Learning to Listen

Suicide

People usually attempt suicide to block unbearable emotional pain, which is caused by a wide variety of problems.  It is often a cry for help.  Most suicidal people give warning signs in the hope that they will be rescued, because they are intent on stopping their emotional pain, not on dying.

Signs and Symptoms

The signs and symptoms of suicide are similar to those of depression.  They may also include:

Low self-esteem is a common factor.

In teenagers, additional symptoms include:

Often these symptoms are ways of coping with physical, hormonal and social changes because the teen lacks the verbal skills to express emotions and finds their problem minimized by adults.  Such behaviour can have lifelong consequences (pregnancy, jail, dropping out of school) which result from truancy from school and/or sexual promiscuity.

A person displaying these signs usually wants help and needs your attention and understanding.  If their problems seem too overwhelming, suicide may begin to be seen as the only way out.  Suicide is a permanent solution to a temporary problem.

The triggering event usually involves a significant degree of loss of some sort.  Feelings become extremely intense, incomparable to any other experience.  Both high and low achievers can be affected.  Depending upon each individual, risk factors may include:

Significant changes in relationships, well-being of self or family members, body image, job, school, university, house, locality, financial situation, or world environment.


Significant losses including death of a loved one, loss of self-esteem, loss of a valued relationship, loss of employment, or personal expectations.


Real/perceived abuse including physical, emotional, psychological, sexual, social or neglect.

Suicide is the second leading cause of death for people aged 15 to 24, surpassed only by accidents. More than10% of high school students have undertaken at least one non-fatal suicide behaviour.  Gay or lesbian youth are six times more likely to try to kill themselves than heterosexuals.

Friends and relatives may be deceived by the casual way (“I wish I could just jump out a window”) that profoundly depressed people speak of suicide or self-mutilation.  They are not casual because they “don’t really mean it”, they are casual because these things seem no worse than the mental pain they are already suffering.  A formulated plan (“I’m going to jump in front of the next car that comes by”) should be taken as an immediate medical emergency which may require hospitalization.

Prevention

Attempts at suicide, and suicidal thoughts or feelings, are usually a symptom indicating that a person isn’t coping.  This is often as a result of some event, or series of events, that they personally find overwhelmingly traumatic or distressing.

Individuals who want to kill themselves are not suicidal forever.  With proper help, the hopelessness dis-appears and the individual can begin to cope effectively again.  You can help by recognizing the warning signs and getting them help quickly.  Reassure your friend that you want to help them, but suggest that you need to involve some mental health professionals in order to ensure their safety.

In many cases, the events in question will pass, their impact  can  be  softened, or   their  overwhelming nature willgradually fade if the person is able to make constructive choices about dealing with the crisis when it is at its worst.

Be aware that an improvement in mood after depression can signal that the decision to commit suicide has been made.

Intervention

A person attempting suicide is often so distressed that they are unable to see that they have other options.  We can help prevent a tragedy by trying to understand how they feel and help them look for better choices that they could make.  Suicidal people often feel very isolated.  Because of their distress they may not think of anyone they can turn to, furthering this isolation.  If you are worried that your friend is in immediate danger do not leave them alone.  Take them with you to find help or stay with them and phone for help.  The more people you involve the better the chance of saving the individual from permanent harm.

If someone you know tells you that they are feeling 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”, i.e. ask them to promise you that they won’t commit 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, teacher, community health centre, counselor, psychologist, social worker,  youth worker,  minister, etc.  If  they appear  acutelysuicidal and won’t talk, you may need to get them to a hospital emergency department.

Suicidal people, like all of us, need love, under-standing and care.  People usually don’t ask “are you feeling so bad that you’re thinking about suicide?” directly.  Locking themselves away increases the isolation they feel and the likelihood they may attempt suicide.  Asking if they are feeling suicidal has the effect of giving them permission to feel the way they do, which reduces their isolation.  If they are feeling suicidal, they may see that someone else is beginning to understand how they feel.

Do not be afraid to ask direct questions like: “Are you thinking of killing yourself?”, “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 the pain you’re going through made you think about hurting yourself?”, “Have you ever felt like just throwing it all away?”  These clarify the situation for you and let your friend know that you are open to discussing the topic of suicide.

Never describe anyone as “crazy”.  This has strong negative connotations, probably isn’t helpful and is more likely to dissuade someone from seeking help which may be very beneficial, whether they have a diagnosable mental illness or not.  Ask your friend if they have ever tried killing themselves before, if they have a plan, and if they feel that they no longer have a support system.  If they say yes to two or more of these questions, they are at high risk of committing suicide.  Answering yes to one of these questions indicates medium risk, and no to all indicates low risk.

It’s also important to take the person’s 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 were in a situation where they were seriously considering killing themselves, in case they become suicidal at some point in the future, or they are suicidal but don’t initially feel comfortable about telling you.

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 shoulders.

Previous attempters are more likely to attempt suicide again, so it’s very important to get unresolved issues sorted out with professional help or counseling as necessary.  Some issues may never be completely resolved by counseling, but a good counselor should be able to help a person deal with them constructively at present, and to teach them better coping skills and better methods of dealing with problems which arise in the future.

Learning to Listen | Active Listening Skills
Depression | Postvention | Printable Version

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