Sometimes we need to discuss topics that are difficult to read, but important nonetheless, both for clinicians and women with postpartum depression. This is one of those topics.
It has long been presumed that suicide is an impulsive act linked with mental illness. And it does, unfortunately, pose a very real threat within the population of postpartum women. Because of this, clinicians and families alike must be vigilant about assessing any suicide risk and following through with actions that might reduce this risk.
Asking a new mother who sits desperately across from you seeking immediate relief if there are guns in her house can feel counter-therapeutic at times, or intrusive, or downright rude. She may be insulted by the question, she may be startled, she may simply say no, or she may say yes.
Reducing her access to available opportunities is crucial when considering the impulsive nature of suicide.
In a recent article in the New York Times magazine, this was examined in brilliant details in “The Urge to End it: Understanding Suicide.”
Read the article. It is wonderfully written and well-researched. It’s important.
The author points out that we have evidence to support the notion that “merely closing off one means of self-destruction” by creating “physical barriers to suicide” or “means restriction”, does indeed significantly reduce suicide. This raises the question that most people often ask: If people really want to kill themselves, won’t they just find another way?
It seems they will not.
Richard Seiden, professor emeritus and clinical psychologist at the University of California at Berkeley School of Public Health, says this is largely due to a time factor. If we distract the person by slowing down their means to act, we allow time to pass that may block the impulse.
“At the risk of stating the obvious,” Seiden said, “people who attempt suicide aren’t thinking clearly. They might have a Plan A, but there’s no Plan B. They get fixated. They don’t say, ‘Well, I can’t jump, so now I’m going to go shoot myself.’ And that fixation extends to whatever method they’ve chosen. They decide they’re going to jump off a particular spot on a particular bridge, or maybe they decide that when they get there, but if they discover the bridge is closed for renovations or the railing is higher than they thought, most of them don’t look around for another place to do it. They just retreat.”
So ask the hard questions. Take a detailed suicide assessment. Make sure you do your best to understand what she may be thinking or contemplating, even if she doesn’t “look like” she’s capable of thinking these things. Make certain you know what she has access to. Do your best to implement “means restriction.” Reduce the temptation, reduce access, interfere with the obsessional loop that can lead to impulsive acts, let her know you will do your best to protect her from her thoughts.
Ultimately, we understand that there is only so much we can do. But we can, at least, be doing that.
Click here for PPSC Suicide assessment