Trigger Warning: This week’s article discusses the topic of suicide and may be sensitive for some readers.  For help with suicidal thoughts for you or someone you know please call the National Suicide Prevention Lifeline at 1(800)-273-8255. This line is available 24/7. 

I am doing this because I am too weak to withstand the years of pain and agony ahead. Each breath is becoming difficult for me to take… Please forgive me. Forgive me because I cannot forgive myself.

From suicide note of Iris Chang, “Actors and Celebrities Who Committed Suicide,” 2019

Suicide is one of those topics that all of us (even some in the mental health profession) find difficult to discuss. In fact, many mental health graduate programs have students complete coursework specifically aimed at practicing suicide support discussions so that they will be comfortable asking future clients about this sensitive topic. As if the subject weren’t difficult enough for many to broach, loads of misinformation pervades our society as to what suicide symptoms look like, who is most likely to attempt it, and what treatment is available for them. So what are the facts? What are the myths? And how can we help those who struggle with suicidal thoughts?

Suicide and Suicidal Thoughts

While suicidal thoughts (known to mental health professionals as “suicide ideation”) is not an official diagnosis, the DSM-V lists Suicidal Behavior Disorder as one of the “Conditions for Further Study” (American Psychiatric Association, 2013). Suicidal behavior can occur at any age, but is most frequently seen in adolescents and adults (American Psychiatric Association, 2013).

Approximately 25-30% of people who make one suicide attempt will go on to make more attempts in the future (American Psychiatric Association, 2013). Most who attempt or complete suicide suffer from some form of psychiatric illness. According to the DSM-V, the most common mental health disorders of people who experience suicidality are:

  • Bipolar Disorder (I and II)
  • Major Depressive Disorder
  • Schizophrenia
  • Schizoaffective Disorder
  • Panic Disorder
  • PTSD
  •  Alcohol Use Disorder
  • Borderline Personality Disorder
  • Antisocial Personality Disorder 
  • Eating Disorders
  • Adjustment Disorder

As of the DSM-V’s publication in 2015, 36.3% of people with Bipolar I and 32.4% of people with Bipolar II attempt suicide. The lifetime suicide risk of people with bipolar is estimated to be at least 15 times that of the general population, accounting for approximately 25% of all completed suicides (American Psychiatric Association, 2013).

Suicidal Thought Symptoms: Recognition

What comes to mind when you think of a person who is close to completing suicide? A hopelessly sad, isolated, teary person who is either severely overweight or underweight, who never gets out of bed, and who constantly talks about how much she wants to die? If your mental image is anything like this, know that you are not alone. Many assume that people on the verge of ending their lives display these types of symptoms, which are easy to pick out. And perhaps some experiencing suicide ideation do act this way. However, I’ll challenge you to reconsider the accuracy of this mental image by looking through the following list of celebrities who completed suicide.

  • Iris Chang: Author and journalist, best known for her New York Times bestselling book, The Rape of Nanking. In 2004, at age 36, Chang died from a self-inflicted gunshot wound. She had a history of clinical depression and bipolar disorder.
  • Robin Williams: Oscar-winning actor and philanthropist. In 2014, at age 63, he ended his own life by hanging himself. Prior to death, Williams struggled with substance abuse, clinical depression, and was diagnosed with Lewy body dementia.
  • Ernest Hemingway: Nobel Prize and Pulitzer Prize-winning novelist. In 1961, at age 61, Hemingway died from a self-inflicted gunshot wound. Prior to death, Hemingway struggled with clinical depression, dementia, and brain trauma. His father, brother, sister, and granddaughter also completed suicides.
  • Marilyn Monroe: Actress, singer, model, and arguably the most iconic sex symbol in Hollywood history. In 1962, at age 36, she died after overdosing on barbiturates. Monroe struggled with substance abuse, depression, and anxiety (among many other possible psychiatric illnesses) throughout most of her life. Prior to death, Monroe was fired from her last movie after years of strained relations in the film industry, due to her mental illness’s impact on her work performance.
  • Kurt Cobain: Guitarist and front-man of the popular 90s grunge-rock band Nirvana; In 1994, at age 27, he died from a self-inflicted gunshot wound. Prior to death, Cobain struggled with heroin addiction, depression, and physical health problems. He had attempted suicide a month before completing it.
  • Sylvia Plath: Pulitzer Prize-winning poet and writer, best known for her novel, The Bell Jar. In 1963, at age 30, she completed suicide, placing her head in a gas oven. Prior to completing suicide, she had previously attempted it multiple times. She had a history of struggling with clinical depression. In 2009, her son also committed suicide.
  • Ian Curtis: Lead singer and lyricist of the British band Joy Division. In 1980, at age 23, Curtis completed suicide by hanging himself. Prior to death, he was struggling with anxiety from the pressures of his work. He had attempted suicide one month before completing it.
  • Sophie Gradon: Beauty contestant, reality TV star, and the former Miss Great Britain. In 2018, at age 32, she completed suicide, taking large amounts of cocaine and alcohol before hanging herself. Prior to death, Gradon struggled with clinical depression and social anxiety disorder.
  • Chris Kanyon: American professional wrestler and author. In 2010, at age 40, he completed suicide, overdosing on prescription medications. Prior to death, Kanyon struggled with bipolar disorder. He had difficulty accepting his homosexuality, which contributed to his mental health problems. He had expressed suicide ideation prior to completion, even writing a suicide note.
  • Kate Spade: American fashion designer of luxury shoes and handbags. In 2018, at age 55, she completed suicide, hanging herself. Prior to death, Spade suffered from anxiety and clinical depression. She and her husband had separated ten months prior to her suicide, contributing to her vulnerable emotional state.

(All information above comes from “Actors and Celebrities Who Committed Suicide,” 2019).

How many of these people match the mental image described in the paragraph above? Looking at their pictures, reading about their backgrounds and personalities, seeing how high-functioning, talented, and ambitious they were prior to ending their lives, how can we ever be certain the people we see every day aren’t feeling just as hopeless and low as these people were?

As these examples show, there is a strong connection between psychiatric illness and suicide. However, it is important to remember that mental illness itself does not necessarily drive someone to suicide; it is the sense of hopelessness, the belief that one can never escape the emotional pain of mental illness, that leads to it. If there were any other means of escaping this pain, they would not think about or complete suicide. It is essential to understand this, in order to help people experiencing suicide ideation.

Assessing for Suicidal Thoughts

In assessing whether a person is suicidal, counselors will often ask questions such as:

  • How often do you think about ending your own life?
  • Has anything bad happened to increase these thoughts lately?
  • Has anyone in your family attempted or completed suicide?
  • Have you thought about how you would do it?
  • Do you have access to the means of following through?

Questions such as these help clinicians to figure out how likely the person is to attempt suicide and whether more extreme interventions are necessary to protect him (“Risk factors and warning signs,” n.d.).

In asking such questions, therapists are determining:

  • Whether the client thinks about suicide continually, to the point of it being an obsession;
  •  Whether these thoughts are more intense due to a triggering circumstance, such as a divorce or employment termination;
  • Whether there is a family history of completed suicides;
  • How deeply the client has planned a means of completing suicide; and
  • How likely the client is to complete it, based on whether or not the client has access to the means of following through with his plan.

Another question to consider is, what prevents the client from completing suicide? For example, someone who stays alive to take care of his children has a sense of responsibility that serves as a protection, which someone who feels all alone in the world might not have.

The point of asking suicide-related questions is never to shame or stigmatize the person, or (worse still) to find a reason to lock the person away in a hospital. To clarify, therapists are never “itching” for the chance to involuntarily commit anyone who discloses that he has thought about suicide. The truth is, many people experience suicidal thoughts and never come close to acting on them. Involuntary hospitalization is the therapist’s most extreme legal means of protecting a client who is very likely to attempt/commit suicide if he is allowed to leave the therapist’s office and who has refused to voluntarily commit himself. The purpose of involuntary commitment is to protect the most vulnerable clients, not to punish or to traumatize them (Schimelpfening, 2020). No ethical therapist would ever take such an action lightly.

How to Help Someone Experiencing Suicidal Thoughts

When it comes to helping those who experience suicidal thoughts, compassion and patience are key. Never assume that because someone thinks about suicide, it means you have to “call up the guys in the white coats.” In fact, the tendency of so many to “fly off the handle” when faced with suicide talk is what prevents many from communicating their feelings when these thoughts are still manageable. In order to combat suicide ideation, one must be able to communicate these thoughts to others and to know that they are still accepted, no matter what they are experiencing.

As difficult as it is to hear about such feelings, keep in mind that what this person wants more than anything isn’t for you to miraculously make her well, but to understand, support, and empathize with her as she puts her pain into words. Your loved one likely wants to know that you are willing to help her find a means of easing a pain that is so intense, death sometimes seems like a preferable option.

Please remember that putting pressure on someone to stay alive or, worse still, guilting the person for having such thoughts is never helpful. All this communicates to the person is that you are not someone who can handle hearing about this type of thing. Instead, try giving your loved one space to talk, to get out whatever is hurting her, listening nonjudgmentally without interruptions. Then, if the person is open to it, try discussing how you might work together to combat these thoughts. Acknowledge your appreciation that your loved one came to you to discuss something so difficult and sensitive. Reinforce how much you love the person and want to offer support. For many, this might include helping the person to take the crucial step of starting psychotherapy.

Such conversations are never easy and nobody expects you to go about it perfectly. So long as you answer your loved one with compassion, validating her experiences through your words and actions, you are on the right track. In communicating your desire to help, you are letting your loved one know that she is not alone, that so long as she keeps finding a reason to live, you will never give up on helping her. In the long run, this may be the most precious gift you could ever give to her.

Courtesy: Gwendolyn Brown, M.S..

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