I’ve been praying and thinking and praying some more and overthinking a little bit more about writing on this subject, because it is so incredibly heavy and carries so much trauma and emotion and tragedy with it. Our community has just lost someone to suicide, and everyone is still raw and reeling. The subject of suicide is incredibly sensitive and complex, and because of this I want to be as intentional as possible with the words that I use. I want to bring honor to the lives lost to suicide, comfort to the survivors, and hopefully some education to those who are struggling with knowing how to deal with and talk about such an intense subject.
Here’s the paradox: Suicide is one of the most difficult subjects to talk about because suicide isn’t talked about. When do we hear about suicide? When someone has died by suicide. And that’s about it. We don’t talk about feeling suicidal. We don’t talk about the difference between a suicide attempt, a suicide threat, and suicidal ideation. We don’t talk about passive vs. active suicidal ideation. We don’t talk about when we’re struggling with whether we want to live or not, or how rampant suicide is in our culture. We don’t talk about the variety of reasons that a lot of people attempt and lose their lives to suicide (it’s not always depression). We don’t talk about how we should respond when someone loses a loved one to suicide. We don’t talk about how to ask a friend if they are suicidal. We don’t talk about what to do if that friend is suicidal. We’re worried that if we bring up suicide, it will give someone the idea of attempting suicide. We don’t know how to talk about it; therefore, we just don’t talk about it. But maybe we should. Maybe it’s time we talk about suicide.
First, Some Stats
- Suicide is the 10th leading cause of death in the United States.
- Suicide was the second leading cause of death among individuals between the ages of 10 and 34, and the fourth leading cause of death among individuals between the ages of 35 and 54 in 2016.
- Every day, approximately 123 Americans die by suicide.
- Over 47,000 Americans died by suicide in 2017, but there were over 1,400,000 attempts.
- The rate of suicide is highest in middle-aged white men. Males are over 3x more likely to die by suicide than females, and white males accounted for 77.97% of suicide deaths in 2017.
- Lesbian, gay, and bisexual children and adolescents are 3x more likely than heterosexual children and adolescents to attempt suicide at some point in their lives.
- More women attempt suicide than men, but more men die by suicide than women. This is mostly because the means in which men usually attempt suicide is often more violent (and many times involve firearms.)
Next, Some Definitions
To help us understand the subject of suicide, we need to familiarize ourselves with the terminology. The National Institute of Mental Health put together the following definitions:
- Suicide is defined as death caused by self-directed injurious behavior with intent to die as a result of the behavior.
- A suicide attempt is a non-fatal, self-directed, potentially injurious behavior with intent to die as a result of the behavior. A suicide attempt might not result in injury.
- Suicidal ideation refers to thinking about, considering, or planning suicide.
I’d also like to add that there is a difference between having passive suicidal thoughts and being actively suicidal. Having passive suicidal thoughts means you may wish to die or wish you could go to sleep and not wake up, but you don’t have an active plan or intent to die by suicide. Being actively suicidal or having active suicidal ideation (or thoughts) means that you have (or are working toward) a plan, intent, and the means to carry out your plan to die by suicide.
Risks and Warning Signs
We learn a lot of facts through statistics, but they don’t exactly help us navigate the very raw reality of either coping with losing someone to suicide, knowing and helping someone who is suicidal, or feeling suicidal yourself.
First, lets discuss risk factors. NAMI has done an excellent job putting together a list of risk factors. They state, “Research has found that about 90% of individuals who die by suicide experience mental illness. Oftentimes it is undiagnosed or untreated. Experiencing a mental illness is the number one risk factor for suicide.”
A number of things may put a person at risk of suicide:
- Substance abuse, which can cause mental highs and lows that exacerbate suicidal thought.
- Intoxication (more than one in three people who die from suicide are found to be intoxicated)
- Access to firearms (the majority of completed suicides involve the use of a firearm)
- Chronic medical illness
- Gender (as previously stated, though more women than men attempt suicide, men are 4 times more likely to die by suicide)
- History of trauma
- Age (people under age 24 or above age 65 are at a higher risk for suicide)
- Recent tragedy or loss
These aren’t all of the risks, but absolutely make an individual more susceptible to suicide.
Now, let’s talk about warning signs. Warning signs are red flags that often come before a suicide attempt. Save.org has put together a good list of warning sings:
- Talking (even jokingly) about wanting to die or killing oneself
- Talking about feeling hopeless or having no purpose
- Talking about feeling trapped or being in unbearable pain
- Talking about being a burden to others
- Acting anxious, agitated, or reckless
- Sleeping too little or too much
- Withdrawing or feeling isolated
- Showing rage or talking about seeking revenge
- Displaying extreme mood swings
A couple of other warning signs that I have noted in my personal experience as a therapist have been
- Recent purchase of firearms
- A sudden positive mood (some people experience an almost euphoric high once they have made the decision to take their own life)
- Giving items away
- Recent attempts to call/contact those they are close to in order to “say goodbye” (without actually saying goodbye.)
How to Ask
So, you know someone with the risks. You’ve noticed some warning signs. What comes next?
You ask them if they are suicidal. It’s that simple.
“Do you want to die?”
“Are you thinking about killing yourself?”
“Are you suicidal?”
I learned a lot about suicide through my education, but it was such a small amount compared to the trainings and real-life experience I gained as a therapist. One of the main things that I learned is that we cannot be afraid to ask someone if they are suicidal. We simply can’t. It can mean the difference between life and death. I know we shy away from that kind of language, but asking directly is the only way we can ask. We can’t say, “Are you thinking about doing something stupid?” We can’t ask, “Do you want to hurt yourself?” We need to ask our loved ones in such a way that they can’t avoid answering. It’s so important, you guys.
What Happens Next
What if they say yes? What if they tell you they are suicidal? What do you do?
- First, don’t panic. They may be suicidal, but they’re not a grenade. Sit with them. Do not leave them alone. Tell them you’re not going to leave them alone.
- If you live in Georgia, call the Georgia Crisis and Access Line (GCAL) at 1-800-715-4225. GCAL is available 24 hours a day, 7 days a week and 365 days a year to help you or someone you care for in a crisis.
- If you’re not in Georgia, you can call the National Suicide Prevention Hotline at 1-800-273-8255 or go to their website and chat with a representative.
- You can also text HOME to 741741 if you’d rather text.
- Make sure they do not have access to anything they can use as a weapon against themselves (guns, knives, medication, etc.).
- Again, DON’T LEAVE THEM ALONE. Stay with them until a mental health professional tells you otherwise.
- Talk to them. Let them feel heard. Isolation is one of the worst things for mental health disorders – let them know they aren’t alone.
Surviving a Death by Suicide
If you have lost someone to suicide and you’ve read this far, I know that the previous sections were probably near-impossible to read. There is such a hurricane of emotions that we feel when we lose someone to suicide, and one of the most prominent is guilt. I know you’re going back again and again and again in your mind, thinking of all the ways you could have prevented what happened. I know you’re picturing their face when reading about the risk factors and the warning signs. I know you’re berating yourself and replaying the days and weeks before over and over, thinking of all the things that could have been said or unsaid or done or undone to change what happened.
And let me tell you that this is absolutely normal. But let me also tell you that nothing, nothing, nothing you said or didn’t say or did or didn’t do caused your loved one to make the decision to end their life. We want so badly to be in control of our circumstances, but the truth is that we cannot control anything or anyone except for ourselves, our feelings, and our behaviors.
This also applies to blame. Blaming others for someone’s suicide is also absolutely normal. We don’t know how to cope with such an indescribable, incomprehensible loss. We always want to know why. And the least painful way to experience the emotions of such a loss is to attribute the suicide to the words or actions of someone else. It’s so human and so normal to deal with suicide this way. Please know this – whether you are the one blaming or you are the one being blamed. Everyone is hurting, and pain is only understood if there is a meaning behind it. We feel that there has to be a reason for the pain. We feel that there has to be a cause. This is how we understand the world. The truth is that we are all just doing our best to survive the loss of someone who chose the opposite of survival.
Our primary, most natural and primal instinct is to survive. It’s so deeply ingrained in us that it drives literally everything we do. It’s impossible to grasp the reality of someone struggling so incredibly much that they choose to go against everything that every portion of their brain is telling them to do. If you’ve never experienced suicidal ideation, you must understand that you will never truly understand this mindset. It will always be an abstract concept, and that’s okay. We don’t have to experience something to show compassion and empathy.
So many times when someone we know loses someone, we just don’t know what to say. We use cliché phrases like
They’re in a better place now.
I guess God needed them more than we did.
God never gives us more than we can handle.
We mean well, but these phrases just aren’t helpful. We often become even less helpful if we know a person who has lost someone to suicide. We don’t know what to say – or worse – we say stupid things that can make the grieving process worse.
So how do we comfort someone who has lost someone to suicide? First, we have to know that not much that we say is going to take their pain away. We don’t have some magic combination of words that is going to give them peace and healing. They may want kind words, they may want silence, they may want a hug, they may want to be left alone, they may need our presence, they may want our absence. Everyone is different and grieves differently. It’s okay to ask them what they need. But we have to be respectful of their wishes. They may not grieve like us, but they are grieving just the same.
One of the main things that I have found that those grieving loved ones have in common is the need for that loved one to not be forgotten.
Say their name.
Let’s talk about the things they’ve taught us, the good times we had with them, what we miss about them, what we’ll never forget about them. Let’s talk about their funny laugh or the time that they helped us through a tough time. Let’s talk about the way they spoke of those they loved and their favorite things.
Let’s not treat their memory as something that is taboo or delicate. Let’s speak of them, and often. That’s how their memory stays alive.
To Those Experiencing Suicidal Ideation
I see you. I know it feels like things will never change. I know you feel like a burden to those you love. I know you feel like the pain will never end and that you would rather die than live another day of this death. Please understand that you are viewing life from under the waves. This isn’t how it will always be, but it feels so real and so eternal right now. Maybe you can see the surface, see the sky and the sun above you, but you are holding your breath and trying to swim your way to the top. Maybe you’re tempted to just stop swimming and let the current take you.
Or maybe you’ve already been taken, and you’re so deep under that you can no longer tell which way is up. Everything is dark and you have no idea where the surface is. You can’t see the sun and your heart is seconds away from exploding from the pressure of the water and from holding your breath for so long.
If you are in the first group, you may be able to swim yourself to the top, but it will be so much faster and easier if you accept the hands that are reaching down into the water to grab you and pull you up. Those hands may be a therapist, or friends, or family, or community, or church… Whatever they are, grab them. Allow yourself to be pulled up. Allow yourself to be saved.
If you are in the second group, some more intensive action needs to be taken. You can no longer swim to the surface, as you’re not even sure where the surface is. When you’re seconds away from drowning, the only thing that will save you is an oxygen tank. Please allow someone else to put the mask on for you. Please call someone you trust to help you. Call the crisis hotline (1-800-715-4225 if you’re in GA, 1-800-273-8255 for national calls) or text HOME to 741741. Drive to a mental health crisis center near you. Better yet, call someone else to drive you. Entrust your survival to people who are trained to save those who are drowning. There is no shame in this. There is no shame in living, in surviving. You are needed here. The world needs you here. You are not a burden. You are so, so loved.
Let’s Talk About It
The rates of suicide aren’t going to change unless we quit ignoring it. We have to talk about it, and not only after the tragic loss of someone we know to suicide. It’s time to end the stigma surrounding suicide. Talking about suicide doesn’t lead to suicide. We can’t sweep it under the rug. We can’t pretend that we’re above it, or that it doesn’t affect us. We have to have hard conversations. Let’s talk about it.
If you or someone you know is in an emergency, call The National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or call 911 immediately.