A woman in her late 20s arrived at the law firm where she worked as an associate one morning, smiling and happily discussing her upcoming wedding to another associate. He had sole custody of his three-year-old son, and she was sharing about choosing the adorable little tuxedo. Early that afternoon she was called into the senior partner’s office. The multi-million dollar case she had been preparing for months was lost because of a major error she had made. She went home, wrote a note to her parents, to her fiancé, and to the client. In a half hour, she was dead by hanging. She had spoken to no one.
I was in my clinical psychology internship at the time. The woman was not a client, but a family friend. Everyone asked me, “How?” How could someone with no (known) mental health history and loving, supportive family and friends kill herself over money lost? Yes, she probably would have lost her job, but she had so much more in her life. I answered that none of us can know what she was thinking or feeling, but we might make some guesses based on her suicide notes:
- She felt overwhelming guilt, despair, and hopelessness.
- She thought she had let down her client, her family, and all who knew her.
- She saw herself as a burden now.
- She saw no other way out of her pain, no other options.
In his book The Suicidal Mind, Edwin Shneidman collated hundreds of suicide notes in an attempt to understand the mindset of someone who takes their life. Examples include:
- “I sit alone. Now, at last, freedom from the mental torture I have been experiencing. This should come as no surprise. My eyes have spoken for a long, long time of distress I feel. The rejection, failures, and frustrations overwhelm me. There is no way to pull myself out of this hell. Goodbye, love. Forgive me.”
- “My dearest ones—You two have been the most wonderful things in my life—Try to forgive me for what I’ve done—Your father would be so much better for you. It will be harder for you for a while—but so much easier in the long run—I’m getting you all mixed up—Respect and love are almost the same—Remember that—and the most important thing is to respect yourself—The only way you can do that is by doing your share and learning to stand on your own two feet—[Name], try to remember the happy times and be good to [Name]. Promise me you will look after your sister’s welfare—I love you very much—but I can’t face what the future will bring.”
Maybe you read the above examples and thought about the other options they had to address their problems. Maybe you read the above examples and related to how each person felt. This blog post is for all of you.
If you have never had a suicidal thought, please know that some of your friends and family have thought or may think about killing themselves. One in six people has suicidal thoughts at some point in their lives. Suicide is the SECOND leading cause of death in the US for people ages 10 through 34, with almost 45,000 dying by suicide in 2016. According to the CDC, 1.3 million people attempted suicide in 2016, although that is likely an underestimate since more than half the people who engage in suicidal behavior never seek health services. That means it is up to every person, every community to keep an eye out for signs that our loved ones may be at risk for suicide. For every suicide, it is estimated that between 6 and 32 people are left picking up the pieces. Such survivors of suicide themselves are at risk for suicide, along with a host of other consequences to their health, work, and overall lives.
If you have had a suicidal thought, please know that you are not alone. As noted above, suicidal ideation affects millions of people. It is also a common symptom of depression. Although 1 in 6 people have suicidal thoughts, only about 1 in 20 make a plan to kill themselves or attempt suicide. Thoughts alone do not mean you will lose control or act on the thoughts. However, thoughts of suicide should always be taken seriously as a sign that you need support. Whether it is a specific situation causing you stress or an overall sense of feeling down, talking about your thoughts and concerns is the first step to feeling better. Choose someone you trust, and start with sharing the situation or the ways you are feeling. Speaking with a professional can be a welcome relief as well as helpful in finding strategies to deal with your thoughts and feelings.
Whether you are looking out for yourself, a friend, family member, or acquaintance, you can be aware of the signs of suicide. It is important to recognize the difference between suicide being preventable and suicide being predictable!! This is similar to the idea of accidents being preventable versus being predictable. Following safety guidelines in many situations can prevent accidents. Understanding the factors that led to accidents can help us develop better safety measures to prevent future accidents. But sometimes accidents happen that you could not have foreseen; they were unpredictable. Similarly, if a family member or friend commits or attempts suicide, you are not responsible. Besides the simple fact that we cannot make other people’s choices for them, it is possible they did not show any of the common signs, like the woman I described at the beginning of the story. However, just as with accidents, we all can stay alert for signs of the danger and take steps to prevent suicide in ourselves and others.
What are the signs of suicidal thoughts or plans?
- Talking about wanting to die or suicide.
- Preparations for death: giving away belongings, making plans for being dead, final farewells.
- Looking for a way to kill oneself. Taking steps such as practicing a plan for killing oneself, or purchasing means to kill oneself.
- Feeling hopeless, trapped, or in unbearable pain.
- Feeling like a burden to others.
- Acting anxious, agitated, or reckless.
- Displaying extreme mood swings.
- Showing rage or talking about seeking revenge.
- Withdrawing or feeling isolated.
- Increasing the use of alcohol or drugs.
- Sleeping too little or too much.
Of course, many of the above signs occur with people who have no suicidal thoughts or have suicidal thoughts and no intentions of acting on them. Still, you never want to assume the signs don’t mean anything or will go away. Check in with the person, or get help if you see these things in yourself.
What can you do if you are concerned that someone may be at risk for suicide?
- Express concern about whatever sign you observe, and ask the person how they are feeling/doing/thinking.
- Ask the person if they are thinking about killing themselves.
- If someone is not thinking about suicide, you asking will not ‘put the idea in their head!’
- If someone is thinking about suicide, you asking about it will not make them more likely to do it!
- Help the person create a safety plan (see below).
- Call the US National Suicide Prevention Lifeline at 1-800-273-TALK (8255). Available 24/7/365.
- Take the person to the emergency room, or seek help from a health professional.
- Campbell resources:
- Dr. Stanton has open office hours 12-1 p.m. daily in room 141 of Levine Hall and is always happy to talk with people with questions about mental health.
- Medical, graduate, and health professional students can contact CUSOMBH@campbell.edu to talk to a counselor.
- Undergraduate students can contact the Counseling Center at (910) 814-5709 (ext. 5709).
- Faculty and staff can access confidential counseling through the Employee Assistance Program at 1-800-460-4374.
- Campbell resources:
- Remove any objects that could be used in a suicide attempt (e.g., guns, knives, pills, etc.).
- If possible, do not leave the person alone.
What can you do to prevent thoughts of suicide from turning into plans of action or behaviors?
- Develop a safety plan with steps for dealing with your suicidal thoughts and associated emotions. WRITE IT DOWN! Steps can include distracting activities like journaling, taking a walk, playing with a pet, or doing the things you have enjoyed in the past. Connecting with someone, whether through a casual conversation, a trip to get coffee, visit someone’s house, or more in-depth discussion of your feelings, can be the most helpful step. Calling the crisis line (1-800-273-8255) or your doctor/counselor is a great option. If none of these steps work and you might take action on your suicidal thoughts, get yourself to your nearest emergency room or call 911.
- Keep your home safe by getting rid of ways to hurt yourself, such as guns, extra pills, razor blades, ropes, etc.. This removal is temporary until your thoughts and feelings improve so that nothing impulsive happens. The majority of suicide attempts occur while people are under the influence of alcohol or other substances, and many are described (by survivors) as unplanned. Removing the means to hurt yourself gives you extra time to think about your actions before something dangerous happens.
This post has looked at suicide prevention from the point of view of self and other, but really everyone reading this can help prevent suicide in your community, and everyone reading this could be at risk for suicide one day. There is a saying among football fans that ‘Any given Sunday, any team can beat any other team.’ This is regardless of how good or bad the teams playing each other are. As reflected in the opening example, ‘On any given day, under certain circumstances, any one of us can be at risk for suicide.’
I worked in Veterans’ Administration clinics for 12 years, where there are many research and prevention programs related to suicide. One thing that caught my attention is that more veterans had an appointment with primary care or other specialty medical clinics in the month preceding their suicide than they had in mental health. That led to the slogan across the hospitals: “Suicide Prevention is Everyone’s Business.” Now I hope you will make it your business, too.
A sobering fact: One study places the rate of suicide attempts among US medical students at 10%, double the general population.
If you or someone you love is having thoughts of suicide, please call the National Suicide Prevention Lifeline at (800) 273-TALK (8255); https://suicidepreventionlifeline.org/
September is Suicide Prevention and Awareness Month. For more information:
- National Alliance for the Mentally Ill: https://www.nami.org/Get-Involved/Awareness-Events/Suicide-Prevention-Awareness-Month
- Suicide Prevention Resource Center: https://www.sprc.org/
- Suicide Awareness Voices of Education (SAVE): https://save.org/
- American Association of Suicidology: https://www.suicidology.org/
- Center for Disease Control: https://www.cdc.gov/violenceprevention/suicide/
To learn more about the Behavioral Health Department or to request an appointment, visit us! Behavioral Health