Search for mental health; Suicide

We're Forest Hospital located in displaying the lanai presents the search for mental health and exploration of the newest advances in psychiatry. During this series physicians and other professional personnel working in the area of mental health at Forest Hospital a hundred bed clean facility will discuss the latest advances in mental health care research and education. Such topics as alcoholism adolescent behavior marital problems problems of the aged suicide emotional problems and others will be presented on the search for mental health. Your host for this series is Mr. Morris Squire administrator of Forest Hospital. This is Morris squire at the American Psychiatric Association convention and Lanty city and I special guest for today is Dr. George Murphy of St. Louis Missouri. Dr. Murphy is the associate professor of psychiatry at Washington University in St. Louis

and he is currently completed a very interesting bit of research on suicides. I wonder if you would tell us a little about. What you found in this study. I might start with the background for the suicide research. We started out by getting the list of all of the suicides in the city and county of St. Louis. Over a period of a year and as soon as possible after the judgment of suicide by the Coroner We contacted the Klamath and conducted extensive interviews with family members to try to get as much information as possible about what this individual had been like before his suicide. What symptoms he had shown if any what kinds of distress whether he indicated that he had suicidal thoughts on his mind. What other things he had tried to do to solve the problem. And so on and out of this we were able to reconstruct a picture of the kinds of.

People who committed suicide actually it didn't turn out to be kinds of people who commit suicide but people with kinds of illnesses especially ones is very much so. As a matter of fact two psychiatric illnesses alcoholism and depressive illness manic depressive disease if you like or a depressive reaction either to psychiatric conditions which contribute most heavily to suicide and probably contribute about two thirds to three fourths of all suicides. My inordinate a large amount is a similar suicide prone. No St. Louis has just about an average rate of suicide for the United States there is considerable variability from one part of the country to another in this general area the rate is a little below. The national levels on the West Coast in the mountain states it tends to be higher. How were you able to determine that these people committed suicide with these reported suicides I understand there are people who commit suicide but they sound like accidents and so they're reported as accidents.

These were all coroners verdicts of suicide so we didn't have to get into the problem of making the decision ourselves if the coroner said it was suicide that was a more serious concern than a suicide. So actually there are people who you didn't investigate who could very well of committed suicide but who were diagnosed a different way for various and sundry reasons people who had car accidents people who may have had heart attacks different kinds of things that were really different causation. There's always the possibility of that and I think the lay press likely has carried a certain amount of discussion of the possibility of automobile accidents. Off unmasking a suicide we tend to be rather skeptical of that idea. One of the points we're thinking about in relation to this is that while about a third of the suicides as judged by coroners verdicts

have left suicide notes the literature contains only a single instance of a suicide note left by someone dying in an automobile crash. This suggests to us obviously there's a possibility that people crash in their automobiles to kill themselves have taken pains to conceal the fact that it was suicide. On the other hand so many suicides don't take pains to conceal it that we think probably the rate of suicide from just automobile crashes for example is a lot lower than it's currently being supposed to people commit suicide to punish other people. Rare occasion there is the implication in a suicide note or in a communication to a relative or family member or someone just prior to the act that would lead you to think that punishment or getting even had something to do with it. But I would like to

emphasize that this is a very uncommon thing that far and away the majority of suicides are taking their lives for reasons centered around their own concerns and their own feelings of hopelessness or worthlessness or inability to cope with things. Dr. Murphy I wonder if you could describe the two own says and what kinds of things in our radio audience could look for that. Could suggest the possibility that these people are going to commit suicide and therefore can't put something back into measures to early use. I'd be glad to I suppose that depression is the most under-diagnosed psychiatric illness around. The symptoms are often. Of the kind that permits the illness to masquerade to something else for example. About half of the people with depression present was to the physician with substantially medical complaints that is a headache or

dominant pain or pain elsewhere. Some failure of the body to be functioning in the way that the person is accustomed to as a physician will take the trouble then to inquire about how the individual is feeling in other ways he will discover a number of other very important. Areas in which things aren't working right for example the individual characteristically will be. Either waking up early in the morning and be unable to get back to sleep or he will wake repeatedly during the night with periods of inability to return to sleep. Insomnia can be one of the signs and sodomy is a common sign but most characteristic is this early morning waking early morning early neurotic tends to have trouble getting to sleep. The depressive most characteristically says I have no trouble getting to sleep but i wake up after about two hours and can't get back to sleep. The dream is have something to do with this. The people have bad dreams. That way they wake up early in the morning.

We have not made any very specific study of dreams and obviously in the suicide study we had no opportunity to ask about dreams in the early morning wakening our impression is that if there are dreams and there are unpleasant dreams this would be associated but many people don't report dreams in connection with their wakening they wake up and they feel terrible they feel hopeless they feel discouraged. They feel miserable and this can make a lot of the rest of the night and this is a symptom which continues and continues and continues along with this there are symptoms such as loss of appetite and loss of weight fatigue difficulty concentrating difficulty making decisions and. Cheerfulness feelings of hopelessness and worthlessness. Now all of the symptoms that I've mentioned everybody has had one or another of these at some time everybody's had a headache everybody has had an episode of trouble concentrating. The way that one makes a diagnosis of depression is by finding all of

these symptoms occurring at the same time and being kind of limited in time to a few weeks or a few months. So anybody could observe this. If they have immediate contact with another person I suspect the employer could observe some of these but mostly families can observe these signs very easily. I'm sorry I was just going to say the family is in the best position to appreciate it. I was going to ask you the people who are doing rapid eye movement studies the R.E.M. people in the US people who are working with sleep deprivation. Had they come up with any in the studies of that. I don't know if they're doing depression studies by the way but if they do depression studies do they find people with the same symptoms waking up early in the morning and go back to the dream business for a second. Did you have any information regarding people with certain kinds of dreams who wake up very early. Not not in this particular study. So far as I know the people who are studying dreams have. Thus far confined their investigations to normal subjects and I think this is proper You

have to find out what's going on in the usual situation before you can know how to regard what's abnormal. I thought ALL ALL ALL medicine all psychiatry started with pathology. Are you talking about norms I know. I'm talking now about basic research and I think the dream studies or basic research they don't start with pathology but rather with normal functioning. That's very interesting. How about the melancholy we discussed now depression so we got some signs of depression how about the alcoholic. Well alcoholism is a good deal more obvious and simply consists of the individual drinking too much over a period of time with the result that he has some impairment of his social functioning is job functioning his. Economic sanctions so that he loses jobs he has trouble with his family or he has some trouble with his health. And we would make a diagnosis of alcoholism one and one or two of these kinds of troubles have occurred in the presence of regular and excessive drinking. These people too are

prone to commit suicide. What percentage of the preciousness compared to alcoholism in our series about little over half of the suicides were depressed and about a fourth were suffering from alcoholism so between them they account for roughly three fourths of all of the suicides. So I think we can. Tell people about these two areas I suspect we can do something. This covers the bulk of the suicide problem. There are six million alcoholics in this country of ours. Yes that's true and of course people who have depressions. There may be more of these in the long run but while alcoholism is a chronic illness in which a person continues to do the same kind of thing day after day year after year depression is an episodic illness and an individual may suffer from depression for a few weeks or months or maybe a year and a half and then he gets over it and

one of the great tragedies of depression is the suicide rate because people kill themselves in their despondency suffering from an illness from which they would recover if they didn't die from suicide. Well then I suspect we have to be very watchful in these two areas. Are there some programs that are now available to the people in your community that such as Dr. Diamond's Suicide Prevention Center in. Saint Louis in St. Louis and in Los Angeles and also in The New York City situation. A suicide prevention center is just beginning to be established in St. Louis actually we've concentrated more on education of the physicians in the community since we feel that a recognition of the suicide risk that's involved in depression particularly in people over from the age of 40 is going to do the most good in the way of prevention.

So people over 40 people who are depressed people who are alcoholics. Now what are you doing about education of the physician. You're a psychiatrist yourself how do you educate physicians into these and don't they know this already. Oh no the particularly the association of suicide with alcoholism was really not. Very well defined until we had done our work and this has been duplicated by a group in Seattle who did their studies in substantially the same way we did in substantially the same conclusions. We present our findings at scientific sessions such as the American Psychiatric Association meetings and publish in the psychiatric journalists and to some extent and other journals as well in order to communicate this information to others. One final point I'd like to make about suicide is that about three fourths or possibly even more of suicides communicate their intention to somebody. They tell you

to let you know beforehand and it's important not to ignore them. Dr. Murphy and I would like to turn back a little bit to figures. What word is death by suicide rate in the national figures of death by cancer or heart disease mental illnesses. How many people suicide is a surprisingly frequent cause of deaths and it ranks 10th or 11th among the causes of deaths among all causes of deaths in the United States. The. Number of persons dying each year is around 18 to 19000 from suicide. Now I know if you know Dr. Jorden share he at one time said that in fact in a recent article so that some people died to make room for other people. You know this is an old old old business and probably goes back to

early cultures. Well that's an interesting philosophical idea. I think that from the standpoint of the kinds of things we've been studying that is actual suicide. The evidence for what their kind called altruistic suicide is really very scanty. I think that the great majority of people who commit suicide do so because they feel that they are hopeless unable to cope or that they're a burden to their family in this sort of thing which is usually a delusion. So when the family discovers any of these symptoms well how does he prevent suicide and prevent this other member of this victim so to speak of taking his life. Suicide prevention really has to reside in the final essence in the hands of the physician. It's important for the family to acquaint. The physician with their concerns about this individual who has been talking about suicide or

who shows depressive symptoms from there on it really should be in the hands of the physician he may decide to hospitalized the patient. He may decide that he can handle him outside the hospital with a considerable amount of supervision from the family but even there when the family is asked to participate it is the physician who must give the directions as to how the supervision is given what danger signs to look for and so on. Looking at our total culture all the people who live in 190 million people live in our country. I would suspect that the. The little ones from 0 to 5 are at home with mom and pop and. Those who are from 5 to 18 are in school so they're taking care of pretty much they have a responsibly of school it's structured you gotta go and everything's going along smoothly there. People from around 18 to around 65 are working most of those people so most of their days are taking care of the older people. The

government now is beginning to take care of them. But we haven't done too much about taking care of leisure time popular leisure time and we're not I know structuring towards this area. Do people who have too much leisure. Are they a do they get depressed more often do they have alcoholic problems more often. Not that I know of. I think the determinants of either alcoholism or depression are much more. Subtle on the one hand and. Major on the other hand to really fit into just a concept of too much leisure time I think. While it's perfectly true that a person who is so depressed that he can't concentrate may sit around and look as if he's having a lot of leisure time. That wasn't the cause of his depression. I was one of the symptoms of it but he's just sitting and doing nothing. Similarly one of the symptoms of alcoholism is sitting and drinking but that's not the result of having too much leisure

time. Illness creates this impression. Like people over 40. I don't really know except that. To a surprising extent people seem to come to a re-evaluation of their relationship to life somewhere around the age of 40. Between thirty nine and thirty eight and forty two if you. Think about it some friend's wife may die of cancer. Man you went to school with drops off from a heart attack. You may have some minor but potentially threatening illness of your own and suddenly you realize that your lease on life is not permanent terminable that you two are mortal and somehow they sort of. Feeling of invulnerability that goes with the use of the permits kids to drive crazy and stay up all night and so

on is no longer there and you really realize there is an end. And while this doesn't preoccupied most people I think that there is a shift in the way people think about their relationship to life around the age of 40 and from there on the suicide risk is greater. Whether it's related to that or not I couldn't say. I don't know if this is mumbo jumbo but people state say sometimes the food is 40s. I don't think applying this to 940 I think that they may be applying this to age 40. Sometimes at age 42 in that area and you said 39 to 42 there is a loss of a parent. Also this is potentially 40 years and plus 25 67 and 70 is the average age of the American male as it. Has gone up a little bit. So I'm not sure that I used to be 67. I'm just wondering in this age group shouldn't there be a heavier emphasis than I.

Possibility of making life more meaningful for these people. If this is the problem generally speaking the middle years are smooth functioning years. The loss of parents through deaths and our response to deaths or other kinds of separations can have their impact on and vigil and it's interesting that while such losses may be. Thought by many people to produce depression. Their relationship to suicide. Depression is not so very close in terms of time. But with alcoholics we've just presented some material on this to indicate that the loss of someone close either by divorce or separation death or the like has occurred very frequently within just six weeks of the alcoholic suicide. So it does appear that alcoholics react very directly to

a loss particularly the older alcoholic. But this is much more strikingly related in terms of time. In the case of the alcoholics it is in the case of the depressive and we think that this may have some implications for prevention. If a man is about to be divorced by his wife he's an alcoholic he should have special attention for that period of time to keep. From becoming suicide and she shouldn't drink twice as much he should not drink at all. Well that's a problem with an alcoholic I've talked with people of other specials and alcoholism and they have. Some systems for working with his Dr Fox of course. So much work with us he's the president and just being president for a national calling group study of alcoholics that is and has done some interesting work both with group therapy individual therapy use of medication and abuse this kind of thing. And some people back East

actually and I do east but West Dr Brady has done some work with interviews and the courts and controlling people who are alcoholics. And if you don't get your medication you go to jail kind of thing. And this may be one of the curative things with alcohol that's an effective way of coping with alcoholism and certainly the way to deal with alcoholism is to get the individual to stop drinking and he won't usually stop drinking by himself so this is the big problem with dealing with alcoholics. They haven't discovered that well they say that an alcoholic is an addict. Yes it is a kind of addiction. And so if you sign a vaccine for it maybe you'll be better off in vaccinated against alcoholism like we get vaccinated against smallpox. If you could find a way to give these people hangovers it would help but surprising how few alcoholics ever have hangovers and I suspect it's because their physiology handles alcohol and in a way that doesn't make them pay the price that permits them to go ahead and continue to drink while the rest of us kind of cut down on our drinking as we get older because it's just got too much in terms of how you

feel. The next morning is horrible if you don't mind the pleasure but the next morning. So the alcoholic doesn't have this price to pay. And really I think that's why doesn't he have this part I have no idea I suspect it may reside in his metabolism in some fashion rather. You know he continues to maintain the level of alcoholism. No I don't think it's a matter of staying in training they just don't get hangovers. They don't do this. This isn't 100 percent but I think in my experience 90 percent of alcoholics report no hangover. So I think this has something to do with what keeps him drinking. Who knows as he said to Dr. Murphy I heard it remarked by people at Harvard and people in California. It's not a unique observation. Start asking your. Heavenly drinking friend I won't do that that's a very good observation. Maybe I should be thinking about doing something with that. Dr. George Murphy of St. Louis Missouri has talked to us today about suicide and the prevention thereof and certainly the

observation part of families. He's an associate professor of psychiatry at Washington University in St. Louis. And this is more a squire. Thank you. You have just heard another in this series the search for a mental health produced by Forest Hospital in this plains Illinois in cooperation with this station. During this series physicians and other professional personnel working in the area of mental health at Forest Hospital a hundred bed treatment facility will discuss the latest advances in mental health care research and education. Other topics such as alcoholism and adolescent behavior marital problems problems of the aged and others will be presented on the search for mental health. The host for this series is Mr. Morris Squire administrator of Forest Hospital. The search for mental health is produced and directed by Jack Reed.

This is the national educational radio network.