Robin Williams' death has served as a stark reminder that we have a long way to go in helping people at serious risk for self-harm. Part of the challenge, say experts, is that despite their stigma, suicidal thoughts are quite common, particularly among people who are depressed. “Suicidal thinking is common and widespread, especially among people with mental illnesses,” says Dr. Dost Ongur, chief of psychotic disorders at McLean Hospital and a psychiatrist at Harvard Medical School. “Yet we don’t have good ways of deciding who is at genuine risk, and who is suffering but who won’t go through with hurting themselves. The reality is that there is no established way of saying this person is at higher risk than that person.”
It’s not that anyone is expecting that a simple blood test or brain scan will provide the answer; the machinations of the body and mind are too complex for that. But as researchers learn more about the brain processes that lay the foundation for things like depression or addiction, they are moving toward developing a suite of tools that could help to at least triage people who are most vulnerable to harming themselves. “It’s something that comes over people; it can last hours or days, but not forever. If you can keep somebody safe during that period, it would pass," Ongur adds. "The depression would remain, and the substance abuse would remain, but the intense feeling of not being able to go on would pass.”
Identifying people who might be especially vulnerable to those episodes could be a first step in preventing suicide attempts. In July, scientists reported finding that a gene involved in tamping down a stress response is different among those who have tried to end their lives compared to those who had not. The gene is integral to activity in the brain’s prefrontal cortex, which is responsible for things such as impulse control and reining in negative thoughts. It was in short supply in patients who reported suicidal thoughts.
Another group, led by John Mann at Columbia University, is focusing on the brain chemical serotonin, known for its role in mood disorders, and at Harvard, researchers are exploring the use of a bedside test that can probe the brain of patients with mental illnesses for clues to suicidality. All of these strategies, says Ongur, could help to shed more light on the black box that lies at the intersection of thought and action. “We don’t have a good framework for explaining what happens in the moments when a person is preparing to commit suicide.” That provides a window of opportunity for potentially life-saving interventions.
Mental illness and substance abuse—both of which are correlated with suicide—are treatable, and could be the first step toward shifting patients away from self harm. Strengthening relationships can be another important factor. “The sponsor in AA is an example, a psychotherapist is another example and family relationships are other examples. We live in a relational world and people consider the impact their actions have on people important to you,” Ongur says.
But strengthening such relationships also requires a shift of a different kind, a societal change in how we perceive mental illness and react to those affected. “One of the big issues remains the stigma of mental illness, especially suicide,” says Ongur. “We are still dealing in a very real way with suicide not being something that is talked about openly and commonly. I saw a comment that the best tribute to Robin Williams would be talking more openly about suicide and making it part of a national conversation so that more research can be done and more people can be helped.”