Discussion Mental disorders may prevent, not cause, suicide

[Eudaimonic]

https://www.researchgate.net/publication/385554792_Mental_disorders_may_prevent_not_cause_suicide

 

[Dot]

S/ thy r sayng tht mentl dsordrs devlp as psychogcl defnses agnst suicde - e.g depressn tkes awy ppl motvatn t/ act on pain & addictns etc r copng mechnsms fr avoidng pain

Wld b intrstng 2 C wht = thr opinns of cnditns sch as BPD whch hve 10% suicdlty r8 & hw sme cnditns hve mch highr ctb r8tes thn othrs- & hw sme cnditns whch as defnses & rsponss t/ trma cre8 furthr issus & pain whch add t/ suicdlty - wth BPD agn b-ing xample

"Humans needn't perpetually worry about sui-
cide for the same reasons that orangutans and polar bears
can get on with their lives without being bothered by
(respectively) heights and the cold: we, like them, are bio-
logically equipped to handle the special hazard that comes
with our evolutionary habitat. Equipped, that is, for the
habitat that prevailed in our evolutionary past: quick and
easy means of lethal self-injury probably did not feature in
our ancestral environment and are an Achilles'heel today.
Keeping guns, pesticides and other death-traps out of
harm's way is a sensible precaution: it buys time for the
psyche's defences to stand down from potentially deadly
crises.
As clinicians, if we try not to let our anxiety about sui-
cide get in the way, and if we keep a sense of proportion as to
the realistic level of risk, we can focus instead on trying to
understand and ease patients'underlying distress –which
is usually not about suicide.

As for mental illness, to be
clear, we are not saying that psychopathology should be
left untreated. Of course, pharmacotherapy has an important
role. We are saying that medication cannot be the be-all and
end-all. If this theory is broadly right, mental disorders often
stem from a common root: psychache. We need to look
beyond the diagnosis to the underlying pain and try to alle-
viate that as well. In this respect, we are no different to any
other medical specialty: symptomatic treatment must not be
conflated with curative treatment, but they may be used
together.​

 

[waistcoat]

I'm not sure how relevant this is, but my dissociative identity disorder (DID) has definitely prevented me from suicide several times.

anytime one of us gets suicidal a protector part comes into play and stops us.

 

[Eudaimonic]

Btw, the author of this paper also wrote a very interesting book titled "The Evolution of Suicide,"(you can find it on annas-archive) where he argues that "SI" should be understood as a series of adaptive defenses that are triggered rather than an instinct. He argues that the malfunctioning of these defenses is not predictable, making suicide an inherently aleatory phenomenon.

That said, I find his favored approach very unethical: restricting means at all costs even though the people seeking them will continue suffering from psychache.

hw sme cnditns whch as defnses & rsponss t/ trma cre8 furthr issus & pain whch add t/ suicdlty - wth BPD agn b-ing xample

He talks about how the "keepers" as he calls them - the last lines of defense against suicidal behavior - can become maladaptive and end up causing/contributing to the very thing they were intended to prevent.

These 'keepers' are the most relevant type of adaptive defenses for anyone here seeking to understand the workings of "SI."

From this draft chapter: "The final defences are "keepers"—emergency interventions, activated by intense, chronic psychache, which function to prevent suicidal ideas from being enacted. Keepers present as diverse symptoms of psychopathology: "pain-type keepers" use emotional numbing and other measures to lessen the necessity for suicidal escape; while "brain-type" keepers interfere with cognitive faculties usually sufficiently to make suicidal action difficult to organise"

The brain-type keepers are where the role of mental disorders is most salient. But of course, they can backfire by increasing psychache.

 

[EvisceratedJester]

Ah, this guy again. I feel like it's important to note that his ideas don't seem to be super well-known in psychiatry, at least from what I have gathered. This is important to note since it might make it harder to evaluate the validity of his claims. This is the only paper I can find in which some other authors look into his ideas and evaluate them. In the case of the claim of mental disorders evolving as preventative measures against suicide, they conclude that:

Although several elements of the model meet multiple criteria of causation, the prediction that the majority of CMDs are evolved defences against suicide is, in our view, the least supported part of the model. It is possible that we may be proved wrong through well-designed empirical studies, but as things stand, the range of counterevidence does not, in our opinion, currently support this sweeping prediction.

*CMD stands for Common Mental Disorders

I'm not saying this because I think he's completely wrong or any of that. It's just that this isn't the first time that I've seen people on here eagerly cite his research and I feel like it's important to note that we shouldn't just be blindly believing all of this. His work doesn't seem to be that popular which crcreate an issue since we have no clue as to how most others in similar fields to his feel about his views. How much can these ideas be backed up? Are there other hypotheses that do a better job of explaining this? What are the potential shortcomings of these ideas? These are important things that need to be taken into consideration but because his work seemingly not being well-known by mainstream psychiatry or psychology circles, it makes it hard to find papers by other researchers looking at his ideas. The one I thanked above is the only one I've found so far.

Maybe I'm completely wrong here. Maybe I didn't look hard enough. Idk. I just feel like we should look at this a bit more critically though instead of just blindly accepting it because it lines up with our own beliefs and biases.

 

[slowdance]

It's interesting and it makes sense to me but the journal has an impact factor of 1.7 so take it with a grain. Thanks for sharing the article though. Fascinating read

 

[WhatCouldHaveBeen32]

Well if we just go at the idea by face value, mental illness can prevent suicide just because it exists, as in , if one is truly without any illness, his brain will still pressure him into considering it , especially when in our society it's something decently well researched and he could go on a fool's errand to find out what kind of mental illness he has (he actually has none), so just the concept made him continue to live to find a cure that does not exist for him. Now if the mental illness itself can make you live, it depends, some don't and some might , if you have CPTSD for example especially in combination with other things , life quickly becomes a pre death experience for you. For the other side I can't speak

 

[Whale_bones]

I just feel like we should look at this a bit more critically though instead of just blindly accepting it because it lines up with our own beliefs and biases.

Of course, no one should blindly accept any idea. I don't think just sharing the article is suggesting we do that though (though I recognize you mention other discussions, and maybe there was some over-eager acceptance going on there).

I think the article is very clear that they're simply presenting the idea and asking for more investigation into it. They refer to it as "a new direction for mental health research" while acknowledging its potential limitations and the importance of current treatments like pharmacotherapy, being clear that they're not suggesting that be removed.

"As for mental illness, to be clear, we are not suggesting that psychopathology should be left untreated... We acknowledge that the pain–brain theory about the link between suicide and psychopathology does not explain all mental illness. However, we think that it is worth further consideration, as it asks novel questions, suggests testable avenues for research and has profound implications for clinical practice and risk assessments".

So the article itself isn't asking for blind acceptance; quite the opposite, it's asking for more research into the subject and just setting out the basics of why that may be worth it.

This article was written by two people, Annie Swanepoel and C.A. Soper, and seeing as the person listed first is usually the "lead" or the person that contributed the most, I don't think it makes sense to attribute this work to only Soper.

 

[ShatteredSerenity]

I skimmed through this article but I couldn't make much sense of it, probably because I'm a software engineer trained in mathematics and psychology is not my domain. But I have bipolar disorder and I don't understand how this theory applies to the symptoms I experience. Around 20% of people with bipolar commit suicide, one of the highest rates of all mental illnesses. I can't imagine how bipolar symptoms evolved as anti-suicide responses. The things I did during a manic episode destroyed my life, and when I subsequently entered a depressed episode I felt intensely bad about what happened and started seriously wanting to commit suicide.

I get that it's hard to explain how mental illnesses evolved when the traits are detrimental to reproductive fitness, so there's value in creating a new hypothesis. But there are many other hypotheses about evolution of mental illness that seem more plausible to me.