Just about every list of “suicide myths” mentions this one: “If a person is serious about killing themselves then there is nothing you can do.” But is it always a myth?
In important ways, yes, it is a myth. There are many things that loved ones of a suicidal individual can do to help – things like asking directly about suicidal thoughts, fully listening to the person, providing nonjudgmental emotional support, removing firearms and other lethal means from the home, giving a list of resources for help and support, and helping them to get professional help.
At the same time, especially when suicidal thoughts and behaviors persist for many months or years, loved ones may come to a point where they have to recognize their limitations. In some important ways, their hands are tied.
Recognizing My Own Limitations with a Loved One
I came to the realization many years ago that I could not fully protect a close friend from suicide. She went through an extremely suicidal time for over a year. One night, she came to my house at midnight with her wrist bleeding. She had attempted suicide. She refused to let me call an ambulance, and it even took much persuading before she would let me take her to the ER. They gave her stitches and discharged her to my house (she refused hospitalization and did not meet criteria for involuntary commitment). The doctors advised me to remove all sharp implements and pills from her reach.
My friend stayed with me a couple days. When she went back home, I was left with this feeling of abject helplessness, this recognition that she might kill herself, and also this sudden acceptance that ultimately I could not control if she died by suicide.
Even when she was at my house, even with all my sharp implements and pills hidden in the locked trunk of my car, I could not have prevented her suicide. I had to use the bathroom sometimes. I had to sleep. She could have walked out the door at any time and found other sharp implements, pills or means to die by suicide. Ultimately, though I did what I could, I was helpless.
Recognizing Your Limitations
No matter how desperately you may wish otherwise, there is only so much you can do to stop another person from dying by suicide. You cannot monitor a family member or friend every second of the day. You cannot remove all means for suicide entirely from their world. Although you can talk with them about their suicidal thoughts, you cannot read their mind if they choose not to share them.
Even professionals are not fully able to prevent suicides. One study found that almost 1 in 5 people who died by suicide had seen a mental health professional within 30 days of their death. That means that in the United States, with almost 43,000 people dying by suicide in 2014, more than 8,000 of them had recently seen a mental health professional. A study in Finland found that almost 10% of suicides occurred within 24 hours, at most, of an appointment with a health professional.
Even inside locked psychiatric hospital units, even when patients are under constant supervision, some patients die by suicide. That is staggering. It is also illuminating. If mental health professionals and psychiatric hospitals cannot prevent all suicides, then how can friends and family be expected to do so?
Coping with Your Limitations
When I realized my inherent limitations with my friend, I came up with a saying (I’m sure I’m not the first):
Do everything you can, but know you can’t do everything.
It is hard, terribly hard, to sit with the fundamental helplessness you may feel about your loved one who is in danger of suicide. At these times, it can be helpful to really recognize that most people who end up dying by suicide have depression, post-traumatic stress or another mental illness, a genuine and sometimes severe illness, just like cancer or heart disease. Although the illness is treatable in most cases, and although most suicidal people go on to live many years without ever dying by suicide, the illness might prove to be fatal.
Michael J. Gitlin, M.D., is a psychiatrist who lost a patient to suicide shortly after finishing his psychiatric residency. He wrote about his experience in a poignant journal article. As somebody who specialized in treating people with severe depression, he articulated the high probability of suicide among some of his patients. He came to accept that his work was like that of a doctor working with cancer patients: Not everyone could be saved.
I am not saying that loved ones and therapists should not do what they can to prevent a person’s suicide. Of course they should! Many lives have been saved by the actions of concerned others who did their best to help. But if a life is lost, that does not necessarily mean that anyone failed, that anyone made a grave mistake, that anyone is to blame.
You do everything you can, with the understanding that “everything you can” cannot be everything.
EDITED: February 5, 2015
*© Copyright 2013 Stacey Freedenthal, PhD, LCSW, All rights Reserved. Written For: Speaking of Suicide
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