Introduction

Thank you for wanting to help a suicidal thinker. You play an important role, requiring patience, stamina, and perseverance. Bearing witness to his or her pain is no easy task, but however strange this may sound, it’s important to realize that suicidal thinkers most likely want to live. They just think they want to die because their brains are bent on killing them.

When my mind focused on suicide, it was craving relief—from psychological pain, or “psychache,” a term coined by Dr. Edwin S. Shneidman.1

Whenever I had suicidal thoughts, I was in one or more of these feeling states: I felt painfully alone; I felt volcanic anger and wanted to punish someone; I felt free-floating anger and had no healthy outlet for it; I felt afraid of being abandoned (so I thought I’d abandon first); I felt afraid that my needs would never be met (so I’d create a crisis to get them met); I felt overwhelmed by responsibility or financial stress; or I felt completely hopeless that my life would ever improve. At times it hurt to live.

My heart craved love, yet when offered appropriate love, I often refused it for a number of reasons: habit, depression, personality disorder, the need for control, a fear of rejection, a fiendish brain. My rejection of love intensified the psychache and raised the stakes on suicide, which made me crave love even more. Living in a suicidal mind is incredibly complicated. And tiring.

On its website (www.suicidology.org), the American Association of Suicidology states: “People having a crisis sometimes perceive their dilemma as inescapable and feel an utter loss of control. These are some of the feelings and things they experience:

In Definition of Suicide, Dr. Shneidman describes ten common suicide characteristics:

  1. The common stimulus for suicide is unendurable psychological pain. Pain is what the suicidal person is seeking to escape. It is psychological pain of which we are speaking; metapain; the pain of feeling pain. The main clinical rule is: Reduce the suffering, often just a little bit, and the individual will choose to live.
  2. The common stressor in suicide is frustrated psychological needs. Suicides are born, negatively, out of needs. Psychological needs are the very color and texture of our inner life. Most suicides probably represent combinations of various needs. The clinical rule is: Address the frustrated needs and the suicide will not occur.
  3. The common purpose of suicide is to seek a solution. First of all, suicide is not a random act. It is never done pointlessly or without purpose. It is a way out of a problem, dilemma, bind, challenge, difficulty, crisis, or unbearable situation. It is the answer—seemingly the only available answer—to a real puzzler: How to get out of this? Its purpose is to solve a problem, to seek a solution to a problem that is generating intense suffering. It is important to view each suicidal act as an urgently felt effort to answer a question, to resolve an issue, to solve a problem.
  4. The common goal of suicide is cessation of consciousness. In a curious and paradoxical way, suicide is both a moving toward and a moving away from something; the something that it is moving toward, the common practical goal of suicide, is the stopping of the painful flow of consciousness. The moment that the idea of the possibility of stopping consciousness occurs to the anguished mind as the answer or the way out in the presence of the three essential ingredients of suicide (unusual constriction, elevated perturbation, and high lethality), then the igniting spark has been struck and the active suicide scenario has begun.
  5. The common emotion in suicide is hopelessness-helplessness. In the suicidal state [the common emotion] is a pervasive feeling of hopelessness-helplessness. I believe that this formulation permits us somewhat gracefully to withdraw from the (sibling) rivalry among the various emotions, each with the proponents to assess that it is the central one of them all. To the extent that suicide is an act to solve a problem, the common fear that drives it is the fear that the situation will deteriorate, become much worse, get out of hand, exacerbate beyond the point of any control. Oftentimes, persons literally on the ledge of dying by suicide would be willing to live if things—life—were only a little bit better, a just noticeable difference, slightly more tolerable. The common fear is that the inferno is endless and that one has to draw the line on one’s suffering somewhere.
  6. The common internal attitude toward suicide is ambivalence. We can now assert that the prototypical suicidal state is one in which the individual cuts his throat and cries for help at the same time, and is genuine in both of these acts. This accommodation to the psychological realities of mental life is called ambivalence. It is the common internal attitude toward suicide: To feel that one has to do it and, simultaneously, to yearn (and even to plan) for rescue and intervention.
  7. The common cognitive state in suicide is constriction (tunnel vision). . . . Suicide is much more accurately seen as a more or less transient psychological constriction of affect and intellect. Synonyms for constriction are a tunneling or focusing or narrowing of the range of options usually available to that individual’s conscious when the mind is not panicked into all-or-nothing thinking. The range of choices has narrowed to two—not very much of a range. The usual life-sustaining images of loved ones are not disregarded; worse, they are not even within the range of what is in the mind.
  8. The common interpersonal act in suicide is communication of intention. Clues to suicide are present in approximately 80 percent of suicidal deaths. It is a sad and paradoxical thing to note that the common interpersonal act of suicide is not hostility, not rage or destruction, not even the kind of withdrawal that does not have its own intended message, but communication of intention. The communication of suicidal intention is not always a cry for help. First, it is not always a cry; it can be a shout or a murmur or the loud communication of unspoken silences. And it is not always for help; it can be for autonomy or inviolacy (to not be violated) or any number of needs. Nonetheless, in most cases of suicide there is some interpersonal communication exchange related to that intended final act.
  9. The common action in suicide is egression. Egression is a person’s departure or escape, often from distress. Egression means to leave, exit, or escape. Suicide is the ultimate egression. Suicide is a death in which the decedent removes himself or herself from intolerable pain and simultaneously from others in the world in a precipitous fashion.
  10. The common consistency in suicide is with life-long coping patterns. In almost every case what one does see are certain displays of emotions and use of defenses that are consistent with that individual’s reactions to pain, threat, failure, powerlessness, impotence, and duress in previous episodes of that life. In general, . . . suicide, although enormously complicated, is not totally random and it is amenable to a considerable amount of prediction.2

If suicidal thinkers are trying to end psychache, and psychache stems from frustrated psychological needs, your job is to help them meet those needs.

When I confided in someone about suicidal thoughts, I did so out of trust, even if my general treatment of that person was erratic. If the other person had the ability to give and receive help openly, both of us benefited from the exchange. If, on the other hand, that person’s ability was limited (for any number of reasons), his or her feelings of inadequacy or frustration often collided head-on with my feelings of rejection and abandonment, fueling the suicidal situation.

When a suicidal thinker or depressed person comes to you asking for assistance, be aware of your limitations; it’s okay for you to ask for help. I suggest that you do what you can for the person in the moment, then seek additional support and guidance. It is both dangerous and impossible for a layperson to try to remedy the situation alone. See part 7 for a comprehensive listing of prevention organizations and resources.

You’ll quickly see that this part of the book has little to do with changing the suicidal thinker. Rather, I discuss how the rest of us can change ourselves so we can better support the suicidal thinker. The only person who can “fix” the suicidal thinker is the suicidal thinker, with your loving support and the guidance of a professional.

After a review of the risk factors, warning signs, and statistics of suicide, the rest of part 5 is divided into three sections: words, beliefs, and actions—what works, what doesn’t, and why.

By holding to certain beliefs about the suicidal situation, I believe that our actions and words contribute to a more (or less) productive atmosphere for growth. By engaging in certain actions—good listening skills, for example—we convey the belief that it’s okay to talk about it. By choosing appropriate words rather than words that don’t work, we take the suicidal person seriously, practice patience, and affirm the belief that change is possible.

My personal examples are supplemented with guidelines from professional suicide prevention organizations. If anything I say sounds simplistic, know that I am well aware of the difficulty involved. My road to freedom was wracked with obstacles and setbacks.

I’m sorry that someone you love is considering suicide. If it’s any consolation, I put people through the wringer before I finally “got it” and stopped the suicide cycle. I’ve come to realize that I had to go through what I did in order to get to where I am today, which is a place of profound gratitude and lasting peace.

May your love and compassion reach the heart of the suicidal thinker, and may your willingness to grow aid in that person’s transformation. I can say from experience you’re in for a bumpy ride, but it is definitely worth the effort. So are you.

Change is possible and love heals. You can make a difference. So hang in there, breathe, find support, get educated, and remember: there is no need to go through this alone. This book is dedicated to all of you; I wish you well.