opportunity to live a decent life.

SwampCat, BSN

Specializes in Psychiatry. Has 3 years experience. 310 Posts

I agree they are worth it, but as someone who has dealt with depression for 20 years I question if it is our place to say "No, you can't call it quits yet" as we don't fully understand what thy are going through. Yes depression is treatable, but even treated some question the point of continuing on. I can't help but question what this is all for. This is all there is to life? Lived experiences? So what? I'm not impressed. Sure, I enjoy life but if I decide I'm done, why can't I be done? What if they just don't want to do it anymore?

We don't hospitalize people who run away and restart their lives under an alias and put their old life to death, but isn't it close to the same thing, regardless of the physical body still being alive. What about autonomy? The right to do to yourself what you desire. Maybe I just view life and death differently than the culture I was raised in?

Maybe my question can't really be answered in a way I hoped it could.

Why can't people with bipolar just be the way they are? Why can't people with schizophrenia just be the way they are? Why can't they kill themselves if they want? ..because they are ill, they don't know how to stop the pain but with direction, a little will and intervention people can have quality of life after during and after these challenges. Similar questions could be asked for people who have what is viewed as a medical illness from dependencies like; why can't we let people with COPD finish themselves off? People with cirrhosis? Their behaviour doesn't suggest they want to live, they have poor quality of life & largely their autonomy is taken by addiction. It's all health and illness, I don't really see a distinction, only the symptoms are different. Do you understand that wanting to die is mental illness and is not just another day-to-day choice? Also know that these are shared illnesses and we must consider the families a co-patients. Why don't we as individuals, communities and nations address the determinants of health rather than accepting all the injustices that contribute to people's desire to kill themselves? We help, that's the job. If we can't help who will? If you as a mental health professional don't believe in recovery what chance does the Pt have?

Alex Egan, LPN, EMT-B

Specializes in Home Health (PDN), Camp Nursing. Has 9 years experience. 6 Articles; 857 Posts

I really do understand where your coming from OP. When my mother was on her last in patient stay, she just looked at me and said "why won't you let me go, just let me rest". I defiantly had a moment where I felt selfish, and had to really ask myself why I was so opposed.

She's more mentally stable now. Truthfully she has had some degree of suicidal ideation for the last 10 years, and her prognosis is poor, even with treatment. I have come to look at the suicide of persons with prolonged mental illness, who have been undergoing treatment, as a natural outcome of a severe disease process. Similar to a chronic medical of who dies of a prolonged illness, despite all available treatment.

I group persons who suddenly and unexpectedly commit suicide, with sudden cardiac arrest victims. They both have undiagnosed and untreated illness in many cases, and are both tragic.

PeacockMaiden

Specializes in psychiatric nursing. Has 3 years experience. 159 Posts

While your post is controversial, I must say that I pondered the same question before. I am a psych RN in inpatient. We see so many clients come back again, and again, and again. I realize they have an illness. Some people will never recover though, as sad as it is.

I think it would be totally unethical to deny these clients care and treatment, but at some point they are just a drain on economic resources (since many cases are charity or medi-care,medi-Cal (in CA)). Something is not working in the treatment of these patients.

What is a better treatment strategy for people who engage in chronic self harm behaviors? I wish I knew.

Undone

158 Posts

Wanting to die may not always be an illness, maybe sometimes it's a well thought out end to unbearable mental suffering.

Ever seen the Sissy Spacek movie "'night Mother"?

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience. 142 Articles; 9,940 Posts

Here are a few thoughts from someone who was recently inpatient for suicidal ideation:

First, most people who are thinking of suicide don't really want to die; we simply want our pain to stop. If there is a way to make the pain better---even for a short time---I think it should be done. That also goes for anyone considered a "low-value" patient, e.g. homeless, addicted, severely mentally ill.

Second, I think our culture's way of viewing suicide as a selfish act needs to change. Many people who attempt suicide are indeed thinking about their families/friends when they get to that point, but it's because they think their loved ones would be better off without them. I know that's what I thought when I was contemplating using the gun in my dresser drawer. Yes, it's a twisted way of thinking, but when one is that far down the rabbit-hole, our brains lie to us!

I also believe our duty as nurses is to try to protect the sick from the consequences of their illness. Yes, patients can and should help themselves, but we don't judge the non-adherent diabetic or COPD patient as harshly as we do the mentally ill. Believe me, suicidal patients aren't in a position to decide what's best for themselves; that's why we put them in a locked facility where they can't harm themselves until such a time as they achieve stability (or as long as insurance or Medicaid will pay for it). I'm thankful that someone did that for me; a week away from my life on the outside made it possible for me to feel safe again, and then resume my appointed rounds.

I'm doing better now, but the nature of my illness is such that I will more than likely go through more such episodes. Would you give up on me and let me kill myself? Or would you try---again---to save me from myself?

Just asking.....

mtskier

18 Posts

This is a great question, and framed objectively and clearly by the OP. I have to admit I had similar personal questions raised during my own psych rotation this past semester. Good discussion thus far.

Davey Do

Specializes in around 25 years psych, 15years medical. Has 43 years experience. 1 Article; 9,467 Posts

It's always good to Question the Mainstream Partyline and hear from an Alternative Perspective, SwampCat!

MrChicagoRN, and others, have answered your Question well enough- basically, there's always Hope. And suicide is often viewed as a Selfish Action that affect the lives of others, which is Unfair. And so on and so forth.

However, One System of Beliefs- which is somewhat off the Beaten Path- ascribes to the Notion that the Physical Body is in such Pain that the Spirit needs to Take Flight.

I believe I read that in Edgar Caycee on Reincarnation by Noel Langley.

Alex Egan, LPN, EMT-B

Specializes in Home Health (PDN), Camp Nursing. Has 9 years experience. 6 Articles; 857 Posts

I also believe our duty as nurses is to try to protect the sick from the consequences of their illness. Yes, patients can and should help themselves, but we don't judge the non-adherent diabetic or COPD patient as harshly as we do the mentally ill. Believe me, suicidal patients aren't in a position to decide what's best for themselves; that's why we put them in a locked facility where they can't harm themselves until such a time as they achieve stability (or as long as insurance or Medicaid will pay for it). I'm thankful that someone did that for me; a week away from my life on the outside made it possible for me to feel safe again, and then resume my appointed rounds.

I'm doing better now, but the nature of my illness is such that I will more than likely go through more such episodes. Would you give up on me and let me kill myself? Or would you try---again---to save me from myself?

Just asking.....

Of course it's our duty as nurses to help people who are sick. I don't think anyone is advocating just letting psych patents hang themselves on the unit like wind chimes.

As I said I think the view of suicide as a selfish act is the big issue. It's the often preventable end of a disease process.

Frankly I judge noncompliant diabetics and COPDers more so than psych patients with suicidal ideation. Persons with ideation care enough about family and friends to consider they would be better without them.

Noncompliant's often stress the family unit and the system with the disregard they show for their own health, as they also move towards suicide, just more slowly. I think a lot of these persons would also benefit from a psych consult.

studentnursemon86

Specializes in ER/Emergency Behavioral Health.... Has 8+ years experience. 245 Posts

I once had issues with depression and suicidal thoughts as a teenager. I didn't see an end to my feelings and I couldn't get out of my current situation. I saw a therapist who said "suicide is a permanent solution to a temporary problem." There are so many resources for the mentally ill; medications to help with schizophrenia, antidepressants, talk therapy and then there is always trying to change the situation causing depression and anxiety. Suicide doesn't solve the problem. Yes, it may end pain and suffering, but it also puts an end to any positive things that could follow from treatment.