The Pandemic, Suicide Rates, and Social Isolation

Written by on December 30, 2020 in All Posts with 48 Comments

We don’t know if suicide rates in the U.S. have gone up since Covid-19 first spread around the country, but it’s not hard to find reports of people whose suicides seem indelibly linked to the pandemic.

There’s Dr. Lorna Breen, the ER physician in New York City who worked 18-hour days in the height of the pandemic’s first wave last spring, and then contracted the virus herself.

There’s Christian Robbins, a 16-year-old who killed himself a month into the pandemic in Washington, D.C. His father agonizes about the what-if’s: What if they hadn’t cancelled their family vacation? What if schools hadn’t closed? What if the pandemic had never happened?

And there’s Spencer Smith, a high school sophomore in Maine who died in early December. He left a note for his parents saying he felt stuck at home and disconnected from his friends.

Suicide doesn’t have a single cause. There’s usually a confluence of reasons, which can include mental illness, substance addiction, stressful life circumstances, biology, exposure to suicide, and numerous others. So, it would be simplistic to blame suicides on the pandemic alone. But the pandemic certainly isn’t helping.

Are Suicide Rates Increasing during the Pandemic?

Official statistics about suicide in the U.S. won’t come out for a while. Right now, on the cusp of 2021, statistics for 2019 were released only a week ago. (There was good news, too: The suicide rate dropped by 2.1%, the first decrease in 15 years. However, good news is relative. More than 47,000 people died by suicide in 2019.)

Early research findings about suicide during the pandemic are mixed. Some areas, such as the Pacific Northwest and New Mexico, found no increase in the pandemic’s first 6-7 months. However,  a study in Maryland found that the suicide rate almost doubled for Black people in the first few months of the pandemic, relative to the same time period during the prior three years. Paradoxically, the same study found that suicide rates dropped by nearly 50% for white people early in the pandemic.

Whether the pandemic is leading to more suicides or not, it’s creating conditions that increase suicide risk. At least 10 million Americans still have lost their jobs. This has left many millions of people without enough food, resulting in hours-long waits at food banks. Poverty has increased. An “eviction tsunami” is predicted once a national moratorium on evictions ends. It’s worth noting that poverty and unemployment are significant risk factors for suicide, as is homelessness.

The Perils of Social Isolation

Perhaps the most dangerous side effect of the pandemic, besides the virus itself, is social isolation. Humans are social animals. We need conversation, touch, laughter, camaraderie. Zoom and phone calls are better than no connection at all, but they can’t nourish us in the same way as a face to face conversation, a hug, a literal pat on the back, a kiss, sex.

Staying at home and physically isolating from others has meant the obliteration of normal daily life. For many people, the new normal means not working at the office or going to school among their peers. If you’re taking care to protect yourself or others, the new normal has meant not going out to restaurants or the gym, not going home for the holidays, not seeing your friends in person.

To me, a United Nations photo captures, no doubt unintentionally, just how deadening isolation can be. A pill bottle encloses a solitary chair. The pill bottle is shut, devoid of fresh air.

The image reminds me of Sylvia Plath’s infamous bell jar of depression. In her autobiographical novel, she compared her feelings of inner deadness to “sitting under the same glass bell jar, stewing in my own sour air.” (Sylvia Plath killed herself one month after The Bell Jar was published.)

The effects of isolation are so grave that experts worry it’s killing older adults, especially those in nursing homes who can’t receive visitors unless a wall and window separate them. Some nursing homes are taking creative measures to let human contact continue, like the one in Texas using “hugging booths” created by Boy Scouts.

Do You Feel Suicidal During the Pandemic?

Even with the devastating effects of the pandemic, it’s important not to convey that suicide is the solution. It’s not. If you’re feeling despair or thinking of suicide, please call the National Suicide Prevention Lifeline at 800-273-8255 (TALK) or use other free resources listed here.  

And please, remember that things are constantly changing. The new vaccines will, as far as we know, get the pandemic under control

Remember the UN picture I mentioned of the empty chair inside a pill bottle? There are a couple others, too, and they’re more uplifting. Though they’re not explicitly suicide prevention ads, they certainly could be.

“BETTER DAYS ARE COMING,” one states, again and again.

“This isn’t forever. It’s just right now,” another states.

Often, it can sound like a superficial, trite reassurance to say your situation is temporary, when it might be anything but. But at the moment, as far as we know, the pandemic actually is temporary. The end of the pandemic is beginning, now that effective vaccines against Covid are being distributed

It’s true: This isn’t forever. It’s just right now.

Who’s to Blame for Isolation in the Pandemic?

As long as I’m bemoaning the toxic effects of isolation, I want to make something clear: This article is a lamentation, not a diatribe.

Many people look to others to blame for the isolation and other hardships wrought by the pandemic. I understand the desire to blame someone, anyone, who can be held accountable more than an invisible pathogen can.

Some people blame policymakers. One mother in Illinois is suing the governor and local school district for this very reason. She states her son Trevor Till killed himself in October because shutting down schools and extracurricular activities deprived him of the connections he needed to stay alive.

“He thrived on being busy… These kids NEED THEIR ACTIVITIES! IT IS WHAT HIGH SCHOOL IS ALL ABOUT….” she wrote in a Facebook post.

Trevor’s death, and others’ like his, are tragedies. At the same time, as harmful as isolation can be, I don’t see a way around it in a deadly pandemic of a novel virus. Even with widespread stay-at-home orders and restrictions on businesses worldwide, 1.8 million people had died of Covid by December 30, 2020. In the U.S., almost 348,000 people died of Covid in 10 months, compared to 328,000 deaths from flu or pneumonia in the previous 6 years.

Imagine how much longer the list of Covid casualties would be if fewer people had stayed home, if schools and businesses had remained open without restrictions, if travel had continued unabated. Millions of people would have died in the early months of the pandemic alone. Such an enormous number of deaths would have created even more grief, isolation, and disruption to the economy than those caused by the preventive shutdowns.

Knowing that it’s necessary to hunker down doesn’t make it any easier. It will still be many months before society fully reopens. This makes it all the more important that you connect with others and manage your stress if you’re waiting until it’s safe to resume your old ways of living.

Surviving Social Isolation

Though targeted toward older adults, the journal article “Loneliness and Social Isolation during the Covid-19 Pandemic” contains a list of useful suggestions for people of all ages on how to cope with isolation during the pandemic.

  • Use technology to stay connected. No doubt you’ve been doing this for months already. My mother, sisters, and our families have talked via Zoom every Saturday since March. We come from three different time zones; one sister’s in California, I’m in Colorado, and my mother and another sister are in Texas. Our kids (my mom’s grandkids) often join us. Before the pandemic, the last time we were all together was at my father’s funeral, in 2015.
  • Structure every single day. Structure and routine can help fend off chaos, even if your routines all occur at home. It might not lessen your isolation, but it could help you to feel less anxiety.
  • Keep up physical and mental activities. Remember, exercise doesn’t just help your body. It also improves mood and cognition.
  • Get outdoors. After a few months of staying at home, I discovered my vitamin D levels were precariously low. The doctor prescribed pills with 50,000 units of vitamin D. Now, I take 2,000 units a day and make sure I take regular walks during peak periods of sunlight. (Fortunately, I live in Denver, an exceptionally sunny city.)
  • Take care of your emotional health. Get therapy, if needed. (If you can’t afford it, check out this article.) Try out anxiety management tools like meditation and deep breathing. Ask friends and family for help if you need it.
  • Reach out to older adults you know, and their caregivers. For that matter, also reach out to people you know who are parents of young children, health care providers, other essential workers, and anyone else who seems especially vulnerable to the stresses of the pandemic.

Questions for You about the Pandemic and Social Isolation

What have you done to cope with isolation and other stresses of the pandemic over the last year or so?

What has helped you to stay connected to others?

Please let us know your thoughts in the comments.

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  1. Paul says:

    I don’t know if I’m alone in this but as someone who was depressed going in, the social isolation aspect hasn’t touched me at all. I was a recluse before COVID and never required much if any interaction with other people even when I was doing better earlier in life. Today when I do go out, wearing a mask actually helps my social anxiety a little. I worry about money, but in other respects l feel I am doing better under these circumstances, not worse.

    I wonder if the stats would show that people who were already withdrawn had no incident spike at all during this time, and that the people who are having problems are the outgoing, extroverted types who are usually very well adjusted?

    • Stacey Freedenthal, PhD, LCSW says:

      Paul,

      That’s an intriguing question. It makes sense that the effects of social isolation might be more dramatic for people for whom it represents the greatest contrast. I expect researchers will explore these possibilities in the years to come.

      Thanks for sharing here!

  2. Cindy says:

    That one UN poster says “This is not forever, it’s just right now!” That sounds like complete and utter b.s. considering that we are Day 520 into “15 days to slow the spread” and many, many weeks into “4 to 6 weeks to flatten the curve”! I hate to break it to the UN and the CDC that a year and a half with NO END IN SIGHT is FOREVER!

    • Paul says:

      I just read today that they’re likely going to require 6 month booster shots because the vaccines don’t last as long as expected, which of course means this state of affairs is likely to likely last another 6 months to a year. It’s ridiculous. It’s completely bonkers that medical professionals expect a society to live like this indefinitely, and I can’t imagine all the harm that has been done. Not just to the elderly but to children too.

      My son is on the spectrum, and had just spent 3 years in early intervention to get him on the normal development curve and fit in somewhat with normal life. He gets out of that and into school (where he’s just another student) and the first thing they do is shut school down for 18 months. Sure, we try our best but where does that leave him? I am convinced there are a lot of kids who haven’t done any significant work academically since March 2020, and this will leave a permanent mark on the personalities of all the young kids who have lived through it.

      I have a really hard time believing that the effects of the disease would have been worse than the effects of the lockdown unless COVID is like the Black Death and I have not seen any evidence that it is.

  3. lee says:

    didnt know where else to put it but dont know if you know NBC news used this iste as a resource https://www.nbcnews.com/news/us-news/if-you-or-someone-you-know-crisis-these-resources-can-n1267774

  4. Shaun says:

    I have just come home from attending an “honor walk” where dozens of us lined the halls from the ICU to the OR as our colleague’s 17-year-old son was rolled past on his way to become an organ donor. His parents found him several days ago, almost-but-not-quite completely dead. His father – our colleague – is an ER physician and worked on him until the ambulance brought him to our emergency department, where the young man’s father has worked since before he was born. Everyone on duty that day either knew the young man or knew of him from his father, who is a warm, thoughtful and caring human being. We are all devastated.

    I am also an emergency medicine provider, and a nearly 60-year-old member of the LGBTQ community also bullied and beaten down since earliest childhood for incredibly obvious gender non-conformity then later sexuality – and I am and have been chronically suicidal since age 12 if not earlier. By chronically suicidal I mean that suicide is my constant security blanket, my exit strategy. I am never, ever without a plan and a means (perhaps counter-intuitively, I think that is how I have survived for so long, just knowing that I can check out when I have finally, absolutely had enough). I cannot recall the last time the option hasn’t crossed my mind at least several times a day, although I believe there have probably been weeks or months with only occasional and fleeting thoughts.

    And I have been acutely suicidal multiple times; planning, rehearsing and so forth. So I believe I can relate to the sentiments of many of the folks who posted here earlier. I personally *have* been helped by both medication and therapy, but clearly not “cured.” I was lucky enough to have a truly remarkable therapist for something close to 25 years and we had the discussion many times about the futility of reminding me that “this too shall pass.” She meant the acute pain, the almost unbearable exacerbation of the chronic underlying misery that I’d otherwise learned to live with. I am proof that “it” does pass – that most excruciating phase – at least it does for most people. I am also proof that it can return, sometimes again and again, for those of us especially cursed. My argument to her in the last many years of our association was that whether or not “this” particular episode would pass was irrelevant, as I had no reason to believe it would not return again. Why would I want to keep going through that, or why should I not at least have the option to decide whether I wanted to bear it all again? One can recover from all kinds of injury and torture – physically – but if it then happens again, and you heal, and then suffer again, and keep repeating the cycle, is it so wrong to simply not want to or be able to bear the agony yet again?

    In my profession, I have to intervene with patients in crisis. While early in my career this was a greater ethical concern for me (I’d gone through more than one suicidal crisis before entering this field) I have come to find that many people are, in fact, glad that they were prevented from killing themselves, that their crisis did pass and they found life worth living again. Even before tonight I have worked with survivors of those who were not “saved” and I can tell you that human wails of grief are like a knife to the souls of all within earshot.

    Yet as I watched that boy roll pass me tonight, this child I met only once when he was a toddler but whose growing-up I’ve heard about from Dad all these years, with many of my colleagues crying and my heart breaking for his family – I could not help thinking on a parallel track, if you will, that I am in the midst of possibly the worst crisis of my life and I am by no means committed to living indefinitely. Virtually everything in my life has fallen apart in the last 3-4 years and I am not through the worst of it yet. I have my plan and I check on my means at least weekly. I don’t for a minute believe that I would leave nearly so many broken hearts behind, but there are those few who care, and suicide has ripples that carry a long way. I know this, and I simultaneously know that I am capable of putting all of that aside – selfishly, one might fairly say – if I feel I need to. And no, I am *not* saying people who contemplate or complete suicide are selfish – only talking about myself and my ability to be aware of yet in the end not care if I hurt others to end my own pain.

    What is my point? Maybe several: not all therapists are bad, not every suicidal person is chronically depressed (or even depressed at all, believe it or not). Some people *are* helped by hotlines and medications and yes, even affirming posters or slogans (in addition to other modalities). These things have not worked for many of the folks who have posted here and clearly they have not worked for me, but I am still in favor of doing every thing we can because some of it will be helpful to someone.

    For those of you who may be interested, there are some interesting medical options coming around for treatment-resistant depression and acute suicidality, such as ketamine therapy. Other than the nasal spray isomer version, I don’t believe there is FDA approval yet and I am not aware of any broad agreement in the psychiatric community on how to use it (form of administration, dosing, frequency, with or without concomitant talk therapy, etc.) and so probably not covered by insurance – even if one happens to have insurance. Lots of clinics ready to take your money though, so if you look into it be sure to do your research first. Personally I don’t have the financial resources at this time, especially as I am not sure which way is the “best,” but if those two factors change, I will look into it – if I’m still around.

    As I write on every condolence card, I wish (all of) you peace and healing – whatever form that may take for you.

    • Stacey Freedenthal, PhD, LCSW says:

      Shaun,

      How sad about your colleague’s son, and about your own recurring pain. Thanks for sharing your own experience. I think it’s extremely valuable for others to read, because you describe very realistically (and painfully) the ongoing, fluid nature of chronic suicidality, with its long cycle of ups and downs. But you also testify to (some) others’ survival and gratitude for it, and you allow for hope, at least for others if not also for yourself. Your message is important for others to see.

      One of the things (for there are many) that most resonates with me about your comment is this: “…not all therapists are bad, not every suicidal person is chronically depressed (or even depressed at all, believe it or not). Some people *are* helped by hotlines and medications and yes, even affirming posters or slogans (in addition to other modalities). These things have not worked for many of the folks who have posted here and clearly they have not worked for me, but I am still in favor of doing every thing we can because some of it will be helpful to someone.”

      That’s my belief, too. I hear from some people via this website or email who seem to operate under the assumption that if therapy, hotlines, affirmations, etc. don’t help them, then they don’t help anybody. It’s a very dichotomous, all-or-nothing way of thinking. I know that not everybody can be helped, but that doesn’t mean we should give up on everybody.

      I’m sorry about all the pain you experience. I’m sorry about all the pain so many, if not all of us, experience. Life is very hard, even cruel, at times, and I wonder if we go about the business of it all wrong. Perhaps the pursuit of happiness sets us up for disappointment, and we need to make a different kind of relationship with the pain and anxiety of living, which afflicts some of us more than others. Of course, finding any semblance of peace of mind amid the internal and external stresses of life is easier said than done, especially when so many bad events and unbearable living situations happen to so many people.

      It doesn’t seem counterintuitive at all, at least not to me, that suicide is your “constant security blanket,” and that knowing that you can check out when you’ve had enough has helped you to survive. It reminds me of an article that refers to “suicide fantasy as life-sustaining recourse.” Also it brings to mind Nietzsche’s quote that suicide is a great consolation, for it gets many people through a difficult night. I talk about the comforting aspects of suicidal thoughts in my article When Suicidal Thoughts Do Not Go Away. The article might be of interest to you if you haven’t seen it already.

      Anyway, thanks again for sharing your experiences here. As you do for others, I wish for you peace and healing.

      • Tom H says:

        Stacey, I’ve read your accounts elsewhere of your own experiences with emotional pain and, like just about everyone else here, I’m sure, I’m very glad you are doing much better today. I’m also happy to know that Shaun and you and others who care are in the … caring professions. So please don’t take my comment as any kind of antagonism.

        You wrote to Shaun above, “I hear from so many people via this website or email who aren’t helped. Some seem to operate under the assumption that if therapy, hotlines, affirmations, etc. don’t help them, then they don’t help anybody. It’s a very dichotomous, all-or-nothing way of thinking.” You offered this as justification for “not giving up on everybody.”

        Stacey, in my long career working with medical communities and legal communities and publishing about end of life decision-making, I have never heard anyone make a serious argument that others should be given up on. I have never heard any argument to the effect that mental health doesn’t “help anybody.” The arguments I hear–the ones that are winning in more and more legislations around the world (most recently Spain and in the recent expanse of its present end of life decision-making laws, Canada)–virtually ALL have to do with personal choice. And this is prevalent here in this article’s comment section, too.

        Most commenters recount their own pain and the failure of various systems to offer what the commenters themselves would find helpful. I’m confident that the great majority of commenters here and elsewhere where such comments aren’t immediately censored would agree that therapy helps some people. The very fact that these individuals come here to share their stories supports this. There’s healing, however temporary, in merely sharing in a supportive environment.

        So, with sincere respect, I disagree with your assertion that “It’s a very dichotomous, all-or-nothing way of thinking.” While some people may think that way, I believe empiricism would show this is a great minority representation. And where such a perspective exists, I think it’s largely a reaction to people feeling invalidated and dismissed when they share with the professional community that interventions are not succeeding. While people will obviously disagree with me, I am encouraged that more and more legislations around the world are agreeing that it is the individual living her/his life, not the rest of us living outside that life–regardless of our own experiences with pain and resiliency–who should be the ultimate arbiter of her/his own life’s value.

        Most people do not believe therapy helps no one. Most people do not subscribe to “dichotomous, all or nothing” thinking regarding mental health. Rather, most people want the power to decide whether interventions (pharmaceutical, behavioral…) are working, whether they’re working well enough, and when/if the pain is persistent enough and bad enough not to be FORCED to keep enduring it.

        Thanks for allowing the comment and peace to everyone.

        • Stacey Freedenthal, PhD, LCSW says:

          Tom,

          Thank you for sharing your thoughts. It gives me the opportunity to clarify. When I said I hear from “so many people,” I didn’t mean to imply that most people think so dichotomously about suicide prevention. I really ought to change my phrase from “so many” to “some” (and will do so shortly) to avoid any impression that I believe people with these viewpoints represent the majority. With that said, I don’t publish comments here that are factually inaccurate, that actively encourage suicide for others, or that personally attack individuals who try to help suicidal people to recover, so the reader comments that you and I see are different.

          I appreciate that you acknowledge dichotomous thinking does occur, though you “believe empiricism would show this is a great minority representation.” It may well be a great minority representation — indeed, it must be, or we wouldn’t have the policies and funding supporting suicide prevention that we do have. I agree with you that a unilateral stance against suicide prevention often reflects exasperation and rage about a system that is failing to help the commenter. I just wish that people wouldn’t portray their own negative experiences as universal inevitabilities, because this can do harm to others. (I often see the same dynamic with psychiatric medications, by the way. Though the minority, some people state things to the effect of “meds hurt me so nobody should take them.” This ignores the complex reality that some people have been helped by meds, some hurt by them, and some helped by some meds and hurt by others.)

          Thanks for your kind words about my doing better today than in the past, and peace to you, too.

      • Tom H says:

        Thanks for clarifying, Stacey. Please allow me to go on record regarding one critical matter. While I believe that the great majority of people advocate many different kinds of therapy (religious, philosophical, self-help/popular, nutrition, exercise, CBT…) and so do not support the conclusion that therapy-in-general is universally ineffective, a valid and persistent question is what, precisely, does it mean for an intervention to “work”? There’s a body of international publications pointing out problems with the definitions and assumptions inherent in the dominant clinical models of mental health and with diagnostic reliability. These are among the chief reasons others, including other clinicians, researchers, and the lay, question the dominant hypotheses of cause/effect and intervention efficacy (what “works”) in mental health.

        I respect the feeling that others’ perception that something doesn’t work (like inoculation against a virus) could negatively skew the public’s decision-making, but I give people far more credit to be able to research the evidence in support of different interventions. Surely if an intervention is successful, the population prevalence of the condition it’s designed to treat should significantly abate. And over time, the evidence of amelioration becomes so overwhelming that those who doubt the intervention’s efficacy find it challenging to substantiate their views. If, on the other hand, the condition it’s assumed an intervention is effective against persists, I think skepticism and challenge are both healthy and critical.

        I support people’s freedom to decide for themselves what, if anything, lessens their pain. I also strongly oppose coerced interventions, especially for legal adults who can coherently articulate their own life evaluations. Thanks for the opportunity to exchange comments, Stacey.

      • lee says:

        (cant tell if this response will go towards the post to which i am responding. )re sucicidal thoughts as a security cushion

        Until I read all medical journal and other articles I was not aware of how high the rate of failure is and the high chance of damage. It is a sobering concern.

      • Anonymous says:

        No, we shouldn’t give up. We should grant the right for sane individuals to end their suffering peacefully.

        There should always be a means.

  5. Sam says:

    I am an ethnic and gender-identity minority in the US. Just starting off with that, I’m sure, will garner lots of antipathy. But I want to let others in my shoes who’re too ashamed to speak up know someone here gets where they’re coming from. From elementary school through high school, I was mercilessly bullied. I was once beaten with a saw in woodshop when the teacher was out of the room. Nothing ever came of that–not even formal punishment for the abusers. When I wasn’t in school, I was locked inside my single parent’s shanty-apartment in a high crime neighborhood. I never once played outside my entire childhood.

    Then I went to college. I thought my life would begin. you have no idea how excited I was to finally be around accepting, supportive people! No more bullying because these kids were supposed to be very bright and open-minded enough to understand there are different people out there. I still remember finals week of freshman year, calling home crying because I hadn’t made a single friend and I felt so incredibly lonely. My mother rebuked me and told me to be a man. That was the last time I opened up to her before she died.

    I sought out some of the country’s finest mental health teams at supposedly the best mental health sciences center of scholarship in North America. Years of therapy and pharmaceuticals did absolutely nothing for me. I became lonelier and lonelier. And whenever I timidly expressed how painful the social isolation was for me, the other person would remind me in a slightly disdainful tone, “You’re not entitled to other people’s time or company.” Later in life, others would gladly exploit my loneliness to squeeze from me what personal benefits they could. I never once encountered the compassion and empowerment which, from reading the professional articles online, I thought were out there if I only reached out for help.

    So imagine my shock now, with the pandemic, to be reading from so many people online isolated for just a few weeks to months how devastated they feel. And imagine my bewilderment to read from professionals that we’re a “social animal,” as if to say, “Of course, people who don’t have enough quality, supportive companionship suffer.” Where were these voices of validation over the DECADES when I suffered alone, despite joining groups, despite volunteering, despite reaching out to my “community”?

    Loneliness and social isolation matter when the people suffering these things matter to others. The homeless, I’ve read, can suffer terribly from social isolation and loneliness. And the US has a frighteningly large homeless population. But I don’t remember hearing among non-specialists about the painful isolation many homeless regularly suffer. The same is true of many of the US’ chronic poor who work 60+ hours a week to exhaustion and barely ever speak with others beyond the most cursory grunts required of them at work. Yet despite the working poor growing in numbers in the US, no mention of the effects of loneliness and social isolation on them. And what about groups widely despised in the US–like transgender individuals who have one of the country’s highest suicide rates due partly to factors like social isolation? Again, little if any mention of the effects of loneliness and isolation on them.

    I’m very sorry anyone is experiencing now what people like me have been experiencing without relief for decades. But if we now deeply understand how terrible isolation and loneliness can be, how will we respond, once things are back to normal for most of us, to those “whining” about how lonely they are? (Rhetorical)

    • Ben says:

      Hello Sam,

      Thank you for sharing your life with us. I am 60 y/o and also on the GLBT spectrum. My family totally rejected me, so I well know true isolation. I’ve had Major Depression and DID my entire life.

      How can one not be depressed when totally disowned by family? When even my registered sex offender brother is respected by my parents while I am not? Life is cruel.

      Hope you find a way out of your isolation. Best wishes.

    • Larry says:

      I have avoidant personality disorder so I have always lived with a pathological fear of embarrassment and humiliation. Being around other people sucks the life out of me because I have to pretend to feel comfortable and confident while on the inside I am shaking with fear. Strange as it sounds, living a life of social isolation would be the best thing possible for my mental health.

      The only other way for me to effectively remove myself from the discomfort of social interaction is to commit suicide and unfortunately I lack the will ( so far ) to actually carry it through.

  6. Paul says:

    Have you ever suffered from severe depression yourself?

    I ask this not to be some kind of gatekeeper, but because things like “Hang in there”, and “It’s not forever” (which are like suicide prevention ads, you’re right), and posting the general suicide prevention hotline as though it’s a panacea are like nails on a chalkboard to a lot of people, and it makes me wonder if the people who write those ads have any idea what the target audience actually feels like.

    I feel like these ads and these statements need to be more real. Depressed people are the ultimate realists IMO, and I always use realistic things to ground myself when I get bad. Watching a video of people doing post-suicide cleanup with the family still in the house. Or reading something written by a survivor or a parental suicide, that snaps me back. Around me in my basement, I’ve got all kinds of pictures which were drawn by my son. That’s not like a co-worker having a coffee cup which says, “World’s Greatest Dad”. It’s more like crosses being drawn on a wall to keep Dracula away. It all sounds bleak but this stuff has extended my life, such as it is, by around 5 years now in my estimation.

    A friend asked me once if OTC medications would work for suicide. I didn’t tell her, “don’t do it, we all love you!”, or that her problems would pass. Because that’s bullshit, and she would know it is bullshit. Instead I told her what she wanted to know; that they might work and they might not, and I gave her a very graphic description of what the experience would probably be like, and I concluded by saying that she’d be in so much pain that if they didn’t work she’d be wishing they did, and if they did work she’d be wishing they worked faster. Then she wrote back and talked about what was really bothering her, and I at least believe she opened up because the discussion was honest.

    Look at anti-drunk driving videos. Cartoons of cops pulling people over didn’t have any effect. Videos of car crash aftermaths and tearful people who had lost loved ones had an effect.

    Just my 2c

    • Stacey Freedenthal, PhD, LCSW says:

      Paul,

      You make many good points here, and it’s wonderful that you have things that help you and that help others. Five more years is quite a difference. As for straight talk about suicide, my post Are You Thinking of Killing Yourself? might be of interest to you. While it does attempt to help people tap into hope, it also discusses the possibility of attempting suicide and surviving with serious injuries.

      To answer your question about whether I’ve experienced severe depression, I wrote about one of my experiences in my essay A Suicide Therapist’s Secret Past. (After that essay was published, I explained my decision to stop hiding my own suicidal past, in my blog post Why I Came Out of the (Suicide) Closet.)

      As I said in my reply to another comment of yours, I thank you for sharing here!

    • Ben says:

      Agreed. I’ve faced suicidal ideation off-and-on for some forty years, and whenever someone writes, “Hang in there! It will get better!” I know that person has never experienced suicidal ideation. When someone writes, “Call the Suicide Hotline at xxx-xxx-xxxx,” I know that person is a therapist just trying to CYA.

      And, it’s all meaningless.

      For those of you who wonder, I’m 60 y/o and I’ve tried to off myself perhaps five times over the last forty years. All those trite statements therapists make (e.g., “You’ll be glad we saved your life! This depression will end soon and then you’ll see that depression is only temporary.”), are often false. I have never been happy to be saved. I have never thought, “Thank G-d they saved me, that depression was only temporary!” Never, not once, have I thanked the people who saved me. I have never been happy to be alive.

      For some of us: Life is hard, then you die.

      I’m not saying you should give in and off yourself. Even if you suffer severely, as I have, there can be a few moments, here and there, that are OK. Even I can find things to do (generally, math or whatever) to get my mind off death for a bit.

      It’s hard to commit suicide; people think (like I did, when young) that you just swallow a handful of pills and drink some booze, then it’s all over. That rarely works. Almost always, some do-gooder finds you, there’s an ambulance ride, you get treated like dirt by the professionals (’cause, you know, only scumbags try to off themselves), and then you REALLY wish you were dead. There are ways to do the job right, but most people fear them.

      And, get this: If you attempt suicide (and, again, it will most likely turn out to be an attempt, due to Good Samaritans), your therapist may abandon you. One would think that a serious therapist would stick with his or her client, but that’s often not the case. So, you might very well get released from the hospital to find that you no longer have any support whatsoever.

      So now you know.

      • Paul says:

        Well put. Regarding therapists, anyone who told you definitively that your depression is only temporary has no business working as a mental health professional. Not only do they not understand the condition, but they trivialized how you felt.

        I’m not surprised to hear you were dropped when things got tough. That’s never happened to me, but I do know from stories and personal experience that a psychiatrist will drop a patient in a hot minute because in the end, they don’t need us and they have lots of other potential patients. We’re the ones who need them.

        I strongly believe that the doctor/patient power dynamic is way out of whack when it comes to mental health. Once you know what your conditions are and you’ve found medications that help you, doctors essentially just become the gatekeepers of your meds. And you might be alright on whatever you’re prescribed, but all it takes is for that doctor to decide to drop you, or retire, or move away, and you’re left with nothing and worse yet with no instructions on how to handle tapering and withdrawals, which you have to deal with as well as your original problems that required those meds in the first place. It might take months to get your meds started up again even if you move fast and are lucky enough to find someone who accepts new patients.

        In fact right now I am tapering off Lexapro as I’m no longer under the care of a physician. What would have happened if I hadn’t stockpiled meds in the event of this happening? Tapering too fast virtually incapacitated me last time I had to do this, and I was doing my best to research the correct tapering method. Going cold turkey off a high dose of an SSRI, which is a situation that some patients must end up in at times, might well kill someone.

        Sorry, that stuff is a peeve of mine. Mental healthcare has a long, long way to go, and the problem is more with the attitudes towards it than the technology.

      • Erinn says:

        Ben, I almost feel like we are living parallel lives. I wish things could get better, but when the abuse starts at age three, how does one “get better?” It becomes who you are. I will never be “enough.”

  7. Mark S. says:

    We do not have data about the 2020 suicide rate in the US yet, but we have some partial information about something else. Drug overdose deaths appear to have sharply increased during the pandemic:
    “Overdose Deaths Accelerating During COVID-19”
    https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html

    Since drug abuse is a form of self-harm, I’m guessing there is a correlation between deaths from suicide and deaths from drug abuse, so this may hint that the suicide numbers for 2020 are going to be higher than in previous years.

    • Stacey Freedenthal, PhD, LCSW says:

      Mark S.,

      That’s an excellent point. Suicides and accidental overdoses (as well as deaths from alcoholism) are considered to be “deaths of despair.” Many of those overdose deaths also might be hidden suicides. (The CDC information that you linked to doesn’t specify whether the overdoses were intentional.)

      Thanks for sharing that link here!

  8. Ben says:

    I am a 60 y/o law student living alone on campus. Due to our virtual environment, I have never met my student colleagues, neighbors, professors, or administrators. I’ve never even set foot inside our library. It is too dangerous for me to take public transportation, so I cannot visit my friends or even go shopping. Amazon delivers my every need.

    Am waiting now for my first semester grades to be posted. If my grades do not pass muster, I must not only leave law school but also immediately vacate my campus apartment. Given the difficult rental market and my fixed income, such a failure would lead to immediate homelessness. Without law school or even a place to live, there would be nothing left to live for.

    • Stacey Freedenthal, PhD, LCSW says:

      Ben,

      Your situation illustrates painfully well just how drastically the pandemic has changed our lives. So much deprivation. So much isolation. Are you at least able to use the school’s counseling center services online? If not, I hope you’re able to connect with help elsewhere. As always, the national hotline (800-273-8255) and crisis text line 741741 are good resources.

      Thanks for sharing here. I hope very much that you passed your classes and don’t have to worry about homelessness. And if you didn’t, I hope you’ll still have things to live for.

    • Ben says:

      Thank you for your kind response. Yes, this is what the pandemic has done to us. The isolation is incredible, and when disaster strikes, there is no safety net.

      Our campus counseling services department is closed for the holidays, but we do have telephone access to ’emergency’ counselors, if need be – although they are truly just LCSW-types screening people for suicidality.

      The big problem is, if I don’t pass and must move off campus, then I will no longer be a student here and so will not be able to use the counseling department services at all. So I will be kicked out of law school and made instantly homeless, but yet have no access to my fine campus doctoral-level therapist. Pretty scary.

      I am not going to live on the streets. Nothing could be worth living for on the streets. Would take a pretty incredible Pollyanna to find something worth living for while sleeping in a gutter.

      • Stacey Freedenthal, PhD, LCSW says:

        Ben,

        You’re most welcome. I agree with you, this pandemic has put in stark relief just how terrible the “safety net” is in the U.S. About the only thing I’ve seen policymakers get right is the pandemic unemployment benefits, which actually have increased income for some people. Otherwise, $1,600 in stimulus over a period of 10 months, while better than nothing, is hardly enough to help people significantly. The eviction ban is good for the moment but hard on Mom-and-Pop landlords; there should be rent relief, instead. But the corporations – oh my, did they ever make out! Some of them, anyway. Usually the ones that least needed it.

        I digress. (Perhaps there’s another blog post in me about this.)

        Anyway, just know that others do care, even though that may feel invisible to you, and even though it doesn’t pay the bills. I hope you’ll let us know here if you passed your classes. I recognize why you’d feel terribly hopeless if you have to go to a homeless shelter, but it could just be a temporary stepping stone to housing assistance and other resources, depending on where you live and what the resources are there.

        One last thing: I am an LCSW with a Ph.D., too. Many LCSWs I’ve met are equally skilled, and some more so, as some of my colleagues with a Ph.D. or M.D. I say this only so you can know that if you do call the counseling center for help, it’s possible you will be helped! (I know, it’s also possible you won’t, but at least that’s not a foregone conclusion.)

        I’m grateful you’re writing here. Even if it’s from afar and over words on a computer (or phone) screen, it is still a connection with another human being. In today’s world, that can be precious.

        • Ben says:

          In California, where I live, homeless shelters are few and far between, perhaps due in part to our mild weather. The vast majority of our homeless population sleep outside, even those with small children. In all likelihood, if I don’t cut it in law school, I will be actually sleeping on the streets, quite literally.

          Regarding the LCSW comments, let me just add that the skill set of any therapist, no matter the degree earned, has much to do with the individual’s natural capacities, propensities, and professional paradigm.

          For instance, an LCSW friend earned her BA in social work, and then earned her LCSW with a traditional focus in social work. She never intended to be a therapist, but she is one now because that’s where she happened to find herself job-wise after graduation. But, she really knows little about psychology: Even I, with a BA in psych and a couple of years of graduate study in psychobiology research under my belt know more than she does about abnormal psych and even psych in general. She admits this fact freely. And her situation is on par with other LCSW therapists with similar orientations. On the other hand, I also know an LCSW who is psychology-oriented and incredibly good with trauma patients; she is downright the best EMDR therapist I have ever met. But, again, this is due to her professional paradigm and interests. She had and has no actual interest in social work but rather in psychology and therapy itself; she didn’t want to spend the time/money on a doctorate in psych, so she steered herself to the most psych-oriented LCSW program she could find, and then after graduation set out to become the best trauma therapist she could be with said training. But most LSCWs will, if truly interested in psychology and therapy, eventually head the direction of a doctorate in psych.

          Now, add to the mix my many friends with doctorates in clinical psychology. They are, hands down, the best trained therapists out there. They sought their undergrad and grad degrees because they were specifically interested in psychology and ‘doing’ therapy. Their degrees required them to engage in therapy, take research courses, engage in research, and do all sorts of things that prepped them to be hard-core therapists and real academics. Some are naturally better at therapy than others, primarily due to their natural capacities, but they are all exceedingly well-trained. Those with a PhD or PsyD in clinical psychology are hands-down the best trained therapists.

          Last, regarding psychiatrists (and most especially psychopharmacologists), those with an MD: They do not take ANY psychology courses at all and have no training in psychology, let alone ‘doing’ therapy, whatsoever until their first year of residency. They then do a rather perfunctory psych residency, generally only learning to ‘do’ therapy well enough to be able to distinguish whether the psych medications they prescribe are meeting patient needs. Here again, this is largely due to their professional paradigm. Those who are interested in psychology and providing therapy generally seek psych degrees, not MDs. Those who seek MDs, to become psychiatrists, are interested in drug treatment, not doing therapy. Hence, no surprise that psychiatrists are almost always really poor when they do attempt therapy.

          In conclusion, doctoral-level clinical psychologists are by far the best trained, masters level MFC-types are the second best trained, LCSWs are the bottom of the barrel in psych training (which is ironic because, as the therapists commanding the lowest salaries, they do the heavy lifting these days), and psychiatrists cannot even be graced with the title ‘therapist.’ But, again, natural capacities come into play. Some therapists, no matter the degree, are totally clueless. And, some therapists, no matter the degree, are damn good – possibly natural therapists. It all depends upon a person’s personal and professional paradigm. Training can, at times, be almost secondary.

          Not knowing you, I would hazard a guess that you probably earned your LCSW first, then later realized that it didn’t provide you with the solid psych background you desired, and so later sought your doctorate in clinical psych. So, one might conceivably argue that you, yourself are a poster child for my argument. 🙂

          Apologies for the soliloquy. This is an interesting topic.

        • lee says:

          Stacey your last comment in your reply hit home. I wont be totally honest with where I am in regards to the issue but yes it is a form of connection and for that i am very appreciative.

      • Ben says:

        Just wanted to update everyone. Passed my courses and so completed my first semester of law school successfully. Still living at the law school, living alone in an on-campus studio, finishing my second (virtual) semester. Terribly depressed but making B grades.

        Was vaccinated a few weeks ago and will receive my second ‘booster’ shot on April 1. So, by about April 15, I will be relatively safe and finally able to leave home to shop, etc. My one+ year of isolation will be at a relative end in just a few weeks.

        Our law school will return to an in-person format in August.

        Still having serious issues with depression. I seem to be dissociating a lot more.
        It seems like a mild version of my DID has returned. Hopefully, this will calm down once I am able to be out and about in public. Interesting how life goes on for decade after decade, even as miserable as I am.

        Best wishes to you all. Hope your depression has lifted.

        • Stacey Freedenthal, PhD, LCSW says:

          Ben,

          I really appreciate your updating us. I’ve wondered how you were doing, and I’m grateful to hear that you’re still with us. Of course, I’m also sorry that you’re continuing to suffer with depression, dissociation, and feeling miserable. I hope you feel at least some relief from the misery as your isolation lessens. It’s amazing that the pandemic has shut things down so much for over a year.

          Thanks again for your update. Feel free to do so again! 🙂

  9. lee says:

    I have eye usage pain so scanned article. Just read more of it. re Trevor, it is very sad when especially someone young dies regardless of the reason but it appears mother would rather look outside herself then inside herself for what she might have missed that Trevor may have tried in verbal/nonverbal ways to tell her about how he was feeling.

    • Stacey Freedenthal, PhD, LCSW says:

      Lee,

      I considered not posting your comment, because I believe it unfairly blames people who lose somebody they love to suicide. However, I know others might hold the same view, so I’m hoping that by approving your comment and posting a reply, I can help dispel a myth. That myth is that when somebody dies by suicide, it’s because their family and friends failed in some way. Sure, in some cases there are specific areas where people could have done something different or better. But it’s wrong to assume this is always the case.

      Even when family and friends do everything possible – even when they pick up clues, even when they talk with the person about their suicidal thoughts, even when the person gets professional help – suicides still happen. Sometimes it’s because the suicidal person hid their suicidal thoughts, whether due to feeling ashamed, not wanting to burden the people they loved, feeling hopeless that anybody could help, not wanting to be stopped, or having some other reason for secrecy. And when people did miss signs, overlook risk, etc., it’s often only recognizable in hindsight.

      Two posts along these same lines go deeper on the topic:

      “If Only”: Self-Blame After a Loved One’s Suicide

      “You Can’t Do Everything”: Limitations in Helping a Suicidal Person

      Thanks for sharing, Lee. I hope you’ll take my response in the spirit it’s intended — to help people look at themselves with compassion, not blame. I know, readers have left comments that some people who lose somebody to suicide deserve blame, not because they missed subtle signs but because they sadistically abused the person. That’s a different topic. Here I’m talking about people who were doing the best they could with the information they knew at the time. They deserve our sympathy.

      • lee says:

        Thanks Stacey, That was why I used the word “might” rather then the affirmative of missed with no qualifier.

      • Paul says:

        There’s nothing anyone can do. No-one can stop the suicide of a severely depressed person who is not acting on impulse. Either the person will resolve their issues themselves via determination, medication, life changes, and/or a change in mental outlook, or sooner or later their mental state will kill them.

        When it comes to fighting depression, bottom line you are on your own. That’s just how it is. You don’t make a phone call and a team of dedicated professionals show up and make everything better. A friend or family member doesn’t declare their love for someone and then suddenly that person sees the world in a whole different way. It’s not like that.

        There was a friend I worked with for several years who had trouble coping. He was the kind of guy who was almost at his capacity even when life was normal. He fell apart after a severe breakup around 2007, and he fell apart again when he was fired in 2010. I remember telling people after his firing that he was going to end up killing himself, and he eventually did in 2016.

        I feel bad for him and I’ll probably end up the same way at some point, but that is just how it ends up sometimes. There’s nothing you can do to ‘fix’ someone like that. You can’t get someone out of that mentality by smiling at them.

        And who says they’re wrong in their outlook? Maybe it’s more insane not to see the futility and ridiculousness of people and of life, and not trying to drag life out until you’re 90, like crawling up to the very top of a sinking ship so that you can last a few extra minutes before you sink. I’ve read studies somewhere which showed that out of everyone, the mildly depressed tend to be the most realistic about most matters.

        Anyway… impulsive suicides from a teenager, I could see that not being picked up. But I find it extremely hard to believe that someone can be severely depressed for an extended length of time without the people closest to them becoming aware that something is not right. Your whole personality changes. My belief is that when someone says, “I can’t believe X killed themselves! They didn’t seem depressed”, then that person didn’t know the deceased anywhere near as well as they think they did.

        • Stacey Freedenthal, PhD, LCSW says:

          Paul,

          I appreciate the comments you’ve shared tonight here and on another post. I don’t expect to change your mind, but for the sake of others who read your comment above, I want to point out that there are things people can do to help someone who’s suicidal, even someone with high intent to die. Evidence-based treatments such as cognitive behavior therapy, dialectical behavior therapy, and the Collaborative Assessment and Management of Suicidality have been shown to reduce suicidal thoughts or behaviors in many people. Several medications, such as lithium and clozaril, have evidence of reducing suicidal thoughts in some people, while other medications improve conditions in some people that can lead to suicidal thoughts. For example, antidepressants reduce depression in some people, though suicidal thoughts increase in a small percentage of people who take antidepressants. Safety planning has been shown to reduce suicide attempts, especially when it involves removing firearms or other lethal means from a person’s grasp.

          I recognize that suicide isn’t always preventable, but it very often is. We can’t know in advance that someone’s suicide is inevitable. I address these points in my post Is Suicide Inevitable for Some People?

          Thanks, Paul, for sharing here.

  10. lee says:

    I am alone. I also have a physical issue that does not allow me to mask. At least i was able to get out to stores once or twice a week so at least i would see others. I called dept of health today due to the surge and the mutation and they told me do not go out . Have things delivered or do pick up which means my isolation will become even greater. Great ideas in article but for some of us physical limitations/social limitations preclude trying them

    • Stacey Freedenthal, PhD, LCSW says:

      Lee,

      That’s so difficult and painful. You’re right, some of the suggestions, like spending time outside and exercising, aren’t tenable for many people. Technology, though often a burden, also is a gift these days. I was curious and looked up online support for people who are alone. It brought me to an article that might interest you: 6 Virtual Groups to Join if You Want to Make Friends. (Sorry, the title is kinda corny, but really it offers ways to connect with others online.) There are other resources too, if you’re interested in looking for more. I realize you’re probably wanting to see people in person, too, not online. Soon, I hope!

      • lee says:

        Thanks Stacey for taking the time to reply. The choir sounds like something I can look into. Unfortunately the others are not doable for me, 1 is only for those in UK 2 require eye involvement i cant do and one is for over 75 but hopefully others here can make use too of the link and the suggestions. I will check out the choir one later today and will send it to my choir director. (Unfortunately I joined that choir about 2 months before pandemic started so that ended in real life very quickly, no time to even make acquaintances with most of the members > Thanks again

  11. Thanks so much Stacey for putting all this into perspective for us. I love the hug booths! A lot of people have been asking me if COVID raised the suicide rate, assuming it will do so due to unemployment, isolation, etc., but we won’t really know till the stats are available. As usual, you offer pertinent info, practical tips, and compassion. May this post circulate widely!
    On another note, I’ve been assuming that those who’ve lost someone to suicide during this pandemic are suffering more than ever due to constraints on funerals, hugs, and seeing loved ones for support–but in talking with some of them online on Survivor Day, they said that being at home was giving them more private time for their grief work.

    • Stacey Freedenthal, PhD, LCSW says:

      Susan,

      It’s great to see you here! Thanks for your kind words. I appreciate the feedback.

      What you say about private time for grief work is interesting. I’ve been struck by how many funerals I’ve heard about that were conducted over Zoom. That seems terribly sad to me. What a time to be disconnected — no hugs, no shared tears (well, that aren’t separated by computer screens). But I also wonder if for some people who are grieving it’s a relief to not have to be present for a big crowd. Then again, like everything, it’s probably good for some, bad for others, just as some teens are struggling with not being in school but others are relieved to be free of the bullying and stress they experienced there.

      Anyway, thanks again for sharing. I hope you’re staying safe and well!

  12. Linda Straubel says:

    Thank you, Dr. Freedenthal, for these thoughtful words and your words of encouragement. I’ve saved the two graphics you linked to your comments to share on my FB page. Thank you for letting us know there is hope, still.

    • Stacey Freedenthal, PhD, LCSW says:

      Linda,

      Thanks so much for the feedback. I’m delighted to know that my words, though depressing in parts, were also hopeful. Amid so much suffering, that was my intent.

      And I’m glad to hear the graphics are helpful to you. (Be warned, I cropped one of them because it has a phrase that isn’t the best wording for suicide prevention purposes; it says “hang in there.”)

  13. Maree Dee says:

    Thank you! Great information.

  14. Frank says:

    My life is over.. 58.. barely can walk due to Osteoarthritis.. have Meniere’s disease and losing my hearing.. I got COVID but I got over it. I live alone.. no family.. no friends.. never had children.. I sit in my apartment playing video games. I haven’t seen a human in a long time. I work from home answering the phones.. but that will end.. Without a job I will be homeless. There will be nothing left for me and no where to go. Exiting this world is all I have to look forward to.. Docs tell me my health will only get worse and nothing they can do.. I need Hip replacement but its very expensive. My Insurance is the best I can afford and they want a high deductible… more than I can pay. There is no reason to live

    • Stacey Freedenthal, PhD, LCSW says:

      Frank,

      Your situation sounds terribly painful. I’m wondering if you’re getting help. I know a therapist can’t change your health problems and job situation, but they could be a good sounding board as you sort through things, help you see where your mind might be playing tricks on your perceptions, help you feel less alone, and more. They also may know resources in town that can help you with rent assistance and other social services. The hotline (800-273-8255) and text line (741741) can also be a resource.

      Thanks for sharing here. I hope that you will have other things to look forward to soon, even if (and especially because) that seems impossible to you.

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