Chapter 6
Suicide
Jim Smith was a chubby, good-natured man with a good, easy job, a nice wife and his home paid for. He had been into my office several times, always with a good story for me. I knew his in-laws and had taken care of his mother-in-law when she died in her late eighties with a heart attack. His office visits were for colds, checkups and other little conditions that occur to all of us from time to time.
One evening, about an hour after dinner, he was sitting with his wife, reading the evening paper. “I think I’ll go to the bathroom and shoot myself,” he suddenly announced. He was always joking, so his wife thought nothing about it and continued with her knitting. Suddenly a shot rang out and Darlene was shocked into a stupor. She finally came out of it enough to rise and walk to the bathroom, whence the sound had come. There he was, shot through the head, sprawled on the floor. It was too late for any life saving effort, for he had completed the job.
There was never an indication as to the reason for his action. She said they had never quarreled, there was nothing about his work that displeased him, nor was there any trouble in his life. He was only fifty-two years old, in good health and everything to live for.
This was during the war, but we don’t know if there was any connection to the war. There is always a strain about war, even to the most menial, even though far removed. There is always an uncertainty about life and certain added responsibilities even to all individuals. Some feel the responsibilities, and some hardly notice them. Of course, the closer one is to reality, the greater the strain, but with Jim, there were no relatives involved, so there was no way of knowing why he, suddenly in his joking way, told what he was going to do. And what he did was final.
Mr. Wakefield was another healthy individual of eighty-two. The first time he came in to see me, he wanted a low cholesterol diet, so he would not build up a lot of atheromatous material in his arteries. We had a blood cholesterol determination, which showed a normal figure. He was slender, dressed well, had a normal blood pressure reading and a normal electrocardiogram. In fact, he was spry and in excellent health. His visits were more social that anything, after his checkups proved satisfactory. He had a very lovely, healthy wife who was devoted to him. Several times I thought to myself how wonderful it would be to be similarly situated at his age. He had a good income from an insurance business, so there were no financial worries.
One day he came in as usual and waited until I was not too busy, so he could visit with me a bit. He was jolly, in a very jovial mood. He related something funny that had happened in the neighborhood, had the usual checkup, and went home.
That night his wife went to bed early, while Mr. Wakefield sat up to read. Later in the night, when she discovered he had not gone to bed, she went in to see why, and found a note saying, “Goodbye darling,” and he was dead. There was half a bottle of Nembutal on the table, prescribed by another doctor, two years before. There was no indication why he went that way, since he had not a worry in the world that we could determine.
Then there was Mr. Butler, who was under treatment for a chronic heart and kidney condition. We generally refer to this as CVR, or cardiovascular-renal condition. He responded nicely to medication and was doing very well, but his wife was a holy terror, harping and haranguing about something all the time. He continued to work since his work was at a desk. Those were the hours that were best for him. What a pleasure to be where there was relative peace and quiet, away from harassment; but when he strode in the door at home, his troubles began. The poor woman could not control her tongue, and all the pent-up troubles and imaginary troubles of the day simply had to burst forth in gushing sequence. Now a man can stand only a certain amount of that when he is well, and even less when he is ill.
Mr. Butler came to the conclusion that it simply was not worthwhile, so he quit taking his medicine for a few days, without saying anything about it. Soon he was beyond recovery and was soon freed from his wife’s caustic tongue. This proves there are different ways of committing suicide.
Another older man with hypertension did all the things I told him not to do. He smoked, took no medicine, worked hard, argued, drank great quantities of liquor, and finally one day when sawing a big limb from a tree had a massive stroke and died. I always felt that it was self-inflicted.
There are about twenty-five thousand known suicides a year in the United States. In addition, there are many unsuccessful attempts, bringing the figures to one hundred seventy-five thousand to two hundred thousand. Children’s suicides are in two classes of individuals: the chronically depressed and the delinquent, misbehaving groups. In fact, three percent of all suicides are in children under fifteen years of age. Some children are so hostile in their environment they do not tolerate discipline. School pressure, love affairs, family dissention, all play a part. Data compiled by the Metropolitan Life Insurance Company reveals a sharp increase in the past few years. Accidents were the cause of most deaths in children and suicides were second.
Many people give warning of their intentions, so that the suicide prevention centers are in a position to stop many intended victims. It is estimated that every minute of the day someone consciously attempts suicide, and sixty to seventy a day succeed.
No one likes to be blamed for a suicide. Consequently, many are hushed up, if possible. We wonder where the doctors fail, but there are many who never see a doctor who are suicide victims. Some try again and again until they succeed. Which reminds me of a case in Parkland Hospital in Dallas. A fellow who was a senior medical student while I was a junior, had a girl brought in three times to his service, each time following ingestion of some poisonous tablets. She took them straight, and they made her sick to her stomach each time, so she threw them up. Her stomach was pumped each time, and she was sent home, only to come back again. This resident questioned her carefully and found out she was fully determined to repeat the procedure until she succeeded. Whereupon he suggested that she make a solution of one of the tablets and drink it and it would be all over. She followed his directions and it worked. They could do nothing for her when she was brought in for the last time. We do not condone that kind of action, however. Instead, it is up to us to save lives rather than take them.
One of the surprising things is that doctors, dentists, and lawyers are high on the list of suicides. Doctors and dentists have many drugs available to them, and alcoholics, schizophrenics, and depressives seem to have a tendency to suicide. Psychiatrists, for some reason, have the highest rate of all. Notes left reveal the individuals to be very unhappy, though not necessarily mentally ill. The unhappiness results in emotional upsets, or in many, there may be a long, painful illness, loss of hope, or no happy future to consider. These seem to increase with age, so that the highest rates are in widowers over sixty-five years old.
There is no inherited tendency, but I know of three in one family, most probably due to the conditions under which they lived. In England, two brothers, psychiatrists, have taken that way out, but in England the rate among psychiatrists is higher even than in our country.
Alcoholics are suicide prone, and since alcoholism is on the increase, so are suicides.
Marriage seems to be a stabilizing factor, and when there are children, it is even more stable.
It might be mentioned that poor health, such as an incurable cancer, heart condition, or other great debility is frequently the cause of suicide. One young man who lived after jumping off the Golden Gate bridge revealed it to be a sudden, temporary obsession that occurred to him as he was driving over. He had never thought of it before he did it.
The effect of individuals on others is very interesting. Dr. Curtis Judd of Heidelberg found that the mental changes in hospital personnel working with patients had quite an effect. He found that when anxiety rose among the residents and paramedical staff, such as symptoms of loneliness, worry, uncertainty, despondence, inadequacy, decrease in confidence or depression from any cause, there resulted a raised anxiety level in the patient group, increasing their tension and directly increasing a suicidal tendency.
No group is more prone to suicide than are narcotic addicts. It has been noted that fourteen percent of 188 deaths among addicts were due to suicide. Of course, overdoses are very lethal and may be included. Fifteen percent of deaths are attributed to overdoses, some of which may have been suicide. Since there is such a variation in the amount of heroin one purchases, it is really difficult to determine whether death may be due to accidental overdose or even murder, in instances where an extra strong dose is involved. But among the heroin addicts especially, there is frequently a very severe depression, and depression is one of the main causes of suicide.
Many people make an attempt at suicide in order to attract attention. The slashing of wrists is especially easy, and if one slashes only so far and is where others are near, it will bring plenty of attention. But we never can know if it was for attention or really was meant to do the job. The fact that suicide is the fourth leading cause of death among the very happy age of nineteen to twenty four, and this in spite of all the suicide crisis intervention services and suicide prevention lines listed in the telephone book, simply means there must be a great deal more depression now than ever before.
It is interesting that during both of the last wars, the suicide rate decreased. Could it be that people simply were more occupied, had more things to do, and more definite goals in mind?
Many suicides go unreported because we have no way of classifying them as such. Take the one individual who speeds his car off a cliff or into a tree. No doubt many of these are really suicides. Also, the individual who is burned in a car or in peculiar circumstances may be likewise a suicide. The man who attempts a hold up where he knows there is an excellent chance of being shot is another instance where we can wonder about it.
It is said that about one tenth of all the people who contemplate suicide will at one time try it. For some reason, the rate is higher in Hungary, and divorced people are more likely to succeed when they try.
The taking of sleeping tablets may sometimes be an accident. Perhaps a person takes one or two, then forgets, but usually when many are taken at one time, the individual knows full well. They are clear, and after calculating and thinking it over, have decided that this is the best way to solve their problems.
Some patients realize that continued or habitual drinking or smoking can be a means of slow suicide, but as it is not rapid in its effects, they discount both. But in the case of alcohol, cirrhosis of the liver is very fatal, and in a thirty-year medical practice one sees several cases. Not everyone, fortunately, is liable to develop cirrhosis, but chronic alcoholism does bring it on. And everyone knows the danger of cigarette smoking to the lungs, heart, and blood vessels. Yet the smoker and the drinker continue blithely on their merry way and seem to think nothing of it.