Enrique Echeburúa, psychologist: "Those who commit suicide want to stop suffering, not stop living"

Enrique Echeburúa (San Sebastián, 72 years old), emeritus professor of Clinical Psychology at the University of the Basque Country (UPV/EHU), says that when a suicide occurs, in addition to the deceased himself, there are other victims, and they do not receive adequate support. "The first thing is to make it easier for that family, who has lost a child, or that person who has lost their partner, to vent, to comment on it," he explains. "The worst thing is the silence, because many people do not talk to them, even from their circle of neighbors or their friends, because they do not know how to approach, and this leads to social isolation," he continues in a video call conversation.

The psychologist, who has just published a book entitled Death by suicide (Pyramid), has summarized in just over 150 pages the fundamental aspects of a particularly human and painful phenomenon. "We have a very high cognitive capacity that can make us experience suffering and disappointments with great intensity, and make us aware that we can end our lives. Those who commit suicide want to stop suffering, not stop living," he says. In the work he tries to present this public health problem, to understand it and to combat the stigma that has made it difficult to take adequate prevention measures and has increased the suffering of survivors.

Question. Can suicide be fought as if it were a disease?

Answer. Suicide is not a mental disorder like depression or addictions. In a high percentage, from 70% to 90% of cases, there is an underlying mental disorder, but there are 10% to 20%, who are people who can reach a moment when they make an existential balance, see that their life no longer has meaning, that they do not have a life project, that they feel isolated and experience a certain fatigue of living. These people may be influenced by external factors, such as an economic collapse. Shame, feeling socially marked at a certain moment, can also lead them to commit an impulsive act of despair, because death is seen as the only way out of suffering.

Q. There is now an especially intense concern about suicides in young people and adolescents. Has the situation worsened?

A. The highest number of suicides in Spain is not among young people. The peak is in adult life, between 30 and 59 years, and a second peak in those over 65, which can account for approximately 25 to 30%. Teenagers or young adults, between 15 and 30 years old, can make up about 13%. It is much less frequent than in the elderly, but the sensitivity to suicide of a young person is much higher. Another important issue is that, in recent years, in Spain, the number of deaths from traffic accidents has been radically reduced, and these deaths largely affected young people and now, in that group, suicide appears with a much greater relevance of unnatural death.

More informationWhat can be done in Spain to curb the growth of suicides?

Q. There is also more concern about mental disorders in adolescents, apart from suicide.

A. There are other phenomena linked to suicide, but which are not suicide, such as self-harm in adolescent girls or suicidal ideation. There are many people who have suicidal ideation and that, if not treated properly, can translate over time into a completed suicide. In Spain, from the pandemic, there would be a clear increase in people with suicidal ideation or adolescents who self-harm. On the other hand, regarding the number of completed suicides, we lack a broader time series to be able to draw conclusions. In principle, suicide is relatively stable numerically. The most relevant data is not the increase, but that there is no decrease, when that has been achieved in other sectors, such as traffic accidents, or homicides and femicides. It also happens that there is now a much greater sensitivity to this phenomenon, which is undoubtedly positive, because that can cause us to invest more resources.

Q. Do you have any idea why it doesn't go down?

A. There is a lack of understanding and there had also been no serious suicide prevention programs, which are beginning to be developed now. The situation is much better than it was five years ago. There are suicide prevention programs in the National Mental Health Strategy, which has made this problem a priority, the autonomous communities also have suicide prevention plans at school level, we are training the police, firefighters, and professionals who are related to this type of behavior. That, in the medium term, is likely to yield results.

The psychologist Enrique Echeburúa has just published the book 'Death by suicide'Javier Hernandez Juantegui

Q. Is there anything that could be done that is not being done yet?

A. If we speak, for example, of adolescence, much more must be done. Many adolescents are very sensitive to emotional storms, which are experienced with a much greater intensity than in adult life, and that in cases of serious disappointments, in the couple, in relation to parents, with friends, with school results, with suffering bullying for being different, can lead them in a rapture of impulsivity to commit a suicide attempt. In adolescents, the family and the role of the school have a very important weight. In the family, parents may not be going to detect the risk of suicide, but they can see that their child has depression, or an anxiety problem, or that he stops eating or gets hooked on social networks. These are risk factors and it would be good to consult these problems, not necessarily suicide. You can also count on school or educational psychologists that may be at school or with the primary care doctor to refer to the mental health center in the most serious cases. And there are also the telephones that the government has launched, the ANAR Foundation, the Telephone of Hope, the telephone number that the Ministry of Health has put in. All this makes it easier to deal with crisis situations and make it less likely that suicide can be committed. Then, we must also bear in mind that suicide sometimes arises impulsively and there is no chain of behaviors to detect. But it can be done with access control to drugs, to places like some high bridges or access to firearms.

Q. And as general measures for people of all ages?

A. Added risk factors should be monitored, such as having a family member who has committed suicide, having had a suicide attempt, being male, being over 60, living alone or having a chronic or disabling illness. They are risk factors that must be paid attention to give extra support from the medical, psychological and social resource point of view. It is also important to monitor, as we have said, serious mental disorders, depression, psychosis, if there is an alcoholism problem or an eating disorder.

From the educational point of view, both family and school, it is important to create what we call the protective factors. How to make these people resilient to dislikes or jobs or setbacks they may have in their lives, based on promoting self-esteem. For example: do not ridicule them if they are not the first in the class. In general, it is about getting them to have emotional stability, teaching them to solve problems and manage emotions and stressful situations, to promote social relationships, sharing sorrows and joys with the people around us. That is a very important protector for a person.

Q. Can knowledge about the phenomenon be improved to better cope with it?

A. There is something that is not usually done and is what is called the "psychological autopsy". It was created primarily at the behest of insurance companies to determine whether the cause of death was an accident or suicide, because sometimes suicides excluded from collecting an insurance policy. Therefore, they were interested in determining what the causes were. Then, what we wanted to see was what circumstances in each specific case could have led to the loss of that person's life. And that was a study that was done counting on the relatives, with the people who had been with that person, after having let a few months pass from the death when the people were already in a position to provide information. Thus, we wanted to know more about the variables that lead to suicide and thus establish better prevention programs. This is not carried out systematically, because it is very complex to do so, but it would give us light to make better prevention campaigns and more specific treatments, also at different ages.

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