FREQUENTLY ASKED QUESTIONS ABOUT SUICIDE

People usually attempt suicide to block unbearable emotional pain, which is caused by a wide variety of problems. It is often regarded as a cry for help. A person attempting suicide is often so distressed that they are unable to see that they have other options:

In the vast majority of cases, people would choose differently if they were not in great distress and were able to evaluate their options objectively.

Most suicidal people are intent on stopping their emotional pain, not upon dying. Because they have mixed feelings about living and dying they inadvertently give warning signs.

No, having suicidal thoughts does not imply that you are crazy, nor necessarily mentally ill. People who attempt suicide are often acutely distressed and while many are found to be depressed to some extent, this may often be a reactive depression which is an entirely normal reaction to difficult circumstances.

There are a number of victims who suffer from a diagnosable mental illness or endogenous depression with other underlying causes.

Appleby and Condonis[1] write: The majority of individuals who commit suicide do not have a diagnosable mental illness. They are people just like you and I who at a particular time are feeling isolated, desperately unhap- py and alone. Suicidal thoughts and actions may be the result of life's stresses and losses that the individual feels they just can't cope with.

In a society where there is much stigma and ignorance regarding mental illness, a person who feels suicidal may fear that other people will think they are "crazy" if they tell them how they feel, and so may be reluctant to reach out for help in a crisis.

People who are suffering from a mental illness such as schizo- phrenia or clinical depression do have significantly higher suicide rates than average, although they are still in the minor- ity of those who attempt kill themselves. For these people, having their illness correctly diagnosed can mean that an appro- priate treatment can begin to address it.

It depends what aspect you talk about. Talking about the feel- ings surrounding suicide promotes understanding and can greatly reduce the immediate distress of a suicidal person. In particu-

lar, it is OK to ask someone if they are considering suicide, if you suspect that they are not coping. If they are feeling suici- dal, it can come as a great relief to see that someone else has some insight into how they feel.

This can be a difficult question to ask, so here are some possi- ble approaches:
"Are you feeling so bad that you're considering suicide?" "That sounds like an awful lot for one person to take; has it made you think about killing yourself to escape?" "Has all that pain you're going through made you think about hurting yourself?"
"Have you ever felt like just throwing it all away?"

The most appropriate way to raise the subject will differ accord- ing to the situation, and what the people involved feel comfort- able with. It's also important to take the persons overall response into consideration when interpreting their answer, since a person in distress may initially say "no", even if they mean "yes". A person who isn't feeling suicidal will usually be able to give a comfortable "no" answer, and will often continue by talking about a specific reason they have for living. It can also be helpful to ask what they would do if they ever were in a situation where they were seriously considering killing them- selves, in case they become suicidal at some point in the future, or they are suicidal but don't initially feel comfortable about telling you.

People can usually deal with isolated stressful or traumatic events and experiences reasonably well, but when there is an accumulation of such events over an extended period, our normal coping strategies can be pushed to the limit.

The stress or trauma generated by a given event will vary from person to person depending on their background and how they deal with that particular stressor. Some people are personally more or less vulnerable to particular stressful events, and some people may find certain events stressful which others would see as a positive experience. Furthermore, individuals deal with stress and trauma in different ways; the presence of multiple risk factors does not necessarily imply that a person will become suicidal.

Depending on a person's individual response, risk factors that may contribute to a person feeling suicidal include:

• Significant changes in:
  • Relationships.
  • Well-being of self or family member.
  • Body image.
  • Job, school, university, house, locality.
  • Financial situation.

    
    
    
    
    
    

  • World environment.

• Significant losses:
  • Death of a loved one.
  • Loss of a valued relationship.
  • Loss of self esteem or personal expectations.
  • Loss of employment.

• Perceived abuse:
  • Physical.
  • Emotional/Psychological.
  • Sexual.
  • Social.
  • Neglect.

Often suicidal people will give warning signs, consciously or unconsciously, indicating that they need help and often in the hope that they will be rescued. These usually occur in clusters, so often several warning signs will be apparent. The presence of one or more of these warning signs is not intended as a guarantee that the person is suicidal: the only way to know for sure is to ask them. In other cases, a suicidal person may not want to be rescued, and may avoid giving warning signs.

Typical warning signs which are often exhibited by people who are feeling suicidal include:

• Withdrawing from friends and family.
• Depression, broadly speaking; not necessarily a diagnosable

mental illness
such as clinical depression, but indicated by signs such as:

• Loss of interest in usual activities.
• Showing signs of sadness, hopelessness, irritability.
• Changes in appetite, weight, behavior, activity level, or sleep patterns.
  
• Loss of energy.
• Making negative comments about self.
• Recurring suicidal thoughts or fantasies.
• Sudden change from depression to being `peaceful'.

• Talking, Writing or Hinting about suicide.
• Previous attempts.
• Feelings of hopelessness and helplessness.
• Purposefully putting personal affairs in order:
  • Giving away possessions.
  • Sudden intense interest in wills or life insurance.
  • `Clearing the air' over past personal incidents .

This list is not definitive: some people may show no signs yet still feel suicidal, others may show many signs yet be coping OK; the only way to know for sure is to ask. In conjunction with the risk factors listed above, this list is intended to help people identify others who may be in need of support.

If a person is highly perturbed, has formed a potentially lethal plan to kill themselves and has the means to carry it out imme- diately available, they would be considered at greater risk for attempt suicide.

Suicide has traditionally been a taboo topic in western society, which has led to further alienation and only made the problem worse. Even after their deaths, suicide victims have often been alienated by not being buried near other people in the cemetery, as though they had committed some utterly unforgivable sin.

We could go a long way to reducing our suicide rate by accepting talk about suicide by removing the social taboos, and allowing the suicidal feelings to be expressed. A person simply talking about how they feel greatly reduces their distress and minimizes the pressure to act upon these impulses. They also begin to see other options, and have a lesser need to attempt suicide.

There usually are people to whom a suicidal person can turn for help; if you ever know someone is feeling suicidal, or feel suicidal yourself, seek out people who could help, and keep seeking until you find someone who will listen. Once again, the only way to know if someone is feeling suicidal is if you ask them and they tell you.

Suicidal people, like all of us, need love, understanding and care. People usually don't ask "are you feeling so bad that you're thinking about suicide?". Locking themselves away in- creases the isolation they feel and increases the likelihood that they may attempt suicide. Asking if they are feeling suicidal has the effect of giving them permission to express their feel- ings and reduces their isolation and may see that someone else is

beginning to understand how they feel.

If someone you know tells you that they feel suicidal, above all, listen to them. Then listen some more. Tell them "I don't want you to die". Try to make yourself available to hear about how they feel, and try to form a "no-suicide contract": ask them to promise you that they won't suicide, and that if they feel that they want to hurt themselves again, they won't do anything until they can contact either you, or someone else that can support them. Take them seriously, and refer them to someone equipped to help them most effectively, such as a Doctor, Community Health Center, Counselor, Psychologist, Social Worker, Youth Worker, Minister, etc.

Don't try to "rescue" them or to take their responsibilities on board yourself, or be a hero and try to handle the situation on your own. You can be the most help by referring them to someone

equipped to offer them the help they need, while you continue to support them and remember that what happens is ultimately their responsibility. Get yourself some support too, as you try to get support for them; don't try to save the world on your own should- ers.

If you don't know where to turn, chances are there are a number of 24 Hour anonymous telephone counseling or suicide prevention services in your area that you can call, listed in your local telephone directory.

Never! The act of patient listening does a lot for the talker. Counseling is not a magic cure-all. It will be effective only if it empowers a person to build the sort of relationships they need for long-term support and problem solving. It is not a "solu- tions" in itself, but it can be a vital, effective and helpful step along the way.

While it's not a long-term solution in itself, asking a person and having them talk about how they feel greatly reduces their sense of isolation and distress, which in turn significantly reduces the immediate risk of suicide.

People that do care need to set aside their usual reluctance to be direct in talking about suicide because it's something of a taboo subject.

In the medium and longer term, it's important to seek assistance to resolve the distressing problems as soon as possible. Previ- ous victims of self injury behavior are more likely to attempt suicide again, so it's very important to get unresolved issues sorted out with professional counseling.

Some issues may never be completely resolved by counseling, but any counselor is able to assist a person in dealing with their distress constructively.

Different services vary in what they offer, but in general you can ring up and speak anonymously to a counselor about any sort of problem in a no-pressure context that's less threatening than a face-to-face session. Talking the situation over with a caring, independent person can be of great assistance whether you're in a crisis yourself, or worried about someone else who is, and they usually have connections with local services to refer you on to further help if required. You don't have to wait until the deepest point of crisis or until you have a life- threatening problem before you seek help.

Demand for telephone services vary, so the most important thing to remember is that if you can't get through on one, keep trying several until you do. You should usually get through straight away, but don't give up or pin your life on it. Many people that feel suicidal don't realize that help can be so close, or don't think to call at the time because their distress is so overwhelming.

With the availability of the internet and Email, it is possible to contact suicide prevention services, all over the world by simply "clicking" on the web page address of one you prefer. You can obtain an almost infinite list by doing a search for "sui- cide". There are also psychotherapeutic email services that can be contacted for assistance whenever needed, by doing a search for "psychotherapy" or "counseling".

It's quite likely that some people that read this will one day attempt suicide, so here's a quick suicide prevention exercise: think of a list of 5 people who you might talk to if you had no one else to turn to, starting with the most preferred person at the top of the list. Form a "no-suicide contract" with yourself promising that if you ever feel suicidal you will go to each of the people on this list in turn and simply tell them how you feel; and that if someone didn't listen, you'd just keep going until you found someone that would. Many suicide attempters are so distressed that they can't see anywhere to turn in the midst of a crisis, so having thought beforehand of several people to approach would help.

Suicide is often extremely traumatic for the friends and family members that remain (the survivors), even though people that attempt suicide often think that no-one cares about them. In addition to the feelings of grief normally associated with a person's death, there may be guilt, anger, resentment, remorse, confusion and great distress over unresolved issues. The stigma surrounding suicide can make it extremely difficult for survivors to deal with their grief and can cause them also to feel terribly isolated.

Survivors of someone else suicide often find that people relate differently to them after the death, and may be very reluctant to talk about what has happened because they are not sure of how to address the issues following the death of a friend. They often feel like a failure because someone they cared so much about has chosen to die, and may also be fearful of forming any new rela- tionships because of the intense pain they have experienced through the relationship with the person who has completed sui- cide.

People who have experienced the suicide of someone they cared

deeply about can benefit from "survivor groups", where they can relate to people who have been through a similar experience, and know they will be accepted without being judged or condemned.

On the internet, support groups exist for every imaginable topic and while you may not find addressed to suicide, you can find ones addressed to depression, grief, guilt, etc in which suicide is a more readily available topic.

Whether it is legal or not makes no difference to someone who is in such distress that they are trying to kill themselves. You can't legislate against emotional pain so making it illegal doesn't stop people in distress from feeling suicidal. As a helper your good Samaritan offices are perfectly proper and cannot be held against you as abetting a suicidal victim.

Each of us is responsible for our own actions and life choices. In a sense then, an individual may have the right to do as they wish with their life, including to end it if they so desire. Western societies in particular tend to emphasize individual rights over communal rights and responsibilities. However in fairness to yourself, you are not ready to die until you have taken care of last things; making arrangements for your body, your property, giving valued items to people you love, saying goodbye to them and most of all writing a blessing to the people who will be most affected by your death. These last things will do a lot to fulfill your obligations to everyone including your- self. If you then wish to kill yourself, you will have earned the privilege.

However, every person exists as part of a larger network of relationships of various types which set the context in which an individual's rights and responsibilities exist. People who feel lonely, isolated, distressed and hopeless about their future can find it extremely difficult to recognize supportive relationships which may exist around them. This often causes them to grossly underestimate both the degree of support which could be gained from those around them, and the impact that their suicide would have should they complete it.

Footnotes:

1. "Hearing the cry: Suicide Prevention", Appleby and Condonis, 1990. ISBN 0-646-02395-0
   
2. Copyright 1994, 1995, 1996 by Graham Stoney
3. The FAQ as presented here has been modified by Fred Cutter,Ph.D. on March 31, 2001, and is subject to the same copy right provisions as noted above. This article may be freely redistributed provided that this copyright message remains intact. Any other form of commercial distribution requires explicit permission from the author. mailto:Fred Cutter,Ph.D.