Can we identify people who are at high risk for ending their own lives and get them the help they need? The answer is Yes. We can. It is now possible to more accurately spot these individuals and effectively intervene than it has ever been. This hopeful answer is especially important today in the wake of an increase in suicide.
In fact, last week the U.S. Centers for Disease Control and Prevention reported a gradual climb in the suicide rate and in calls to suicide hot lines during the recession years of 2007-2008. There is a popular misconception that a single event -- in this case the recession -- is usually responsible for driving a person to kill him/herself. However, it is certainly true that one triggering event, such as losing one's job or home, may well be "the straw that breaks the camel's back" in a person's lifelong struggle against destructive ways of thinking and ineffective ways of coping with stress. "Myth-busting" is vital to suicide prevention because unfortunately issues of suicide and mental illness are still stigmatized in our society, which has led to the spreading of considerable misinformation about these topics.
A related article in the Wall Street Journal cited the CDC findings and at the same time, called attention to an important key to preventing suicide: "About 90% of those who kill themselves have a mental health disorder, most often depression or substance abuse." This figure has been validated by researchers who have also reported another interesting statistic: only a small number, about 8 percent, of depressed or mood disordered people commit suicide. This leaves approximately 92 percent of depressed individuals who probably will not die by their own hand. In other words, most depressed or substance abusing people do not end up killing themselves.
But what distinguishes the relatively small number of depressed or mood-disordered individuals who will probably kill themselves from those who will probably not? How can we identify the people who are the most likely to end their lives? In our research, we found that among a group of depressed and normal individuals, those who made serious suicide attempts thought differently from those who had never tried to kill themselves. These men and women reported experiencing specific ways of thinking about themselves, others and the world that could be easily distinguished from the way non-suicide attempters were thinking. Therefore, it is extremely important to understand what is going on in the mind of a person who is contemplating suicide.
On a self-report questionnaire, The Firestone Assessment of Self-Destructive Thoughts (FAST), the people who had made previous suicide attempts endorsed negative thoughts or "critical inner voices" that told them they were a burden to their family and friends. "You'd be doing your family a favor if you killed yourself." (This has been labeled "perceived burdensomeness" by researcher Thomas Joiner.)
Suicidal people tend to endorse thoughts on the questionnaire about being alienated from others, "You don't fit in. You don't belong. You just don't matter." (This has been labeled "thwarted belongingness.") In addition, because of past traumatic experiences, many of these people have acquired an ability to dissociate, that is, to cut off their feelings and bodily sensations, including feelings of physical pain. This makes it possible for them to carry out acts of physical violence against themselves. Their loss of feeling is reflected in cold, rational thinking that prevails in the weeks and days leading up to the ultimate act. "How are you going to do it?" "Well, you have to get hold of pills. You have to buy a gun." "You have to be careful. Don't let anyone know what you're planning to do." At the very end, shortly before taking action, the person tends to experience thoughts baiting him or her to "Go on and do it, you coward. You'd better do it. It's the only thing you can do."
How can we recognize when someone we know is thinking in these ways? Are there any other signs that we might be able to observe in friends and family members? Yes, there are definite red flags, including the following: having trouble sleeping; isolation, withdrawal from friends, family or social activities; loss of interest in hobbies, work, school and in one's personal appearance; giving away possessions; making out a will; experiencing a recent personal loss; taking unnecessary risks; and talking about suicide.
Contrary to another popular myth, people who talk about suicide often do go on to kill themselves -- they are not simply trying to get attention. We should take their communications seriously. Frequently, the suicidal person will talk about wanting to kill him or herself or allude to "not being around any more," yet when someone shows concern, he or she may quickly deny that he or she is in distress. This back-and-forth behavior speaks to the ambivalence in suicidal people; a part of them wants to die, but the other part wants to live.
What can we do to help someone who is in the midst of a suicidal crisis and put them in touch with the help they need? The documentary film Understanding and Preventing Suicide provides several guidelines: First, engage the person at risk in a personal way by paying close attention and making the person feel accepted. Convey your feelings of empathy and try to see things from the person's perspective. Second, ask if the person is thinking about suicide; don't be afraid to be direct, yet also be sensitive. Your attitude will give the person permission to talk about suicidal thoughts or plans. Third, ask if the person has a plan, the time frame, and the means, how is he or she going to carry out the plan? Fourth, develop an action plan with the person to get him or her to professional help, that is, arranging a meeting with a counselor or psychotherapist, and accompany him or her there.
This is your only task, to deliver your friend or family member to a person who is qualified to give him the treatment he needs. You can also make arrangements for emergency support if the steps of your plan for action cannot be carried out. For example, have the person or his or her significant other call the local or national suicide hotline 1-800-273-TALK you can also download the brochure "Help Us Save Lives."
On a simple, everyday level, each of us can reach out and act kindly toward everyone we meet. We can smile at people; we can take the time to talk to someone who looks distressed, ask them what's wrong, and we can engage our returning military personnel in friendly conversation.
I am reminded of a man in one of our films who miraculously survived jumping from the Golden Gate Bridge. In the film, he describes his last hours before jumping: "Then I heard voices; it was on the bus, 'You must die. You must die'. I began to cry softly in the back of the bus. I began to think, if one person comes up to me and says, 'Are you OK?' or asks if anything's wrong, I'll tell them everything ... I was on the span for over 40 minutes, but no one asked. So I thought 'No one cares, It's time to go.' And I jumped."
As I said earlier, we need to understand that most suicidal individuals, like the man on the bridge, are ambivalent; they are powerfully divided between wanting to live and wanting to die up until the last moment. So it is worthwhile for us to make an effort because many of these people are just waiting to be stopped, they are waiting to be interrupted, they are waiting to be helped. Go ahead and smile at somebody, it doesn't take a lot, it doesn't cost you anything. It could possibly save a life.
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