Suicidal thoughts and impulses often accompany depression, and suicide may be a real risk. Some people are repeatedly tormented by these impulses, which they experience as frightening and painful, while others have them appear as if out of the blue, detached from emotions. The impulse to spin the wheel and drive suddenly into oncoming traffic is horribly common, though no one ever talks about it
Suicide, the "worst case" outcome of depression, is officially the tenth most common cause of death in America. There are 33,000 documented suicides annually, but the true incidence is probably double that (because police and medical examiners prefer not to label ambiguous, solitary deaths as suicide). One out of every two hundred people will eventually take their own lives. And although I personally think that suicide can sometimes be a rational choice for people who are in intractable pain or facing great disability, the vagueness of the boundary lines means that we have no reliable data on how many suicides are people who are really depressed, how many are "rational." My experience is that far, far more suicides are truly depressed. Among adolescents, the suicide rate has quadrupled in the past twenty-five years. A few years ago in a small city near where I work, there were eight suicides among young people in one year. These were usually young men just out of school, often while they were intoxicated, usually with no “warning signals” beforehand. An angry, bitter kid who has an unexpected disappointment, gets high, and has a gun close at hand is a disaster waiting to happen.
I once got to know Jane, whose twenty-year-old son had shot himself while she slept in the next room. This was a young man no one would have described as depressed; rather he was a troublemaker. With a history of arrests for minor offenses as a juvenile, he had been sent to a “reform school” when he was fifteen. Since being discharged, he had lived off and on with Jane and with friends. He worked occasionally, drank a lot, and got into fights.
On the night he took his life, Jimmy had two pieces of bad luck that probably put him over the edge. First he met his ex-girlfriend at a local hangout; she went out of her way to be snotty to him. Then he ran into his father at another bar. A true town drunk, the father barely recognized his son; when he did, it was to ask him for money.
Jimmy came home about midnight. His mother woke, got up and spoke to him, asking him if he needed anything. He was drinking a beer and reading a magazine, and as far as Jane could see, he was his usual self. She went back to bed. Jimmy went to his room and wrote a brief note, more a will than a suicide note. He wanted his brother to have his motorcycle, snake, and hunting rifle. Then he shot himself with the hunting rifle.
Jane kept asking me why. I couldn’t tell her what I thought was the true answer to that question, because I thought it was too cruel; but in my opinion she and her son were as much victims of chance as anything else. If you take any sample of impulsive, alcoholic youth whose lives are going nowhere, get them drunk, expose them to rejection, and leave them alone with a gun, some of them will shoot themselves. Which ones take their lives on any given night is just the law of averages. Are they depressed? They sure are, but they can’t admit it or show it.
Jane is like most survivors of suicide I’ve known. You certainly don’t get over it, but you learn to live with it. She was depressed herself for over a year, had terrible headaches (a psychosomatic symptom mimicking her son’s injury), was unable to work, became overwhelmed with stress, and went from doctor to doctor seeking relief from her pain. Antidepressant medications didn’t help; all I could do was listen while she grieved. Eventually her headaches became less frequent and she began to have a little more energy to put into her life. I think of her every time I hear of an adolescent suicide.
The American Foundation for Suicide Prevention, a very worthwhile organization, now organizes community walks to raise funds and awareness of suicide, and they seem to be attracting more attention every year. See outofthedarkness.org.