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What can I do to help someone who may be suicidal?
by David L. Conroy, Ph.D. Original location
- Take it seriously.
Myth: 'The people who talk about it don't do it.' Studies
have found that more than 75% of all completed suicides
did things in the few weeks or months prior to their
deaths to indicate to others that they were in deep
despair. Anyone expressing suicidal feelings needs
immediate attention.
Myth: 'Anyone who tries to kill himself has got to be
crazy.' Perhaps 10% of all suicidal people are psychotic
or have delusional beliefs about reality. Most suicidal
people suffer from the recognized mental illness of
depression; but many depressed people adequately manage
their daily affairs. The absence of 'craziness' does not
mean the absence of suicide risk.
'Those problems weren't enough to commit suicide over,'
is often said by people who knew a completed suicide. You
cannot assume that because you feel something is not
worth being suicidal about, that the person you are with
feels the same way. It is not how bad the problem is, but
how badly it's hurting the person who has it.
- Remember: suicidal behavior is a cry for help.
Myth: 'If a someone is going to kill himself, nothing can
stop him.' The fact that a person is still alive is
sufficient proof that part of him wants to remain alive.
The suicidal person is ambivalent - part of him wants to
live and part of him wants not so much death as he wants
the pain to end. It is the part that wants to live that
tells another 'I feel suicidal.' If a suicidal person
turns to you it is likely that he believes that you are
more caring, more informed about coping with misfortune,
and more willing to protect his confidentiality. No
matter how negative the manner and content of his talk,
he is doing a positive thing and has a positive view of
you.
- Be willing to give and get help sooner rather than later.
Suicide prevention is not a last minute activity. All
textbooks on depression say it should be reached as soon
as possible. Unfortunately, suicidal people are afraid
that trying to get help may bring them more pain: being
told they are stupid, foolish, sinful, or manipulative;
rejection; punishment; suspension from school or job;
written records of their condition; or involuntary
commitment. You need to do everything you can to reduce
pain, rather than increase or prolong it. Constructively
involving yourself on the side of life as early as
possible will reduce the risk of suicide.
- Listen.
Give the person every opportunity to unburden his
troubles and ventilate his feelings. You don't need to
say much and there are no magic words. If you are
concerned, your voice and manner will show it. Give him
relief from being alone with his pain; let him know you
are glad he turned to you. Patience, sympathy,
acceptance. Avoid arguments and advice giving.
- ASK: 'Are you having thoughts of suicide?'
Myth: 'Talking about it may give someone the idea.'
People already have the idea; suicide is constantly in
the news media. If you ask a despairing person this
question you are doing a good thing for them: you are
showing him that you care about him, that you take him
seriously, and that you are willing to let him share his
pain with you. You are giving him further opportunity to
discharge pent up and painful feelings. If the person is
having thoughts of suicide, find out how far along his
ideation has progressed.
- If the person is acutely suicidal, do not leave him
alone.
If the means are present, try to get rid of them.
Detoxify the home.
- Urge professional help.
Persistence and patience may be needed to seek, engage
and continue with as many options as possible. In any
referral situation, let the person know you care and want
to maintain contact.
- No secrets.
It is the part of the person that is afraid of more pain
that says 'Don't tell anyone.' It is the part that wants
to stay alive that tells you about it. Respond to that
part of the person and persistently seek out a mature and
compassionate person with whom you can review the
situation. (You can get outside help and still protect
the person from pain causing breaches of privacy.) Do not
try to go it alone. Get help for the person and for
yourself. Distributing the anxieties and responsibilities
of suicide prevention makes it easier and much more
effective.
- From crisis to recovery.
Most people have suicidal thoughts or feelings at some
point in their lives; yet less than 2% of all deaths are
suicides. Nearly all suicidal people suffer from
conditions that will pass with time or with the
assistance of a recovery program. There are hundreds of
modest steps we can take to improve our response to the
suicidal and to make it easier for them to seek help.
Taking these modest steps can save many lives and reduce
a great deal of human suffering.
Warning signs
Conditions associated with increased risk of suicide
- Death or terminal illness of relative or friend.
- Divorce, separation, broken relationship, stress on family.
- Loss of health (real or imaginary).
- Loss of job, home, money, status, self-esteem, personal security.
- Alcohol or drug abuse.
- Depression. In the young depression may be masked by
hyperactivity or acting out behavior. In the elderly it
may be incorrectly attributed to the natural effects of
aging. Depression that seems to quickly disappear for no
apparent reason is cause for concern. The early stages of
recovery from depression can be a high risk period.
Recent studies have associated anxiety disorders with
increased risk for attempted suicide.
Emotional and behavioral changes associated with suicide
- Overwhelming Pain: pain that threatens to exceed the
person's pain coping capacities. Suicidal feelings are
often the result of longstanding problems that have been
exacerbated by recent precipitating events. The
precipitating factors may be new pain or the loss of pain
coping resources.
- Hopelessness: the feeling that the pain will continue or
get worse; things will never get better.
- Powerlessness: the feeling that one's resources for
reducing pain are exhausted.
- Feelings of worthlessness, shame, guilt, self-hatred, 'no
one cares'. Fears of losing control, harming self or
others.
- Personality becomes sad, withdrawn, tired, apathetic,
anxious, irritable, or prone to angry outbursts.
- Declining performance in school, work, or other
activities. (Occasionally the reverse: someone who
volunteers for extra duties because they need to fill up
their time.)
- Social isolation; or association with a group that has
different moral standards than those of the family.
- Declining interest in sex, friends, or activities
previously enjoyed.
- Neglect of personal welfare, deteriorating physical
appearance.
- Alterations in either direction in sleeping or eating
habits.
- (Particularly in the elderly) Self-starvation, dietary
mismanagement, disobeying medical instructions.
- Difficult times: holidays, anniversaries, and the first
week after discharge from a hospital; just before and
after diagnosis of a major illness; just before and
during disciplinary proceedings. Undocumented status adds
to the stress of a crisis.
Suicidal behavior
- Previous suicide attempts, 'mini-attempts'.
- Explicit statements of suicidal ideation or feelings.
- Development of suicidal plan, acquiring the means,
'rehearsal' behavior, setting a time for the attempt.
- Self-inflicted injuries, such as cuts, burns, or head
banging.
- Reckless behavior. (Besides suicide, other leading causes
of death among young people in New York City are
homicide, accidents, drug overdose, and AIDS.)
Unexplained accidents among children and the elderly.
- Making out a will or giving away favorite possessions.
- Inappropriately saying goodbye.
- Verbal behavior that is ambiguous or indirect: 'I'm going
away on a real long trip.', 'You won't have to worry
about me anymore.', 'I want to go to sleep and never wake
up.', 'I'm so depressed, I just can't go on.', 'Does God
punish suicides?', 'Voices are telling me to do bad
things.', requests for euthanasia information,
inappropriate joking, stories or essays on morbid themes.
A warning about warning signs
The majority of the population at any one time does not have
many of the warning signs and has a lower suicide risk rate.
But a lower rate in a larger population is still a lot of
people - and many completed suicides had only a few of the
conditions listed above. In a one person to another person
situation, all indications of suicidality need to be taken
seriously.
Crisis intervention hotlines that accept calls from the
suicidal, or anyone who wishes to discuss a problem, are (in
New York City) The Samaritans at 212-673-3000 and Helpline at
212-532-2400.
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