On average, about one out of 10 schizophrenic patients commits suicide. The high risk of suicide in schizophrenia is due in large part to the depression and paranoia that characterize the disorder. Some patients hear voices telling them to hurt themselves. As a result, caregivers of schizophrenia patients must be on guard for signs of self-harm and possible suicide.
In the general nonschizophrenic population, men are more likely than women to commit suicide, whereas women are more likely to attempt it but to be unsuccessful. This is also the case among schizophrenia patients. Men are more likely to try lethal methods of suicide such as using a gun or jumping in front of a train, whereas women are more likely to take an overdose of pills or cut themselves. Patients who are most at risk of committing suicide are in the first few years of their illness. In Surviving Schizophrenia, Dr. E. Fuller Torrey suggested that those patients who are at the most risk of committing suicide know that they are sick and are hopeless about the future.
They may not respond well to medication and understand that their previous level of functioning is no longer attainable. These feelings may lead to frustration and depression and lead patients to believe that there is no way out of their illness. Suicide, then, becomes the perceived only option and a last resort.
Although schizophrenia patients may plan and execute a suicide attempt, many patients die accidentally by their own hand. A patient might become psychotic and enter a dangerous situation. For example, patients might believe that they can fly and jump out of a window. A recent example of an accidental suicide is the shooting of Rigoberto Alpizar. Alpizar was a passenger on an American Airlines flight leaving Miami, Florida.
Before the flight took off, he allegedly demanded to get off the plane and said that he had a bomb in his backpack. Air marshals demanded that he surrender and lie on the ground but he refused, instead reaching for his backpack. As a result, Alpizar was shot and killed on the jetway. No bomb was found on his person or in his luggage. After the shooting, Alpizar’s wife claimed that he was mentally ill and hadn’t been taking his medication. She believed that his strange behavior was psychotic and due to his illness. Although we don’t know why Alpizar behaved as he did, many suspect that this was a form of suicide caused by psychotic symptoms.
Caregivers of schizophrenia patients are encouraged to be vigilant about depressive signs, changes in behaviors, or indications that hallucinations or delusions are encouraging the patient to hurt himself. Therapists should be contacted immediately, and sometimes patients need to be hospitalized to ensure their safety. Although many people assume that talk of suicide is simply a call for attention, all suicidal behaviors must be taken seriously, especially in people with schizophrenia.
Heather Barnett Veague, Ph.D.
Heather Barnett Veague attended the University of California, Los Angeles, and received her Ph.D. in psychology from Harvard University in 2004. She is the author of several journal articles investigating information processing and the self in borderline personality disorder. Currently, she is the Director of Clinical Research for the Laboratory of Adolescent Sciences at Vassar College. Dr. Veague lives in Stockbridge, Massachusetts, with her husband and children.