Thoughts of suicide are common in people with post-traumatic stress disorder (PTSD), depression, and other mental illnesses, or who are going through hardship in life. Although suicidal ideations are fairly common, they do not in and of themselves indicate that a person will actually commit suicide. That does not, however, mean they should be ignored. Even if a person is claiming thoughts of suicide “just to get attention,” those claims should always be listened to and responded to with compassion, care, and support–preferably in-person support. Ignoring suicidal “cries for attention” can lead to actual suicide.Responding can be as simple as sitting in a room with the person, holding them, sleeping near them, or giving them a hug. If you can’t be physically with them, phone calls or texts are the next best solution. But this is in response to suicidal feelings and ideations. If someone is truly suicidal, then being left alone is never an appropriate response (unless, of course, you hope for that person to die–let’s hope there’s nobody out there whose friends and family actually want them to die).
I am not an advocate for hospitalization for suicidality. Here’s why: in the United States, the mental healthcare system is often hostile and negligent. Patients can be strapped down to beds for reasons as simple as requesting to use the phone or bathroom too frequently. There is also no privacy, and suicidal patients are often given few clothes or comforts, placed under restrictive regimes, denied access to nature, and restricted or denied access to friends and family–all things they actually need to recover! Most hospitals in the United States do not use trauma-informed approaches when dealing with suicidal people, which makes hospitalization for suicidal people with PTSD especially triggering. As I experienced personally, if the attempt involved the use of illegal and/or stigmatized drugs, the response from hospital staff can be outright cruel. Restricting a depressed or traumatized person in a typical hospital environment is generally an act of cruelty that will lead to exacerbated feelings of hopelessness, anger, and abandonment.
But intervention is necessary. When my husband was in psychosis and wielding weapons, he needed intervention and stabilization. Unfortunately, he only received hospitalization. Many psychiatric facilities in the United States are overfull and not actually equipped to properly deal with the complexities of mental illness. Some hospitals, for example, refuse to treat addiction using evidence-based methods and even go so far as to force patients into withdrawal from prescription medication. Others staff people who look down upon those suffering from illnesses like depression, Borderline Personality Disorder, or PTSD, which are popularly associated with “negative behaviors.” Yet others fail to provide the full scope of psycho-social and economic assistance that necessitates true change. If we as a society are going to continue to implement hospitalization as a response to suicidal behavior or mental illness, then we first need to radically change the mental health system. Until then, the best thing to do, in my opinion as someone who knows what it feels like to lose all hope, having the support of friends and family–and, most importantly, not being left in solitude–is the most appropriate and effective way to prevent a suicide. A friend from Seattle wrote recently on Facebook about putting together a collection of writings on “crazy-sitting,” which involves friends and family taking turns to care for a mentally ill person until she’s stabilized. Although this method requires considerable time and emotional commitment from other people, if performed properly and to its full effect, it would, in the long-run, require less resources and be more effective than the current hospital protocols, which often act as revolving doors of misery.
To me, “crazy-sitting” means sharing the burden of your loved one’s pain by going to their home or inviting them to yours. It means never leaving the person alone while in acutely suicidal mode–though that doesn’t mean not giving them privacy if they need it to feel better (make sure you can hear their movements, and check in verbally or visually on their wellbeing occasionally during this time period). “Crazy-sitting,” or supporting a suicidal person, means exercising patience and forgiveness while the person works through the tumultuous and painful emotions that are causing the suicidal thoughts. Support means letting go of resentments toward someone whom you care about in order to prioritize their life and well-being; if you were fighting with someone who becomes suicidal, set that aside. You can always revisit the disagreement later, if you still feel it matters after you’ve helped the person. One example of this was me and my husband; we were planning to separate when he went through psychosis, but I ended up moving across the country with him instead to prioritize his mental health when I realized how ill he was and how much he needed care.
Of course, my decision backfired. I am now alone, sick, without my children, and in extreme pain due to having prioritized my husband’s mental health over my own. But that’s not a statement against support. It’s a statement against supporting someone alone. Mental illness is hard. When a person is suicidal, it is because she feels more pain than she can bear. That kind of pain is not going to easily handled by one person; it’s already killing the person experiencing it, so one friend or family member alone can’t shoulder that pain either. In order for “crazy-sitting” to work, there needs to be a willing and committed support system that can take turns being available to the person in need. Those supportive people need to be able to tell each other when they’re feeling burned out, so that they can take turns keeping company with the suicidal person. Sometimes the people most compassionate toward those with mental illness are others with mental illness–but that means “crazy-sitting” can be triggering. So if you’re putting together a team of supporters, make sure you’re all willing to listen and support each other, too.
Any time someone expresses thoughts of suicide, they need to be granted love and compassion. Ignoring them, telling to go ahead and do it, cutting off contact from those they love, isolating them, or punishing them are never the right reponses. Giving them hugs, keeping their company, cooking or sending them a nice meal, and staying in touch are good starts–but the most important thing is to make sure a caring friend or family member is physically with this person. She likely needs professional help, but professional help is meaningless without the palpable knowledge that there are people nearby who love you. Physical isolation is actually considered a form of torture–someone who feels or is abandoned or alone is very likely to commit suicide. Here are some signs that a person’s thoughts of suicide have progressed beyond the “keep-in-touch” phase to the “go stay with that person right now” phase:
-The person is fixated upon suicide; he brings it up repeatedly, searches methods on the internet, or collects items that may be used to complete suicide (razors, weapons, pills, rope, etc)
-The person has experienced a sudden major negative life change like the loss of a loved one or housing
-The person’s speech and movements are slowed (which can sometimes be mistaken for intoxication on downers). The person is seen staring into space or walking very slowly. The person is less able to think and speak clearly, as compared to her normal state of being.
-The person cries frequently. When a person cries at random or in public, that’s usually a sign of deep pain that requires immediate attention and affection.
-The person says or does uncharacteristic things, like giving away possessions, saying heartfelt goodbyes, thank-yous, or apologies, or neglecting normal duties.
-The person stops making plans for the future; maybe she stops working or participating in other activities.
-The person experiences a serious physical injury; the combination of emotional and physical pain can be unbearable.
-The person has been denied requests for support, comfort, or help.
-The person has been told they are a burden or treated like a pariah by family.
-The person’s sleep patterns change; either they sleep too much or too little, or they sleep too much but very fitfully.
These are just a few examples to watch for if your loved one ever talks of suicide. “Crazy-sitting” involves immense emotional labor, but before you say you can’t help, take a moment to truly imagine what life would be like if this person were gone. Do you truly wish your friend or family member to die? What kind of emotional toll would her death take on you and your family? Would it be greater supporting her through this time? Does this person have value to you at all?
I think if we had more people willing to set aside differences and give a hug to a suicidal person, less people would go through with the act. That’s not to blame the families of everyone who has committed suicide; sometimes there are no signs and nothing you can do. But sometimes there are lots of signs, and very simple actions (like simply ensuring the person is safe, healthy, and not alone) can be the literal difference between life and death.
I am not suggesting anyone commit suicide, but being left alone with serious suicidal thoughts has always felt, to me, like an indication that people don’t care. What do you think? If someone does not have anyone who is able/willing to help them through a difficult time, and who would rather hold onto resentments or punish their behavior instead of helping them get healthy, does that person still have a reason to live? What is it? Let me know in the comments.