I still feel a little anxiety whenever I ask someone about suicide.
I have no fear when asking The Question — “Have you been thinking about killing yourself?” — but sometimes I find that I’m not breathing while I await the answer.
What if this person says “yes”?
This anxiety persists even though it’s literally part of my job to ask this question. Despite having asked this question thousands of times, I still feel a twinge of unease whenever it is time to ask. I still feel nervous even though people have answered “yes” when I’ve asked The Question. I still wonder if my interventions will be effective despite knowing that I have helped people choose to live.
I still have to remind myself that it is a blessing if someone tells me, “Yes, I’ve been thinking about killing myself.” It means this person trusts me enough to share this information with me. It means this person has faith that I’m not going to freak out. It means that we can talk about death, what it means to this person, and why suicide seems like the best option. It means that there is hope that the conversation will lead to a discussion of other viable options.
It means that, in this moment, this person is willing to live.
During my training, I had several teachers who would offer gentle correction to people who said, “I feel suicidal.”
“‘Suicidal’ is a thought, not a feeling,” they would offer. “What are the emotions that are leading you to think about suicide?”
That snippet looks condescending and contrived on the screen. When said with skill, it steers the conversation to areas that can lead to change.
It is hard, if not impossible, to change emotions with willpower alone. Consider all the unseen things that can shift your emotions:
- a fragrance that resurrects a memory from your youth
- the sound of stranger’s voice that reminds you of another person
- the feeling of the sun on your skin after a dark winter
Emotions are powerful. They can promote certain thoughts or drive certain behaviors. Sometimes emotions feel so overwhelming that, to cope, we have thoughts that death is the best option.
“Do you want to die? Or do you want to feel different?”
Whenever I learn that someone has died from suicide, I recall five specific people. Three of them tried to kill themselves while under my ongoing care:
- one arrived in the clinic with long, bleeding lacerations on both arms
- one had spent hours on top of a tall structure, debating whether to jump off
- one missed an appointment and I somehow knew that something had happened; this person used a friend’s gun and shot a bullet through the chest
Two of them did kill themselves:
- one jumped off of a tall bridge
- one took an intentional overdose of alcohol and methadone
There are people who I have worked with in acute settings — crisis centers, jail, emergency departments, medical and psychiatric hospitals — who tried to kill themselves, but never told me. There are people who have killed themselves after I met them, but I haven’t learned of their deaths.
I don’t think about the five people frequently, but they cross my mind from time to time. I hope the three are living lives they believe are worth living.
I say prayers for the two who are deceased, but the words of my prayers come from a language that has no shape or sound.
To prevent suicide, we must be willing and able to talk about it. This doesn’t mean that anxiety, fear, and discomfort are absent during conversations about death and dying. Talking about suicide does not increase the likelihood that people will kill themselves. In fact, these conversations often bring relief; it offers a perspective that frequently differs from the one that predominates in our heads.
The onus to broach this topic should not be solely on the person who is thinking about suicide. If we ever sense that people we love are not doing well, asking how they’re doing and learning more about what’s on their minds shows that we care.
When people are thinking about suicide, sometimes the best way we can help them is to let them know that we see them. We want them in our lives. And that may be how we can help them choose life.
Maria Yang is a psychiatrist who blogs at her self-titled site, Maria Yang, MD.
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