The light at the end of the tunnel - June 25, 2007

A very popular TV programme recently discussed the subject of suicide. As a long standing dental surgeon, who for a long time practised my profession and values overseas, I wish to share my views discussed during a seminar I attended in the US.

What should a dentist do when a patient talks seriously about committing suicide? Experts in suicide prevention maintain that all health workers should be familiar with emergency measures to help save people from taking their own lives. The dentist, as a health professional, should know what to do until a medical or psychological specialist can take charge of the patient. The dentist should strive to recognise and help the suicidal patients. Suicide may be viewed as the tragic climax of an unsolved psychological problem. The factor commonly implicated in the literature on suicide etiology is the psychological condition called depression.

Correlations between suicide and depression have been reported in the range of 62 per cent to 97 per cent. Some patients suffering from depression may be driven to suicide because they feel worthless, helpless and hopeless.

It is a fallacy to think that a person who threatens to commit suicide will not perform the act. Others give behavioural clues about their intentions, such as hoarding drugs.

Sex is a factor in suicide risk. Women attempt suicide more often than men. Men are more apt to succeed because they use more lethal techniques than women - for example guns as opposed to pills used by women.

Recently, there has been a sharp increase in the suicide rate among adolescents. Marital status influences suicide risk. Single and divorced people are at a greater risk than married people.

A family history in which close relatives have taken their own lives increases the risk of suicide. The medical history may reveal evidence that the patient has been treated for depression with drugs. Physical signs of depression should be noticed; slow gait, sluggish speech, downcast eyes.

Since depressed patients often experience ailments without organic basis, the dentist should be alert for patients with complaints of oro-facial pain and no detectable etiology.

Alcoholism and drug abuse are highly correlated with suicide. Chronic illness - cancer - reduces one's capacity to tolerate stress and increases suicide risk. Fear of physical illness such as being convinced that one has cancer may lead to suicide.

To learn whether a high risk patient is considering suicide, workers in suicide prevention advise that the patient be asked whether he sometimes wishes he were dead. Many patients will be relieved to discuss their secret suicidal longings. They will feel less alone, less ashamed and less driven to suicide.

Although the depression which underlies the suicidal act may be a chronic condition, the suicidal impulse itself is of short duration. This impulse may last minutes or hours; sometimes days. It may recur, but each episode has brief time limits. Our immediate aim in suicide prevention, therefore, is to help the person survive the suicide crisis by giving emotional first aid with sincere communication and get the patient to a psychotherapist. The things we say to the suicidal person may be the most important words we ever say to another person in our lives. The patient should be encouraged to talk about his feelings of isolation and worthlessness.

Experts in suicidology suggest in trying to dissuade the patient from taking his life. Try not to gush sympathy. The patient may feel that he does not deserve such concern due to his general sense of worthlessness and may cause him to lose faith in the judgment of his rescuer. They suggest giving firm commonsense reasons for staying alive and that other people have overcome similar episodes of despair. If death seems attractive to him, try to find out why. It may be that he wants to make someone feel guilty and make him realise that if he kills himself, he will not be able to witness the reaction of that person. If he has no psychotherapist, advise him to go to a hospital.

Intervention efforts should not be restricted to just one to one relationship. It is important to get in touch with his relatives. Experts say avoid a pact of secrecy with the patient. Explain to him that you are acting in the best of interests by communicating with people who love and rely on him. It is important that the family cooperates by removing all lethal drugs and weapons. Tell them not to leave the patient alone; suicides usually are committed in private.

Many psychiatrists and psychologists have been calling upon health professionals to become involved in suicide prevention. Intervention efforts are based upon an understanding of suicide as a desperate act of a depressed patient.

When a high-risk suicidal patient is identified, first aid measures - verbal procedures, precautionary steps and referral to a specialist - are indicated.