Tuesday, August 12, 2014

The Contagion of Suicide and How to Help

Last night, I wrote about the death of Robin Williams, likely from suicide. Social media is flooded with tributes to Robin Williams, prayers for his family, remembrances of a remarkable career and talent, and not a few unkind remarks about the cause of his death from hurting people who don't understand the pervasive nature of depression and haven't heard the siren song whose lyrics so convincingly say "The only way out of this is to end it. You will never feel better and you are a burden on everyone you care about." However, one thing hasn't bubbled to the surface that I think is important to note.

Suicide can be contagious.

Ok, now let's step back for a second. What I absolutely DO NOT mean is that depression is a contagious illness and that being around a person exposes you. That's ridiculous.

What I do mean is that a person, especially a young person, struggling with depression, sees the suicide, and something happens. A thought crystalizes. Suicide, once not an option or a thought or a viable outlet, suddenly has possibilities.

I have seen this happen in schools, in families, in communities. I've talked to people who have attempted suicide (which fails sometimes, not for lack of intent, but by human error, or quick intervention by others, or maybe sometimes divine intervention, who knows.)

If you have a friend or family member who is struggling with depression, it might be a good time to check on them. To have a conversation, and to encourage them to keep fighting and seek help if needed. Most people aren't therapists, and your role is not likely that of mental health professional in your friend of family member's journey. However, that doesn't mean that there aren't things you can't do. You can. You can be an important member in that person's community, fulfilling your own role.

I sometimes train lay people on mental health issues. In the last ten years, I can't count how many times I've given a talk on suicide. Over the years, I've compiled a list of things you CAN do to support someone going through depression or who has suicidal ideation:
  • Listen to them, nonjudgementally. No one wants to hear their feelings invalidated. Sentiments like "you just need to get over this," or "it's not that bad," aren't helpful, because the person going through depression CAN'T just "get over it." Often, there is chemistry in the brain that is literally preventing a person from feeling good, and the rest of the time, maladaptive thought patterns have gotten so pervasive and tangled that the person is just stuck.

  • Validate their feelings: "I understand you feel really down right now.

  • Inquire how they are handling their feelings, including a gentle check for self-harm or suicidal thoughts. 20% of people with depression attempt suicide. Don't worry about "putting the idea in their heads." It is better ask. Try a question like: "I'm really concerned about you, and I want to make sure you are safe. Have you been having any thoughts about ending your life?"

  • Don't feel that you have to handle this alone. Encourage the person to seek help: a local community mental health center, a private counselor, medication, even hospitalization (mostly anymore, this is short-term, not "Girl Interrupted.")

  • Ask open-ended questions the person can't just respond "yes" or "no" to.

  • Communicate that you care, and that you support them.

  • Offer activities - a walk, going to the mall, a short outing, playing a board game, getting out in the sun. Depression can rob a person of energy and enthusiasm, but its also a vicious cycle. Activities can be life giving and help with dopamine levels (feel good chemistry in your brain) and actually help increase energy, even if the person feels tired at the end.   

  • If they are having thoughts of suicide, ask if they have a plan.

  • Take all threats of suicide seriously.

  • If a person is actively suicidal ("I am going to kill myself, and I have a plan.") don't leave the person alone. Seek help. Contact friends or family to stay with the person. Call 911 if necessary. Frankly, it is better to have someone upset with you for taking action than not upset with you and dead or seriously injured.

  • Take care of yourself. Supporting someone with depression or other mental health issues is important work, but it can be draining. Don't help to the point of your own harm.

  • Get your own support system.

  • (And, as an update) My friend Steve pointed out (rightly) that I didn't specifically call this last bit out, and I should have: Stay connected. Call them if you haven't heard from them in a while. Check-in. Depression warps thinking and tells people "You haven't heard from so-and-so in a while. Why should you call them? They obviously don't care about you." From there, it's not a hard jump to "No one cares about you." Phone a friend, stop by. You never know (and may never know), your contact may save a life.  

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