when one is suffering near the end of life with little realistic
expectation of future happiness or usefulness. That seems acceptable,
maybe even healthy to me (See Quill, 1993). But where there is any
hope, including through the use of therapy, medication, and strong
pain-killers, suicide is just not a good option. At least, one should give
talking treatment and drugs a try.
A major problem among the elderly is that depression is
overlooked or neglected by the primary care physicians and families.
Maybe old folks are expected to be unhappy; maybe doctors dont ask
and they dont tell; maybe general physicians dont know how to ask
or test for depression. Anyway, their sadness, lack of interest, and
discouragement dont get treated correctly. A recent study reported in
the March 3, 2004 issue of Journal of the American Medical Association
took an innovative approach. Randomly older patients considered
depressed were assigned to routine care or to a special
intervention which involved a MA level depression-care manager,
and either SSRI medication or, if they didnt want to take pills,
psychotherapy by the care manager. Their feelings of depression and
frequency of suicidal thoughts were measured at 4 and at 8 months.
Results: Psychotherapy provided the fastest and the most effective
treatment of depression and suicidal thoughts. At 8 months, 70% of
the elderly who had started with major depression and thoughts of
suicide had lost those thoughts, compared to 44% of the usual care
patients. The massive use of antidepressants in GPs offices may
eventually drag psychologists and social workers into the general
health care process.
Almost 80% of all suicidal persons have been depressed for weeks
and, of those, 65% to 80% have "cried for help." Many have gone to
see their family physician; others have hinted to friends. Most have
mixed feelings about killing themselves. They certainly want to be less
miserable. They definitely want a solution, but at the moment, they
can't think of any other way out. Only an estimated 5% to 20% of
attempters definitely or completely intend to die; yet, many are willing
to run the risk of death. They sometimes yearn to be rescued and for
life to get better. I once had a deeply depressed patient who took drug
overdoses three or four different times but always just before our
appointments, partly, I think, to see if I would save her. These cries
for help are usually telling others they are terribly upset and hurting,
that they need help, care and love. If you hear such cries (comments,
hints, questions, and jokes included), take it very seriously, listen and
show your concern, urge him/her to get professional help immediately.
You don't have to solve all their problems; just a little help--a little
relief from the pain--may save a life (Shneidman, 1985).
Suicide may result from an almost infinite number of causes and
A therapist may find some of these mental conditions and
situations related to suicide: 1. Intolerable life situations: Life
seems a total mess, faced with terrible losses or catastrophes, feeling