Responding to Suicidal Thoughts

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Dr. Kathy Maupin and Brett Newcomb discuss the the topic of suicide and methods to help friends and family that may be suffering from depression.

This week, Brett Newcomb and I are talking about an issue that is very frightening for most people who have encountered it: suicide. There are many myths about suicide. One in particular is that if you discuss it with the person involved, they are more likely to harm themselves. This is not true. If you talk with them about what they are thinking or feeling, they are more likely not to act on it.

Doctors sometimes encounter patients who claim that they are suicidal. In the previous couple of weeks, I had two clients who came in after receiving testosterone replacement pellets and share with me that prior to receiving the pellets, they had decided that if the treatment did not work, they would kill themselves. They no longer thought they could bear to live. Happily, they both felt that the treatments had restored them and put their lives back on track. But, this conversation with the two patients led me to discuss it with Brett, who has had more extensive training and experience with suicidal individuals.

This podcast is the result of our discussions about how families and friends can help when they become suspicious that someone they love is thinking of killing themselves. It also makes some recommendations for professionals who are not particularly trained or experienced with the issue of suicide.

One of the things we talk about is determining a scale of lethality in the individual’s thinking. We ask if he or she has a plan for how and when they will attempt suicide. The more specific their answer to the question, “Do you have a plan and have you acquired the means?” the higher the risk. If they remain vaguely intentional then they need to be cared for and helped, but there is less likelihood that they will act to harm themselves.

Brett reminds all of us that we cannot afford to ignore this kind of talk or to dismiss it as attention-seeking action. While it may well be true that the individual is seeking attention, it is important to respond appropriately and supportively; not to become angry or dismissive. Reacting in an angry or dismissive manner may actually work to encourage someone to “prove” that they are serious by making some sort of attempt at self-harm. We also discuss how the risk is increased for those who attempt suicide multiple times. Often, what happens is that the multiple-attempter keeps narrowing the rescue window until they finally go too far and actually pass away, even though they did not really intend to do so. Many of these individuals mentally bargain with fate or with God, and think that if God wants them to survive, or if they are meant to survive, then someone will come in and save them. But they cut the window of safety or the margin for error smaller and smaller and eventually, there is no time to save them.

Professionals who are trained to deal with suicidal thoughts can obtain a safety contract. They know how to do it and they know the mechanics of constructing one that will work. Others should not attempt to negotiate such a device. If you are not a trained professional, you still need to know a couple of things. Don’t be afraid to ask questions or to talk to the individual, and ask for help from someone else. Call the police, call the therapist, call the parents or best friends and ask for their help. Listen to your friend and remain calm. Ask grounding questions such as “why today?” “What would happen if you waited until tomorrow?” “What will happen to your family?” These kinds of questions often break through the despair and help ground the person. So, talk to them. Be sympathetic and seek help for them. Never agree to keep their secret about their suicidal thoughts. Save your friend’s life, even if it costs you the friendship.

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