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Why Do Doctors Ask (Dumb) Questions About Suicide?

If you’re in treatment for depression and have ever mentioned a desire to die, you’ve probably heard these questions:

  1. How would you commit suicide?
  2. Have you make a plan to commit suicide?

And others.

So a commenter recently mentioned that this is just a way of “covering their backs,” and “. . . if I were serious about killing myself and had made a plan, why on earth would I tell them?”

This is a logical question, but an uninformed one. In studies, we know that people who attempt suicide do reach out for help and do not really want to die.

mp9002016851Suicide is a Serious Problem

Suicide is the 11th leading cause of death in the US and is the 3rd leading cause of death among adolescents and young adults. Suicide is not to be taken lightly and doctors are trained (rightfully) not to take it lightly.

95% of people who commit suicide have a mental illness. (Depression is the leading mental illness indicator of suicide, but depression combined with other conditions like anxiety or an eating disorder is more dangerous than depression alone. Anorexia has the greatest rate of suicide with more than 1-in-5 anorexics dying of suicide.)

Lifestyle Suicide Predictors

Suicide has been studied extensively by the mental health community and in addition to mental illness predictors we know many other predictors of suicide:

  • Demographics (such as age, sex, ethnic background and religion)
  • Substance abuse
  • Occupation
  • Gun availability
  • Media / internet content
  • Life experiences (recent and past)
  • Prior attempts

And many others.

Mindset Suicide Predictors

Most people who commit suicide are under the care of a doctor or see a doctor within three weeks of committing suicide. These people want help but they commonly don’t ask for it directly. Many people come to doctors for complaints not related to suicide so the doctor must ask questions to determine if suicide is actually the underlying concern.

So, understanding that we know many of the predictors of suicide and understanding that most people do, in fact, want help, the questions doctors ask try to determine if that is what the patient is really saying. While it is logical to think people who want to commit suicide would lie, this isn’t actually the case.

ExamWe know the mindsets to investigate are:

  • Do you have thoughts of hurting yourself or others? (For some, suicidal feelings can become homicidal.)
  • Do you have a plan to commit suicide? (The more specific the plan, the more likely suicide is.)
  • What do you think your suicide would achieve? (People who feel other would be better off without them are more likely to attempt suicide.)
  • Do you have hope for the future? (Hopelessness is a major factor in suicide attempts.)

Suicide Questions Do Prevent Suicide

Suicide likelihood is a hard thing to assess and in many cases the doctors seeing the patients do not have a well-developed relationship with them and so it is hard to gauge the patient’s true crisis. These questions are a way of doctors trying to assess clear indicators to prevent a person’s death.

While, absolutely, a patient can lie to a doctor about their intentions, the fact of the matter is, the patient is in front of a doctor proving that, on some level, they do want help. People do not really want to die. People want to escape their pain. People need help to do that.

Resources

If you’re considering suicide, call a helpline right now. There are caring people sitting on the other end of the line and they want to help you. Reach out to them.

Read fellow HealthyPlace blogger Amy Kiel’s recent accounting of her suicide attempt: Never Going Back: Memories of A Suicide Attempt

Information in this article was mostly found here. Only a tiny portion of suicide predictors are mentioned above so I recommend looking at the article for all the details.

You can find Natasha Tracy on Facebook or @Natasha_Tracy on Twitter.

This entry was posted in Depression, Talking to Doctors and tagged , , , , , . Bookmark the permalink.

19 Responses to Why Do Doctors Ask (Dumb) Questions About Suicide?

  1. Amy Kiel says:

    Thanks for mentioning my post Natasha and especially for writing an excellent post on this issue!

    This is great information and full of truths. People do want help and need help to find relief for their suffering. I am glad that doctors ask the “dumb” questions because I personally have answered them honestly in the past and it has helped me and my doctors.

  2. Hi Amy,

    And thank-you for sharing your experience. It’s chilling to think of someone taking one pill after another with their child in the next room but it’s important for people to understand that happens and people come back from it.

    “I am glad that doctors ask the “dumb” questions because I personally have answered them honestly in the past and it has helped me and my doctors.”

    And thanks for sharing that too. It’s good for people to hear.

    - Natasha

  3. Dan says:

    I agree that doctors asking these questions are neccessary and helpfull. However, sometimes I don’t answer them truthfully due to how persistant my suicidal thoughts are and I don’t want the doctor overeacting to the situation. Maybe that means that they arent serious enough. I don’t know… What I do know is that my suicidal thoughts are very regular. It’s been just over a year since my last attempt and I’m still working on keeping those thoughts from taking over again. So far, so good.

  4. Hi Dan, so far so good indeed.

    One of the things the article I linked to mentions is the “intangibles.” Basically the feeling the doctor has about whether you are acutely suicidal or not. And sometimes this involves asking the questions and assessing the lies.

    And yes, I agree, we do know ourselves. And hopefully between you and the relationship you have with your doctor, you’ll be able to know when you need a greater level of care.

    - Natasha

  5. Dr Musli Ferati says:

    Even suicidology has made great invention on etiopathogenesis of suicide, it is remain more unacquainted facts about this fatal humane vice. Indeed this acute auto-destructive behave has stir up the interest of many scientist to every humane sciences such are: medicine, sociology, psychology, philosophy, anthropology, theology etc. Although all above mentioned sciences give important information of this social disastrous phenomenon, medicine, exactly psychiatry is to confront directly with person who commit suicide. Therefore, they bears the responsibility on these unfortunate persons. The challenge is enormous. However, till now there are many knowledge in psychiatry on suicide and suicide predictors as preventable measures against this exterminate act. The same are gained by taking the history of illness, that imply to ask the patient a lot of unbecoming questions. Thus, it may to rescue from death many depressive patient who are mostly susceptible from suicide. Furthermore, when it is known that depressive disorders in 90% of cases are curable.

  6. Julie Cochrane says:

    Yeah, unfortunately, having been early onset (5 years old) with bipolar 2, and having been terrified of an unsuccessful suicide attempt, I researched high lethality methods. So “do you have a plan”–the answer I always have to give is, “After 40 years of mental illness and having an engineering and researching kind of mind, I have multiple, redundant, specific, high-lethality plans that are independent of the availability or inavailability of various resources that may or may not be available to me at any given time. Um…sorry? It was one of those oddly comforting hobbies for awhile. It’s a little like having the car keys in your pocket if you get dragooned into attending a really lousy party.”

    I would like the party to quit sucking. It’s not really that I want to be talked into staying at the party–although when I’m not depressed, I have fun here. It’s not that when I’m really depressed that I truly don’t want to get the heck out of the party–I truly do. I don’t “want to be helped” for my own sake.

    I mean, I “want to be helped” in the sense that I want someone to make the pain stop. But if they can’t make the pain stop and all they’re going to do is yell at me and blame me because I can’t work and get a job and other people are having to support me, then for crying out loud, just shoot me already. Or at least get out of the way and let me–or substitute any one of any number of equal lethality, relatively quick and relatively pain-lite methods.

    Mostly, I stick around because there are a very, very few immediate family who are specifically, personally attached to me and would be unduly hurt if I checked out early. However, if I was sick or injured or freezing to death or otherwise had a situation where I had a convenient, tactful, “natural causes” exit from the bad party, I’d say hasta and split.

    It’s not that I don’t love my people, it’s just that my pdoc hasn’t been able to get my depression lifted up to euthymia again for the past year despite getting my current meds maxed out, so the “next thing to try” is going to be, well, something different.

    It’s painful, it sucks. It’s a really obnoxious party right now. And of course I’m not going to get proactive about the suicide thing. But if I had a nice, convenient “natural causes” excuse and all I had to do was not act? Yeah, I’d take that tactful out.

    Do I “want to be helped” in the sense that I want my pdoc to try something different and get the pain stopped? Sure, absolutely. Do I “want to be helped” in the sense of, “Oh my god, life at all costs, stay at the damn party through all kinds of pain no matter how much it hurts, pain is such a small price to pay because life is sooooo precious”? Puh-lease. Spare me. Hell no.

    I think “sane people” (for want of a better term) drastically undervalue pain management as applied to depressed people.

  7. Hi Julie,

    Let me be honest with you – your comment is making me cry. Not because I feel bad for you (although I do) but because I know exactly what you’re feeling. I know that pain. I know that longing. I know those plans. I know the helplessness. I know where you are in treatment. I have been there, right beside you, in the pain, and I really, really get it.

    If I had the words to help, even a little, I would gladly give them to you, but all I can tell you is that you’re not alone. I can’t fix your treatment and I can’t make the thoughts go away but I can say I stand beside you.

    And I can tell you this – you are absolutely right that sane people have no idea what pain management is for those with a mental illness. But I believe the fight of that pain is monumental and worthwhile. Your leaving this comment here has been very worthwhile. There is a valiancy in your fight that you might not be able to see, but I can. I don’t know if that means anything to you but I know it means something to those around you. You are strong and you are powerful and you prove that every day by continuing forward.

    Thank-you for taking the time to comment here. I know you have put the words out that express what so many people feel, but just can’t say.

    - Natasha Tracy

  8. Des Kehoe says:

    Here in the UK it just seems that you are yet another piece of paperwork to fill in.
    Don’t get me wrong they do their jobs but there seems to be no “why do you feel this way?”There is a lot of covering of backs in the system and it just dosen’t work.
    I am seeing a new shrink in a couple of weeks and i will give them my ears but we will just have to wait and see

    Sorry to moan but having a bad day

    Des

  9. Missy Richmond says:

    I, too, have a few failed suicide attempts. I was very lucky that a friend randomly stopped by or I’d not be here. I have bipolar 2 with treatment resistant depression. I have many things going on…things I’ve battled for 24 years, since age 14. Anorexia, rape, chronic pain, autoimmune diseases, rapid cycling, anxiety, agoraphobia, mental abuse, financial ruin and I’m now blind from a rare genetic disease, Stargardt Disease, that I was diagnosed with late 2008..when I had perfect corrected vision. I’m now past legal blindness. I lost my career, Dental Hygiene, because of that. It took me 3 years to win my Disability case. In that court room, very unexpectedly, the Federal Judge asked me how often I think of suicide. This was last December. I was sworn to truth, so I truthfully, tearfully answered: every day of my life. I go to sleep praying I won’t wake up. I cry when I do, sometimes. I lost my best friend to suicide last November. I loved him, had discussed all my knowledge of depression, urged him to see a therapist…everything. I am lucky in that he happened to answer his phone for me to tell me he loved me, and I, him..2 days prior. I had no idea of his plan. I now know the intense grief those left behind experience, which keeps me from acting on my own feelings. I’ve had every therapy in the world, taken a novel of medications, spent multiple visits willingly in private psychiatric hospitals. I wonder if there will EVER come a day that I DO NOT think of suicide. The scariness of going blind surely isn’t helping. And my depression has made me put off getting my Medicaid, so I have no health insurance and no money. Actually, I’m filing bankruptcy, much to my dismay.

    I don’t have answers. Every day I hope it gets better. I am religious about taking my medications. I know I’d be dead without them. I do my best to avoid my triggers. I have the Suicide Hotline number saved in my phone. I am a constant worry to everyone that loves me, ironically making it impossible to go to them just to talk to. Truthfully, I feel dead already…just physically alive, like it’s a punishment. I desperately WANT to get better. I’ve tried all the alternatives as well. The only thing I haven’t done is shocks. I’m preparing that I’m going to have to try.

    I plan to see a psychiatrist, therapist, pain clinic, neurologist and urologist as soon as I get my insurance. I can barely afford my monthly medications. I have goals. I think those help give me hope. Hope keeps us alive. If we can just come up with even 1 goal…there’s hope. I’m not suicidal, but as someone mentioned above, were I to find myself in a life or death situation, I wouldn’t fight it. I think there’s a LOT of people who feel this way, but the stigma prevents them from coming forward. Thank you for freely writing about it. If you help just one person…that’s a great accomplishment.

  10. Hiro says:

    I honestly feel “put on the spot” every time a healthcare professional asks me, “Have you ever tried to commit suicide?” or “Do you ever think about killing yourself?” Especially when it’s the first few sessions, making me extremely uncomfortable, and more likely to either lie about my past, or make it “not a big deal.” When they start out with questions like this, especially if we are not comfortable with each other, I feel like it cuts off a communication line.

    Yes, when you make such a global statement… Yes. I have wanted to kill myself before. I have wished I were dead, or that there were an easy way to disappear. But haven’t we all? Sure, I have tried to kill myself.
    But I am here to talk to you about the present, how I should be dealing with what I am right now, and not the suicidal urges I had 10 years ago, or 2 years ago, or maybe a few months ago, when situations were completely different. My medical conditions and mentalities change so rapidly that I really want to discuss what is going on NOW- not what was going on before in my head (one of those quirks of having “bipolar tendencies,” I suppose…).
    What I want support for is how I’m trying to live my life through now; not how I was trying to end it a decade ago.

    Of course, when we become close, and it comes up in one of the sessions after a year, two, or whenever we can forge a nice trustful relationship, I wouldn’t mind going back to it and talking about it- as long as the doctor knows who I am now, and what we are talking about is the past, and that I’ve changed, and whatever problems I was having then are not the problems I’m having now (if I am suicidal at the moment).

    For example, when I was in middle school, I was suicidal. I was extremely depressed, very confused about life (I am a first generation immigrant, so everything about “growing up in America” was new to my whole family, and my parents were unable to support me). I was bullied, couldn’t make friends, and though I made great grades, felt like nothing. I wanted to die- disappear.
    Last year, I wanted to die and disappear. But it was because I was diagnosed with Arteriovenous Malformations, was having multiple seizures, and living daily in fatigue, dizziness, exhaustion, stress, anxiety, and depression that today may be the day that I have a stroke, causing me to have brain damage or die.

    Both are “wish I were dead” mentalities, but for completely different reasons. Digging up my past pre-teen woeful years and trying to talk to me about it would not have helped my last year’s situation. Or this year’s, where I am dealing with different kinds of problems, but I’m trying to keep my life in a forward trajectory (though expecting to not get there- a lot of therapist don’t understand that, either… That I go through my day as though I will live until old, but expecting to be dead in a few years- which, I personally think, allows me to appreciate life a lot more).

    I honestly think, at least for me, this is a question that requires a LOT of trust. I am not going to admit to a random doctor that “I wanted to kill myself” so that they can make instant judgement above me and “how to deal with me” based on that statement. Once they know me better, I would feel much more comfortable talking about it.

  11. Missy Richmond says:

    Hiro,
    I’m so sorry for all you’ve been through. I feel somewhat like you. I have no qualms about talking about my suicidal Ideations, as they’re pretty much always with me. However, I STRONGLY agree about needing help from the dr/therapist with the PRESENT first. Every therapy I’ve had that started in my past, I ended up leaving after a few months. Even if it was every week. I feel like you: what good will it do me today to talk about many years ago? How will that help me today? I understand the past is important and know it will indeed play an integral part in my therapy, just as it does in my life. However, I want help to cope with today and tomorrow, next weekend, next week. I think we are of the same mind: start with today and work backwards. My most successful therapy did just that: helped me to deal with the here and now, then started taking parts of my past and helping me to see how it all integrates, and teaching me very desperately needed coping skills. Regression therapy was an absolute nightmare for me. It left me worse than I walked in. It ignored everything in my life at present.

    I’m not saying that everyone needs the type of therapy I would like to have. It’s very individualistic; however, every person should know that they may need to see a few (or several) different therapists or doctors before they find the right one. Don’t give up. I don’t think that’s talked about enough, either. After all, it’s one of THE most personal relationships you’re going to have. It has to be the right fit.

  12. Nikky44 says:

    The last person i would talk to is the doctor.

  13. Steve says:

    In my experience – when you answer this question truthfully as in yes I want to die – absolutely nothing happens. I answered yes to this question asked by a psychiatrist – he referred me to a therapist with a 6 month long waiting list. I said yes to the therapist assessor when she asked me 6 weeks later- I asked her to call me the next day as I was afraid I would act on these thoughts – she never rang. I left five messages for her – she never contacted me. I took an overdose. I answered yes to the therapist when she asked this question, when I finally got to see her after 6 months ( with no support in the mean time and trying to keep myself alive all that time with these thoughts) She said – OK I see, well bye for now, see you in 2 weeks. Realising she was not going to help me I took another overdose. Basically when they ask you if you feel suicidal and you say yes – they don’t do anything. so I don’t know why they bother asking you in the first place. When I get asked this question again im just gonna say no because there is no point telling the truth.

  14. Q says:

    Tens of thousands of people will never address the root causes of their depression because they refuse to tell their therapists/psychiatrists/doctors about their suicidal thoughts. Why? Because they’re (rightly) afraid of being committed against their will.

    It’s time for the “medical community” to put the interests of patients ahead of malpractice liability. And yes, sometimes those interests are helping the suicidal person understand her thoughts, not preventing her from committing suicide.

    Why is assisted suicide all right but suicide among ‘healthy’ people (as if depression isn’t a horribly painful disease) is discouraged? It seems to me you should either be against all suicide or be willing to give people the benefit of the doubt.

  15. stevie B says:

    I answered this truthfully today and told my Doctor about my exit plan. I dont think she really knew what to say accept the standard you really should continue seeing the Therapist when we all know that does not help. The medications only fog my head so I am weened off them. The exit plan seems to be the only real solution. So I may as well go ahead with the solution cause there sure as hell dont seem to be any other way.

  16. Thank you for addressing the issue of suicide/discussing suicidal ideation. Contrary to a common belief, talking about suicide does not make someone more likely to commit suicide; it actually makes them less likely. But you already know this.
    The standard questions that are asked have two functions: they are designed to assess the degree of risk (and if someone’s thinking of suicide, the risk is always there, of course, so this assessment isn’t judgmental or dismissive — it just looks at how close a person is to following through on a plan in the moment), and the questions are also designed to, hopefully, open up further conversation. Therapists and patients ideally can discuss protective factors and develop a safety plan tailored especially for the patient based on the questions. I know from experience that sometimes it’s really hard to answer these questions honestly, but even opening up a little bit will start the process of healing so that eventually someone will want to live rather than want to die.

  17. jc says:

    Why is it that ppl think telling someone in mental pain that they are not alone…or millions suffer the same depression…think that will make the person feel better? I am sorry but at the point of feeling hopeless why would i care who or how many feel the same? If i got cancer would it make me feel better to know million of ppl have cancer? Not so much.
    When i am tormented by inner pain, suicidal or just having a bad day, it gives me no comfort in knowing others are feeling the same….it only angers me that the world is so very hurtful. I am sure i sound very selfish but the reality is when i am so hopeless and helpless, so totally consumed by inner turmoil, i need someone to acknowledge my pain….not by telling me how many ppl suffer the same. Sorry if this doesnt make sense….but in an irrational mind it it hard to sound rational.

  18. Christy says:

    I have on 3 seperate times attempted suicide, 2 overdoses and one cutting incident. I am so happy that I was not sucessful as I have a 14 year old son who would have been devistated. I often think some of the same things as mentioned above however would never act on it.I have a fabulos Doc and he has me on the right “cocktail” so life is good!

    Thanks for listening and I hope everyone can find their cockyail too!

  19. Lucy Howard says:

    Please can I ask with the questions asked, that can a true assessment be really done in some cases, would it be logical to say that someone could be really serious and they just need to get it off their mind with someone that’s not in their circle , but if they were to say I want to say goodbye and they can’t when asked is this viewed as a person is not serious or they are scared of being admitted and therefore unable to act.

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