R. Murali Krishna, M.D. President

Every minute, someone in the United States attempts suicide. Every 15 minutes, someone succeeds in that attempt, and a life is lost, a family is shattered, and a shadow of pain and questioning is thrown across friends and acquaintances.

When someone attempts or commits suicide, people close to that person usually have one immediate question: Why? At the deepest levels, the reasons for suicide are varying mixes of biology, genetics and brain chemistry. We know tendency toward suicide can run in families. And medical research has found that the brains of people who commit suicide have lower levels of serotonin activity than the brains of other people.

Whatever the causes are at deeper levels, they generally find expression in one of several ways.

Overwhelmingly, people attempt suicide out of a sense of hopelessness. Many times the hopelessness is part of depression. But sometimes the hopelessness is circumstantial, such as crises in important relationships or personal finances. Whatever the cause, people who attempt suicide see the future as overwhelmingly bleak, and believe that leaving the world altogether is the only solution to problems that seem unbearable.

People also commit suicide out of a sense of desperation, a feeling that life if impossible without changes that seem beyond the realm of possibility. People with this sense of desperation feel they must do something, and sometimes that something is suicide.

Guilt may also be at the root of suicide. People who have survived a traumatic incident where others were killed or seriously injured sometimes develop what is known as survivor guilt. As part of that response, some people begin to hate or punish themselves. At its extreme, these feelings can lead to suicide.

Aggression and violence, which are natural biological drives, may drive a person to suicide if not handled in a healthy way. In a professional world which is too often pressurized by escalating time conflicts, economic pressure and competition, these drives can be destructive. Studies demonstrate that people live longer and experience fewer ailments when they have lower levels of hostility and aggression. It's not much of a leap to make the supposition that they are less likely to commit suicide, too.

How can you know if someone is thinking of committing suicide? About 70 percent of people who commit suicide give out clues as to what they are thinking. Some will make direct statements about how they feel like killing themselves, or that they don't know how much longer they can deal with the situation that is disturbing them. Others may even hint they have acquired the means for suicide, such as saving up pills with which to take an overdose. Warning signs of suicide include:
- deepening depression
- talking about suicide
- statements about hopelessness, helplessness or worthlessness
- preoccupation with death
- suddenly happier, calmer
- loss of interest in things one cares about
- visiting or calling people one cares about
- setting ones affairs in order
- giving things away
- risk taking or self-destructive behavior

If you know someone who exhibits some of these warning signs, there are a number of steps you should take.

Listen. Empathize with their feelings and let them know you care. Be available and understanding.

Help find other options. People in emotional crisis don't think clearly and may believe suicide is their only option. Help redirect thoughts into positive action and looking for solutions.

Buy time. Suicide is often an impulsive decision. Encourage the person to not make irreversible decisions while in crisis.

Call in others. Enlist the aid of someone else close to the person a spouse, a friend, a caring employer. All can be important allies in the process. If the crisis seems acute, call 911, a suicide hot line, a hospital emergency room or a mental health center. In an acute situation,
do not leave the person alone.

Offer to arrange for professional help. Let the person considering suicide know you are so concerned that you are willing to arrange for help beyond the immediate conversation you are having. Offer to call his or her psychiatrist or family physician, or arrange for an evaluation of his or her emotional or mental health.

Overall, the sense you want to give to people considering suicide is that the suicidal crisis is temporary, they are not alone, help is available and they will survive the pain. By no means can you be certain that offering these assurances will prevent suicide.

When people are suicidal,
there are simply no guarantees.
In the time it took you to read this article, five or six people in the U.S. attempted suicide. Perhaps someone even died from that attempt. By educating yourself, you're now better able to help someone who is considering suicide.

Just as important, you're also better equipped to raise the topic among friends and family. Suicide is somewhat of a taboo topic in this country. By not talking about it, misunderstandings and myths remain unchallenged. With education about suicide and the willingness to share information and engage in conversation about it, many lives can be saved.

R. Murali Krishna, M.D., is president and COO of INTEGRIS Mental Health Inc., one of the state's largest providers of mental health services. He is also president of the James L. Hall Jr. Center for Mind, Body and Spirit. He has maintained a private psychiatry practice for more than 25 years and is a clinical professor of psychiatry at University of Oklahoma Health Sciences Center.