• Paula Fontenelle

In my previous post, I talked about warning signs, so the natural question after that is: what should I do if I believe that someone is thinking about suicide?

The first thing to do is to be direct about it. No beating around the bush. There is a myth about suicide that if you bring it up you could put the idea in someone's head. The opposite is true. Being open about it will possibly bring relief to the person. When this is done properly, that is, without judgment, this attitude will help validate what they are feeling. I have seen it happen firsthand.

One day, I received a call from a friend that I had not seen for a while. At the time, the theme of suicide was quite familiar to me. I had already published my book and knew of the warning signs, so a few minutes talking to her were enough to sense that something was off. I can’t recall what she said, maybe it was the sound of her voice, but I remember what I did. “Are you calling to say good-bye to me? Are you thinking about suicide?” I asked.

She burst into tears and explained all the details she had carefully prepared so that she could end her life the following week. After listening to her for a long time, I assured my friend that although I could never truly know what she was feeling, I could tell that she saw no way out of her situation. This is relevant because a suicidal person often has a constricted view of the problem. Their sense of hopelessness interferes with their perception. By acknowledging that, you build a solid foundation to start a constructive dialogue.

The next step is to try to identify where they are in terms of planning. Think of self-inflicted death as a continuum that starts with thoughts, which can be situational or frequent, and moves toward ideation, attempt and completed suicide. Being able to determine in which stage the person is will define the type of intervention needed.

My friend had already bought a lethal amount of medication, a ticket to a city far from where she lived and had a day and time set for the attempt, so I knew that it was an emergency. At the same time, I felt that after we talked, she was more serene and calm. I asked her to give me a chance to set up an appointment with a psychiatrist, and three days later, she was diagnosed with depression.

Most suicides are associated with a mental disorder that is either inadequately treated or remains undetected. In her case, I could see many symptoms of depression, so it seemed the best course of action at the time. This happened eleven years ago. She is still alive and well.

Be proactive. Many times, after listening to someone who is in distress we say things like “if you need to talk to someone, call me” or “I’m here in case you need a friend.” Instead of waiting for them to take the initiative, do it yourself. Be present. Send a text, call them, show them you mean it. Pain immobilizes people. They may be feeling alone or thinking that no one will understand what they are going through, so if we keep a distance, we may validate this belief.

Try to broaden their support system.

Nothing is more healing than feeling loved.

Involve friends, family members - with consent -, mental health services (in schools and colleges, for example), and religious communities, if that’s the case. Helping a suicidal person is an extremely stressful task. No one should do it alone.

Finally, a few tips on what to avoid:

  • Right and wrong statements, like "You shouldn’t” or "That's not true.”

  • Even if you feel shocked, try not to show it because it can keep the individual from opening up.

  • No clichés, such as "you have everything to live for” because it can reinforce the shame and guilt they are probably already experiencing. The same applies to statements like "You will hurt your family," "Suicide is for cowards," or "Suicide is the easy way out.”

And remember:

Self-preservation is the most primal of human instincts, so any inclination toward self-inflicted death must be taken seriously. 
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  • Paula Fontenelle

Every time Davis and his mother Marcia said good-bye to each other, they performed a simple ritual: it started with her saying “God be with you, son. Your mom loves you,” to which he would reply “me too.” They would smile with affection and part. But on that day, he did something different. Before leaving the car, Davis looked at her and, without waiting for his mom’s words, he said “Mom, I love you very much,” and left, hastily. The following day, Marta received the heartbreaking news of his suicide.

This is what suicidal people do. They behave out of tune. They scream at us - many times through silence - in an effort to express their internal pain. It may come in words, in gestures, in mood swings, in risky behavior, or isolation. Davis tried all of them. Marta told me about problems in school during his early teens, the excessive partying later on, the drugs most of his friends used, and the numerous girlfriends he had in his youth. Sounds like a normal young man trying to find his own identity, right? Not quite.

Apart from interviewing the mother, I also talked to his younger sister, Mayra. I often try to get more than one version of a story because it adds depth and gives a clearer sense of what happened. In this case, it provided insight into what was going on in his life. More importantly, it made it possible for me to trace the warning signs he had exhibited before his death.

According to Mayra, at the age of 14, Davis had a car accident right after his girlfriend ended the relationship. Later, they found a letter in which he had written: “I wish I could vanish from this world.” This made it clear to the family that crashing onto a tree had been an intentional act.

Being able to identify warning signs can be very hard, even when they are verbally communicated. Minutes before leaving the car and saying “I love you, mom,” Davis told his mother that the constant arguments he was having with his wife would sometimes make him wish to... (he completed the sentence by moving his hand across his neck as if he were cutting it open with a knife).

She asked him directly if he was contemplating suicide, and he said: “yes, at least I would stop causing problems to everyone.” Marcia asked him to be patient because, with time, the arguments would pass. Today, she plays this scene in her mind over and over again, asking herself what she could have done differently.

man alone looking through a window
by Noah Silliman

Research shows that most people who die by suicide express their wish one way or another, but we are unable to either notice these warning signs or to assess their risk level. Apart from the verbal ones, which are more easily identifiable, such as “I want to disappear/die,” “life has no meaning anymore,” or “I am a burden,” these messages are often expressed by changes in behavior, mood, and appearance. In a way, they are similar to symptoms of depression: isolation, lack of hygiene, sadness, substance use, sleep dysfunction, mood swings, irritation, lack of pleasure, and apathy.

When it comes to suicide, some specific warning signs represent red flags because when present, they usually mean that the individual has advanced from thoughts to effective planning. This happened with my father, but again, we were only able to see it in retrospect. The day before his death, he paid my sister a visit. She could tell that there was something wrong with him. Every time she mentioned that I would return from vacation in a few days, he would reminisce about a trip we had taken together a few years prior. When a person decides to take their own life, they stop making plans because they ‘know’ that there is no future ahead.

Suicidal people talk about the past because, for them, there will be no tomorrow.

Apart from reminiscing, they organize practical things, especially finances. They pay debts, open joined accounts so that someone else can access their money, discuss the will, etc. The idea is to leave no hurdles for the family. Saying good-bye is also common. They call old friends, family members, and pay unexpected visits to loved ones. I had this experience. One day, a friend called me and I could immediately tell that she wanted to talk to me for the last time. I asked her directly: “are you thinking about suicide?” She fell silent for a few seconds, then burst into tears. It turned out that she had everything planned for the following week.

Another red flag should be raised when the person starts to give away possessions, particularly those with sentimental value. By doing this, they are sending the message that nothing else has value anymore.

Finally, there is one warning sign that frequently baffles those who are left behind: the apparent improvement of symptoms. Time and time again, I have heard mourners say “but he/she seemed to be doing much better.” It may sound like a contradiction, but it actually makes sense. The reason behind the sudden change in mood - when depression seems to be in remission, for example - is the fact that there is no more internal conflict, the ambiguity is gone, therefore, the individual does feel better. The angst is lifted, and as a result, they convey the misleading impression of recovery.

The question is: what should you do in case you identify the signs in someone you know? I will explore this theme in more detail on a future post, but the basic thing to do do is to address it in a straight forward manner. Ask if they are thinking about killing themselves. Try to assess where they are in terms of planning. This is very important because it will define your course of action. Build a support system, in other words, don’t do it alone. Involve other people and, if possible, family members. Finding a doctor may be also important because many suicides are related to mental illnesses that are either undiagnosed or remain untreated.

Finally, one of the most important things to keep in mind is: don’t judge their thoughts and actions. You can’t possibly know what they are going through. Judgment feeds the shame they are likely already experiencing. By doing that, you will make them feel even worse. And remember:

Suicide is rarely associated with a wish to die; it is primarily a desire to put an end to unbearable pain.
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  • Paula Fontenelle

I was a successful journalist and published author in Brazil until my father took his life in 2005. Now I'm a psychotherapist and an activist in suicide prevention.

In January that terrible year, I was on vacation in the US when I received a call from my older sister Renata. She was worried about our father. Earlier that day, he had stopped by for a visit, and during the many hours he stayed there, she noticed he was in deep emotional pain, the kind of pain that is best expressed by silence. 

"I think he wants to hurt himself. There were times I could see his lips quivering as if he were about to cry," she said. "Don't worry, I will be there in three days. I will talk to him when I arrive," I replied. The next day, I woke up with Renata sobbing on the phone: "He is dead. He killed himself." 

For the next several months, my life was a blur. Simple daily habits were overpowered by question marks that screamed "why?" at me, repeatedly. This is a common reaction experienced by those who lose a loved one to suicide. Even when we think we have the answers, nothing ever seems to be enough. This kind of void can never be entirely filled.

My dad was a man of strong principles. He was an extrovert who made friends easily; a people's person. Our home was always open (and full). Weekends were especially crowded because he would cook delicious meat — in the Brazilian way — with charcoal "churrasqueiras" (grills). Everyone would gather around him to hear his stories and music. Fontenelle — the name he was called by — was admired and loved by many. 

He was also a self-taught man. Coming from a family who had lost everything to his father's gambling addiction, very early on he had to work in order to support his mother and siblings. His deepest regret was that the financial circumstances of his family didn't allow him to go to college. But his lack of formal education never got in the way of his love of learning. In fact, it fueled it. 

His nickname was "walking encyclopedia." Dad was one of those people who seem to know everything about everything. When I began to study English, asking him the meaning of a word was usually a source of annoyance. My question would always be followed by another question: "What is the context?" he would reply. With luck, I would have my answer in ten to fifteen minutes. Irritated, I would roll my eyes and wish I had just looked at the dictionary instead.

But that was only part of his complex personality. Buried inside the outgoing, friendly man, were unseen layers of raw, unresolved pain. Somehow, even as a child, I knew that he kept something from us, a wound so deep he could not bring himself to share. At least not in a healthy way. Drinking changed that. On the weekends, we would gradually lose him to alcohol, and although we still couldn't name his pain, it would touch all of us. 

My outgoing father would turn into a silent, tormented man who would listen to classical music with his head in his hands, staring at the tabletop, surrounded by hundreds of books and albums that filled the room. 

In front of him sat a bust of Beethoven, his favorite composer. Sometimes, I would listen to sonatas and symphonies with him, twirling around the center table, pretending to be a prima ballerina on stage. He would interpret the pieces in detail: "Can you hear the drums in the background?" he would ask. That was the only way he could get the little ballerina to stop for a second. 

The secret he never shared

The time surrounding his death was a tough one. He was 68 years old, and in a short window of 2 years, after three decades of marriage, my father had divorced my mom, moved in with someone else (who had 2 young kids), had opened a business, and was struggling to keep up with his bills. We had become quite close, and I knew things weren't easy for him. At times, he would come to my home for lunch and just sit in silence. His bleak demeanor was familiar to me, it was the same I remembered seeing as a child.

One day, I asked him to see a psychiatrist. I could sense a tone of hopelessness in his voice. He followed my advice and days later, told me he had been diagnosed with depression. We talked about it, and he promised to follow the treatment — one I would submit to myself after his suicide — but never did. My father was a proud man. The idea of being mentally ill was incompatible with his self-image. The pills remained untouched until the day he died.

After his death, I buried myself in books. This is my way of dealing with pain. And as a journalist, I was driven to investigate anything I didn’t understand. To find the story behind the story. I interviewed his best friends, family members, specialists, authors in the field of suicidology, mourners, and many people who had attempted suicide in the past. It was during one of these interviews that I finally learned about my father's secret.

All our lives, my siblings and I knew very little about our grandfather. What we had been told was that he was a gambler who had died when my dad was twelve years old. The family had been left with no money, so being the oldest, my father had to work to pay the bills. It turns out that I had already been born when my grandfather died but was too young to remember. What my dad didn't want us to know was that by confronting his family's past, he would have to face his own demons, and that was too much to ask. 

My grandfather represented a cracked mirror my dad could not bear to look into.

Here is the real story I learned from my uncle when I interviewed him: my grandfather was addicted not only to gambling but also to alcohol. One day he got sick, was taken to the hospital, where he would remain for days, and was told that if he ever drank again, he would die. When discharged, he walked to the nearest bar, had a few drinks, and on the way home, he fell dead on the sidewalk. At the time, my dad was in his thirties, which means that Renata and I had already been born.

Shame is a powerful concealer. It had kept part of our own family history hidden from us. It's still hard for me to believe that this secret survived thirty-nine years. Thirty-nine years of silence. It only came out because by then, I had already decided to write a book about suicide prevention, and was rewriting my own story. 

Since my father's suicide, I have left a career in journalism, finished a degree in psychoanalysis, and will soon graduate with a Master's degree in counseling, in the United States.In Brazil, I have been working with suicide prevention since the publication of my book "Suicide: the interrupted future", in 2008. My website (in Portuguese) has thousands of views every month, and I have just launched my site in English so that I can reach a wider audience. The book will soon be published in English as well.

Suicide is everywhere; it touches all of us. 

Currently, it is the tenth leading cause of death worldwide; the second-leading cause of death within the 15–29 age group. Every year, we lose approximately 800,000 individuals to self-inflicted death. People like my father, who was in immeasurable pain and saw no other way out.

In this space, I will share everything I have learned about suicide over the years. I cannot bring my father back but I know I can help others understand their grief, and maybe be more compassionate toward those who take or attempt to take their own lives. I invite you to join me in building a community where, together, we can fight the persistent stigma that still surrounds suicide while lighting a path towards healing and hope.

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