Columbia University Medical Center

Rethinking Suicide: A New Approach by Dr. Victoria Arango

Dr. Victoria Arango

In a world where so many people fight to survive illness, it can be hard to understand why someone would choose to die. But what if suicide isn’t really a choice? What if it’s a disease?

Dr. Victoria Arango, PhD, is associate director of the Division of Molecular Imaging and Neuropathology at the New York State Psychiatric Institute at Columbia University Medical Center.  She has been studying the biology of suicide for over twenty-five years, and she’s come to believe that how we think and talk about suicide is as important as her pioneering anatomical studies of the brains of people who have died by suicide.

In her view, suicide is a disease that should ultimately have its own classification in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

The Suicidal Brain vs. the Depressed Brain

Until the 1980s, Dr. Arango noted, research scientists assumed that studying the brains of people who had committed suicide meant studying depression. They thought that only people who were depressed committed suicide.

“But when you compare the brain of a person who was depressed with the brain of a person who died by suicide, the suicide brain has a much more localized change than the depressed brain,” Dr. Arango said. She first reported these findings in a 1995 in Progress in Brain Research.

Dr. Arango explained that the part of the suicide’s brain that is most changed is the prefrontal cortex, which is more developed in humans than in any other species, including nonhuman primates. The prefrontal cortex is involved with “executive function,” which carries out such complex tasks as decision-making and working toward goals. The orbital cortex, the area of the prefrontal cortex just above the eye, regulates behavioral inhibition and is the region most affected in the brains of those who commit suicide.

“It’s as if people who die by suicide are unable to control the urge to kill themselves,” she said. “And if you are the person left behind, it’s normal to wonder why a loved one would hurt you in this way. Well, the person really didn’t. He or she just didn’t know what else to do. It is no one’s fault.”

A Constellation of Factors

“Suicide doesn’t just happen,” Dr. Arango said. “A constellation of things needs to happen before people kill themselves.”

More than 95 percent of those who commit suicide have a diagnosable psychiatric disorder. The mental illness most associated with suicide is major depression.

But a psychiatric diagnosis is only one factor, even if that psychiatric disorder has a biological basis. There is also a specific biological vulnerability to self-destructive behavior. And in addition to a psychiatric diagnosis and a biological vulnerability, “some life event usually triggers suicide,” Dr. Arango said. Triggers vary immensely, from a child’s fear of bringing bad grades home to an adult’s feeling overwhelmed by financial worries.

Of course, a trigger by itself does not lead to suicide, even though it’s often the focus of those who are left behind trying to understand what happened.

“There are people who would never think of suicide when something terrible happens, and there are others who think of suicide first,” Dr. Arango said. “It’s so wrong, the way the news media present it. To say that a kid killed himself because he was bullied in school gives the absolutely wrong impression. Responsible reporters say that the person was depressed or was schizophrenic—say the full truth, not just the immediate trigger. I think that is irresponsible communication.”

A New Way of Talking about Suicide

If the media tend to sensationalize suicide, families often suppress it. The silence that hangs over families who have lost family members to suicide is, according to Dr. Arango, dangerous.

“I think that we are failing to prevent suicide because of the high level of stigma—people don’t want to reach out, and people don’t want to talk about it.”

In the future, Dr. Arango sees a world in which we shift our focus to the underlying psychological and biological problems that cause suicide, rather than the triggers. Once researchers have a biological picture of suicide, clinicians might be able to monitor higher-risk patients more closely than others.

“So many people blame the person who commits suicide when really, it must be so terrible—to feel such despair that the only possible option one can imagine is that one,” she said. “So one of the good things, I think, about finding something biological in this is that it should help to remove the stigma associated with suicide.”

Michele Hoos

 

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