The death of a loved one will impact us differently, and this also depends on our previous relationships. For example, it is particularly difficult to raise a child through adolescence if their older brother or sister killed themselves. I have not contemplated committing suicide but I understand the dark forces that can drive a person to it.

Suicide is a complicated thing. Whatever the motive, whatever the unfathomable darkness that stirs within us, there is no doubt that it will generate catastrophic effect on the family left behind. The questions that cannot be unfolded, the guilt, the anger, the disintegration, destruction – there are simply not enough words to say how devastating it is. 

Suicides are not peaceful deaths: They leave wounds that take generations, and they will never fully heal. Often, we also fail to acknowledge the extent to which, for example, depression can drive people toward suicide. Take for instance the tragic death of Mike Thalassitis who died of suicide due to depression. 

Suicides are, in fact, often preventable. More often than not people who are deeply depressed and have thoughts of suicide don’t tell anyone. But in my experience, those who willingly tell other people about their suicidal ideation are usually sharing the responsibility of their anguish and are crying for help.

When we talk about suicide, it is also helpful to examine it from the perspective of ‘four givens‘. First suggested by Irvin Yalom, they are called ‘givens’ because they are unavoidable. Death is one of those ‘givens’ and to be alive means having to resolve these ‘givens’ in some way:

• Death – How do we live knowing we are going to die?
• Freedom – How do we use the freedom we have to choose how we live our lives?
• Isolation – We are born alone, and we die alone. How do we reconcile our internal sense of ‘aloneness’ with our need for company?
• Meaninglessness – How do we make meaning in a universe which is essentially meaningless?

Although they may seem quite distinct, these ‘givens’ tie rather neatly into the first one: death. Yalom says that an innate fear of death is present at every level of human consciousness: from the most conscious and intellectualised, to the deepest depths of the unconscious, which manifests as death anxiety. 

For many people, the fear of death results in not fully living. And given that we are all going to die at some point, death anxiety is a normal part of the human experience. However, in his book The Four Agreements, Don Miguel Ruiz , writes about ‘surrendering to the angel of death’. By this he means accepting the impermanence of everything. Nothing really ever belongs to us. It’s all on loan and death can take it at any time. Death takes us out of our normal routine and reminds us of the temporariness of life.

It is normal to be afraid of death but death anxiety becomes abnormal when it forms the basis of pathological thoughts and behaviours that interfere with normal living. As therapists we know that death is related to a number of anxiety disorders including specific phobias, social anxiety, panic disorder, agoraphobia, posttraumatic stress disorder and obsessive compulsive disorders. For example, when children experience separation anxiety disorder, it is often connected to excessive fear of losing major attachment figures (such as parents or other family members), to harm or tragedy from car accidents or significant illness, or when seeing clients with OCD (obsessive compulsive disorders) who repeatedly check  stoves and locks in an attempt to prevent harm or death. Finally, specific phobias are characterised by excessive fears of heights, spiders, snakes and blood – all of which are driven by death.

There is also a specific phobia of dying called thanatophobia or fear of death. Thanatophobia is an unusual or abnormal fear of personally dying and/or being dead that impacts the otherwise ‘normal’ or healthy functioning of the person possessing this fear that might appear disproportionate to an outsider relative to the actual risk or threat the individual faces.

In many Buddhist traditions, a purposeful contemplation of death is one practice that is used to help individuals become aware of the constancy of change and life’s fragility. This concept suggests that when we realise that nothing in life is permanent and everything is easily broken, we look at events in our lives differently.  We may appreciate to a greater level not only what we have (including health, relationships, and possessions), but also the people we love.  From this perspective, while we may grief loss (from the breaking of a favourite cup to the loss of something greater), we understand it to be part of a greater whole.

Archbishop Desmond Tutu, who won the 1984 Nobel Prize for his role in the anti-apartheid movement in South Africa, once said: ‘When you have a potentially terminal disease, it concentrates the mind wonderfully. It gives a new intensity to life. You discover how many things you have taken for granted – the love of your spouse, the Beethoven symphony, the dew on the rose, the laughter on the face of your grandchild.’ 

Death is both certain and uncertain. We know it will happen, but we don’t know when. One of my friends who is a wonderful psychiatrist passed away earlier this year. It took me by surprise.

I was just taking in his recent cancer diagnosis. The prognosis didn’t look good, but death moved even faster. Losing a friend hurts deeply. But it’s irreversible. When I miss him, I feel sad, but it also reminds me to celebrate life.

When death knocks to your door, be ready to leave and live without regrets. Let’s not hold onto life as if it’s permanent because it can blind our spirituality. We can’t control how long we live, but you can manage how we live. For most of us, this is a very difficult thing to do. But we can do it, albeit imperfectly. We need to surrender to the fact that death, like life, is messy, unpredictable, scary and challenging. And if we come to terms with to another fact that each of us will make the journey in the best way we know how. 

Stelios Kiosses is the clinical lead for Dementech Neurosciences. He is also a research collaborator with the Computational Psychopathology Research Group at the University of Oxford. 

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