Adult Suicide

by Lorie Vander Schuur White, R.N.C., B.S.N.

• Neal is 65. He has just retired, and instead of enjoying his retirement, he finds himself bored and irritable. He doesn't know what to do with all his time, and he feels he doesn't have a meaning or purpose in life.
• Michael is 43 and has been a vice president of his firm for three years. He feels the challenges are gone from his work, and he'd like to make a change. But the house is mortgaged, one child is in college, and another needs braces. His responsibilities don't allow him to risk his job security and try something new.
• Sue is 27. Five months ago she gave birth to a healthy baby daughter, but Sue is deeply depressed.
• Mary is 54. She has terminal cancer. Doctors say treatments are no longer effective for her.

Sue, Michael, Neal, and Mary are typical of people who attempt suicide. Suicide is no respecter of sex, age, race, or religion. Potential suicide attempters work in your business, live in your neighborhood, attend your church, and perhaps sit at your dinner table. What do you need to know to help an adult who is contemplating suicide?

First of all, it helps to be educated about some of the facts. More women than men attempt suicide, but more men than women actually commit suicide. Men make more serious attempts; they are more likely to use means that insure success such as gunshot or hanging. Women more typically choose a means less lethal (like overdosing on pills) and after doing so, may call someone. Throughout an adult woman's life span, her suicide risk factor remains fairly consistent. Men, however, are high risks from age 18-25. Then it levels off and peaks again for high risks after age 65.

There are many reasons people contemplate suicide. Remember, however, these "reasons" may not make sense to you. They aren't logical because a person contemplating suicide usually doesn't think logically. When people get to the point of attempting suicide, their thinking is unclear and their reasoning is muddled.

There are four main factors that help explain why someone might attempt suicide.

Suicide is an attempt to communicate. If people can't say what's going on inside them, then suicide is an indirect way of expressing their turmoil, an attempt to call attention to their plight. It's a cry for help.

Suicide is a mastery over fate. People who are deeply depressed often believe they have no control over their fate. One way to gain some control is by taking their own life.

Suicide can be anger/rage turned inward. A person might think, "I'm so angry, I'm going to harm myself." Suicide is also a way of "murdering" someone with whom the attempter is angry. For example, maybe I'm furious with my husband. I feel I can't deal with that anger directly. Or perhaps I've tried to deal with it and I don't get anywhere-my husband isn't listening and we're not resolving our problems. I get so angry and obsessed that I incorporate in myself what angers me about my husband. Therefore, suicide is a rage reaction to feeling a loss of control with another.

Suicide is a way to escape from a painful or humiliating situation. This is sometimes called "culturally- or socially-sanctioned" suicide. If people are terminally ill, they may consider suicide to spare the family the expense of long hospital care and the pain of watching them suffer and die. Or if someone has an illness they fear might bring embarrassment to the family-such as AIDS-that person may consider suicide a preferable option to dying from the illness. Sometimes suicide is seen as a way to reunite with a relative or friend who has already died. This is often true for older people who want to rejoin a dead spouse.

To a logical, clear-thinking person, these reasons may not make sense. But even if you can't understand the reasoning, it's important you know the warning signs so if someone around you is considering suicide, you will be able to pick up the signals before it is too late.

Here are some common behaviors that may indicate a person is thinking about suicide. Watch for:

• hopelessness and helplessness
• depression
• anger or hostility (This has to be consistent hostility with no resolution.)
• anhedonia (Nothing in life gives the person pleasure.)
• guilt leading to a wish to be punished
• isolation or withdrawal
• insomnia
• impulsiveness (This is out-of-character; it means someone who usually is careful is suddenly making impulsive decisions.)
• ambivalence (The person can't decide whether or not to commit suicide.)
• preoccupation with death or suicide (The person seems intrigued with the idea of dying and with people who have committed suicide.)
• displaying thoughts, words, or actions that are "end centered." (Normally we say we'll be "happier" when we reach a certain goal. "End-centered" people will make statements like: "I'll finally be happy when I complete college," or "Once I have a baby, I'll be happy." They think they'll feel some ultimate emotion or will have achieved the ultimate goal when something is done.)
• giving items away (This can mean suddenly making a will and checking into life insurance.)
• termination of significant relationships or commitments (Someone who has always been involved in church, job and has close friends suddenly cuts off all contact and ends all involvement, ending things and preparing to die.)
• sudden uplift in mood (People suddenly have a sense of happiness when previously they were very depressed. They have made the decision to commit suicide and feel peaceful now they've finally made a choice. This attitude differs from people emerging from a true depression who undergo a slow, gradual process to recovery and are not suddenly happy.)

Taken separately, these signs may not mean anything. Any of us can exhibit any one of these on certain days in our lives. But concerned friends and relatives will watch for signs in loved ones. If you see these signs in someone you care about, what do you do? You can be vital in helping someone.

First, deal with the feelings of suicidal people. Probably the most common feeling is ambivalence. Any person contemplating suicide is ambivalent-this is what makes helping and saving a person possible. People need reinforcement of their will to live. Be willing to talk with them. Focus on the fact that they are ambivalent. That's all right because you can help them think of the reasons they don't want to die.

Help them express their feelings of hopelessness and helplessness. If you can increase their hope without giving false reassurance, their suicide wishes will decrease. Help by pointing out the areas in their lives where they do have control. Help them realize hopelessness is a part of a depression. Depression is a time-limited disease; it's not terminal. People have control over getting help and dealing with depression. If someone says, "I feel hopeless about my marriage," don't say, "Your marriage will survive." That's false reassurance. You can say, "There's help available to work on problems in your marriage." Giving hope can be a particular challenge when the suicidal person is retired. If he/she had a high priority on work throughout life, retirement was probably traumatic. Help them understand they will be depressed while they're adjusting. Don't lie, but remind people this isn't a permanent condition.

Suicidal and depressed people have often turned their anger inward. They must learn to recognize and express that anger. Many know they're angry, but don't know why and don't know where to go with it; they feel stuck. Give them permission for dealing with and expressing the anger so it doesn't eat away inside them.

Probably your most important role is staying supportive. Sometimes people help encourage a friend to get professional counseling, but then back off. Initially be willing to talk and say, "You need help, and I'll help you get it." Then be willing to continue the relationship.

Many suicidal people are struggling with low self-esteem. They need increased self-esteem, self-respect, acceptance, and a feeling of belonging. Some of these feelings can come from a therapist, but they're most meaningful when lay people and peers reinforce them. Many suicidal people ask, "Do people really care? Sure my therapist cares, but that's his/her job. But what about my fellow church members? Fellow employees?" If peers care, that's tremendously reinforcing for the suicidal person. Being accepted after a suicide attempt is a big issue for many people. Peers need to be able to accept people who have made the attempt and not be afraid of them and not view what they've done as an unforgivable sin.

It's important for you to know when and where to get help for someone contemplating suicide. "When" is best defined by "whenever." Whenever you have a feeling a person is contemplating hurting her/himself, that's the time to get help. It's even all right to say, "Some of your actions lately have made me wonder-are you thinking about harming yourself?"

There are good agencies all over. Look in the telephone book. Call a hotline or helpline.

Remember, you should take all suicide comments seriously. This can be difficult. What if you're dealing with someone who is typically down and typically talking hopelessly? It can be difficult to figure out whether the person is serious or not. The best advice is: if the person is talking about harming themselves, take it seriously no matter if this is the first or hundredth time they've talked that way.

Once the risk of suicide is over, people need help looking at the underlying problems that brought them to the point of contemplating suicide. Maybe they've called a crisis line or hotline and they've decided not to commit suicide, but they still need help. Encourage them to get professional help. The hotline might have been a start, but they need counseling to get to the underlying problem.

Christians deal with the same problems that would lead someone to suicide as much as non-Christians do. I believe Christians struggle more trying to decide if suicide is an acceptable option for them. They ask themselves questions like: "How will God judge me? How will God feel about this act? How will God feel about my choosing this way to deal with the problem?" They will experience more ambivalence than non-Christians.

However, it's important to remember suicidal persons aren't thinking rationally. If they were thinking rationally, they might say, "I'd never consider suicide an option. God wouldn't want me to do that."

After people have attempted suicide and then understand the underlying problem, they see the suicide attempt as part of their illness. They feel bad it happened, but know it was a result of an illness, not necessarily a non-Christian event. However, they struggle with the acceptance of the people. They think, "How am I ever going to go back to church and face all those people knowing that they know I did this? How are we ever going to get past that? Will they judge me?" For Christians, going back to church after a suicide attempt can be extremely stressful. It's important to not be judgmental and to support a Christian who has survived a suicide attempt.

Depression is linked to suicide, but not a necessary component. People commit suicide when they're under the influence of a drug, when they have a terminal illness, when there are problems at work or at home, or for any number of reasons. As someone who cares, you must pay attention to warning signs and help someone who is suicidal to get professional help. Remember to stay supportive throughout the whole process so the person feels Christian love and acceptance. It's not easy-not for you nor for the person you care about-but it's worth it