In July 2011 I wrote a post entitled, “Ten things not to say to a depressed person.” It was the first piece on this blog to attract a large audience and I own much of my blogging success to that post and its companion piece, “Ten supportive things I’m glad somebody said to me.”
I’ve decided the time is right for a similar piece on dealing with suicidal people (although I’m definitely not expecting the same number of readers for this post!). Suicidal thoughts have been a problem for me since around Christmas and the wide variety of responses I’ve received to my blogs and tweets, along with training to be a Mental Health Instructor, have given me cause to think about how people respond to individuals they know to be suicidal. A common response is feeling that they must throw some logic at the problem. What people don’t realise is that not only does suicidality work to a logic of its own, many attempts to reason the person out of their thoughts aren’t actually as logical as the would-be helper thinks. Another view is that the suicidal person needs a jolt, a shock to the system. Still others offer platitudes and “positive thinking”. All of these approaches have flaws, and here’s my guide to why.
1) But you have so much to live for! Well, but you see that’s your judgment, not mine. Each of us gets to decide whether we have quality of life, because no one can ever really walk in our shoes and experience our unique suffering. History is littered with amazingly talented but mentally unwell people, from Virginia Woolf to Vincent van Gogh, who took their own lives despite phenomenal achievements. Think that’s because they lived in the days before psychiatry and medication? Think again. Only last year official National Treasure and President of Mind Stephen Fry disclosed that despite being an incredibly successful writer and broadcaster, he had recently attempted to take his own life. Where you see success, I may see an unending bleakness. Where you see reason, I see a person who won’t acknowledge my pain. And if you won’t acknowledge my pain, how can you be on my side?
2) You are so young, you have your whole life ahead of you. Let’s unpick the logic of this one. Suppose you were in acute physical pain. Suppose you’d been in this pain since adolescence, maybe even childhood. Suppose you’d been told there was no cure for your pain, that medicines provided respite for some but might or might not work for you – there was no way of telling. If someone pointed out that you were only twenty-five, would you think, “Goody! I might have another sixty years of this!”? Of course not. You’d most likely be scared by the prospect of living on in pain, a pain you were already struggling to cope with. Pointing out how many decades of suffering could expect would hardly improve your attitude to your situation.
3) I hope you’re not planning on doing anything stupid. I unfollowed someone on Twitter just recently for saying this to me. If you feel trapped and desperate and believe nobody can offer you a solution, wanting to remove yourself from the equation actually feels fairly sensible. Sure, some suicides are impulsive (especially if alcohol is involved) but actually it’s often something people have often thought long and hard about. Many take all the steps they can to minimise the impact on their loved ones, putting financial and practical affairs in order before they do the deed. When you tell me my careful plan is “something stupid”, you’re dismissing its importance – a fast track to alienating me. In fact, it makes me feel like you think I must be stupid. If you’re worried, say so, but don’t dismiss it as stupidity. What’s wrong with saying, “I’ve seen/heard you mention suicide, and I’m concerned about you. Are you safe? Is there anything I can do to help?”
4) Suicide is a permanent solution to a temporary problem. This perennial internet favourite is, like many positive thinking soundbites, both trite and inaccurate. Yes, some people have single episodes of mental illnesses and go on make a full recovery. And yes, for those with more severe and enduring illnesses there will probably be periods when we are relatively well and we do want to live. But bipolar disorder is not a temporary problem. Schizophrenia and schizoaffective disorder are not temporary problems. Borderline personality is not a temporary problem. There are, as yet, no cures and for many of us, the fluctuation is part of the problem. It’s hard to stay motivated, to stick with medication regimens and self-management plans, to work on applying our learning from therapy (should we be lucky enough to be offered it) knowing that on one unidentified day in the future, we are going to relapse. Maybe it won’t be such a bad episode; maybe it will be horrendous and we’ll end up in hospital. We have no way of knowing, and little control over our situations. So excuse me if, 29 years into my condition, my problems don’t seem that temporary.
5) Think of the damage you would do to your nearest and dearest. You know what? I do very little but. Suicidal people are well aware that if they carry out their plans, somebody’s going to get hurt. For many that could be a spouse, parents or children. It might be friends who would miss them terribly. Professionals can be devastated to lose a client to suicide. There is no way to make a clean, painless break. Knowing this makes us feel awful, selfish, a terrible, terrible person. And what does feeling like a terrible, terrible person do to someone who already acutely depressed? It makes them feel still worse. Getting them to dwell on the harm they might cause is counterproductive. You think you’re giving them a wake up call? You might actually be increasing the risk they carry out their plan.
6) You need to stop dwelling on your problems. Leaving aside how all consuming it feels to be suicidal, severe and enduring illnesses are genuinely life-threatening. Each year about 5550 people in the UK die by suicide and worldwide this figure is around one million (World Health Organisation). A 2013 study found that people with my condition, bipolar disorder, were 20-30 times more likely to die by suicide than the general population. This is massive and ignoring it isn’t going to go away. I’m sorry if it makes you uncomfortable but the severity of my condition is a fact. Suppose I had cancer? Suppose I had a heart condition? Would worrying about that be considered navel-gazing? Would a friend find a preoccupation with a physical illness morbid or boring? If you’re worried I have too narrow focus help me find other things to think about, but be constructive, not critical. Take me out, Write me an email. Send me a card. Lend me a book. Give me a gym pass.
7) You’re just looking for attention. Yes. Yes, I am. And my question to you is: since when has it inappropriate or unacceptable for someone in acute pain to want/need attention? If I were in physical pain you’d urge me to pay attention to the signals I was receiving; why should emotional pain be different? Sometimes I want attention because I’m scared. I’m scared that I might carry out my plans, I’m scared of the intensity of the pain, and I’m scared that nobody will understand me. I crave reassurance and the kind of attention that might help me stop feeling so awful. Often that’s going to look like NHS intervention but when professionals ask me, “What would be helpful here, Charlotte?” I often have no idea, then I get scared they’ll withdraw their help. So yes, I want supportive attention that says, I am here. I am here for you and I’m not going away. But not….
8) I’m calling 999! There will be situations when it’s appropriate to call 999. If someone is on a bridge, perhaps, or holding a knife to their wrist, or if their feelings are part of psychosis and they are very unwell and disconnected from reality, maybe it’s time to call the emergency services. Mental Health First Aid training makes it very clear you should never try to intervene physically in a high–risk situation. But in general when someone discloses suicidal thoughts, use the first rule of the Hitchhiker’s Guide to the Galaxy: DON’T PANIC! Panic gives the message that the disclosure is just too awful to accept, right when I’m feeling dreadful in the first place. That creates distance between us, which isn’t helpul. I’m not expecting you to be inauthentic. It’s OK to share that you are shocked or concerned to hear I am thinking of killing myself, but I can do without shrieking, swearing or giving me the message that I’m a freak.
9) You won’t do it – nobody who talks about it ever does. This is one of the biggest falsehoods in mental health. Again I’m not really sure where it comes from, only that it’s been around a long time. Very many people who take their own lives have mentioned it to someone, even if indirectly (“I sometimes think everyone would better off without me” or apparently tangentially (“I should really put my affairs in order”) so the Samaritans list it as one their myths on suicide. It’s also possible that someone very distressed might just take this statement as a challenge: “You don’t believe my pain is real? Well, then I’ll show you!”
10) You’ll feel differently next week. Oh, you have a crystal ball! Well, I have experience. My depressions have often lasted months, every day feeling like torture. Being asked to hang on for a week has felt totally impossible. In any event, in the case of bipolar “feeling differently” is often part of the problem. Yes, I might feel differently next week, but differently doesn’t usually mean I will be experiencing normal mood. I could be hypomanic. I could be paranoid. I could, worst case scenario, be in a mixed mood state, which is the same as saying suicidal only I’ll be agitated rather than sleepy and slowed down. And what if I do feel the same next week? And the week after and the week after that? Are you going to give up me? What I want is for you to be realistic. That’s not the same as giving up hope. That’s not the same as giving me the message I’m never going to get better. I just want some acknowledgement that we don’t know when I’m going to be well, that this is a horrible situation to be in, and that not knowing is part of my pain.
So there we are. Another facet of bipolar, another ten things I wish I didn’t have to hear. I could’ve written more than ten this time, but round numbers work better. I hope others will add their own suggestions – and perhaps more crucially, what they do like people to say when in a suicidal crisis.