Suicidal Thoughts

Nothing is as scary to parents, children, spouses, and loved ones as somebody they care about expressing suicidal thoughts, which is referred to as “suicidal ideation” by mental health professionals. The idea that this person we care about would choose death over life is frightening. We feel both responsible for that person’s well-being and terribly helpless. 

Answering the Question “Why?”

Some people are in such great pain or in such difficult circumstances that they feel that their lives aren’t worth living. Suicidal thoughts may be brought on by a major life transition, such as the death of a loved one, loss of a job, or the end of a relationship-situations that may leave people feeling overwhelmed, desperate, hurt, and helpless. 

Other people may be experiencing a steady decline in the quality of their lives, and may blame themselves and think that something is wrong with them. The more they blame themselves, the less worthy they feel of having success, having friends, or having fun. They perceive the future as hopeless. Others feel so buried under so many things that have gone wrong that they feel like they are drowning.

What are the warning signs?

There is no “typical suicidal person.” However, there are several behaviors that can indicate that a person is seriously considering suicide. These include:

• talking about committing suicide and preoccupation with death and dying
• trouble eating or sleeping and noticeable change in personal appearance
• loss of interest in work, school, or hobbies and withdrawal from social activities, friends, and family
• experiencing or expecting a significant personal loss (spouse or other)
• drastic change in behavior, often taking unnecessary risks as if they didn’t care what happened
• increased use of alcohol and drugs
• signs of preparing for death-making funeral arrangements or giving away prized possessions
• the most significant indicator is an expression of suicidal intent.

Any combination of these actions might alert both family and friends that a person is struggling with life and considering suicide as an option.

What can I do?

One of the most important things that you can do if someone you care about talks about suicide is to remain calm and listen to that person. Remember that people who are feeling suicidal isolate themselves, so reaching out to them is vital. They need you to encourage them to talk and then they need you to listen carefully. Other important things to keep in mind include:

• Talk openly and directly about suicide. Use the words “suicide”, “kill yourself”, and “dead” in a clear way.
• Be non-judgmental and accept the person’s feelings, even if you disagree with them. Don’t get into a debate as to why they should stay alive, or whether suicide is right or wrong; your arguments won’t help and the suicidal person might tune you out.
• Show your interest and support. Don’t let the person swear you to secrecy. It’s unfair of them to ask you to do so.
• As a person tells you that he or she is thinking about suicide, start thinking about people you can ask for help. You can do a lot to help the person initially, but the situation is too dangerous to handle entirely on your own. Your best source of help will ultimately be a mental health professional, most likely a therapist, who has the knowledge and training to give the suicidal person the assistance they need.

What is Therapy Like?

Initially, the therapist will talk with the suicidal person and listen carefully as he or she tells their story. A test may be done to determine how suicidal the person is. The person may also be asked to sign a “no suicide contract,” in which he or she promises not to commit suicide without first seeking help. If the therapist feels that the situation is too dangerous, the therapist may suggest short-term hospitalization to keep the suicidal person safe for the moment. 

The therapist will treat the suicidal person as a unique individual with unique problems. This can be accomplished in several ways-some therapists will see the individual alone, while others will see suicidal people in groups. Marriage and Family Therapists conduct therapy sessions with both the individual and his or her family. Because so many suicidal people isolate themselves, family therapy brings the family into the sessions to support the individual who is having problems. The family can also provide insight as to what pushed the person to consider suicide, and what might change in his or her life to make life better. Once the family understands the suicidal person’s story and feelings, they can help him or her from sliding back into isolation. The family will be asked to agree to work with the suicidal person in order to change the atmosphere of the family into one of hope and mutual encouragement. In this way, the person with suicidal thoughts, the therapist, and the family act as a team to improve the family relationships and, in the end, the life of the formerly suicidal person. 

Suicide in the Elderly

There is a special challenge in addressing suicide among the elderly where the annual suicide rate is higher than other age groups. Moreover, elder suicide may be significantly under-reported. Not counted are “silent suicides,” such as deaths from overdoses, self-starvation or dehydration, and “accidents.” Double suicides involving spouses or partners occur most frequently among the aged.

An obstacle faced by mental health professionals and other caregivers in reaching this group is that older adults do not usually seek treatment for mental health problems. As such, family and friends can play an important role in prevention. 

Characteristics of high risk are increasing age, being a white male, and being divorced. The strongest risk factor appears to be a major psychiatric disorder at the time of death, as major depression is very often associated with suicide in later life. Most elder suicide victims either live with relatives or are in regular contact with family or friends, and this implies that depression is more a factor than social isolation. Misuse of alcohol in combination with a psychiatric illness is also a risk. All of these factors can be further intensified by medical illness, family discord, financial trouble, physical disability, unrelieved pain, loss and grief. 

Problems with public notions of what is, and is not, acceptable with regard to suicide, and the belief that old age equals depression, contribute to the lack of appropriate treatment of suicidal behavior and disorders among the elderly. The family can contribute to the risk–or to the reduction–and treatment of suicidal older adults. 
A trained mental health practitioner, such as a family therapist, who is experienced with handling issues of the elderly, including depression and high risk for suicide, can offer services to help the suffering older adult, as well as assist the family as they cope with various issues surrounding the problem. 

Studies show that brief therapy can be very beneficial, and even more so when combined with medication for depressive disorders. Over 80% of geriatric patients in one study recovered from depression when treated with this approach.

Resources

• 1-800-SUICIDE: This service will connect you with a crisis center in your area.
• American Association of Suicidology: This organization of professionals who focus on suicide is the best single resource to both professionals and the public. It covers the entire gamut of information and referral sources on a wide variety of suicide issues.
• National Institute of Mental Health: Men & Depression