As a psychiatrist, part of my job is to talk to people about suicide. Hearing about suicidal thoughts is not uncommon; they are a symptom like all other symptoms I consider in my assessments. Often people are fearful that if they admit to feeling this way I will instantly hospitalize them against their will. (Not true: There are only certain situations when I have to, which I will explain later).
Suicidal thoughts need to be talked about and, usually, don’t mean a person wants to die. They want to feel better but don’t know how to, and often don’t believe they can. Suicidal thoughts can be shorthand for “I feel ashamed, alone, helpless, depressed, guilty, angry, hopeless, and fearful.” Suicidal thoughts can remind people that they are in ultimate control of their lives during times when they feel out of control and scared.
Suicidal thoughts can be a coping mechanism meant to soothe and reassure. Often people aren’t handed a basket full of healthy coping mechanisms as children. Parents model coping and they themselves may have never learned emotional self-care. Coping mechanisms taught to some children may be tools like:
There are other reasons that people think about or attempt suicide. Someone could be under the influence of a substance and react impulsively when their thinking is altered. Or maybe someone is manic, psychotic, or severely depressed.
Choosing life: Some people develop suicidal thoughts early in life and revisit these thoughts when feeling overwhelmed, alone, out of control, or when depression resurfaces. These thoughts can be like a tattered, ugly, worn, old sweater that you put on. Initially, it provides comfort, but then you realize it is scratchy, too hot, and stifling. Ultimately, these thoughts, like the sweater, need to be thrown away so that one can be free and move forward with choosing life.
To prevent suicide, we must be willing and able to talk about it. Talking and asking about suicide doesn’t increase the chance that people will kill themselves. People who are suicidal often feel alone and stuck and can benefit from someone asking them how they are.
How to help someone who is suicidal: If you sense someone is struggling, ask them how they are! Talk openly and matter-of-factly about suicide. Show that you care with your attention and ability to see and hear them. Help to break through their bubble of isolation by reaching into them and acknowledging them and their pain. Be willing to listen and accept their feelings without judgment.
Help for suicidal thoughts: If you feel suicidal, reach out for help. Find a psychiatrist or a therapist. You are in ultimate control of your life but we can help you see other options. Let us help you find that inner strength, that reason to live and that light that can shine from within. It can take hard work, but with perseverance, recovery happens. It is often said that suicide is a permanent solution to a temporary problem (Read this post for ideas about how to create a suicide prevention plan).
Sometimes people benefit from temporary hospitalization when acutely suicidal. Hospitalization can buy us some time to put a recovery plan in place and give us a chance to help. No one is hospitalized permanently for suicidal thoughts.
Will I be hospitalized if I admit I have suicidal thoughts?
The laws around involuntary hospitalization differ by state. In general, a person can be hospitalized against their will if they are deemed at imminent risk of suicide, i.e. with plans and intent to carry them out. It is obviously not a perfect science determining who is imminently at risk and who isn’t, and mistakes can be made.
There are laws that protect people from having their rights taken from them and I take this extremely seriously when trying to make a determination about the need for hospitalization. Even if I don’t agree with your choices, that doesn’t give me the right to hospitalize you, unless there is accompanying imminent danger.
Suicide Prevention Hotline
In the U.S., if you are feeling suicidal and unsafe, call the suicide helpline at 800-273-8255. They are available 24 hours a day and will provide nonjudgmental and confidential support for free. There are helplines around the world: Visit the International Suicide Hotlines for a list of numbers.
Recovery is possible
I cannot emphasize this enough: Recovery from suicidal thoughts is possible. People can heal and discover inner joy again. Life can be restarted and feel purposeful. Take a chance and let a trusted person know how you feel. So many of us want to help. Let us join you on your path of healing.
And for others worried about someone's safety and wondering if they need help for suicidal thoughts: Ask the person directly, listen nonjudgmentally, and assist them in finding help if they need it. Suicide prevention can take teamwork. Don't keep concerns about a person's suicidality to yourself or agree to keep secrets. Reach out and get advice and support for yourself, too.
Copyright Dr. Melissa Welby