Sunday, October 4, 2015

The "100% Preventable" Myth

We get such mixed messages. People—including some doctors and therapists—say that “you did all you could” or that “if they’re determined to kill themselves, you can’t stop them.” The overall suicide rate has held fairly steady over time. Yet the suicide prevention field implies, by its very name, that suicide can be prevented. Some groups even claim that suicide is “100% preventable.” This misleading message has spread in recent years to government, military, nonprofit, and educational web sites and programs, as well as news media. At a survivors support group I visited, a member was upset after seeing a “100% preventable” billboard while driving to the group, and others chimed in with similar disturbing experiences. 

Ronnie Walker, founder of the excellent web site, Alliance of Hope for Suicide Survivors, documents the spread of “100%” claims and their harmful effect on survivors. The claims reinforce our sense that we did not do enough, even if our loved ones gave no signs of suicidal despair or intentions, or even if we as family members strove mightily for months or years to help them. Walker suggests we look on 100% preventability as a “possibility” for the future but recognize that we have a long way to go to meet that goal. 

I’m no expert. From what I’ve learned and experienced, it seems that many suicides are preventable--up to a point. Some people in despair get beyond help when they reach the point of no longer being able to think clearly, to feel, or to care about their connection to others. At that point, they get tunnel vision or voices in their head that lead to thoughts only of suicide, putting them in a kind of “suicide trance." That seemed to happen with Noah as he moved through the last weeks of his life in a daze, barely able to converse or connect, much less call a psychiatrist. The challenge, it seems to me, is early detection and intervention: recognizing when distressed people may be moving toward that point, convincing them to get help, and continuing to show them our love, concern, and vigilance. 

Many survivors of suicide loss have to live with the tension between believing that “this did not have to be” and having felt powerless to help our loved one. We may get involved in suicide awareness and prevention in the hope of saving even one life, yet at the same time wonder if such efforts would have had any impact on our lost one.  I doubt that Noah would have ever attended a suicide prevention workshop at his college or called a crisis line—though maybe one of his friends would have, and maybe that would have made a difference.

More experienced survivors in my support group help me understand that suicide may not be 100% preventable, but we can and must do more as a society. We must de-stigmatize mental illness and suicide and make it acceptable for everyone, across gender, age, race, culture, religion, and sexual orientation, to ask for help. We must put resources and commitment into suicide prevention research and action, as well as accessible, compassionate mental health services, with the hope that over time, those efforts will help more people cope, heal, and avert suicide. We need innovative outreach geared to the specific needs, tastes, and lifestyles of populations at risk, like the “it gets better” campaign for LGBTQ youth. We need to train all adolescents and college students in mental wellness, coping skills, and depression/suicide awareness and to spread such training to workplaces, nonprofits, and health organizations. 

As an ancient Jewish sage wrote : “It is not your responsibility to finish the work [of perfecting the world], but you are not free to desist from it either” (Pirkei Avot/Ethics of the Fathers 2:16). I can agree with that 100%.

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