Experts: approach issue of suicide through mercy - New government study reveals suicide rate in United States increased in recent years

A recent upsurge in the suicide rate in the United States has spawned headlines and worry. As researchers try to determine what’s causing the increase, people who minister to people at risk for suicide and the loved ones left behind say the most important thing for Catholics to bring to the discussion is an attitude of mercy.

“Thank God we have someone like Pope Francis, who emphasizes the mercy of God,” said Father Charles Rubey, founder and director of Catholic Charities’ Loving Outreach to Survivors of Suicide. “When he said, ‘Who am I to judge?’ that was so important. We need to leave the judgment to God.”

That message is resounding in the wake of a study released by the Centers for Disease Control in April showing that the age-adjusted suicide rate in the United States increased 24 percent, from 10.5 to 13.0 per 100,000 population, from 1999 to 2014, with the pace of increase greater after 2006.

Suicide rates increased during that period for males and females and for all ages from 10 to 74. The suicide rate for middle-aged women, ages 45 to 64, jumped by 63 percent over the period of the study, while it rose by 43 percent for men in that age range, the sharpest increase for males of any age. The biggest jump in suicide rates was among girls ages 10 to 14, but the number of suicides in that category remains relatively small.

That rate accounts for more than 41,000 deaths by suicide.

While the Catechism of the Catholic Church clearly designates suicide as a sin and says it is always wrong, it also acknowledges that mental illness, suffering and fear can mitigate the culpability for suicide.

The catechism goes on to say, “We should not despair of the eternal salvation of persons who have taken their own lives. By ways known to him alone, God can provide the opportunity for salutary repentance. The church prays for persons who have taken their own lives” (Catechism of the Catholic Church, 2283).

When Rubey hears of a priest telling a parishioner that her sister who killed herself is in hell, or telling a family that they need to get special permission to have a funeral Mass for their brother, he sometimes wishes the catechism was not so clear on the matter, he said.

“But maybe it’s wise to say it’s a sin because to say it’s not a sin would then give permission to someone who is considering suicide,” Rubey said.

Rubey said that it’s important to understand that while the rate has increased since 1999, this is not a historic high.

“It’s depressing,” he said. “It’s also not that alarming.”

That’s because the U.S. suicide rate has fluctuated between 10 per 100,000 and 13 per 100,000 for more than 100 years, said David Clark, a psychiatry professor at the Medical College of Wisconsin who studies suicide and suicide prevention. He spoke at the LOSS program’s April 24 brunch. That puts the rate released by the CDC at the top of what has become the normal range.

He acknowledged that if the suicide rate continues to rise, it will break the pattern.

“The pattern implies that it’s peaking right now. We’ll see,” he said.

The only exceptions have been in the 1910s and the 1930s, when the suicide rate spiked.

In the time that records have been kept, the rate among different groups of people — men, women, teens, seniors, white people, black people, Latinos — has varied more widely, he said, but the overall rate has remained fairly steady.

“The group that accounts for the highest number keeps shifting,” he said. “I wish we understood why.”

That’s not to minimize the significance of the recent increase, he said.

“It’s actually the difference of 7,000 unlived lives,” he said. “If we could keep it down to 10 all the time, that’s how many lives we could save.”

The 116 years of suicide records cover the advent of modern psychology, the development of psychotropic drugs and much wider access to psychiatric care, but the suicide rate has shown relatively little change.

“If we’re honest, we’re not making a very big dent with all the programs and all the treatment,” Clark said. That doesn’t mean there’s been no progress.

“In 2016, we know a little about identifying people who are high risk, and we have some programs that work for some people,” he said. “We’re learning more all the time, but we have to be really modest about how much we know.”

While the spike in suicides in the early 1930s is widely attributed to the Great Depression, Clark said there isn’t any clear indication of a single cause for the earlier spike, and he cautioned against looking for simple reasons.

Suicide is the product of enough different forces coming together — genetics, psychiatric illnesses, economic factors and others — that it’s too complicated to say a rise in the suicide rate comes from any one thing.

It’s complicated enough that concentrated efforts to reduce suicide rates in other countries also have had little or no effect, Clark said.

“It’s very frustrating,” he said. “Probably our prevention strategies are simplistic and naïve as of 2016.”

Cliff Saper, clinical psychologist and associate vice president of outpatient programs at Amita Health/Alexian Brothers Behavioral Health, agreed that many factors contribute to an individual’s decision to take his or her own life.

“Suicide often happens because people feel helpless and hopeless and don’t see a way out and are lacking in the skills needed to manage an overwhelming sense of anxiety and depression,” he said.

Add to that the variety of real-life stressors, including divorce, social isolation and financial instability that can affect people, and the availability of lethal means of suicide, he said.

“Clearly, the most lethal way people have of killing themselves is by guns,” he said. “And we aren’t doing anything about that.”

There is consensus on risk factors, including mental illness and access to a means of suicide, whether that’s a gun, drugs or nearby train tracks, and protective factors, such as whether someone has strong family ties or strong religious faith, he said. Warning signs include a drastic change in behavior, a settling up of affairs, engaging in markedly more risky behavior than usual, isolation, and either not sleeping or sleeping all the time. People in chronic pain also are at risk, Saper said.

“We need to teach people skills to manage their overwhelming stress. These people have a skills deficit. If we can teach them better ways to manage their overwhelming feelings, we can prevent suicides,” he said.

Clark said that one thing psychologists have learned is the role mental illness can play, with depression, bipolar disorder, schizophrenia, alcoholism and drug addiction most often associated with suicide risk. Treating the illness reduces the risk. For example, people who have suffered depression can be helped to avoid suicide.

“It’s a recurrent illness,” he said. “People between episodes look fine. Nothing I do to educate or counsel you today is going to stop it from recurring. But when you get it again you need to notice it. You need to know about your illness, to get back into treatment as soon as possible. Some people go from the first symptom to high suicide risk in a matter of days.”

People who suffer from depression should also make sure their families and people around them understand their depression, because sometimes the person with depression doesn’t recognize it right away.

“They might think they’re just tired or they’re getting sick,” he said.

Rubey agreed that family members and other people must step in.

“I think it behooves us, if we see someone that we’re concerned about, to ask the question, ‘Are you thinking about harming yourself?’” Rubey said. “That’s a difficult question for parents to ask one of their children, or for one spouse to ask another. The stigma attached to mental illness is alive and well. We have to get past that.”

The stigma extends to families of people who commit suicide.

“Families feel stigmatized when there’s a completed suicide. People are asking, ‘What was wrong with that marriage? What was wrong with that family?’” he said. “There’s nothing wrong with that marriage, with that family. The person who completes a suicide has an illness. That illness is as real as heart disease or cancer or diabetes. These individuals deserve our tenderness, understanding and acceptance.”