Let’s (Really) Talk about Suicide

In a week when two celebrities, Kate Spade and Anthony Bourdain, died by suicide within days of each other, so did hundreds of other people in the U.S. One of them was named Flinn, a classmate of mine in high school.

On Flinn’s public Facebook page, an outpouring of sympathetic posts, one after the other, creates a trail of digital tears. In a long stream of posts expressing their heartbreak, people lament the pain and suffering that Flinn endured.

Nobody uses the word “suicide” or “killed himself.” Nobody says he intentionally ended his life. But he did die by suicide.

Stigma and Suicide

It’s heartbreaking – not only Flinn’s death, but also the conversation around it. There is so much stigma, fear, and pain attached to suicide that many people dare not say its name.

I don’t fault those who avoid naming suicide. Instead I fault society and social conditioning for teaching us to treat suicide as unspeakable.

If we can’t acknowledge suicide when a person has died, then how can the living expect to talk openly with friends and family about their urges to end their life? It’s awfully hard to help suicidal people – and for them to ask for help – if we treat suicide as if it is a dirty word.

Avoiding the Question

Many people are too scared to talk directly about suicide – even some therapists. In my book Helping the Suicidal Person, I describe a co-worker at a counseling hotline who explained that she would never dare ask anybody if they were having suicidal thoughts. And she thought I was a freak for doing so.

I teach a class on suicide risk assessment and intervention to aspiring social workers at the University of Denver. On the first day of class, I ask them to write down one or two questions they would ask someone to determine if the person is thinking of suicide.

Some come right out with it and ask: “Are you thinking of suicide?” “Do you think of killing yourself?”

Others ask, “How has your sleep been lately?” “Are you depressed?” “Do you think of hurting yourself?” Those questions will help you learn if someone’s sleeping poorly, depressed, or thinking of hurting themselves – not if someone’s thinking of suicide. Perhaps the conversation will lead there. Perhaps not.

“Hurt yourself” is a euphemism that some people use for suicide. Instead of asking, “Do you want to kill yourself?” they might ask, “Do you want to hurt yourself?” Yet there are people who intentionally hurt themselves without wanting to die. There are also people who desperately want to die and view suicide not as a means to hurt oneself, but to stop hurting. So the person’s answer to “Do you want to hurt yourself?” might not mean what you think it does.

Fears of Asking about Suicidal Thoughts

Why don’t people ask directly about suicide? They may fear that talking directly about suicide gives others the idea (it doesn’t), as if everybody on earth who has finished elementary school doesn’t already know about suicide. Or they might consider it impolitic to name suicide, because of the stigma attached to it. Or they might be afraid of saying the wrong thing, or of angering the person, or of being unable to help.

These are all legitimate fears. It’s scary to ask someone about suicidal thoughts. But avoiding the topic does not make the problem go away. It drives it underground, where a suicidal person may feel even more alone in the darkness.

Ways to Help Suicidal People

© Skdesign | Dreamstime Stock Photos

To truly foster open, constructive conversations about suicide — to create an environment where people can ask for help from loved ones and professionals — we must actually name it. Only then can more suicidal people feel welcome to reveal their thoughts.

Only if we name suicide can we reach out to those we worry about and ask, “Are you thinking of suicide?” And then we can truly listen and join with the suicidal person.

There are specific techniques for asking a person about suicidal thoughts that can lessen the potential for stigma, shame, and discomfort. One way is to convey that the person is not weird or wrong to have suicidal thoughts: “Sometimes people who feel as crappy as you do have thoughts of killing themselves. Do you?”

Talking about Suicide

Once potential helpers can talk openly about suicide, it opens the door to conversations that can lead to help, hope, and healing. If you’re wondering how to respond to a suicidal person, check out my post “10 Things to Say to a Suicidal Person.” I also have a post, “10 Things Not to Say to a Suicidal Person.”

I have no idea if these conversations occurred with my old classmate Flinn, or if they would have helped him. I remember him as someone who loved to surf in the feeble waves of Galveston and play hacky sack in between classes, but it’s been 30 years since I last saw him.

What I do know is that Flinn died in a way that many people actively avoid naming. This silence about suicide can be deafening, making it exquisitely hard to hear those whose cries most need to be heard.

If you think of suicide, please consider calling the National Suicide Prevention Lifeline at 800.273.8255 (TALK), texting the Crisis Text Line at 741-741, or getting help from other resources listed at www.SpeakingOfSuicide.com/resources/#immediatehelp.

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Stacey Freedenthal, PhD, LCSW, is the author of “Helping the Suicidal Person: Tips and Techniques for Professionals,” a psychotherapist and consultant, and an associate professor at the University of Denver Graduate School of Social Work.

Copyright 2018 by Stacey Freedenthal, PhD, LCSW. Written for SpeakingOfSuicide.com. All Rights Reserved. Except where noted, photos purchased from Fotolia.com.

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  1. Anonymous says:

    I have had suicidal thoughts since childhood, I have been in therapy and on meds for decades. I am managed, barely. One thing/treatment/crutch I have not seen in the comments or the posts I’ve read are service dogs. My service dog is the reason I wake up each day and one of the main reasons I don’t actively seek to end it all. I need to be here to take care of her and her life revolves around caring for me. She is unconditional love, something very few if any humans can provide. The caveat – you need to truly love the dog in order for the partnership to work. I live for my dog. She is my world. The downside is that when her time on earth is over, I will lose my lifeline – probably be in hospital for a while, heavily sedated most likely. However, in the meantime, the need to care for her and protect her gives me a reason to exist. She makes me wake up each day even if I don’t feel like it. A hungry dog that needs to pee is more persistent and demanding than 6 alarm clocks and timed lights. Just a thought for those that might find a psych service dog a useful addition to their current treatment plan. It was a previous psych Dr. ( in a previous town) that recommended I get one. She has helped me through the past 10 years more than any pill, although I still take those too.

    • Stacey Freedenthal, PhD, LCSW says:

      Anonymous,

      Thank you for sharing. What a gift that your service dog helps you so much. What a gift, too, that you shared this hopeful advice with others here.

      I would add that much of what you said applies to any dog, whether or not a service animal. I highly recommend a pet of any kind for improving one’s mental health! That said, it sounds like a service dog can be even more special because of their devotion to their person’s well-being.

      Thanks again for letting folks know. I hope she’s with you for years more to come.

  2. Tore Nielsen says:

    I often decide against talking about suicide because I don’t have anything hopeful or productive to say. I couldn’t be one of those people who de-mystify suicide by giving talks.

  3. Milestiba says:

    Within the first couple of sessions (group and individual) with my new therapist, I learned that she had a client die by suicide a couple years ago. She felt like she had missed something and talked about how she had to deal with it. I deal with severe chronic suicidal ideation. Possibly a huge trigger for her. In the state where I currently reside, if a person has no insurance, they are only provided 12 individual sessions in a lifetime. So, I was not willing to really work with anyone. By the time I was able to have insurance, I had everything worked out… my suicide plan. I had done recon of the area, I have all the supplies I need, I have everything in place should this next (the sixth) attempt not work, and I have the compulsion to attempt this plan almost daily. Between a mental health wellness center I was directed to, and the tenacity of my new therapist, I have started to have much better days more often. And the bad moments seem even more severe than when it was all I ever had. So, it is terrifying even to me.

    My therapist, however, has avoided any direct conversation regarding my suicidal ideations. It has bothered me because it left me not really understanding her tactic. Was she of the impression that if we dealt with everything else, it would go away? Because after three months, that was not happening. Still, I had my crisis counselors who have worked with me and kept me alive over the last year to bounce ideas off of and keep encouraging me to go back to my therapist and talk. I sent her a post from this blog, I sent her posts from The Mighty, I sent her a screen shot of the book I had ordered (Helping the Suicidal Person by Stacey Freedenthal, PhD, LCSW) with the hope that if the advice came from another LCSW and didn’t seem to come from me, then maybe we could make headway.

    I am struggling with 5 “perfect” kill dates in the next three weeks and I just fight the urge to shut down and go ahead and try to kill myself in order to protect people from the monster I have believed myself to become. On Thursday, my therapist told me that she has realized that she has been taking the “punk” way out. Her word, not mine. She also believes that she needs to deal with this better because it has left us in idle instead of possibly moving us forward more effectively. I don’t have any idea what that means. But, how often do providers tell their consumers that they were wrong? Everyone has consistently told me that they hear what I am saying and my therapist is working really hard to help me when she could easily tell me to go find someone else instead of trying to learn how to adapt and work with me. About two months in, my therapist point blank told me I am one of the most difficult consumers she had ever worked with. I know it can get worse. I know what we have to work through. I know what has happened in the past. I have had severe troubles with past therapists (including reporting to the Board of Psychology and having the therapist and her family retaliate with exaggerated claims in order to file criminal charges against me) and that makes for a lot of problems in my current therapeutic relationship. I don’t know what all this will lead to, but I struggle with wondering how much better it really would be just to try and kill myself. If she hasn’t worked with me too long, it can’t be that devastating, can it? That is what my mind tells me. It’ll be easier for her the second time around. She has to know by now it is not her fault.

    But then, I know how crappy that is… not because I know this person all that well, but because I have spent several hours reading accounts of mental health professionals and first responders that were in the midst of dealing with suicide… whether crisis counselors, therapists, police officers, etc… and they all had trouble even with people they never met before… even though I adamantly do not believe anyone will care when I am gone… I can still read those pages and think that maybe my mind is wrong.

    I guess it shows something that I have no longer remained at one with my depression. It is definitely something that I am actively fighting… even though I do not always feel so successful doing it.

    Thanks for your blog, your book, and your work on such an important issue. It was a huge turning point for me when I came across your work. You have continued to speak to me in a manner that reaches me and makes sense and helps me fight to stay alive. Perhaps one day… all my work will be able to help others. Who knows?

  4. Janet says:

    Culture is most certainly a sublimation of death anxiety. Suicide is a taboo subject because the strength to face another day often comes from a group-think… “everyone else is doing it.”

    There is inertia to living, and it’s put in check when someone kills themselves. The unspeakable option reveals itself as “there”, as always being “there”. Death is always a tragedy, but a suicide’s death is marred with controversy.

    There are few things I staunchly believe in; one of these things is the unalienable right of any person to end their life when they see fit. The subjective, personal life of an individual is magnitudes greater in depth and complexity than anything else and it deserves absolute respect.

    • Pattie says:

      Agree.
      Who, among us, has the moral superiority to claim the right to define the act of suicide-for someone other than themselves- as wrong or bad?
      Even further, No laws should give authority to that false notion of moral superiority!
      To justify encapsulating the act of suicide into laws that criminalize it, or more commonly now to “allow for a person’s rights to be denied” if someone is believed to be planning to kill themselves, is wrong on so many levels that I don’t even know where to begin…

  5. DF says:

    “On a scale of zero to ten, how much do you want to be alive these days?”

    • Df, Not sure who you are asking, but I’m in a chatty mood today I guess. On a scale of one to ten, i guess I am a 10 simply because i’m … well… alive. I guess if I stop to consider how much it would take to shift that to wanting to kill myself…questioning how solid or fragile my resolve to live is at the moment. Probably a 2 or a 3. It would not take much to tip me over and pour me out. It is a very frightening feeling, to be afraid of yourself.

    • Pattie says:

      I think you’re suggesting thats what you think the question should be, rather than “do you want to kill yourself?”, right?
      I like it!

  6. Thank you so much for this Stacy! I was nodding my head all along! I even texted my counselor and told him my thoughts on asking “Do you want to hurt yourself?” vs “Do you want to kill yourself?” I would add to that, “Do you want to die?” because there is rarely a day that goes by that I don’t want to die… but I do not want to kill myself. Even so, that is a choice I make daily. I know when people ask me “How are you?” or “How ya doin?” they are really asking if I want to kill myself. I’m not sure that I could ever make them understand that to me there is a difference in wanting to die and wanting to kill myself. Even seeing it in print makes me question the validity of the thought. Anyway, I appreciate this article so much. You just have no idea.

  7. Pattie says:

    Yes. Thanks Stacey. This is a safe place for those of us who live with these issues, and are not allowed to talk about them.
    And yes, I hate the phrase “hurt yourself” because of the reasons you stated. It’s a misused phrase that doesn’t really fit suicide, and it has caused many of us to suffer because of offbase assumptions that only confirm our fears that “no one understands”.
    The only thing I would add for people who dont know how to approach the topic of suicide- in addition to listening- is that you actually have to CARE. Many people DONT, and personally speaking, i would prefer that if you are just trying to show that you care, and just want me to feel like you care by listening, please, dont bother. Dont pretend to try. Because if I open up to you, i might tell you how difficult it is, how much pain I’m in, and then i would notice how quickly you back off.. because you are afraid I might ask something more of you, and then i have to find out that you’re really not sincere at all– in fact, you’re quite selfish. And thats something i really dont need to see again and again.

  8. Penny says:

    Thank you, thank you, thank you for sharing this. As someone who lives with CPTSD, this piece is a breath of fresh air. Suicidal thoughts are a symptom of my condition, results of my right frontal lobe being damaged by years of an amygdala at defcon 5. Yes, it’s sinister. Yes, there are moments when hanging on seems impossible. Yes, I’d like my condition to be reacted to like I just said I had cancer, instead of having to hide in a tower Quasimodo style for fear of judgement. I’m not contagious, so if someone expressed empathy for me, they won’t catch the suicidal thoughts, the dissociating, or the muscle armoring by doing so. Don’t be fearful of having tough conversation with your family, friends, or co-workers. Ask directly, “Are you thinking about killing yourself?” Then be compassionate, don’t advise, and just hold space for what comes next. It’s a decompression to be spoken to so genuinely, to be cared for in that horror of wanting to die. Your empathy might just save a life.

  9. Suzanne Lenz says:

    I go out on a limb here because I feel these things need to be said. I refuse to be embarrassed. Someone needs to hear these words. I speak from personal experience and from the unspeakable pain of trying to prevent my own suicide after my husband’s sudden & horrible death. I have thus far succeeded but not because of anything I was lead to believe would help me. I ended up relying on my own tenacity and loving my family & friends so much that I could not bring this upon them. That has made the pain even worse. There are times when the mental anguish becomes more powerful than love and that is something only a person who has been there can understand – a person who can relate to what a struggle it is to hold on, to try to keep your grip onto something you cannot even imagine let alone see and to do this during a raging, lashing, stinging, unrelenting typhoon of mental pain. Minutes become hours; hours become days. Here is the problem – if you are suicidal, don’t want anyone else to know you are losing your grip on life, and you go onto any of the websites to “help” you, all you find are pictures of teenagers & cheer leading garbage – nothing for the ages most at risk (middle age, elderly, men). And I ask WHY do YOU personally want to stop a person from taking their own life? What is it that makes it so awful to you? Is it so awful that you would be there at all hours of the morning & night? Would you change your work schedule? Would you fly across the country? And I ask, would you try to prevent the death of someone from other fatal diseases or do you just accept their death as a foregone conclusion? If you were to save the life of a suicidal person, what would you do it for? Are you willing to do what it would take to help create a life for them that is worth living? Can you eliminate the disease that haunts them and is so unbearable that all they want to do is end the excruciating pain? Do you care so much that you’d give of yourself, your time, your money at any hour of any day or night to prevent the suicide? Or are you content to throw pills, 800 numbers and websites at the suicidal person and then feel at peace with yourself – you’ve “done all you could.” And I ask this also – have you yourself ever called one of these 800 numbers only to hear a teenage sounding kid who says, “Hello. What would you like to talk about?” And when you say, “Never mind – this was a mistake” not long after, the state police are knocking on your door – just what you need your neighbors to see. This 800 call – made on a lovely summer afternoon
    – after you dialed family member after family member & friend after friend trying to find a life raft & all you get are answering machines & comments like, “that’s between you & your maker” or “that’s up to you.” Now, you will never risk calling this number again and you will surely not talk to anyone else about your suicidal thoughts for fear of being “turned in” or watched like a hawk instead of receiving the care and compassion you so much need. So when pills, therapy, family, friends, doctors, prayers, psychiatrists, websites & 800 numbers let someone down one after the other, why on earth do you become so upset when the poor soul finally resorts to the only option they feel they have left – ending their pain in the only way now possible to them? The same useless editorials & nonsense that passes for “insight” proliferate all forms of media after a celebrity suicide and then it will all die down; and once again, the walls of suicide will welcome so many more new members. Family & friends that DID try to help or had no clue will be left in writhing pain and subjected to the pathetic babbling that people who profess to care spit out. And again I have to ask, 1. why is death by suicide so much more awful to you than any other manner of death?; 2. why do you feel you need to stop it? and 3. if you can give a sincere answer to 1. & 2., what are you willing to do that has any affect or meaning? How will you truly help those who continue to try to find a reason to live?

    • Pattie says:

      Suzanne Lenz,
      Wow, could not have said it better. I sooo agree! Thank you.

    • Joe says:

      Hear, hear! It’s all well and good to talk the talk about encouraging open, constructive dialogue, but in a society that stigmatizes the suicidal and dismisses them as not thinking correctly, a reality check is in order.

      Your experiences serve to highlight the other side of the conversation that gets left out: the judgments, the platitudes, the “get help”s, the police dispatched by the hotline operator, the incarceration followed by the huge medical bill for their “services”. All too often the situation is framed as the suicidal being too embarrassed or too afraid to reach out when the reality is they reach out all the time and are insulted, dismissed, and punished in response. The goal isn’t to help but to stop the offending behavior.

      It’s no coincidence that you see mostly pictures of teenagers on these anti-suicide sites. The example always trotted out in support of anti-suicide policy is the teenager who wants to die because her boyfriend broke up with her. It’s easier to dismiss problems when you can attribute them entirely to irrationality. Disease, chronic pain, chronic loneliness, etc. are not so easily invalidated.

      Like most of what you read in a heavily pro-life society, the conversation is very one-sided; it’s all about how “potential helpers” can breach the guard of the suicidal so they may be made properly receptive to the helpers’ truths. So long as this arrogant posture is maintained there will be no dialogue, just the happy and healthy talking down to the unhappy and unhealthy.

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