As a psychiatrist, part of my job is to talk to people about suicide. Suicidal thoughts are a symptom like all other symptoms that 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, 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 they are in ultimate control of their lives during times they feel out of control and scared.
Suicidal thoughts are often 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 denial, repression, externalization, anger, alcohol, drugs, and/or violence.
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, it needs to be thrown away in order to 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.
There are other reasons besides coping mechanisms that people think about or attempt suicide. Maybe someone is under the influence of a substance and impulsively reacts when their thinking is altered. Or maybe someone else is manic, psychotic, or severely depressed.
If you sense someone is having a hard time ASK THEM HOW THEY ARE! 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.
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 suicide is a permanent solution to a temporary problem.
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.
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. Just because I don’t agree with your choices, or even in the case of untreated psychosis, it doesn’t give me the right to hospitalize you unless there is accompanying imminent danger.
In the US, if you are feeling suicidal and unsafe call the suicide help line at 800-273-8255. They are available 24 hours a day and will provide you nonjudgmental and confidential support for free. There are help lines around the world also! Visit www.suicide.org/hotlines/international-suicide-hotlines.html for a list of numbers around the world.
You can also find more information on resources here: https://drmelissawelby.com/resources/ as well as additional posts about recovery from depression: https://drmelissawelby.com/blog/
I cannot emphasize this enough: recovery from suicidal thoughts is possible. Life can be restarted and people can heal and discover inner joy again. 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.
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