'Parasuicide' versus 'genuine' suicide

Consultant clinical psy-chologist Dr Karen Richards makes clear the distinction between parasuicide and a genuine suicide attempt. In the former, Richards told The Sunday Gleaner, "A person may flirt with the idea. It may not be as concrete as 'I want to die', 'I want to be out of this discomfort I am in', 'I can't take this anymore', 'I want to sleep and not wake up'. They may play scenarios in their heads," she said.

Thoughts may become action, still, not to the extent of actually intending to kill oneself, but, Richards said, "they may engage in risky behaviour and low-level self-harm".

There may also be a pattern of repeated self-harm. "They may have taken an overdose, they may have flirted with the kind of behaviour that causes injury but not death," she said.

However, that may actually lead to their death, as Richards says they may go too far and actually end up committing suicide. "They may think that 15 pills may be OK, but 15 tablets on a bottle of rum may be the killer," she said.

Depression

The person who seriously intends to end his or her life may already be showing "some classic signs of depression". These include being withdrawn, less communicative, and becoming disinterested in areas of their life in which they previously had deep interest.

One strong sign is that they may have a foreshortened view of their future, with no medium- and long-term goals. Some persons considering suicide may go about setting their affairs in order, winding up pursuits, and cancelling long-standing plans.

"Suicide is not always an impulsive act. We sometimes associate it with being impulsive. In some cases it may be well thought out," Richards said.

Isolation, which often precedes suicide, feeds on itself. "They may become more isolated, maybe deliberately, as when we are depressed there is a tendency to not want to be around people, a tendency to believe that others may not understand how we feel. Some may be ashamed of their suicidal ideation," Richards said.

Family patterns are another factor, Richards saying: "If you have a family member or a role model who has committed suicide, you are more likely to contemplate it when you are depressed." Then there is social shame, like a man who finds out that the entire community knows his wife has been sleeping with another man.

- M.C.