September 11, 2009

A wee chat about suicide, for World Suicide Prevention Day

Such an ugly ugly word.
Such a sad thing, for the person, the family, the friends, the world.
MS and suicide are rather closely tied. It all starts with the underdiagnosed depression in MS patients - often no one even enquires, or figures people with MS are just adjusting to a chronic disease and thus a bit blue.
Why does depression occur in MS? The official answer is that no one knows, since we aren't really sure why depression occurs in anyone. Some hypothesize that it is due to brain changes caused by the disease, changes in neurotransmitters or conduction of impulses, damage done by lesions in the brain. Some think it is adjustment. Others, including me, think it is a combination of the above plus the loss of control MS presents to you. MS is unpredictable, unreliable, teases you on by making you feel well, then knocks you flat. It steals little bits from you at unexpected moments - sensation during an embrace, strength during a walk, ability to talk during a presentation, ability to taste during a luscious dinner.
Some hypothesize that MS patients commit suicide more frequently because it represents a taking control over a disease process over which they have no control. I know when I was first diagnosed, I researched ways to commit suicide. I made my plan, a "just in case" plan, in case I ever needed it. I had to do this to give me that feeling of control. I make sure I always have the means available, although I will likely never do it. I just need to know that I can.
According to Feinstein's research (2002), almost 30% of MS patients harbor suicidal intent over the course of their illness. Sadovnik et al (click on title for source) found that 15% of all deaths in a MS clinic population were due to suicide - a two-fold rate of suicide compared to the general population .
Risk factors include alcohol abuse, social isolation, and unemployment. Many people with MS start to isolate themselves, because of their inability to get around, their fear of incontinent episodes, their fear of mental lapses. A goodly proportion give up work because of the overwhelming fatigue associated with the illness. This both leads to financial problems and more isolation.
It's no wonder alcohol abuse seems like a good idea...
People with most chronic diseases benefit from continuing involvement with life and with a continuing purpose. I think it is something for the health care system to think about - how to keep people involved, how to allow the patient control over their health and conditions, how to point them towards the right place for support and involvement. Often the "system" is all about taking control, wresting it from the patient, putting it in the hands of the expert. Maybe it is time to reevaluate this...
The rate of suicide in MS is highest in the first year of diagnosis, often before true disability sets in. Perhaps this is where it is most important to offer help. I know I was diagnosed and left hanging for six months with no one but my wonderful drug company nurse to keep my soul together. I don't think this is right. I think we should focus intense intervention for people newly diagnosed to get them settled on a good path to managing the disease, and with this perhaps prevent the carnage of suicide. What do you think?
In the meantime, perhaps everyone should look about you and see who might be in the most need of support, ill or not, and reach out. Suicide can be prevented. But we have to talk about it first.

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