September is National Suicide Prevention Awareness Month. As a mental health professional and specialist in the area of suicide prevention and crisis response, this topic is very important to me and the work that I do. Furthermore, my own personal battle with suicidal ideation and mental illness has enabled me the understanding and empathy needed to work with this challenging topic.
Due to the cultural beliefs around suicide and mental illness as a whole, most people find it very challenging to share openly about their personal experience, not only about mental illness, but simply just about challenging times. People tend to think that difficult emotions and mental illness are a sign of weakness and inferiority, and we prefer to portray ourselves in a certain light, one that we feel is favorable to others. Unfortunately, we also tend to believe that our self-worth and confidence is directly dependent on our successes and good fortunes.
Under these circumstances, why would we ever want to share openly about our pain and suffering?
It is here that we propagate the vicious cycle of stigma, shaming ourselves into pretending that nothing is wrong, covering up our wounds with the Band-Aids of distraction, and never fully allowing ourselves to heal.
As challenging as it is to talk about, our willingness to discuss the topic of suicide is paramount to erasing stigma and getting help to those who may be suffering.
It is your vulnerability and imperfections that make your strong, relatable, and worthy of your deepest heart’s needs and desires.
A mindful approach to this discussion begins with radical acceptance that mental illness plagues all of us. None are immune. Whether you yourself experience the symptoms and behaviors of a mental disorder or not, you at least know someone who does. In fact, research shows that 1 in 3 people will have a psychiatric disorder in their lifetime (Kessler et al., 2004).
Just think about that for a moment.
A simple Acceptance and Commitment Therapy exercise to grasp this idea of prevalence of mental illness is to imagine every single person you know in your life. Imagine that all these people are standing shoulder to shoulder in a very long line. Now imagine that you are standing before this line of all the people you know. See their faces, recall memories of activities with them, allow yourself to really see them and feel whatever emotions are brought up by your experiences with them. Now imagine that you move through this line from the beginning and all the way to the end, counting every third person. Recognizing that every third person is likely struggling with mental illness, and maybe even suicidal ideation.
Imagine the magnitude of this.
Be it directly or indirectly, we are all affected.
The second piece of approaching this topic mindfully is to increase awareness about the automatic thoughts, emotions, and judgments that are brought up by the discussion of suicidality and mental illness. It’s best to begin by using a mindfulness practice to connect to your breath and cultivate calm and stillness. Naturally allow thoughts, emotions, and judgments to arise. Simply label the thoughts, emotions, and judgments as you become aware of them. Avoid any judgments about the thoughts or emotions. Simply just allow them to be there without trying to change them in any way.
Keeping this practice in mind, let’s discuss the myths commonly associated with suicide.
Myth 1: It’s NOT “normal” to think about suicide.
Suicidal ideation, or thoughts about suicide, are fairly commonplace in the world of mental illness. The Center for Disease Control (CDC) reports that “more than 9 million adults reported thinking about suicide in the past year” and “more than 1 million adults reported making a suicide attempt in the past year.” Furthermore, the CDC reports that suicide is the 10th leading cause of death among Americans, putting up there near Heart Disease, Cancer, and Stroke. However, this number drastically increases when reviewing suicide among certain age groups, particularly our youth, such that suicide is the 3rd leading cause of death among ages 10-14 years old and the 2nd leading cause of death among ages 15- 34 years old.
Myth 2: Those who commit suicide don’t warn others.
Often there are many warning signs that are communicated verbally or non-verbally by someone who is considering suicide. These can include the following:
· Excessive moodiness or mood swings.
· Severe anxiety and agitation.
· Changes is personality or having a sudden sense of peace.
· A loss of sense of purpose or meaning in life.
· Severe hopelessness and worthlessness.
· Experiencing a recent crisis or trauma.
· Withdrawal from friends, family, work, and responsibilities.
· Reckless, acting out behaviors, that are often risky in nature (i.e. promiscuity, substance abuse, excessive spending, socially inappropriate behaviors, etc.).
· Self-harming behaviors (i.e. cutting, burning, hitting head, etc.).
· Overt discussion and questions or preoccupation with death and dying.
· Making preparations and getting their business in order (i.e. creating a will, giving away possessions, cleaning house, etc).
· Making passive statements such as, “I wish I wasn’t here.” Or “I can’t do this anymore.”
Myth 3: Those who talk about suicide are just attention seeking.
As mentioned above, people who are thinking about suicide often send out warning signs, trying to communicate their distress, as well as to seek help. This is not merely attention seeking as a way to boost self-esteem and self-worth. Rather, these individuals are crying out for help by seeking care and understanding from others, as well as a way to managing their difficult emotions.
Myth 4: People who think about committing suicide want to die.
People who think about commit suicide often DON’T want to die, rather they want to find a way to end their pain. Hopelessness and despair, a common symptom of depression and anxiety, is the thought or feeling that pain and sadness will never go away. Individuals experiencing hopelessness often feel paralyzed by their suffering and believing that the only way to end it is by result of their death.
Myth 5: Suicide is selfish.
Another common symptom of depression and anxiety is worthlessness, which is just the opposite of selfishness. Worthlessness leaves people believing that are no good, not deserving of love, and that the world would be better off without them. People who struggle with thoughts of suicide almost always feel useless, insignificant, and unimportant.
Myth 6: Symptoms of mental illness, such as thoughts of suicide, are strictly due to a chemical imbalance.
Although it is true that some mental health symptoms, such as suicidality, may be due to a chemical imbalance, this is not always true. Research shows that other times mental illness may be caused by some combination of medical problems, genetic vulnerabilities, situational experiences, trauma, poor mood regulation, and a heightened arousal to stress (Harvard Health Publications, 2009).
Myth 7: Talking about suicide with someone who is showing warning signs may encourage them to attempt suicide.
Asking someone about suicide does not assist them in any way in carrying out their thoughts or plan. If anything, the more you can assert yourself in inquiry about suicidal ideation, the more likely you will be viewed as a strong support who will not be easily scared away. If you observe the warning signs of someone’s potential suicide, get talking with them. Ask them questions. This will allow you to learn more about their experience, express your concern and empathy, and work with the individual to create a safety plan for their care and wellbeing.
One final mindful approach to this topic is to take care of yourself.
Suicide is a very difficult topic that can cause secondary trauma to the supportive others and helpers. In discussing this, you will naturally rouse personal thoughts, feelings, and judgments that may be very challenging and may lead to your own feelings of sadness, anger, helplessness, exhaustion, or burnout.
Begin to take care of yourself by cultivating a self-care practice, including unplugging from technology, using mindfulness to connect to your 5 senses and find stillness, getting some exercise, getting out in nature, developing a gratitude practice, or giving back to your community. Please see my article here for more tips of developing a self-care practice.
Lastly, check out the resources below for more assistance:
- 911- Crisis emergency assistance
- 211- Los Angeles County Community Resrouces
- National Alliance on Mental Illness (NAMI)
- National Suicide Prevention Line: 1-800-273-8255
- Los Angeles County DMH Access Line: 1-800-854-7771