The Urge To End It, by Scott Anderson, is a stunning piece. Well-written, and well-researched, it challenges the stereotype that suicide is always well thought out, carefully planned, and the result of a conscious and un-ambivalent decision. He focuses on the impulsivity and momentary desperation involved in many suicide attempts, and raises awareness about means restriction as a potent intervention.
For clinicians, there are several important take-home points and cautions:
- Expressed suicidal ideation is only one part of an assessment of risk for suicide; impulsivity, high intensity stressors, and agitated emotional pain signal as much about risk as suicidal ideation.
- We need to ask about available means and seek to disable lethal means whenever possible.
- We need to advocate for public policy that promotes means restriction--this may save the life of someone in our care (or in our lives).
- Ambivelance runs deep. Even in the moment of jumping, survivors report feeling regret, not wanting to die. We are built for living, and those who help distressed individuals have a powerful force on our side.
- We need to ask about how bad the pain is and how intense the desire for escape, even (especially) with individuals who have not previously expressed suicidal ideation.
There are probably other lessons from Anderson's excellent article, including understanding more about the subjective experience of someone who attempts suicide. The article is not short, but you'll be rewarded for the time spent to read it all the way through.