When is it okay to kill yourself?

Suicide and attempted suicide from a medical perspective

Suicide (page 2/9)

Causes of suicidality and attempted and completed suicides

From a medical point of view, completed suicides and attempted suicide are often viewed as a symptom of a mental disorder that requires treatment (e.g. depression, bipolar disorder or schizophrenia).

However, since empirical studies have not yet been able to find a reliable causal connection between depression and suicidal behavior, the symptoms of depressive disorders can primarily be used as indicators of suicidality:

  • Long-term studies have shown that around 15% of all inpatient depressed patients die of suicide. In relation to the total population, it is significantly less, namely two percent.
  • The existence of pronounced depressive moods could be proven retrospectively in 40-70% of those who died of suicide. At the time of suicide ideas and suicide attempts, depressive symptoms almost always appear at the same time.
  • On the other hand, the majority of depressed people never report suicide ideas or even attempted suicide, either during or outside of their depressive episodes.

However, severe pain or other serious ailments, illnesses or disabilities that the person concerned no longer wants or can no longer endure can trigger a suicide attempt.

In suicide research, there is consensus that early drug treatment and psychotherapy can help the person affected, but that this does not necessarily prevent them from suicide.


If there is a risk of suicide, experts speak of suicidality. There are many reasons for developing suicidality and any subsequent attempted suicide. But they all have one thing in common: those at risk of suicide are in a situation that pushes them to their personal limits, they cannot and do not want to go on living as they did before.

Thoughts of suicide usually arise when the person concerned is exposed to an unbearably high level of suffering (according to their own feeling) and they no longer have any hope. You ask yourself what is still worth living for - and you cannot find an answer to it.

Case study Anna, 45 from Berlin with suicidal thoughts

Ultimately, they see the only way out of the unbearable situation for them to be flight to death.

Suicidality always assumes that people who intend to commit suicide reflect carefully on this step and weigh up various options. Nonetheless, the majority of actual suicidal acts are primarily an impulse act when the current emotional pain has become unbearable.

Studies of suicide attempts concluded that 4% alone were carefully planned, but only 7% were more or less harmless.

The consumption of alcohol, medication and drugs in particular often increases this impulse character due to the associated loss of self-control. As a result, suicidal acts often appear impulsive and poorly planned, even though the suicide arrangements appear long and carefully planned.

The impulsiveness of suicidal acts is usually fed by a certain ambivalence on the part of the suicidal person with regard to his or her desire to actually die: in most cases, people who intend to commit suicide do not want to die at all and still try to kill themselves. The intention to commit suicide is very seldom one hundred percent.

The following research result speaks in favor of this point of view:

"It is consistently reported that suicidal intent was corrected in less than two days in 68–80% of patients and in less than ten days in 90–99% in less than ten days."
(Source: "Bronisch, Thomas: Der Suizid: Causes, Warning Signals, Prevention")

Persistent suicidality

Often times, thoughts of suicide develop over a long period of time. Then one speaks of persistent suicidality. This in turn is also associated with a long path of suffering for those affected.
Sometimes an incident that is considered to be a minor matter in a mentally healthy condition can literally bring the barrel to overflowing and be the trigger for a suicide (attempt).

However, suicidal thoughts do not always have to be constant in all those affected; sometimes they can also be pushed aside. When those affected feel worse again, they are more present again.

Sometimes, however, it is also external events that put those affected into a difficult situation: for example, the loss of a loved one, serious illnesses, chronic pain, but also debts and unemployment, partnership conflicts and separations.

Acute suicidality

Sometimes the suicide is also a short-circuit act that usually arises without thinking long about possible consequences - and often without prior warning signs. He comes as a surprise to relatives and friends and leaves them at a loss.

This phenomenon of so-called ad hoc suicide is increasingly observed in teenagers. Adolescence is a difficult time for some teenagers anyway: low self-esteem, general insecurity, family arguments, lovesickness, and sometimes bullying at school as well. Experience has shown that many young people in particular can deal with such problems even worse than adults and react more impulsively. In extreme cases, a short circuit can occur.
Warning signals and instructions for outsiders can therefore be completely absent. Often adolescents are more withdrawn anyway and do not talk much with their parents and relatives, withdraw and set themselves apart, which is often seen as a normal side effect of their phase of life and not as a possible indication of an impending suicide.

An imitation effect can also occur, especially with teenagers. This can be observed, for example, in television programs and films with this kind of content, or also acts of imitation of suicides in the music scene, such as those found after the suicide of Kurt Cobain, for example.

Who is particularly at risk?

Suicidality occurs in all social classes and can affect young and older people. For some people, however, the risk is increased:
- In people with mental illnesses such as depression or schizophrenia
- For addicts
- For people who are in an exceptional situation or life crisis (for example due to external circumstances such as the death of a loved one, indebtedness or unemployment)
- In people with incurable diseases and severe pain
- In older people who suffer from illnesses, are lonely, no longer have a zest for life or no longer have courage to live
- For young people who are in a personal crisis or have family problems

Other types of suicide

There is also the so-called extended suicide or suicide attempt. In a double suicide, two people kill each other; in a mass suicide a whole group of people. Take-away suicide occurs when, for example, a parent kills themselves and their child. The self-explanatory term of the wrong-way driver suicide comes from the US. In the case of a terrorist suicide, suicide is often only a means to an end, mainly the killing of others.