How do you help a partner, relative or friend who feels suicidal? The situation is disturbing for anyone, and can be even more difficult for people who take too much responsibility and need to have things fixed and resolved.
Every situation is different, but there are some guidelines that can be helpful. Please be aware that I cannot give advice specific to a particular person in crisis. I’m offering general principles, and these cannot substitute for direct professional help.
While this post will inevitably be incomplete, I will try to help you sort out what’s within your control and what’s out of your control. We will explore the practical aspects of helping, then the more personal ones. But first, I’ll describe my early experience with helping people who are suicidal.
Contents
Crisis Line: Accepting Limits and Learning to Listen
My first venture into the world of mental health came when I volunteered at a suicide prevention service in New Orleans, Crisis Line, over 45 years ago. I was prepared with the boundless wisdom of a 20-year-old, a few college psychology courses and weekend volunteer trainings, and far more self-help books than anyone that age should have had.
Volunteering at Crisis Line did not require the same sort of commitment that a partner or friend in crisis requires, so it didn’t expose me to the kind of stress that having someone you’re close to in crisis does. But I did learn a lot.
One of the first things I learned was that stopping suicide is usually out of our control. We may be able to offer what the person in crisis needs in order to get out of that state, but it’s still really up to them. The training at Crisis Line punctured my fantasies about the efficacy of my heroic will-power and determination. They introduced me to my rescue complex.
If someone is resolved to kill themselves, they can do it eventually, once they’re off the phone call, out of the hospital, or otherwise free to do what they want.
But still, my experience at Crisis Line was that my listening was good medicine, a sort of reverse medicine, in that I would draw out their feelings rather than put pills inside them. It didn’t always help, but on a few occasions it seemed to be just what they needed.
Since then, as a psychotherapist, I have had patients who planned to kill themselves but changed their mind eventually and have lived more fulfilling lives.
But that decision was theirs; it’s never been in my control. I can throw a rope, but they choose whether or not to grab it.
Warning Signs
When is it time to be concerned or try to get help for someone who is suicidal? Here are some of the symptoms that could indicate a serious problem:
Depressed or flat mood
Loss of interest in the things they used to love
Isolation
Self-recrimination
Irritability
Hopelessness
Previous suicide attempts
Specific suicidal plan with the means and intent to carry it out
Here are characteristics of populations at higher risk:
Older
Male
Substance abusers
Isolated
Chronic physical pain
Financial problems
History of trauma
Family history of suicide
Still, don’t jump to conclusions. Among the thousands of patients I’ve interviewed or worked with, there were very few that had never had a moment in which they wished to just have it all over with. Suicidal ideation is not as strong an indicator of likelihood to commit the act as having a specific plan with intent and the means to carry it out.
First Aid: Immediate Help
If someone has said that they have a plan to kill themselves and they intend to carry it out, you can call 911, call the local mobile crisis unit (if there is one), or take them to the emergency room.
Remove anything from their home that they might be able to use to kill themselves. Certainly remove any guns, but, depending on their stated intent, also beware of ropes, knives, pesticides and medications.
Either of you can also call 988, the (national) Suicide and Crisis Hotline. Calling a suicide prevention service may be helpful to get them through a difficult moment when no friends or family are available. 988 can connect the suicidal person to support systems, and they can also be helpful to you as the concerned friend or relative.
But don’t expect too much. This is first aid, not deep aid.
And be careful that a suggestion like calling a crisis line doesn’t sound like you’re trying to get rid of them. Connection with family and community may be one of the most powerful factors we have in preventing suicide.
Connection heals, isolation hurts.
So, please remember that your relationship with them just in itself can be helpful, and that whatever you say or do, you want it to foster your bond with them.
In-Patient Help: Hospitalization
Perhaps better than calling 911, it may be best to take them to the emergency room, if they are willing, and have them admitted to a hospital.
Hospitals usually serve to prevent immediate suicide and start medications with the hope of stabilizing the patient. They may get some individual psychotherapy and or group therapy to start recovery. Maybe. Maybe not.
Psychiatric units (at least those that accept insurance) are generally pretty uncomfortable, and do not want to extend the patient’s stay. They will not make it warm and cozy for them. This can serve as incentive to get better and get out, but once out, that incentive to get better may fade.
In fact, some researchers argue that hospitalizations may even contribute to suicide rates both during and after hospitalization due to humiliation, coercion, stigma, loss of social role, and loss of control. Still, the odds of that happening are lower than what may happen if they are not hospitalized.
Out-Patient Help: Psychotherapy
There’s plenty of research which says that psychotherapy is effective in preventing suicide. While most forms of psychotherapy can be helpful, Dialectical Behavior Therapy (DBT) in particular is intended for people who often feel that they want to kill themselves. DBT teaches skills that help people to handle feelings that otherwise might make them want to end things.
Therapy helps people make conscious decisions, but cannot make those decisions for them. Simply having a non-judgmental and objective person listening, as therapy usually does, is helpful enough for many, but not all. DBT offers a more directive approach which can be helpful to those in most immediate need.
Finding a therapist isn’t always easy. But if you can find one, it would be good for the patient to have extra sessions in the first few weeks to help stabilize them.
Over the long term, having someone they can be perfectly honest with is part of healing. Also important are the encouragement to question their assumptions and the stories they tell themselves, and to find more fulfilling ways to live.
Please be aware that trying to be a therapist to a partner, friend, or relative is not a good idea. I’ll get to your role in a moment.
Medication: It Can Help, But It Can Hurt, Too
There is evidence that medications can lower the risk of suicide, and they can help patients use therapy more effectively.
But there is also evidence that suicide is more likely to occur while taking certain medications. Still, on balance, medications help more than they hurt. Here is a good review from the University of Chicago about which medications to be concerned about.
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Even if they accept some sort of medical intervention, stay in touch. One fear of depressed people is that no-one wants to be around them. Don’t deny that it can be hard to be around them when they’re depressed, but emphasize that they are worth it and that you still care. Remember, connection is crucial.
Now let’s talk about what you can do in your personal conversations with them.
Drop the Judgment: Comprehending the Incomprehensible
People who are in the midst of a serious depression or suicidal episode often experience intrusive and distorted thoughts, thoughts that come on them violently. These are not intentionally or consciously generated. They rise up unbidden from the unconscious. As much as they would like to, the suicidal person can’t just snap out of it and make themselves be “reasonable.”
Some of the most debilitating distortions they are subject to are:
My family and friends are better off without me.
I’m different and don’t fit in anywhere.
This is totally out of my control, and that’s painful and intolerable.
If it seems to you like they have a good life, and you can’t imagine why they would want to kill themselves, multiply the distress you hear from them by ten: having resources, talent or privilege only make them feel worse about themselves.
Many people who suffer from depression feel intense shame about their mental state, and feel that they have failed to use what they have been given. Given all those resources, they feel they should be able to handle it, and since they can’t, they feel like they should just end their life.
If you haven’t experienced a major depressive episode, it may be difficult to understand how profound and debilitating it can be. Remember the worst physical pain you’ve ever experienced and try to imagine hurting psychologically to the same degree.
What may be difficult for both of you is that you can’t see depression hurting the way you see blood pouring out of a bad gash. But in the same way, life is pouring out and it hurts like hell.
And nobody gets it.
Beware of Rescue Fantasies
One danger for partners, family members and friends is thinking that they can prevent a suicide and save them. In the long run you can’t keep someone from killing themselves, but you may be able to give them enough relief by listening so that they can clear their head, get professional help, and make better choices.
Many readers of this blog are habitual fixers. This is not the time or place for that. What you may need to do is to turn your compulsive energies onto your need to fix so that you can be with them as they are rather than try to rescue them.
If you feel an urge to fix or correct, observe what you are afraid of feeling that might lead you to push them. Powerless? Helpless? Reminded of your own depression or that of someone you loved and lost? Don’t try to avoid your own feelings by fixing theirs.
There are limits to what is within our control. And many of us feel too much responsibility in a situation like this. We like to think that there must be a solution to any and all problems—if we could just figure it out and work hard enough to execute that solution. But that’s very idealistic, if not naïve.
My point is not to give up hope, but rather not to be attached to outcomes.
Not to remove yourself, but rather not to buy into the feeling that you’re responsible for rescuing them.
Not to stop loving, but rather not to imagine your love could cure them.
Victim Stances, Manipulation and Tough Love
It might seem brave and smart to offer tough love to someone who is suicidal. While it’s conceivable that someone could gain some insight that way, it’s a very risky strategy. Like gasoline on a fire, depression thrives on demands and expectations, and tough love could make that worse.
After almost 35 years of making my living as a psychotherapist, there are very few situation in which I could imagine using tough love to try to stop someone from killing themselves.
Might some people revel in their victim mode and manipulate us? Absolutely. But I can’t sort out those cases in a blog, nor would I be willing to take the chance of pushing them over the edge unless it was very clear there was a pattern of manipulation and that they needed to be challenged.
If this is a concern in your situation, you might find my posts about Rescuers, Victims and Persecutors helpful.
Support: Be Receptive, Not Prescriptive
Aside from practical interventions, the most important thing you can do is to listen and let them talk. Draw their feelings out rather than trying to force reason into them. Advice at a time like this could do more harm than good. Unsolicited advice usually ends up leaving them feeling that you don’t understand how difficult their situation is if you think such simple suggestions would work.
Imagine, for a moment, what that feels like.
Try to understand what they’re going through and let them know you do—but only to the extent that you really do understand.
An example of advice that’s typically good advice, but bad advice at a time like this is to recommend they be grateful for what they have. While I highly recommend gratitude as an ongoing practice for just about everyone, it can backfire in this situation.
Ask them about their feelings, how they are coping with them, and if there is anything you can do. Don’t be afraid to ask if they are thinking of harming themselves.
Generally, receive and welcome their thoughts and feelings rather than trying to correct them. Fostering an experience for them in which they feel accepted may be the best thing you can do to interrupt the suicidal urges.
Mirror back simply and empathically, without interpretation or interruption, what you hear from them. “It sounds to me like what you’re saying is that living as you are is extremely painful. I think I can understand that. It must be hard when nobody gets it.”
Once you’ve listened, and empathically validated their feelings, you may be able to share your personal experience of them: “I know it feels to you like everyone would be better off without you, and that feels horrible, but that’s not my experience of you, or of what others think of you.” Often the best we can do is to let them know that we care and that we are there for them.
If there is an opening for feedback, you may be able to question their thinking, their interpretation, or their story. But not the feelings that come with those.
After, when you have time, process any critical or despairing feelings you may have about their suicidality and what it was like to be with them. Supporting someone during a suicidal period is hard work, no matter how meaningful and important it is to you. Self-care and getting your own support is also crucial.
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Ideally, hearing themselves as they talk to you, and hearing you mirror their feelings empathically and simply, will help them realize that what needs to die is not they themselves, but their inner Dictator, Tyrant, or Judge, along with their unrealistic standards, black and white thinking, and self-attack.
With that death could come a new life.
But remember, you are the midwife, not the mother.
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