I Donât Want to Die is for anyone who works in the field of mental health or seeks help for a vulnerable loved one who may be showing suicidal tendencies.
With decades of clinical experience and research behind it, this new look at suicide prevention takes a comprehensive approach to the assessment of suicide risk and presents effective approaches to intervention and prevention.
Starting with an overview of depression and its effects, I Donât Want to Die discusses why and how someone chooses suicide as a âway outâ of their problems. A thorough assessment tool and strategies for intervening in a suicidal crisis are described in a clear, easy-to-follow style.
The need for suicide education in schools and the role of the media are also discussed. I Donât Want to Die also examines the ethical issues often faced by those who work in the field of mental health and poses the question for the practitioner as to the ârightâ of an individual to commit suicide.
I Donât Want to Die is written in a user-friendly style for professionals and laypersons, and it offers a unique approach that focuses on both content and process when assessing risk.
I Donât Want to Die is for anyone who works in the field of mental health or seeks help for a vulnerable loved one who may be showing suicidal tendencies.
With decades of clinical experience and research behind it, this new look at suicide prevention takes a comprehensive approach to the assessment of suicide risk and presents effective approaches to intervention and prevention.
Starting with an overview of depression and its effects, I Donât Want to Die discusses why and how someone chooses suicide as a âway outâ of their problems. A thorough assessment tool and strategies for intervening in a suicidal crisis are described in a clear, easy-to-follow style.
The need for suicide education in schools and the role of the media are also discussed. I Donât Want to Die also examines the ethical issues often faced by those who work in the field of mental health and poses the question for the practitioner as to the ârightâ of an individual to commit suicide.
I Donât Want to Die is written in a user-friendly style for professionals and laypersons, and it offers a unique approach that focuses on both content and process when assessing risk.
UNDERSTANDING DEPRESSION IS a vital part of understanding why someone commits suicide. While a common myth claims that people who commit suicide are âcrazy,â conventional diagnostic and statistical manuals define depression as a mental disorder, which can be categorized as a mood disorder, which is just what it sounds likeââa mental disorder that affects oneâs mood. Many mental health conditions include symptoms of depression, such as bipolar disorders (also classified as a mood disorder), post traumatic stress disorder (PTSD), thought disorders, including schizophrenia, postpartum depression, acute trauma, and seasonal affective disorders, and anxiety (also considered a mood disorder, though a slightly different type in relation to its symptoms and possible origins). Treatment approaches are typically specific to the type of disorder, but there are similarities, which specialists must determine as they offer treatment. Depression and anxiety are two of the most common forms of mood disorders. Depression is characterized by several major symptoms that could go either way. For example, someone may suffer from a lack of sleep, or they may sleep excessively, anywhere from twelve to fourteen or more hours a day, and remain tired. Appetite disturbance is also a symptom of depression, which can cause a lack of appetite or overeating. Many of us know someone who combats their depression by trying to eat away their feelings with a package of Oreos. Other symptoms of depression include sadness, irritability, apathy, anhedonia, and a general loss of interest, caring, and motivation for almost anything. 1 2 I DONâT WANT TO DIE Depression affects people in different ways. For example, adults tend to manifest most of what are considered âclassicâ signs of depression. Adolescents, however, particularly adolescent boys, do not always exhibit these stereotypical signs. Almost by nature, adolescents experience emotional ups and downs. One minute, a teenager might appear happy, while the next minute, they might be anxious, agitated, sad, angry, depressed, or frightened. These so-called mood swings can be attributed to hormonal changes and the emotional upheaval of adolescence. I remember a comic strip about a teenage boy named Kudzu. In one strip, Kudzu is walking along, looking normal. In the next panel, his eyes are bugged out, his hair is on fire, his arms and legs shoot out in all directions, and his mouth is wide open. In the next panel, he is walking along, looking like himself again. The caption read âHormone Attack.â T his is what makes diagnosing depression in adolescence difficult, along with many other potential psychiatric disorders. As mentioned, depression is particularly difficult to diagnose in adolescent boys. Depression in a fourteen- or fifteen-year-old boy is often exhibited by anger. Weâll examine this more in chapter seven. MANY FACES, MANY FORMS Now, you can begin to see that depression has many faces and can be manifested in many different forms. Understanding the origins of depression for each person is just as important as understanding how that person is affected by their depression and how it manifests itself. In general terms, depression comes in two forms. The first is classified as a depressive illness. This is a form of depression that has a specific psychophysiological foundation that can be traced to certain biochemical imbalances and shortages. T here is more and more evidence of genetic predispositions to depressive illness. We are also learning more about bipolar disorder TOM BUTERO, MSW 3 and the potential risks that occur mostly during the depressive phase of the disorder. T he symptoms of a depressive illness usually include most, if not all, of those mentioned above. They can, however, be, and often are, of a much more severe nature. The best approach to treatment is a combination of medication and psychotherapy. Talk therapy alone will not address the physiological aspects of the illness. Medications to treat depression have come a long way, especially in the last few years. Now we also have a family of supplemental meds that work in tandem with a primary antidepressant medication. Medications to treat bipolar disorders, psychotic illnesses, and other biochemically induced depression have also seen significant advances in terms of their effectiveness. In my experience, any type of depressive illness is less prevalent than a type of depression I refer to as being more reactive in nature. Donât misunderstand. A psychophysiological basis for a depression is serious and can carry an even higher level of risk for suicide than a reactive depression. This is mostly due to the severity of the depression. T hat said, the dynamics behind suicidal ideation or even an attempt are similar, despite the circumstances. GRIEF AND DEPRESSION In On Death and Dying, Elizabeth Kubler-Ross defines the five stages of grief. One of those stages is depression. I believe Kubler-Ross is referring to reactive depression; the personâs depressive mood is a reaction to something that occurred in their life. I have found that this type can usually be traced to some form of loss. Kubler-Ross talks about loss in relation to death. I suggest, however, that you expand your definition of loss and understand that the concept can be attributed to different experiences. For example, relational breakups are a loss. Relocating can be a loss, cutting ties with close family, friends, and coworkers. Loss can relate to how we function in certain areas of life. That 4 I DONâT WANT TO DIE straight A student, for example, who gets a C for the first time may experience a loss relative to their grade point average, class ranking, and sense of accomplishment. T he injured athlete who is forced to give up their sport experiences a loss. Developing a life-threatening illness can be seen as a loss of health and wellness. T hese are examples of loss, but they are defined differently. I have seen that no matter what type of loss someone experiences, their reaction is akin to grief, as Kubler-Ross describes. T hinking about loss in this way helped me identify varying degrees of grief. Defining a clientâs feelings in this context can help them comprehend the ânormalityâ of their experience. LOSS OF IDENTITY AND DEPRESSION In the early 1980s, there was a sharp increase in unemployment in the US. You can draw your own conclusions as to the reasons behind it, but one factor stood out. Many of the newly unemployed were professionals and upper level managers in their fifties, who, after working twenty-plus years for the same company, were being laid off in large numbers. Many of them were men who also occupied traditional roles of husband and father and were often the primary source of income for their families. At that time, I worked for an agency in an upper-middle-class suburban area of Chicago. While following local news and tracking other sources, we discovered that the communities we served seemed to have an inordinate number of men who fit the profile as I have described and found themselves newly unemployed. In response to this phenomenon, I decided to organize a weekly support group for unemployed men. I wasnât trying to be discriminatory or exclusionary, but I was working with the theory that there were probably several issues, reactions, and concerns that these men would have in common with each other. This proved to be the case. TOM BUTERO, MSW 5 Our initial concerns about how a group like this would be received and whether we would get anyone to participate were put aside when f ifteen men, ranging in age from their late twenties to early sixties, showed up to the first meeting. Some returned after the first meeting, and others did not when they realized that the goal of the group was not to help them find a job but to help them deal with the emotional issues associated with their situation. T he group continued for more than a year, and as people came and went, we decided to include activities related to job seeking, such as role-playing interviews and videotaping them for review. At one point, we brought in an executive recruiter who explained what he looks for in a candidate and how to prepare a rĂ©sumĂ© and cover letter. Over time, the group took on a life of its own. I knew it had become successful when they met without me while I went on vacation. Some members developed friendships that continued outside the group. A few even organized a group outing to a Cubs game. T he sense of loss (and depression) these men experienced was evident from the first day they walked into the group. The loss of their job was the most obvious trigger, but there was also a loss of income, security, and, in some cases, family. At least two members had their marriages end in divorce. Whether this was a result of their job loss is debatable, but it was likely a contributing factor. We also saw an overriding loss of identity, which affected their sense of self-worth. When new members joined the group, I asked everyone to introduce themselves. âMy name is Howard. Iâm an engineer.â âIâm Frank. Iâm a plant manager.â T his is how it went. Each man identified himself through the lens of what they did for a living. They were architects, scientists, insurance executives, computer consultants, etc. Take those positions away, and they struggled to answer that question. Even though they were no 6 I DONâT WANT TO DIE longer doing that job, they would still define themselves in relation to their chosen profession. T he difficulty for many was how persistently they held onto that identity, which sometimes got in the way of their ability to seek employment in a different field. However, a few were able to apply hobbies or avocations to their job search. There was no question that the group offered a much-needed outlet. As a clinician, I also observed them from a more detached perspective in relation to their emotions and behaviors. It was amazing how some worked through their loss and grief, while others struggled. Many of the most recently laid off men entered the group in a general state of denial and, later, anger. Many needed to vent about how unfair it was and how angry they were at their employer. At the same time, they talked about how this was a transitory situation and that they were sure they would have no problem finding a new job within a few weeks. One new member was younger than most. James was married and had two young children. He came to his first meeting with a bit of bluster. âThis is just temporary,â he said. âIâll be fine.â âReally?â said another member. âIâm an accountant,â James said. âThey always need guys like me, so Iâll be fine.â âWell, if thatâs the case, why are you here?â said Lawrence, one of the charter members. James smiled. âMy wife thought it might be a good idea. You know, maybe pick up a few tips. Gets me out of the house too. I think she wants me out of her hair.â T his comment prompted a few smirks. Do they appreciate his futile attempt at humor, or is this their way of warning, wait and see? I thought. After two weeks, then a month, and then six weeks, James was no TOM BUTERO, MSW 7 closer to securing a job than his first meeting. He had a few interviews, but the candidate pool was too large. Sensing his struggle, the other members tried to offer support. âIâm beginning to think this is not going to be as easy as I thought,â James said. One of the members couldnât help but laugh. âYou just now f iguring that out?â âListen,â Lawrence said. âIâve been coming here for over four months. But Iâm nowhere closer to finding a job than I was last summer.â James looked at him. âSo, why do you keep coming? Whatâs the point?â âThe point, my friend, is that it keeps us sane,â said Lawrence. âThings are tough out there. Youâre just finding that out. But at least here, I can share my frustration and my anger with people who understand where itâs coming from. Do you get angry?â James looked puzzled. âDo I what?â âDo you get angry? Do you blow up at people?â Walt, another member piped in. âAre you sleeping? You look like youâve lost a few pounds since I met you. Are you eating? I bet you arenât. Do you ruminate? Are you worried?â âOkay, wait a second,â James said. âWhatâs with all these questions? Whatâs any of this got to do with getting a job?â Lawrence looked at me. âTom?â I looked at James and then at the rest of the group. âItâs called grief,â I said. James shook his head. âI donât get it.â I looked around the circle of chairs. âGentlemen?â One by one, they spoke up so quickly and pointedly that I almost couldnât keep up. Lawrence, again, took the âpodium.â âJames, when you first came here, you were in denial. We all saw it. You remember?â He went on, âYou were so sure youâd find a job right away. It 8 I DONâT WANT TO DIE never occurred to you that it might not happen that way. Now youâre looking and sounding angrier.â âAnd maybe depressed?â another member offered. T he more they said, the more James looked sad, almost defeated. Lawrence had become the unofficial spokesperson for the group. He held up his hand as if to say enough. âJames, listen. Weâve all been there, exactly where you are. Tom has been our go-to guy to explain what it all means, but weâve all been there.â âSo, what are you saying?â James said. âIâm saying that what youâre going through is normal,â said Lawrence. Alex spoke up. âThe good news is that you can get over it. I have. I came here in the same state as you are now, but I got past it.â âHow?â James asked, now more interested. Alex explained himself. âThis group helped me. I was able to share what was going on inside. I got the support I needed from these guys to move on. You will too. You just have to let it go and realize that who you are doesnât have to be wrapped up in a job. Once you do that, the rest is easy.â James listened, but I wasnât sure he was getting it. âDo you get what theyâre saying, James? Do you hear them?â I asked. âI think so, but Iâm not sure. But I donât understand how this helps me find a job.â Alex threw up his hands and sighed. âOh, youâll get it eventually. Just keep coming and listening and learning. Youâll get it.â James finally did âget it.â In fact, three weeks later, he found a new job. We werenât sure what happened, as he just stopped coming to the group. The following week, the local bakery delivered a box of goodies with a note from James, thanking us for everything. T his is how it went. New members would join the group, and I could almost pinpoint where they were in relation to their grief TOM BUTERO, MSW 9 process. Almost invariably, reality would set in about how difficult it was to find a new job. Thatâs when the depression phase often began to show. T hose who were able to work through that stage successfully and move on finally got to the final stage of acceptance. Interestingly, for many of them, it wasnât until they reached acceptance that they were able to find employment. I drew a very unscientific conclusion that being stuck in one of the earlier stages of grief was getting in the way of their ability to find new jobs. Sometimes, I observed a member of the group as he got stuck in the depression phase of his grief process for what seemed like an inordinate length of time. At that point, I sometimes offered to meet with the person individually to discuss those feelings. When asked, they were forthcoming about whether they had experienced thoughts of suicide. As far as I know, there were no attempts among any of the members, but a few of them were clearly having difficulty working through their depression. Some felt that they could benefit from one on-one therapy. Boundaries being what they are, I would refer them to a colleague for ongoing individual work. T his group was a clear example of how a loss other than death can trigger a grief reaction. It also displayed how being stuck in the depressive phase can lead to suicide consideration. ONE SIZE DOES NOT FIT ALL Depression exists âin the eye of the beholder.â Something perceived by one person as relatively inconsequential might be extremely troubling to another. For example, consider an adolescentâs experience of the loss of a pet. While most adults would react to this with sadness and loss, a young person may be more deeply affected. T hink about this. The dog is often a teenâs most loyal friend. The dog doesnât care if they didnât clean their room. The dog doesnât care 10 I DONâT WANT TO DIE if they failed an exam. The dog is there every day to greet them with a wagging tail and kisses. The loss of this lifetime companion can be traumatic for the adolescent. Feelings are legitimate, no matter the situation. This is especially important for parents, spouses, etc., to understand and appreciate.
In 2023, 12.8 million Americans seriously considered suicide, 3.7 million made a plan, 1.5 million attempted it, and 49,000 diedâthe suicide clock increments by one every 11 minutesâand by 100 in less than a day.
One of the major causes of death in the USA today is suicide. No one really wants itâitâs only when someone comes to the point of defeat while coping with some insurmountable threat to life that they groan in surrender, âI really donât want to die⊠someone, please help me!â At that point, the right help can save most.
Suicide is an age-old problem that society silently condemns. Thereâs a stigma attached, and, besides other negative connotations, why I believe it leaves a footprint so stark and sobering is that it presents a specter of the defeat of human life itselfâthus, something none can ignore.
Over the centuries, assisted by concerned people from other walks of life, the medical profession has been trying to cope with and contain suicide. Consequently, Tom Buteroâs I Don't Want to Die: A New Look at Suicide Assessment, Intervention, and Prevention is particularly valuable because it presents a modern and up-to-date view on this disturbing topic. Moreover, the author is a suicide specialist who has over 40 years of practice experience as a clinical social worker, after acquiring an MS degree in social work from George Williams College, Chicago.
The book singles out depression as the central cause of suicide. A series of demographic factors abets depression. To assess an individual's risk of suicide correctly, the doctor must use expert skills to choose the right ones that match the clientâs exact context.
Whatâs new and noteworthy about this book is the up-to-date picture it presents of suicide in our timesâan age marked by the pace and pressures of living in an advanced, digital, high-tech world! For instance, it informs a new type of suicide called âsuicide by copââone caused by provoking a police officer to kill you (e.g., pointing a gun at an officer to provoke a return of fire, but not kill). Another is the concept of "no-suicide contract," a suicide prevention strategy in which the client agrees to delay suicide for a short time. The USA decriminalized suicide in 2013. Consequently, this book also discusses issues like ethics, situations when it is right for one to intervene in the life of a suicidal person (even against their wishes), etc., within the broadened framework of current law.
This book, which reads like a supplementary resource on mental health, has a limited and clear audienceâmainly clinical social workers/psychologists/psychiatrists. No one else can benefit much from it, so I recommended it only to mental health students/professionals, and physicians/those who care for those at risk of suicide.