Suicide and Multiple Sclerosis
Suicide and MS have had a long relationship. This is Suicide Prevention Week (Sept. 5-11), and Sept. 10 is Suicide Prevention Day.
Depression is experienced in 40 - 60 percent of the MS population. Although MS is not a fatal disease, severe depression accounts for 3 to 15 percent of MS deaths by suicide. These are not insignificant statistics. While I am not a doctor, psychiatrist, psychologist, or any kind of trained therapist, I am going to talk about MS an suicide today. There are so many options for MSers who feel the pain of depression as well as some other symptoms. There are documented cases of assisted suicides associated with MS, although it doesn’t happen so frequently since disease-modifying drugs have come on the scene. People who have MS and have developed symptoms that make life unbearable consider their options, and some select suicide. Of course, what is unbearable is an individual measure. Even Dr. Jack Kevorkian said, “I don’t persuade to suicide.”
My mother died early last year, but she was depressed and ready several years earlier. After her first stroke, she selected the retirement home where she wanted to live. Another stroke, and she had few abilities and fewer life skills. In time subsequent strokes began eliminating her remaining abilities one by one, including mental abilities, and finally her memory. Her memory was not completely gone as evidenced by her wave as we left after a visit.
One time years earlier I told her about a fun and interesting movie, Harold and Maude. I was impressed by the character Maude who was so full of life and adventure, but had a planned to die when she turned 80, and she did. My mother was not so amused.
Americans don’t like to talk about death at all, and they find themselves unprepared when the moment happens. We know we are all going to die, and we need to take responsibility by preparing, making decisions, and communicating those decisions to family and health care members. Anyone who is depressed finds it hard to go through those steps alone.
People with MS are at higher risk than the general population for depression, which has several causes.
A known side effect of interferon-based disease-modifying drugs is depression, so taking medication to make the MS better results in depression. A lesion in the section of the brain that controls mood could cause depression to come and go, just as with any other symptom. Living with MS is often unpredictable, painful and isolating, and leads to extended periods of frustration and helplessness — sure to bring on depression.
Anyone with MS can be depressed at some time, and the depression makes it more difficult in daily life, but it is difficult to ask for help. The bleakness of MS is multiplied by depression, and sometimes leaves the MSer open to thoughts of suicide to end the pain. One of my favorite authors, Albert Camus, said, “All healthy men have thought of their own suicide.”
It is not always so easy to spot someone who is depressed, even for health care professionals. It seems depression can be a hidden condition. Jerry Kennard gives hints on recognizing depression in another person. When depression is suspected, a doctor should be notified so further inspection can take place.
Mohandas K. Gandhi, the Indian leader who influenced so many, confessed, “If I had no sense of humor, I would long ago have committed suicide.”
Another quotation by Albert Camus is, “There is but one truly philosophical problem, and that is suicide.” Suicide does take thought, and should be considered it is not such a solitary act. Although one person makes the decision and has the control of time and method, more people are involved. Children feel abandoned. The entire family, friends, neighbors and co-workers have a sense of loss, greater than a natural death, and they don’t understand why. So many people — and even pets — are affected. It does take thought.
If death is an option, then life must be an option, too. "Life is better than death, I believe, if only because it is less boring, and because it has fresh peaches in it, " Alice Walker famously said.
Depression, even in MS, can be treated successfully. Drugs, psychotherapy and other forms of treatment may strengthen coping skills. The life span of any typical MSer is only five to seven years less than a same gender, similarly aged person without MS. Life spans are increasing and the quality of life is improving. There is always hope and it seems ever-increasing.
If you feel depressed, hopeless and alone, and you think suicide is the only answer, think again. Tell someone. Talk to your doctor. Talk to your family or a friend. Write to an online friend or write a blog. Call a suicide hot line. There are some valuable resources listed below in Notes and Links. Look at the Depression section right here on HealthCentral. There are people who are mildly depressed and people who are severely depressed, all bravely sharing their feelings, questions, and answers.
Try something to help organize your day. Make a list of things to do tomorrow. Keep it short. Include items like listening to music, talking to a friendly voice, enjoying the sunlight, or some other activity you have enjoyed before. Be sure to add time to eat and take your medications. One item can be to make a short list for the next tomorrow.
Something that might help think through things are lectures from the TED Conference. The TED Conference is a forum of riveting talks by remarkable people. Here is one case that I enjoyed by Dan Gilbert, author of Stumbling on Happiness, who tells us how we can be happy when things don’t go as we planned. The video takes 21 minutes, but it is fun and it has a valuable message.
Why did the guru refuse Novacaine when he went to his dentist? He wanted to transcend dental medication. I don’t mean to be frivolous about suicide or pain, but we have to try to keep a sense of humor. I understand pain. Along with MS, I have trigeminal neuragia (TN) or tic doloureux, nicknamed the "suicide" disease. TN is credited with causing the worst pain known in the medical community. Attacks are very short, but mine tend to come in clusters. A couple of years ago, the attacks were practically constant, affecting my ability to talk, eat, drink and even take medicine. My last attack cluster lasted for months until I found the right pain medication for me.
It is my understanding that TN attacks become more frequent with age. As I age that tendency threatens, and I do not know how I will respond. During my period of constant attacks I understood how people could consider suicide. Something has to end that pain. There has to be hope, and I believe there is always hope.
My online friend Michael B. Gerber wrote a short post in his personal blog that I think is appropriate here. Look at this post and then listen to his short, but inspirational graduation speech.
MS is a difficult disease to live with. There is pain, depression, no warning that it is coming, and no guarantee that it can be corrected. But still, suicide is a decision that cannot be reversed. Once it is done, that’s it. There is no pain. There is nothing. In life, there is always hope.
Notes and Links:
Merely Me’s article - Multiple Sclerosis - “But I’m not Quite Dead yet” Mortality and Multiple Sclerosis