Lifeless

National Suicide Prevention week was September 6-10. Many suicide prevention entities designate the entire month of September as Suicide Prevention Awareness Month. For those of us who have served on the frontlines of healthcare or public safety, every damn day is suicide prevention awareness day. 😢

I revisit this topic once or twice a year, but it is ever-present in the news: this celebrity ended his or her life, this friend or family member was found dead as a result of suicide, that stranger walked into a venue with an unloaded firearm brandishing it before officers in what had to be an invitation to suicide by cop. Sigh. Provisional statistics from the CDC report 49,449 US deaths from suicide in 2022 – up almost 3% from 2021.

When I was a pre-clinical medical student, our psychiatry lecturers told us that females attempted suicide three times more often than males, but that males were three times more successful than females in achieving death. The difference came from the lethality of their means of suicide. Females more often chose overdose with prescription or OTC medications. Males more often chose firearms. It is thus not surprising that most of the 100+ suicide attempts that I attended as a medical resident and then as a private Internist were women. There were a few men, but they were vastly outnumbered by women. Why? The men were most often seen by police officers or the coroner; they never made it to the ER because they were dead at the scene. Alas, guns even in the hands of amateurs, are lethal instruments.

Many of our suicide by overdose patients in medical training took overdoses of tri-cyclic antidepressants – the treatment of choice for major depressive illness in those days. Major Depression is most often attended by symptoms of hopelessness, worthlessness, and an inability to experience pleasure (anhedonia). That’s a cohort ripe to end it all. Of all my depressed, suicide attempt patients, only three were successful.

The first was a young man who ingested antifreeze to end his life. We managed to bring him back from the brink, but after some weeks in the psychiatric hospital, he was found hanging from a door with his own belt around his neck. The second was a young man who hanged himself in the crotch of a tree branch. He had severe brain swelling when I saw him in the ER crash room. My efforts to bring him back were ineffective; he died of anoxic brain injury. The third was a young fellow who took a month’s supply of tetracyclic antidepressant that he had hoarded for this purpose. He too died of anoxic brain injury. Sigh, what a waste.

Asphyxia, as a means of suicide is effective. Celebrities no less than Anthony Bourdain and Robin Williams committed suicide by asphyxia. But did you know that suicide by asphyxia is the most common means of suicide among children and adolescents? Firearms are a second cause in this demographic, of course.

I’ve been perseverating about suicide since this morning when I read an email from Texas Gun Sense – a non-profit, gun-control group that I have supported since its inception several years ago. That email observed that 26,993 people died of suicide by firearm in 2022 – that’s just shy of 55% of all the US suicide deaths that year. In Texas alone, the toll was 4,193 souls. Of those attempting suicide that year, 8.5% were successful. Of those attempts involving firearms, almost 90% were successful. I bet most of them were men.

Gun control is about public safety, for sure – the safety of children in schools, shoppers in stores, people in their workplaces and places of worship. It is also about public health – suicide prevention and the prevention of domestic violence fatalities.

Sometimes I have to wonder as did a young John Connor in Terminator II: Judgment Day, “We aren’t going to make, are we? People, I mean.”