Suicide as an Auto-Immune Response

A philosophical and medical discussion on life’s most drastic action

An autoimmune disease is a condition where the body’s immune system turns to attack the body itself, rather than simply defend it. It’s a complex process where agents within us converge to react with hostility to other agents or areas within us — a civil war.

Type 1 diabetes, multiple sclerosis, lupus, Celiac disease, Graves disease. These are all common auto-immune diseases. Although, the full list is laborious and often contested. New information about the nature of health reveal more auto-immune disease, as our knowledge matures, we make new discoveries surrounding certain illnesses, sometimes bringing them under the umbrella.

There’s been a long-running discussion around depression being an auto-immune disease, at least in some contexts. The cytokine hypothesis of depression argues that major depressive disorder (MDD) is caused by cytokine proteins in the brain which emit a signal to increase inflammation, and then interfere with the signalling of key mood-regulating neurotransmitters. Namely serotonin. This inflammation can also affect the hypothalamic-pituitary-adrenal (HPA) axis, which can lead to chronically high levels of cortisol, intimately linked to stress. Not only that, but pro-inflammatory cytokines can increase oxidative activity in the brain, which has been connected to disruption in their typical function.

High levels of pro-inflammatory cytokines have been found in people who suffer from depression. The question isn’t whether they’re correlated with depression, but whether they’re the leading factor. This is where discussions split into two directions.

Depression as an Additional Element of Many Established Auto-Immune Diseases

Auto-immune diseases can often be debilitating. Increased stress from the body attacking itself can easily lead to discomfort and mental anguish. Constant medical appointments, chronic pain, lifestyle modifications, and various medicines can understandably impede ‌a person’s quality of life. It’s clear to see how depression could be a co-morbidity of an auto-immune disease. This would be more akin to how depression is higher in those who are neurodivergent — it’s not that being neurodivergent is a sign of depression, but that we live in a neurotypical world, where the public’s understanding of these experiences is limited. Life can feel deeply unfair, both on a structural and emotive level.

Depression as an Auto-Immune Disease in-and-of Itself

This is the slightly more controversial argument that depression, when paired with pro-inflammatory cytokines, is an auto-immune disease itself. For this, we would need a study that examines people diagnosed with depression, but without any typical auto-immune diseases. No study like this exists, but some results point to this being a possibility.

Not that all forms of depression are auto-immune. Oftentimes, a person will enter a depressive state after external factors, like deaths in a family or trauma (psychological or physical). But in the situations where depression arises without any discernable external reason, it may still hold weight. We need to be careful when discussing this, as depression is multi-faceted, and if inflammatory responses are linked to all forms of it, then we diminish many other people’s lived experiences. It would place us in the same position as those who posited the chemical imbalance hypothesis of depression, which pushed for chemical-stabilizing medication as the solution.

The answer is more likely that it inflammation can be a defining factor of depression, but that it’s dependent on the individual.

Depression’s Functional Role Within an Individual

From an inward perspective, depression itself does function like an auto-immune disease. It does feel like the body attacking the body. Or at least the mind eroding the mind. The dull, corrosive, and destructive nature of depression operates similarly to how the immune system tackles our physical body.

The possible key distinction is that when our immune system is spiked into action, it performs as if it’s helping or saving us. Those with depression tend to lack an inward experience of feeling like its presence is protecting them, inadvertently or overt. Extreme forms of paranoia or anxiety might fit this role a little better. They’re defects in how we react to the world, with the overarching aim of self-preservation.

Suicide’s Role in Self-Preservation

Depression might not neatly fit into the functionality of an auto-immune disease, but a depressive state can birth suicidality, or suicidal ideation. This is the collection of thought processes that point towards a person considering or evaluating the decision to take their own life. This can present as a form of solution: to the sickness of reality, or the torment of living — both living in the world, and inhabiting and occupying a mind that feel dislodged from the world. In other words, an intense and drastic solution to the problem of living.

Suicide does not present itself as being self-preserving. It’s not the same as a function of the body choosing to attack itself whilst presenting itself as helping. Auto-immune diseases tend to operate in a way that separates the immune response from the part of the body it’s responding to. Self-harm fits this structure more neatly: to bring harm onto your own body with an aim to provide some immediate perceived relief.

Suicide is harder to partition. It would require somebody perceiving the taking of their own life as an act of kindness unto themselves.

But… sometimes it does manifest like this. The idea of removing yourself from an environment you view as hostile is a form of self-preservation. What happens when you view the entire world as that environment? Or your living situation in which you cannot view a less violent means of escaping? Or a collection of thoughts and feelings that embody you which seem to be glued to you?

If this is a form of self-preservation, what is the self in this context? The self can be conceived as all about you that exists in the present, and perhaps which you brought into the present from your past. The notion of “preservation” shows a desire for the self to continue into the future in some capacity. Suicide feels, by definition, like an opposition to preservation. It’s the final removal of the self from persistent living — the marker that nothing will preserve beyond this.

Yet, preservation can also be considered the crystallising of something, the slashing of its ability to continue its growth, and to be in stasis. When we preserve food, we’re preserving it from decay. It’s the same for artwork, clothing, and other inanimate objects. Suicide can look like the preservation of the self in its current state, and while that current state might be unpleasant, if somebody perceives their future to be a continuation of that discomfort or even an increase in it, then it’s a form of preserving.

It feels contradictory. But that’s what gives suicide its auto-immune shaping. It’s contradictory for the human body to fight itself in the name of itself. It’s contradictory for the mind to construct theories of death to save its life. Auto-immune diseases exist on an axis that spits on the notion of a holistic self-preservation. They’re a reminder that we’re not a tightly aligned and constructed machine, but a collection of processes which can sit in conflict.

Suicide and Immunity

Suicide can act as an ultimate auto-immune response. Not only can ideation form in an auto-immune space, where inflammation can potentially lead to depression, but the very function of suicide acts as the self waging war on the self, for the benefit of the self. A civil war of the mind, which has convinced itself that death is the answer when asked how to live life. Suicide can be viewed as salvation, galvanised by the perception that preservation is not about continued existence, but about bracketing the existence that’s already present, and calcifying it without further growth — saving the self from further erosion by severing any ties to a future.

At this point, we must return to the notion of an auto-immune disease. The argument so far sits comfortably in one space, while occupying two. Suicide can easily be framed as akin to an established auto-immune condition, where “auto-immune” is a metaphor. But this could also be read as suicidal ideation being an auto-immune disease in itself.

This is not what I’m saying. Suicidal ideation is seen as a symptom of illnesses like depression, rather than a disease itself.

Rather, I argue that suicidal ideation can be an auto-immune response, born from an auto-immune disease (in this case, the disease being depression, especially when associated with high levels of pro-inflammatory cytokines). Another route to tackle this would be to examine suicidal behaviour disorder, which exists in the DSM-5, defined as:

“A self-initiated sequence of behaviors believed at the time of initiation to cause one’s own death and occurring in the last 24 months”.

When considering this, remember the immune system is made up of several factors. Psychoneuroimmunology is the study of how psychological processes can tie to our immune system. The hypothalamic-pituitary-adrenal axis often plays a role in these discussions, as this is a major component regarding what happens after certain thought processes (such as perceived threats) are treated within the body. This mechanism can malfunction during inflammation within the brain. The response from ourselves should be to preserve ourselves in some way when we feel negatively, but it’s entirely possible for someone’s conclusion to be a preservation that does not relate to continued living.

Candace Pert discussed the role of emotion in relation to immunity in her text “Molecules of Emotion”. Much of her work related to the intimate relationship between thoughts and feeling and how our immune system reacts to them, with some of her arguments crossing the bridge and treating the two as not only calibrated, but integrated. Thoughts and emotions can act as representations of an immune response, or actions from signals within the body on how we should react to preserve ourselves.

Her research was largely on neuropeptides, which are amino acid chains in the body that can modulate neural activity and are involved in processes such as mood, appetite, pain, and stress. She spoke of a bidirectional relationship between neuropeptides in relation to the body’s immune response and the thoughts and emotions that occurred within a person, calling for a more unified idea of us as an information network. She noted:

“The striking pattern of neuropeptide receptor distribution in mood-regulating areas of brain, as well as their role in mediating communication throughout the whole organism, makes neuropeptides the obvious candidates for the biochemical mediation of emotion”.

Neuropeptides are part of our immune system, and as they’re a huge aspect of how emotions arise and how thoughts are influenced or triggered by them, this means our thoughts and emotions are included in our immune responses.

This can be read as a reductive argument for the existence of thought and emotion. Although, it can also read as a physical representation of activity that is more ephemeral. It doesn’t necessarily say all mental activity can be self-contained within physicality, but more so that mental activity can mapped onto the body, perhaps not with the same vibrant and rich definition and expression that comes with inward perception, but a less dimensional and crude manifestation.

At the crux is the idea that her work includes thought processes in the architecture of the immune system, and therefore thoughts that impede on our immunity can be considered as the immune system working against us, or some notion of us. And it’s not to say all thoughts fit under this, but it does provide a framework for considering suicidal ideation to be an auto-immune response, at least where there is more classical immune activity present, such as a high degree of pro-inflammatory cytokines, seen in those with depression. This would make suicidal ideation a malfunction of the notion of preservation, at least the form of preservation that a healthy body and mind strive for.

Final Words

I say all of this not as a defence of suicide, but as a means of understanding how it can manifest, helping to add a new framing to it. Suicidal ideation may not be an auto-immune response in the literal sense, although depression can be an auto-immune disease, and suicidal ideation could serve as a symptom or co-morbidity. However, if we gain a greater understanding of how auto-immune diseases operate, and how suicide takes form in a person’s mind, I would be unsurprised if it got classified as one in the future.

This article switches between treating the concept of suicide as an auto-immune response in both a metaphorical and literal way. If it feels like the text struggles to sit exclusively in one spot, that’s because it does. At the heart of it is the notion that suicidal ideation can sometimes map so easily onto the concept of auto-immune responses because there are times when actually is one.

The issue is of language: the way a malfunctioning thought emerges will naturally read differently than a malfunctioning internal process that leads to inflammation. Once we enter discussions on thought and emotion, our language must change as we’re discussing matters that are richer and more ephemeral. If a physical malfunction from our immune system occurs which relates directly to our thoughts, then it will have a more distinct, inward experience to it than the malfunction of something that has less direct influence. Think of it similarly to how one of the first symptoms of somebody being given the wrong blood in a transfusion is a sense of impending doom (due to the increase in adrenaline, among other intense actions occurring all at once). These concepts are more nebulous, but that’s because they reach beyond cold biological activity into the realm of thought.

The more we understand auto-immune diseases and mental health, the more we’ll start to expand the term. Our research in them has already transformed them from a narrow set of conditions to a more encompassing schema of health.

For further critical discussions on culture, and medicine, check out my physical magazine, Existential Horror. This is a 250+ page publication designed to be a critique and celebration of psychedelia and substance-use culture. Vol 2 is out now!