12 Mar (WALES) – In the England and Wales there are roughly 5000 suicides in roughly 60 million people per year. This would until recently have led to around 2000 hangings per year, 34 hangings per million people per year, 3.5 per 100,000 people per year. Bridgend in South Wales has a population of 40,000. The greater Bridgend area has a population of 130,000. There should be 18 hangings per 100,000 people over a 5 year period, 24 per 130,000 per year. In recent years however in both the US and UK there has been a rise in the number of hangings so that this mode of death now accounts for 50% of cases. If this applies in the Bridgend area, we might expect 28 hangings per 130,000 over a 5 year period, roughly 6 per year.
There were in fact 79 hangings in Bridgend between January 2007 and February 2012. The hangings continue unabated, so the true figure may be in the 90s. This means there have been 16 per year – an excess of 10 or more hangings per year.
There have likely been a lot more self-destruction than this in Bridgend. Coroners have considerable discretion and recently a great deal of encouragement to use narrative, open or death by misadventure verdicts rather than to record a verdict of suicide. To record a suicide verdict they should be satisfied that the person intended to kill themselves. One of the primary indicators of intent is a suicide note. In the Bridgend cases, there have been few suicide notes. This has made it easy for coroners to manage perceptions of what might be going on.
Having a narrative or open verdict can be extremely important for families. I have written reports in over 20 inquests arguing that it would be appropriate to return a narrative rather than a suicide verdict, in the case of people whose suicide has been triggered by an antidepressant.
But this use of narrative verdicts has produced a situation where suicide figures are close to worthless.
The British suicide rate is comprised of cases recorded as suicides along with a proportion of narrative, open or other verdicts, with the proportion chosen down to bureaucratic whim. We do not have a self-destruction rate and absolutely no idea as to how many verdicts, either suicide or narrative, are linked to antidepressant or other drug intake.
A website antidepaware was recently set up to track deaths by suicide or misadventure or related that are related to antidepressants. It has logged over 1600 UK suicides involving antidepressants of which 43% were recorded as suicides by the coroner, 26% as narrative verdicts, 19% as open verdicts, 5% as death by misadventure and 7% as accidental.
HANGING AND KNEELING
While the suicide rate has become ambiguous, it is not possible to conceal the number of hangings.
Bridgend has had an unusual number of hangings. An apparently odd feature is that these hangings have involved a lot of kneeling. The fact that many victims have been found hanging but with their feet on the ground or close to kneeling has given rise to speculation about internet or other cults, and about serial killing rather than self-destruction.
I had been exposed to relatively few SSRI suicide cases when Linda Hurcombe came to me telling me of her daughter Caitlin, who after 6 weeks on Prozac hung herself using her horses’ lanyard (see Let Them Eat Prozac).
Soon after that with colleagues I ran a healthy volunteer study designed to test how antidepressants work. In this study, two completely normal women while taking the SSRI sertraline (Zoloft) became suicidal. One of these two had vivid imagery of hanging herself.
Around this time too I got involved in the Miller case. Matt Miller was a 13 year old boy who had just changed schools and was feeling nervous. His parents prompted by the teacher brought him to a doctor who put him on Zoloft. Seven days later he hung himself in the bathroom between his parent’s bedroom and his bedroom.
BIG PHARMA WEIGHS IN
Pfizer, the makers of Zoloft argued that this was not suicide but auto-erotic asphyxiation gone wrong. As evidence, they pointed to the fact he was not suspended several feet above the floor but had his feet on the ground, almost kneeling. They went so far as to scour the carpet in the bathroom to collect potential evidence for seminal stains.
It was Yvonne Woodley’s case in 2010 that explained the hanging issue to me – something that anyone with an interest in the area could in fact have found from Wikipedia. Yvonne Woodley was a 42 year old woman who was having marital difficulties. She presented to her doctor with sleep problems. The doctor viewed her as being under stress, and as posing absolutely no suicide risk. She gave Yvonne citalopram. A week later the doctor noted that Yvonne was more agitated and there were fleeting thoughts of suicide – so she doubled the dose of citalopram. After a suicide attempt, she doubled it further and a short while afterwards Yvonne hung herself.
She hung herself in the attic of her house. Given the kind of person she was, the rest of her family found it unbelievable that she would have hung herself in the house with her two daughters downstairs but a common feature of SSRI suicides is the apparent lack of concern for the effect on others.
The fact that Yvonne was close to kneeling enabled the coroner to return a narrative rather than a suicide verdict. The pathologist explained that when people are weighing up the possibility of hanging themselves, wondering about it, they might put a rope in place and test themselves against it. If they do this, it is in fact very easy by putting pressure on the carotid sinuses that are in the side of the neck to slip out of consciousness and falling forward to end up asphyxiated. If you have begun with your feet on the ground you can end up kneeling or close to kneeling… (MORE)