12 things you should know about Suicide

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 power of connection and caring

handsofchakraenergy-greenElizabeth, a mental health worker, arrives in Nepal immediately after the earthquake. There was total chaos. The ground was literally not stable as it shifted with tumbling rubble and aftershocks.

The first person Elizabeth meets is Prem, a young man looking lost and bereft. “Where are you going?” she asks.

“To the river to kill myself. Both my parents were killed in the earthquake. There is no reason for me to live,” Prem replies.

“Oh, no. You are coming with me. We will stay together until you feel safe,” Elizabeth states.

Prem follows Elizabeth and they set up a tarp shelter held down by rocks. He stays for 24 hours and tells Elizabeth, “I feel safe now.” They exchange contact information and Prem promises to text regularly. And he does.

Weeks later, Prem calls Elizabeth and happily announces, “My parents are alive! I found them in a tarp hospital some distance away. They are safe and alive. You saved my life. You saved their happiness. I am only alive because of you.”

Prem continued to text Elizabeth every day for many months to let her know how he was doing. We never know exactly how life will unfold nor understand the unique difference we can make in another’s life and how one chance meeting saved a life.

The 7 Points On The Spectrum Of Suicide

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

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.

13 Everyday Ways to Prevent Suicide

September 10  is World Suicide Prevention Day where we focus our attention and energies on the rampant global epidemic of suicide and consider ways to end this pernicious, deep sorrow.

From my research, I would say everyone has been impacted by suicide. Be it their own abstract thoughts, a school rocked with grief at a student’s suicide, the loss of a loved one, the sudden death of a coworker or hearing about the friend of a friend. Alas, suicide is everywhere and touches every aspect of society.

It feels fitting that today I share with you once again 13 Everyday Ways to Help Prevent Suicide. Please never estimate the power of one to make a difference.

What can we do to help?

Here are 13 small steps that we can all take to help tip the balance in favor of life. We never know the impact we make on one another:

  1. Be neighborly.

Reach out to decrease loneliness and isolation. I love the story of the woman who would occasionally leave freshly baked pies for her very lonely, dismissive and cantankerous neighbor. After almost 16 months, the wall finally came down and a connection was made.

 

  1. Become the anti-bully.

Become tolerant of others. Don’t punish differences. Be it hair color, body size, sexual preferences, clothing choices, religion, culture, race, socioeconomic status, level of education, kind of work, appearance or any other something that is different from you, learn to accept.

Making someone feel small, belittled and terrified does not serve any of us. And that kind of terror begets terror. Let’s stop the cycle and increase the cognitive dissonance around bullying.

 

  1. Seek help.

Check out your local resources and find help for your depression, addiction, run-away anxiety, PTSD and other mental health concerns. You don’t have to do it alone. There’s no shame in getting help. Ever. We all need a helping hand from time to time.

 

  1. Be kind.

Give others the benefit of the doubt. Lend a helping hand. Proffer a smile. Or simple be present and acknowledge. Kindness is never wasted. It positively shifts energies and impacts the neuroplasticity of our brains. Not only does kindness makes us feel good, it’s good prophylactic medicine.

 

  1. Be proactive.

Write a check, volunteer or take steps to help those of in need of a job, a bed, a meal or how to read a book. Advocate for mental health resources. Support our veterans. Every little bit does count.

 

  1. Work on your emotional intelligence (EQ).

Fluency in expressing our feelings in a direct, non-threatening way we can make a huge difference in our personal interactions. It helps us feel connected and understood. After all, we are social beings.

 

  1. Make peace with yourself.

No more cursing at your inner demons. No more emotionally leaking or ranting and raving due to your unhealed childhood wounds. If needed, get help. And learn to accept – and, even, love – your very humanness.

 

  1. No more bad-mouthing.

Put an end to the snarky comments, gossiping and mean-spirited character attacks. Put judgment and criticism in the deep freeze. We never know someone’s situation, particular context or backstory. As the saying goes, everyone is struggling and fighting their own battles, a running, pejorative commentary of another only causes more pain.

 

  1. Develop your cultural IQ (CQ).

We all share one blue-green marble. Let’s respect our wealth of cultures and learn to understand one another. The more we learn, the greater are our experiences as we expand our respective comfort zones. Crickets may not be my go-to food, but I am happy you are enjoying your crunchy meal. There is room and space for each of us.

 

  1. Practice compassion.

Who needs judgment? Practice compassion. Compassion asks us to walk in one another’s shoes. Compassion asks us to treat others the way we would wish to be treated. Compassion asks us to lead from the heart.

 

  1. Practice Latitude.

Everyone has a bad day, a bad season or, even, a bad couple of years. Sometimes, we just need to let it go, let it slide and give the other person (or ourselves) a break. Sometimes, what we don’t say can be the greatest gift of all. Latitude allows us to take a breath and re-center.

 

In the behavioral sciences, we know that accentuating the positive goes much farther than harping on the negative. With discernment, you will know where to practice latitude.

 

  1. Talk and disempower the stigma of suicide.

Suicide is universal and global. It has been around since the earliest of times. Suicide has been tainted by taboo, shame and guilt. Don’t be afraid to talk about suicide. Bring it out in the open. Don’t be afraid to ask. The “S” word is far too prevalent for us to ignore its presence or to be in denial. Let’s have heart-to-heart conversations and put suicide in the light of day. No more secrets. No more hiding. Let’s talk. Let’s connect and change the paradigm.

 

  1. Be a power of example.

Our actions often speak louder than our words. Walk in your integrity, coherence and with an open heart.  Share some of your light. It can help ease the darkness.

Thank you for your open, caring heart.

 

And please share if you find this of value. You can never underestimate the power of a suggestion. Many thanks.

 

 

 

A Psychologist’s Suicide

hThe word came that a friend and colleague, a clinical psychologist, had committed suicide.  She had suffered a hammering of profound losses and fell into a deep hole of depression.  She had placed herself in good professional hands, was hospitalized for two weeks, and released with medications and a discharge summary that she, herself, could have written.  She, later, took her life by overdose.

And if you are a clinical type, then you might be interested in knowing that she – and we will call her Susan for our descriptive purposes here — had been hospitalized once before as a young adult due to a breakdown of sorts.  That initial breakdown had shaped her career.  I would also suggest that it enhanced Susan’s humanity and made her more accepting of the mysteries of life.  Susan was a very skilled and gifted therapist.  Over the course of her professional life, she had helped so very many find their way to safety and sanity, which, of course, makes it even more incongruent that this healing type woman would take her own life.  Then, again, we are all human.

Susan was a huge dreamer – big, significant dreams, healing dreams, dreams that reverberated in her 3D life with books, pictures, and the like tumbling, on occasion, from her walls and book shelves.  Susan analyzed dreams with her patients; she explored their multi-nuanced aspects with her colleagues. Susan understood the imaginal world and the power of metaphor to transform a life.

Yet, even with all those gifts and talents, Susan’s well of despair flooded.  Taken hostage by her biochemical influences, she crossed the border of her inner terrain and entered into the place without light, with nary a crack in the darkness.  All that training and education notwithstanding, suicide seemed the answer to Susan’s very distraught and off-balanced self.

Suicide is not painless; it leaves loved ones – and in this case, patients, too – reeling in disbelief and “what if’s” and “If only, I had …” It’s hard to be left under such messy circumstances. We think, perhaps, we could have done something differently – made a move or said the right words that might have tipped the balance in favor of life.   Death is not easy on a regular basis, but it becomes tainted and shame-faced when described as a suicide.  It’s as if we, the survivors, have somehow failed to do our part.  We feel responsible.  We feel confused and, sometimes, angry, too.   “How could they?” we puzzle, as if it had anything really to do with us.

As a psychologist as well as a former suicide hot-line responder, I understand all too well what can lead up to those moments when suicide is considered a possibility that can – with enough pain and tight, airless thinking — become an option to end the torment.

I get it. I’m not saying I like it, condone it, or anything else, but I understand how someone can get there.  I understand the trajectory of suffering.   I have witnessed the sheer desperation of unabated pain — be it physical, psychological, or both — and the dark places that it can take you. I have seen how a life can crumble in on itself, worn down by the struggle, the relentless struggle.

That much pain changes a person; it leaves an indelible mark.  Suicide becomes all about moving out of the desperate pain.  It is a very intimate act; it is self on self, in all of its swirling eddies of emotional tumult. There is little room for anyone else.

There are many paths of pain and despair.  For some, suicide is an impulsive act of fury and pain; for others, it is a release from the daily torment that makes life unbearable. For some, it is the tight, airless room where they cannot draw a deep breath; much less consider compassion for the self. Suicide is an act of violence against the much-hated, broken, and wounded self.

Suicide leaves a wake of questions.  I have opted to forego the questions.  It does not change anything.  What I know is that my friend was in pain, was biochemically unbalanced, and made a choice.  Needless to say, I wish her choice had been different, but who am I to say?  Her act teaches me about the fragility and ferocity of the human spirit.

In the aftermath, I have come up with what I think is the perfect antidote.  I am sending loads and loads of light to my friend, Susan.  It seems like the perfect thing to do after all that darkness.  And, who knows, maybe it will help her soul refind its sparkle.

The five reminders from loss

The hard-flint beauty of loss is that it serves as a teacher. Loss reminds us what has become “back-burnered” in the daily press of life.

1. Life is short.

2. Life is precious.

3. What matters most is love … who we love, how we love, what we love and when we choose to open ourselves with courage and vulnerability to love.

4. Loss precipitates change.

5. Loss reminds us that we still have time to fine-tune the focus our lives, re-arrange our priorities, revitalize connections and be the love we want to be.

Sometimes, it’s hard to see the gifts of sorrow, but they are present and, equally, patient until we are ready to claim them.

May you be held in peace.

 

Held and remembered

The other day, a small rectangle of a yellowed newspaper article, taped onto a cut piece of an index card, fell out of book that was a pass-along from a friend. I was touched by the compassion of these words, the knowing of the hold and pull of grief on the heart as well as the talisman these words served for my beloved, long-time friend:

“You begin to realize that everyone has a tragedy, and that if he doesn’t, he will. You recognize how much is hidden beneath the small courtesies and civilities of everyday existence. Deep sorrow and traces of great loss run through everyone’s lives, and yet they let others step into the elevator first, wave them ahead in a line of traffic, smile and greet their children and inquire about their lives, and never let on for a second that they, too, have lain awake at night in longing and regret, that they, too, have cried until it seemed impossible that one person could hold so many tears, that they, too, keep a picture of someone locked in their heart and bring it out in quiet, solitary moments to caress and remember.” (Author unknown)

The second piece of paper to flutter out of the book was a post-it reading “Be here now.” Again, how apropos amidst the bittersweet knot of loss to be reminded to stay present, carrying on with our hearts full of love and memory. As our unknown author says, “to keep a picture of someone locked in their heart and bring it out in quiet, solitary moments to caress and remember.”

I have two thoughts: One, a life well lived, clearly carrying forward the memory of our loved one, is the greatest homage to the one(s) we have lost. And two, the ones who are no longer physically present are most certainly present within our hearts and our souls. I often feel they are the quiet guides who help us along the way.

We remember. We hold. We go forward with our someone in our heart.

 

The Path of Grief

Grief is akin to putting on your hip waders and walking into the deep, murky water of your psyche, the home of your inner life, where there are churning emotions and roiling thoughts along with forgotten bits and pieces. The footing is rocky, uneven, and unpredictable. You never quite know what will slide up against you or tangle your footing. There is so much you cannot see or discern beneath the waters. You move slowly and tentatively forward, sweeping debris and sludge away from your person, and choking back tears. Sometimes, you stand stock-still until there is enough fortitude to take another step. It’s an arduous, crazy-making process. And it’s a game-changer, too. Your worldview is forever changed, and your heart is re-assembled.

 

There is only one response

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