awareness and understanding of suicide

12 things you should know about Suicide

Posted on by Adele Ryan McDowell

Pain-Suicidal-lossSuicide is a dirty word, mired in judgment, shame, and taboo. It is often whispered or, even, denied (“Oh, he died of heart attack.”) or avoided (“She died suddenly.”).

Given the staggering statistics, isn’t it time we take suicide out of the closet and bring it into the light? Isn’t it time we begin the conversation so we can help one another and find solutions to help alleviate the enormous amount of pain circling our planet?

The first step is to understand suicide. This helps make sense of the unknown and feared, the tainted and tabooed. As a former suicide hot-line responder and a practicing psychotherapist who has worked with suicidal clients for 30+ years, here are 12 considerations I wish everyone understood about suicide:

1. Suicide is universal.
Suicide is not a foreign concept. Each and every one of us know someone, or know someone who knows someone, who has considered or acted upon suicide. Further, most everyone would allow when in a dark, despairing place that the thought of ending all of their pain — even in the most fleeting of abstract ways – has crossed their mind.

2. Suicidality is a global epidemic.
From young to old and across every socio-economic strata, suicide reaches every nook and cranny of our planet. According to the World Health Organization, globally, there is, on average, one suicide every 40 seconds.

And, the number of suicide attempts is astonishingly higher. The National Research Foundation reports that the number of suicide attempts can be 20x greater than the deaths by suicide.

3. Why do people choose suicide?
Generally speaking, suicide happens because at that moment in time — and with the likely impact of extreme emotional pain, haywire neurochemistry, constricted thinking, trauma, dire circumstances, and/or the influence of substances — it felt like the only response to end the agony of their life.

4. Suicide has many faces.

Suicide can be a tipping point of pain or shame; a plea for help; a response to mental illness and biological vulnerabilities; the last gasp of despair and resignation; a consequence of hopelessness and isolation; an impulsive mistake; a conscious ending of life; the ultimate act of rage and fury; the result of unabated terror; a response to abandonment; the repercussion of accumulated stressors; as well as collateral damage from violence, addiction, and trauma.

5. Depression is the strongest risk factor for suicide.
And this makes sense. Deep, intractable, dark-holed depression offers no options or possibilities. It is a tight, cramped, airless space. Individuals feel stuck, profoundly tired, deeply detached and disconnected. They hurt all over. Nothing makes sense. Their thinking is binary and boxed. And they feel utterly despondent and despairing. There is no sense of self. There is overriding pain which is often expressed as “There is no point. Why should I live?”

6. Survivors of a suicidal loss are at risk for suicide themselves.
Death becomes tainted and shame-faced when described as a suicide. Suicidal grief is complicated. There are so many mixed emotions (i.e., guilt, anger, heartbreak, confusion, to name a few) that are left in its wake.

Suicidal loss is also traumatic and leaves survivors reeling after the sudden death. They may have witnessed the suicidal act, discovered the aftermath, and/or repeatedly envision the specifics. And as with all grief and trauma, each experience opens the door to the memory of other experience of loss and trauma.

Further, since the taboo of suicide has been broken and the threshold crossed, a surviving loved one may choose to end their own pain in the same fashion.

7. The majority of people do not leave suicide notes.
When people who attempted suicide were asked why they left no note, they allowed that they were unable to find the right words and felt guilty; were preoccupied with preparing for their exit; felt no once would really care; felt no note was necessary; were too tired and they wanted their family to forget them as soon as possible.

8. Please don’t say “committed suicide.”
In the Western world, suicide (not assisted suicide) has been decriminalized. It is no longer accurate – and considered insensitive by many – to say “committed suicide.” Instead, you might try “died by suicide.”

9. Suicide is not an act of cowardice.
Imagine if I were to put a pillow over your face, wouldn’t you try to stop me? Our instincts are to fight for life. Suicide happens for a lot of reasons. Cowardice is not one of them. Pain – physical, mental, psychological – is the predominant catalyst.

10. Listen if someone talks about being suicidal or makes off-hand threats about suicide, death or dying.
These are warning signs. Suicidal people may express their suicidal feelings before they act as a way of seeking help or connection. Please do not argue, lie, cajole, shame or bully. Do not dismiss or ignore their expressions of pain and despair. Simply listen with an open, non-judging heart. Allow them to air out their dark thoughts and feelings. Fully listening to someone and knowing you are being heard is an enormous, healing gift.

11. If a loved one is on the verge of taking suicidal action, trust your good instincts and act quickly:
a) Establish physical safety.
b) Have compassion and create a connection.
c) Insert a pause to stop the momentum and expand the circle of help with possibilities and resources.
a. Call the 24 hour, toll-free hotline at 1-800-273-TALK (8255) (English and Spanish).
b. Text the crisis text line 741-741.
c. Find online support groups; 24 hour teen crisis lines, and specialized veterans services.
d. Get professional help.
e. Go to the Emergency Room of your local hospital.

12. Ultimately, suicide is a lesson of compassion.
Suicide teaches us to release judgment, extend a helping hand, and remember we are all connected in our humanity. You know the saying, “There, but for the grace of God, go I.” Compassion, not judgment, is the only response to suicide.

The 7 Points On The Spectrum Of Suicide

Posted on by Adele Ryan McDowell

Every three seconds, on average, someone is attempting suicide, according to research out of India. The numbers of suicide attempts are exponentially higher than the number of completed suicides, which average every 13 seconds across the globe per the World Health Organization (WHO). Tragically, every minute of every day is influenced by some aspect of suicide.

Suicidality shows itself in a range of behaviors and thoughts that can become more fixed and concretized. There is a progression of pain and disconnection. Emotions are not linear. Thoughts can be disordered and scattered. There is no straight line or exact trajectory. That said, there is a continuum of suicide, where aspects of suicidality are portrayed by each individual in their own idiosyncratic manner.

Over my 30+ years of clinical work, these are the aspects of suicide I have seen in the consultation room and through crisis intervention lines. There are seven points on this spectrum, each with its own degree of severity. Clearly, some points are more intense and critical than others, but each is to be taken seriously and warrants professional help.

1. Ideation
Quite simply, you are thinking about suicide. You are rolling the idea around in your brain. Does this make sense for me? Would it be my answer?

Many people consider suicide in the abstract. What if? Thinking does not necessarily mean doing. Ideation is considering the option — usually, when there seem to be few options, and distress and overwhelm are at the fore.

2. Gestures
This is a seeming attempt at suicide by self-injury without serious or fatal consequences. Taking an overdose of aspirin or cutting one’s wrists are good examples.

(Please note, there is a distinction between self-harm and suicidal gestures. Cutting as self-harm is intended to relieve crushing emotions or to be able to feel something and no longer be numb; whereas, the intention of suicide is to cease the painful feelings and end one’s life. That said, be it self-harm — very common with trauma survivors who are at risk for suicide — or a suicidal gesture, both indicate a need for professional help.)

Suicidal gestures are a cry for help and, sometimes, attention. They are an alarm bell for action to be taken. These gestures are often labeled with the unfortunate term “para-suicide,” which minimizes the gravity of the situation. Repeated gestures are frequently a precursor to a completed suicide.

3. Passively Suicidal
This is a form of suicidal ideation. You are thinking about it, but know at this moment you would never do it. It sounds like a plausible idea because you are in so much emotional pain. There is a level of resignation in this thinking.

If someone magically took you out of your misery, you feel certain you would not fight back. You don’t want to feel so much pain any more. You are thoroughly depleted and paralyzed. You are exhausted on every level; you feel powerless and unable to change your current situation.

4. Active Thinking
This form of suicidal ideation is farther along the spectrum. You are developing a plan. You are working out the details. You know exactly what, when, and how you will do it. For some, there is relief in having a plan. For others, there is a grim satisfaction in imagining the impact their death will have on others. Maybe now they will understand how much I hurt.

5. Thinking and Doing
There are two forms of thinking-and-doing; one is planned and the other is impulsive.

Planned:
You are now making a concrete plan. You are making preparations, securing the necessary accoutrements, and orchestrating how you will make your suicide happen.

Frequently, when individuals have reached this step, they may present themselves as happy to their loved ones and therapists. They have a plan of action. They are resolved, and there is no more equivocation.

Sometimes, the plan is enough in and of itself and serves as a fallback position if everything goes horribly wrong. When there are self-doubts about the viability and impact of the plan, the individual may be open to outside intervention and assistance, and the plan may crumble.

Impulsive:
Impulsive thinking-and-doing is, as the name states, impulsive. It’s a flash of a thought and a rush of feeling that makes sense at the time. It’s an immediate way to end the internal anguish. Frequently, this occurs with teens and young adults.

This impulsivity can be accelerated by substance abuse that lowers the inhibitions, a history of risky behavior, unfettered anger, and unrelenting anxiety.

Impulsivity can also be triggered by a psychotic incident where there may be delusions and hallucinations. For example, voices in a young man’s head told him to kill himself immediately because all of his family were now living on another planet.

6. Chronically Suicidal
The chronically suicidal are individuals who, by virtue of mental illness, are always in and out of suicidality. Usually, they have been on psychiatric meds for years, and they have been hospitalized frequently.

Suicide is their default wiring. It’s where they land when their pain escalates; their thinking contracts, expands, or becomes chaotic; and they want to escape from the effects of their medications. The chronically suicidal want out; they want their internal struggle and torment to be over.

7. Slow Suicide
Slow suicide speaks to a long-term history of intractable, unrelenting addiction and substance abuse, such as full-blown anorexia nervosa, chronic heroin abuse and alcoholism.

Slow suicide is evidenced by a lifetime of self-harm that chronically erodes a person’s health, well-being, mental stability, emotional resilience, and vital energy. There is inordinate pain, grief, and anger. Unresolved trauma is likely.

Slow suicidal people choose to stay stuck in their toxic and self-defeating spin and steadfastly refuse any offers of help and assistance.

Suicide is never easy. We know it’s not painless. This spectrum of suicidality delineates the range of behaviors and thinking in order to increase understanding and compassion and, perhaps, circumvent tragedy.

This column was also featured on The Huffington Post Canada.

The many faces of suicide

Posted on by Adele Ryan McDowell

purplenightscapeSuicide is many things.

Suicide is not a sin, from my point of view. Some religions espouse hellfire and damnation; others ponder the intention of the suicidal individual. Since I see all of us on a path to open our hearts, expand our consciousness, and operate from our Best or Higher Selves, I do not believe that the Divine—in any form or moniker—is looking to punish us for being human. The Divine is all about love—unconditional love—and helping each of us find the pathway to that conclusion. Individuals who take their life by suicide are not punished. (Quite frankly, haven’t they lived through enough hell?) That is old school thinking to me. If you believe in heaven, they are in heaven. If you believe in past lives, their souls are being readied for their next assignment. Where we all can agree is that the soul has moved out of the constraints and limitations of the 3D world and moved to another non-physical dimension.

Suicide is not a crime. (For the record, suicide is no longer illegal in the Western world, where suicide has been decriminalized. There are, however, legal ramifications to assisted suicide and the like).

Some say the weak choose suicide. I disagree. “Weak” is not the operative word here.

Suicide can be a tipping point of pain or shame, a plea for help, a response to mental illness and haywire neurochemistry, as well as the last gasp of despair and resignation. Suicide can also be an impulsive mistake, a planned ending of life, a shredded soul, the death of the ego, or the ultimate act of rage and fury. (That rage and fury is often the much wounded child-self battling mightily for control or screaming in enormous pain.)

Suicide can be a choice that we may or may not understand on the 3D level, such as a teaching tool for our loved ones or choosing to do profound work from the Other Side.

Suicide can be a part of our destiny, our soul path toward healing.

Suicide can be the result of soul loss.

Suicide can be a game-changer. After the loss of a loved one to suicide, your view on life changes. Life becomes more fragile, more precious, and more cherished. This holds true for those who have attempted suicide as well. For them, the attempt may lead to a spurt of fresh energy and a re-engagement with life.

And suicide is definitely a societal, and, therefore, a political and moral issue. We human beings—and our organizations, corporations, or governments—can be terribly self-serving, ruthless, abusive, and tyrannical toward others. Acts of violence, war, and exploitation damage and destroy the very souls of our being. We lose ourselves and the meaning of our lives. Suicidal thoughts and actions are a part of the collateral damage of these polarizations.

Further, suicide can be a powerful teacher. It teaches us the great lesson of compassion. It opens us in ways we never thought possible. Suicide asks us to accept a loved one’s choice and circumstance. Suicide asks us to forgive ourselves for our perceived wrongdoings, including our inability to prevent our loved one from harm. Suicide requires us to face our guilt, anger, and shame. Suicide asks us to accept the unacceptable, the inconceivable, the horrific, and make peace with it. Suicide asks us to live with an open heart. This means no judgment, no castigation, and no punishment. We see one another through a lens of acceptance. We allow each other to be who we are—in all of our shortcomings and crazy-making ways as well as all of our idiosyncratic wonderfulness.

There is only one response

Posted on by Adele Ryan McDowell

Too often suicide is met with judgment, criticism, shame, and taboo. Suicide is the result of a confluence of stressors, circumstances, and experiences. It is an individual response to pain of every shape, size, and dimension. Suicide leaves a rippling wake of shock, horror, and grief. Isn’t it time we pull suicide out of the shadows and meet it with compassion?

darkblue-compassion

Let’s not declare war on suicide, let’s make peace

Posted on by Adele Ryan McDowell

Suicide is a not a target, or an adversary. It is an individual response to a confluence of factors.

If we want to address suicide, then we must sink down into the essentials and deal with the factors that contribute to suicide. And those factors are how we treat one another and ourselves. It is that basic.

Why not embrace differences, understand commonality, and reinforce the idea of oneness? We are all connected. Let’s go for bridge-building. Let’s develop our C.Q., our cultural quotient, so that we understand one another better. Let’s make room at the table for everyone. We can agree to disagree, and we can find the common thread in our shared human experience.

Why not expand our perspective and provide tools? Let’s raise our E.Q., our emotional quotient, and gain mastery. Let’s become fluent in emotional intelligence so that we can talk to one another, express our anger, and deal with conflict in an effective way. We can have healthier relationships. Let’s teach energy techniques and self-healing modalities, like HeartMath®, Reiki, Therapeutic Touch, and shamanism, for self-empowerment, resilience building, and an increased understanding of the power of personal energies.

Why not change our focus? We can increase cognitive dissonance around bullying, unethical behavior, and violence. We can work toward eradicating the learned responses of shame and fear. We can promote cooperation vs. competition; and we can make life-work-balance a priority. These are possibilities and options to create a healthier and happier society.

Speaking of priorities, how we treat our children says volumes about our societies. Let’s feed, house, clothe, and educate our children. Why are any children on this globe going to bed hungry? Let’s address childhood sexual abuse, sex trafficking, and domestic violence. Children are in crisis—and they are our future.

Let’s share our burdens by practicing empathy and cultivating compassion. We need to walk in one another’s shoes. Let’s give our wounded the help they need. Mental health services, VA services, and the like are in dire need of public support and funding. Substance abuse requires more long-term treatment strategies. Why is this problematic?

And if we are to address the pervasive soul loss, then we need to honor the soul. We can move toward that by rebalancing priorities, respecting Mother Nature, healing Mother Earth, celebrating the arts, course-correcting the pace, being open to creative expression, and developing more meaningful ways of connecting with one another.

And, lastly, we need to live peace, with ourselves and with others. If we cannot accept ourselves, if we feel we are forever unworthy, we will act in ways that can have enormous ripple effects. Peace is a five-letter word that offers relief and healing. And it starts with each of us.

The connection between suicide and childhood sexual abuse

Posted on by Adele Ryan McDowell

It’s September and we are honoring suicide awareness and suicide prevention. To that end, we are sharing again some of our most popular posts.

Circling the international news is the story of the assisted suicide of a young Dutch woman due to long-term childhood sexual abuse. This woman in her 20’s asked for — and was granted — euthanasia by lethal injection.

She requested an end to her life due to intractable trauma (i.e., severe Post-Traumatic Stress Disorder) and concomitant medical issues (i.e., advanced anorexia, chronic depression and hallucinations) that left her primarily bedridden.

Her story has raised questions and concerns.

As a mental health professional who has worked first-hand with childhood sexual abuse survivors, I have witnessed the repercussions of the compounded and complicated trauma of childhood sexual abuse.

Read more here.

 

 

Understanding teen suicide helps make sense of the heartache

Posted on by Adele Ryan McDowell

n-lonely-sad-woman-large570Suicide is heartbreaking. And suicide is especially crushing when a teenager has made the lethal choice to end their life. What happened? As the adults in their lives, we cannot fathom how things went so bad so fast. We feel so certain there could have been another way, a different choice. Yes, we might have been mad, but love comes first, above all, and we would have helped you.

And so begins the hell for parents and loved ones of a teen suicide. You are full of questions and “what ifs,” reeling in shock and disbelief. You rethink everything. What did you miss? Were there signs? You thought it was normal teenage angst and withdrawal. You had no idea it was this bad.

Or maybe you did. Maybe your teen’s life was a maelstrom of chaos and upheaval. He or she kept unraveling, becoming riskier, angrier, withdrawn or hell-bent on self-destruction. You were considered the enemy. Communication had shut down. You felt powerless. It was hard to recognize this snarky stranger who avoided eye contact with you at all possible costs as your child.

The teen years are an emotional roller coaster

Teenage years, by definition, are tumultuous. The brain is not fully developed. Hormones reconfigure bodies and play havoc with emotions. Psychologically, teens need to individuate — pull away from their parents to become their own person. These years are physically, emotionally, mentally and socially difficult. They can be hard to negotiate. Teens can be extreme and dramatic — and their parents, too, who wonder who they have become in trying to manage and protect their teenager. It’s a highly sensitive and volatile stage of life.

Please click this link to read the remainder of this article which is a part of “Frame of Mind,” a new month-long series focused on teens and mental health by the Huffington Post Canada:

http://www.huffingtonpost.ca/adele-mcdowell/understanding-teen-suicide_b_11833820.html

Suicide and Soul Loss

Posted on by Adele Ryan McDowell

Not all suicides are defined by mental illness, substance abuse, and unrelenting pain. There are many ways in which we see and interpret the world. From time immemorial, the soul, our spark of being, has been viewed as our primary force of life. It is what animates us.

If we have been abused, humiliated, oppressed, terrorized, tortured, traumatized, or hurt physically or emotionally in any powerful way, our soul can be crushed. Our life force leaks out. We are no longer our whole selves. We have lost some of our light and we are hunkered down in a protective, survival mode. If the soul loss is profound, we become numb, hollow, and begin to move through life in a disconnected, zombie-like way. We see profound soul loss in the eyes of our military, childhood sexual abuse survivors, and the severely bullied, to name a few.

Soul loss should also be considered a primary cause for suicide. Soul loss does not necessarily preclude the diagnostic criteria, but, instead, often views the diagnostic criteria as further evidence of soul loss.

The Indigenous world has long honored the soul. Illness, depression, trauma, and other Western-labeled maladies are explained as soul loss.

If the soul is tended, then the body, mind, and heart can heal.

To explain further, here is an example:

In South America, a young girl is no longer speaking. She has become totally silent. Her parents take her to doctors and specialists, but to no avail. As a last resort, they drive to a village in the country and take their daughter to a local shaman. He tells them to leave their daughter with his tribe for the week. The shaman then instructs the women to bathe the girl daily and, while bathing her, they are to sing her healing songs. At the end of the week, the girl begins to speak and tells of the rape she had recently endured. She had refound her voice and was healed.

I suggest that soul loss runs parallel to psychoneuroimmunology (PNI), which looks at the mind-body (and often, spirit) interaction. Science does recognize that our thoughts and feelings influence our well-being. As a result, we now see more holistic treatments, an awareness of the role of the soul, as well as an acceptance of assorted energy modalities to help bring the individual back to wholeness.

Understanding the ramifications of soul loss is an important factor in looking at suicide and suicide prevention. If we don’t feed our souls, we lose our animation and our energies dissipate. We would be well served to consider soul loss when assessing suicidality.

Why understanding is helpful

Posted on by Adele Ryan McDowell

After you have lost  a loved one to suicide, you feel anything but powerful or strong. Most likely, you are at your most vulnerable, full of heartbreak and deep grief.

Suicide leaves a trail of uncertainties and questions. Knowledge can help make some sense of the unimaginable. When we learn more, we have a basis for comparison. We realize, perhaps, that our situation is not so unusual. Plus, we can accept more fully the biochemical or psychosocial elements that have led to a suicidal action. When we understand more, we are no longer so confused, confounded, or upset. We find steadier footing, and we find ourselves more emotionally and mentally stable. Indeed, knowledge can serve as a powerful healing ally.

Peace can never be achieved by force.
It can only be achieved by understanding.
Albert Einstein

Suicide and mental illness

Posted on by Adele Ryan McDowell

Suicide is considered a mental health issue. Why would someone want to take their own life? They must be crazy.

And, sometimes, they are. There are people who cannot function on a day-to-day basis, do not bathe for a year, receive messages to kill themselves or others, or believe their fillings are wired to Martian intelligence. There are very real neurological and biochemical influences that place these patients at high risk.

Untreated depression is considered the number one cause of suicide. If you, or someone you love, has experienced the reality of major depression, you know what a devastating, debilitating, and a biochemical illness it is. The depressed person does not see or think clearly. She is locked inside a black, airless box that offers no light or perspective.

Hospitalization and medication have saved many lives. William Styron, in his memoir, Darkness Visible: A Memoir of Madness (1992), eloquently detailed his descent into, and recovery from, depression, which he called, “a howling tempest in the brain . . . dreadful, pouncing seizures of anxiety.” Styron understood the stranglehold of depression: “The pain of severe depression is quite unimaginable to those who have not suffered it, and it kills in many instances because its anguish can no longer be borne.”

Along with major depressive disorder, the psychiatric illnesses that can lead to suicidal actions are bipolar disorder (formerly known as manic depression), borderline personality disorder, post-traumatic stress disorder (PTSD), schizophrenia, and other psychotic disorders.

Did you know that the single greatest risk factor for suicide is a history of suicidal behaviors and attempts? Of course, this makes perfect sense, and if someone you love has these behavior patterns, take them seriously.

If you have lived with a loved one who has suffered from any of these mental illnesses, your life has not been an easy one. Nor has theirs. No one chooses to live with a debilitating psychiatric or psychological disorder that frequently moves in and out of crisis. It is painful, chaotic, exhausting, and terrifying for both the patient and loved ones. Ongoing treatment and meds are usually necessary to help make life more manageable.

A psychiatrist colleague of mine, once shared this with me: The majority of her patients who ended up in the hospital emergency room had stopped taking their medications, which then precipitated the subsequent disintegration.

Whereas, Nancy Kehoe, PhD, RSCJ, a Harvard Medical School professor, clinical psychologist, and nun, offered a new take on psychiatric hospitalizations during a lecture I attended decades ago in Boston. She allowed that for many of her patients, a psychiatric hospital gave them a much-needed sense of community and connection. And, with that sense of community and connection, they were able to heal. And by heal, I mean to find some stability so that they could return to the world as a functioning participant.

This made me think of the African tribes as well as many of the Indigenous people who work as a community and address the soul to help those in pain (of any kind) to find relief. There are many paths to wellness and wholeness.