Positive Health Online

How should you react when your client, a family member, or a friend tells you they are thinking of taking their life?  

Think about the following scenario. You have been taken into someone’s confidence. You may even have agreed not to tell anyone else. The challenge is implicit – you must find a way to stop it. You must love enough, be clever enough, have professional skills enough;  if what is threatened is done, it will be your failure.

The person might be very close to you – maybe your best friend or a teenaged son or daughter. 

What a heart-breaking threat to baffled friends, or parents who are doing the best they can.

What a dangerous temptation it can be to the well-meaning social worker or therapist – to accept this challenge to their professional skills.

Call up all your compassion and courage; the conversation begins with this hard fact:

“If you really intend to make yourself dead, no one can stop you.”

“People can make themselves dead no matter what their circumstances are. They do it all the time, even in hospital, or prison - even under suicide watch. We need to establish, right now, that if you want to make yourself dead, you’ll be able to find a way to do it. The power, and the responsibility, rest with you.”

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Picture Credit; Engin Akyurt on Pixabay

As professionals, as parents, as friends, we need to be able to protect ourselves from ever being in the false position of the one who can be good enough, loving enough, clever enough – to win the struggle to keep someone alive who wants to be dead.

Paradoxically, we need to be prepared to take seriously the person who tells us they wish they were dead, or fears that they might take their own life.

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With this first, necessary part of the conversation out of the way, we turn our courage and our compassion to the next part:

“If you were sure you wanted to be dead, you’d be out there doing it. The fact that you are here, telling me how you feel, means that there’s a part of you that wants to be protected from that choice. I will do all that I can to help you.”

Then, we need to be brave enough to hear them out. To listen to their whole story. To accept that this is a real choice they are considering.

(And by the way, don’t fall for the myth that people who threaten suicide never actually do it. The fact is that most people who end up killing themselves have usually told someone how they feel, sometimes more than once. If someone tells you they are in that much pain, believe them.)

It takes courage to hear them out – to hold back from the natural desire to argue with them, to persuade them that things aren’t that bad, to minimize what they are telling you. They are suffering, and they are suffering for a reason (or several!)

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In a recent episode of the Radio 4 programme, The Moral Maze – How Should We Talk About Suicide? one of the participants stated, and no one disagreed, that of course we could never know the reasons for a suicide. Really? It is quite likely that at some point, a person who ultimately ended their own life did tell someone, or more than one person, the factors that were pushing them in that direction. We certainly can know at least something about why that suicide took place.  The Samaritans have had many of these conversations, and collectively will know a great deal about both personal and societal reasons for suicide.

Another feature which was almost entirely absent from the discussion in that episode was any mention of suffering. ‘Mental distress’ was only briefly mentioned during the closing statements. There was no mention of intractable physical or emotional pain, which might lead to a ‘rational’ decision to take one’s life.

There are rules, for the protection of listeners and viewers, about what can and cannot be broadcast about suicide. This may have contributed to the sense that the discussion remained abstract, as it may not have been possible to address some central issues.

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Picture Credit: Ryan McGuire   displayed on Pixabay

People who are so desperate as to consider ending their lives are desperate because they are in pain – physical or emotional. People in extreme pain want an end to the pain, not to their lives. Only when no other alleviation is available does ending their lives become the ultimate choice.

Just being heard, being encouraged to tell everything about their situation, without being judged, or reassured, or argued with is a powerful healing experience.

And the more completely the story is told, the more clues there will be about things which might help.

Because the conversation then should proceed to “What, specifically, can you, or I do to tackle these problems?”

During the time I was working in mental health settings, and as a private psychotherapist, it was a legal obligation to notify a person’s doctor if they were ‘at risk of harming themselves or others’ and it makes sense to follow this rule – but preferably the person themselves should do the notifying. There are psychoactive drugs which can alleviate emotional pain, and this may be the best first port of call. Also, there should be a thorough medical examination to establish whether a physical health problem is causing the psychological distress. Recent advances in research on the connection between gut health and mood disorders may lead to an unexpected prescription, such as referral to a nutritionist.

In your extended conversation, you may have heard about an abusive childhood, a current toxic relationship, addiction problems, marital problems, family problems, financial problems, legal problems, career problems – each of which points to the appropriate professional help to seek out.

As a friend, and even as a professional mental health worker, you cannot solve all (or even any) of these problems. What you can do is support your friend, family member, or client, in taking positive actions on their own behalf.

If this kind of support is refused, leaving you feeling both responsible and helpless, you are dealing with a person who wants to punish someone for their suffering. 

Suicide can be a very angry business – “You’ll be sorry when I’m dead” shouts the four-year-old in a tantrum – this is the adult version of that rage.

This is why it is important to, lovingly, step aside from the role of omnipotent saviour. You’ll do all you can, but the final decision rests with that person.  A courageous and compassionate response might be to state: “I’m not to blame for your distress, and you won’t achieve happiness by making me suffer, but I love you and I want to help. Let’s set to work together.”

Whilst the ultimate responsibility remains with the suicidal person, don’t be afraid to believe in their suffering, and to offer what help is within your power. You cannot save that person, but believing what you are told, hearing out their story, doing what is within your power just might be enough to persuade them to save themself.

Throughout my career, I always took seriously the information that a person felt suicidal, in the way I have described so far.

In an era when you were legally required to notify a person’s GP if they were judged to be ‘a danger to themselves or others’ and there were legal powers to enforce an ‘involuntary’ hospital admission, (both of these may continue to be the case) I never had to invoke these powers, although I always made it clear to my patient that I was prepared to do so if it seemed necessary. (Unlike many people, including both clients and professional colleagues, I thought of these powers not as dangers to civil liberties, but rather as an ultimate protection offered by the state, and I let my clients know this was my view.)

As individuals and as professionals hearing suicidal thoughts, we can be caught between the fear of over-reacting or of under-reacting, when a question arises about whether to invoke the help of a GP,  a Social Services crisis team, 111 or even the police.  If you anticipate that a person might be about to share such thoughts, any request ‘not to tell anyone’ should be responded to with ‘I can’t make that promise if I think you are in real danger’. If you are taken by surprise, you still have that obligation.

Whether in personal or professional life, keep in mind that if you over-react, you risk only personal or professional embarrassment. If you under-react, you risk regretting it for the rest of your life.

Believing what patients have told me and taking them seriously has served me well. There have been no suicides in institutions while I was on the staff, and none in my private practice. I may have over-reacted at times; it has been my good fortune never to have fatally under-reacted.

Towards the end of my time in the Social Services, the late 1980s, it had become increasingly difficult to get a patient a place in a hospital. The well-intended movement toward care in the community has meant that social safety nets have been weakened and lost. Increasingly, it is the police who deal with mental health crises, and all they can offer is containment, which will increase suffering, not relieve it.

Particularly in response to under-funding and lack of staff, much mental health provision today seems to have to rely on containment, and suicide prevention by force - again, increasing suffering, mot alleviating it.

All suicides are contextual and involve many different factors. The question of suicide inevitably brings us back to the societal causes of suffering – economic pressures which increase poverty thereby limiting people’s ability to provide for themselves and their families.  Oppressive working situations, lack of health care, poor housing – there is a seemingly inexhaustible list.  

You can look at a piece of legislation, such as the ‘bedroom tax’, or sanctions on benefits claimants, and know there will be suicides.  Suicide is ‘mainly relational’ – but what does it do to relationships to lose one’s living, or one’s home?

You may not be able to blame a specific suicide on a single, specific cause. Nevertheless, suicide is always a red flag for something which is causing suffering, a signal of a problem which should be identified and addressed. In The Moral Maze we were warned against the ‘weaponizing’ of suicide – using it to insist on some political change. Really?  Suicide, especially more than one suicide in a similar situation, is a warning to be heeded - pointing to a change that really needs to take place.

Addendum – Two Unorthodox Approaches

Frank Farelly, the originator of Provocative Therapy, invites us (always with sensitivity and love), to investigate further. To ask such questions as, have you thought of how you would do it? Do you know what that does to the body? Do you know what a person who dies in that way will look like to the person who finds you?  Have you investigated the cost of a funeral? Who will end up with your favourite things? What about your cat?

Faced, not with protests and emotional attempts to talk the person out of it, this calm and sympathetic encouragement to consider the practical details can be a surprisingly effective way to change the thinking of a person threatening suicide.

The Samaritans warn against discussing methods. This is not a discussion of methods, rather it is inviting the suicidal person to think out for themselves the basic realities of what they are proposing. It is unlikely that they have done so, and even if they have, a kindly invitation to think it through even further will draw them away from any glamorous drama they may be imagining, back to earthy and unattractive details.

Provocative Therapy, Frank Farrelly and Jeff Brandsma, Meta Publications, First published in 1974, latest edition, 1994. ISBN 0-916990-03-6

NLP Offers Another Unorthodox Way to Break the Pattern

Because – wouldn’t it be wonderful if you could cut through it all, immediately, stop all the nonsense – all the nonsense that little voice is telling you about what a bad person you are (you aren’t a bad person) and how everyone would be much better off if you weren’t around (they wouldn’t be better off, they’d be devastated) – all that nonsense, even just for a bit?

Well actually, you can, if you and your depressed friend are willing to follow a set of instructions.

Look at the two photos above. Two very different people, both clearly thinking very dark thoughts.

Within the framework of NLP, you can know that both these people are thinking about what terrible people they are, that they don’t deserve to live, and that saying these things to themselves, and believing them, is making them feel very bad.

NLP claims that to engage in these processes – telling oneself things and feeling bad – they must be gazing downward, to the right for the self-critical rant, to the left for the bad feelings.

Get your friend/client to stand up straight, shake themself, put their shoulders back, and gaze upward. They won’t want to do this, because depression tells them they are not allowed to feel better, and that you are not allowed to help them feel better.

Depression is telling them to keep doing what they are doing, not to interrupt this process of making themselves feel bad. And they will sense that standing up straight and looking up would interrupt it.

So, take them for a walk, and get them to keep looking up – at interesting rooflines, the higher branches of trees, cloud formations.

They won’t be able to help feeling better, and they won’t thank you for it. There’s nothing as disconcerting as discovering that in certain positions and while doing certain things, one simply cannot feel suicidal at the same time! 

It won’t be easy for them to allow themselves to use this information and put ‘looking up’ into their repertoire of ways to feel better. But it’s a start!

Based on concepts from NLP; also A Beginner’s Guide to Lifting Depression, Les Simpson and Nancy Blake, Lifelight Publications, 2016.

Afterword

My career included nine years as a staff member of a psychiatric day hospital, followed by two years as a specialist social worker working with ‘fat file’ complex cases. As part of the shift towards care in the community, I was given responsibility for developing and running a new program in a purpose-built Social Services day centre for people with mental health problems. After four years I became Principal Officer Health for Scunthorpe and Grimsby, then Information/Policy Officer concerning HIV. After a subsequent year as Senior Social Worker at Castle Hill Hospital, I retired to work for the next twenty years as a UKCP accredited neurolinguistic psychotherapist.