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The Elephant in the Room

There are only a few emergency situations in the practice of psychiatry. However, these emergencies can be devastating—not just to the patient and their loved ones, but to everyone involved, including the care providers. Suicide is the most feared emergency of them all. It’s a hard topic to discuss, in both clinical and non-clinical settings. It is the elephant in the room, and society needs to have a conversation about it.

According to U.S. Centers for Disease Control (CDC) reports in 2016, suicide rates increased by 24 percent between 1999 and 2014. In absolute numbers, nearly 45,000 suicides occurred in the United States in 2016—more than twice the number of homicides—making it the 10th-leading cause of death. Among people aged 15 to 34, suicide is the second-leading cause of death.

“Why did they do it?” is the question we all ask. There are a handful of common factors that arise when one works with people struggling with suicidal feelings.

While rates of depression, anxiety and other mental illnesses are increasing in our society, more than half of suicides are due to societal factors.

Hopelessness or despair—the feeling that there is no solution to a problem one is facing—is a leading factor. This is often coupled with the feeling, “Nobody gets me.”

Another factor to consider is the social isolation that many of our youngsters are reporting. As we are advancing to a more tech-dependent socializing experience, it deprives us of all of the benefits of socializing, even at the neuronal level.

We also have to deal with the onslaught of chemical toxins in our food, water and environment that is compromising our microbiomes and leading to inflammation in our guts, brains and throughout our bodies. Researchers at John Hopkins are finding evidence that irritation in the gastrointestinal system may send signals to the central nervous system (CNS) that trigger mood changes, which may explain why a higher-than-normal percentage of people with IBS and functional bowel problems develop depression and anxiety.

All these factors can contribute to poor stress moderation, poor coping skills, poor distress tolerance and poor problem-solving skills. Over time, this can create the state of apathy and despair that can eventually lead to suicide.

Perhaps it is time to view suicide as a public health crisis. However, suicide is most often viewed as a “mental health crisis” and the common refrain in the media is that more access to mental health treatments should be available. Unfortunately, the answer is not as simple as it seems: a study published in 2017 in the International Journal of Risk & Safety in Medicine, declares, “The previous assumptions that treatment with antidepressants would lead to a drastic reduction in suicide rates are incorrect for the population of young women. On the contrary, it was found that an increasing tendency of completed suicides follow the increased prescription of antidepressants.”

Of course, one cannot abandon provision of care delivery systems altogether, but it should make us all reevaluate what we are doing in response to a problem of this magnitude. It is high time that we move away from a simplistic “medication or therapy” solution.

Within a holistic, root-cause framework, we can evaluate the role of hormones, nutrition, relationship skills and problem-solving skills. We can put in place solutions to optimize these areas. At the level of the society, we can work towards reducing stigma surrounding mental illness and suicide, and we can commit to enhancing the inter-connectedness that we have with each other. We can teach meditation and other self-help skills that promote a decrease in stress. We can work for equitable distribution of nutritional and other resources, and we can provide resources for vulnerable populations such as teens and veterans. We can make our environments less toxic, and we can reconnect with nature.

But none of this will happen until we take the first step: We must talk about the elephant in the room.

Aruna Tummala, M.D., is a board-certified adult and geriatric psychiatrist and founder of Trinergy Center for Integrative Psychiatry, which is located at 12800 W. National Ave., New Berlin. For more information, call 262-955-6601, email or visit

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