Suicide is a touchy subject. It’s complex topic that many people have strong feelings and opinions about. At the same time, it is an issue that not many people are really educated on. Suicide makes many of us uncomfortable and in this society, whatever makes the majority uncomfortable gets pushed under the rug at best. However, the misinformation that many people have about suicide leads to those in need not receiving the kind of support necessary from their loved ones, from healthcare professionals, and from society at large. In this piece, I want to talk about suicide: what suicide is, the difference between thinking about suicide and being at risk of actually doing it, bodily autonomy, and suicide prevention. I hope with this information, people are able to better support their loved ones and/or find the support they need while going through difficult times in their lives.
Suicide is the act of ending one’s own life on purpose. As a psychotherapist, I know that people who are suicidal don’t necessarily want to die. They want an escape from their current situation. Many people tend to see someone killing themselves as the problem when actually suicide is usually a symptom of other problems. Something or some things else are going on in that person’s life. There are other issues adding stress to their lives, bringing them to what feels like a breaking point. And a person who is suicidal sees suicide as a definite way to escape from their pain.
Now, being at risk for committing suicide is different from having suicidal ideation. Suicidal ideation aka thinking about dying or killing one’s self is actually very common. Most people have had times in their lives where they have thought about wanting to die in their sleep or wishing they were dead/not alive anymore, which are examples of passive suicidal ideation. Many people have also fantasized about jumping in front a train or car, etc. for a second as it’s about to past them. This urge/fantasy is usually short and most people never actually do it. It’s so common that therapists are not generally concerned with just thoughts of death. Thinking about their death by itself does not make someone at risk for committing suicide. Thoughts of committing suicide without a method, intent/desire to die, and a clear plan are usually on the low risk end. However, someone is in immediate risk of suicide if they have a way to kill themselves on standby, a specific plan of how they’re going to do it, and the intent/desire to do it. Otherwise, thoughts of suicide on their own are opportunities for conversations.
I believe in bodily autonomy. There are times, unfortunately, when someone’s problems are not resolvable for them. All the suicide prevention efforts (which I’ll get into next) could have been attempted and everyone could have put their all into it and, for whatever reason, it is not enough for someone to want to stay alive. I believe people ultimately have bodily autonomy and even if they want to end their lives, it’s their body and their life. At the end of the day, when everyone leaves and goes back home and/or goes to sleep, they have to be alone with their pain. I think it is selfish and torture to force someone to stay alive who doesn’t want to be. If every measure of suicide prevention available has been used and every bit of support in the person’s life has been accessed and the person still does not want to be alive, from a humanistic perspective, it is unethical to force them to live with their pain for someone else’s personal values. If you want someone to stay alive, then it’s time to put in some work.
Suicide Prevention in Treatment
Because I believe in bodily autonomy, it is my obligation as a mental health professional to 1)provide a safe space for people to process what they’re going through, 2)help them receive as much clarity on their situation as possible, 3)find and weigh other options to escape their situation, and 4)help them build a support system. All with the hope that with more resources and more options, the person will be able to resolve their situation in other ways, using other options. Ultimately, suicide prevention is addressing people’s stressors and problems. Again usually people struggling with suicide want freedom from suffering, not necessarily to die. It’s a common reaction to want to avoid talking about suicide out of fear of pushing the person “over the edge” or “giving them any ideas,” but that’s not how suicide risk even works. In mental health treatment, when dealing with someone who is suicidal, it’s time to get curious, ask open-ended questions, and not be afraid to go deep with a client. What symptoms is the person experiencing? What is going on in their lives and how can that be addressed? Who is around that can support them?
With these kinds of questions in mind, therapists usually encourage at-risk clients to use a safety plan. In treatment, therapists help clients brainstorm and create their own personal safety plan, which usually involves about 4 steps.
Step 1: Identifying the situation. What are some signs that let you know you’re starting to feel hopeless, sad, frustrated, etc? Do you feel it in your body? Do you feel tired all the time? Do you lose your appetite or eat more than usual? Or is it more in your head/thoughts? Do you get racing thoughts, for example? Mindfulness techniques [Here’s a piece I wrote about how to find the find one for you] are great ways to get a clearer idea of how you’re feeling if you aren’t sure.
Step 2: Self-soothing. What can you do for yourself to go back to how you were feeling before? What are some things you can do to cope with these feelings/this situation? How did you get through difficult times in the past? What stops, if anything, you from you using these coping skills now and how can you get around whatever is in your way?
Step 3: Who your people? (I said what I said). Being able to self-soothe is important, but also don’t be afraid to reach out to trusted people in this difficult time. Who can you ask for help? And what kind of help do you want from each person? Do you wanna vent? Do you need to leave home for a couple days? Do you need someone to make sure you eat? Do you need help going to the Dr? Do you need help with classes? Do you need money or transportation? Do you need help filling out paperwork? Do you need someone to babysit your kids for a couple days? If your social circle is fairly small, what social agencies are in your area that provide free or low cost services? A lot of community organizations can provide resources or referrals to free or low cost assistance that many people are not aware of.
Step 4: Emergency services: Do you feel comfortable calling emergency services? What hospital would you want to go to in a worst case scenario? It’s better that you choose than to have a stranger choose for you. How would you get to the hospital if needed? Do you have any suicide hotlines handy (See the post on depression here for a brief list of hotlines at the end)?
I always suggest suicidal clients have multiple copies of their safety plan in different areas for emergencies. Keep copies in your bag, jacket pockets, wallet, car, in your room, at your partner’s place, in a few trusted friend’s homes. etc. Tell the people on your safety plan what their role is and what kind of support you need from them at those times.
How You Can Help Someone Who Is Suicidal
Let me start by saying that no amount of positive thinking and yoga is going to “fix” suicidal ideation and stop someone from wanting a permanent escape. It’s like trying to cure a tumor with just positive thinking and a vegan diet. Not gonna happen. You got to get at the root of the problem. What is making them want to escape from their lives in a permanent way? If you want to help people who are suicidal, listen to and support them in addressing the issues that led them to feeling this way. Go at their pace. Let them lead the discussion and ask them what kind of support you could give to them during this time. While also making sure to set firm boundaries for your own mental health. Here’s the piece I wrote here on how to set firm boundaries. Or if you can’t help fix the major issue(s), support them by listening to them when they ask AND do small things to make their life easier. What everyday struggles could you help them with? Laundry? Food? Do they need help with child care? Or do they need your company? The suicidal person has to wrestle with their main issues while trying to stay alive. Your support could go a long way in easing their burden and increasing their chances of survival.
Too many ppl use the hotlines as the first level of defense and I want to dispel that. The first level of defense should be community-based prevention. Meaning building up strong friendships, chosen families, community bonds, etc. to the point where it’s normal to sincerely check in on each other’s mental health and actually step in to help when needed. Yes, give people hotlines to call. Hotlines are good resources if you need to speak about something anonymously, if you literally don’t trust anyone else in your area, etc. Hotlines are incredibly important…and also is there anyone in their personal lives who can talk to them? Sometimes people don’t want to talk to a hotline. They want to know that someone in their personal life cares about their situation and supports their fight for survival. Check in on your friends and I’m not talking about hollow check-ins between acquaintances. The “You good, fam? I saw your TL…” and “Yeah, I’m good. Just tired and a little stressed from work/school, lol”. Not the polite, fake checking in. Most people don’t get real about checking in because they don’t believe the other person actually cares and/or wants to take on the extra burden of helping someone else. Let’s get real though. Who’s your crew? Them? Those folks? Protect them. What keeps a pair or a group strong is sincerely opening up to each other, checking in on one other, and supporting each other through life’s mess.
I talked about squads checking for each other in the 4th part of my parenting series here where I also briefly talked about how it’s “very Western, very colonizer, to rely on a nuclear family (spouse and kids) for everything”. And it honestly doesn’t work. And going the individualistic Western way of pulling yourself up by your own bootstraps is literally impossible. That phrase was originally meant to describe something impossible that no one should be expected to do. And look, capitalism twisted the original meaning to trick us into fighting towards an impossible goal. Draining us of our health and life to feed the machine. There are so many lonely people in this world under this system. We should be relying on each other too.
If someone is opening up to you and talking to you about their suicidal ideation, it is a huge sign of trust. More often than not, they just want to talk about/process their experiences without feeling like they have to protect other people’s feelings, comfort, etc. And they trust you to be that non-judgmental, not pushy person for them. If someone you know tells you they are suicidal, don’t make it about how sad you and others will be if they die. It’s cruel to emotionally blackmail people into staying alive if they are suffering. Psychological suffering is just as earth shattering and life changing as physical suffering. Guilting them makes their pain about you so now they have their personal hell AND your feelings to manage all at the same time, which can make their own symptoms even worse.
Suicide is not selfish. You don’t know people’s lives and people’s pain. If suicide offends everyone’s sensibilities and morality so much, it would be in everyone’s best interest to do their part to make life bearable for everyone. Many of the problems and stressors that make life so painful are made worse by and/or are ultimately caused by systemic oppression of all kinds. In this way, disability rights, racial oppression, misogyny, transgender rights, capitalism, etc. are all public health issues. That all said, again, there are situations that cannot be solved for some people and assuming all efforts were made towards prevention, that person’s bodily autonomy should be respected.
I want to make a separate note to highlight this point: Calling the cops is the very last option if someone is suicidal, especially for Black and Brown people. What are ways you can maintain safety before reaching a point where one might consider calling the police? If you can get the person into the hospital or other other forms of safety, without calling the cops and possibly further endangering a life, great.
Suicide is a very difficult topic to discuss and it’s even harder to actually be in a situation where life doesn’t appear to be worth living anymore. It feels like a losing battle and people can find themselves wishing for any kind of peace or escape. This is where support from chosen and/or biological families, friends, and ideally the community can come into play along with any necessary treatment. Coming together and addressing the actual problems going on in that person’s life instead of guilting them into living a life full of suffering without their consent. All this…while also coming to terms with the possibility that maybe all the words and support in the world might not be “enough” to prevent loved ones from making that final, permanent choice. And realizing, as I said before, that people ultimately have bodily autonomy. The sadness and loss experienced by people still living are real and legit, but those feelings are not more important than the deceased person’s pain. And finally, it’s not anyone’s “fault” for them doing what they felt needed to be done. I hope this was helpful in giving people some clarity on how to better support those in need and/or find the support they need themselves to make informed decisions.
Thanks for reading. The next piece on Sunday 11/11/18 will cover grief. I will be explaining what grief is, what it can look like, and the psychological importance of mourning and mourning/memorial rituals.