Suicide - Not the Way to End Suffering, Part I
The call came through on my business line on Saturday morning, just after breakfast. “I’m not calling for personal counseling,” the concerned voice at the other end related. “I’m calling because I think we have a suicide problem in the community.” We talked a long time about the number of recent suicides in the area, the tragic circumstances behind them, and I agreed to write this article in the column.
Typically, an article on suicide is either written for the reader considering ending their own life or it is directed at friends and loved ones with advice on how to help prevent suicide. The impression is given that it’s an “us and them” thing, with them being the poor souls feeling driven to the brink of self-destruction. An incredible sense of alienation is one of the most distinguishing features of someone who feels suicidal. This two-topic way of addressing the subject perpetuates the idea that the suicidal are essentially different than the rest of us. It is alienating in itself. If we are to truly embrace the suicidal among us, we must begin by embracing them as part of us. This begins by addressing the topic from both perspectives at once.
Breaking the Taboo of Silence
We begin by shattering the taboo that the suicidal are somehow “other” than us, by having the courage to recognize how uncomfortable and vulnerable we feel in our own lives with respect to whether and how our lives are worth living. When someone close to us appears to be drifting toward the edge, it’s only natural to want to look the other way. I once shared that no matter how old or mature we get, we human beings remain essentially like babies in a nursery – When one cries, all want to cry. In our need to believe that we are invulnerable to the bitter winds that can blow our own life off its course, we reflexively fail to see the threat. We fail to see the drift of others, because we are frightened to look at our own potential vulnerability.
We have been taught that by society. We have been subtly taught that to talk about suicide, increases its possibilities – for those at risk; even for us. So, we are afraid to talk about it. The tragedy is: the opposite is true, so silence is the killer. Talking about our potential for self-destruction saves lives. Few people live a lifetime without some ambivalence about living at some point in their lives; far fewer than those of us who come to a place of seriously considering whether we should continue.
Art Kleiner, quoting David Nolan, Director of the Marin Suicide Prevention Center, said, “Anyone . . . can be suicidal given the right circumstances or the proper amount of stress.”
With over 100,000 reported suicides reported worldwide each year, of which 30,000 are in the US, suicide is the leading cause of unnatural death of people in all age brackets.
Additionally, we don’t have good predictors of who is most likely to commit suicide. Because different people are so variable with respect to resilience in some aspects of life, but not in others, and across time, it’s virtually impossible in every case to reliably predict who will, or will not, take his or her own life. This limited ability to predict pertains to mental health professionals, let alone the vast majority of us not formally trained in this area. The best beginning to a solution is to stop looking for blame in the wake of suicide tragedies and to begin talking about their potential before they happen.
By recognizing that we all have the potential for self-destruction, we begin to remove the stigma of shame from the potential victim and everybody else in their circle of life. This actually includes a whole continuum, from accomplished suicides, to attempts and gestures, to reckless and foolhardy behavior (often involving alcohol and/or other drugs) that can accomplish the same end, but with the less stigmatizing label of “accident.”
Understanding and Dealing with Suicide Potential
Casting the silence taboo aside, what needs to be said for all of us to have a basic understanding of suicide and how to deal with its potential in our lives? First, we must be willing to see the potential, whether it be in ourselves or in those who share our lives with us. Untreated depression is the number one cause of suicide, so learn to recognize the signs and symptoms of depression. Remember that virtually all suicidal people are depressed, but not all depressed people are suicidal. Those who are will often talk to trusted relatives or friends about their feelings. In fact, 70% of those who have committed suicide have told someone in advance. However, the shame factor may result in statements coming out in the form of hints and innuendo. Such statements should be considered seriously, as we’ll discuss below.
The fact that those of us who become suicidal typically talk about it to varying degrees is an indicator of another common characteristic: ambivalence. People who are considering ending their lives generally do not really want to die; they simply want to end the pain and suffering that has become the overwhelming focus of their lives. While their reach for help is almost always tentative, those of us who respond must be anything but tentative. When we are in the role of responding to someone who may be potentially suicidal, our approach should resemble how we would respond to our recognition of a sliver of glass in their eyelid. We should recognize the potential danger, immediately and resolutely offer our complete focus to their problem, yet approach the danger with such gentleness and compassion that they neither flinch, nor blink.
In simple terms, this means being straight up and real in addressing comments suggestive of self-destructive thinking, yet responding with enough sensitivity and tact that the person is not driven back into their shell. Being available and willing to respond in this manner is increasingly important in this modern era. Where funding cut-backs and privatization have seriously compromised the public mental health system, it falls on all of us to do what we can to look out for each other. Many of us have taken Red Cross courses like First Aid and CPR, but nothing is yet universally offered by any agency I know of on the topic of suicide prevention. This article is an initial step in that direction, allowing recognition and help when others, or ourselves, begin to get into trouble.
Talking to a Suicidal Person
Given an understanding of the topics we just covered; let’s imagine a successful encounter with somebody who is thinking of suicide. If the person is clearly depressed and we recognize enough symptoms, it is okay for us to broach the subject in an appropriately private setting.
We offer conversation addressing our awareness of the apparent sadness or depression. While we express concern, we realize that mostly listening will encourage the person to open up. If our companion has made a statement alluding to suicidal thinking, we can go straight to the point; otherwise we should take our time.
There is a hierarchy of questions we can explore with our companion, gently and gradually getting to deeper and deeper levels of their suffering. One way of exploring for suicidal thinking is to first approach the question of whether the person feels hopeless. Does it seem to them that things will ever get better? Does the person have thoughts of death? If so, have they had suicidal impulses? Has the person had an urge to kill himself/herself? If he or she acknowledges these concerns to this level, we can be reasonably sure our companion is at risk, but to what degree?
The next level to explore with our companion is whether she or he has an actual plan for suicide; the more detailed the plan, the more lethal the method, the greater the risk. At this level, it is important to find out when the person intends to kill him/herself. The more immediate the plan, the greater the risk. Finally, has suicide been attempted previously? Was the attempt(s) planned or impulsive? Prior attempt(s) and higher impulsivity indicate greater risk. Alcohol and other drugs increase the risk.
From here, we move to another level, where we compassionately encourage our companion to use his or her own resources to begin moving away from risk and toward resolution. The emphasis is on their resources, not ours – not our opinions, not our reasons for living, not our religious reasons for not committing suicide. I cannot emphasize this enough. We do not moralize; we do not lecture; we do not judge! We do not express surprise or shock at anything shared if our person is to feel safe in opening up. First, we are offering help to someone who is very likely too swallowed up in their suffering to hear. To quote one anonymous everything2.com blogger who struggled with suicide, “I swear to God, there's nothing you could have told me, no way you could have reached me, if I had decided. In any way, in any manner. Nothing could have touched me. I didn't care; and I wasn't in touch with your world at all.”
Granville Angell © 6/2006
Granville Angell, EdS, LPC, NCC, a licensed professional counselor, invites readers to submit questions for his column to his web site: www.transitions-counseling.com . He may be reached at his private practice, TRANSITIONS Personal & Family Counseling Services by emailing angell(AT)transitions-counseling.com or calling 704-276-1164.
To call TRANSITIONS/SoulMentors: (704) 276-1164