They're trying to take control of their destiny and alleviate their own suffering, which usually can only be done in death. These people aren't depressed, psychotic, maudlin, or crying out for help. The decision to die by suicide for some is based on a reasoned decision, often motivated by the presence of a painful terminal illness from which little to no hope of reprieve exists. They have a philosophical desire to die.I've watched more than one teenager die a horrible death in an ICU days after such an ingestion when remorse has already cured them of their desire to die and their true goal of alerting those close to them of their distress has been achieved. For instance, a young teenage girl suffering genuine angst because she feels lonely or has gotten into a devastating fight with her parents, may swallow a bottle of Tylenol-not realizing that in high enough doses, Tylenol causes irreversible liver damage. They often don't believe they will die, frequently choosing methods they don't think can kill them in order to call attention to their challenges, but they are sometimes tragically misinformed. These people don't usually want to die but do want to alert those around them that something is seriously wrong. They're crying out for help, and don't know how else to get it.Substance abuse and the underlying reasons for it are generally a greater concern in these people and should be addressed as aggressively as possible. Hospital admission is, therefore, not usually indicated. They may try it again the very next time they become drunk or high, or never again in their lifetime. The remorse is often genuine, but whether or not they'll ever attempt suicide again is unpredictable.

Once sobered and calmed, these people usually feel emphatically ashamed. Often related to drugs and alcohol, some people become maudlin and impulsively attempt to end their own lives. Untreated or poorly treated psychosis almost always requires hospital admission until the voices lose their commanding power. Psychosis, too, is treatable, and usually must be treated for a schizophrenic to be able to function at all. Schizophrenics are just as likely to talk freely about the voices commanding them to kill themselves as not, and also, in my experience, give honest answers about thoughts of suicide when asked directly. The worldwide incidence of schizophrenia is 1 percent and often strikes otherwise healthy, high-performing individuals, whose lives, though manageable with medication, are often derailed from their original promise. Psychosis is much harder to mask than depression, and is arguably even more tragic. Malevolent inner voices often command self-destruction for unintelligible reasons. If you suspect someone might be depressed, don't allow your tendency to deny the possibility of suicidal ideation prevent you from asking about it. Despite making both parties uncomfortable, inquiring directly about suicidal thoughts, in my experience, almost always yields an honest response. Often, people suffer with it silently, planning suicide without anyone ever knowing. Because depression, as we all know, is almost always treatable, we should all seek to recognize its presence in our close friends and loved ones. They shouldn't be blamed for falling prey to such distorted thoughts any more than a heart patient should be blamed for experiencing chest pain it's simply the nature of their disease. The state of depression warps their thinking, allowing ideas like, 'Everyone would all be better off without me' to make rational sense. The pain of existence often becomes too much for severely depressed people to bear. Severe depression is almost always accompanied by a pervasive sense of suffering as well as the belief that escape from it is hopeless. This is, without question, the most common reason people die by suicide. In general, people try to kill themselves for six reasons:

Suicide notes