Suicide: An invisible reality
Suicide is a social problem that requires a public health approach, not a mental health problem. Suicide is a complex and multifactorial phenomenon that affects millions of people worldwide, and represents one of the leading causes of death. The World Health Organisation (WHO) estimates that every year more than 700,000 people die by suicide, which is equivalent to one death every 40 seconds. In Spain, 11 people die of suicide every day, with 3,952 people dying of suicide in 2023.
Despite these alarming numbers, suicide remains a taboo subject, preventing access to effective treatment and prevention. Adding to the taboo is the stigma when suicide occurs, increasing individual and family suffering, making it difficult to grieve for the deceased. From a psychological perspective, it is fundamental to understand that suicide is not an easy ‘decision’ or a selfish act, but the result of an accumulation of emotional, social and biological factors that generate great suffering for which there is thought to be no way out.
It is when suicidal suffering is perceived as unchangeable that feelings of helplessness set in. We must always bear in mind that the person does not want to die, they only want to stop suffering. To quote Edwin Shneidmanlo: ‘Suicide is not a choice, it is the end of unbearable pain’.
Therefore, psychological intervention is not only essential, but can also make the difference between life and death.
What risk factors can we find?
Suicide is multi-causal, the result of the interaction between various factors among which we can find:
- Psychopathologies: depression, anxiety and bipolar disorders are conditions that significantly increase the risk of suicide. These pathologies are often accompanied by feelings of hopelessness, apathy, no life purpose and intense emotional pain that lead people to feel that suicide is the only way out.
- Social isolation: People who lack emotional support networks or who live in isolation are more likely to be suicidal. The lack of a support system can intensify feelings of loneliness and hopelessness.
- Traumatic experiences: Violence, child abuse, loss of a loved one, bullying and any traumatic event can lead to deep emotional suffering and increase the risk of suicide.
- Biological factors: Studies have shown that there are genetic and neurobiological components that influence suicidal behaviour. Dysfunction of neurotransmitters such as serotonin is linked to an increased likelihood of making a suicide attempt.
- Socio-economic context: Poverty, unemployment and economic instability are also factors associated with increased suicidal ideation.
These factors do not act in isolation. Their combination can significantly increase the risk of suicide.
Are there warning signs to look out for?
Verbal Cues
Feelings of hopelessness: ‘there is no solution’; ‘it will never get better’.
Despair: Feels that he can’t take it any more, feels lonely, that he is in the way, that nobody cares…
Guilt, shame and self-hatred… ‘I am worthless’.
Comments on death …. ‘I’d like to disappear’; “I need to rest”.
Unusual farewells…. ‘Know that you have been a good friend’; “I will always love you”.
Openly expressing wishes to take one’s own life.
Non-verbal Cues
Sudden change in usual behaviour
Seeking mechanisms to harm themselves
Social withdrawal/isolation (lack of energy)
Passive attitude, apathy, sadness.
Neglect of personal appearance
Difficulties in concentration and memory
Alteration of sleeping and eating patterns
Closing unfinished business; giving away personal items, closing social media accounts, saying goodbye to people ….
Significant non-verbal behaviour when asked about suicidal ideation; crying, looking at the floor.
The importance of early intervention
It is essential to understand that suicide is preventable. Early intervention and appropriate support can save lives. Prevention and psychological intervention can help people to identify and modify negative and destructive thought patterns, promoting a shift towards more pleasant and realistic thinking.
In addition, the focus on prevention should also involve those close to the person at risk. Family, friends and peers can play a crucial role in detecting early warning signs and seeking professional help.
Let’s Take action
The stigma surrounding suicide is one of the biggest obstacles to suicide prevention. Many people who think about suicide do not seek help because of the fear of being judged or misunderstood. As a society, we must work to change this reality. Talking openly about suicide, without prejudice or stigma, can make it easier for us to seek the support we need. It is essential that we break the silence and promote a culture of empathy, understanding and above all, compassion.
As mental health professionals we have a responsibility to educate and raise awareness of this issue, but we can all contribute to suicide prevention. Learning to recognise the warning signs, being willing to listen and offering emotional support are small steps that can make a big difference.
What can be done about this invisible reality?
Suicide is a public health problem that cannot be ignored. As a society, we must commit to offering emotional support, promoting mental health and ensuring that people at risk have access to the resources they need. Psychological intervention can save lives, as we must bear in mind that when one’s sense of freedom is threatened, one suffers greatly, hence the need to look for the affected person’s reasons for living, as well as the search for a vital goal.
Today is the time to offer support and a helping hand, because we all need to be ready to act and be part of the solution. We can no longer allow asking for help to be seen as a sign of weakness.
If you or someone you know is going through a difficult time or feels there is no way out of their suffering, don’t hesitate to seek professional help, we are here. In addition, there are national resources such as the Telephone of Hope (teléfono de la esperanza) and 024 (suicide hotline of the Ministry of Health).
Carmen Mandly
Health psychologist expert in animal-assisted therapy, early care and neurodivergencies.