Do we want a war on suicide?

A meeting in Chicago today kicks off the countdown to Suicide Awareness Day on September 10.

Efforts to control self-destructive behavior can backfire. Look at prohibition and our failed "war on drugs." Despite all the efforts at prevention deaths from suicide seem to increase. Have we made suicide a new forbidden fruit? Could prevention efforts paradoxically contribute to suicide risk?

In the film Sybil psychiatrist Wilbur goes to her patient's residence to rescue her from suicide. Has Hollywood influenced us to hold those who treat the mentally ill responsible for their suicides? But making others responsible has the unentended consequence of creating an incentive to avoid professional entanglement with such individuals. How far do we want to escalate this war? According to neuroscientist Michael Gazzaniga writing in his review of The Anatomy of Violence by Adrian Raine in the May 4, 2013 Wall Street Journal, "British policy makers" -- not psychiatrists -- have established "a new disease called 'Dangerous and Serious Personality Disorder.'" Authorities can lock up those so "diagnosed." Could they not also "lock up" those deemed at risk of suicide with no pretense of treatment?

Statutes in a growing number of states allow their physicians to assist terminally ill patients in killing themselves, but only after a mental health professional has certified them (ironically) free of mental illness. Those who attempt to kill themselves outside these laws often fail in their attempts, but we provide those who avail themselves of legally sanctioned assisted suicide with the means to accomplish their wishes with near certainty.

If instead of launching dramatic efforts to prevent suicide we as a society condoned rather than condemned the act and even made available less violent means, could we be certain that more would succeed in killing themselves? Might the numbers drop instead? Perhaps a different set of individuals would die. As with "legalization" of marijuana, we could implement regulations. Under such a system we might require limited counseling and a cooling off period before providing access to lethal overdose. (Think Soylent Green.) Might we offer a choice of methods, perhaps even including placebo? We could require psychiatric evaluation and inform the individual of avialable treatments that might make life seem more worthwhile. Pre-suicide counseling might focus on examination of consequences for family and friends or facilitate saying goodby and eliciting support. Could such an approach lead to fewer impulsive suicides or fewer violent suicides? Might a reduction in failed attempts contribute to an overall reduction in harm?

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