Suicidal Christians - a Paradox? Article Reference: Nucleus, October 1987, pp15-20; Author: Dr. Richard J. Turner Though in some societies suicide has been ritualised, the Western World has largely condemned it. In AD 452 suicide was regarded as an act of diabolical possession. Those who committed suicide were refused Christian burial. They were buried with a stake through the heart, at a crossroads. To attempt suicide was against English law. Between 1946 and 1955, of 44,956 people who attempted suicide in England and Wales, 5,794 were brought to trial. All but 347 were found guilty and 308 people were sentenced to imprisonment. The Suicide Act of 1961 removed attempted suicide from the statute book as being a criminal offence. Rather, those who attempted suicide were seen as individuals requiring care and help. Surveys have shown that many doctors, physicians and surgeons, are not sympathetic to patients who attempt suicide , often regarding them as "attention seekers". Although such a view point is understandable, since those working in physical medicine have responsibility for patients suffering from serious physical pathology, it has been of concern that often, those who are seriously psychologically distressed have not received the kind of support and help that they need. The Christian church, too, has not always been sympathetic to the needs of this group of patients, often taking too simplistic a view of the problem, seeing faith as the only answer to depression. Christians who have become depressed and attempted suicide have often found themselves lonely and isolated and unable to share their difficulties with fellow Christians; feeling guilty, that in some measure their difficulties have been due to a lack of faith. Who commits suicide? Research into suicide and attempted suicide really began in 1958 with the work of Stengel and Cook. They concluded that those who commit suicide and those who attempt suicide are two rather different populations. Those who commit suicide tend to be older, more isolated and with high levels of psychiatric morbidity. Their motive is clear. Those who "attempt suicide "/parasuicide/non-fata1 deliberate self-harm, are a heterogenous group with varied antecedent factors. The psychodynamics of their acts are complex and it is not always easy to assess the motive behind any given episode. For teenagers, conflict with a key individual is an important antecedent factor, perhaps a row between mother and father or boyfriend and girlfriend. Amongst the middle-aged and elderly, a lack of close friends, loneliness and isolation are important factors; having no one to turn to in times of distress, marital failure. Some episodes of deliberate self harm are failed suicide. 1% of self-harm patients commit suicide within one year. Why commit suicide? Many who harm themselves are seeking for symptomatic relief. They may feel so anxious and tense that they just want to opt out for a while; to have a sleep. For younger people, a self-harming act may be a form of risk-taking behaviour. The adolescent may be gambling with his life - if he survives, then he presumes that things will work out. Others may be giving a 'cry for help', designed to communicate distress, or to influence relationships with consequent benefit to the patient. For those who are already helpers, it may be a challenge to do something different. Self-harm Incidents. Increased 3 fold between 1960 -1980. Account for 1:10 of all medical admissions, 1:5 of all medical emergencies. Prevalence is greatest amongst young people. Methods commonly used: - age 15-20 years: analgesics, salicylates overdoses . Mostly obtained from a shop or family medicine cupboard -age 20-35 years: tranquillizers, hypnotics - obtained on prescription from their GP. -aged over 35: hypnotics - from repeat prescriptions Self-harm rates have paralled the increase in prescription rates of minor tranquillisers Successful suicides High level of psychiatric morbidity. Particularly of major depressive illness. Schizophrenics are at a significantly high risk. Assessment of self-harming patients This requires concern and skill. Sadly, they are often admitted to busy medical and surgical wards where they may be dealt with in a somewhat cursory fashion. The developnent of self-poisoning units has been a welcome development in a number of areas but in the country as a whole, there are few facilities of that kind. The Hill Report [1] published in 1968 suggested that all self-harming patients should be assessed by a Psychiatric Team. A more recent report of the DHSS Working party [2] has suggested that other professionals, having an interest in this particular area, can adequately assess and help such patients. Thus, in some areas, social workers and nurses are involved. The assessment of a patient who has committed an act of deliberate self-harm requires time. There is a need to establish rapport, best done in a situation away from the public area of a ward. The assessor needs to: Understand the self-harming episode. Antecedent factors and the motivation. Assess the patient's mental state. Those who are psychiatrically ill will need to receive appropriate treatment, if necessary in a psychiatric unit. For those whose motive has not been one of suicide, one must: Clarify and list the current problems. Assess an individual's coping resources and supportive relationships. Establish what help the individual needs and what he/she is prepared to accept Negotiate a contract about further action. All this requires care, patience and understanding on behalf of the assessing professional. Prevention of suicide and self-harm is a challenge for all the helping professions. There is no simple answer. If suicide and self-harm are viewed as a 'last resort', then plainly there is a need for appropriate help and, if necessary, treatment at an early stage of an individual's distress. The general practitioner is often the first person a man or woman thinks of seeking at a time of crisis. Many studies have shown that he is an acceptable confidante. However, an average six minute consultation is really not enough for a patient in such a situation. Much longer is required. Too often tranquillisers are prescribed as a quick solution. These are not the answer to an individual's personal problem and if they are not adequately dealt with, the prescribed drug may become the agent for self-harm, when the frustration over the situation overwhelms the individual. Many general practitioners find it useful to invite such patients to return for a longer and more relaxed appointment. The management of those who are involved in recurrent episodes of self-harm is often a challenge to the specialist psychiatrist. For such patients firm and consistent help from the same therapist is required. In time, maturer ways of coping with stress begin to develop. Voluntary agencies have done much to relieve the suicidal. In 1953, the Reverend Chad Varah of St Steven's Church, Walbrook, in the City of London, founded the Samaritans. This organisation now spans the whole country and has groups operating in most major centres. As a telephone counselling service that provides a listening ear to all who wish anonymous contact, it has done much to relieve distress. Are Christian Immune? Christians are not free from stress. Depression is an experience of many, and suicidal feelings occur for some. Many consult with psychiatrists, ashamed that they have needed to see a doctor, guilty that their difficulties may be due to lack of faith. In the scriptures we see men of God defeated by circumstances, Moses (Exodus 33:14-18), Elijah (I Kings, 19), John the Baptist (Matthew 11:2). There have been modern men and women of God too, C.S. Lewis in his book 'A Grief Observed' [3], describes the very real devastation that he experienced following the death of his wife, Joy. David Watson, in his autobiography 'You are my God' [4] describes the depression that was sometimes his experience. The story of God's dealings with Elijah teaches us much. Through the battle with the prophets of Baal on Mount Carmel, God's name had been vindicated, yet Elijah becomes depressed, not able to see the truth of the situation, believing that he is the only man ofGod left. Pursued by Queen Jezebel he flees to Horeb. He comes to a broom tree, sits down under it and prays that he might die. God gives him rest and physical refreshment. He demonstrates his care and concern and provides a helper in Elisha. Living the Christian life is tough. Nowhere in the Bible is it promised as a life of ease. Jesus said, 'take up your cross and follow me', (Matthew 16:24). When a person beoomes a Christian he does not escape difficult circumstances but he can experience the peace and strengthening power that comes from God. Experience of the peace of God begins when we have peace with God. Once we are received into God's family we are no longer separated from him. He is for us (Romans 8:31). If we are God's, his love and concern encompasses us in whatever condition we are. He is there even in the darkest place (Romans 8:32-36). For those who are in the 'valley of the shadow of death' God promises His presence and His restoration (Psalm 23:1-4). In Philippians 4:6-7, we are urged to share our problems with Christ. We are promised that our hearts will be kept in union with Christ and that we will experience his peace. Jesus cared for the destitute and downcast, for the worried and lost. We remember how He appeared after his resurrection to the disciples in the upper room, 'peace be unto you, He said, and showed them his hands and his side' (John 20:19-20). Jesus understands our deepest needs, as on the cross he experienced the most terrible pain and loneliness (Matthew 27:45). As Christians we have the responsibility laid upon us to share the peace which He offers with those around us who, for whatever reason, are distressed, depressed, perhaps despairing of life itself. In our daily work, on the wards, in the Accident & Emergency Department, in the GP surgery, we will find men and women in need of peace. We have to give them time, to hear their story, to listen and to try and understand their situation. Under God we have a responsibility to demonstrate that they are valued for who they are; that their life is precious. We have the opportunity to bring them practical help and sustenance. We have the privilege of restoring hope. It is a joy to see eyes opened to see a new future . References The Hill Report. Joint Sub-Committee of the Standing Medical Advisory Committees. Hospital treatment of acute poisoning. London, HMSO 1968. Health Service Management. Self Harm. HN 84 (25). C.S.Lewis. A Grief Observed, Faber 1961. David Watson, You are my God, Hodder and stoughton, 1983. suicide index resource centre Copyright ©2002 Christian Medical Fellowship. Comments, suggestions, information: email webmaster@ethicsforschools.org CMF is a registered charity (No 1039823)