I’ve spent most of my medical career treating people who’ve tried to take their own lives or who are at risk of dying by suicide. What I’ve learned from my patients and research conducted in my lab is that the conventional approach to suicide prevention has been absolutely wrong.
We’ve certainly become more open to talking about suicide. Last year, the family of country singer Naomi Judd disclosed that she took her life with a firearm, saying it was a “piece of information that we are very uncomfortable sharing.” In the last three months, the families of pro golfer Grayson Murray and former United Kingdom cricket star Graham Thorpe disclosed that each of them had died from suicide. Thorpe’s daughter told a reporter that the family is “not ashamed” talking about his death, adding: “There is nothing to hide and it is not a stigma.”
But despite more openness and greater attention in the media, suicide rates in the U.S. are higher than they’ve been in 80 years. Nearly 50,000 Americans killed themselves last year, and more than 1.2 million Americans tried to do so. Globally, one person dies from suicide every 40 seconds.
It’s time to take a more scientific approach to suicide prevention.
To begin with, we don’t know who is most at risk of attempting suicide. The centerpiece of suicide risk assessment today is asking suicidal patients to honestly tell us about their plans to kill themselves. This is absurd.
Studies tell us that 75% of people attempting suicide do not answer this question truthfully because they can’t process their own mental state, or they’re determined to die and do not want to be stopped.
Suicidal mental state is an acute, potentially deadly psychiatric illness. A growing number of researchers now call this condition suicide crisis syndrome. Yet, incredibly, there is no formal medical description or diagnosis for this condition.
Without a formal medical description or diagnosis, there can be no clinical trials, no approved pharmaceutical treatments and no health insurance reimbursement for this condition. Doctors are uncertain about how to treat suicidal patients and fearful of lawsuits caused by a lack of clear protocols and treatment guidelines. The result: Suicidal patients usually do not receive treatment and are often rejected by the medical system and psychiatric community.
We can change this.
Working with researchers from 15 countries, our lab has developed the construct of suicide crisis syndrome. It is an intense, emotional state, characterized by an intense sense of entrapment, emotional pain and loss of cognitive control. We have shown that this syndrome is similar across multiple cultures and languages and is predictive of near-term suicidal thoughts and behaviors. We have also shown that when it is included in emergency room suicide assessments, clinicians make full use of the diagnosis and patients have better outcomes.
Suicide crisis syndrome needs to be added to the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is the standard reference book used by health care professionals to diagnose mental disorders.
Making this change to the DSM will help health care professionals more easily diagnose and treat those at most risk and create a paradigm shift in suicide prevention. Risk assessment will finally be based on an objective illness description rather than unreliable and misleading suicidal ideation.
Last year, our lab made a 1,000-page submission to include suicide crisis syndrome in the DSM. We are continuing to provide information, and I am hopeful that this condition will soon be incorporated in the manual.
But formal changes to the DSM, while important, are not enough. Mandatory training on suicide crisis syndrome should be provided in medical and nursing schools, hospitals and other health care institutions. Lay people should also be given access to information about this syndrome.
I know from the work at our center that suicide crisis syndrome can be recognized if you know what to look for.
I also know that treatment can make a huge difference. Our lab has seen promising results with a short regimen of medicines. The key is to treat suicide crisis syndrome like other medical conditions and provide optimum treatment in the early stages before it develops. Our lab has used a staging framework that helps identify those most in need of treatment and care.
As a psychiatrist working with patients at high risk for suicide, I’ve faced many emotionally challenging moments. I’ve also been privileged to work with courageous and inspiring people who’ve recovered from the depths of despair. We owe it to these patients and all those at risk to take a different approach to preventing suicide. We have the knowledge and tools to do it.
If you or a loved one is struggling, help is available. Call 988 to reach the suicide and crisis lifeline.
Dr. Igor Galynker, Ph.D., is a professor of psychiatry at the Icahn School of Medicine and director of the Suicide Prevention Research Lab at Mount Sinai Hospital.
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