It has been a heavy week on Betty’s Battleground.
Last Wednesday I posted the letter I didn’t write when I attempted suicide on my birthday last year.
On Monday, I kicked off my guest post series “Tales From the Other Side” with a beautiful and heartbreaking letter written to the sister Connie Hulsart, from the blog Essentially Broken, lost to suicide.
I know, this blog has not been the easiest to read this past week. Nor the easiest to publish, believe me. But it is important to understand suicide. The mentality behind it, which I showcased in my letter; the complex effects and aftermath, which Connie demonstrated with grace and raw honesty in hers, and also how to recognize suicidal behaviors in others and what to do about it.
Suicide is very serious. It is the 10th leading cause of the death in the United States, and, according to the American Foundation for Suicide Prevention, there are twenty-five more attempts for every single completed suicide. And that’s just what’s reported. We have no way of quantifying the attempts, completed suicides, and ideations that occur unreported or unrecognized. According to the World Health Organization, over 800,000 people die from suicide each year. It is approximated that someone, somewhere on the planet, completes a suicide every 40 seconds.
Let that sink in.
Every 40 seconds. That means that in the time you have been reading this, at least one person has died by his own hand.
Suicide merits understanding.
I am not a psychological expert. I cannot replace the advice of professionals. But I have been there. Many, many times. My most serious attempt was in 2016, but it was not my first. Besides my other attempts, I have considered suicide on numerous occasions. I have spent years in a suicidal state, mostly due to my PTSD. I am going to wrap up what has become “Suicide Week” on Betty’s Battleground with a Suicide Survivor’s Guide to Recognizing Suicidal Behavior, and some suggestions on how to help. Some of these are research based; many are based on my experiences with being suicidal. As I said, I cannot replace the advice and opinion of a psychological expert. If you believe that you or someone you know is suicidal, it is a good idea to talk to a professional. You can also call the National Suicide Prevention Lifeline: 1-800-273-8255. In my opinion, it is always beneficial to combine the knowledge of experts with the knowledge of experience, so here is what I have learned from being suicidal:
The Suicide Survivor’s Guide to Recognizing Suicidal Behavior
or, What I Learned From Attempting Suicide
Clinical depression is the number one risk factor for suicidal behavior. Depressed people often think about suicide. Not all will act on those thoughts, but if you see that someone you love is exhibiting signs of depression, it’s a good idea to keep a close eye on him, and to suggest that he get professional help. Here are some symptoms of depression to watch out for:
- Changes in sleep habits, especially oversleeping
- Social isolation; depressed people will often stay indoors and avoid going out with friends
- Uncharacteristic lack of attention to personal grooming and hygiene; depressed people often feel too tired or down to care about personal appearances. They may even forgo showers or basic hygienic practices if the depression is severe.
- Physical slowing; depressed people sometimes move and talk very slowly. They may also mumble, sit with their head and shoulders hunched, and speak very quietly.
- Non-participation in previously pleasurable activities; people suffering from depression will withdraw from activities that they used to enjoy, finding them boring or characterizing them as a “waste of time” instead.
- Obsession with death; this is a big one to watch out for. If your loved one is talking about death a lot, then it may signal that her depression has deepened into suicidality. The talk does not have to be about her death to be of concern. It can just be about death in general, or people who she knows who have died. Pondering death is part of the human condition. If you’re close with someone, you may discuss death at some point. That’s normal. But a depressed person will bring up the subject often, and may persist even when others involved in the conversation no longer wish to continue.
There are other symptoms of depression, but these are the ones which, in my experience, are most noticeable to people on the outside.
So, now that you have recognized that someone you know is depressed; what can you do?
First, suggest that your loved one get professional help.
A lot of people have an aversion to seeking help for depression. It’s really helpful to reassure your loved one that his depression is not his fault. Open up about seeing a therapist yourself, if that’s your truth. Or, if you really can’t convince him to go to a “shrink,” depression treatment doesn’t have to look like pills and talk therapy. A mindfulness and fitness routine, like daily yoga, walks, and/or running, will help reboot his brain’s chemistry so that he begins to produce those pleasure chemicals which depression saps. If finances are not an issue, he can try alternative therapies like somatic therapy, or acupuncture. He can attend group sessions, if one-on-one therapy sounds too daunting; this will also help him to see that he is not alone. Whatever “help” looks like for your loved one, it is important to get him up and engaged in treatment.
Second, be a friend.
Severe depression can look scary. It is scary, but I cannot overemphasize the value of compassionate, non-judgmental friendship as a tool against depression. It makes a world of difference just to know that there is at least one person you can talk to, without having to pay to talk to them; one person who will genuinely listen and care about your pain. Occasionally, very depressed people become belligerent with their pain. They may say or do hurtful things. It is okay to tell your loved one that you will not accept abusive behavior. But, unless the behavior is so out of hand that it jeopardizes your own mental health, please don’t abandon her.
Third, make an effort to reach out on a daily basis.
There is a good chance that your loved on will withdraw. She may stop calling. She will probably stop hanging out. That doesn’t mean she doesn’t want affection. Even a text saying “Hey, I know you’re feeling down and I want you to know that I love you and I’m here for you,” is an enormous help. Even if she doesn’t respond, keep doing it. Every day. Set a reminder if you have to, but don’t stop. I guarantee you that whether she shows it outwardly or not, your loving vigilance is noticed and appreciated.
2. Feeling Better After a Depression
Yes, you read that right. Feeling better after a depressive episode is one of the biggest known risk factors for suicide. People who are in the midst of a depression are often too depressed to do anything about it. They are more likely to stay in bed curled into a ball for days contemplating suicide, than to actually go out and do it.
The period when the fog of depression begins to lift, and the person’s energy starts to return, is also the most dangerous. The human brain is, in essence, an organic machine. After behaving a certain way for a while, it becomes trained to behave that way. So, even though a person may be feeling better, his brain is now trained to think that self-harm and suicide are good options. And now he has the energy to complete the act.
This happened to me. Before my birthday I had been feeling depressed, but on my birthday, I woke up relatively happy and energetic. By the end of the day, I was in the hospital being treated for an intentional overdose.
By now you have probably heard that it takes 21 days to form a new habit. Actually that study showed that it takes a minimum of 21 days to form a new habit. So, use 21 days as a guideline, but keep an eye on your friend as long as he exhibits concerning symptoms. Concerning symptoms include:
- A sudden increase in energy after experiencing a depression
- Appearing calm or happy after seeming very down
- Sudden decrease or ceasation in talking about death after having been obsessed with it
- Reaching out to friends and loved ones after withdrawing; giving people a lot of compliments; making amends for past slights
- Giving things away: This is a huge one. If your loved one is giving away her valued possessions after experiencing a depression, she has not had a sudden conversion to minimalism. She is planning a suicide.
- Telling people that she is going to commit suicide: I know, this one seems obvious, but you would be amazed how many people ignore this major warning sign. If someone tells you that she is considering, or is planning to commit suicide, believe her. I can’t tell you how many times I simply announced that I was planning suicide, and most people ignored me, or reached out for half a day and then figured it was okay. She may only make the announcement once, and it might not be the day she does it.
Okay, so your friend is doing these things. What do you do?
First, tell someone.
This is a big deal. Don’t go around telling everyone, but find one or two people who you trust, and who you know care about this person as well. If you don’t know any of her other friends or family well enough to trust them, then choose someone who you know cares about you. This is for your support as much as hers.
Second, spend time with her.
Seriously, for those 21 days or so, hang around her. You might have to bug her or intrude upon her private time, but this is a matter of life and death. She’s unlikely to attempt suicide with people around, and if she does, she’s unlikely to succeed. Try to use that time to get her back into the healthy habits and activities she used to enjoy, or to start new ones. Now that she has energy again, this is a perfect time to start a fitness routine together. Exercise is an enormously helpful for combating depression. It boosts the production of “feel-good” chemicals like endorphins and serotonin, among other benefits. Even a long walk, or twenty-minutes of deep stretching will help.
Third, keep encouraging her to seek professional help.
Find a local group for her to attend and, if appropriate, accompany her to her first meeting. If you have never battled depression, you may want to contact the group leaders first, just to explain the situation and make sure it’s okay for you to be there. Most likely, it will be.
Mental health professionals are quick to tell the friends and family of people at risk for suicide to call 911 if they show any serious signs of suicidal behavior. You can have someone committed against his will if he poses a risk to himself or others. I am more hesitant about taking this approach. Take it from someone who has been there: Inpatients in mental wards are treated in an atrocious, dehumanizing manner. Besides making it nearly impossible for a person to commit suicide, these wards are, in my opinion, detrimental to a person’s mental health. Don’t get me wrong: If she’s wielding a gun or you consistently have to snatch pill bottles out of her hands as she tries to down the whole thing, AKA if she’s really out of control,yes, have her committed. But I think a better option is to create a “watch force.” Basically, you and your friends take turns staying with her at all times until she is feeling better. This may be difficult, but if you can get enough people involved, it should be possible. When you decide to stop, she should be eating, bathing regularly, engaging in pleasurable activities with genuine satisfaction, and willingly attending some kind of structured therapy. Again, this is temporary and only for extreme circumstances.
A lot of practitioners will have a suicidal person sign a contract. I have always thought these were rather silly and mostly just a way of ensuring the therapist doesn’t get sued, but it may work if she truly cares about you. At least it will give her something to consider. A contract is what it sounds like: a piece of paper that she signs promising not to end her own life.
3. A History of Suicide Attempts or Suicidal Ideations
If your loved one has attempted suicide in the past, or has talked about it a lot, then she is at risk for attempting again.
Suicidal people will often “test the waters” for a long time. I did it for years. A lot of people think that if someone talks about suicide a lot but doesn’t act on it, that they are just trying to get attention. I have always been baffled by this mentality. First, they may be engaging in self-harm or making minor (or even major, but unsuccessful) attempts without anyone knowing. Second, yes, your loved one is trying to get attention. Because she’s in pain and needs help. Give it to her. (This is different than the abusive practice of threatening suicide to gain something specific, like stopping a lover from leaving. Genuine, non-abusive cries for help will be more like Facebook posts or telling you she’s suicidal out of nowhere). I can’t stress how important it is to pay attention to this stuff. It goes ignored so often, and that really baffles me. Some examples are:
- Asking if she would be missed, in general or by someone specific.
- Talking about her funeral or asking for details about what it would look like.
- Asking on social media whether anyone cares about her.
- Cutting scars or wounds on her body. These are concerning whether they are hidden or easily viewable, though if they are hidden she has most likely passed the “seeking help” stage, and is approaching the “acting on it” stage.
- Confessing that she has attempted suicide in the past. Sometimes people will admit to this to help others or as part of a contextual conversation (as I am doing), but this is concerning if it’s out of context or without any apparent purpose.
- A burst of social outreach followed by extreme withdrawal: the outreach could mean phone calls. For me, it was usually on social media. It could look like a flurry of happy photos from the past, re-posts of tragic news stories, vagueposting, existential ponderings, or a combination. Then nothing. While she is posting, she’s distressed, but alive. You should be most worried when she stops. It’s probably not because she feels better, but rather because she has moved onto the planning/acting stage.
Alright, someone I care about is doing these things, what do I do?
Any of the steps listed above will help. An action specific to this category is to respond. Respond compassionately. It is still amazing to me how many supposed friends ignored me when I was in crisis, or the callous way in which some acquaintances actually mocked me. One time, when I was really depressed and posted about in on Facebook, a friend of a friend called it my “diary of depression” and told me she hoped that I didn’t unfriend her, because it was funny to read.
Look, having matured a bit, I know that these types of posts are annoying. But depression is an isolating disorder, and being suicidal is scary and embarrassing. As weird as it may sound, sometimes it is less scary to announce your need to the world, than to reach out and ask a single person. So seriously, if you see someone you care about doing these things, respond. And follow up. Don’t just leave a comment and assume it’s okay now. You don’t have to give him advice or say anything disingenuous. Just keep reminding him that you care, ask him how he’s doing, and let him know that you are someone he can talk to. Passing on some resources may also help. There’s the National Suicide Prevention Lifeline, and also this website, which I have found especially helpful when I have been in a suicidal state.
Sometimes, a suicidal person will show none of these signs at all. Sometimes, it’s the circumstances of her life. If you hear or notice that she is expressing a deep discontentment with one or more factors in her life, or that she is feeling “stuck” or unable to escape a specific person or situation, then she is also at risk for suicide, and will need you to help in the ways listed above. Simply being available, and letting her know it, can make an enormous difference.
If you try all of these things, and someone you love ends up making an attempt, don’t blame yourself. Sometimes we can do everything right, and it still won’t be enough. Sometimes a person’s pain is too great for intervention, or their desire not to be helped too stubborn. Take it from someone who attempted suicide despite having awesome friends: It’s not your fault.
If she survives the attempt, don’t blame her either. Suicidality is a sickness. The human brain is wired for survival. Wanting to die is an aberration, and it is not her fault. If your loved one survives a suicide attempt, you may feel angry and you have the right to your feelings, but talk about it with other people. Don’t tell her until she has healed, and do not take it out on her. Do not abandon her. Do not shame her, yell at her, try make her feel guilty, or tell her to do it again. That last one may seem obvious, but you would be surprised how people behave when they are deeply hurt. Seriously, if someone you love has survived a suicide attempt, she needs love, companionship, and deep caring.
As I mentioned earlier, I am not a medical professional. What I have written here is not intended to replace the advice of a professional. But these are the symptoms most prevalent for me when I was suicidal, and the actions which I felt would have, or which actually did, help me. Hopefully they can help you too.
Do you have any other suggestions or examples of suicidal behavior? Leave them in the comments below.
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