When It Is Darkest: Why People Die by Suicide and What We Can Do to Prevent It

by Rory O'Connor

An evidence-based self-help book on understanding and preventing suicide.

When you are faced with the unthinkable, this is the book you can turn to.

Suicide is baffling and devastating in equal measures, and it can affect any one of one person dies by suicide every 40 seconds. Yet despite the scale of the devastation, for family members and friends, suicide is still poorly understood.

Drawing on decades of work in the field of suicide prevention and research, and having been bereaved by suicide twice, Professor O’Connor is here to help. This book will untangle the complex reasons behind suicide and dispel any unhelpful myths. For those trying to help someone vulnerable, it will provide indispensable advice on communication, stressing the importance of listening to fears and anxieties without judgment. And for those who are struggling to get through the tragedy of suicide, it will help you find strength in the darkest of places.

Genres: Nonfiction, Psychology, Mental Health, Audiobook, Psychiatry, Self Help, Philosophy

352 pages, Paperback

Published January 3, 2022

Reviews

[Sara]

I found this book helpful and amazing.
Started reading this after Azarakhsh Mokri introduced it...

یکم از خود کتاب و حرف های آذرخش مکری بیارم:
چندین مدل نظرات راجع به خودکشی برا روانشناسا/روان پزشک ها وجود داره.

اعتقاد نسل دومی ها در ارتباط با خودکشی میگه در نیمی از خودکشی ها اختلالات روانپزشکی وجود ندارد.

نکته اینه که اختلال روانپزشکی با اختلال رفتاری و شخصیت های سمی و مشکلات فلسفی و اجتماعی باید جدا کنیم.

بحث روزمرگی خودکشی : Everydayness of suicide

افسرده بودن تو بعضی مواقع مانع خودکشی هم میشه. (هم حالشو ندارن، هم بی تفاوتی و میگن ببینیم چی میشه. یا اضطراب مرگ پیدا میکنن.)

افکار خودکشی حقیقتا انقدر نادر نیست.

افکار خودکشی ≠ اقدام خودکشی.
اینطور نیست که اگه فکر شدید بشه تبدیل میشه به اقدام. پروسه ش فرق دارد.

توانمندی کشتن خود از کجا میاد؟ ربطی به افسردگی و ناامیدی و اینا ندارن. تا سالیان سال می‌تونه فکر بمونه ولی هیچوقت ممکنه عملی نشه.

هیجانی که باعث خودکشی میشن لزوما افسردگی نیست و تقریبا اصلا افسردگی نیست. هیجانات دیگه است.

از همون هیجانات که متفاوت از افسردگیه میشه به درد روان= mental pain, psycheache اشاره کرد. این درد همپوشانی داره با درد جسمی. تو سیر تکامل میگن افرادی که نتونستن اتصالات خوب و پایدار در دوران کودکی نوجوانی شکل بدن این درد ممتد روان رو بیشتر دارن.
در تله افتادن هم از مشکلاست. نه راه پیش داره نه راه پس.

کتاب Intelligence trap، تله هوش. آدم هایی که زیاد به خودشون مطمئنن و عقل کل میدونن خودشون رو گیر یه سری تله میندازن.

در تله افتادن درونی. خودم از فلان چیز خودم خسته شدم . خودم رو نمیتونم مدیریت کنم! مرتبطه با کمال‌گرایی و تکانه ای بودن و احساس عقل کل بودن.

خودکشی پدیده ای بحران محوره. تدریجی و فراگیر نیست. در خودکشی با گلوله ، معمولا یا فکرش در میره یا گلوله؛ یعنی یا طرف خودشو می‌کشه تموم میشه می‌ره، یا بحرانه تموم میشه.


خودکشی با اختلالات خواب همراهه. و ربطی به افسردگی نداره؛ میگن وقتی نمی‌خوابی میشینی به اینا فکر می‌کنی و نشخوارش می‌کنی و دیدت هی بسته و بسته تر میشه و فکر می‌کنی خودت بدبخت ترینی. تفکر بسته یا تلسکوپی میگن بهش.

خسته شدن و اگزاسشن، اضافه شدن بار روانی کمر طرف رو میشکنه.


فکر منسجم خودکشی رخ داد با بالایی ها؛ حالا آیا منجر به خودکشی میشه؟ خیر! احتیاج داره تبدیل به اقدام هم بشه.

اکثر افراد یه ترس از مرگ و خویشتن داری برا مرگ خود دارن.
افرادی که در طی زندگیشون هی با خودشون بازی کرده باشن؛مواجه شدن با معقوله مرگ؛ ترسشون از مردن می‌ریزه و کم‌کم توانایی اقدام به خودکشیشون می‌ره بالا.

سایکوپث ها ممکنه فکر خودکشی کمتر بیاد سراغشون ولی مرحله گذر از فکر یه عمل توشون راحت تر و سریعتر رد میشه.

حتا بحث بررسی تتو اینه. چون با بدنشون محافظه کار نیستن و مرحله مرحله آماده میشن و کیپبلیتی کشتن خود رو به دست میارن. اینا رو میشه گفت شجاعت ولی خب حقیقتش اینه که با بدن خودشون راحت ترن اینا و خیلی اتفاقات رو ممکنه بیارن. یه سری خیلی جون دوستن و هیچ جوره آسیب نیمخوان بزنن به خودشون.

دیدگاه IMV. فاز انگیزشی و فاز ارادی.
قبل انگیزشی⇜ انگیزشی ⇜ ارادی
تو قبل انگیزشی ها: دوران تکامل و رشد شاد یا اتصالات امن نداشتن، استرس بالای محیط، استرس بالای اجتماعی و ... (ولی هیچکدوم قطعی نیست ها! وسیله خودکشی ویکده) محصول اینا میشه مغزی که شکننده است و‌ تاب‌آوریش پایینه
حالا هر مغزی که تاب آوریش پایینه منجر به خودکشی میشه؟ ابدا! میگه معقوله بغرنجه

حالا با خودش درد روان رو از فاز اول آورده و وارد فاز دوم میشه: تله اینجاست. احساس عجب گیری کردم؛ دید تونلی؛ شکل گیری یک بحران؛ احساس تحقیر شدن تو اون بحران چون کمال‌طلبه.
حالا یه چیزی اینجا هست که خیلی مفیده: حمایت اجتماعی.
وقتی تو مخمصه افتادی یه دوست خوب/یکی که بتونی رازتو بگی بهش یهو یه ریلیف خیلی گنده بهت میده. یه حجم زیادی که میرن بستری میشن خوب میشن همینه. گاهی مددکار اجتماعی ، دوست و... تو اینا خیلی بیشتر از روانپزشک میتونن جواب بدن. اینا میان تو بحرانه اختلال ایجاد میکنن

تو دید تونلی فقط به بحران فکر می‌کنی و چون نشخوارش می‌کنی خود بحرانه غلیظ و غلیظ تر میشه. بعد شروع میکنی شاخ و برگ دادن بهش. یه حجم زیادی از چیزایی که فکر می‌کنی اصلا رخ نمیده ولی چون نگرانی داری خلاقیتت در جهت مخرب پیش می‌ره. بحرانه با دید خلاقت بدتر میشه.
برا همین هوش و خلاقیت بخصوص تو شب ، یه سری شاخ و برگ عجیب غریب میسازه و بحرانه رو بدتر می‌کنه.

وحشت منهدم کننده یهو رخ میده. احساس درد روانی که از فاز یک میاد رو پررنگ می‌کنه و فاز دو رو به ته می‌بره

فاز سه وقتیه که یه سری چیزایی های که قبلن داشتی به ضررت تموم میشه: با بدنم راحتم. جون عزیز نیستم. تجربه های متفاوت عجیب غریب کردم. مرگ رو جلو چشمام دیدم.
اینا فاز ارادی شدنشون می‌تونه خیلی راحت تر رخ بده. یعنی عبور از انگیزه و ایجاد عمل

محیط هم موثره. میگه اگه راه سهل برا کشتن خود وجود داشته باشه ، اقدام به خودکشی به شدت افزایش پیدا می‌کنه.

ممکنه فکر کنی اگه خب اسلحه نباشه می‌ره سراغ قرص، قرص نباشه جلوش، می‌ره خودشو از بلندی پرت می‌کنه پایین و... ولی نه! مطالعات نشون داده توان افراد برای آسیب به خود خیلی محدود و منحصر به روش های خاصیه.
یعنی مثلاً اگه اسلحه رو از جلوشون برداری، با اینکه کلی افکار خودکشی دارن ولی اقدام نمیکنن دیگه.

از سال ۲۰۰۰ خودکشی تو دنیا رو به کاهشه و دلیلش، کاهش این اتفاق تو کشور چین و هنده. درصورتی که مثلا خودکشی آمریکاو... رفته بالا ولی آمار جهانی کاهش داشته.
دلیلش چی بوده؟
دیگه دسترسی به سم های دفع آفات نداشتن تو اون دوتا کشور و همین باعث شده رسیدن به فاز سه خودکشی برا آدم‌ها سخت بشه و آمار جهانی خودکشی رو‌ آوردی پایین. چون نشون داده شده برا بعضی افراد روششون قابل تغییر به روش دیگه نیست.

دیدگاه های مختلف برا خودکشی رو گفته بود



افسانه های غلط در مورد خودکشی. (تو پرانتز توضیح درستشون رو می‌نویسم)

❌آنهایی که در مورد خودکشی صحبت میکنند در معرض خطر نیستند. (در نسل جدید باور دارن هیچ‌کسی در مورد خودکشی اعتقاد یک سویه و‌ تام ندارن. همونقدر که دلش میخواد خودشو بکشه همونقدر هم دلش میخواد نکشه.)

❌همه افرادی که خودشونو میکنن بیماری روانپزشکی دارن. (گفتیم ندارن دیگه)

❌خودکشی بدون هشدار اتفاق میوفته (تو یه سری آره)

❌پرسش در مورد خودکشی فکر در مورد آن را در سر شخص می‌کارد.

❌ افراد خودکشی کننده واضحا می‌خوان که بمیرند.(امبی‌والنسه)

❌وقتی کسی افکار خودکشی پیدا می‌کند همواره خودکشی کننده می‌ماند.(بحران محوره)

❌ خودکشی ارثی است. (راحت بودن با بدن و تحمل درد ارثی هست ولی خود خودکشی نیست.)

❌ خودکشی برای جلب توجه است.(حتا اونا مه سبک اقدام میکنن هم نه! چون توانش همون بوده. میترسیدن از بیشترش)

❌ عامل واحدی دارد.

❌ قابل پیشگیری نیست(وقتی شناساییش کنی دیگه پیشگیری میشه. شناساییش سخته.)

❌ فقط گروه های خاص اجتماعی به واسطه آن می‌میرند.(ربطی به موفقیت شخص. اجتماعی بودن فرد. یا کتاب افسرده و سمی خوندن شخص نداره.)

❌بهبودی حال هیجانی به معنای کاهش خطر خودکشی است . (ممکنه روحیه خوب باشه ولی ربطی نداره به خودکشی)

❌ افکار خودکشی نادره.( نه خیر گذر از مرحله فکر به اقدامش نادره ولی فکرش زیاده)

❌ آنها که روش های کم خطر اقدام میکنن در مورد کشتن خود جدی نیستند. (نه خیر؛ توانمندیشون مشکل داره)



افسانه پوچی خودکشی اسکاندیناوی
خودکشی ربطی به به پوچی رسیدن تو کشور های مرفه نداره.
خودکشی گروه تو یه سری کشور ها برا همین آمار ها درست نیست.
خودکشی تو کشور مرفه بیشتره، مثلا چون مسن هاشون بخاطر سلامت بالاترشون بیشتره و خودشکی تو مسن ها بیشتره. نه چون مرفه ترن.

اشراف زادگان روم باستان تو دوره خاصی، خودکشی با کلاس شد. اشراف زادگان و اینا حتما انجام میدادن. پز میدادن و حتا به دروغ میگفتن خودکشی کردن.

مرگ های متعدد یهودا
با آمدن مسیحیت و عجین بودن خودکشی با مرگ یهودا که سمبلی از شرارت هست؛ خودکشی رو انگ کردن.
فرهنگ و اجتماع هم در کنار روان‌پزشکی خیلی تاثیر دارن برا خودکشی.

اطرافیان شخصی که خودشو کشته هی سرزنش میکنند خودشونو ولی باید آگاهی افزایش پیدا کنه که این بحرانه و کلی موارد داره و تقصیر هیچ‌کس نیست.
خودکشی انقدر چیز ساده ای نیست هی ساده سازیش نکنین که افسرده بود به پوچی رسید و ....


Suicide is not selfish
Characterising suicide as selfish simply adds to the stigma around it. And when stigma increases, help-seeking declines, ignorance flourishes and deaths soar.


She [and it is more common that females are stigmatised in this way] has cut herself again, she’s just attention-seeking; if she’s serious about killing herself, then she’d just do it.’ Of course, the suicidal individual is trying to draw attention to their distress, perhaps viewing self-injurious behaviour as the only way to manage it. But this is not ‘attention-seeking’ in the way that those who are being dismissive suggest. It is a marker of distress, not usually a marker of attention-seeking. For me, it is very simple. Imagine the pain or distress that an individual must be experiencing such that they would inflict pain on themselves as a means of managing or relieving how they are feeling. Every act of self-harm, irrespective of motive, needs to be taken seriously and deserves a compassionate, human response.
....
To relieve me of my suffering and pain.’
‘To take the pain from my heart to my arm.’
The next two quotes are also extremely powerful:
‘The physical pain rules out the emotional pain.’
‘Couldn’t escape. I just didn’t want to live anymore.’
...


Do not listen to anyone who says that an improvement in emotional state means lessened suicide risk. Not only is this a myth, but it may be tragically incorrect, with the inverse relationship being true. It seems that improvement in emotional state is associated with increased rather than decreased suicide risk. The logic is as follows: when someone is in the midst of a depressive episode (for example) and overwhelmed with pain, they often do not have the energy or motivation to formulate and enact a suicide plan. However, if they settle upon suicide as the means of ending their pain, then their emotional state may lift as they believe they have found the solution to their problems – suicide being the permanent means of ending their pain. The knock-on effect is that, as their emotional state improves, their motivation and energy return and they now have the emotional and cognitive capacity to plan and carry out their suicidal act. If, however, there is a reasonable explanation for the upward shift in mood, that’s a relief and there is less of a reason to be vigilant

[Amir]

خب رفاقت من و این کتاب برمیگرده به دقیقا ۸۷ و نیم روز پیش از این نوشته. تجربه‌ی وحشتناکی که هنوز هم بهش فکر میکنم از ترس به تیکه‌های نامساوی تقسیم میشم. صبحش پاشدم و اصلا نمیدونستم چی شده ولی انگاری کنترل رو داده بودم دست یکی دیگه. روزی که تقریبا همین ساعتا با آرامش تمام نشسته بودم و داشتم دوز متناسب رو برای یه مرگ آروم و راحت حساب میکردم و نتایج جالبی هم پیدا کردم=)))).[موقع درس خوندن اینقدر تمرکز نداشتم=))))).] خب از این حرفا بگذریم.
تا یه زمانی تصور بر این بود که خودکشی محصول جانبی بقیه‌ی بیماری‌های روانپزشکیه اما نسل دوم سویسایدولوژیست‌ها چیز جالبی رو متوجه شدن. اینکه نیمی از افرادی که خودکشی میکنن، اختلال مصوب روانپزشکی ندارن. خودکشی یه پدیده‌ی بغرنجه، عامل و ماهیت واجدی نداره و به همین خاطر نمیشه مداخله‌ی واحدی رو براش در نظر گرفت. یه چیز جالبتر اینکه افکار خودکشی اونقدرا هم که فکر میکنیم نادر نیستن، حتی تو ۴۰ درصد جمعیت نرمال به سادگی دیده میشن.
بحث اصلی توی افرادی که به سمت خودکشی میرن درده، البته یه درد ذهنی که هیچ چاره‌ای براش ندارن و صرفا برای راحت شدن از این درد دست به خودکشی میزنن. قصدشون مردن نیست، خلاص شدن از درده چون حس میکنه نه راه پس داره و نه پیش.
یه چیزی هست اینه که بسیاری از افراد وقتی توی چرخه‌ی نشخوار فکری میفتن، اونقدر به اون مسئله و تله‌ای که توش گرفتار شدن فکر میکنن که یه دید تلسکوپی پیدا میکنن و درگیری ذهنی اون مسئله چنان زیاد میشه که بی‌خوابی هم روش سوار میشه و همین دوتا از مسائل مهمی هستن که فرد رو به سمت خودکشی میکشن. پس خواب خوب خیلی خیلی محافظت میکنه از فرد.
داشتن افکار با اقدام خیلی متفاوته، یعنی خیلی‌ها افکار رو دارن ولی به سمتش نمیرن. چی باعث میشه به سمتش برن؟ اگر فرد به واسطه‌ی شغل یا زندگیش همیشه در معرض مرگ باشه، مثلا پزشکه، پرستاره یا هرچی. دوم اینایی که زیاد بلا سرشون میاد و همش دارن از بچگی از در و دیوار میفتن [ما بهشون میگیم چل و فل=)))))] و آسیب میبینن.
تکامل ناشاد و ناامن در کودکی اگر همراه بشه با در تله افتادن و دچار مشکل شدن و یکی از این آدمایی باشیم که همش با مرگ هم سروکار داره، یه مسیر تر و تمیز به سمت خودکشی داریم.
توان آسیب افراد محدود به روش‌های خاصیه و اگه بتونیم مثلا اسلحه رو از دستشون دور نگه داریم میتونیم تا حد خوبی مانع از آسیب بهشون بشیم.
چندتا نکته‌ای که خیلی خیلی خیلی مهمه اینه: کسایی که به هرصورتی درباره خودکشی حرف میزنن در معرض خطرن، خودکشی همیشه بدون هشدار نیست، ارثی نیست، افراد نمیخوان بمیرن و صرفا میخوان از درد راحت بشن، همیشه سویسایدال باقی نمیمونن، به هیچ وجه برای جلب توجه نیست، عامل واحدی نداره، قابل پیشگیری هست ولی قابل شناسایی نه، هیچ گروه خاصی رو درگیر نمیکنه و روش کم خطر به معنی جدی نبودن نیست.
و همیشه و همیشه حرفا و وجود یه دوست میتونه کمک کننده باشه.
دکتر مکری خلاصه‌ای از این کتاب و مطالب وابسته به اون رو با صدای زیبای خودش منتشر کرده:
https://t.me/DrAzarakhshMokri/1222

[Peter]

A good introduction to a difficult topic

Having read quite a few books on the subject of suicide and attempted suicide, I'm always interested when new books about this subject are published. But the question is if such a book contributes anything to the already extensive bibliography.

I'd say that 'When it is darkest' is a good introduction to the subject, but only if you are mainly interested in the practical side of suicide and suicide prevention and less in its history and profound psychological investigation of the causes of suicide.
Although the author does introduce his own model of suicidal behaviour: the integrated motivational-volitional model (IMV), it's mainly a synthesis of the existing scientific investigations into the causes of suicidal behaviour (genetic, childhood trauma's, mental illnes, etc...) I didn't really find any new information in this model.

Moreover the author seems to be mainly concerned about suicide prevention, because a large part of the book is dedicated to short term and long term interventions for suicidal patients. You won't find much new information here either. All in all I'd recommend this book if you are new to the subject and are looking for a non-technical introduction to the subject, but if you've Kay Redfield Jamison, Edwin Schneidman, Al Alvarez and others, this book probably isn't for you.

[Leena]

Having just lost someone to suicide, I found this book insightful, difficult to read at times, and strangely enough empowering.

This book has helped in my own grief through understanding. It has also given me the tools in how to talk about suicide and suicidal thoughts, how to spot those red flags that someone might need help, but the most important thing I took away was what to actually do when someone needs help.

If you have questions about or are bereaved by suicide please read this book.

[Nays]

TW: Suicide (though it should be said the author never refers to methods or graphic detail throughout the book, which I was grateful for)

It's so difficult to know how to understand and talk about suicide. I've been searching for a book like this for a long time. When it is Darkest is a compassionate, clear and informative read about what factors influence suicidal thoughts and behaviours, and how best to support people directly or indirectly affected by suicide. The author combined a wealth of academic and personal insights throughout, which made every point easy to understand and every piece of advice easy to visualise and action. The book is caring, and in no places condescending. It's a very nuanced look at suicide and what we as individuals and as a society can do to better prevent it. I'm a psychologist myself, and I appreciated the health psychology angle the author took that suicide is a preventable behaviour and not simply a clinical hallmark of 'illness'. Overall, the book was a very refreshing and much-needed perspective on this issue. I finished it feeling empowered to better support those around me.

I wish I'd read this book a long time ago, and I'm so glad this work is in the world. I'd recommend it to *everyone*, but particularly for people who are looking to better support and understand themselves and the people in their lives. Like many others, I've been nervous about 'saying the right/wrong thing' when it comes to discussing suicide with those affected, and I feel much better prepared for this discussion and better able to support people after reading this book. Excellent work, go read it!

[Amirreza Mahmoudzadeh-Sagheb]

"When It Is Darkest: Why People Die by Suicide and What We Can Do to Prevent It" by Rory O'Conner

کتاب حاضر در چهار بخش به بررسی خودکشی می‌پردازد:

بخش اول با آمارهایی درباره‌ی خودکشی آغاز می‌شود و توضیحاتی کلی درباره‌ی این که چه کسانی بیشتر در معرض آن هستند ارائه می‌کند. در پایان بخش اول هم باورهای غلط درباره‌ی خودکشی شرح داده می‌شوند.

بخش دوم بخش اصلی کتاب به نظر من است؛ در این بخش الگوی یکپارچه انگیزشی-ارادی رفتار خودکشی‌گرایانه شرح داده می‌شود و به عبارتی به چگونگی شکل‌گیری افکار و قصد خودکشی در مرحله‌ی اول، و چگونگی تبدیل افکار خودکشی به اقدام به خودکشی در وهله‌ی بعد می‌پردازد و عوامل خطر هر یک از این مراحل را تشریح می‌کند. نقطه‌ی قوت این الگو یا مدل این است که مدلی عملی است و می‌تواند سرنخ‌هایی درباره‌ی نحوه‌ی پیشگیری از خودکشی با مداخلات مختلف در مراحل مختلف الگو، ارائه کند.
شمایی از مدل مذکور را می‌توان در لینک زیر مشاهده کرد:
https://suicideresearch.info/wp-conte...

در تصویر زیر هم عواملی که در تبدیل ایده‌پردازی خودکشی به اقدام به خودکشی نقش دارند، ذکر شده‌اند.
https://suicideresearch.info/wp-conte...

بخش سوم به برخی مداخلات برای حفظ ایمنی افراد خودکشی‌گرا می‌پردازد.

بخش چهارم نیز به بررسی حمایت از افراد در معرض خودکشی و نیز حمایت از بازماندگان فرد خودکشی‌کننده می‌پردازد.

در مجموع کتاب حاضر شمای خوبی از ابعاد مختلف خودکشی ارائه می‌دهد و در جای خود، با مثال‌های متعدد واقعی، شاهد بر سخن خود می‌آورد.
از نکات مثبت کتاب می‌توان به تعداد مطلوب رفرنس‌ها اشاره کرد؛ هرچند، یکی از مترجمان (دکتر محسن رضائیان) در جلسه نقد و بررسی کتاب به خودارجاعی‌های زیاد کتاب نقد وارد کرده بود. با این حال، در جای خود، نویسنده شواهد مغایر با شواهد پژوهش‌های خود را نیز ارائه کرده است و یک‌طرفه به قاضی نرفته است.

[Naoise Panda]

I definitely recommend this book, it just depends what life experiences you have on this topic when going to read this. I've lost friends by suicide and have unfortunately struggled with my own mental health since the age of 12. The topic is handled so well and I really appreciated the preventative measures approach to it. I was tentative at first, as I usually am around books that hit so close to home. No matter your experience on the topic, I would recommend to take this bit by bit. For me anyways, it wasn't a sit down and get through it in one go kind of book. I am glad I read it though. It has been 6 years since my own darkest time and I do often wonder how I can help friends/loved ones in the future. This has been a great help.

[Cristian Rusu]

Suicide is not selfish
Characterising suicide as selfish simply adds to the stigma around it. And when stigma increases, help-seeking declines, ignorance flourishes and deaths soar. Daniel and Kiara, who we met in the previous chapter, were not selfish, they were in pain, and suicide was their means of ending that pain. In their different ways, their deaths were acts of desperation. If you have never been in that dark place, it can be difficult not to see suicide as anything other than selfish. But the reality is that, for the vast majority of people, they see their suicide as a selfless act, their way of trying to stop the suffering that they perceive they are causing their loved ones.
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Suicide is not the coward’s way out
This phrase has a long history in the discourse around suicide, but again, it is unhelpful, stigmatising and insulting to many. When people suggest that suicide is cowardly, I usually ask them to think about what they understand by the meaning of coward, to consider the individual words that may trip too easily off their tongues. Irrespective of the method of suicide, to end one’s life is difficult. Not only do you have to overcome the most basic self-preservation instinct, but for many the act of ending one’s life is physically painful. It is most definitely not a cowardly act; it is an act of desperation and most often a manifestation of unbearable mental pain.
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Suicide is not caused by a single factor
Like any other cause of death, the factors that lead to suicide are multiple and varied. However, too often the media representations of suicide are simplistic. For example, newspaper headlines such as ‘Cyberbullying killed my son’ used to be quite common, but thankfully as more and more media outlets adhere to the reporting guidelines, such irresponsible reporting has declined. In the same way that smoking is one of the risk factors for death from lung cancer, we also know that a range of other genetic, clinical, psychosocial and cultural factors play a role. Suicide is no different in this regard from other causes of death – there is no single risk factor; there are many pathways to suicide involving multiple risk factors.
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Suicide is not the fault of those bereaved
It is important to remember that the suicide of your loved one is not your fault. Sadly, and all too often, those left behind, those bereaved by suicide, blame themselves, thinking that they should have done more. The guilt and regret can be especially painful if the last encounter they had with their loved one was an argument or a disagreement. Unfortunately, it is likely that an interpersonal crisis such as an argument will have occurred in the hours, days or weeks before the death. When I think back to my first published academic paper, a detailed examination of the factors associated with 142 suicides in Belfast, Northern Ireland, we found that marital or relationship problems were the most frequently reported stressor. But this does not imply causality and, as I have said time and again, suicide is caused by multiple factors. In addition, no one would ever expect an argument or disagreement to end in the death of their loved one. Irrespective of the circumstances, a single individual should never be held responsible for another person’s actions. The common theme running through each of these nots is that suicide is driven by the desire to end one’s pain rather than wanting to die.
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However, the difficulty arises when one feels trapped internally, when our internal world becomes a source of pain rather than of comfort. It no longer feels like a safe space. And if this pain and perceived lack of safety escalate, a bit like a storm brewing, then it can begin to feel more and more like there is nowhere safe to hide, nowhere to rest or relax, nowhere left to escape to because existentially you are trying to escape yourself. At such times, suicidal thoughts are much more likely to erupt because, in such a trapped state, we find it impossible to imagine a time when these thoughts will subside. We become imprisoned by our thoughts and feelings. We are trapped inside ourselves and feel that there is no escape. And it’s exhausting. If we add into the mix that these thoughts are often contaminated by feelings of shame, loss, self-hate, rejection and anger, we can begin to get a sense of what mental pain feels like.
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Entrapment is mental pain and mental pain can be entrapping. When in mental pain we search for solutions to end that pain; this search may include distracting oneself from the pain, talking to family or friends, removing oneself from the defeating situation, taking medication, drinking alcohol to dull the pain, seeking professional help, or countless other things to help cope with or manage the pain. Sadly though, as entrapment increases and if no solutions are found, the likelihood that we consider suicide as a means of escape increases. This is when tunnel vision can make things precarious, because the more blinkered we are in our thinking, the fewer and fewer potential solutions come to mind. As each potential solution is discounted or dismissed, we edge another step closer to concluding that suicide is the solution – the ultimate but permanent solution to ending the pain. The rate at which the discounting happens is different for each of us. As a result, for some, the suicidal act may appear impulsive and for others it may seem to be more measured. Clearly, for most of us, suicide is never the conclusion we come to when we experience mental pain.
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Some people, like Ed, describe the pain in terms of needing the seemingly relentless thinking to end; that the turmoil in their heads is exhausting. They may be overwhelmed by a never-ending ruminative cycle of negative thoughts about themselves, the world and their future – or, more commonly, their lack of a future.
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It’s sometimes the only option, the only power you have left in your life. Because life takes everything away from you. Your self-worth. Your achievements. Your community. Your friends. Your family. How you feel about yourself. Because when it is all gone, you will have a decision left and that is whether or not to live.
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To get a better idea about what we mean by socially prescribed perfectionism, consider the following two items taken from the Multidimensional Perfectionism Scale: 1. ‘I find it difficult to meet others’ expectations of me.’ 2. ‘People expect more from me than I am capable of giving.’ We normally ask people to rate the extent to which they agree or disagree with statements such as these on a seven-point scale. In the full scale, there are 15 items, so, when added up, the scale yields a wide range of scores. Take a minute to think about how you would respond to these two items. Don’t worry, though, we cannot classify you as a social perfectionist from your responses to these two questions! Even when we use the full scale in our research, our focus is not on a single individual’s score, it’s on a group of respondents’ scores. Usually, we are tracking trends in people’s answers and seeking to map these trends on to other factors such as suicidal ideation. Most people score somewhere in the middle on perfectionism scales, which isn’t that unexpected, as most of us try to please others, to some degree, at least some of the time. As it happens, I score highly on socially prescribed perfectionism, which didn’t come as much of a surprise to me. I am overly concerned about what others expect of me and I spend too much of my waking life worried that I’ve let others down or ruminating about some potential social faux pas that I may or may not have made.
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To illustrate the role of socially prescribed perfectionism a little more, there’s a simple metaphor that I often use when I am explaining social perfectionism to an audience: those who score highly on socially prescribed perfectionism have psychological thin skins and those who report low levels of socially prescribed perfectionism possess psychological thick skins. As we navigate everyday life, if we have a psychological thin skin (like me), when we encounter social threats, such as rejection or defeat or loss, we will experience these much more keenly. And, over time, these experiences may contribute to feelings of low mood and emotional distress – and potentially, in some cases, to the emergence of suicidal thoughts. Social perfectionism is like having a chink in your psychological armour. Although not fatal, it is one vulnerability factor such that when the piercing arrows of social defeat or rejection come our way, they are much more likely to get through our defences. They are much more likely to penetrate our psychological skin.
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Amanda really struggles with what she sees as the pressure to be perfect in the eyes of others: Even though part of me knows what I am doing is perfectly okay, I just cannot stop myself thinking that I am not good enough and that if only I worked harder, I’d be able to please them. And even when I think I have done well, I know that I will have to try even harder to do as well the next time. In many ways, Amanda is the archetypal social perfectionist, caught in a vicious cycle of needing social approval, working tirelessly to obtain it, feeling valued by others, then shifting back again to seeking more approval and pursuing it again and again. It’s relentless. It feels to her like a never-ending rollercoaster of highs and lows and, every now and then, she needs a ‘time out’ and steps off the rollercoaster. Sometimes it gets so bad that she has to stop going out, stop seeing her friends, stop putting herself forward to do things at work because she is so petrified of failing, of letting others down. Then, after some respite, she’ll feel rejuvenated and will get back on the rollercoaster again. Although she has never attempted suicide, she still feels overwhelmed a lot of the time, thinking that she’s a ‘waste of space’, periodically feeling suicidal and that she’d be better off dead. When I asked her specifically about times when things felt particularly stressful, she struggled to answer, saying that even the smallest of tasks make her feel anxious and uptight. It is like every task, no matter how small or insignificant, is an opportunity to fail, another opportunity to let others down.
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Early life adversity
Without doubt, there is a robust relationship between the experience of early life adversity and poor mental health, including suicide risk.  Early life adversity can be assessed in many different ways, but it is frequently recorded in terms of adverse childhood experiences (ACEs) that pertain to the first 18 years of life. These experiences include emotional abuse, physical abuse, sexual abuse, exposure to violence directed at a parent, exposure to household substance abuse or household mental illness, parental separation/divorce or having a household member in prison.  Numerous studies have shown that as the number of ACEs increases, an individual’s health outcomes across the lifespan deteriorate.
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Conversely, an individual who has an avoidant orientation tries to maintain distance or autonomy in relationships, as they have a negative view of themselves as well as those around them. Unsurprisingly therefore, such an orientation doesn’t often yield nurturing and fulfilling relationships. Sadly, there was clear evidence of avoidant attachments being associated with suicidal thoughts and attempts, and similarly there was a clear relationship found between anxious attachment and suicide risk. An anxious attachment orientation is problematic because the individual is striving for acceptance, but they struggle with receiving affection because they don’t think they are worthy or lovable. This type of attachment is also sometimes called preoccupied or ambivalent attachment.
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I don’t trust anyone because I know that people are going to leave. Like my mum left me in the middle of a road, in a car, so she’s done that, and she’s apparently meant to love me, then what are other people going to do? […] it’s just easier not connecting with someone and just sticking by yourself. If somebody ran me over tomorrow, I’d be pretty ready to go, like, I wouldn’t fight it. I’m completely done because everyone’s just leaving. There’s got to be something wrong with me and I don’t know what it is, that’s the thing because everyone says that it’s not me, but the common factor in everything that’s happened is me. Joanne’s sense of abandonment and worthlessness is palpable. She appears to have given up her fight for life and sees suicide as the solution to her interpersonal problems. It is heartbreaking to think that she sees herself as the problem and doesn’t seem to be fearful about dying, as if she’s resigned to death.
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This lack of self-worth, feeling insignificant and worthless is also mirrored in another transcript, from Matt’s interview when he reflects on being suicidal. He’s 27 and has attempted suicide twice: I had no friends, I had no family and, you know, I’d weighed up all the consequences and the paths and I really couldn’t see me living or dying making any impact. I was so depressed at the time and so hopeless at the time […] then I might as well just go and turn off the lights because it would be easier for me and it’s not like I’d be leaving much behind.
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Negative urgency is an emotion-based type of impulsivity that comprises acting rashly when in a negative or distressed state. In the context of suicide risk this makes sense, because negative urgency is also associated with impairments in self-regulation, specifically in our capacity to inhibit our impulses. If you rate highly on negative urgency and you also feel trapped, it may be more difficult to inhibit the urge to act on your suicidal thoughts and therefore suicidal behaviour becomes more likely. We have also found that alcohol-related negative urgency is perhaps unsurprisingly associated with the transition from thoughts to suicidal acts.
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In terms of suicide risk, the concern is that mental imagery, a cognitive volitional factor, forms part of the rehearsal process that precedes a suicidal act. Like any other type of rehearsal, the replaying in our mind’s eye, of any behaviour, increases the likelihood that we’ll enact that behaviour.
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Statistically speaking, if you engage in suicidal behaviour once, then you are more likely to do so again. And it doesn’t seem to make a difference whether the past self-injurious behaviour was suicidal in intent (suicide attempt) or not (non-suicidal self-harm).72  Take all acts of self-injurious behaviour seriously.
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Self-criticism is a personality trait and vulnerability factor that is associated with poor mental health and suicidal ideation.79  Crucially, though, its negative effect is most marked under periods of stress. In and of itself, self-criticism does not lead to suicide, but it can increase the likelihood that someone feels defeated. It can also drive the ruminative thoughts associated with depression, hopelessness and entrapment.
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for suicide to occur it requires both the motivation (thoughts of suicide) and the volition (factors that make someone act on their thoughts of suicide).
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about 40 per cent of people who die by suicide will have told someone beforehand that they’re suicidal. Telling someone else that they are suicidal is a good thing because it suggests that they’re reaching out for help. Also, it is a brave thing to do, as they may have been reluctant to disclose their feelings. They may be anxious not knowing how you will react. So, if a friend or colleague does say they’re suicidal, try not to be judgemental. Try not to react with shock, dismay or disbelief. Compassion and empathy are needed, otherwise they may close down again emotionally.

[Mihrdāt]

"خودکشی معمولاً به خاطر اشتیاق به مردن نیست؛ به خاطر میل به پایان دادنِ یک درد روانی غیرقابل‌تحمل است."

از آخرین تابوهای باقیمانده‌ی بشر پدیده‌ی کشتنِ خود است. رفتاری که هر 40 ثانیه جان یک نفر را می‌گیرد، اما خیلی به ندرت درباره‌ی آن صحبت می‌کنیم.
مسئله‌ی مهمی که همین ابتدا باید در موردش صحبت کرد این است که خودکشی برخلاف باور عمومی، رفتاری مغلق و پیچیده است؛ چیزی که در بسیاری از موارد فارغ از بیماری‌های رسمی روانشناختی رخ می‌دهد. در نتیجه وظیفه‌ی هر فردی که احساس مسئولیت می‌کند این است که فراتر از توضیحات آسان و سطحی به این اتفاق دردناک بنگرد. در همین راستا نویسنده بخش ابتدایی کتاب را تماماً به شکستن افسانه‌های ساده‌انگارانه‌ای اختصاص داده که حول و حوش خودکشی وجود دارد. مثل:

آنکس که قصد خودکشی دارد، در مورد آن حرف نمی‌زند / افرادی که خود را می‌کشند حتماً افسرده یا بیمار روانی‌اند / خودکشی بدون هشدار پیشین رخ می‌دهد / پرسیدن در مورد امیال خودکشی کسی این ایده را در ذهن او خواهد کاشت / آنکس که خودکشی می‌کند دنبال جلب توجه است / خودکشی قابل پیشگیری نیست / افکار خودکشی به ندرت پیش می‌آیند / آنکس که خود را می‌کشد قطعاً می‌خواهد بمیرد.

اما چرا خودکشی اینطور قربانی می‌گیرد؟ نویسنده مدلی را برای توضیح این پدیده ارائه می‌کند که از سه بخش پیش‌انگیزشی، انگیزشی، و رفتاری تشکیل شده است.
در وهله‌ی اول بعضی افراد پیش‌زمینه‌ها و ویژگی‌های شخصیتی‌ای دارند که آنان را در برابر رخدادهای زندگی آسیب‌پذیرتر می‌کند. نوعی کمال‌گرایی اجتماعی، تکانشوری در فکر و رفتار، روان‌رنجورخویی، دشواری‌های کودکی و حتی نوع واکنش محور ترشح کورتیزول در این دسته جای می‌گیرند. اما همه‌چیز صرفاً این نیست. خودکشی بیش از آنکه فکر کنید پدیده‌ای «روزمره» است. نه به معنای پیش‌پاافتاده بودنِ آن، بلکه به این معنا که نیاز به فاجعه ندارد؛ بسی اتفاقات ساده و پیش‌پاافتاده هم که می‌توانند ماشه‌ی گلوله را بچکانند. بالاترین درصد از همین اتفاقات روزمره هم مربوط به حوزه‌ی «بین‌فردی» است.

انگیزه‌ی خودکشی معمولاً از یک احساس شکست یا تحقیر شروع می‌شود؛ شکست یا تحقیری که فرد درون آن گیر افتاده‌ و هیچ راه خلاصی از آن نمی‌بیند، یا حداقل به چشم او نمی‌آید. وقتی مهارت‌های حل‌مسئله و تنظیم هیجان ضعیف شده باشند، راهی برای خروج از آن موقعیت به ذهن نمی‌رسد و به علاوه هیجان‌های منفی هم هجوم می‌آورند. خُلق منفی خاطرات فرد را نیز مخدوش می‌کند تا در نگاهِ به گذشته چیزی جز شکست و حقارت در زندگی خود پیدا نکند. مجموع این عوامل میدان دید ذهنی فرد را تنگ و تنگ‌تر می‌کند تا اینکه نهایتاً خود را درون زندانی می‌یابد که هیچ راه برون‌رفتی از آن پیدا نیست. بدتر زمانیست که این زندان، نه بیرونی، که مربوط به خود فرد باشد؛ وقتی احساس گیرافتادگی میان فکرها و هیجانات او را رها نکند.

چنین موقعیتی یک قدم تا رخداد خودکشی فاصله دارد و آن فاصله «توانمندی اقدام» است. این بازوی مستقل توضیح می‌دهد که هر انگیزه‌ی خودکشی به اقدام منجر نمی‌شود، زیرا چنین رفتاری توانمندی منحصربه‌فردی می‌طلبد. میزان دسترسی به وسایل کشنده، یک برنامه‌ی طرح‌ریزی‌شده، حساسیت یا تحمل بالا نسبت به درد، نداشتنِ ترس از مرگ، گرایش به رفتارهای تکانه‌ای، در معرض مرگ و خودکشی بودن در طی زندگی و مهم‌تر از همه «سابقه‌ی خودکشی پیشین» از عواملی هستند که می‌توانند ریسک اقدام به خودکشی را در افراد بالا ببرند.

مجموعه‌ی تمام این عوامل در نهایت ممکن است تراژدیِ غمناکی را رقم بزند. اما افسانه‌زدایی از این پدیده‌ی شایع و غمناک در آخر امیدواری با خود به همراه می‌آورد؛ چون شکافتن و فهم دقیق‌تر مسئله، راه‌های مختلفی پیش روی ما می‌گذارد تا از آن طریق مداخله کنیم و جان‌هایی بر سر دوراهی را به زندگی برگردانیم. این پیام امیدوارانه خطاب به کسانی‌ست که کتاب بهشان تقدیم شده: «آنان که عزیزی را به خاطر خودکشی از دست داده‌اند و آنان که هر روز برای زنده ماندن تقلا می‌کنند.»

[Lauryna]

This book is comprehensive without being overwhelming.

In this book, an extremely difficult topic about suicide is displayed gracefully and with so much compassion for everyone: for the one in pain and thinking about suicide, for the one who has a friend or family member suffering, for those who lost someone to suicide, and for specialists who work with people at suicide risk.

It is rare to read not just about suicide prevention from a specialist’s point of view but also to tap into a specialist's personal life where he shares his own journey through coping with the loss of two friends to suicide and his strategies for helping friends and loved ones.

The IMV model presented by the author is quite a holistic one. The IMV model is described in such a way that it can be helpful for a specialist to start using it in practice, yet be simple enough for a person to educate themselves on the topic and use it on an everyday basis and whenever they are in need.

I personally would recommend it to anyone even slightly interested in the topic of suicide in general or anyone who would want to refresh their skills in suicide prevention.

[Jeanne]

Not a beach read (took me 3.5 mos to finish, b/c when you conduct suicide research by day, you might opt for fiction at night), but definitely a well-written book sharing hope & insights from suicidology that are useful to practitioners, researchers, & really anyone, affected directly by suicide or not.
I bought this at the AAS conference & briefly met the author, also attending his lecture. If I didnt think I might someday need to look up one of his citations, I would find an author-narrated audiobook pleasant.

[ZohreH]

مثل روز برام روشنه که یه مدت دیگه که شایدم خیلی دور و دیر نباشه، خودکشی هم مثل خیلی خیلی خیلی از مسایل تابویی دیگه حق مسلم ما انگاشته خواهد شد و تموم اونایی که کتابها نگاشته و قلمها فرساییدن و حلق ها پاره کردن، اگه زنده باشن تا اون موقع انگشت حیرت به دهان می گیرن

حالا کاری ندارم به این حرفا، فقط یه مسأله دارم، اونم اینکه ما کی باشیم که بخوایم برای بقیه تعیین تکلیف کنیم
کی گفته خودکشی بده
کی گفته اونی که خودکشی می کنه عزت نفس نداره

شاید خودش بهتر می‌دونه که برای برون رفت از این بن بستهایی که الان توش گیر کرده راه خاصی نداره، اصلن راه خاصی هم باشه، از یه دونه بن بست در میاد دو روز دیگه زرتی می افته وسط یه بن بست دیگه و طبق تجربه ای که من به شخصه تو تمام این سالها بدست آوردم این بن بستها و چاله چوله ها تمومی ندارن. هر مرحله سخت تر و طاقت فرسا تر از مرحله قبله

خلاصه اینکه کی گفته عقل مایی که خودکشی نکردیم هنوز، بهتر و تیزتر از اونایی که خودکشی کردن یا نزدیکی هاش هستن، کار می‌کنه. به نظر من که این طور کتابا یه مدت دیگه فقط در حد خاطره می مونن. مثل هزاران تابویی که بودن و الان نیستن

امیدوار بودم شرایط زیست اونقدر روال و عالی بود که هیچکس تمایلی به مردن نمی‌داشت. اما واقعیت چیز دیگری است

کتاب جالبی بود
دوباره میخونمش

[Leeroy William]

Honest, informative, moving, practical and supportive insights into suicide. I highly recommend this book - we all need to be more aware and compassionately supportive in our society for the storms that beset us all. All healthcare professionals should read this book, as they encounter people at their most vulnerable…and therefore need better knowledge, awareness, communication and skills to support patients, families and colleagues.

[Sandrine]

A very technical and informative book about suicidal behaviour. The author helpfully differentiates suicide and mental health; he also explains the path from suicidal thought to suicidal acts.
While a difficult read, it put some structure to what I have been trying to analyse myself. The MIV models fits what we have sadly experienced.

I have not been able to ready the 2nd part about prevention but could recommend the book to anyone experiencing or close to someone experience suicidal thoughts. We need to help each other.

[Larysa]

Brought me some comfort in the hardest month of my life, I think it may help others too.

[Pedram]

در اوج تاریکی
مصلح میرزایی
نشر ققنوس

[Brooks]

good book! academic without being dispassionate, impersonal or inaccessible. obviously no foolproof panaceas to be had but it lays out some good strategies and reframed my thinking on suicidality in a few ways. respect!

[Ghazal]

خیلی خوب بود.

[Elli]

I work in the field of suicide prevention so my review here might be more critical than most. I had some issues with how little O'Connor discussed marginalized groups and how socioeconomic status interacts with suicidality and suicide deaths. I also thought his presentation of certain statistics throughout the book was clumsy at best, and irresponsible at worst. For example, he would switch between discussing suicide rates at the population level and suicide rates per capita, without clearly identifying when he was using which frame of reference. And this sentence in particular: "At least 1 in 10 adolescents will have self-harmed by the age of 16 and, of those, 1 in 5 will be girls." Seeming to suggest that girls make up only 20% of adolescents who engage in self-harm, which is simply untrue. Rather, 20% of adolescent girls will have self harmed by the age of 16 - that's a massive difference! And these are just a couple of examples where I noted these jarring statistical issues.

O'Connor inconsistently applied nuance throughout this book, especially in chapters 3, 4, and 5. He seemed to swing rapidly between speaking in black and white terms (e.g., there is no singular cause of suicide) to seeming to contradict himself (e.g., all suicide is preceded by feelings of entrapment). While discussing myths around suicide, he would call something a myth, and then include a caveat that actually it is partially or even mostly true.

While there is definite value in O'Connor's IMV model at a scientific research level, it didn't seem like a good addition to this book. It was overly complicated for a pop-psych book, and as a professional reader it was largely duplicative of other available resources in terms of clinical value. While it seems useful for a more scientific explanation of suicide, I don't see it being useful as a diagnostic or treatment tool. It was interesting and I appreciate it on an intellectual level but ultimately it wasn't a good addition to the book. The information could have been presented in a more accessible way.

That said, my issues are largely because I read this book as someone working in the same field, when this book is meant for the more general public. While nothing here was really new to me, there is some valuable discussion taking place about the stigma around suicide and limited access to mental health care. It also reinforced many of the practices already in place where I work. In my opinion, he also provides the bare bones of what the public can do to prevent suicide. It is better than nothing, but if you have a vested interest in suicide prevention I would highly recommend looking into an ASIST workshop (by LivingWorks) in your area to learn more hands on skills.

Rory O'Connor has made many valuable contributions to the field of suicidology, this book is just not one of them.

[Cat Doench]

I think this is a great resource for those who are suicidal, who know someone who is suicidal, and those who have lost someone to suicide who want to learn what they can do to help prevent losing any future loved ones to suicide. 800,000 people lose their lives to suicide a year worldwide and that’s entirely too many. I feel the most helpful part of this book was the safety plan laid out. Honestly, I feel everyone should have a safety plan written out because you just never know when suicidal thoughts can hit. There is a template for the safety plan and it’s very helpful. When someone is actively suicidal, it’s hard to calm down and remember coping skills because you’re caught up in such an intense mental state overwhelmed with pain. Having a safety plan written down would be beneficial in these moments to help ground you and potentially calm you down and allow you to try to do the things to help get your mind off the thoughts. It sounds simple, but it’s truly life changing. This book, though helpful, can be hard to read at times. So be gentle with yourself getting through it. It helped me understand better why I struggled with suicidal ideation and attempts throughout my life. I unfortunately was trapped in a perfect storm of factors that lead to suicidal behavior. It takes a myriad of factors to get someone to that point in most cases, and I seemed to have hit nearly every one. I feel everyone should read this book because it would help erase the stigma surrounding suicide and potentially save many lives. We all need to come together and quit shaming suicidal behavior to be able to help those who struggle. We need to keep open communication and not feel so uncomfortable talking about it. We need to not be so afraid to check in with those who are struggling. A sense of belonging and being cared for can go such a long way to help those struggling get through their battles.

[Sana]

‘When it is Darkest’ is an incredibly informative, accessible book about suicide: why it happens and how we can best prevent it. It has helped me understand the nuances and depths of suicidal thoughts and deaths, as well as understanding that suicide is preventable and the role we can each play in its prevention.

Rory O’Connor does a terrific job at combining scientific research (presented in an easily digestible and understandable way) alongside personal experience and stories. The interweaving of these two aspects was so helpful in creating a depthful understanding of suicide.

I also very much appreciated that he tried throughout to consider the effects of structural & individual discrimination on suicide risk. Including commentary on the socioeconomic states of countries and how this affects risk.

I would recommend this book to everyone. It is one of those absolute must-reads to help us all have a better understanding of the severity of suicide and understand how we can each work to prevent it.

[Staci Harrison]

As both an attempt survivor and loss survivor, I have read countless books about this difficult subject. By far, this is the most accurate, thoroughly researched, and well written book. For myself, it was therapeutic to hear the author describe much of how I felt, things I had no words to articulate, reasons behind what drove my almost constant thoughts of ending my despair and hopelessness, as well as what lead up to my attempt. In 2018 I lost my only sibling to suicide. In 2020 my cousin died by suicide. Being estranged from family, my daughter and I had to grieve alone. The chapters dealing with the aftermath of a loss helped me sort out the grief which I had not yet processed. The narration is both fantastic and comforting. I highly recommend this book.

[Wendelle]

This is such an important and compassionate book. It is written by Prof. Rory O'Connor, a psychology professor at the University of Glasgow where he also heads the Suicidal Behavior Research Laboratory. First of all, Prof. O'Connor is a courageous individual. It must be hard to be thinking seriously about suicide and suicide prevention 24/7 as part of his job. Additionally, he has a dual function of meeting with and responding to both suicidal individuals and the bereaved and providing them with care and attention when they come to him seeking answers for their personal and highly affecting lived experiences concerning suicide. It must take a toll on his mental health to have this occupation, but he takes it seriously because he is very, very devoted to both suicide prevention and education of others on suicide research and help.

Some of the things this book highlights is how suicide is borne of feelings of entrapment in one's life situation, feeling like a burden on others, feeling that one has low or thwarted social belonging, and having tunnel vision that one's grim situation will not get better and everyone else 'will be better off' without this person. These are all heartbreaking things to hear that someone is feeling. Prof. O'Connor emphasizes that suicidal attempts are a 'cry of pain' from someone. They have unbearable mental pain, not necessarily a desire to die, and want release from the pain.

Prof. O' Connor also highlights some continuing myths about suicide. This include the widespread belief that suicide is attention-seeking behavior and manipulative. He says, instead, that we should think of self-harm attempts as attention-needing. The person is in so much mental pain that they harm themselves. This should elicit compassion instead of dismissal. As for being manipulation, the professor highlights that it's not manipulation to desire a certain response from others.

The professor also explains what suicide is not. In list form, suicide is not the following. Suicide is not intended to be selfish. It is not cowardly. It does not have single factor. It is not solely explained by mental illness (some suicide attempts are due to extreme change in life circumstances, such as divorce or job loss or loss of a child to suicide). It is not the fault of the bereaved.

The book on page 195 includes a nice 'safety plan' for people having suicidal thoughts. The five steps they should outline include:
listing the warning signs of images or moods or thoughts showing that a crisis is brewing;
listing internal coping strategies that the individual can take, such as leisure or exercise activities;
listing the people and social settings they can go to for distraction;
listing the people they can go to for help; listing the professionals or agencies that they can contact immediately during a crisis;
and finally, listing ways to keep the environment safe (disposing of tools that can be used as suicide mechanisms, removing triggers, etc). I think this safety plan can save lives.

Suicide might seem like a highly theoretical situation until it happens to someone we know. This book provides guidance and also answers. The professor lists some examples of how a caring word or simple checkup on others can actually save them, immediately disentangling them from dark thoughts. People need social connections and to know that they are not a burden to their loved ones, that we are here to support them and love them. I highly recommend this book that was written with an agenda of saving people's lives and preventing suicide.

[pourya bahiraei]

معتقدم که گیر افتادن در دام دردی تحمل ناپذیر کلید درک خودکشی است زیرا من آن را محور اصلی مسیر مشترک منتهی به خودکشی میدانم

تو سه ماه اخیر بیشتر از هرموضوع دیگه‌ای درباره خودکشی خوندم، درباره خودکشی مستند دیدم، درباره خودکشی موزیک شنیدم، و درباره خودکشی با آدم‌ها حرف زدم.
به امید اینکه یه روزی بفهمم چرا دوستامون بعد از کشیک میرن پاویون و دیگه برنمیگردن. مهمتر از اون بفهمم چرا تو پیشگیری از خودکشی اینقدر ناتوان و سردرگمیم.

روری اوکانر از اون کمبوهاییه که کمتر میشه مشابهش رو پیدا کرد. استاد روان شناسی سلامت و رییس انجمن بین المللی پیشگیری از خودکشی که بیشتر از بیست سال در زمینه خودکشی فعالیت آکادمیک کرده اما از قضا بلده چطور خیلی ساده از در و دیوار مثال بزنه تا مخاطب عمومی رو با خودش همراه کنه.
دیدگاه اوکانر تو این کتاب با همه تفاسیر بر پایه یک جمله کلیدی بنا شده:

خودکشی بیشتر از اینکه میل به مرگ و لزوما حاصل از بیماری روانی باشد، رفتاری است برای پایان دادن به درد و فرار از گیر افتادن در دام درد روانی.

نیمه اول کتاب به درک بهتر از رفتار خودکشی اختصاص پیدا کرده، به خصوص اینکه خودکشی دقیقاً چه چیزی نیست.
که:
۱- خودکشی خودخواهانه نیست
۲- خودکشی راه فرار ترسوها نیست
۳- خودکشی ناشی از فقط یک عامل نیست
۴- هر خود‌کشی‌ای مساوی بیماری روانی نیست
۵- خودکشی تقصیر سوگواران نیست

و نیمه دوم ارائه‌ایه از مدلی برای درک مراحل و اقدام موثرتر برای پیشگیری از خودکشی که اوکانر اون رو IMV (الگوی یکپارچه انگیزشی-ارادی) نامگذاری میکنه.
به طور خلاصه این الگو به سه مرحله تقسیم میشه؛

۱-مرحله پیش انگیزشی: پیشینه‌ای که خطر خودکشی در اون شکل گرفته مثل: ناملایمات‌های سال‌های اول زندگی ، الگوی کمالگرایی اجتماعی، سبک‌های دلبستگی و یا نوع واکنش به استرسورها

۲-مرحله انگیزشی: مرحله دوم روی بروز افکار خودکشی گرایانه متمرکزه. تحت تاثیر عواملی مثل: نوع نگاه به آینده، احساس گیر افتادن و مکانیزم های حل مسئله در زمان بروز مشکل

۳-مرحله ارادی: مرحله سوم عواملیه که احتمال اقدام به خودکشی رو تو فردی که به خودکشی فکر میکنه افزایش میده. تحت تاثیر: میزان دسترسی به ابزار، برنامه ریزی برای اقدام، سابقه رفتار مشابه، درد روانی غیرقابل تحمل و تکانشگری رفتاری.
نکته کلیدی در مرحله ارادی اینجاست که:

عواملی که به افکار خودکشی گرایانه منجر می شود با عواملی که احتمال اقدام به خودکشی یا مرگ بر اثر خودکشی را افزایش می دهد متفاوت است. صرفاً این طور نیست که افرادی که بیشتر به خودکشی تمایل دارند بیشتر احتمال دارد دست به خودکشی بزنند بلکه به نظر میرسد گروهی مشخص از عوامل ارتباطی مخصوص با اعمال خودکشی گرایانه دارند تا افکار خودکشی گرایانه

در نهایت فصل‌های پایانی به توصیه‌هایی برای نزدیکان سوگوار از خودکشی، و همینطور نزدیکان افراد پرخطر اختصاص پیدا کرده که چطور میتونن به خودشون و اطرافیانشون تو این مسیر کمک کنند.

پ.ن: دکتر مکری هم تو یکی از ویدیوهاش خلاصه خیلی خوبی از این کتاب رو ارائه میکنه که چه کتاب رو خوندین چه نخوندین، تو درک بهتر مفاهیمش کمک کننده است.

[Isobelle Keith]

This was a difficult but important read. Here is a summary of what stood out for me:-

• 1 person dies by suicide every 40 seconds somewhere in the world.
• The impact of bereavement by suicide is vast. As many as 135 people likely know each person who dies by suicide.
• There are lots of myths and misunderstandings about suicide.
• Suicide is not a selfish act, for most it is the ultimate act of despair.
• About 40% of people who die by suicide will have told someone beforehand that they're suicidal.
• There is zero evidence that asking about suicide plants the idea in someone's mind. If you are worried someone might be suicidal, please ask them directly.
• If someone tells you they're suicidal try not to be judgemental or react with shock, dismay, or disbelief. Compassion and empathy are needed, otherwise they may close down emotionally.
• Warning signs someone might be suicidal include: -
o talking about being trapped, a burden on others and feeling hopeless about the future.
o They have experienced loss, rejection or other stressful life events and are struggling to cope.
o They are sorting out their affairs, such as getting their will in order.
o There is an unexplained improvement in mood because they may have decided that suicide is
the solution to their problems.
o There are marked changes in behaviour such as sleeping, eating, drinking or drug taking.
o They are acting or behaving unpredictably or out of character.
• Self-compassion is crucial for our well-being. Research literature has found that self-harm and suicidal ideation are less likely in people who reported higher levels of self-compassion. Be kind to yourself.
• Sleep disturbance may increase suicide risk as it contributes to psychiatric disorders and impulsivity as well as affecting decision-making and emotional regulation.

[Edoardo Albert]

A priest friend once told me that of all the funerals he has to preside at, the hardest are those for people who have committed suicide. Long gone are the days when they were denied a funeral, consigned to unconsecrated ground, but still the grief and the guilt among the living is keenest for those who wonder, without hope of answer, if they could have done something else, something more, to stop what happened.

A strength of this book is the realisation that, no, the living are not guilty and, just as importantly, neither are the dead. For it’s not that those who commit suicide want to die but rather that they can no longer bear the pain of living.

O’Connor’s book usefully surveys the research on reasons for suicide, ways to prevent suicide among those at risk, and how the living can cope with how the dead departed. It does not make for light reading but, should it be be necessary and please God it shall not be, then this is a good place to start to try to understand something that remains, at its dark heart, without understanding.

[Aspen Nord]

As someone struggling with depression and multiple deep traumas, I was recommended this book because it’s considered a professional resource that could help with my issues.

But what stood out more was how much space the author spent talking about his own journey—seeking help for his mental health. And even though this book is meant to help prevent suicide, it felt like the author was venting about himself A LOT. It often centered around HIS grief over the people he lost in his life—his family, his friends.

While I was hoping to find more professional content, I had to sift through endless emotional dumping from the author. I felt really uncomfortable about that.

I came to this book for help—not to be taken on a tour of someone else’s negative energy. It felt unprofessional, especially because he kept bringing up the people in his life who died. I mean… do I need to remind you that some of your readers are actively struggling with suicidal thoughts? We’re looking for support, not to be overwhelmed by your unprocessed grief.

[Rhea Vaughn]

Having survived my own darkest season and come out the other side, I picked this up during Mental Health Awareness Month hoping for something more actionable and compassionate — a guide to recognizing when someone is struggling, how to ask the hard questions, and how to truly help.

Instead, this felt heavily clinical and academic, which made it a difficult audiobook experience for me personally. The writing style never fully pulled me in and often felt emotionally distant from such an incredibly human and painful topic.

That said, I do think this book offers valuable insight for readers who enjoy more research-driven or clinical nonfiction. It tackles a deeply taboo subject with honesty and provides important information about suicide, mental health, and risk factors.

While it wasn’t the reading experience I had hoped for, I still appreciate the conversation it’s trying to create — and I’ll be passing it along through my Little Free Library next week in hopes it reaches the right reader at the right time.

[Nicoooooooooo]

A beautifully crafted book.

It worked for me on a personal level, on a professional level as an emergency physician, and on a political level too, the gentle campaigning tone, request for empathy and even the correct use of language from members of the public for those people who have "died by suicide".


I learned A LOT......


And it's all wrapped up in a very personal, easy accessible, non specialist way. It's why I say the book is "beautifully crafted" as the author captures superbly the sheer bewilderment that overcomes people caught up in these situations. The author was caught himself. The introduction alone is very powerful as he agonises about a close friend who "died by suicide".

The book is a powerful manifesto of the need for the general public to let go of many of the urban myths surrounding suicide - most notably people who die by suicide are "selfish or cowardly". The author suggests they are neither.

[Iola Shaw]

I was googling "why is suicide wrong" a fair bit recently. Partly in relation to issues raised at work, partly because my ideation was a little out of hand. Whilst I didn't find the answer, I did find a mix of reading and this book was definitely a big benefit of that search. It is multilayered and therefore has appeal for both a work, personal interest about others and about self perspective. The Integrated Movtivation-Volitional model he outlines helps give a lot of structure. The personal elements are at a level that keeps it professional and personal rather than personable which I found really helpful. If you want an insight into suicide, and a good start point for resources if you want to explore futher I would recommend this whether as a professional a concerned relative/friend or worried about your own wellbeing at times.