A Psychologist Kills Himself
It was September 9, 2019, the second day of National Suicide Prevention Week in National Suicide Prevention Month. A man jumped off a 17-story building in Philadelphia. Police ruled his death a suicide. At the time of his death Gregory Eells, Ph.D. was the head of the student counseling services at the University of Pennsylvania, an Ivy League School. He took the reins of that service in spring 2019 after being head of student counseling for 15 years at Cornell, another Ivy League school.
I hadn’t heard of Dr. Eells before his death. I too am a mental health professional, but our areas of expertise are different. As a result, our professional orbits are separate. But what I have learned about him since his death makes me admire him. Hailing from a town of about 7,000 people in the middle of rural Illinois, he went on the become an accomplished psychologist, and a prominent voice in the area of college mental health. Tens of articles in scientific journals list him as an author. He gave a TEDx talk. For separate year-long stints, he chaired a couple of different professional organizations dedicated to his are of specializations. One of those organizations gave him a Lifetime Achievement Award. All of this before he turned fifty.
Many years ago, someone described suicide to me as a permanent solution to a temporary problem. In his TEDx talk, the topic of which was “Cultivating Resilience,” Dr. Eells highlighted one of the keys to resilience — remembering that nothing, including no bad thing that is happening to us, is permanent. I wonder what happened that caused him to lose sight of that. Irrespective of the underlying factors his death shows that no one is immune to personal tragedy. When hope leaves the soul and despair makes it’s home there, nothing means anything anymore. Professional accomplishments, the praise of peers, and even mental health training become useless.
Suicide-prediction Is A Fool’s Errand
Suicide is hard to predict because it is hard to study. Far more people attempt suicide than die of it. The ones who die of suicide pick more lethal means. An attempt by shooting, hanging, or jumping off a tall building is more likely to kill than overdosing on whatever pills are at hand. However, they may have killed themselves, those who die of suicide are no longer available to scientists for study. They can’t tell us what made them decide to pick the more lethal means compared to someone who survived a suicide attempt.
We think that suicide is always associated with mental illness. That makes intuitive sense to the psychiatrist in me. However, whether that mental illness is diagnosed is another matter. According to the CDC, “More than half of people who died by suicide did not have a known mental health condition.” This makes suicide even harder to predict. I suspect the operative word here is “known.” It’s likely that many of those without a known mental health condition have one, but it’s just not been diagnosed. Either they never sought help, or they did, but the mental health condition was not picked up.
The relatively low frequency of suicide also adds another challenge to predicting it. About 7,500 Americans die each day, of whom about 130 die of suicide. But almost 3,000 attempt suicide each day. Each of those deaths, suicide deaths, and suicide attempts is devastating to those they leave behind. In essence, suicide deaths are 3.5% of all suicide attempts and only 1.7% of all deaths in the US. Preventing the 10th leading cause of death in the US is like finding a needle in a haystack. The only time this is not a fool’s errand is when the needle shows up in a healthcare setting, seeking help. At that moment, it is no longer a question of detecting who is at risk of suicide, but of helping the one known to be at risk of suicide.
Healing Professions Increase, Not Decrease Risk
People think healers like Dr. Eells are immune to the most severe mental health tragedies. I know because I hear it often since my wife Uzma’s death. Many people say to me, “You are a psychiatrist. You know how to handle this.” Sometimes, when showing concern about the kids, they reassure me, “They are fortunate to have someone with your professional background as their father,” and add, as if reassuring themselves, “They will be fine.” If only they knew the stats!
Physicians kill themselves at a rate that is two and a half to four times that of the general population. Psychiatrists do so at an even higher rate of about five to seven times the general public. About one American physician, medical student, or resident dies of suicide every day. The suicide rate is higher in medicine, partly because doctors know how to choose and use more lethal means. Instead of offering protection against suicide, medical training seems to do the opposite. Health professionals may also see getting help as a stigmatizing. Just like other humans, they too feel shame and embarrassment in admitting a mental illness. This stigma is further bolstered by their licensing application process, which in every state asks questions about mental health history.
Recognizing And Responding To Warning Signs
While suicide-prediction is a fool’s errand, many individuals who go on to die of suicide say and do things that could be warning signs to those around them. They may talk about feeling alone, hopeless, or worthless. They may perceive that they are a burden to those dearest to them, or that others would be better off without them. Their use of alcohol or drugs may increase. They may withdraw from their social commitments. They may start giving away things they own. Some may even talk about thinking of killing themselves.
Such talk scares most of us. We don’t know how to respond to it. Typical responses include statements in the vein of “Don’t say that!” or “Don’t worry, things are not that bad!” Even when we try to help, our interest gets directed towards the “why” they would think of killing themselves.
Instead, we would do better to accept that they are thinking of suicide and imply listen. Empathize how bad things must feel for one to think this way. Understand whether these thoughts scare them. Discover if they think about how and when they would do it. Learn what keeps them from acting on thoughts of suicide. Figure out how you could help them lower the odds of killing themselves. There’s a misconception that talking in this way about suicide to someone thinking of it will increase the risk of it. On the contrary, many people thinking about ending their lives feel relieved that someone cares and attempts to understand.
After listening and understanding, the next step is to help the person get help. Help can take many forms ranging from getting other friends and family members involved in increasing support, to getting the person to a doctor or emergency room for an urgent evaluation. It’s essential to stay with them if one believes they are at risk of acting on their thoughts. An intermediate step is to connect the person to the national suicide hotline 800-273-TALK (800-273-8255). It is also critical to discourage a person thinking about suicide from using alcohol or drugs. These can make a person lose their inhibitions and act on impulse. People kill themselves when their emotional burdens overwhelm their capacity to cope. All these steps are ways of temporarily boosting that capacity.
The Balance Between Stress And Coping Capacity
The reports about Dr. Eells tell us that he had recently moved, but his family hadn’t. He had taken up a new job in a university where there have been multiple student suicides over the past few years. It was probably a role right up his alley — he was an expert on resilience and college mental health. Most of us feel an increase in stress when we move and when we take on a new job, even when both are for the better. Distance from our loved ones adds to our burdens. Though we may talk or video-chat with them every day, they are not around to pick up on the non-verbal clues to our suffering. Whether Dr. Eells felt overwhelmed would be but speculation. Nevertheless, for many, if not most of us, what may appear small increases in burdens and reductions in supports add up.
I wish Dr. Eells were here. He had a lot of good work to do, student lives to save. I think he would agree that since we can’t predict whether you, I or any of our loved ones will die of suicide. As none of us is immune, we need to learn to boost our ability to cope. We need to accept that major life transitions are a time of emotional risk. Even desirable changes such as marriage, promotions, graduations, and other personal and professional achievements can overwhelm our coping capacity by increasing our burdens and stretching our supports.
Most of us won’t become suicidal with life transitions. But until we develop an accurate method of predicting who will, doing whatever we can to boost our coping capacity is the least we can do. It might mean going easy on oneself. It means being open to asking friends and family for help, and if none are around, seeking peer support groups or clinical assistance. We need to do this for our loved ones. We must do it for ourselves.
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