Fifteen Eighty Four

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Is Suicide Preventable?

Kees van Heeringen

Photo by ActionVance on Unsplash

Dr. Kes van Heeringen began studying suicidal behavior as a young psychiatrist in the 1980s after having met Valerie following her serious suicide attempt. At the time, it was a complete mystery why such a bright young girl could do such a horrible thing. Since then, an increasing amount of studies have led to the discovery of characteristics that may help to understand and prevent suicidal behavior.

Suicide is the devastating consequence of profound human suffering, affecting millions of people around the world. Unfortunately, suicide rates are increasing in many parts of the world including the US, reflecting the fact that it is difficult to predict and prevent with currently used approaches. This may be due, at least in part, to the fact that there never is one single cause. It has become clear that, contrary to popular belief, suicide is an abnormal reaction to a normal situation: it is often triggered by common events such as financial, relational or professional problems or depressed mood states, which fortunately do not lead to suicidal behavior in the vast majority of people. There thus is something more than a precipitating event or mood state to explain suicidal behavior, and neuroscience shows what this is and how it can be changed in order to prevent suicidal behavior.

The core difference between suicidal and non-suicidal reactions to such common life stressors is intense emotional pain that is perceived as being without end.

The core difference between suicidal and non-suicidal reactions to such common life stressors is intense emotional pain that is perceived as being without end. Studies have consistently revealed remarkable neurobiological correlates of these perceptions in brain functions in individuals with suicidal thoughts and behaviors. These changes are found at cellular and molecular levels, but also in the ways that nerve cells work together in complex systems that give rise to higher-level cognitive functions such as attention and decision-making. Changes in brain systems thus lead to attentional biases that are at the core of the increased sensitivity to triggering life events. As a consequence, suicidal individuals may use different kinds of information about their lives and their future for decision-making when compared to non-suicidal individuals. They thus may be impervious to positive information such as hope and possibilities of treatment. Changes in brain systems lead to the incapacity to learn and change their minds, which leads to the perceived hopelessness that is so closely related to suicide.

At the same time, we are now beginning to understand the causes of these changes. These include genes and early-life adversities. For example, brain imaging studies clearly show that traumatic early-life experiences such as sexual abuse lead to molecular and structural changes in brain systems that are involved in the described neurocognitive characteristics of suicidal individuals.

Targeting these changes in brain systems by means of interventions such as psychotherapy and neurostimulation provides new avenues to the prevention of suicidal behavior. Neurocognitive and neuroimaging studies clearly show that this is possible. Psychotherapy, specifically targeting suicide risk, may reduce attentional biases and facilitate the process of changing negative beliefs about the future that are at the core of feelings of hopelessness. Whether or not in combination with psychotherapy, non-invasive neurostimulation techniques can target particular brain systems and change their patterns of activation so that more positive information is used for decision-making, thus reducing levels of hopelessness. Neuroscientific studies clearly show that learning and the change of beliefs and goals are the primary drivers of neural functioning and plasticity in the brain. There thus clearly is no solid basis for a distinction between ‘biological’ and ‘psychosocial’: both neurobiological treatments and psychotherapy can change the brain systems that are clearly involved in suicide risk.

There should be no more stories like Valerie’s serious and nearly fatal suicide attempt, and neuroscience can effectively contribute to reaching this goal. The study of the neuroscience of suicidal behavior provides badly needed new insights in the causes and treatments of suicide risk.

Find out more about: The Neuroscience of Suicidal Behavior


In honor of Mental Illness Awareness Week and World Mental Health Day, Cambridge University Press is giving away free journal articles and book chapters related to mental health and wellbeing for the full month of October 2018. Click here to learn more.





About The Author

Kees van Heeringen

Kees van Heeringen is a Professor of Psychiatry, Chair of the Department of Psychiatry and Medical Psychology, and Director of the Unit for Suicide Research at Ghent University, Be...

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