Updated 5 January 2025
Suicide remains one of the most complex and least understood phenomena in healthcare despite its devastating impact on individuals and communities. While traditional diseases have tangible pathologies that can be observed, studied and treated, the pathology of suicide remains misattributed, making it an elusive target for developing effective interventions. The role of epidemiology in understanding and preventing suicide becomes paramount in this context, where both physical and metaphysical ailments (or what are actually injuries to the soul) interplay in a delicate balance that can drive an individual to the brink. Isolation is the pathology of suicide. Loneliness and lack of human connection are symptoms which serve as both the strength and the weakness of this unseen pathology - how we treat those symptoms dictates our success in mitigating its deadly consequences.
Human connection is perhaps the most potent antidote to the 'soul disease' of suicide. Numerous studies have demonstrated the protective effects of social support and community engagement on mental health. Empathy, understanding and connection can act as buffers against the despair that leads to suicidal thoughts. Programs designed to promote social integration—like support groups, community events and suicide awareness campaigns—play a crucial role in prevention efforts. By fostering environments where individuals feel heard, valued and understood, we can diminish the hold that isolation has on those at risk, offering them a lifeline back to emotional stability.
The medical field often misattributes the pathology of suicide as a result of poor mental health or psychiatric disorder. This is absolutely not the case. While these factors may contribute in some way to the suicide problem, the fundamental misunderstanding distracts attention from the real problem. The damage created by this misattribution is tremendous, as all interventions are tied to treating this imprecise cause. CBT (Cognitive Behavioral Therapy) and SSRIs (Selective Serotonin Reuptake Inhibitors), for example, are often prescribed to veterans suffering suicidal ideation, with the intent to medically alter the chemistry and pathways of the brain.
WHC's work with veterans - a demographic with a notably high rate of suicide in our nation - makes it very clear that this misattribution exists and is causing harm. The VA's (Department of Veterans Affairs) primary focus has been veteran suicide prevention for the past 20 years, but during that time, the rate of veteran suicide in this country has continued to climb steadily. Veterans who are enduring the crises that often lead to suicide are responding with very expected behaviors to common stressors for veterans. Combat veterans, for example, understand death and dying very well. They understand loyalty, betrayal, following orders and that the actions they performed potentially have a very detrimental effect on their soul. They also understand clearly that what they experienced and learned to expect from daily life in the military is not at all equivalent to what they experience and can expect in the civilian world. Additionally, 50 years of research compiled and examined show that there is no correlation between psychologic dysfunction and suicide. [see footnotes 1,2]
Isolation is the pathology of suicide and takes on a complex function. On one hand, it acts as a major risk factor, exacerbating feelings of loneliness, hopelessness and helplessness. Studies have shown that people who are socially isolated are at a significantly higher risk of suicide, as the lack of social support can intensify emotional health challenges. On the other hand, isolation is often a byproduct of the stigma associated with the misattributed "mental illness", and that actually causes individuals to withdraw from social interactions due to fear of judgment or misunderstanding. (That's simply the stigma issue, when you add on the treatment for those "mental illnesses" such as SSRIs (medications that are frequently prescribed to treat depression, anxiety and PTSD which are targeted to change the brain chemistry, but that also have undesirable side effects) or CBT (which can cause individuals to confront uncomfortable truths about themselves and their behaviors) it becomes extremely tough to overcome the urge to isolate.) Thus, tackling isolation involves not only fostering better social connections but also overcoming the misattribution of suicidal ideation as a "mental illness", breaking down the barriers that prevent open dialogue about moral injury and suicide, and finding ways to redirect the treatment of suicidal ideation to more appropriately focus on providing support that helps well before veterans get to the point where they have lost all hope.
When comparing suicidal ideation to physical diseases, one must recognize the fundamental differences in their pathology. Physical injuries generally have a defined causative agent—be it a virus, bacteria, genetic anomaly or lifestyle factor—and treatments are usually directed towards managing these specific causes. In contrast, suicide is intrinsically linked to an individual's psychological state and emotional well-being. While physical health issues like chronic pain or terminal illness can contribute to suicidal thoughts, the primary pathology lies within the psyche. This isn't simply brain chemistry - it also involves injury to the soul. The conceptualization of suicide as an injury with a pathology, much like physical diseases, necessitates an integrative approach that combines medical, psychological and social interventions to be effective.
Epidemiology, the science that studies the distribution and determinants of health-related outcomes, serves as a critical tool in understanding the nuances of suicide. By analyzing patterns and risk factors, epidemiologists should be identifying the pathology or the mechanism of the disease, and then seek to craft effective interventions that interrupt this pathway. Moreover, epidemiology should be evaluating the effectiveness of preventive measures, ensuring that resources are directed where they are most needed. Unlike traditional physical diseases, where pathogens or physiological malfunctions can be identified and directly observed, the epidemiology of suicide must consider a wide range of psychological, social and intangible factors, making it a multidisciplinary endeavor. The complexity grows when you look hard enough to understand that the calculus that defines how these variables interplay is different for every individual. You cannot just add up the social determinants of health, valuing each of them as equal contributors as in an algebraic equation. The truth is that these variables interact much more similarly to differential equations in calculus. The value of each variable changes based on the relationships of all the social determinant variables within the pot, and based on the day and the individual.
Unlike diseases such as cancer or cardiovascular conditions, where the pathophysiology can be observed and measured, the pathology of suicide is significantly less tangible - covert even, masked under layers of emotional and psychological distress. While physical disease manifests through observable symptoms and biomarkers, suicidal ideation and symptoms are often concealed until it is too late. This hidden nature complicates diagnosis and treatment, necessitating a more sophisticated approach to identify and address the underlying issues. The understanding of suicide as a soul disease becomes particularly apt as it highlights that the manifestations are as real and deadly as those of a heart attack but remain shrouded in obscurity.
The idea of a soul disease encapsulates the invisible, yet profound impact emotional challenges can have on an individual's overall well-being. Unlike physical ailments that can often be quantified and measured, soul disease is a metaphysical injury and includes such ailments as depression, anxiety and suicidal ideation, which are intrinsically subjective and multifaceted. The symptoms manifest through behaviors, emotions and thoughts rather than through diagnostically observable factors (ie: there is no EKG for the soul). This complexity makes them harder to diagnose and treat but no less deadly. Understanding suicide through the lens of a soul disease - injury to my self, my identity, my purpose - underscores the need for a holistic approach to health—a model that integrates the nexus of these dimensions, which are metaphysical in nature. These are not based solely on brain chemistry nor on Freud's understanding of Psychology; physical, psychological, emotional and social dimensions play into requisite preventative and treatment strategies. The brain is not what drives human behavior, but instead the soul, the seat of the heart of mankind, where identity, purpose, love and hope reside. Healing is defined by facilitating the pursuit of faith, hope and love that will nutrify the soul and prolong life.
1: https://artsandsciences.fsu.edu/article/psychology-researcher-fifty-years-research-fails-improve-suicide-prediction; captured 5 January 2025
2: https://pubmed.ncbi.nlm.nih.gov/27841450/; captured 5 January 2025
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