SUICIDE

Let’s begin this discussion with a definition of Suicide:

"A conscious act of self-induced annihilation, best understood as a multidimensional malaise in a needful individual who defines an issue for which the act is perceived as the best solution."

SUICIDE CRISIS

A suicide crisis is a time limited occurrence that signals immediate danger that suicide may be imminent.

Signs of a Suicide crisis often include the following;

1. A precipitating event which can include suicide of a loved one, death of a loved one, diagnosis of a serious illness, loss of health, divorce or separation, loss of employment, retirement, financial difficulties, legal problems or arrest, victims of crime or sexual abuse, witness of violence, poor grades in school to name a few.

2. Intense affective states such as deep depression, acute sense of abandonment or loneliness.

3. Changes in behavior, such as someone who has been deeply depressed for several months all of the sudden are now happy. They may have just reconciled themselves to the completion of a suicide. Sometimes a person who has decided to complete a suicide will say things like; I just purchased a gun, I am going away, etc. Many times they will have all of their affairs in order and are suddenly very organized and have all of their papers in order. Sometimes they will seem more impulsive or withdrawn so you need to watch for these kinds of behavior.

Persons seriously contemplating suicide usually are experiencing at least the following;

a) Unrelenting low mood, clinical depression, a sense of hopelessness or desperation.

b) Sleep problems

c) Making a plan to complete the suicide act.

d) Giving away prized possessions.

e) The emotional crisis that usually precedes a suicide is often recognizable and treatable.

Suicide typically follows a continuum of behavior such as the following;

1. Ideation – like standing on the shore of the suicide “lake of despair.”
2. Gesture – now off the shore and standing in the water of despair.
3. Attempt – They actually jumped into the water and now want to die.
4. Completion - In counseling when a person has actually killed themselves, we refer to it as “completion.”

PREDICTORS OF SUICIDAL BEHAVIOR

Many times a person who is going to make an attempt at completing suicide will formulate a specific plan to do it. One of the matters to be considered if you are attempting to intervene is to determine how specific the plan is. The best way to determine this is to simply ask the person making the plan how they are going to accomplish it. This is not a time to be a shrinking violet and if you can not come to terms with asking probing questions then get some help!

Another inquiry should be the availability of the means to the person making the plan of the means to accomplish the completion of the act. If for example the planning person says he or she is going to overdose on drugs, do they already have drugs in their possession or can they easily lay hands on them.

Consider the method of completion they have told you about and try to determine if the plan once began really be lethal. It would be difficult to bleed to death by cutting the back of their hand and if he or she is going for the wrist they would have to go fairly deep to cause that severe of an injury, especially if there are others around when the attempt is made.

A caregiver also needs to determine if there have been other attempts and some details about those. The victim will usually be more than willing to share that information if asked.

A determination also needs to be made of any resources that are available to the victim such as firearms, poisons and so forth.

INTERVENTION

This leads us into a discussion of the caregiver, friend or relative making an attempt at intervening with the suicide contemplation before the victim is able to complete it.

One should usually begin with asking questions of the intended victim.

One of the most important is to ask,”Have you been thinking of hurting or killing yourself?”

“When did you last think seriously about completing suicide?’

“Do you have the means available? Have you ever attempted suicide before?”

“Has anyone in your family ever completed suicide?”

What are the odds that you will leave and kill yourself when no one is around?”

“What has been keeping you alive so far?” This is an important question to ask because it explores the future and may lead to talking the victim to seek professional help.

WHAT TO DO NOW

First of all, don’t panic or overreact to the situation which I realize is a difficult thing to do if you are not experienced in suicide intervention but it is important and may mean the difference to the victim.

Remain with them, under no circumstances leave them alone and again, try to remain calm.

Try to help them to reframe their thoughts which normally involve restating the underlying problem they have hopefully related to you.

Try to emphasize the temporary nature of their problem and that it will pass.

Be sure to keep yourself sage remembering that suicidal people are not usually very rational and may want to take you down with them. Depressed suicidal people will often try to drag you down with them; again realize that they are not in a rational state.

Try to explore alternative resources such as their friends, relatives, the police if needed or their spiritual leader.

WHAT NOT TO DO

One of the big thins not to do is to start lecturing or arguing the situation. This is usually very counterproductive and may push the victim over the edge.

Again, it is important not to overlook the signs outlined above.

Do not express a visible sense of shock although that is frequently hard to hide if you are. Although signs of shock are normal for those who have not been in this kind of intervention situation before it can be interpreted as condemnation which may further exasperate the situation.

Do not offer empty promises such as “. . . you will be just fine in the morning” because they probably will not be and they will remember the hollow promise. On the other hand do not be overly “cheery” as this is almost as bad. It would probably give somewhat of a circus atmosphere to the situation.

Under not circumstances should you engage in a diatribe of the immorality of suicide or the scriptural references you may feel relevant. I can assure you that a victim at this stage will view the attempt much differently than you intend and it will likely make matters worse.

Once again, DO NOT LEAVE THEM ALONE or assume that they will get better on their own in time. Again, do not remain the ONLY person helping here!

SURVIVORS

There are some reactions to a completed suicide that many survivors share in common.

With that having been spelled out, I want to discuss a few typical survivor reactions that present after a person completes an act of suicide:

There is a natural focus in the early months after the completion of a suicide act that attempts to control the impact of the sudden death.

There is usually an overwhelming need to make sense of the death which impacts people more than anything else. Survivors tend to want to find answers to questions such as why, what could “I” have done differently to prevent this tragedy.

The survivors usually also experience a marked social uneasiness due to the stigma associated with the suicide. Most of the condemnation people experience is societal and is usually masked under innuendo of abnormality and avoidance of the survivors when they need understanding the most.

Myths And Facts About Suicide

Many believe that a person who has been suicidal once will be suicidal the rest of their life and that simply is not true.

Some believe that people who may be suicidal actually intend to die but experience and research has demonstrated that frequently it is only a cry for help, but not always. It is always best to take any suspicion of suicide seriously. Others believe that all people who complete suicide leave a note but frequently and this is not always the case.

Many times a suicidal person has made up his or her mind to complete the act and have come to terms with the decision, resulting in an improvement in his or her mood prior to committing the act.

As a final note here, it is interesting to note that from national statistics approximately 30% of depression inpatients in mental institutions have attempted suicide. About 90% of people who commit suicide have diagnosable mental illness and depression. Bi-polar disease is one of the mental illnesses that rank high on those who have completed suicide.