National Suicide Prevention Awareness Month: A Mindful Approach to Discussing Suicide

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

What Therapy Has Taught Me

Ok Ok, I'll admit it, it has been a long time since I have been in the client's seat.  I'm a Therapist, so of course I believe in the power and the process of therapy, but I've recently also become a client in a whole new way, which has allowed me to rediscovered my love for the therapy process.  

And FYI, if you didn't already know, being a client is hard work!

Many people are afraid of therapy, and I can understand why.  However, most people who are not open to therapy act as if they don't need therapy because they are self-aware enough to handle things on their own.  That may be true, but there is so much to be learned about yourself in therapy and so much more to be gained with a fresh perspective.  As a therapist, who has recently taken to the client's couch, rather than my usual comfy therapist's chair, I know this all to well.

Just like you, sometimes I don't want to go to therapy, because it's just really hard.  I have had moments of feeling defensive towards the therapist when they offer a new perspective on my life, which is particularly difficult to hear.  I've also felt at times that I wanted to run out of the therapy room, because difficult feelings were being triggered.  

As I always say to my client, and now to myself as a client, "you must respect the process."  The difficult feelings, the defensiveness, the denial, all of it is a part of the process.  These are the qualities that help you to grow in therapy.  

And, It's so worth it!

Here are some things that I have learned in therapy as a client, which I believe are to be gained in the therapy process, that makes it all worth it.........

1. No matter how much awareness, intelligence, or lived experience you have, the insight and perspective of a third party person (the therapist) is invaluable to your growth and development.

When you enter into therapy you are relying on the therapist to give you insight and knowledge into your presenting problems to increase awareness and perspective.  

Well, ask and you shall receive!  This will definitely happen in therapy.  It should be noted that it's not all roses either. This is a very difficult process.  But you know what they say, "Nothing worth having comes easy."  

The therapist's input is utterly priceless.  Also, it is undoubtedly very different from your friend's or family member's input, likely more well-thought-out and balanced, but most importantly unbiased.

Even as a therapist myself, when I have been sitting on the client's couch, the insight and perspective offered by the therapist has been extremely helpful, leaving me at many times saying "I never thought about it like that before."

The truth is that when you are involved in your problems, as you always are, your mind becomes cluttered and you cannot see things clearly.  That's true for everyone, even for those who are extremely wise and self-aware. 

2. It's OK to let go of control and perfectionism.

As a client, one of the most helpful things that can happen in the therapy process, is when  your therapist offers alternatives to your preferred or regular way of being.  

Therapists do this in a very simple way, by holding the space for you as the client.  They hold the space by allowing you to be who you are, accepting you as you are, and also offering thoughts on how you can also hold space for yourself and learn to love yourself, flaws and all.

In the therapy process, when you let go of control and perfectionism and just allow yourself to be who you really are, and even make mistakes from time to time, you begin to feels safe in the therapy process.  More than that, you begin to feel safe in life because the therapist offers a corrective experience in which you begin to understand that you are always whole and complete, no matter what.

3. Acceptance.

Isn't this the thing we all want?  To just be accepted?  

One of the best parts of the therapy relationship is when you come to realize that your therapist accepts you for who you are.  No judgment.  Just pure acceptance, warmth, and regard.  When the therapist accepts you for who you are, while at the same time offering suggestions and alternatives ways of looking at the problem, you are able to work through some serious issues, some of which may have been plaguing you for years.  

It is here in acceptance, where you allow things to be as they are, without attempt to change them, that a paradox of change happens.  This is the kind of change that is cathartic and utterly transformative.  

4. Mental health is equally important as physical health.

Enough with the stigma already!  

When you are sick due to an illness or disease, you likely go to the doctor and start the recommended treatment for your physical health (i.e. medication, exercises, diet, etc).  So why is this process any different from your mental health when you are suffering from depression, anxiety, change of life issues, or a broken heart??

When you neglect your emotions, affect, mood, and psychological ailments, they only serve to manifest in other ways, often physical ones.  Maybe these will show up as nightmares, panic for no apparent reason, a feeling of dread, unhappiness, reoccurring stomach aches or other body aches, being 'stuck' in your professional or personal life, tearfulness, etc.

Therapy attends to somatic, bodily issues, that are being affected by psychological problems, as well as helps you to take care of your figurate heart.

You must take into consideration your mental health and emotions in order to be the best version of yourself!

5. Forgiveness.

This is a hard lesson to learn. Anytime.  Anywhere.

Choosing to forgive is a choice that you need to make for yourself.  No one, not even the therapist, can push you to do this.

However, as a client, my therapists have been able to point out to me areas where forgiveness may be helped.  Sometimes this means forgiving others, but usually this means forgiving myself.  Either way, the experience and process of learning to forgive is paramount to your wellbeing.  

I remember being a very young person, who believed that forgiveness was a waste of time and never imagined it as a possibility in my life, because I wanted to be sure to always make those who wronged my pay for their transgressions.  With time, maturity, and with therapy, I have learned otherwise.  

Forgiveness doesn't mean that you condone the wrongs that people have done to you.  It also doesn't mean that you forget such wrong doing.

Forgiveness is simply a willingness to no longer hold onto contempt and anger, or any other negative emotions associated with wrong doing.  

Really, forgiveness is about freedom.

6. Emotions are tricky little suckers.

Some of us are able to control our emotions beautifully.  More power to ya!  

Others of us feel emotions strongly, these emotions change often, and we have a hard time understanding how these suckers work.

I put my self in the latter description.

You are not alone. 

Although my training as a therapist has allowed me to have a great understanding of emotions and skills to use to manage these, this process does not come easy to me, especially when I am acting as the client, rather than the therapist.  Sitting on the client's couch I have felt such complicated emotions, which have been very difficult to understand, even with much awareness and understanding.  I am humbled by the fact that no matter what position you are in, emotions demand to be felt.  You must experience these at their fullest in order to move through them.

 

Consider therapy as a treatment to help you gain insight, awareness, and manage difficult feelings. There is so much to be gained in the process.