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Suicide and Prevention

Every year at the start of Suicide Prevention month, day or week I struggle. I struggle because I do not think all suicides are preventable. I struggle because I have clients who did everything right and in their power to keep suicide at bay with their child or spouse yet it happened.

I feel like saying Suicide is Preventable is sending the message to family members of someone who took their life that they failed somehow. These family members and loved ones already feel that to the depth of their soul. They ask over and over again what could I have done differently? How was I supposed to know, they didn't have any of the signs? Did my words or lack of words push them to this?

I say no!

There are many interventions for suicide that do work. They work if the individual allows people around them to know they are having suicidal thoughts. They may work if a situation can be changed easily. They work if the person reaches out and if they accept the help that is offered.

They do not work when it is 'out of the blue,' with no signs. They do not work if the person tells no one and acts as if everything is okay. They do not work if the person is quickly angered and impulsive.

There is much research being done on the brains of those who suicide. The biggest push is coming from NFL football players following multiple concussions and have CTEs. Research is showing these multiple head traumas do change the brain. We know from research that those completing suicide who have had their brains reviewed post mortem have differences in their frontal lobes. Concussions and TBIs are associated with an increase in suicidal tendencies (American Journal of Public Health) These head injuries are linked to increased depression, anxiety and substance abuse which can contribute to suicidal ideation.

Problems in the left temporal lobe of the brain where mood stability, memory, learning and anger and aggression, dark or violent thoughts and emotional instability.

Low activity in the Prefrontal Cortex is a common finding on SPECT scans of suicidal people. Your PFC is responsible for your impulse control, judgement and decision making. Having an underactive PFC is also a trait of ADD.ADHD. People with this are at higher risk of suicide. A problem discovered in SPECT scans also includes your Anterior Cingulate Gyrus (ACG) that is the ability to shift from one thought to another., Too much activity here makes you more likely to get stuck on negative thoughts.

So can an average person, like a mom, run all her kids through Brain SPECT scans to make sure they do not have this going on? I can't think of any local doctors that would order a SPECT scan based on you wanting to find this out. Brain imaging study from 2017 in Nature Human Behavior found that based on brain scans alone a computer can identify with 94% accuracy which participants had suicidal tendencies.

Research from the Amen clinics has found abnormalities on 21 people completing suicide. They have completed brain scans on over 300 people who have attempted suicide and thousands more who have seriously contemplated it. Both of these studies found decreased cerebral blood flow in specific areas of the brain, particularly in the pre-frontal cortex.

There are as many different stories of suicide as there are lives lost to suicide. In my practice I can say no one is the same. There are parents asking how this happened 5 minutes after I left with a hug and an I love you. There are spouses asking why couldn't they just have divorced me? There are parents of adult kids saying why didn't they come to me? Why? Why/ Why? that is all anyone wants to know following a suicide.

People who have had suicide attempts sometimes ask why didn't you let me die? There are people surviving suicide attempts saying they could only see one way out and that was death.

When we are in our rational brains we can see there are many options, we may not like the options but they are there.

The pain from a suicide death is like no other because people see suicide as a choice rather than a brain disfunction. (Amen 2018)

When underlying brain disfunction is treated symptoms of depression, impulsiveness , helplessness and negative thinking patterns improve.

SPECT scans are not covered by insurance easily. They can be if the root cause is looking for dementia or strokes. Many university hospitals, The Mayo Clinic and Dr. Amen's clinic do perform them. Are they universally available to the average person not really. The out of pocket costs start around $4000. Again you would have to find a location that would be willing to perform such a scan. Though this is amazing information coming from the scans it is still primarily research and not every day medical care.

It may help us to understand why someone may have died by suicide but it is more complicated than that.

There are suicides where looking from the outside in maybe, maybe we could understand why someone might think of it as a way out due to legal charges, child alienation etc. but still more often than not a person would not choose suicide and go to prison or learn to deal with the complications of life whatever they may be.

If you are a suicide survivor I am sorry you have to grieve this loss along with the trauma. Please know that it was not your fault and you did the best you could. Efforts still need to be made with prevention but realistically the suicide rate is never going to be zero.

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