Suicide Prevention: How to Spot the Signs and What to Do.
How to Move out of the Prison of Depression.
When I was 25 my father jumped off a building in Claremont. He suffered from manic depression, now called bipolar disorder, and after the worst time of year for him, the “festive season”, he chose to kill himself in a public way, which was surprising for such a very private man.
I was the last person in our family to see him alive, as he walked down Bowwood Road. I stopped to ask if he wanted a lift and after being told “No”, I drove home, never to see him again. My greatest fear is that I may miss the signs again.
Every day there are 220 attempted and 22 actual suicides in South Africa.
If someone finds themselves in a situation that they can’t cope with, don’t want to fix or don’t know what to do, they could choose suicide as a way out of their reality but research shows that suicide is hardly ever impulsive. It is not helpful to react too quickly or self diagnose what could actually be common behaviour; however, it is helpful to explore and understand possible warning signs so we can look out for them. The degree of the symptoms needs to be taken into account, together with the full picture of the person’s life, but there does seem to be some consensus about what to look out for.
- The following could indicate depression which is considered a leading cause of suicide: anxiety, hopelessness, boredom, disenchantment, aggression, change in eating, sleeping or exercise patterns, social isolation, behaviour change, substance abuse, hyperactivity, inattention, passivity, excessive self-criticism, psychosomatic illness or pain, stress related physical problems, hints of suicide or threats to harm others.
- Alcohol and drug use or other mental illness which can also impair judgement.
- A recent traumatic event causing psychic pain, alienation or lack of purpose. e.g. divorce, illness, death of someone close, loss of job, financial problem, accident.
- Talking about suicide – 80% talk about it and about their feelings beforehand; it is usually not impulsive.
- Saying how useless it is to live or how it would be better if they weren’t around.
- Sorting out and tying up loose ends, having “final” or good-bye conversations.
FACTS ABOUT SUICIDE
It is helpful to know that research shows us that:
- Some suicidal people do not actually choose suicide but gamble with their lives, leaving others to save them.
- Suicidal people want to “kill’ the unbearable and over whelming feelings and not themselves. These feelings may last for a limited period of time only, not forever.
- Most suicides occur within the first three months of an improvement – follow up is needed.
- Suicide occurs in all levels of society – it is neither a rich man’s disease nor a poor man’s curse.
- There is not always an obvious, logical reason.
- Suicide is linked to depression.
- Medication can help but will not provide a cure. It can be helpful to get in touch with one’s emotional life and address how one responds to what happens.
- Always take a suicide threat seriously. Previous attempts indicate how a future attempt may look.
- A threat is a cry for help and indicates distress; respond accordingly and offer what’s needed.
- Aberrant behaviour is also an indication of profound distress and is not just naughtiness or rudeness. Unacceptable behaviour includes shouting, swearing, rudeness, banging doors and sulking, all of which can be warning signs.
HOW YOU CAN HELP
People can be vulnerable and we may not notice their distress until it is too late. However, even when we do notice something is wrong, we don’t always know what to do or may be concerned about interfering or the demand on our own time. We may wonder “What if I’m wrong and they take offence? “How much of my time is helping going to take?” or “I have my own worries.” Actually, if we want to be responsible citizens, it could be seen as our duty to do and say something …… but what?
If you ask what’s wrong, they might say “Nothing.” “Are you alright?” may be followed by “Yes.” “Can I help?” also may not work as they could say, “No, I’m fine.” It is vital that we trust our intuition. The minute you notice, do something! Thinking about it, worrying and discussing it doesn’t help.
In this situation you are noticing that something is wrong and you are in a position to decide what’s needed and then make it happen, even if they resist or you feel awkward. Imagine how you would feel if they did something harmful and you hadn’t done anything or had kept quiet in order to be polite.
People can feel so desperate that they can see no way out. They hang their heads, hold them in their hands. Their whole being and life feels caught in an insoluble catch 22. Desperation can lead to annihilation unless there is a glimmer of hope. Hopelessness can lead to the sufferer’s life, relationships, work and sense of purpose coming unravelled. If they could step back and trust that there is a way out or remember that “this too will pass” then they may be OK. If not, ending it all may seem like the only option. What we can do is try to bring hope which may assist them to make a shift, see things differently and persevere.
I recently had a case where someone told me by email she wanted “out from life.” I phoned immediately to give her a chance to talk about how she was feeling. Mostly that’s what is wanted but this person felt no-one cared or understood. While there are many approaches, the following are suggestions:
IMPORTANT THINGS TO OFFER
- An ear, so they can off-load how they’re feeling. You are not responsible for solving the problem so just listen to it.
- Concern, so they feel they matter. Lack of self worth is often the problem.
- A hand on someone’s back or looking them in the eye with a genuine smile of understanding.
- An action plan. Help them to commit to what they feel able to do for themselves, without over challenging or forcing them. e.g. Eat three meals a day, get dressed, bath, exercise, look for a job, do something creative etc. Talk them through how this is going to happen; who is going to do the shopping and cooking, how and when.
- Follow up. Talk about how you are going to follow up. Get them to commit to an email, SMS or a phone call every day. Try to get them to commit to what they’ll do and, if they don’t, you can prompt them.
- Further follow up. Getting over the hump is hard but staying there needs stamina. The new resolve means breaking old habits which die hard. Continue to check in for a few months.
- If they say that they are contemplating suicide you might try asking them, “What do you thing this action will mean to your spouse/children/friends?”
A phone call, meeting for coffee or an email or SMS each day does not require a lot of time or effort but is immensely valuable – more than you could ever imagine if you haven’t experienced the black hole of depression yourself.
When our help is needed the individual situation will demand that we trust our intuition and act appropriately with integrity and good intent.
My main message is that if you react appropriately, your input may be minor but very meaningful, so there’s no need to worry that you may be sucked in and have your own time taken over.
WHAT NOT TO DO
What they do not need is:
- A patronising attitude.
- Platitudes such as “You’ll be OK.”
- Instructions like “Snap out of it.” They don’t know how.
- “Are you OK?” You know they aren’t. You wouldn’t be asking if you thought they were OK. Act on your intuition; don’t ask about what you already know.
- “Let me know if you need help.” – You know they need help and the chances are they will not ask. They don’t want it to be true that they need help and they certainly are going to find it hard to admit. Just do what you can see needs to be done – make it happen.
- Politeness. Do not beat about the bush, be direct and honest.
- Your burdening yourself with their problems. It doesn’t help if you do too much for them but if they are emotionally unstable they may not be able to do things for themselves. Find a balance. You may have to be more active initially and then pull back as you see them reacting and taking responsibility.
- Your doing it for them. Your role is to guide them, not do it for them. They need help in deciding what will work for them and what needs to be done.
- Talking too much about the problem or situation. Beware of getting caught up in the story and do not take sides. Focus on the issues and the emotions and don’t get stuck with talking about the cause of problem. Insight into the roots of the problem helps but committing to manageable steps out of the impasse will help more.
Luckily most of us don’t get to the point of being suicidal, but we can all experience despair. The suggestions above are just as potent in every day life and thus apply to us all. I have become very aware of vulnerability and how people try so hard to cover it up. It must be something to do with the fact that we associate vulnerability with weakness and so want to hide it. It can show itself in a number of contradictory ways like aggression, blaming others, defending oneself, sulking, keeping quiet in order to keep the peace, nagging … all are very unhelpful and almost guaranteed to achieve the opposite of what we so desperately need. It is useful to understand that expressing our vulnerability can make us stronger and it also can be a means of building meaningful relationships and communities.
CREATING A HEALTHY COMMUNITY
If problems in a family or community can lead to instability, then a healthy community could assist to providing possible healing. It takes a community to raise a child and we all need help from each other. Co-parenting is vital. Every adult can keep an eye open for guidance opportunities, the more subtle the better. It becomes mentoring in passing. We need to reinforce what children know but may need to be reminded of; what they have heard so often from their own parents or carers, but have become deaf to, and will hear from another adult.
New thinking in mental health uses the term intentional peer support which puts people with similar problems together in support groups so they can share their experiences and assist one another. In SA there is a drive to “treat” mental health in the communities and this can be a good thing as it forces the communities to “hold” their members and include them, rather than exclude them or isolate them in institutions. This group support encourages us to own and express our vulnerability in order to make it easier for others to do the same. If we can do this, we can move away from the purely pill-popping paradigm, drop the mask of being falsely strong, and build caring relationships where all types of people can feel accepted, enabling us all to rise to our true strength. Some say we should listen to those labelled “mad” as they could hold the key to the thinking of the future. The famous author, Mark Twain, said, “When we remember we are all mad, the mysteries disappear and life stands explained.”
A caring community is not only needed by those who feel fragile, but is also required if we wish to improve mental and emotional health in general. The job is not for counsellors and practitioners only, it is for all of us, all the time – to strive to bring caring, humane interactions into our way of being – staying awake enough to see opportunities to be kind, where a word said with consciousness can make all the difference.
There isn’t always agreement about the reasons for suicide or about the ethical debate but, in my own journey, I found these to be helpful areas to explore: lack of identity, a dysfunctional family dynamic and behavioural addiction.
One can never really know what someone else is feeling but someone contemplating suicide could believe that they are worthless; that they are making life worse for others or that there is no way out of a difficult situation. They could also have chosen not to want to carry on living. Suicide then becomes a solution. Many scenarios point to an identity crisis. There is likely to be a lack of identity and of self worth, a sense of not being heard or not having a method of self expression; not knowing one’s strengths and weaknesses and an inability to satisfactorily answer the question “Who am I?” or “What is my place in the world?”
I have learnt that I cannot blame myself for my father’s suicide. I wonder, though, if I had shown I cared in an effective way he might have found the strength to carry on. Friends, family and relatives may be too caught up in the bigger picture or be blinded by their closeness to the subtle warning signs of suicide. This is where the community at large can play a vital role. With understanding we might be able to spot and deal with problems before they get as severe as an attempted suicide.
When one person has a problem in a family, everyone suffers from it, not only the person who has the condition. Everyone either has it, is affected by it, or is co-dependent. This means that while the family can offer support, they can also be part of the problem. Often an unhelpful communication dynamic (repressed and unexpressed issues, opinions and emotions) prevails in the family and they could be blaming each other for their problems. This can be seen, for example, where one person will blame another for making them angry and “dump on them” instead of taking responsibility for their own emotions and sorting things out in an effective manner.
An addiction to something may bring immediate relief but when it becomes a habit we are unable to control or stop, it is unhelpful or destructive in the long run. We are aware of being addicted to substances but it is helpful to understand that negative emotions and behaviour can become entrenched and also could be seen as an addiction.
The aspect of mental disorder that is addictive comes out of habitually behaving in a way that enables us to avoid a reality that we can’t cope with. For example, hiding under the duvet means we don’t have to do something difficult. Mastering the addictive aspect requires an understanding of the reasons for the unhelpful behaviour so that people can seek alternative coping methods. This requires changing habitual responses and negative life patterning so as to truly engage in our own healing.
For a support person this is helpful in the long term while working toward re-establishing helpful patterns (habits or ways of thinking) but, in a crisis, pointing out any of this to the sufferer will be unhelpful. Keeping them safe, establishing some helpful patterns, giving support and listening are what is called for in the crisis and the theories can be looked at later. Some people seem to experience emotions more intensely than others. It is helpful if they, or you as a supporter, can create a means whereby these emotions can be harnessed and channelled into something constructive in a contained and controlled manner. Creative activities, such as art, dancing, writing or singing can be useful in this area. So can exercise, gardening or cooking …in fact anything that can energise or motivate one out of the depression. Not only is the outcome beneficial but the activity could also increase the person’s sense of self-worth. Building self-esteem is fundamental.
THE POWER OF CONVERSATION
The more we share ideas about what we have tried, what worked and what we would do differently next time, the more we might be prepared when it happens again. By talking we can also work towards reducing stigma and mystery.
This is why I have been co-facilitating support groups, discussions and facilitated conversations around the subject of mental illness.
After all this, I find I have to revise my greatest fear. Perhaps it is no longer that I may miss the warning signs of suicide but the realisation that in trying so hard to face and understand my problems, I might get too enmeshed in them and forget to live joyously and with gratitude.
Please put these toll free helpline numbers into your cell phone (8am to 8pm, 7 days a week).
Suicide Crisis: 0800 567 567 Support Group line: 0800 20 51 21
South African Depression and Anxiety Group: www.sadag.co.za
Suzanne Leighton is a Complementary Medical Practitioner with a special interest in the initiation into parenthood (pregnancy, infertility, baby massage, post-natal depression) and mental health (depression, suicide prevention, mania, bipolar disorder).
She was one of the founder members of the “Sophia Family Centre” and has been facilitating the Bipolar Disorder support group “The Bipolar Bears” in Cape Town for four years.
In the UK, she was registered with the British Complementary Medical Association and is registered with the Allied Health Professionals Council (SA) in aromatherapy and reflexology. She is also a Reiki master and a registered teacher with the British Wheel of Yoga. Her general practice is in Constantia, Cape Town.
If you wish to organise a workshop, facilitated conversation or discussion on improving mental health, please contact: +27 21 794 2738 or email: firstname.lastname@example.org.
“I have processed and studied the subjects of depression and suicide, mania and bipolar disorder for many years.
Having worked through my pain, I would like to make my father’s suicide both meaningful and a positive legacy by sharing with others what I have learned.
Please email this article to as many people or groups as your are able. I am happy for it (or extracts) to be published, for example in school or society newsletters, community newspapers or corporate magazines. My skill lies in working with diverse groups, facilitating conversation by asking and exploring challenging questions. Please contact me if you’d like to explore these subjects in this manner. “