Читать книгу The Descent of Man - Finlay Young - Страница 7

Every suicidal person has a story as unique as their own fingerprint …

Could the deaths of Brett and thousands of others like him be predicted? At the Solace Centre, one of David’s friends sat in front of me and carefully explained that while life stressors may be triggers, the members’ mental health issues are to be blamed on faulty brain chemistry. There seemed to be comfort found in translating the extreme, often erratic fluctuations of the brain into the even scientific language of neurotransmitters, of serotonin, oestrogen, and dopamine.

Is it possible that certain brains have a genetic predisposition towards suicidal behaviour?

Dr Zachary Kaminsky, Assistant Professor of Psychiatry and Behavioural Science at John Hopkins University in Baltimore, certainly thinks so. He is one of the scientists searching for what has colloquially been termed a “suicide gene”. “Stress is like driving,” Kaminsky told me. “You can drive really fast, and that can be useful, but you have to be able to slow down.” His team compared brains of those who died by suicide and those who didn’t. They had an inkling that for those who died by suicide, a gene called SKA2 was, in effect, acting as a faulty brake pad, failing to control stress.

Their results were fascinating. By looking at this single gene, Kaminsky’s team were able to predict with 80-90% accuracy whether an individual in their research group had thoughts of suicide or had made an attempt.^[1] More research is needed, but signs are positive that, in the future, a blood test may provide some indication of suicide risk. Whether SKA2 could shed light on gender differences in suicide is not yet clear. “It is linked with the cortisol system, and this system does interact with the oestrogen system,” mused Kaminsky when I asked. “So I suppose it’s possible.”

Many others, such as Professor Rory O’Connor, a psychologist at Glasgow University who was recently elected President of the International Academy of Suicide Research, are wary of the idea that there is some magic “suicide gene” to find. “It’s just a vulnerability factor, a test will never tell us why.” It’s that “why” question that O’Connor has spent his academic life exploring. “It’s more important we identify the social and environmental factors,” he told me.

This made me think back sadly to Brett and Blackpool, where he lived and died. It’s a tired seafront town in the north-west of England, with some of the highest rates of prescribed anti-depressants and alcohol related deaths in the country. Crime, poverty and unemployment are also high, with the hugely depressed property prices attracting increasing numbers of those not in work. With that backdrop, it seems unsurprising that Blackpool has one of the highest male suicide rates in the country.

It’s true that in general there is a strong correlation between socioeconomic disadvantage and suicide. In Glasgow, where O’Connor is based, those from the poorest areas are 10 times more at risk than those from the richest. Research published in the British Medical Journal in 2013 showed that during the 2008 recession, English regions with the largest rise in unemployment had the largest increase in suicides. However, it’s not simple. “People who are unemployed are at increased risk of killing themselves, we know this,” O’Connor told me. “But the conundrum is that most people who die from suicide are in work.”

There are no simple answers. Mental illness is another significant risk factor, with some evidence suggesting that 90% of those dying by suicide have a mental illness. Those at the Solace Centre, by virtue of their diagnoses of disorders such as depression, bipolarism and schizophrenia, are amongst the highest risk people in society. However, most of them, like the majority of those with mental illness, will not kill themselves. As O’Connor told me: “Suicide often occurs in the context of mental illness, but it’s not ultimately the reason people kill themselves.”

Most academics think the answer to the big “why” question ultimately lies in the interplay between countless different factors, combining with negative life events that can push vulnerable people over the edge. Every suicidal person has a story as unique as their fingerprint, some bespoke and noxious mixture that causes them to try and step, swallow, jump, slit or inhale their way out of existence.

At the Solace Centre, David talked about the negative events that punctuated his descent. “Gradually it came to a head, 10 years ago, with my mum dying. I was going to commit suicide, couldn’t cope. I’d be at work and suddenly burst into tears. I’d miss work for two days.” These were the hidden tears of a man’s man, working in a very male workplace. Later, redundancy would follow, which caused him to spiral further as he hunted for a new job. No one was there to pull him up. “I don’t have any family or loved ones,” he told me. “When you are depressed, it’s solitary. The walls begin to close in on you.”

The American Association of Suicidology, a membership organisation for all those involved in suicide prevention and intervention, created a mnemonic of all-encompassing sadness to help assess individual risk: IS PATH WARM.

I: ideation (a medical term for thoughts about suicide)

S: substance abuse

P: purposelessness

A: anxiety

T: trapped

H: hopelessness

W: withdrawal

A: anger

R: recklessness

M: mood change

In O’Connor’s research the idea of entrapment is particularly emphasised. “When things break down, the feeling of being defeated means we feel trapped, don’t see a way out, we feel ‘this is not the way I am’,” he said. “The suicidal mind feels a sense of tunnel vision.”

From the suicide statistics, it would seem reasonable to suggest that more men end up deep in the tunnel with the light receding. Yet beneath the gender disparity lies a muddling factor that has puzzled researchers for generations. While it is certainly true that men in the UK and worldwide are as much as four times more likely to die by suicide, it is equally true that women are around three times more likely to attempt it. This has long been known as the “gender paradox of suicidal behaviour”.

The difference is normally attributed to the means selected for the attempt. In the UK, 58% of male suicides victims killed themselves by hanging or strangulation, while only 36% of female suicides did so. For women, the most common method was poisoning, with 43% choosing this less lethal means compared to 20% for men. Men are more prone to impulsive behaviour, and that explains the disparity, or so the story often goes.^[2]

However, leaving the analysis at that misses a few crucial, but highly sensitive questions. Does everyone who attempts suicide actually want to die? When is an attempt not, in fact, an attempt?

Dr Ronald Kessler, a Harvard psychiatric epidemiologist, has been working on the largest suicide study of all time, the ongoing US Army Study to Assess Risk and Resilience in Service-members (Army STARRS). One element of the wide-ranging study focused on failed suicide attempts. By differentiating between survivors and focusing on those who made the most serious attempts, his team were, as Kessler put it, “able to interview those who committed suicide, but after they did it”. This way they were able to establish the varying intents of all those who would normally be classified together as having attempted suicide.

The study suggested not all suicide attempts are equal. “There’s a lot of research done on the difference between predictors of serious and non suicide attempts, between suicide gestures and ‘proper suicide’,” he told me. According to Kessler, we must acknowledge that men and women, when they make that step, are often trying to achieve very different things.

Clinical psychologist Martin Seager, a consultant for the Central London branch of the Samaritans whose work focuses on the psychology of men, traces the paradox back to gender. “Women are, in general, more prepared to seek help and show their distress. A female attempt is often closer to a cry to help, hoping for a response.” Typically, the male is seeking a different outcome. According to Seager, “when he makes a suicide attempt, he doesn’t want anyone to hear it, he wants to succeed”. He compared the action to a soldier “seeking an honourable death”.