Suicide - Afraid to Ask?
by Ralph Seland © 1999
What causes suicide?
We think of depressed people as being suicidal. Some are.
Some aren't. The same holds true for all other possibilities that you might
name. Usually there is no single cause, but there is a layering of one
problem on top of another. It's like the "(con)tributaries"
merging to form a river. For most, that river flows very slowly; for a few,
it rushes toward the waterfall of suicidal death.
In a conversation, the person usually concentrates on the
problems, but will seldom discuss suicidal feelings--unless you ask.
How does it all begin?
FEELINGS come first. -- Feelings like:
Worthless,
Hopeless,
Helpless.
Likely there are no conscious suicidal thoughts.
THOUGHTS turn into a cry for help:
"I just can't take it any
more."
"I can't do anything right."
"I wish I were dead."
"All my problems will end soon."
ACTIONS may give a clue:
Abuse of alcohol, drugs
Loss of interest in hobbies
Giving away possessions
Extreme behavior changes.
An abrupt mood change from sadness to happiness may indicate that the person has made that hard decision to die.
PHYSICALLY, the person may show:
Lack of interest in appearance
Change/loss in sex interest
Disturbed sleep
Change/loss of appetite, weight
These thoughts and feelings likely will not be expressed to
a psychologist, the family doctor or the pastor. They will be expressed to
you, a friend. It is a cry for help. The person may talk about contributing
issues but will seldom mention suicide. He may not realize that his behavior
is suicidal, but he is giving subliminal messages.
So, if you have a gut feeling that all is not well, don't be
afraid to ask. Don't pussy-foot around. If you ask a vague question, you'll
get a vague answer.
Ask, "Are you having thoughts of suicide?"
You won't offend. Hopefully you will get a "No,"
and the conversation will continue without missing a beat. But if the person
is suicidal, he will be so glad to have someone who cares enough to ask.
Asking will not put the thought in the person's mind and cause him to do
something that he would not have done otherwise.
AFRAID TO ASK?
Most people are. You may be afraid to ask because you don't
know what to do if the answer is "Yes."
Assume the worst.
Next thing is to ascertain how serious they are. Compare it
to finding out how serious a friend is about getting married. If he isn't
engaged, and doesn't even have a steady girl friend, he likely won't be
getting married for quite a while. But if he tells you that he will be
marrying Miss Heart-Throb in First Church at 2 PM next Sunday, take him
seriously.
Some important factors to look at are:
Stress,
Symptoms,
Current Suicide Plan
Prior suicide behavior
Resources.
The last three are key. C-P-R.
CURRENT SUICIDE PLAN. Is the plan well defined with
the means available?
PRIOR SUICIDE BEHAVIOR. History of self injury,
including "modeling" by family or others. (If a family member has
suicided, risks are elevated. If the person has tried it once, risks are
very high.)
RESOURCES. Does the person have close friends or a
strong family unit for support? In Canada, the sparsely settled North has
the highest suicide rate, and Newfoundland, where family and community ties
are strong, has the lowest rate per hundred thousand.
For an example, I'll demonstrate how I handle a case on the
distress line which would normally take a fair chunk of time to resolve.
Remember, I've stripped this down to bare bones and have disguised the
identity.
Female. 25 years old. Parents split when she was twelve. Sexually abused by uncle. Divorced. Overdosed a year ago and had stomach pumped. Appears to have no will to live. Is drinking -- trying to get up enough courage to overdose. Is definitely planning to suicide. Children with her X. She sees them twice a month. No church ties. No close friends in area.
What now?
This is no time to play psychiatrist. I'll give her time to vent her problems, but will not try to solve them. As soon as she has vented and is comfortable with me, I will get down to business at hand. My only job at the moment is to lower her risk of suicide. The rest can be dealt with later.
I put my emphasis in three areas.
1) Ambivalence.
2) A hook.
3)
A contract.
AMBIVALENCE.
"From what you have told me, there is a part of you that wants to die. Am I hearing you right?"
(I am indicating that I am in touch with her feelings and am not afraid to discuss them.)
"And yet you gave me a phone call. So there is a part of you that also wants to live?"
(Now I have an easier time to get her on my side of the balance and have her agree that she really wants to live).
A HOOK.
"What is that "something" that keeps you going even when things get tough?"
(I'm looking for a hook that will grab her and give a reason to live even if things are temporarily tough--I emphasize that word.)
"You say your children are really precious. How old are they?"
(I am now reinforcing a reason for her to stay alive and am also diverting her attention.)
A CONTRACT.
"Would you make me a promise?"
(I arouse her curiosity, causing her to listen.)
"Would you promise me that you will not do any harm to yourself between now and the time you see your doctor?"
(I have her repeat the promise back to me. Believe it or not, people will honor this kind of a contract. The length of contract depends upon the seriousness of the situation.)
"And if you miss that appointment, would you promise to phone this number? There will always be someone here for you."
(I'm giving an alternative contract and I am also indicating that there is a safety net in place for her.)
Whether she lives or dies is ultimately up to her. I am not responsible for her actions but, by offering a listening ear, I have given her a fighting chance. By the grace of God, you can do the same.
