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Suicide

How to Save a Life: We Need to Talk About It

It needs to be OK to talk about suicidal thoughts.

Key points

  • It is natural to feel anger, regret, frustration, and confusion when someone you know takes their own life.
  • Suicide is not a bad word, and avoiding the topic may increase the likelihood of subsequent suicides, especially in teens and 20-somethings.
  • The contagion effect of suicide can be reduced through psychological education and intervention.

A few years ago, teenagers in my town started dying.

Like raindrops, they fell.

First one.

Then another.

And when the calls from concerned parents started flooding my phone lines, it was swift and sudden.

I realized long ago that because of my personal demons, a part of my private practice will always be working with suicidal teenagers and their parents, and consulting with school districts to better inform their mental health curriculum.

The latter part of my teenage years were filled with anxiety anytime I called out to see if someone was home and received no answer.

As I was making plans with my boyfriend and struggling with college applications, I became adept at shifting from a chubby, anxious, undiagnosed-ADD teenager to being acutely aware of the danger that might lurk behind a closed door and the sound of silence.

A closed door in my home was like a messed-up version of a game on The Price is Right. I never knew what was behind that door. A half-filled bathtub? A half-conscious body? Or, perhaps a near-empty pill bottle with no one in sight.

It was just a question of turning a doorknob and the luck of the draw.

But, when I grew up, I became a psychologist who didn't shudder at the word suicide.

Several years ago, my hand was slapped for using the phrase "committed suicide," due to the criminal association that was purportedly implicitly implied.

As if anything could be worse than someone you love not wanting to live anymore. As if the word "committed" would trigger a connotation that a legal crime had been committed.

As if a crime against the law could somehow compare with the death of a loved one.

Rules are rules

We were told not to use the word "suicide." It was too painful for the family to accept.

Sometimes there was a religious reason. If this death was not a sin, the hereafter would be better than what had been endured on Earth.

But, the loss of a child, and then another child, and then several more—all of whom would bristle at being called a "child" at the seasoned age of 16, 17, 18, and 20—seemed so much more important than choosing the politically correct verbiage for those stuck in the world of the living.

May you never know the pain of being expected to put one foot in front of the other, and to inhale and exhale as if the world continued spinning round, as if this were a natural, painless experience.

Student organizations blossomed and signs of support for those who were struggling decorated our community and several others nearby. Fundraisers and awareness events and brunches and guest speakers became local fixtures at town halls and libraries. Schools made plans and paid cash for better plans. Teachers became more educated. Sports teams and religious organizations and the occasional celebrity who had broken out of our small town reached out through their managers and agents.

We mourned, whether or not we had known him. Or her. Or the next person that followed suit.

Adrien Olichon/Shutterfly
Source: Adrien Olichon/Shutterfly

Surround, embrace, attack—er, support

At some schools, guidance counselors and outreach services stretched in all directions, covering the middle school and high school students like supernatural spiderwebs, as if they could catch "troubled" children and save them from themselves. As if they felt guilty or responsible for the signs they had missed.

But, in all fairness, there were so many of us that lost sleepless nights wondering what we missed and what we could have done differently. The teachers, parents, therapists, and members of the community spent months second-guessing and re-watching memories of the last interactions, the last moment when maybe we could have made a difference.

Maybe. If only.

Those are the real curse words of humanity. Not the four-letter words we punish our children for speaking in public.

The spiderweb approach was intended to embrace and support students. But, it had one major drawback: high school.

As children become teenagers, school goes from a place to learn among supportive adults to a place with rules and consequences and lessons and pressure—both academic and social.

High school doesn't feel like a safe space for most teenagers. But, there are things we can do to make it better. When school administrators are trained to decrease the stigma of suicide among staff and students, for example, school becomes a place where students are more likely to openly discuss their self-harm and suicidal ideations. This opens up a greater opportunity for depressed teenagers to get the help that they need.

Mental health by force?

Other schools took a more patriarchal approach that seemed aimed at identifying and isolating those students who faculty deemed to be potential dangers to themselves.

Students who exhibited self-harm behavior, or confessed to having thoughts of suicide (suicidal ideation), or listened to the wrong kind of music, or blinked too quickly ... sigh. Who knows. The parameters were never made clear, although the approach had good intentions.

But any student who was determined to be at risk was swiftly sent home, with instructions that they could not return to school until cleared by an emergency room, a physician, or mental health professional. Which ... isn't great.

It is common for suicide to have a contagion effect, especially among teens and 20-somethings. Some schools decided to tighten the reins on emotionally struggling students, and then forced—I mean, um, strongly encouraged—students to provide proof of psychological evaluation and separate them from their peers until medically cleared.

On the upside, research shows that the contagion effect can be mitigated by psychological debriefings, which presumably will be facilitated by the school's forceful approach.

On the downside, the contagion effect of suicide is also increased by social isolation and increased stigmatization. Many researchers theorize that the increased stigma of depression and suicide, especially among male minorities, contributes to the rise in suicidality among African American adolescent males.

What does all of this mean with regard to the "no tolerance" approach some school districts took? If we force individuals struggling with depression and having suicidal thoughts to separate themselves from peers in an effort to prioritize getting help, we are isolating them from their friends. This isolation could increase the likelihood of suicide contagion, and (because teenagers love doing the opposite of what we tell them to do) increase the likelihood of them rebelling by not seeking help.

So, what now?

Minority men are the least likely to seek psychological help.3 Major depression is the "silent killer" among African American men, whether it be death by suicide or death by other self-destructive behaviors. More funding is needed to raise awareness and destigmatize therapy for men in need.

More information can be found at the following links:

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7, dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.

References

1 Wright, T. (September 25th, 2022). "Wynonna Judd is still 'incredibly angry' about mother Naomi Judd's death, feeling 'closer' to sister Ashley." Fox News. https://www.foxnews.com/entertainment/wynonna-judd-incredibly-angry-abo…

Breux P, Boccio DE. Improving Schools' Readiness for Involvement in Suicide Prevention: An Evaluation of the Creating Suicide Safety in Schools (CSSS) Workshop. Int J Environ Res Public Health. 2019 Jun 19;16(12):2165.

Cheng Q, Li H, Silenzio V, Caine ED (2014) Suicide Contagion: A Systematic Review of Definitions and Research Utility. PLoS ONE 9(9): e108724.

Conchas, Gilberto, et al. When School Policies Backfire: How Well-Intended Measures Can Harm Our Most Vulnerable Students. Harvard Education Press, 2016.

2 Wasserman, Danuta and others (eds), 'Early detection and management of suicidal patients in primary care', in Danuta Wasserman (ed.), Oxford Textbook of Suicidology and Suicide Prevention, 2 edn, Oxford Textbooks in Psychiatry (Oxford, 2021; online edn, Oxford Academic, 1 Jan. 2021).

3 https://wp.nyu.edu/steinhardt-appsych_opus/the-masculine-experience-in-psychotherapy-an-examination-of-clinical-processes-and-outcomes/

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