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:
- How would you commit suicide?
- Have you make a plan to commit suicide?
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.
Suicide 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
- 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.
We 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.
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.
Tracy, N. (2011, May 13). Why Do Doctors Ask (Dumb) Questions About Suicide?, HealthyPlace. Retrieved on 2019, June 25 from https://www.healthyplace.com/blogs/breakingbipolar/2011/05/why-do-doctors-ask-dumb-questions-about-suicide
Author: Natasha Tracy
I am an artist and life is nothing more than a painting. You start with an empty canvas and as you live, you fill in the details. But here's the thing, like an artist, you don't just keep adding paint because there's a white space on the canvas, you add paint until the canvas represents your vision. Life is just the same, you don't just keep living another day, just because you can. If you keep wringing another day out of life, just so you can be alive, then *you* are the burden. If you cannot objectively look at your life and say "You know what, I am happy with that painting, it's finished", then you are a more needy person than anyone considering suicide.
If anyone tells you "I understand what you're going through", they're liars. All they understand is what *they* went through and are arrogant enough to think thier experiences is the mirror of yours. The whole motivation of so called *experts* or *advisors* is "Get you onto my level, so I can use my life experiences to show you the error in your thinking". Do people tell their doctor their plans? Yes. Is it because they really don't want to die? NO! In my case it was out of anger, because I was going to die and nobody knew. I was angry that I couldn't just walk up to someone and say "Hey, I'm planning on dying soon", without them giving out the "Don't do it, there's hope" BS that everyone pours out. My family lives 4 doors away and I never see them, so if you think I care how they will react, you're way of base. Friends... fake people who just want something you have and that's why people don't want you to die, because you just might have something they need one day and if you're dead, they can't have it... and they say suicide is a selfish act.
We're not all hopeless, we don't need hope, we just want to be acknowledged for what we did in our lives and allowed to go on our merry way out of life. I should have the choice but I don't. I don't wander the house going "Woe is me, my life is so hopeless, I am such a burden on this world etc, etc...". I pack up boxes, so I don't inconvenience people when they have to clear the house out. I'm practical, I'm logical and I have simply finished my painting and want to put my paint and brushes away.
But you always get the moral-high-grounders who have to tell you otherwise... because they attempted and survived, so now they're better than you.
Do doctors ask dumb questions? Yes, because when it comes to this subject, they're dumb, so what else do you expect? When my doctor isn't asking dumb questions, she's treating me like someone with a cut on their knee... "Here, take this advice three times a day and come back in 4 weeks". It's laughable, it really is. What I do know, is telling a doctor is the most stupid thing you can do.
The fact that you people think all potential suicides *do* fit into your nice little categories, is proof of how ignorant you are, to anything other than the miniscule piece of life-experience you have yourself. Your solution isn't everyone else's solution, so stop trying to tell people that it is. If you can't respect a person's individuality, say nothing. I have seen things you will never see (if you're lucky), so how can you know what it is like to see them? Or to suffer the consequences and after-effects of it?
You also should not allow any bible bashers to push their brainwashing onto people either. Life and death have nothing to do with mythology, don't insult people by allowing fairy-tales into the mix. It's like that Kevin Caruso, thinks he can call everyone *his friend* because he has a donate button on his site. Thinks he has a right to "Love everyone" because you read his parasite page... makes me want to vomit... such pretentious BS.
Final thoughts: Every page I read like this, convinces me that little bit more, that I have chosen the right path.... the exit path.
I'm so sorry you are feeling that way right now. I have had that feeling many, many times. In fact, I have attempted.
What I can tell you, though, is that things can improve with help. There are new treatments every day. RTMS, ECT, ketamine and so on. While I can definitely understand why you might feel the way you do, you don't have to feel that way forever.
Please call a hotline to start getting help: http://www.healthyplace.com/other-info/resources/mental-health-hotline-numbers-and-referral-resources/
There is more out there. Don't give up.
- Natasha Tracy
I'm so sorry to hear what you have shared in this comment. I want you to know that it does get better.
I don't just say this as a person with bipolar or an advocate, I say this as a person who has been sexually assaulted as well. I know what it's like to have images and voices haunt you. Please understand, that while this can be torture, it _can_ get better.
I also say this as a person who has attempted suicide. Even though I felt nothing could help my pain at that time, I was wrong. I have been helped since then.
Please reach out and get help. Please find a therapist who specializes in what you need. Please find a support group. Please see a doctor. Please be open about how you feel and what you have experienced.
We have a hotlines and resources page here where you can start: http://www.healthyplace.com/other-info/resources/mental-health-hotline-numbers-and-referral-resources/
I am with you in this. You are not alone.
- Natasha Tracy
In less than 2 years I have been raped and nearly killed twice. I am falling apart. I have lost everyone. I can't sleep. I can't eat. I have panic attacks every time I have to leave my home. I have panic attacks when the phone rings or someone knocks on my door. Some days I am ok. Some days I do nothing but cry myself sick. Some days I am full of rage. And some days I am nothing at all. I hate my body. I hate being female. I hate myself. I hate this life. I am scared by my own thoughts. I am scared that if I tell anyone what i'm truly feeling they will harm me by locking me up against my will.
Before any appointments I practice my smile. By smiling I can keep myself from telling. By not telling I keep myself safe. It's ridiculous that I have to do this. I don't even see the point anymore. If doctors and therapist actually want to help people then they need stop hurting them. If they want people to trust them then they need to remove the threat of imprisonment.
Avoid that kind of generalisation please.
Some people do want to die or rather "not live" and not for the reason you mentioned, without any medical problem, for philosophical reasons for example.
It is uncommon but it exists.
I am a living proof.
I've never ever told a pdoc that I felt suicidal before even when I was, not because I didn't want help but because I was fearful of the type of help that might be offered. I don't want to be held against my will, or over medicated again like I have been in the past nor would I want to take a chance that I might have my memories erased with ECT performed on me against my will. I've been involuntarily committed before (apparently I lacked insight) and it was extremely stressful. Some of the medication side effects were worse than the illness. I felt like a wild animal trapped in a cage that would do anything to get out. If I had a very good relationship with a down to earth pdoc who I'd gotten to know well and trusted (I'm working on that) I might consider being more open but I would still have to test the waters first before I'd completely come clean with that type of revelation. In the past pdocs were too agressive and jumped to conclusions because unfortunately I have many of the risk factors working against me before I even open my mouth
Thanks for listening and I hope everyone can find their cockyail too!
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.
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.
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.
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.
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.
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.
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
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
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.
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.
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.
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.