Suicide: Join the Conversation

Recently, I have been reading articles on this subject with much uneasiness.

In fact; I hesitate to call suicide a “subject”, because for many; suicide is real and has impacted them. It has reached out and grabbed them in some way. It is someone very close to them, someone they know or someone famous, whose career they have followed.

And, are loved ones LEFT to make “sense of it”?

Do you honestly think that those who submit to suicide want to leave people confused?

Since we can’t go back and ask them, then it is fair to say that the only one who can answer the questions is no longer with us. It is the unintended consequences of suicides that have the living so desperate to find the answers. The focus shifts from the victim very quickly-i.e. upon hearing the news-to ones left to “deal” with it.

I guess we have to rationalize everything, including suicides.

Suicide isn’t the starting point. It’s not even the end point, because so much goes on after a suicide; especially all of the speculative questions and statements that are often incorrect or at best, inaccurate.

Why would someone take their own life?

They had so much to live for; they had “everything”.

How could they do “that” to their family?

No one saw “it” coming.

Suicide is a coward’s way out.

Suicide is a “cry for attention”.

Doesn’t suicide “run” in their family?

All of the statements that are in italics have been a part of the conversations.

For the purpose of this conversation, I am going to address two issues: (1) should fire service suicides be considered for LODD benefits and (2) are suicides 100 percent preventable?

It wasn’t that long ago that Bill Carey wrote an article on the subject of suicides and their inclusion/exclusion as LODD here.

Just like all of the other circumstances where LODD is determined, there are differing opinions of what should or shouldn’t be included.

For instance; International Association of Fire Fighters (IAFF) definition for LODD is:

• Any death of an IAFF member where the deceased member’s family would be eligible for a line-of-duty death benefit under the regulations of the U.S. Public Safety Officers’ Benefits program.

• Any death of an IAFF member that has been determined to be a line-of-duty death by his or her local, fire department or employer.

• Any death of an IAFF member where the member died of an injury or illness incurred while engaged in emergency or non-emergency duties on the job or as a result of the job.

• Other cases where a local president makes a formal request to the General President, who will evaluate the circumstances surrounding the death of the IAFF member and make a determination based on the facts. Such cases could include the death of an IAFF member resulting from an injury or illness incurred while performing firefighting or emergency medical duties as a “Good Samaritan” while off duty, or other similar circumstances.

For inclusion on the National Fallen Fire Fighter Memorial, the definition for LODD can be found here.

To qualify for Public Safety Officers’ Benefits, you need to understand their definition of LODD. It should be noted that under the PSOB Act, as it is written today, suicide would not qualify for benefits, but heart attack, stroke and vascular rupture do.

However; I believe that suicide committed by a firefighter should be included as an LODD.

For many who suffer from depression or PTSD and cannot break the strangle-hold that it has on them, I don’t think that suicide is “voluntary” or a “choice”. It is not like they can just quit being depressed. It cannot be compared to quitting smoking, alcohol or over-eating. Depression is much more complicated and without proper diagnosis and medical intervention, recovery may not occur. For many, thoughts of suicide will become more pronounced, which is why the early signs of depression have to be recognized by those who interact with the firefighter.

Since suicide can be triggered by depression, we should look at the clinical markers that are used to diagnose depression.

According to the Diagnostic and Statistic Manual of Mental Disorders (DSM-5), symptoms of depression may include:

• Fatigue or loss of energy almost every day
• Feelings of worthlessness or guilt almost every day
• Impaired concentration and indecisiveness
• Insomnia or hypersomnia (excessive sleeping) almost every day
• Markedly diminished interest or pleasure in almost all activities nearly every day (called anhedonia, this symptom can be indicated by reports from significant others)
• Restlessness or feeling slowed down
• Recurring thoughts of death or suicide
• Significant weight loss or gain (a change of more than 5% of body weight in a month)

Furthermore, depression in men is significantly underreported. Men who suffer from clinical depression are less likely to seek help or even talk about their experience.

Signs of depression in men may include irritability, anger or drug and alcohol abuse (substance abuse can also be a cause of depression rather than a result of it). Repressing their feelings can result in violent behavior directed both inwardly and outwardly. It can also result in an increase in illness, suicide and homicide.

According to the American Association of Suicidology, the warning signs of suicide are:

• Ideation (the ability to form mental images of things that are not physically present)
• Substance Abuse
• Purposelessness
• Anxiety
• Feeling Trapped
• Hopelessness
• Withdrawal
• Anger
• Recklessness
• Mood Changes

Undetected and untreated depression is the door that leads to suicide. Symptoms are the same or very similar. In both, helplessness is present.

Depression is an illness that occurs in some firefighters and as an illness, it must be treated by the medical community. Depression can occur from a single, traumatic event or can occur from the cumulative effects of a series of traumatic episodes that are related to their chosen occupation. All of the training in the world does not prepare a firefighter for the real world tragedies that they will encounter in their careers.

It is for this reason that I believe that firefighter suicide should be considered for line-of-duty-death (LODD) benefits.

And this is also the reason that I believe that suicides are NOT 100% preventable. The outlier is recognition of the symptoms and getting the affected firefighter into a clinical setting, where proper diagnosis is delivered and follow up care is given in a controlled environment. It affords the stricken firefighter a setting where medications and therapy will be administered, monitored and controlled. It provides the best opportunity for a positive outcome.

When a firefighter attempts to fight their illness without the assistance of medical professionals, they will allow thoughts of frustration, helplessness and worthlessness to over-take them, turning their thoughts towards ending their life.

So, to conclude, my opinion is that firefighter suicide should be considered for LODD benefits and unless the stricken firefighter is in a clinical setting and surrounded by medical professionals, I don’t think that there is any guarantee that the suicide will be prevented.

Fire service leaders need to continue the conversation and fire departments need to join them.

Related links:

Everyone Goes Home

Firefighter Behavioral Health Alliance

Beth Murphy: Firefighter Suicide and Mental Illness

National Volunteer Fire Council

NFPA With Janet A. Wilmoth

International Association of Fire Chiefs

The opinions and views expressed are those of the article’s author, Art Goodrich, who also writes as ChiefReason. They do not reflect the opinions and views of www.fireengineering.com, Fire Engineering Magazine, PennWell Corporation or any of its subsidiaries. All articles by the author are protected by copyright under The Adventures of Jake and Vinnie© umbrella and cannot be reproduced in any form without expressed permission.