Suicide is Painless…..

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…”it brings on many changes”- among the survivors. Losing a patient to suicide is a painful process lending itself to the so-called patient “psychological autopsy”, along with considerable introspection, despite knowing that it is an occupational hazard. Losing a patient to terminal cancer is difficult but the certainty of prognosis is clearer than with psychiatry.

The 3 patients I am presenting all suffered from schizophrenia. Compared to the general population, people with schizophrenia have a more than eight-fold increased risk of suicide. Suicide prevention can be difficult because people with schizophrenia can sometimes act impulsively and without warning.

Two of the  victims were male, one female, all under 35. Unlike those with depression, none verbalized their feelings or ideas of self-destruction. This is common as schizophrenics demonstrate isolation of affect-repressing and being out of synch with their emotional state.

All suffered critical auditory hallucinations eg ” you’re  a faggot or isn’t she silly”.   They also provide a running commentary.. ” look at him, what a loser” etc. this causes no doubt considerable un verbalized torment.

Case1: Wayne was 28 and suffered chronic schizophrenia somewhat controlled with Stelazine. He was very close to his fraternal twin sister and lived with her. After she moved away to college he seemed to be adjusting well at least on the surface and lived with his parents. He enjoyed archery but one day failed to return home after a regular trek in the bush. He was found the next morning leaning against a tree with an arrow in his stomach dead.  The cross-bow was rigged to adjacent tree rigged to fire with a rope on the trigger. The police thought it was originally aimed at his chest and that it would have taken  hours for him to expire. There was no warning or intent expressed to myself or  his family or discussion of the loss he may have felt regarding his sister.

Case 2: Joe was 32 and had schizophrenia for many years. He was on an injectable antipsychotic called Haldol LA. He suffered auditory hallucinations  regularly referring to him as queer but never reported feeling suicidal. He drank 8 beers/day and watched TV continuously on a tiny black and white set. One day in  between my bi weekly visits he hauled a lawn mower into his bedroom and fired it up. He was discovered dead from carbon monoxide poisoning several days later by his brother. No warning of intent was given.

Case 3: This patient, Maria, was 32 and is the lady from the Truth Serum entry earlier posted. I had not seen her for a year as I was out of the country, but apparently she continued on Modecate IM and according to her father whom I met while shopping, seemed happy. She continued to lived at home, did some part-time domestic work and socialized with her boyfriend. One day as per her routine she went to the well to draw water for washing. She did not return and after an hour or so was found at the bottom apparently drowned.There was no indication of foul play, snakebite or loose footing. Suicide was inconclusive but suspect.

None of these people made threats or left notes. None had previous attempts or expressed any sad emotions.The methods were atypical in that firearms or overdosing were not employed. Most people  with completed suicides have a history of major unipolar or bipolar depression. Those with borderline disorders make many attempts often attention seeking.

Those with schizophrenia live in a very lonely private world unable to filter out or stop the bombardment of voices or controlling influences that they perceive. It is unusual for a therapist to be allowed entry into this inner private realm. That has only happened in a few cases such as with Bill discussed previously in The Molecular Hydraulics of Mental Disorder.

The French sociologist Emile Durkheim…described 4 types of feeling  states that predispose to suicide: anomic (rootlessness), altruistic (Kamikaze pilots, above photo), fatalistic (cancer patients), and the egoistic which applies to the schizophrenic world..”reflects a prolonged sense of not belonging, of not being integrated in a community,  feelings of not having a tether: an absence that can give rise to meaninglessness, apathy, melancholy, and depression. It is the result of a weakening of the bonds that normally integrate individuals into the collectivity.”

And to paraphrase Albert Camus, my guess is that for these three people from different countries and backgrounds, suffering the same illness, in the end may have shared one common denominator..”one needs more strength  to live than to kill oneself .”

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