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HELP FIGHT THE STIGMA

© 2019 by Paula Fontenelle

One of the most effective ways to prevent suicide is to be able to identify the warning signs. Research shows that most people give verbal and non-verbal clues prior to taking their own lives. Such marks can be overlooked for two main reasons: they are not taken seriously, or the person who witnesses them is unprepared to recognize the signs as such. Even when they do, it is hard to know what the appropriate response should be. For those who are left behind, this is a common source of guilt. Having the ability to assess an individual's level of suicide risk by noticing changes in mood and behavior can be the first step to saving a life.

Warning Signs

Verbal

  • "I can't take this anymore"

  • ​"I want to kill myself/die"

  • "Nothing makes sense"

  • "It's just not worth it"

  • "What's the point of living?"

  • "I feel trapped"

  • "There is no meaning in life"

  • "I'm a burden"

  • ​"No one cares"

Non-Verbal

  • Mood swings​ (agitation, anxiety, sadness)

  • Aggression/withdrawal from others

  • Substance abuse

  • Too much or too little sleep

  • No more joy from activities they used to enjoy

  • Isolation, hopelessness

  • Lack of care with appearance

  • Engage in risky or self-destructive behavior

  • Become interested in death

In many ways, suicide warning signs are quite similar to symptoms of grief and depression. In terms of risk level, though, some clues require more immediate action, because they indicate an advanced stage of planning. These are:

  • Giving up prized possessions (or pets).

  • Getting in touch with old friends and family members, which can be an attempt to say good-bye.

  • Starting to reminisce.

  • Organizing their financial situation.

  • Getting affairs in order.

  • Showing an abrupt positive mood change.

 

  • Avoiding talking about the future.  

This can happen, for example, with people who have struggled with depression and suddenly become upbeat and happy. Instead of being a real improvement, such a shift is an indication that there is no more internal conflict, because they have already decided to die. The apparent peace of mind is just a non-verbal way to communicate that the ambivalence is gone.

What to Do

Once you have identified the warning signs, it is just as important to make sure you don't scare your loved one away, or worse, shame them into silence. Your approach may have a strong impact on how they will respond to you, and this highly depends on whether or not the individual will feel understood and cared for, instead of judged for what they are feeling. Here are some tips on how to handle this delicate situation:

  • The first thing to keep in mind is to identify the stage of planning they are in. This is very important, because it will help you know the level of care they need. This can range from simple interventions, such as being present and helping with ideas to solve some of their problems, to taking them to a hospital for in-patient emergency care.

 

  • Speak directly about suicide - There is a general belief that talking about suicide may place the idea into their heads. It is actually quite the contrary. When a person has reached the point of suicidal thoughts and behavior, they usually feel isolated and afraid of approaching loved ones. Taking the first step will help them open up and feel loved. Here are some ideas on what to say: "I'm worried about you, and I was wondering if you are thinking about harming yourself," "I know things have been hard for you lately and I would like to help. Are you thinking about suicide?" or "I've noticed you have been distant lately, can I help in any way? Are you thinking about suicide?"

Don't be afraid to use the word 'suicide.' It can relieve them of the burden of having to be the first to use the word and allow them to be direct about their thoughts. The most important thing here is to listen! The natural instinct is to give advice. Keep in mind that you may be the first person to ever talk with them about suicide in a direct manner, so they will need time to open up.

  • Bring hope into the conversation - Lack of hope is the hallmark of suicidal ideation. When a person gets to the point of seeing death as the only way out of their personal crisis, hearing about hope may broaden their view of the future. Reassure them that their current feelings may be temporary and that help is available.

  • Remove weapons and harming objects - Limiting access to methods is one of the best ways to prevent self-inflicted death.

  • Be proactive - Instead of saying "Call me when you need help," make the call yourself if you don't hear from them.

  • Offer to take them to a clinician - Depending on their state of mind, the simple idea of picking up a phone to call a doctor may seem too much, so do it yourself, and if necessary, accompany them to the doctor. Not only will this make the individual feel cared for, but it will also add an extra person to ask the necessary questions and understand what they have been prescribed. 

What to Avoid

  • Don't interrupt the conversation - Let them talk freely, even if what they are saying may seem to make no sense.

  • Don't make judgments by saying things like "I think this is wrong," "You shouldn't," "But you..." "That's not true,"  and "I believe."

  • As much as you may feel shocked by what they are saying, try not to show it. Shock keeps them from opening up and being honest about their feelings.

  • Try not to be invasive - Although the situation requires clarity about the depth of their pain, let the person determine the pace of the conversation. It will take a while for them to trust that they can be truly heard, so if it is a lot for you to take in, take a deep breath and continue listening.

  • Don't argue with them.

  • Avoid clichés, such as "you have everything to live for." Lecturing on the value of life can be detrimental to their ability to talk honestly, because it highlights shame and guilt.

  • Don't shame them by reinforcing negative feelings, particularly guilt. Saying things like "You will hurt your family," "Suicide is for cowards," or "Suicide is the easy way out" is not helpful.

  • Be careful with promises of confidentiality - Depending on their age and life situation, you may need to contact family and friends in order to strengthen their support systems.

  • Don't take suicide threats lightly - Self-preservation is the most primal of human instincts, so any inclination toward self-inflicted death must be taken seriously. 

Finally, don't blame yourself or believe that someone else's life is your responsibility. Offering help and being present is the best you can do, but in the end, they are ultimately in charge of their own lives. 

​​

Myths About Suicide

  • People who talk about it don't really mean it - Not true. Most people who attempt suicide give verbal and non-verbal warning signs.

  • Suicidal people are crazy or mentally ill - Although many suicidal people have a history of mental illness, which sometimes is either undiagnosed or untreated, many will never develop such a disease. Suicide may be a response to extreme stress and crisis situations, such as financial hardship, loss of a job, the diagnosis of a serious disease, a divorce, or a recent loss.

  • When a person wants to die, nothing will stop them - One of the most common feelings present in suicidal ideation is ambivalence. Even the most severely depressed will experience mixed feelings about self-inflicted death. Most of them are not seeking death but rather relief from extreme, unbearable pain, and they see no other way out.

  • If you bring up suicide, it will place the idea in their heads - The opposite is true. Approaching it in a mindful, empathic way can be of great help.