Learn to read the warning signs
The reality is there are times that even medical professionals have difficulty determining how close a person may be to actually attempting suicide. All the more, as a non-health professional friend or family member, you certainly can’t know for sure either. Now if you sense there is a big problem, ask this friend or family member direct questions and point out behavior patterns that concern you. Talking about suicide with someone will not implant the idea in his or her head. Don’t feel scared that you might influence your depressed friend or family member into committing suicide if you ask direct questions because usually depressed people do entertain suicidal thoughts. Remind him or her that you care about him or her and that you are greatly concerned and worried. If necessary, suggest that he or she make an appointment to see a health professional. Better still, offer to go with him or her if you feel this person would have difficulty doing it alone. If you strongly believe that immediate suicide or self-harm is imminent, take this person to a doctor or hospital emergency room immediately.
Here are the common warning signs of suicide:
• Feelings of despair and hopelessness –– Depressed people talk about extreme feelings of hopelessness, despair and self-doubt with those closest to them. Remember that the more severe these feelings grow, and the more frequent they are described as “devastating or unbearable,” the more likely it is that the idea of suicide may enter the person’s mind.
• Suddenly taking care of business –– When a depressed person is “winding up his or her affairs” and making preparations for the family’s welfare after he or she is gone (for example executing a last will and testament), it is a good chance he or she is considering self-harm or suicide.
• “Rehearsing” suicide –– Rehearsing or practicing suicide, or repeatedly discussing specific suicide methods, is also an indication of a commitment to follow through. Even if the person’s suicidal intention seems to come and go and not appear as persistent, such preparation makes it that much easier for the individual to give way to a momentary impulse.
• Substance abuse –– If a depressed person’s condition worsens, he or she may abuse drugs or alcohol. These substances can: 1) worsen symptoms of depression or mania, 2) decrease the effectiveness of anti-depressant medication, 3) lead to impulsive behavior and 4] severely impair judgment.
• Beginning to feel better –– It may sound and appear strange, but a depressed individual may be most likely to attempt suicide just when he or she seems to have passed an episode’s low point and be on the way to recovery. Medical experts believe there is an association between early recovery and increased likelihood of suicide. As depression begins to lift, a person’s energy and planning capabilities may return before the suicidal thoughts disappear, enhancing the chances of another suicidal attempt. Studies show that the period six to 12 months after hospitalization is when patients are most likely to consider or reconsider suicide.
What can you do to help a suicidal friend or family member?
• The first thing you can do is to simply talk or listen to the person. Remember you cannot take on the role of a therapist. Oftentimes, suicidal persons just want someone to listen to them. Yes, this is a tough job for a non-psychiatrist so here are some strategies that have worked for others:
• Show empathy and express concern –– Severe depression is usually accompanied by a self-absorbed, uncommunicative, withdrawn state of mind. When you try to help, you may be met by an individual’s reluctance or resistance to disclose what he or she is feeling. In such a scenario, it is important to acknowledge the reality of the pain and hopelessness he or she is experiencing. Don’t make that mistake of assuming the function of a therapist. This can surely create more feelings of rejection for the person who doesn’t want to be “told what to do.” Remain a supportive friend and encourage continued treatment with a professional.
• Enumerate and describe specific behaviors and events that troubled you –– If you can explain particular ways a person’s behavior had changed, this may help to get exchange of communication started. You can then try to help him or her overcome feelings of guilt. Remember that compounding the lack of interest in communication may be guilt or shame over having suicidal thoughts. It is important to reassure the individual that there is nothing shameful about what they are thinking and feeling. Keep verbalizing that thoughts of hopelessness, guilt and even suicide are all symptoms of a treatable medical condition.
• Work with professional health workers –– Never promise confidentiality if you believe someone is very close to suicide. Keep the person’s doctor informed of any thoughts of suicide. If possible, it is best to encourage the person to discuss it with his or her doctor. But you should be ready to confirm that those discussions have taken place. This may involve making an appointment to visit the doctor together or calling the doctor on your own. Remember that a psychiatrist will not be able to discuss all the person’s condition with you because of what we call “privileged communication.” You should therefore only call to disclose to the doctor your concerns. Whenever possible, you should get permission from the depressed person to call his or her doctor if you feel there is a problem. Otherwise, it could be seen as “butting in” or an intrusion and may worsen the symptoms or cause added stress. Of course, if you believe there is a serious risk of immediate self-harm, call the doctor immediately. You can work out any feelings of anger the person has towards you later.
• Emphasize that the person’s life is important to you and to others. Point out the ways in which the person’s suicide would be devastating to you and others. Share personal stories or pictures of past events.
• Be ready for anger –– The depressed person may feel betrayed by you preventing him or her from committing suicide or getting them into treatment. Remain strong.
• Always be supportive –– Express and offer your continued support to help the person recover.
• Take care of yourself –– Do not focus all of your energy on the depressed person. Ask friends and family to help you in providing support as you keep to your normal routine as much as possible. Pay attention to your own feelings and seek help if you need it. You need to remain healthy in order to be part of the emotional support system.
(For a list of qualified psychiatrists in your community, visit www.ppa.ph and www.rxpinoy.com. If you want to learn more on this topic, attend “The Clinical and Psychosocial Dimensions of Violence: The Role of the Mental Health Professional” at the
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(Please e-mail me at nina.halilijao@gmail.com)
