Suicidal thinking is not rare. The question is whether someone has periodic fleeting thoughts, or an actual plan of action.
By DR. BATYA L. LUDMANdepressed 88(photo credit: )
Dear Dr. Batya,
What does it mean when a person who has tried to commit suicide a few times tells everyone that it won't happen again, but he/she wants to believe it, but can't promise anything? Should this person go to a mental home, psychologist?
I recently received the above letter in an envelope with no name or return address. Given the nature of the topic - one I always take seriously - I decided to address this issue before other letters I've received.
What are some of the signs of suicide risk and how can we help someone in crisis? As a psychologist, I always take very seriously anyone who tells me he or she has contemplated suicide. If one has actually attempted suicide, this is even more serious. If someone who has attempted suicide cannot promise that it won't happen again, as the person in the letter wrote, I believe he needs to be evaluated by a licensed professional with experience in this area.
In truth, as we all know, even if someone promises not to do something, and even signs a contract to that effect, this can always change with little warning. One hopes he knows the individual at risk and that there is a relationship, so that the person will seek help if things turn sour and not make a rash decision that is often regretted later.
Suicidal thinking is not rare, especially among adolescents. The question is whether someone has periodic fleeting thoughts of taking his life, or is contemplating suicide seriously, with a well-developed, or even a vague, plan of action. Many people at some point in their life think about ending their life or question whether their loved ones would be better off without them. They may wish for a time, albeit most often a very short one, that they could just "die."
Often people contemplating suicide don't really want to die. Rather they want to put an end to their pain. Problems may feel insurmountable and they may feel that they are doomed to a life of misery, whereas in reality, if one can find someone to talk through the issues with, he can receive help by getting insight into alternative ways to solve his difficulties and feel much better. In other words, while those considering suicide may feel both helpless and hopeless, when they can be helped to feel hopeful, thoughts of suicide often pass and they are glad that they didn't do anything "serious."
While everyone experiences depressive thoughts and feelings at some point, there are indicators that suggest that problems may have become more serious and demand immediate attention. Suicide crosses all ages and socioeconomic levels. Some of these risk factors or signs include previous suicide attempts; risk taking or self-injurious behavior such as cutting or burning oneself; statements suggesting suicidal thoughts or plans (where, when, how) for carrying out one's death and the means to do so (for example, making reference to not being around at some future time, talking about or having easy access to medications or weapons, and canceling bank accounts) are all clues that indicate something is not right.
Other signs are a sense of helplessness, hopelessness, extreme depression and despair, such as commenting that things will never improve or "I'd be better off dead"; a change in usual behaviors (an increase or decrease in frequency or intensity, or rapid swings in behaviors); a change in personality and daily activities; sleep deprivation; poor decision making; social isolation and withdrawal; or excessive drug or alcohol abuse.
Also, a change in one's feelings, level of functioning, coping strategies or severity of stressors; a recent loss or suicide of a close friend or relative; a significant disappointment in one's life, such as a breakup or being fired from a job; or a history of mental illness, trauma, violence or abuse.
In general, the greater the number of these factors present, the greater the risk. You can help by taking very seriously someone's cries for help, showing him that you care by being a supportive listener and reaching out and by suggesting that he get professional help. He may also need treatment for depression, anxiety, a serious eating disorder or other psychiatric condition, in addition to suicidal thinking.
As a therapist, I actually ask my patients directly if they are contemplating suicide if I have any questions or concerns. As scary as it may seem to ask, this in itself does not increase the risk for suicide. In fact it may actually serve as a deterrent, and lower the risk, as people may feel relief in ventilating their feelings and finally feel that someone is listening and recognizes the depth of their despair. Determining how long they have felt badly and whether they have confided in anyone else may give valuable insight into both severity and degree of support.
For many who contemplate suicide, there is a sense of ambivalence, and what may actually get your attention is their subtle cry for help. Your job is not to agree to keep their suicidal thinking a secret, but in being a positive, calm, caring and understanding influence, to get them the assistance they need. While we can recognize the crisis may be temporary and will pass, and that suicide is not the solution to their problem, they may not see this without immediate help and intervention.
If a person has attempted suicide, does it always mean that the attempter will again entertain thoughts of suicide? Fortunately the answer is no. Most people are suicidal for only a very brief period of time and if they are fortunate enough to get the proper help and support, they may never be suicidal again. Let's hope that in being vigilant and taking the time to talk with those we care about we can gain a greater understanding into the factors that contribute to those who sadly contemplate taking their lives.
The writer is a licensed clinical psychologist in private practice in Ra'anana.
ludman@netvision.net.il
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