A Book Review: Loving Someone with Suicidal Thoughts

• I just don't want to live anymore
• If only I could fall asleep and never wake up
• One well-placed bullet would solve all my problems
• You'd be better off if I were dead

Oh my gosh, words you don't want to hear from somebody you love. It is tempting, so very tempting to say something that will get your loved one to take it back.

Surviving Suicide - Can Our Stories Help Others?

The worst part of being suicidal isn't that it can kill you. The worst part is that you likely suffer alone.

You don't talk about it with friends and loved ones because it hurts them. And they respond by saying hurtful things.

You don't talk about it with a professional because you fear being subjected to the trauma of forced treatment.

No, that's not right, not always right anyway. Sometimes loved ones know how to listen. Sometimes professionals know how to help.

But still. These skills seem to be rare. And it's all so scary.

Even after you're better, it's scary. Scary for you, scary for them. Especially scary if it got to the point of self-harm, a suicidal act. Upon release from the hospital, you are treated to silence. People want to "protect your privacy." They also want to protect their own peace of mind. NOBODY wants you to mention it again.

Live Through This

So an archive of 157 stories of people who tried to die at their own hand, and yet they survived, a place where you can find people who are willing to tell their stories, how they got to that scary place and how they moved beyond it, or how they didn't (the scary lingers), that place is -- transgressive.

Real Suicide Prevention or Self-Satisfied Nonsense?

It's Suicide Prevention Month/Week/Whatever again. Those of us who are or have been suicidal know suicide prevention as a year-round, full time job. Those of us who are or have been suicidal have a whole lot of experience at preventing suicide. Is anyone interested to hear from us? Some of the following came from an earlier post. It bears repeating, 'cuz evidently even some bright people have some strange ideas. Like:

Suicide is not a choice

The way people talk, you'd think we sit down and make a list, pros and cons of suicide. Then based on our calculations, we make some kind of decision. She chose to end her life. Or, How could he have been so selfish.

This is called the volitional theory of suicide, suicide as an act of will. The suicide prevention approach that addresses it is to weigh in on that list of pros and cons, like Jennifer Michael Hecht's book, Stay.

You know -- Suicide is a permanent solution to a temporary problem. Or, Think of what you'll miss out on. Or, whatever. In other words, how dumb or short-sighted or irresponsible or selfish you must be to decide to kill yourself.

Want a Sneak Peak to the Healing Trauma Conference?

The third annual Healing Trauma Conference: Come to the Table: Nourish your Body, Mind, and Spirit, Because No One Heals Alone takes place April 30-May 2, sponsored by Haelan House of Bend, OR -- Healing the Root Causes and Effects of Trauma.

My bit is Sunday morning's keynote address:

Suicidal Thoughts as Trauma:

Taking Charge of My Own Recovery.

Description: Trauma can be both the cause and the consequence of suicidal thoughts. Suicidal ideation is considered a symptom of a mental illness. The mental illness model (what's wrong with you? instead of what happened to you?) suggests that if the illness is treated, then the symptoms resolve. But often, while the thoughts themselves go away, the trauma can go unrecognized, untreated, and underground.

One More Reason to Ask About Suicide

It's always dangerous to listen in when psychiatrists and therapists talk among themselves. I used to do a whole series, OMGThat'sWhatTheySaid, devoted to overhearing what they say about us. More than one post was devoted to their discourse about suicide.

There's been lots of opportunity to overhear in the last several days since the Meghan Markle interview. The clinicians weighed in on Stacey Freedenthal's New York Times article where she dared to repeat what some doctors and therapists have told her (an expert in the field of suicide and suicide prevention), that they fail to ask the question about suicide. There have been proclamations about professionalism, training, protocols, risk-assessment, and - God help us - malpractice.

I started to write a post reporting my own experience of risk-assessment and the failure of my doctor and therapist to ask, even as they told me they were concerned about me. Concerned about what exactly?

But I began to feel -- empty. Like the whole conversation, including my part in it, was missing the boat.

The boat is pain.

What is at stake is whether we have a safe place to talk about our most painful feelings.

What Happened When Meghan Markle Asked for Help?

Ask for help. That is the suicide prevention message. When you are in trouble, ask for help.

And I am not going to suggest otherwise. That's about the only way you will get help. The pain that you are in, the scary thoughts that you are having, there is a way out that is a way through, that leaves you alive on the other side. The way begins when you tell somebody, when you ask for help.

That, alas, is not the end of the story. This week we watched as a princess, a celebrity, somebody who lived in a multimillion dollar house in a multibillionaire family told her story of what happened when she asked for help.

They told her, No.

Confessions of the Good Suicide Survivor Story

I was suicidal. I nearly killed myself. I am glad I didn't do it. Because I got better.

Moral of the story: You will, too.

That's it. That's the good survivor story. Hopeful. Virtuous. I have told that story, and when I do, I get all kinds of strokes, including publication of my writing on other websites.

Some of it is true. It did get better. For me. For now.

For now.

There is more to the story. When I tell the more, I do not get publication. I don't even get acknowledgement that my submitted piece was received. I guess I am submitting to the wrong websites, to places that have one story they want to tell, the good survivor story.

And like I said, it's true, some of it. According to David Conroy, there are 50 million people alive today who have struggled, are struggling, or will struggle with suicide. 45 million of them will die of... something else. That's success, right? 90% of us will find another way.

But that's not the same as the good survivor story. Because for the 45,000,000 of us who survive, we have all kinds of stories.

Suicide is Not a Mystery - Get Beyond the Romance to Get to the Work

Suicidal people have not been quiet this year during Suicide Prevention Month. Most years we are the topic of conversation, not the source of the content of all these campaigns. But Twitter, at least, has been filled with our own voices this year. I have always shot my mouth off, and seldom taken the party line. Which means my voice is never included in the campaigns of the typical mental health organizations.

The following is an example, a post from a previous Suicide Prevention Month, edited with my more current thoughts on the matter.

This is Suicide Prevention Week - from September 8, 2011

When I started Prozac Monologues, I didn't know there was a Suicide Prevention Week. I spent a month writing about suicide in June, 2009. I chose June because it is the month when the highest number of suicides take place. So I wonder why the officially designated week is in September. Maybe because when everybody else is so happy about the sunshine in June, they wouldn't give any thought to the darkness? Maybe because they didn't ask those who are suicidal?

If you want to know my take on suicide prevention, here is the link for those original posts. Among the Labels in the right-side column, you will find links to other posts tagged suicide, suicide prevention, and the like.

Looking back at these posts, I wish I had less to say about suicide. But having this much to say, and frankly, a lot more, I think it's best I go ahead and say it. That was my POV for The Suicide Monologue. And I'm sticking to it. I urge you to take the same approach. If you have something to say about suicide, go ahead and say it.

You know, all those years we never talked out loud about cancer, our silence never saved a single life.

Diagnosing Bipolar - Doing Better to Prevent Suicide

How can I be a better psychiatrist for you?

Frankly, I was gobsmacked by that question. It came in response to reading my book, Prozac Monologues: A View from the Edge. The book is a comedic memoir of misdiagnosis and a self-help book for bipolar. It is both uproariously funny and brutally frank about my suicidal episodes, usually at the same time.

There are two directions to go with that question. This particular psychiatrist cares about both.

What kind of behaviors and qualities could he display that would make the relationship more helpful? Honestly, not all psychiatrists are interested in this question. I don't do relationships; I use psychopharmacology to treat psychiatric disorders, a psychiatrist once told me. Well, that had the benefit of clarifying things.

How can I improve my diagnostic skills? Nevertheless just about any psychiatrist wants to get the answer to the puzzle right, even the ones who treat patients as no more than a puzzle.

A Better Suicide Prevention Month

CW: Cynical Warning.

Anybody else cringe all through Suicide Prevention Day/Week/Month? Anybody else roll their eyes at the "Ask for Help" messages? Or search the lists of "Warning Signs" to make sure you're covering your tracks?

Are you a potential helper and confused by that paragraph? Did you design this poster? Let me explain it to you. The psychiatrist doesn't accept your insurance. The psychiatrist who does accept your insurance doesn't treat your issue. There isn't a psychiatrist. The therapist is available six weeks from now. Or later. What's the point of therapy anyway, the therapist isn't going to pay your rent, if you could make rent you could manage your mental illness just fine, thank you very much.

If you call a help line, what if the cops arrive to handcuff you in front of your neighbors to help you enjoy your free trip to the ER? That's the only thing that will be free. If you go to the ER, you may or may not be admitted. Either way, the bill will leave you homeless.

To Write Love - Hope for Depression, Addiction, Self-Harm, and Suicide

There is power in a story. You tell me your story. You are seen, heard, affirmed. I tell you my story. You know that I am for real. We are not alone.

To Write Love on Her Arms (TWLOHA) harnesses the power of story to offer hope to people struggling with depression, addiction, self-harm, and suicide.

The organization itself began with a story, a young woman who was suicidal but could not be admitted into a treatment program because she was also addicted and they couldn't bear the liability of her detox.

Yes, if you think you're done after you tell your suicidal friend or family member to get help, read that sentence again. Trying to get treatment can be enough of a nightmare to push us over the edge.

But that was just the beginning. A group of friends took it upon themselves to create a safe place and treatment program for this young woman for the five days it took to detox. The treatment program was admittedly unorthodox. She stayed with friends. In rotating teams they supported her, kept her safe. They also took her to concerts, Starbucks, and church. They prayed. They smoked cigarettes. They were her hospital.

Mostly, they listened.

Is It Time to Call a Therapist?

There is a difference between feeling depressed and having depression, which makes it hard to figure out what we need right now when - doesn't everybody feel like crap?

What you are feeling right now might be the entirely normal reaction to this currently abnormal world. Here is what's happening: everybody is experiencing trauma at the same time. Exhaustion, trouble concentrating, insomnia, hopelessness, these are common physical, emotional, and cognitive reactions to trauma. They are also symptoms of a depressive episode. And depression, the illness of depression can lead to serious complications, substance abuse, relationship problems, suicide. Not to mention that it simply sucks the joy out of living. Depression, the illness needs to be treated.

So do you need to see a doctor? It depends. A recent New York Times article can help you sort it out.

Pride Month Report: What Parents Can Do for Their Trans Daughters and Sons

1.8 million LBGTQ youth (13-24) in the US seriously consider suicide each year. The numbers for trans people in particular are even more staggering. According to the UCLA Williams Institute report, 81.7 percent of those surveyed by the National Center for Transgender Equality had seriously thought about killing themselves in their lifetimes, and 48.3 percent had done so in the last year. 40.4 percent of transgender people attempted suicide sometime in their lifetime.

Suicide happens when pain exceeds resources for coping with pain. This report adds evidence to that assertion. The following statistics are pulled directly and paraphrased or quoted from this report.

Misconceptions about Suicidal Thoughts

My publicist seems to think people have a lot of misconceptions about mental illness (she's right), because many of her questions go there. You are very open about discussing your own struggles with suicidal thoughts. What do you think are the biggest misconceptions about people going through similar experiences? So today's post will focus on suicidal thoughts or suicidality.

Suicide is not a choice

The way people talk, you'd think we sit down and make a list, pros and cons of suicide. Then based on our calculations, we make some kind of decision. She chose to end her life. Or, How could he have been so selfish.

This is called the volitional theory of suicide, suicide as an act of will. The suicide prevention approach that addresses it is to weigh in on that list of pros and cons, like Jennifer Michael Hecht's book, Stay.

You know -- Suicide is a permanent solution to a temporary problem. Or, Think of what you'll miss out on. Or, whatever. In other words, how dumb or short-sighted or irresponsible or selfish you must be to decide to kill yourself.

Physician-Assisted Suicide for Mental Illness - It's Complicated, or Not

Two years ago, Mark Komrad attended and presented at a symposium in Belgium on physician-assisted suicide for people with mental illness. Komrad is a clinical psychiatrist, ethicist, and faculty member at Johns Hopkins. He just finished a 6-year tenure on the APA Ethics Committee and helped craft the current APA position on Medical Euthanasia for non-terminally ill patients. [That position joins the AMA to say, in a word, Don't.]

Komrad reported back on his experiences to PsychiatricTimes.com. You can read or listen to the his entire report here. This post quotes the parts that particularly struck me from a suicide prevention perspective.

In 2002 Belgium legalized euthanasia by physician (typically by injection) at the request of patients, and removed any distinctions between terminal vs. nonterminal illness, and physical vs. psychological suffering. As long as the condition is deemed "untreatable" and "insufferable," a psychiatric patient can be potentially eligible for euthanasia. There is a consultative process that basically needs a minimum of two doctors to agree about the patient's eligibility. Also, the patient gets to weigh-in on whether their condition is "treatable." Since the patient has the option to refuse treatments, this refusal may create an "untreatable" situation.

Preventing Suicide Among Gun Owners

Can we reconcile a most basic suicide prevention strategy, means restriction with the 2nd Amendment? Gun owners and public health people have to find a way to talk about this. In Oregon, the conversation has begun.

Gun owners in rural have a sense of responsibility and honor. It's a thing. Part of that responsibility is to protect one's family, one's livestock, and oneself. So let us begin by acknowledging that some gun owners, the ones who live in rural areas where suicide rates are growing the fastest, need guns for protection. But they have to do the protecting themselves. The government, on account of distance and distrust, cannot do the job. And then let us acknowledge that one of the things they need to protect their families (and maybe themselves) from is suicide.

Compare states to states.  Compare regions to regions.  Compare states within regions to other states within the same region.  Compare people of the same age group, in any age group, men to men and women to women.  Compare unemployed people to unemployed people, working folk to working folk.  Compare city dwellers to city dwellers, country folk to country folk.

Compare people with depression to other people with depression; people who are suicidal to other people who are suicidal; people who have a plan to other people who have a plan; people who have a past suicidal attempt to other people who have a past suicidal attempt, for God's sake!

More Guns = More Suicides.

Get it? Rural areas have more suicides largely because they have more guns.

Warning Signs and Suicide Hot Lines Won't Fix This

A psychiatrist remembered his first days on his ER rotation. He dealt with a woman who had tried to kill herself. She was homeless, had been taking meth so she wouldn't sleep ever since she had been raped on the street. The supervisor asked what the young doc intended to do. "Prescribe antidepressants?"

They both knew how stupid that sounded.

In the 80s and 90s, they thought they had this suicide thing figured out. As the number of prescriptions for Prozac rose, the suicide rate was falling. It was widely claimed by people who flunked logic that this was epidemiological evidence that Prozac prevented suicide. Just get more people into treatment. This kind of error is common enough to have its own name: post hoc ergo propter hoc. Or maybe there was some economic incentive behind that sloppy thinking...

Passive Suicidal Ideation and Suicide Prevention Awareness Month

Anna Borges speaks truth about suicidal ideation. In the midst of Suicide Prevention Awareness Month, with its lists of warning signs and gearing us up for the crisis, Anna brings to light the sometimes everyday-ness of suicidal ideation.

I am not always very attached to being alive, she wrote in at article for The Outline, an online magazine. It's not about being in crisis, not about having a "plan," not about needing an intervention. It's more like an indifference to life that sometimes surges into something more serious and then falls back. Like the waves of an ocean.

At 27, I’ve settled into a comfortable coexistence with my suicidality. We’ve made peace, or at least a temporary accord negotiated by therapy and medication. It’s still hard sometimes, but not as hard as you might think. What makes it harder is being unable to talk about it freely: the weightiness of the confession, the impossibility of explaining that it both is and isn’t as serious as it sounds. I don’t always want to be alive. Yes, I mean it. No, you shouldn’t be afraid for me. No, I’m not in danger of killing myself right now. Yes, I really mean it.

The Blues Aren’t Blue For Me - For Suicide Prevention Awareness Month

For Suicide Prevention Awareness Month, guest Margalea Warner tells a story of healing after an attempt and what happened #AfterIDidntKillMyself.

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When I emerged from the gray cloud of near death, the color I woke to was blue. It was an artificial blue, kin to a chlorinated pool water or blue Jell-o or Smurfs. It was a long tube with ridges that seemed to be coming from my face. I couldn't use my mind well enough to know it was a respirator tube. I stared at this blue with bewildered wonder. 

I did not remember what caused the gray. I did not remember walking away from my job at ten in the morning without asking for time off. I did not remember going through my closet and throwing all my clothing in the dumpster until I had very little left to wear.

From deep inside my mind I did remember a room of flickering shadows where I was on trial for witchcraft or for being a bad daughter. I remembered the voices saying that I must be executed. I had to be my own executioner. I remember narrator voice saying, “The prisoner is walking into Reliable Drug.  She is walking through Health and Beauty. She is walking through First Aid.  She is picking up a bottle of rubbing alcohol.  She needs the Reliable Drug brand. It will be a reliable drug. She needs it now. No time to think about it.”

But what happened next? I couldn’t remember if I obeyed the voices. I wish I could remember if I challenged their distorted thinking. All this forgetting makes perfect sense when you consider the gray that followed it. Fortunately or unfortunately, my mind’s computer made a back up copy in the cloud and replayed it over and over years later.

Flip the Script on Suicide Prevention Week

National Suicide Prevention Week starts next week (September 8-14) and I am trying to gear up for it. I can’t remember which I am supposed to watch for, the risk factors or the warning signs. I guess somebody will tell me again.

Not to be snarky – I do appreciate this annual effort to get people to pay attention. You’d think so, given my personal stake in preventing suicide, as in, my own. But I have to confess, these campaigns leave me feeling a bit disconnected from myself. How ironic is that?

I figured it out. The problem is that I pay any attention at all to suicide prevention campaigns. But they are not addressed to me. They are addressed to professionals, friends, and loved ones. They are about me and others who are at risk.

But here’s the thing. Professionals, friends, and loved ones are bit players in the suicide prevention business. The ones who do the heavy lifting are the ones in danger ourselves. So we read the literature, always looking for another trick to try, only to discover that we are eavesdropping on somebody else’s conversation.

Honestly, we don’t need to know the warning signs. Honestly, when we are in late stages of planning, we read those lists to make sure we don’t slip up and give the game away.

The Heavy Lifters for Suicide Prevention