Suicide Prevention

The death of Robin Williams has led to a lot of discussion among my friends on FaceBook.  One of the things that has got a lot of discussion is the topic of suicide and suicide prevention.

First, let me say that I am not a trained counselor or suicide prevention specialist.  We had some instruction on that back when I was in the Air Force and my own experiences may give me some insight but that's all I have to offer.  Perhaps for someone it will be enough.

A number of people have expressed some anger from the aspect of "think of how you're hurting the people left behind."  Well, from my experience, from "suicide prevention" materials I studied in the AF, and from people I've talked to, a person who's suicidal can generally go one of two ways. In one, they just don't believe that anyone cares, or that people would be better off, that their death would be a relief to the folk they leave behind. The other direction is that, yes, they know they'll hurt people. But they're still suicidal so now they feel guilty about the pain their death would cause, which makes them feel worse, which makes them more suicidal, which makes them feel more guilty, which....

In neither case does "think about the people you leave behind" serve as a useful approach to take.

Suicidal people do think about the people they're leaving behind, and the thought makes their feelings of depression worse. They are mistaken. On an objective level what they're thinking is wrong. But their thought processes are messed up by the same issues that cause the depression in the first place.

Now sometimes, "think about the people who care about you" can help but you do need to remember that both of the above are very common reactions. Does that mean that there's no way out? Of course not. A lot of it depends on how far one has gone down the path before intervention. I'm just pointing out one of the elements of depression is ones perceptions and emotional reactions are all screwed up. "Think about the people you'd be leaving behind" is generally not a good approach for a person who is deeply depressed and suicidal and is quite likely to make the matter worse.

One of the problems, and one of the defining points of going from "depression" to "suicidal" is the belief that it won't pass, that you will never be happy, or anything other than miserable, ever again. You might "know" on an intellectual level that it's bogus, that it will pass, but you feel, down inside, that it's forever, that you don't even have one happy day ahead of you. You might know better, but you don't believe it.

That doesn't mean that there aren't approaches that do help. Probably the simplest, and surprisingly quite effective is to just be there, be stubborn about leaving (frequently a depressed person will try to drive you away, thinking in their depression that they're doing you a favor by doing so, that they're not "worthy" of having friends or family around). and let them talk about whatever.

And sometimes, it means medication either temporarily to get out of the current cycle or possibly permanently. When I had my bad episode the first doctor to prescribe antidepressants for me said that because of the severity of my depression I'd probably be on medication as a prophylactic measure for the rest of my life. As it happened I found something better, far better, than medication (since the medications that worked for me had certain side effects that negatively impacted "quality of life" and also put some extra stress on my marriage--you can make your own guesses; I'm not going to say more here). I found that for me (not saying it would work for everyone, or even anyone, else) that getting involved in "outdoorsy" activities like hunting and fishing (hiking, less so), cleared things up in a way that none of the medications ever did.

But the combination of medication and counseling got me out of that very bad period. And the thing that my friends and family did that helped the most was get me into that counseling and to a doctor for the medication.

And, yes, I know that the two paths I described before are not "either/or". It's also "and" because I managed to feel both of them at once, mutually contradictory or not. (I did mention that depression screws up your thinking, right?)

Another thing that isn't very helpful is to ask a person why they're depressed.

When you try to answer that question, your "reasons" sound silly to yourself. And so you feel bad for being depressed over such "trivia". This results in feeling even worse.

That's one of the problems. Everything is so backwards from what a non-clinically-depressed person thinks.

However, the ones who really deserve a bitch-slap are the ones who sneer at "suicide attempts" and "depression" as a "ploy" for attention. While that might happen sometimes, the "cry for help" is generally not a "ploy". If they're crying for help via the means of doing something potentially lethal to themselves (unlike, say that scene near the beginning of Earthquake where Liz Taylor's character dumped a bunch of sleeping pills in the toilet and pretended to have taken an overdose).

If they're going that far, then that "cry for help" is because they really need help.

Even a half-ass suicide attempt which is highly unlikely to work means a person really needs help. Really.

For that matter, even a faked suicide attempt is a pretty serious cry for help, and may well be a first step toward something more serious.