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 connection between suicide and childhood sexual abuse

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 the stranglehold of Big Grief

Worried man blues

We are hard-wired for connection and when a meaningful connection is severed – be it someone who has held a special place in our personal firmament of love and affection or someone who has betrayed and abandoned us — we feel devastating loss.

Loss of this magnitude births grief – grief for what was, what is now and what will never be. Big Grief brings you to your knees. How can the world continue to spin when your world has stopped?
Inside, you can’t stop howling. Night after night, you howl until your voice is gone. You sleepwalk through your days, unable to connect the dots of your new reality. You barely function. You sit on the edge of hysteria.

Grief places a stranglehold on your heart. Your world contracts and constricts. You can’t take a deep breath. Grief holds your breath in shallow field now made fallow with loss. It’s impossible to unclench the tension that locks your body in pain and, even, fury. Your days and night wind endlessly in an ever-tightening knot held buoyant by your tears. Everything has been squeezed out of you. It hurts. It hurts like hell.

It’s hard to imagine there is life beyond your exploded heart. How can you possibly merge back into the cacophony of dailiness and demands when your life has been captured by grief? The hollowness, the memories, the break-downs, the images, the gut-wrenches, the what-ifs have kneed you into a tight, dark corner.

The pain, akin to a high fever, has kept you writhing and sobbing in unrelenting deliriums. The raging intensity of the hot pain eventually crescendos and breaks. You are left shivering in disbelief. You re-enter the world, shaky and vulnerable. Blinking and staring blankly, you emerge with a heightened sensitivity to everything around you. You feel fragile and raw, as if you are wearing new skin. You want blankets and covers and comfort. You take in nourishment and emotional sustenance, spoonful by spoonful.

Your re-emergence cannot be rushed. A part of you has died and another part of you is being reborn. Your struggle has been enormous, one that has left you hanging perilously close to the edge. You have been so very brave.

The splinters of your shattered heart were deeply embedded in your psyche. Slowly and painfully, you extracted their pierced shards. You laboriously pieced together, tiny bit by tiny bit, a new heart, spread-eagled by pain and re-imagined with love and courage.

It has taken a Herculean force of will and enormous personal strength to break out of the tight, madness-filled constriction of grief and to move beyond the darkness.

The world is no longer the same. You are no longer the same. You have new eyes with which to discern the essentials of life. You see more deeply; you can read the soul. You swim in depths heretofore out of your reach because you have learned to hold the tension of opposites.

No longer are you constricted by grief. Now, you can take a deep breath. Now, you are ready, albeit gingerly, to embrace life once again.

The loss of your loved one does not disappear or evaporate, nor is it diminished. Your loss is re-configured. Your grief has been absorbed and incorporated into your being. It’s a forever part of you that has re-arranged your being on a cellular level.

This Big Grief has expanded your heart – a heart that now has the capacity to cradle both the light and the dark.

You have broken the stranglehold.

This article also appeared on The Huffington Post Canada under the title “You Can Survive the Torture of Big Grief.”

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.

 

 

 

Understanding teen suicide helps make sense of the heartache

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

Nora McInerny: We don’t “move on” from grief. We move forward with it.

“In a talk that’s by turns heartbreaking and hilarious, writer and podcaster Nora McInerny shares her hard-earned wisdom about life and death. Her candid approach to something that will, let’s face it, affect us all, is as liberating as it is gut-wrenching. Most powerfully, she encourages us to shift how we approach grief. “A grieving person is going to laugh again and smile again,” she says. “They’re going to move forward. But that doesn’t mean that they’ve moved on.”

Beautifully said. It’s a heartfelt 15 minutes. You will never forget (nor should you) and you can live life. To me, it’s the “and and” concept versus before and after.

“Signs for the Living”

Signs for the Living

Sometimes, after the last snow in May,

after the red-winged blackbird clutches the spine

of the cattail, after he leans forward, droops

his wings, and flashes his epaulets, I imagine

shouldering the yellow center lines of the road.

 

Near the recently thawed pond, within a long

channel of construction, a man holding a sign.

One side says slow, the other stop.

Joy and sorrow always run like parallel lines.

 

Inside the house, when I leave the lights on,

small white moths come like a collection of worship,

pulsing their wings up and up the window,

as if a frenzied trancelike dance,

some dervishes, the others penitent on shaky knees.

 

The first few years after my husband’s suicide

I wanted to the penitent.

I thought I deserved all the pain I could feel.

The drill of roadwork in late summer

was a welcome grinding music.

Now the yellow center lines are flung like braids behind me.

 

by Didi Jackson

(as seen in The New Yorker, October 2, 2017 )

 

RIP: The collateral heartache of trauma and violence

This week, there have been three suicides as a result of trauma and violence, two student survivors of the Parkland, FL school shooting and one parent who lost a child in the Newtown school shooting. This is beyond heartbreaking for both families and school communities who have struggled valiantly to deal with the reality and aftermath of  their respective horrors.

Generally speaking, 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.

In these cases, it is the collateral damage from the trauma of the school shootings and the ensuing complicated grief that most certainly influenced these suicides.

This collateral damage can leave you reeling with extreme emotional pain, gutted by the traumatic endings of  your loved ones’ lives and a high probability of survivor’s guilt.

Deep, intractable, dark-holed depression and breath-inhibiting, complicated grief can leave you in a tight, cramped, airless space where you can feel stuck, profoundly tired, deeply detached and disconnected. You can hurt all over. Nothing makes sense. Your thinking becomes binary, right or wrong, good or bad. In a word, boxed.

You can feel utterly despondent and despairing. Grief can sucker punch you in unexpected waves and leave you swimming in tears. Your sense of self has melted. There is overriding pain, conflicting emotions and, often, a continuous replay of the traumatic and violent specifics that leave you helpless and in agony for your lost loved one. Further, as with all grief and trauma, each experience opens the door to the memory of other experience of loss and trauma.

These three suicides serve as a highly charged cautionary tale that complicated grief and trauma leave our loved ones dangerously close to the edge. Clearly, it’s not easy. It is challenging and calls for all of our compassion, understanding and support of those who have found themselves walking this very challenging (in all possible ways) and, possibly, lethal path.

Suicide is not a natural response. If I were to put a pillow over your face, you would instinctively fight me. The pain, the big grief and the trauma had to be so big for each of these individuals to make the choice they did.

May all three of these survivors of the unthinkable find their respective long-lost peace and be held in the light.

 

Sally and the Sparklers

Two weeks after the funeral, 5-year-old Sally came to see me early one Saturday morning. She was wearing her mom’s leather jacket that dragged across the floor. She looked so small and vulnerable as she came into my psychotherapy office. Sally was there to talk about her grandmother who had died recently. We talked a lot about her grandmother, who had created memorable adventures and fun on their annual summer beach vacation.

Somehow, a ceremony of some sort seemed in order and we decide to create an impromptu ritual to honor her special relationship with her grandmother. At the last moment of preparation, I spontaneously dive into the back of my closet and come out with a buried box of sparklers – for some reason, they seemed like just the right touch.

Sally and I are standing on the back porch of my office when her mom comes up the stairs and looks at me wide-eyed and silently mouths, “I will tell you later.”

As the rain pings off the stairs and banister, all three of us solemnly light our sparklers and silently send our thoughts and blessings to her fun-loving grandmother.

Sally’s mom calls later and tells me that sparklers were an annual tradition with the grandmother. How did I know? I didn’t. But I feel fairly certain that Sally’s grandmother had guided me in some way. And those seconds of sparkly light gave Sally the farewell she needed from her grandmother who, unbeknownst to me, brought sparklers to every beach vacation.

From my perspective, our loved ones are still cheering us on from the other side of the veil. A truly, who couldn’t do with a little sparkly light when our lives have become cloudy.

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.