A Introduction

For many complex health issues throughout history, misinformed views tend to promulgate, leading to a multitude of negative effects, deeply stigmatizing the experiences where these health issues are involved. Without science, untruths and stigma continue to thrive. In the past, before a body of scientific research led to an understanding of what drives suicide risk, many myths prevailed about suicide. These myths not only shaped stigmatized and erroneous views of suicidal behavior but resulted in harshly punitive ideas and judgment of people who experience suicidal thoughts, who attempt, or who ultimately lose their lives to suicide. Now that a multi-disciplinary group of scientific fields is shedding tremendous light on the actual drivers of suicide risk, cultural views are changing, bringing an understanding that while complex, suicide is a health issue.

One myth that may still have echoes in the current day is the erroneous idea that certain individuals are “bent” on suicide, and therefore very little can be done to change course once someone becomes suicidal. Today, scientific research in a broad range of domains – from neuroscience to clinical research to epidemiology and community/public health interventions – shows that despite its complexity, suicide is 1) a health-related outcome and 2) largely preventable.

To understand how suicide can, in many instances, be prevented, and the role health professionals can play in preventing suicide, it is first important to dispel the myths that lead to erroneous assumptions about suicidal behavior and suicide. This chapter sets out 11 truths with their corollary myths about suicide. These myths must be dispelled so that they may no longer undermine efforts to prevent suicide.

B Principles

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  Science of suicide risk and prevention is growing at a strong pace.

  
  
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  The findings from research are shedding light on ways we can understand and prevent suicide.

  
  
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  Prevailing myths are still prevalent since the translation and dissemination from scientific discovery to cultural beliefs and universal knowledge takes time and effort.

  
  
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  Some of the most prevalent and harmful myths are addressed in this chapter with their corollary “truth” presented first.

  
  
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  For example, suicide should not be thought of in terms of weakness or cowardice. Just as those who die from other health outcomes after a “strong fight” with their illness are not considered weak, the same holds true for people who die by suicide.

  
  
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  While suicide can be precipitated by a triggering event, suicide is not thought to be caused by one factor or event. Psychological autopsy method research clearly demonstrates there are multiple risk factors that converge or escalate at a moment of acute risk. While we do not always recognize all of the risk factors clearly at the time, suicide risk usually builds over time with changes in health – brain and body, cognition, perception, sense of hope, social connection.

  
  
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  Because stigma is pervasive and human instinct is to withdraw and isolate when suffering, many hide distressing internal experiences, making suicide seem “out of the blue”, but it is not usually the case. Even in more impulsive cases of suicidal behavior, there are usually numerous other longer term risk factors at play.

  
  
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  Suicidal people are not usually “bent on suicide” but rather are more often ambivalent and can often readily move closer to their reasons for living and sense of hope.

  
  
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  It is not the case that a history of attempting suicide indicates the person is destined to attempt again or die by suicide. In fact, more than 90% of people who live through an even medically serious suicide attempt do not go on to die by suicide.

  
  
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  Our clinical lens can be shaped by understanding that “manipulation” is not at the root of most suicidal behavior (although some clinical settings do select for more secondary gain behaviors). A “cry for help” is just that: a signal of distress that warrants intervention for an at-risk individual.

  
  
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  It is not the case that people who express suicidal thoughts are less at risk or simply talking rather than acting. Many who die by suicide had spoken of taking their life, sometimes directly and sometimes indirectly.

  
  
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  It is not the case that suicidal people will simply find another method if their identified method is not readily accessible.

  
  
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  Asking a patient directly and compassionately if they are thinking about ending their life is a safe and effective way to approach the issue. It is a myth that raising the question will increase risk or “plant the idea” in a person’s mind.

  
  
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  Suicide risk is multi-faceted, dynamic, and often builds over time, therefore there are many opportunities for intervention and prevention.