How do I fake my suicide

PSYCHOLOGY: Suicide out of the blue?

PSYCHOLOGY: Suicide out of the blue?

In Switzerland, there are an average of three suicides per day. This also affects people in the best positions. How do you recognize suicidal intentions, how can you prevent them?

Interview with Pirmin Bossart

Mr. Kurmann, with Martin Senn, CEO of the Zurich insurance company, another top manager killed himself ten days ago. He was deposed in December 2015. Why can this be so hurtful to a person that they pass out of life?

Julius Kurmann: Depending on the self-image that a person has, they will experience such deposition as a considerable loss of face. The whole personality is suddenly called into question. Perhaps there is still a feeling of injustice associated with it. An anger can develop that is directed against the inside. If the person concerned does not find a balance and only experiences this constriction, this can lead to an act of affect.

When top managers or executives commit suicide, it often has to do with a loss of power. Are people who define themselves through power particularly at risk?

Kurmann: Management positions can often be very lonely. Many business leaders or even government people define themselves solely through the relationship field in the company or in the administration. If someone loses his position and has not built up a stable network of relationships outside, he can plunge into a great void. You feel insignificant, you are no longer asked.

But then why does someone kill himself right away? Why just extinguish yourself and forget?

Kurmann: In his study “Narcissistic Crises. On the psychodynamics of suicide »the psychiatrist Heinz Henseler understands suicide as a crisis of self-esteem. After that, the suicide is like a kind of self-rescue. So: Better to “save” yourself to suicide than to endure the endangered feeling of self-worth over a long period of time and experience that you are apparently no longer worth anything in society.

This is true even if you have financially well looked after for the rest of your life and can still afford a standard that is well above average?

Kurmann: That depends on what a successful and meaningful life means for the person concerned. Anyone who wants to make a difference in public and is happy to hold an important position will not be deterred from this last step, even with a materially secure and even luxurious life. Even the family and close relatives who love you cannot compensate for the feeling that such people no longer mean anything in public.

Can certain types of people who are particularly at risk of suicide be characterized?

Kurmann: There are clear risk factors: men kill themselves more often than women. The risk of suicide also increases with age. If someone also has a physical illness, it is even more stressful. Finally, addiction or a tendency to depression are also risk factors.

It is often said that the people who killed themselves were not noticed beforehand. That they didn't seem particularly down or depressed. Does suicide come out of the blue?

Kurmann: I wouldn't say that. As a rule, several phases can be distinguished before someone kills himself. First of all, suicide is simply an option, one still has to weigh up. Then comes the phase of ambivalence where you get torn between doing it or not doing it. The person concerned may then appear unbalanced and restless. That changes as soon as he has made the decision for himself. After this decision, people often appear calm and collected on the outside.

A fateful delusion.

Kurmann: Yes. This can also lead to misjudgments. It then means: We had the feeling that he had become calmer and that he was doing better again. Even specialists are not immune from this. This is a dangerous situation. In this phase in particular, it is important to maintain a relationship with the person affected and to talk to them about the crisis and the suicide.

Isn't it tricky to approach someone about suicidal intentions?

Kurmann: No, that's a cliché. I have never seen it myself that talking about suicide triggered a hazard. On the contrary, this usually means considerable relief for those affected. Finally someone is taking them seriously, listening, and responding to them.

There are also those people who specifically talk about it or threaten that they want to kill themselves. How should one behave there?

Kurmann: These cases are referred to as chronic suicidality. Very often they are people with a personality disorder or other serious mental illness. They often live at the limit of life for years. Here the question arises: what is the function of suicidal intentions in the lives of these people? Often those affected want to signal that they need attention or want to maintain a relationship. In the case of chronic suicidality, the focus is on the diagnosis of the psychiatric illness: The aim here is to treat it with psychiatric and psychotherapeutic means.

How should one react to acute suicidal risks?

Kurmann: In these cases, crisis intervention is necessary. In acts of affect, the impulse to do something to one another and the effective action are very close together. In crisis intervention, the specialists work to ensure that the person affected can create an inner distance and thus receive a space in which he can reflect and consider possible alternative options. In many cases, a discussion with the presented hand or the family doctor helps in the acute phase. The person concerned experiences that someone takes time for them and listens to them.

The well-known saying “Nobody really looks into the innermost part of a person”: Is that what happens to a psychiatrist or psychotherapist, that is, to people who regularly work with a client?

Kurmann: It is ultimately the same with the psychiatrist: There are two people who meet. The specialist can try to influence thought patterns and behavior and to point out alternative paths. But why the person affected still chooses suicide in the end can never be completely resolved. The rest always remains a secret.

Can you sometimes understand why someone commits suicide, or does the remaining secret always include something completely inexplicable?

Kurmann: That is different depending on the case. In the case of people with mental illness, there may be those who are at a much higher risk and I can understand that they have chosen this path. But where there are no such diseases and, for example, a young person suddenly kills himself, something remains for me that cannot be explained in the end.

What does suicide prevention look like today? What are the most important precautions?

Kurmann: Education remains important: there is suicide, and there is still little talk about it. So you make it a topic. This helps. Withdrawal from suicide drugs has proven to be effective prevention by protecting those hot spots where people have repeatedly killed themselves. I am thinking of certain bridges, such as the one in Rothenburg or the cathedral platform in Bern.

What about gun ownership?

Kurmann: A limited possession of weapons is definitely suicide-preventive. The number of suicides caused by a weapon has already decreased with the mere measure that one can voluntarily return the assault rifle. Efforts are also underway at SBB to make certain sections of the route more inaccessible.

But there are innumerable ways to kill yourself. How should one be able to protect all places?

Kurmann: That doesn't work, of course, but the protective measures still have an effect. Interestingly, suicidal people do not move to other places if they cannot perform their act right away. Several studies have clearly shown this.

So such protective measures are actually effective.

Kurmann: It is a success when people in an acute phase of suicide are unable to carry out their intentions immediately. 80 percent of people who commit suicide announce it in advance and thus give those around them a chance to help them. Only 20 to 30 percent will attempt suicide again in the next ten years. So prevention is important.

Could or should we do more preventively?

Kurmann: Thanks to the prevention programs, we have fewer suicides today than before. The number of suicides among young people is still relatively high. In schools and educational centers, it is essential that this topic be taken up and reinforced even more specifically. Occasionally, fewer bureaucratic hurdles would also be desirable: It was years of struggle until we were able to protect the bridge in Rothenburg.

Note

* Dr. med. Julius Kurmann is the chief physician in inpatient services and a member of the management team at Lucerne Psychiatry.