The Revolutionary Ketamine - CHAPTER THREE
THE HIDDEN SIDE OF SUICIDE
“We are always looking for simple answers to complex problems, and they are nearly always wrong.”
—H.L. Menken
Suicide.
The word suicide captivates us. The truth is suicide captures everyone’s attention. However, it’s the actions leading up to suicide that go unnoticed. Suicide is a prominent problem worldwide, and relatively little has been done about it (Van Orden). Staring us in the face is that suicide is not considered a public health crisis; instead, it has been treated as a mental health concern. Even more ominous is that suicide is difficult to study: suicide victims are not available once they have killed themselves. Even if one survives the attempt, they often do not participate in studies, and multiple subjects are needed (Van Orden).
Suicide is one of the leading causes of death globally and has been increasing steadily since the early 2000s in the US; emergency room visits relating to mental-health crises have been rising steadily since 2010 and increased nearly 50 percent during the COVID-19 crisis (Leeb, Ting). In 2018, 10 million people thought about suicide, three million planned to commit suicide, one million actually attempted suicide, and sadly, close to eight hundred thousand people perished from suicide. Why have so many people contemplated suicide, and why have we seen such an increase? We have no simple answers, but the underpinnings of suicide are invariably multifaceted.
The Federal government's commitment to science-based suicide prevention was notably strengthened in 2001 by the National Strategy for Suicide Prevention: Goals and Objectives for Action (USPHS 2001). Interestingly, suicides have increased despite significant efforts by our governments. Every administration since Nixon has rolled out a suicide prevention program. Perform a search with the name of the US president and suicide prevention, and you will see nationwide plans for ending suicide. Reagan instituted June as youth suicide prevention month, Bush signed the Garrett Lee Smith Memorial Act, Clinton boosted insurance coverage of mental health services, and Obama signed the Clay Hunt Suicide Prevention Act. Trump signed the law designating 988 as the universal number for the suicide hotline and Biden expanded the hotline number and awarded millions of dollars to expand mental health services.
Economic downturns almost always bring higher suicide rates compared to prosperous periods (Barr, Harper). For example, Japan’s highest rate of suicide was in 2003, with 34,000 people killing themselves, and that figure fell in 2019 with just over 20,000 suicides. However, in 2020 the number of suicides in Japan is consequential from an industry standpoint; many were young working-class men and women, specifically from the travel industry (Sakamoto). Similar trends exist in the US after a crisis (Sakamoto).
The 2008 financial crisis resulted in thousands of suicides worldwide. In 2022, according to Daily Wire news, Gustavo Arnal, the 52 years old chief financial officer of Bed Bath & Beyond retail chain, jumped to his death from the 18th floor of a Manhattan high-rise two days after the struggling company announced plans to slash the jobs of over 6000 employees and close 150 stores. The stock market, unsurprisingly, experienced historic drops in 2020. We saw millions of jobs lost or furloughed, medical care delayed, and an overwhelming wave of anxiety, fear, and depression. Many Americans fell into poverty for the first time (Benen, Berrenson). Over 54 million Americans filed for unemployment, and 60 million European Union jobs were at risk (Lob).
The Lockdowns
Everyone expected a higher suicide rate during and after the first lockdowns because of the mass social trauma (Travis-Lumer). However, the data indicated a short-term decrease in suicides. This is likely due to the “honeymoon period” or the “pulling together phenomenon” (Reger, Travis Lumer), which is defined as a drop in attempted suicide rates initially after a disaster. For example, in the aftermath of the 2011 earthquake and tsunami in Japan, suicide rates in Fukushima, Japan declined two years following the disaster. Still, the rates increased to pre-disaster levels in the third year (Ohto). Similar trends existed after the 1918 influenza, SARS, and Ebola epidemics. Several suicidologists believe that the preliminary numbers for suicide deaths may be highly underestimated (Singer).
War of the Mind
A suicidal person is at war with their brain, and one’s situational awareness is flawed. It becomes impossible to discern facts, proof, logic, and concern for yourself. On the battlefield of suicidal ideation, the wounded soldier is in a thick, isolating, never-ending fog. In a very real sense, the person is at war with the mind. When a suicide occurs, the mind wins. The enemy within is trying to ambush the paralyzed mind in the kill zone. The voices telling the mind to take one’s own life likely sounds rational and even calming. It might even sound like suicide is the best thing for everyone, including yourself. Those voices asking you to drop your defenses. Then, in a moment of intense vulnerability, if a firearm is at hand, just like that, suicide strikes with nearly ninety-nine percent accuracy. Your chances are only slightly improved with other measures. As in a war, the person needs a leader outside one’s thinking and limited perception. That leader is intuition. That person may be the one with suicidal ideation, or it might be the parent trying to save her son or daughter.
Case: The Dennis Hartman story - Dr. Brooks
“This is an incredible story about a man suffering from major refractory depressive disorder his entire life, associated with traumatic stress disorder resulting from childhood abuse. Dennis describes his existence as “misery” and says, “Living with my depression feels like pain.” He further explains that it’s not something you can show someone, like pointing to an injury or a wound, but it feels like physical pain. Dennis recalls, “I knew I had a problem by the time I was in 7th grade. I had a very traumatic childhood and spent it in a state of intense fear. By the time I reached adolescence, I had a pretty good idea I couldn’t do things as other kids could.” Dennis Hartman spent decades working through a roster of medical treatments for depression. He tried every known depressive therapy (SSRIs, SNRIs, tricyclics, benzodiazepines, etc.); notes Dennis, “A lot of my energy in life has been spent trying to get relief from this pain. On my worst days, I lost the energy. I didn’t have the ability or the strength to inhabit that character anymore… I just didn’t see any way around it.” In his mid-40s, Hartman decided he would end his life, believing wholeheartedly it was humane and reasonable. He explains, “There’s only so much untreatable suffering that one person can be expected to endure in their lifetime.” He chose a date several months away to get his affairs in order and avoid causing his nephew trauma during school finals. Awaiting his date, he heard of an experimental trial using ketamine to treat depression and PTSD. He applied and was immediately accepted.
“The day I received my infusion, my symptoms were raging; anxiety, anhedonia, and insomnia. They turned on the drip, and I was in a dreamlike state, like a spectator watching my thoughts unfold in front of me. Within 15 to 20 minutes of the end of the infusion, I knew something was different. They asked me questions to monitor my mood, and I had trouble pinpointing my symptoms.” Dennis knew something was missing within a couple of hours of the infusion. He explains, “It didn’t strike me as a wave of massive relief. It didn’t feel like something was added to me, like I had superpowers. I didn’t have euphoria. It was a gradual realization over a few hours, something was missing and what was missing was something horrible. If you suffer from lifelong depression, as I have, and it’s all you’ve ever known, it becomes part of your identity. You just feel the world is all about pain, and when I got relief from my first infusion, it was like being emancipated.” Since discovering this treatment, Dennis has become a tireless advocate of ketamine therapy, establishing the Ketamine Advocacy Network to spread awareness of the treatment and connect potential patients with doctors who provide it. As of 2018, over 250 clinics and 1,000 practitioners in the US are now offering ketamine therapy.”
Source: Wolfson M.D., Phil. The Ketamine Papers: Science, Therapy, and Transformation (pp. 293-294). Multidisciplinary Association for Psychedelic Studies.
Intuition is the only thing that can save you from suicide. It is integral to preventing the process leading to the taking of one’s own life. Intuition is our most profound intelligence that helps us discern the signs of denial. True intuition is one’s inner voice and one’s most trusted friend. That gut instinct, which is our intuition, might be what helps you make sense of the paralyzing denial in which your brain is entrenched. The signs of denial are rationalization, justification, minimization, excuse-making, and refusal. It’s human nature to use denial to eliminate the discomfort of accepting realities we’d prefer not to acknowledge. This is part of “cognitive dissonance.”
Intuition and Truth
We are at the front line of one of the worst mental health crises in history. In science, truth is fundamental. But for many caught up in the throws of suicidal ideation, facts and truth matter not. Intuition is a primary defense; in fact, the root of the word - intuere - means to guard and protect.
There is no objective proof; the only evidence you have is the seemingly endless depression and isolation. This is not to say that intuition is always correct, but when you or your family are faced with suicide, that inner voice will be your most trusted friend; it’s the only thing you may have to overcome an otherwise overwhelming darkness.
Like intuition, denial can feel like a mechanism for survival, but denial actually serves our comfort, our emotional pain, and our emotional calm - and it does so through deceit. Intuition is knowing something without knowing why and without seeing complete evidence, but denial is choosing not to see something when all the evidence is there.
Denial, like intuition, turns out to be a protective mechanism for emotional survival. For example, most parents are in denial their children could be severely depressed or have suicidal ideations. In one study, 75 percent of parents did not realize their adolescent was having recurrent thoughts of death (Jones). Another study found that 78 percent of suicidal people denied thoughts of suicide before killing themselves. Denial challenges us to ask ourselves, “What is it I am refusing to see here?” A typical example of denial that we openly accept is malnutrition in poor and rich countries; according to the United Nations, starvation kills around 25,000 people daily, but it’s rarely discussed. We even have a vaccine for starvation - it is called food; one hundred percent effective with zero side effects. Overdoses render similar phenomena. Denial ostensibly serves our comfort, emotional pain, while we try to make sense of what is happening.