01 March 2017

To be, or not to be...

"To be, or not to be…" Anyone who has made it through high school English probably recognizes these words from Shakespeare’s Hamlet.  Have you considered what Hamlet is talking about in this famous monologue?  To put it simply, he is contemplating suicide.

Data from the CDC indicates that suicide is a large and growing issue in the United States.  Based on the CDC numbers, someone dies from suicide every 13 minutes in the US.  And given the relatively low “success” rates of suicide attempts, that means two people attempt suicide every minute in this country.   For some demographics, suicide is a bigger killer than cancer, than drug use, than texting while driving.  Think about the times you hear about these other dangers in an average week.  Now think about the last time you heard a commercial or a discussion on how to prevent suicide.  Scary, isn’t it?

National studies indicate that about 25% of the US population will experience clinical depression in their lifetime.  Similar studies suggest that 9-10% of people contemplated suicide in the last year, with estimates that 20-25% of Americans will contemplate suicide some time in their lives.  Those numbers indicate that most of us know someone who has thought about killing themselves.

Sadly, most people have no idea how to respond to these feelings in themselves or others.  I don't mean that people don’t care.  On the contrary, I think most people would like to prevent suicide.  The problem is knowing what to say or how to react.  Luckily, you have found the answer (if you finish reading this article).  Let’s first look at some of the worst myths about suicide.  Then we will talk about how to best respond to suicidal thoughts.

Myths about suicide

Thomas Joiner wrote a great book called Myths about Suicide.  If you find this discussion at all interesting, I encourage you to get his book and read his insights.  I have included some of his thoughts here.  The rest of the ideas are based on my own experience.  (Please don’t negatively judge his book if I do a poor job presenting the ideas.)

Myth 1: Someone contemplating suicide is irrational
Irrational = unbalanced = not thinking clearly = crazy.   That is the initial reaction for most people when they hear someone might be considering suicide.  I can’t speak for everyone; I can tell you that in many cases, thoughts of suicide are based on logical, deductive reasoning.  The person may be incomplete in the thought processes, but that does not mean he or she are nuts.  In most cases, the person has found evidence that supports his decision.  She or he has considered the options, and deduced that death is the best possible solution.
Myth 2: Suicide is selfish
How often have you heard someone question a suicide with a comment like, “how could he do that to his children / family / spouse?”  The implication is that the person committing suicide did this to harm others.  Others may imply that suicide was an “easy way out” that didn’t consider the impact on others.  In Myths about Suicide, the author suggests two premises that often for the basis for contemplating suicide: 1) the world is a better place without me in it; and 2) nobody is connected enough to me to be that hurt by my death.  Suicidal ideation often involves beliefs that include: “I am a burden on others;” “others will be happier if I am not around;” and “nobody will notice I am gone.”  Again, some of the ideas may be flawed or misunderstood.  The point is not that the logic is correct.  The point is that the person is acting not for his or her own benefit, but because it may improve the lives of others.   
We don’t question the motives of the soldier that jumps on the grenade to save others or the mother that dies saving her children from a fire.  Why do we question the father that kills himself because his life insurance will feed his struggling family?  Why do we question the daughter that sees the struggles her parents face because of her illness and decides to end her life?  Why do we question the ex-convict who worries about being a threat to others and chooses to die rather than potentially re-offend?  Whether you agree or not, the person contemplating suicide believes he is making life better for others.
Myth 3: Suicide is a cowardly act
“He took the easy way out.”  “She wasn’t willing to fight.”  Join me in a short experiment.  Find a pin or needle (you know, a tiny piece of metal with a sharp point).  Now, jab that into your thigh two or three times.  Unless you regularly give yourself injections, you probably have a very hard time trying to do that.  We humans come factory-equipped with powerful life-preservation programming.  We are conditioned to fight to stay alive.  We don’t even want to poke ourselves with a pin.  Imagine the determination required to cut open your own body, to take poison, to put yourselves in direct danger.  Suicide requires the person to overcome the strongest of instincts.  Suicide is NOT an easy way out.
What do we do?

Now that we know some of the misconceptions about suicide, what do we actually do when someone we know is considering death?  Hospitalize them?  Point out the flaws in their logic?  Guilt them into not doing it?  Probably not the best solutions – in fact, some of these ideas may make the situation worse.

Sadly, there is no miracle cure for someone amid suicidal thoughts.  And I certainly can’t speak for everyone that has contemplated dying.  But please consider these suggestions from my own experience.  (NB: I am not writing this from my perspective to seek sympathy or a pat on the back.  I simply don’t know how all people in the situation think, so I can only speak from what I personally think, feel, and want.)

  1. Be genuine. Be honest and sincere and real.  When I am feeling depressed, ashamed, or hopeless, my BS-meter goes to 11.  As William Parrish says in Meet Joe Black, "Don't blow smoke up my ass.  You'll ruin my autopsy."  If you lie trying to convince me to change my mind, I am going to know.  In fact, even if you are being honest in that situation, I may not believe you.  And if I catch you being disingenuous about why not to die, I am going to stop listening.
  2. Empathize with me. Imagine that you truly believe that the world is better without you.  Imagine that you honestly think that after a few months, nobody will care or even remember that you died.  Imagine how sad, lonely, and hopeless you would feel.  The emotions can be profoundly painful.  Once you can imagine that, then just empathize with me.  Don’t sympathize or try to “fix it.”  Not sure you know the difference?  Watch this two-minute video from Brene Brown to understand the difference.
  3. Share what you feel. I don’t mean tell me why I shouldn’t die; I don’t want direction or advice.  Think back to the two primary foundations for suicide: the world will be better, and nobody will care.  If you disagree with those conclusions, then share the why (but not the “therefore”).  What does the why sound like?  I care about you.  I appreciate you.  I am grateful for you. If you are really insightful, include a specific reason.  I appreciate you; thank you for helping me with my homework.  I am grateful when you listen to me; I feel less lonely when you listen to me.  Keep it simple.  Focus on how YOU feel because of MY actions.  The purpose is not to convince me to act a certain way.  The purpose is to show that you find value in me and that you feel a connection to me.
  4. Take a “pro” approach.  We often try to win arguments by focusing on what is wrong with the alternative.  We highlight the negative consequences of the considered action: “Think of the pain you would cause your parents.”  “There is not enough money to pay for the therapy your children would need.” While these may seem like good arguments in your own mind, let me translate how that is understood in the suicidal mind.  Feeling suicidal is tied up with feeling overwhelming shame.  In other words, I have convinced myself that I am a bad person, that I am not good enough, and that therefore, my being around has a profoundly negative impact on others.  When I hear how my suicide would make things worse for others, I use that as justification. I think, “See!  I am a terrible person.  Even in death I mess everything up.  Why would anyone want someone like me around?”  Shame is a terrible motivator.  Rather than bringing up the reasons against suicide (the “con”), focus on the reasons for life (the “pro”).  Just make sure you remember suggestions 1, 2, and 3, or I won’t believe you.
  5. Be present and listen. I can promise you that you will not be able to convince me not to commit suicide.  This is actually a great thing for you.  It means you don’t have to save me!  You're off the hook, so STOP TRYING.  Rather than sitting there trying to come up with the perfect response, just listen.  Let me tell you why I feel this way.  Let me share my thoughts without being judged.  Don’t think about what to say next.  Just sit with me and listen.
  6. Let me make the choice. This is probably the hardest of all the suggestions.  When we hear about something painful (and suicide is awfully high on that list), we want to FIX it.  I already know there is medication. (I have some.)  I already know there are therapists (I have one).  I am aware of the suicide helplines, the statistics on attempts, and the survivor stories.  I know about prayer and scriptures and faith and the gospel.  I may turn to any one of those things.  But I will turn to them because I decide to, not because somebody told me I should.  You can ask if I am aware of these options, but then please leave it at that.  (And don’t force the issue.  If I confide in you, and you lock me in the hospital, I am not likely to confide in you ever again.)  
  7. Pray for me. Just because I don’t want to hear a lecture on faith or how god feels about suicide doesn’t mean that I don’t believe in something greater than us all.  I do believe God can inspire.  (I also believe he doesn’t force.)  Notice that the suggestion is to pray for me – not for a specific outcome.  
  8. Be my friend. Remember that one of the factors for suicide is feeling disconnected.  So send me a text.  Give me a call.  Let me know you thought about me. (Suggestions 1-6 still apply.)  I am not looking for someone to babysit (read: suffocate) me.  I am not looking for someone to tell me what to do.  I just want to know that somebody cares and values me.  Put into practice the quote from Camus, “Don't walk behind me; I may not lead. Don't walk in front of me; I may not follow. Just walk beside me and be my friend.” 

I can’t guarantee success.  These ideas may not work for everyone else, but I have a hard time believing that you can go wrong with the eight recommendations above.

“To be or not to be, that is the question.” 

There isn’t one simple answer.  Personally, I think the most effective solution doesn’t focus just on suicide.  I think the best answer is in the way we live and treat others.  I believe that the more valued, appreciated, and connected a person feels, the less likely that person is to contemplate suicide.  So, if there IS a single answer to preventing suicide, it is connecting with those you care about and letting them know you are grateful for them.