In this installment of The Eminents series, I interview Dr. Mark Goulston. He is a psychiatrist, former Assistant Clinical Professor of Psychiatry at UCLA-NPI and inventor of Surgical Empathy, an approach he used with suicidal patients for more than twenty five years and none of his patients died by suicide. He is the co-author of the recent book: Why Cope When You Can Heal?
MN: Beyond hopelessness, is there another common reason that people contemplate suicide?
MG: What people who haven't been suicidal don't understand is that when you feel what seems like unending psychological pain, death offers to take it away. But as my late mentor and suicide prevention pioneer, Dr. Edwin Shneidman, used to say, "Suicide is a permanent solution to a temporary problem."
MN: If you’re feeling suicidal, what questions should you ask yourself?
MG: What hurts so much that I can't bear it? When was the last time I felt that way and didn't think it would pass but it did? What expectation was I counting on that didn't come true? Given that, what backup plan can I come up with?
MN: If you’re feeling suicidal, are there self-help tactics you recommend?
MG: Think of someone living or dead who loves or loved you, believe or believed in you or knew that you will get through this. If you can't picture such a person, think of a hero of yours, perhaps a famous one like Hillary Clinton or Winston Churchill or someone you know like your favorite teacher or boss. Then imagine that person talking you through your suicidal feelings by asking you, What just happened to make you feel so awful? What did you think when it happened? What did you feel when it happened? Why does that make you want to kill yourself? Then imagine telling them, "Because I can't take the pain anymore." Now imagine their saying to you, "I know and I understand how you don't think you can take the pain, but know that I love you and believe in you and I know that it will get better... and I wouldn't lie to you. Now take three long slow breaths and tell me what would be a better thing to do right now? And then do that."
MN: Would those tactics’ success depend on why the person is considering suicide?
MG: It can work whatever the reason because whether it's hurt, fear, anger, guilt, shame or even hopelessness, feeling that someone cares about you may cause you to shift to feeling grateful, appreciative and missing the person. That can lessen suicidal feelings and feelings of being alone.
MN: If you’re feeling suicidal and want help, how would you suggest a person attempt to find the right help?
MG: Reach out to someone who you know cares about you and will not overreact or give you advice you don't want. You might say something like, "I don't mean to bother you but I need your help because I'm very down and thinking of hurting myself." You can also call the National Suicide Prevention Lifeline at: 800-273-8255, which is available 24/7, and the person you speak with has been trained to help.
MN: What do you think of the argument that people should have the right to decide whether to end their life, certainly as an older adult with end-stage disease but even a younger person?
MG: In all honesty, I can understand it, but I have mixed feelings because during my career, I have seen people who appeared to have a sound reason for wanting to kill themselves that would understandingly cause anyone to feel depressed, but when they were treated for depression, their suicidal feelings went away or they were able to deal with those feelings without giving into them.
MN: Are there relatively reliable differentiators between someone who is crying for help versus likely to attempt suicide?
MG: The more risk factors that are present, the more likely they are to attempt it. Those risk factors include: prior suicide attempts, family history of suicide attempts or completed suicide, concurrent drug and alcohol problems, untreated mental disorder, little to no support system, legal/criminal problems, financial problems, marital problems, job problems/loss, and recent relationship loss.
MN: Let’s say you’re unsure of whether a person is suicidal, what question(s) should you ask?
MG: "I couldn't help noticing, but you haven't seemed as up or positive as you usually are. Would you be willing to tell me, what's going on? Then, you might ask, “At its worst, how down or awful are you capable of feeling?" If the person pushes back and asks you why you're asking, say something like, "Because I have felt very down in the way I'm perceiving you are feeling and although I didn't want to talk about it with anyone, I really needed to talk about it and if I had, it would have helped. I wouldn't have asked anyone if I could talk to them, but would have appreciated it if someone reached out to me as I'm trying to reach out to you."
Previous installments in the The Eminents series include multiple-intelligences theorist Howard Gardner, ethicist Peter Singer, behavioral geneticist George Church, self-improvement expert Tony Robbins, Washington Post columnist Robert Samuelson, and physicist Michio Kaku.