What We Mean When We Talk About Suicide

Cropped image of person speaking on phone at curtaind window with soft light in roomWhy would someone want to end their own life? For some people, it’s a bleak mystery. For those of us who have lost someone to suicide, it’s much more. It can put a rip in the fabric of our lives, threatening to unravel everything we know.

As a clinician, I sometimes find myself in conversation with someone who wants to end their life. I’m a mandated reporter, like a wide variety of service providers. This means I have an obligation to break the person’s confidentiality—the legally guaranteed privacy of what they talk about in therapy—in order to ensure their safety when it comes to risk of self-harm. I advise people of this the first time we meet. Because of the mandate, I set whatever my thoughts and values are regarding someone ending life and work to keep the other person as safe as I can.

When their safety is more assured, when the risk of acting on their thoughts of suicide is decreased, I ask them what suicide means.

In the discussion that follows, names have been changed and personal identification has been filtered out to protect confidentiality.

We each live a world of meanings. Often these meanings are unique to us—what my childhood meant to me might not be what yours did to you. In couples counseling, I’ve noticed that partners sometimes ascribe very different meanings to the phrase, “I love you.” The same is true with suicide. Sometimes just being able to get this material out of their head and into dialogue with an interested and receptive other person can make all the difference.

When I first met Dana, he was actively suicidal. He had a plan (to jump out of a window), the means (his apartment was on the sixth floor of his building), and a time frame (the next time one more thing in a never-ending series went wrong). I initiated an involuntary hold, and he was later hospitalized. And while he objected to this as it was being put in place, he was glad of it as his fearful and angry mood resolved.

Working with Dana, we discovered that he became overstimulated quickly when trying to complete tasks, and for this reason he would put them off or reject them completely. The crises that resulted from this strategy added to his sense of being overwhelmed and with nowhere to turn, of always being one step away from an absolute catastrophe. And while he was able to not think about things like paying his bills, he tended to ruminate about this imminent but unclear catastrophe. For him, suicide seemed like a way of getting free from the radio station of his anxious thoughts.

Even though suicide wasn’t the best—or, as it turned out, the only—way of “turning off the radio,” it suddenly made sense to both of us. Because of this, we were able to brainstorm some alternative ways for Dana to take breaks, as well as to focus on tasks for brief periods. And now that we knew what suicide meant to him, we were able to use the presence of those thoughts as a way of tracking overwhelm.

We each live a world of meanings. Often these meanings are unique to us—what my childhood meant to me might not be what yours did to you. In couples counseling, I’ve noticed that partners sometimes ascribe very different meanings to the phrase, “I love you.” The same is true with suicide. Sometimes just being able to get this material out of their head and into dialogue with an interested and receptive other person can make all the difference.

Ben was in his early 80s. When we met for our initial consultation, one of his first statements was, “I don’t want to live anymore.” While he didn’t discuss a plan or means (other than to note “if I had a pill I knew would work I’d have already taken it”) I knew he had access to medications. I frequently assessed him for risk of harm during our work together. And yet my honoring his feelings also seemed to relieve them. He told me about the loss of most of the people he loved, the isolation he lived with on a daily basis, and the shame and anger he felt at having to depend on a niece (not one of his favorite nieces, but the only one who lived in the same area) to take him to do his shopping and run his errands—“and always on her schedule, and making it clear she hasn’t got much time for me.” For Ben, suicide meant a clear way of declaring his independence and his rejection of what he identified as charity that seemed motivated by duty and by nothing like affection.

Because the idea, though not the action, of suicide could be tolerated in our conversation, Ben was able to articulate what it meant. From there we moved to imagining what it might be like to communicate some of what he was feeling to his niece, via role-playing. Often I was the niece, receiving a piece of his mind in the form of his legitimate feelings. But sometimes Ben was the niece, and to my presentation of grievances he was able to note he had a young family, he was concerned about his elderly uncle, and it was hard to balance everything. Eventually he began saying some of these things to the niece herself, and the result was their relationship deepened a bit and he experienced some relief from isolation.

Ted also talked about suicide at our first meeting, describing his stockpile of sleep and pain medications and his feeling he couldn’t see the value of keeping himself safe. I called 911 and made my report while he witnessed this. He was assessed as not sufficiently at risk for hospitalization. Perhaps inviting him to be present while I made the phone call helped to establish a good connection between us. He said he could tell I was trying to take care of him.

As our sessions continued, he described the verbal, emotional, and physical abuse he had experienced as a child (which formed the basis of a call to the Department of Children and Family Services and subsequent report). Feelings of worthlessness and guilt were triggered by his recent AIDS diagnosis. For Ted, suicide meant giving up a struggle he felt he could never win, which was to prove to the universe his life was worth preserving. Building on his witnessing me trying to get him hospitalized, we addressed his trauma, focusing on ways he could keep himself safe, not just in terms of suicide but in terms of choices about self-care, drug use, and companions. As he became more invested in keeping himself safe, he eventually surrendered his stockpile of meds to his pharmacy.

For someone living with severe illness, suicide sometimes means insurance against suffering. Chris told me, “I know if it gets too bad, I can just leave.” He also told me that knowing he could determine how much was too much helped him face severe illness and sometimes equally severe treatments. Bill, dealing with multiple opportunistic infections that weren’t responding to treatment, decided in consultation with his doctor to stop all medical intervention and go into palliative care, or hospice. In one of our last conversations, he explained to me that his decision meant death with dignity.

Joe, enraged to be losing control over his body and his mind, died by suicide. Ironically, two months later a new treatment protocol was made available that would have reversed many of the symptoms he found unendurable.

Now we come to another set of meanings related to suicide: those of the survivors.

I met Richard two weeks after Joe’s suicide. Even though Joe had told Richard in clear terms he “wasn’t going to stick around to see how bad it got,” Richard had still been shocked by his action. The grief he felt over the death of his husband was compounded by overwhelming levels of guilt. The guilt was so difficult Richard considered suicide himself, although he didn’t have a specific plan.

“What would that mean, if you killed yourself?” I asked him.

“That I failed to keep him alive,” he said bleakly. “That it was my fault.”

“So the meaning of his death is that you failed him?” Something about hearing it said back to him like this caught Richard’s attention. Gradually he began the work of separating his life from Joe’s, and the more challenging work of allowing Joe responsibility for his own death.

Bill was an intern to whom I provided clinical supervision at the community mental health agency where we both worked. One morning, I had to disclose to him that a woman who had been seeing him for depression had died by suicide over the weekend. Bill’s first reaction was shock, then denial. What surfaced then were feelings of responsibility, failure, and guilt. According to his religious orientation, he told me, suicide was a “sin.” Was he guilty because he hadn’t kept this woman alive? Was he now lost to the possibility of redemption?

We’re connected to each other in a network, even to people we’ve never met. Following Robin Williams’ death, many of the people I worked with were deeply shaken. Like the narrator in the poem Richard Cory, they questioned how much value could be found in their own lives if someone as accomplished and widely loved as Williams could end his. For weeks after the event, I found myself in conversations in which another person’s suicide was seen as a denial of meaning to the lives of people he’d never met. The need to identify and assert the value of continuing to live took on the aspects of a crisis for many people.

Sometimes the poets say it more simply and elegantly than psychotherapists. James Krusoe, in his book of poems on the suicide of an acquaintance, Notes on Suicide, describes this life, including its hardships, challenges, and even despair, as an inducement to keep living. “All this,” he asserts, “was just to keep you here.”

Sometimes, knowing what an action means frees us from the compulsion to complete the action.

If you are in crisis or considering ending your life—and particularly if you have developed a plan to end your life, gathered the means to carry it out, and decided on a time—please consider initiating hospitalization for yourself by going to any emergency room or by calling 911.

None of us knows what happens after this life. But as long as you stay in it, change remains possible.

© Copyright 2016 GoodTherapy.org. All rights reserved. Permission to publish granted by Peter Cashorali, LMFT, therapist in Pasadena, California

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Adrian

    Adrian

    September 9th, 2016 at 10:21 AM

    I find it to be so sad that for so many people they see that there is no other alternative to stopping the pain that they are feeling other than by killing themselves. I guess I can understand but then there are other parts of me that thinks that they are totally selfish but this choice, leaving behind so many other people who will be hurt by this choice. I know that the decision is not rational and that I am looking at it from a point of view that is, but I would wonder if there is ever anything that could lead me to feeling so lost and hopeless and feeling like this was my only way out of the misery I felt.

  • beau

    beau

    September 9th, 2016 at 2:02 PM

    I am just glad that we are finally starting to have this conversation.

  • Ryleigh

    Ryleigh

    September 10th, 2016 at 7:51 AM

    If people truly understood the grief that they leave behind in the others left to pick up the pieces then they would never even have this as an option :(

  • Jo

    Jo

    September 10th, 2016 at 1:48 PM

    I cannot imagine even the grief of losing someone to suicide, very painful I’m sure and hard to reconcile. I have seen people die ‘naturally’ and thats hard to reconcile! Suicide is not selfish though, I really don’t think so. When I think of it I’m isolated and the outlook is bleak and obviously the mood is low and threatening to drop even more. Its perception and its life, some lives are not worth living and only the person inside can know that. All the outside stuff doesn’t matter, its how we are inside that matters – our sense of self. That gets reflected back to us all the time by others – whether they love us or not is irrelevant – it is whether we love ourselves that matters – if thats missing or messed up then the pain of going through life with someone who hates you or constantly critisises you plus a bleak outlook in terms of success and happiness that makes a good recipe for it. Not really selfish at all just experiencing life in a deep and distorted way

  • Silence

    Silence

    September 10th, 2016 at 5:51 PM

    There needs to be a better way. If I’m going to do myself, You will never know it, because your too busy calling 911 instead of helping.

  • Peter Cashorali, LMFT

    Peter Cashorali, LMFT

    September 11th, 2016 at 5:47 PM

    Pain is a reality. Given the right combination of circumstances many of us would think about suicide. So it can helpful to give some thought as to how you would provide yourself with compassionate self-care if you were having such thoughts. Who would you want to be in contact with? What are the ways that you can get refreshment? take breaks from stress? And, do you have to wait until it’s a crisis before you take this good care of yourself, or seek out others to help you do so? Yes, it’s often the case that someone’s suicide hits those who loved them most the hardest. And no, calling 911 isn’t all of treatment. But it’s sometimes what makes further treatment possible. Thank you all for responding to this.

  • Faith

    Faith

    September 12th, 2016 at 10:21 AM

    We don’t know the depths that one has to reach when they start to see this as the only alternative that is left for them

  • shayne

    shayne

    September 12th, 2016 at 2:31 PM

    Talk about it?

    I never hear anyone talk about it other than well on this website and it features pretty prominently. I think that that is a good thing because it starts the talk when you might be too uncomfortable to talk about it otherwise. But still, I wish that it was something that we felt more comfortable talking about more, because I think that if we could be a lot more open about it then that could save lives in a way that we haven’t ever been able to do before.

  • Ron

    Ron

    September 12th, 2016 at 3:02 PM

    When you have difficulty loving (or even liking) yourself and feel that the ones closest to you look at you as a complete screw up and do not love you either or your addictions no longer numb the pain, the thoughts of suicide maliciously creep in. There is no stopping them from doing so. It is unfortunate that there is such a negative stigma surrounding those of us that have contemplated or even attempted this way out. Shayne is right, if we could be more open and honest about the feelings and thoughts, a lot of us would be saved

  • Cara

    Cara

    September 13th, 2016 at 10:18 AM

    When I think of suicide I think of sadness over the grandfather that I was never able to meet

  • Mazza

    Mazza

    September 14th, 2016 at 4:28 AM

    I concur with beau and Shayne. Surely bringing this subject out in the open and discussing it ‘normally’ could make a huge difference to some people. I’ve struggled with these thoughts for 30 years but never acted on them. Reading this article, I’ve never considered that I had a ‘meaning’ to it and considering this and finding my meaning has changed the way I feel! I felt quite powerless before and felt that I just had to manage those feelings, when they arose. Great!

  • lawson

    lawson

    September 15th, 2016 at 12:53 PM

    We have to be much more willing to come out of the shadows on this subject. It can be a hard one to deal with but if we are ever going to stop this growth in the numbers of people who choose to end their lives each year then we have to be open and honest talking about this and stop making it be something that one would feel ashamed of. I want to encourage people to not hide it when they are feeling this desire but to be willing and feel like they can talk to another person about these feelings before they have gone so far down that road that they can’t return.

  • Barbara

    Barbara

    September 17th, 2016 at 6:39 AM

    I wonder why suicide is illegal Because it is considered murder as in self murder or murder of your own self Are we property of the state? If a person tries to commit suicude and fails can they be arrested? Like arrested for attempted murder? There in lies truth though that with suicide we are trying to murder our self because we hate ourselves or cannot COPE with ourselves Therein lies the solution We must find a way to deal with our self and all aspects of our self

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