Monday, 24 November 2008
The death by overdose of a 19 year old Abraham Bigg on camera watched by thousands of people on the internet is tragic. Commentary about this has focused either that it was online and people actually encouraged him to carry through with his act (sic) or that "internet causes suicide". Just to put this in context there are over 30,000 suicides in the USA every year - so what was different about this death? People have very different views about people who want to die. Historically the view that people who want to "self murder" are bad people who should be condemned has been prominent. This is clearly what a lot of people watching this thought. More recently thinking of suicide as a medical probleem has generated several useful ways of thinking about suicide prevention including effectively treating mental illness. What hasn't been emphasised is that Mr. Bigg had a bipolar disorder the adequate treatment of which represents an important opportunity for suicide prevention. This however is not a sexy headline - especially when compared with internet causes suicide. The other thing to note here is that clearly Mr. Bigg was ambivalent about death - otherwise he wouldn't have killed himself in a way which also offered the chance of someone saving him. Mr. Bigg's exposure by web cam to a potentially vast audience was both an expression of anger and hope. It is a truism that if someone is talking to you about suicide they are ambiivalent and at least part of them wants to live.
Monday, 1 September 2008
A sign of things to come. The FDA in the USA is now considering the case of various drugs prescribed for “physical illness” in causing an increase in suicides. The two drugs reported to be in the spotlight are Singulair (Montelukast sodium) an asthma medication and Neurontin Gabapentin). The report describes two people who committed suicide whilst on these drugs – and that really is the difficulty. Providing any evidence for a connection between the prescription of these drugs and suicide is going to be hard to do as suicide is such a relatively rare outcome – even in people taking antidepressants it is a rare outcome and hard to prove a connection. One solution proposed is to set up a monitoring system for all new drugs to look at suicidal thoughts – however thinking about suicide is a wobbly old construct which is quite complex and doesn’t usually lead to any actions. It certainly is not the same as thinking about death (something it is often confused with in teenagers). However at least this shows that yet again thinking about physical and mental problems as separate is not a particularly helpful thing to do.
Tuesday, 19 August 2008
The fact that depression is common in people with cancer is not on the face of it that surprising. When bad things happen to people they grieve for what they have lost - which includes going through a period of depression. Maybe what is more surprising is that 92% of people reported not feeling significantly depressed. In liaison psychiatry one of the major day to day issues is the problem of other health professions not recognising significant depression because it is "understandable" or normal. One take home message from this study is that even when bad things happen most people do not get depressed and feeling that they would be better off dead is not a normal and "understandable" reaction.