Suicide Sensitivity

Myths and Misconceptions

Suicide is a taboo topic of conversation in most cultures and as a result there is much ignorance and misunderstanding about it. If we are going to do something to prevent the high rate of suicide we need to start debunking the myths surrounding it. Here are some of the more common myths about suicide:

Myth: Once someone is suicidal, he or she will be suicidal forever.
Reality: People who want to kill themselves are 'suicidal' for only a limited period of time. During this time they either move beyond it, get help or die.

Myth: If they failed in an attempt it means they don’t really want to succeed.
Reality: They just got it wrong or were found out too early. Chances are that they will try again.

Myth: If someone tried to kill themselves once, there is a much smaller chance that they will try again.
Reality: As many as 80% of all completed suicides occurred after previous attempts. This is especially true for young people.

Myth: Suicidal people don’t want to live.
Reality: With the exception of some terminally ill people, most suicidal people do want to live. They just believe they can’t cope; can’t see a solution to their difficulties or believe others will be better off without them.

Myth: Suicidal people clearly want to die.
Reality: Ambivalence is a marked feature of a suicidal person. Many don't want to die, but simply want to escape an unbearable situation.

Myth: Deep religious faith makes suicide impossible.
Reality: Religious people are not immune to depression and other emotional problems. Religious people also commit suicide.

Myth: Those who threaten suicide won’t carry it out – it is just a cry for attention.
Reality: Although those who keep their plans secret are more predisposed to lethal intent, those who threaten suicide very often do carry it out. All suicide threats must be taken seriously. If it is a cry for attention, instead of dismissing it, we should be asking ourselves: “Why does this person have to resort to these drastic measures to get attention?” and “What can I do to give them the attention they are crying out for?”

Myth: People who are going to kill themselves don't normally talk about it. They just go ahead and do it.
Reality: Most people either talk about it or do something to indicate that they are going to kill themselves. There is no need to blame yourself if you didn't see it coming, but if you are worried about someone you know, make sure you read all about the warning signs (see below) you may see before a suicide attempt, and also find out what you can do to help (see below).

Myth: It is a bad idea to ask people if they are suicidal. Talking about suicide might give them the idea that they should kill themselves.
Reality: On the contrary, talking about suicide will help someone considering suicide to deal with some of the heavy issues involved and diffuse the tension. A willingness to listen shows the suicidal person that people care and are willing to help.

Myth: If a depressed or suicidal person feels better it usually means that the problem has passed.
Reality: If someone who has been depressed or suicidal suddenly seems happier, don't assume that the danger has passed. Once a person has made a decision to kill themselves, they often feel 'better' or feel a sense of relief at having made the decision. It is important to be aware that a severely depressed person may lack the energy to put their suicidal thoughts into action, but once they regain their energies (and so feel ‘better’) they may well go ahead and do it.

Myth: Young men are at the highest risk of killing themselves.
Reality: Males between the ages of 18 and 24 are in the group with the highest growth rate of suicide, but older men are actually at the highest risk of killing themselves.

Causes of Suicide

No single explanation is sufficient to account for all types of suicide. It results from many complex sociocultural factors and is more likely to occur during periods of a socioeconomic, family or individual crisis (e.g. loss of a loved one, unemployment, confused sexual orientation, difficulties with developing one's identity, disassociation from one's community or other social/belief group, or honour).

There are a number of factors that seem to be associated with suicide:

Depression – During the deep, horrible despair of depression, many people feel that suicide is the only way out. The need to stop the pain becomes overwhelming and suicide is seen as a relief.

Contrary to popular belief it is often not the people who are most severely depressed that commit suicide, but rather those less severely depressed. With severe depression a person usually does not have the energy to commit suicide. It is when they are being treated and their mood is starting to improve that a person is most at risk. They are depressed enough to think life is not worth continuing, but have enough energy to make and carry out preparations for suicide.

Loss of hope – Hopelessness may be the greatest predictor of suicide. Many people cite the following as a trigger for their suicide attempt:
No hope for the future
No hope that things will ever change
No hope that I will ever be well and- /or stable
No hope that I will ever be able to meet my goals in life
No hope that I will ever be able to have a successful relationship or career
No hope that I will ever be able to accomplish anything.

Desperation – People with suicidal thoughts often feel totally overwhelmed. They feel they have too many problems all at once so that they feel trapped and suicide appears to be the only way out.

Low Self-esteem – The low self-esteem that often accompanies depression and bipolar disorder is a key contributing factor to suicide. Many people with suicidal thoughts believe that the world would be a better place without them. Self-accusation and guilt go hand in hand with such perceptions. They feel they are complete failures and that there is no point in being alive. They become obsessed with memories of past failures and feelings of inadequacy.

Loneliness – An overwhelming feeling of loneliness and isolation is a contributing factor in suicide. People who experience depression and bipolar disorder often feel that no one cares about them and may even feel that their family and friends wish they were dead. Some people even think that suicide is a way of ‘getting back’ at family that doesn’t want them. Many of us experience these feelings at times, but with depression they can be greatly exaggerated.

Depression is often accompanied by a deep fear of desertion by friends, family and other support members. A number of suicides and/or suicide attempts have coincided with the ending of a close relationship either by death, separation or abandonment.

Shame and/or guilt – Suicide often seems the only way to escape embarrassment, guilt or financial havoc.

Bad memories – Depression combined with feeling overwhelmed with bad memories, particularly associated with childhood abuse, can act as a trigger for suicide.

Seasonal Triggers – The holiday season, when it seems as if everyone else is having a great time and experiencing the joys of togetherness, can be the worst time of year for someone who is depressed. It is a well-known fact amongst crisis care workers that the Christmas holidays are the time when the greatest number of suicides and suicide attempts take place.

It’s worth noting that in the northern hemisphere Christmas coincides with winter and reduced daylight hours, when Seasonal Affective Disorder (SAD) is often diagnosed. (SAD, also known as winter blues or winter depression, is a mood disorder in which people who have normal mental health throughout most of the year experience depressive symptoms during a particular season - usually winter).

Consumption of alcohol or other substances – Alcohol is a depressant and it is well known that consumption of alcohol reduces the inhibition to commit suicide.

According to the Violent Death Reporting System, in 2004 73% of suicides tested positive for at least one substance (alcohol, cocaine, heroin or marijuana).

Life stressors – There is a very high correlation between stress and suicide. Suicide is often preceded by a stressful event such as suffering a loss (of loved one, employment, economic or social status)

Other factors associated with suicide include:

Separation and divorce

Academic pressures

Serious illness

Occupational stress

Loss of job

Behavioural Clues to Watch For

Although some people will deliberately keep it secret, most people either talk about it or do something to indicate that they are going to kill themselves. The following are warning signs you may see in someone considering suicide. Take them seriously and seek professional help if you notice any of the following:

• Previous suicide attempts
• Preoccupation with death/violence: TV, movies, drawings, books, at play, music
• Giving away prized possessions
• A visit to a doctor/medical specialist followed by a sudden withdrawal
• Talking or joking about suicide. Death becomes a favourite conversation topic
• Any exaggerated reaction to ‘trigger events’”. If a person is already depressed over a substantive problem (such as financial difficulties) a minor, unrelated misfortune can be seen as ‘the last straw’
• Symptoms of Depression such as:
• Apathy and negative attitude
• Wanting to be alone
• Loss of memory and concentration
• Loss of interest in food and sex
• Sleeplessness
• Neglect of personal appearance and hygiene
• Preparations: buying sleeping pills, gun, etc.
• Risky behaviour: jumping from high places, running into traffic, self-cutting
• Having several accidents resulting in injury; ‘close calls’ or ‘brushes with death’
• Obsession with guns or knives
• The most ominous sign of all is a sudden improvement in mood. ‘Cheering up’ often indicates that a person is at peace because of a final resolve to commit suicide. A person in a depressed mood tends to lack the energy to do it.

Verbal Clues to Listen Out For

As mentioned above, although some people will deliberately keep it secret, most people either talk about it or do something to indicate that they are going to kill themselves and want these signs to be seen. The fact that the signs go unnoticed serves only to deepen their conviction that nobody cares.

The following phrases and sentences are warning signs that someone may be considering suicide. If you ever hear anyone say these things ask them directly if they are thinking of killing themselves. (See What to do below) Remember it is a myth (see above) that raising the topic of suicide will make someone do it. It is more likely to have the opposite effect; it is often a relief for the suicidal person to talk about it and know that someone cares enough to listen.

• “I can’t keep on like this.”
• “I’m not sure I can take it anymore.”
• “It’s not worth it.”
• “When I am gone….”
• “They can do what they want – I really don’t care anymore.”
• “I don’t have to worry about it anymore.”
• “It’s hopeless. Nothing is going to change my situation.”
• “Life is just not worth living anymore.”
• “I wish I could disappear forever.”
• “I just want to end it.”
• “I have had enough!”
• “Everyone will be better off if I were dead.”
• Asking questions such as: “If a person did …this or that….would s/he die?”
• “I want to see what it feels like to die.”

What to Do

• Ask directly if the person is considering suicide. For example: “Are you thinking of killing yourself?” (Contrary to what most people think it won’t ‘put ideas’ into some body’s head. Instead it will often lower anxiety levels and allow the person to express pent up thoughts and feelings).
• If they answer “yes” then ask direct questions to ascertain just how seriously they are considering suicide. Ask: “How will you do it?”, “When will you do it?” and “What preparations have you made?” The more answers they have to these questions the more serious it is.
• Encourage the person to tell you why they want to commit suicide.
• Be calm, serious and attentive. Uncontrollable emotion places an additional burden on the person already feeling overburdened, while morbid humour can be dangerously insensitive to someone contemplating suicide.
• Bargain with them, but don’t be held to ransom. Promise them you will do something for them (only promise things you are able to do) and ensure they promise to do something for you in return.
• Urge them to speak to a professional who is trained to help (for example a psychologist).
• If they are unwilling to go to a professional, encourage them to visit their doctor, spiritual advisor or to see a lay counsellor.
• Tell other people about it in order to get help for the individual.
• If the risk of suicide is high have someone stay with them to watch over them for 24hours a day.
• Have them hospitalised - against their will if necessary - until treatment takes effect and they are out of danger.

What NOT to Say

A lot – the best counsellors are measured by how little they say, so listen and then listen some more!
Never say the following:

• “Go ahead and do it – I won’t stop you!” The person will feel you don’t care and feel even more alienated. They may be encouraged to call your bluff.
• “So it’s the easy option you want – the coward’s way out.” Suicidal people experience an appalling amount of emotional pain and their self-esteem is so low that they are defenceless against criticism like this. It will make them feel even more useless than they already feel.
• “Don’t be selfish.” Suicidal people very often commit suicide as an act of selflessness - they feel a burden to others.
• Never minimise their feelings by saying things like: “Come on that doesn’t sound so bad.”; “Just snap out of it.”; “But you have everything to live for.” Remember in their mind it is bad, they can’t snap out of it and they don’t think they have anything to live for. Rather spend time finding out why they think as they do and getting them professional help.

Treatment After a Suicide Attempt

Most people have trouble knowing what to say and do after someone has attempted suicide and often go about things in the wrong way. Remember that someone who has attempted suicide is probably feeling hopeless, desperate and even worse than before the attempt and needs to be treated as follows:

• With love, understanding and compassion. Not indifference, judgement or disgust.
• In a positive manner. Not detached, cool or with rejection.
• Acknowledge what has happened. Don’t avoid the person or act as if nothing happened.
• Allow the person to talk to you about their suicide attempt and their feelings if they want to. Don’t avoid the issue.
• Give the person encouragement to want to live, while still recognising the depth and validity of their despair. Show you understand their wish to die.
• Ensure the person understands that you don’t want them to attempt suicide again. and you will do what t you can to help them feel better.

Self-Help Suicide Prevention Tips

If you have a tendency towards mood swings and- /or suicide, or realize that you have thoughts of suicide, set up a system to help prevent you from carrying it out. Obviously it is best to do this while you are stable. Here are some ideas of things you can do:

Set up a suicide support system – make a list of at least five people that you can turn to when you are feeling suicidal. Ideally, your list should include stable and understanding family members, your health care professionals (psychologist, doctor, counsellors etc.) and the staff at the local mental health/crisis center, as well as the local 24-hour crisis counselling phone line. You need at least five to ensure that at least one is available in case of a crisis. You should never expect any one person to be available to you at all times.

Ideally, the people on your list will know you so well that they may be able to spot your mood swings even before you do, and will promptly assist you in taking evasive action.

Ask the people you have chosen whether they would be willing to be part of your support system and explain what possible scenarios might arise when their assistance and support would be needed and the kinds of action you would like them to take on your behalf. Give them permission ahead of time to do whatever they have to do to keep you safe.

Make a pact with these people that you will call one of them without fail at times when you are thinking about or feeling suicidal. Have them arrange for someone to stay with you until you start to feel better and to get you help.

A useful resource in South Africa is SADAG – South African Depression & Anxiety Group. SADAG is part of the Suicide Prevention Global Referral system on Facebook. Visit https://www.facebook.com/pages/The-South-African-Depression-and-Anxiety-group/335962293097734

Or call SADAG on 0800 21 22 23 and a counsellor will assist you.

For suicide and crisis support around the world please visit: www.befrienders.org .

Get support – Don’t allow yourself to be alone when you are having suicidal thoughts, even though you may really want to be alone. Have someone with you around the clock, no exceptions. You may wish everyone to just leave you alone, but don’t let them. Your life at these times depends on the presence of others.

Express your emotions – Talk to a member of your support team. Let all your feelings out. Members of your support team will want to take it in turns to listen to you as it can be draining and exhausting for them, but that’s fine; keep expressing your emotions. (Note that expressing emotions does not mean ‘acting them out’. You cannot do anything that will hurt others or yourself).

Remind yourself how good you are, and how good it is to be alive – have pictures of your favourite people (partner, friends, children, parents, grandparents) all around your home. Put special letters, diplomas, awards and all other honours where you can easily see them. Keep a list of your accomplishments on your fridge door and next to your bed. Keep mementoes of special times in obvious places. When you are feeling suicidal, just look around at all these reminders of why you should live.

Regulate the medications you have on hand – Many people with mood disorders keep old prescription medication hidden away in case they want to commit suicide at some later time. Medications are easy to accumulate and having them around can prove too tempting when you are suicidal. Throw away all the old medications and only get new prescriptions filled in small quantities.

Of course, you must stay on your prescribed medications, even if they have miserable side effects and make you feel awful. You need them so you don’t become more depressed and suicidal. Have regular appointments with your doctor or psychiatrist so you can be constantly monitored.

Get rid of all firearms – No firearm should be kept in a home where there is anyone who has a tendency to be suicidal. It is too tempting to use them. They are a quick, easy-to-use, drastic and horrible resolution to a surge in suicidal thoughts and feelings.

Be cautious about driving – When you are starting to feel suicidal, give your keys to a member of your support system. This is not a safe time to be driving. Make other arrangements to get to where you need to go; use public transport, ask the person who has your keys to drive you or arrange lifts with other people.

Pray – Lots of people do it and lots of people find it helpful.

Write, draw or paint – Expressing your emotions through writing, drawing or painting can be very cathartic (easing painful emotions). Do it for yourself - it is not for anyone else. Do whatever you want, in any way you want to do it. It is not for grading. Just be open and honest emotionally.

For Those Left Behind: Self-Help Coping Tips

• Allow yourself the time to grieve, give yourself as much time as you need. Don’t feel the need to be ‘strong’ in front of everyone.
• Know that it is not time that heals but the journey you undertake within.
• Be compassionate with yourself and surround yourself with people who understand.
• Be sincere with people you trust and tell them exactly how you feel, writing a letter to them can be of great benefit as friends and family can then have more understanding.
• Allow others to grieve with you.
• Don’t avoid speaking about the loved one lost.
• Allow people to share good memories and experiences of the loved one.
• No one can take the pain away, but support from other loved ones helps.
• Try and stick to a routine as much as possible.
• Don’t blame yourself; it is not your fault.

If you have recently lost a loved one to suicide or the anniversary of their passing is approaching and you feel you may be in need of help, call SADAG on 0800 21 22 23 and a counsellor will assist you.

Suicide Trends and Statistics

Looking at statistics and understanding the trends is useful for suicide prevention, but as you look at these shocking figures please bear in mind that it is not the numbers that matter but the people behind them. Each and every statistic represents a person who was or is in desperate need of help. We need to do what we can to reduce these figures. 

• Untreated depression is the number one cause of suicide, and suicide is the third leading cause of death among teenagers (National Institute of Mental Health [NIMH], USA) and yet two thirds of those suffering from depression never seek treatment.
• Although suicide rates have traditionally been highest amongst elderly males, rates among young people have been increasing to such an extent that they are now the group at highest risk in a third of all countries.
• Globally 55% of suicides occur in the 15 to 44 years age group and 45% of suicides occur in the 45 years and over age group.
• Suicide attempts are up to 20 times more frequent than completed suicides.
• Mental health disorders (particularly depression and substance abuse) are associated with more than 90% of all cases of suicide.
• The highest suicide rates are reported in Europe, particularly Eastern Europe.
• The Eastern Mediterranean Region and Central Asia republics have the lowest suicide rates.
• Nearly 30% of all suicides worldwide occur in India and China.
• Youth suicide is increasing at the highest rate.
• There are four male suicides for every female suicide.
• There are three female suicide attempts for each male attempt.
• Men are three times more likely to be successful than women since they usually choose more lethal means (guns or jumping off buildings)
• More suicides take place in cities than rural areas.
• There is a higher rate of suicide in times of economic recession.
• Separated/widowed people show higher rates of suicide than married people. Those with minor children show the lowest.

In the US, the Centre of Disease Control and Prevention reports that:

• Overall, suicide is the eleventh leading cause of death for all US Americans, and is the third leading cause of death for young people of 15-24 years.
• Although suicide is a serious problem among the young and adults, death rates continue to be highest among older adults of 65 years and over.

According to SADAG, in South Africa…

• Between six and eight thousand suicides are recorded every year
• There are 220 attempted suicides every day.
• There are 22 suicides a day.

These trends and statistics reveal that there are too many people desperately in need of help and support. Please do what you can to bring suicide out into the open. Talk about it and share this article with others.