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After the recent suicide of Hollywood director, Tony Scott, this CNN psychiatrist writes about suicide. He knew Scott personally and opens his writing about Scott, but then goes on to his professional and other experiences with suicidal patients and thoughts on suicide in general.

Selected excerpts here only. If you can, I do suggest reading the full article directly.

Psychiatrist: I hate suicide but also understand it
By Charles Raison, Special to CNN
updated 11:40 AM EDT, Tue August 21, 2012

Severe major depression is probably the most unbearable pain a human being can withstand for any protracted period of time. Many people who died of cancer have written eloquently about how the crushing pain from their tumors paled in comparison to the pain they felt when depressed.

With all other pain, most people can maintain some sense of separation between themselves and the pain. As horrible as it is, the pain is in their arm, or leg, or belly or head. But there is still a "them" that is separate from the misery.

Depression is different. Because it is at its essence a perceptual disorder, it causes one to see the entire world as pain. It feels painful inside, but it also feels painful outside.


In fact, even psychiatrists have a difficult time predicting when someone is at heightened risk for suicide. In part, this comes from the fact that many people who really want to kill themselves keep their mouths shut about it and just go do it. In part, it comes from the fact that suicide is often an impulsive act driven by acute and unpredictable increases in anxiety and despair that one cannot predict in advance.


Third, even over the suicidal person's objections, the means for committing suicide should be removed from the environment. Guns should be taken out of the house. Pain pills should be taken elsewhere.

Fourth, studies conducted over the last 20 years suggest that the biggest short-term risk for depressed people to kill themselves is the development of unbearable anxiety. If a loved one with depression begins to pace the floors or do other things suggesting that they are becoming consumed with terror, panic or dread, the risk for suicide shoots up.

Finally, it is not true that talking about suicide increases the likelihood it will happen. In fact, studies suggest the opposite.

So if you have a loved one with depression who is struggling with the will to live, one of the best things you can do -- over and above getting them immediate health care -- is to check in with them regularly and honestly and act if their drive to die intensifies.
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