Great emotional and behavioral changes are at play:
• Overwhelming pain or pain that threatens to exceed the person’s pain coping capacities. Suicidal feelings are often the result of long-standing problems that have been blown up by recent events. There is a resulting new pain or loss of pain coping ability.
• Hopelessness: the feeling that the pain will continue or get worse; things will never get better.
• Powerlessness: the feeling that one’s resources for reducing pain is exhausted.
• Feelings of worthlessness, shame, guilt, self-hatred, "no one cares." Fears of losing control, harming self or others.
Personality becomes sad, withdrawn, tired, apathetic, anxious, irritable, or prone to angry outbursts.
• Declining performance in school, work, or other activities. (Occasionally the reverse: someone who volunteers for extra duties because they need to fill up their time.)
• Social isolation or association with a group that has different moral standards than those of the family.
• Declining interest in sex, friends, or activities previously enjoyed.
• Neglect of personal welfare, deteriorating physical appearance. There is a big change in sleeping or eating habits as well. (Particularly in the elderly) Self-starvation, dietary mismanagement, disobeying medical instructions.
Watch out all the more if there are previous suicide attempts and explicit statements of suicidal ideation or feelings. Some even rehearse their plans and set a time, venue, and date for the attempt.
Parents should pay attention to self-inflicted injuries, such as cuts, burns, head banging and reckless behavior.
• Share your morbid fantasy. Tell your therapist, a friend, a family member, or someone else who can help.
• Distance yourself from any means of suicide. Guns, knives, blades, medicines-a-plenty, ropes should be out-of-sight.
• Avoid anything that will trigger the desire and remove inhibition such as alcohol and other drugs of abuse.
• Avoid doing things you are not competent in. A blow on your ego and self-esteem will add fuel to the fire.
• Make a schedule and follow it dutifully. Strike out tasks when they are done. A sense of order and predictability boosts your feeling of being in control.
• Include in this daily schedule at least two 30-minute periods for activities that give you much pleasure such as: listening to music, playing a musical instrument, meditating, doing relaxation exercises, doing needlework, reading a book or magazine, taking a warm bath, sewing, writing, shopping, playing games, watching your favorite DVD or video, gardening, playing with your pet, participating in a hobby, taking a drive or a walk.
• Take care of your physical health. Eat a well-balanced diet. Don’t skip meals. Get as much sleep as you need, and go out for one or two 30-minute walks each day.
• Make sure you spend at least 30 minutes a day in the sun. Bright light is good for everyone with depression, not just people with Seasonal Affective Disorder (SAD).
• You may not feel very social but make yourself talk to other people. Whether you talk about your feelings or about any other topic, reducing your social isolation is likely to be helpful.
Remember that while it may feel as if it will never end, depression is not a permanent condition. So take heart.
Myth 2: Anyone who tries to kill himself has got to be crazy. Perhaps 10 percent of all suicidal people are psychotic or have delusional beliefs about reality. Most suicidal people suffer from the recognized mental illness of depression; but many depressed people adequately manage their daily affairs. The absence of "craziness" does not mean the absence of suicide risk.
"Those problems weren’t enough to commit suicide over," so some people say. You cannot assume that because you feel something is not worth being suicidal about, that the person you are with feels the same way. It is not how bad the problem is, but how badly it’s hurting the person who has it.
Myth 3: If someone is going to kill himself, nothing can stop him. Suicidal behavior is a cry for help. The fact that a person is still alive is sufficient proof that part of him wants to remain alive. The suicidal person is ambivalent – part of him wants to live and part of him wants not so much death as he wants the pain to end. It is the part that wants to live that tells another "I feel suicidal." If a suicidal person turns to you it is likely that he believes that you are more caring, more informed about coping with misfortune, and more willing to protect his confidentiality. No matter how negative the manner and content of his talk, he is doing a positive thing and has a positive view of you.
Myth 4: Talking about it may give someone the idea. Better confront it while it’s early. People already have the idea; suicide is constantly in the news media. If you ask a despairing person this question you are doing a good thing for them: You are showing him that you care about him, that you take him seriously, and that you are willing to let him share his pain with you. You are giving him further opportunity to discharge pent-up and painful feelings. If the person is having thoughts of suicide, find out how far along his ideation has progressed.
• Listen. Give the person every opportunity to unburden his troubles and ventilate his feelings. You don’t need to say much and there are no magic words. If you are concerned, your voice and manner will show it. Give him relief from being alone with his pain; let him know you are glad he turned to you. Show patience, sympathy, acceptance. Avoid arguments and advice giving.
• The depressed will ask for non-disclosure of his suicide plan but do not attempt to help alone. Get help for the person and for yourself. Distributing the anxieties and responsibilities of suicide prevention makes it easier and much more effective. Respond to that part of the person and persistently seek out a mature and compassionate person with whom you can review the situation. (You can get outside help and still protect the person from pain causing breaches of privacy.)
• Most people have suicidal thoughts or feelings at some point in their lives; yet less than two percent of all deaths are suicides. Nearly all suicidal people suffer from conditions that will pass with time or with the assistance of a recovery program. There are hundreds of modest steps we can take to improve our response to the suicidal and to make it easier for them to seek help. Taking these modest steps can save many lives and reduce a great deal of human suffering.
(Thank you, Shine, for the information you have shared. I am sure that a lot of those who responded to the article last week got a better handle on how to deal with depression.)