Suicide: When it hurts too much to go on

Wednesday, March 11, 2015
Interview with Dr. Ziad Nahas MD, MSCR
Suicide: When it hurts too much to go on

The topic of suicide has received much attention over the span of 2014 and it is a serious public health issue that affects everyone. The death of Robin Williams put suicide up front and into the spotlight, somehow making the matter more real and magnified to fans and the general public. With social media bombarded with the devastating report as the news broke, people started talking and wondering – why? How could someone famous, wealthy, and always so funny reach that point of no return? While there will always be many unanswered questions in each unique scenario, there are some elements we can try to understand to put this mental illness into perspective. The important point to make here is that suicide is preventable – so let’s get talking about it.


Dr. Ziad Nahas is a Professor and Chair of the Department of Psychiatry at the American University of Beirut Medical Center (AUBMC) and the Director of Mood Disorders and Neuromodulation Program. He discussed with us the dynamics of suicide with the goal of shedding some light on such a serious and important issue. It’s time to get talking about mental illness openly in Lebanon.


What statistics do we have regarding suicide rates in Lebanon?

Suicide is a global issue; it is one that affects individuals of all ages, races, ethnicities, and socio-economic status’. The WHO estimates that 800,000 people die from suicide each and every year. Here in Lebanon, it is estimated that at least one person dies from suicide every three days.


What are the risk factors for suicide?

In regards to risk factors, the first and foremost factor is a history of suicidal behaviors or attempts. It is worth noting that according to the U.S. Department of Health and Human Services, at least 90% of all those who attempt suicide suffer from one or more treatable mental disorders including depression, drug/alcohol dependence, and schizophrenia. In addition, other risk factors include a family history of suicide, having a terminal illness, having gone through a stressful life event or loss, feeling socially isolated and alone, and having a history of abuse or neglect.


Many people view suicide as a selfish act. What can you say about this?

Those who are suicidal do not actually wish to die; rather they simply want to end the terrible and unbearable pain they are experiencing. Ninety percent of suicide cases are the result of some kind of mental illness – and mental illnesses need treatment just like any other physical illness or disease. Suicide affects everyone; for family members, it is devastating and the emotional wounds last a lifetime.


If someone we know expresses suicidal thoughts or behavior, should we always take it seriously?

Any verbalization on the topic of suicide should be taken completely seriously. This is a cry for help; it’s not only a warning sign. If you pay close attention, there are often a number of warning signs, even if subtle. Those who are suicidal often experience severe levels of anguish and might reveal significant changes in their lifestyle. Seek help if you notice any of the following warning signs:


  • Losing interest in most activities
  • Saying things such as “I have no reason to live”
  • Feeling trapped
  • Suffering from unbearable pain
  • Feeling they are a burden
  • Using alcohol and drugs
  • Behaving in a reckless manner
  • Withdrawing from typical, daily activities
  • Having extreme mood swings
  • Having an interest in death
  • Giving away personal possessions


Did you know that although women are more likely to attempt suicide, men have a higher rate of dying from suicide? People over the age of 65 are at the greatest risk of death by suicide.


When a person is unsuccessful in their suicide attempt, how does it affect them?

Someone who has been unsuccessful in their suicide attempt can end up feeling even worse than they felt in the first place. They might feel more depressed, ashamed, and of course, guilty. Such feelings can be due to their failed attempt of suicide and/or because they realize how they have affected and disappointed their loved ones.


How can we all work on prevention together as a community?

If you know of someone who is struggling with suicidal thoughts, it is mandatory to seek help as soon as possible.  If you recognize the symptoms of suicidal thoughts, measures can be taken to reduce the chances of a suicide occurring. It is the emotional pain that drives such thoughts and that can be treated. There is help available. No one should hesitate to seek the help they need.


What does the treatment for suicidal thoughts and behaviors entail?

Treatments include psychotherapy, medications, and hospitalization. Psychotherapy aids patients to comprehend how their thoughts and behaviors affect each other. This form of therapy is very effective for many who struggle with ideas of hurting themselves. There are various medication treatments available as well to effectively treat a patient’s underlying mental illness. Two particular drugs known to be protective against suicide include lithium and clozapine – of course prescribed under the supervision and guidance of a physician. Those at a high risk level of committing suicide must be hospitalized; this includes those who have attempted suicide in the past, those who have shown intention, and those who have been suffering from severe depression or any other mental illness.


Suicide is a complex issue and one that needs to be discussed openly. The more we all talk about it, the better we can try to tackle it. If you or someone you know is dealing with mental health issues, do not hesitate to seek the necessary help. Through AUBMC, Embrace has been created to increase public and professional awareness of mental health issues.



What is Embrace? Embrace Fund at AUBMC is an awareness support network for mental health in Lebanon and the Middle East affiliated with the Department of Psychiatry. It is a one of a kind charitable and fundraising initiative for mental illnesses.


How Can Embrace Help? Embrace will help cover some of the outpatient and inpatient hospital treatments for underprivileged individuals who suffer from disabling and often life threatening psychiatric and psychological conditions. These include mental illnesses such as depression, bipolar disorder, schizophrenia, generalized anxiety disorder, obsessive compulsive disorder – all of which if are not treated – can lead to serious disability and an increased risk of suicide among individuals suffering from them. A major goal for Embrace Fund is to create the first suicide prevention hotline in Lebanon and the Middle East. Donations are needed to accomplish this goal.


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Did you know…?

  • Suicide occurs all over the world and can take place at almost any age. It is the second leading cause of death in 15-29 year olds. For each adult who died by suicide, 20 others attempted it (WHO, 2014).
  • In its latest report on suicide prevention, the World Health Organization estimated that 43 deaths by suicide occurred in Lebanon in 2012 (WHO, 2014). However, official records for that same year reveal a serious discrepancy: 107 deaths by suicide were registered. Accordingly, someone dies from suicide in Lebanon every 3 days. Experts believe this number is an underestimation of the scope of the problem. Social, religious, and legal aspects of the local culture bias the reporting of suicide cases.
  • A number of local studies have also highlighted the presence of suicidal ideation, a major risk factor for death by suicide. The Global School-based Student Health survey revealed that 15% of students aged 13 to 15 years in Lebanon seriously considered attempting suicide at one point in the 12 months prior (WHO, 2011).
  • Two recent studies conducted by the AUBMC Department of Psychiatry (pending publication) also point to the urgency of attending to this problem. One found prevalent suicidal ideation rate among healthcare workers in Lebanon. The other estimated that a third of psychiatric patients seeking treatment struggle with thoughts of self-harm.
  • In Lebanon, one out of every 4 individuals suffers from a mental disorder throughout their lives, but, only a minority obtains treatment (Karam et al., 2008).
  • The World Health Organization recommends a number of strategies for suicide prevention, including reducing access to the means of suicide, having responsible reporting by the media (i.e, not sensationalizing or glamourizing suicide) and strengthening community and social support.
  • Embrace Fund is taking a serious first step towards suicide prevention in Lebanon by starting a well-needed conversation around a taboo topic and a serious problem that affects us all.
  • On September 21st, 2014, a special early morning walk took place at Raouche with proceeds raised for funding a suicide hotline, a vital service that is currently non-existent in Lebanon. Alongside, a major happening was revealed with a large banner physically embracing the Raouche rock with a message of hope: If we can embrace Raouche, together we can embrace everyone so not to have 1 suicide every 3 days in Lebanon.
  • In a short period of time since its launching in October 2013, Embrace Fund at AUBMC set in motion the first large scale media-driven National Mental Health Awareness Campaign in Lebanon “Fekko el 3e2de,” and more recently the National Awareness for Suicide Prevention Campaign “Akeed ra7 fee2,” and began assisting underprivileged psychiatric patients in covering their treatment expenses.