Statistically, suicide is the highest cause of death in men between age 20 and 49. This is not to diminish the female suicide rate, merely to present statistics. And the suicide statistics are shocking, with greater numbers of men taking their own lives than are killed in road accidents, or by cancer and coronary heart disease. Of the 6 233 suicides in the UK in 2013 (male and female), a remarkable 78% were males over the age of 15.
Globally, it is estimated that over 350 million people suffer from depression. An estimated 800 000 people worldwide commit suicide every year. So the depression estimates are likely very conservative. This is not to suggest that a person need be depressed in order to want to take their life. Indeed, some estimate that 54% of suicide deaths in the USA from 1999-2016 were of people who had no mental health diagnosis. Whatever the precipitating factors are in suicide statistics, the fact remains that figures are shockingly high.
The following brief guide is not intended to be a philosophical position on suicide, but rather is a response to people who are experiencing suicidal ideas as a feature of depression, PTSD and other distressed states of mind:
1. Here and Now: seek help today before you feel worse
Typically distressed people begin to entertain suicidal thoughts because they want their suffering to end, not necessarily their entire life. So it is crucial that you seek help immediately if you are depressed, troubled and having suicidal thoughts or feelings. Depression in particular, like any form of suffering or unwellness, is best tackled as early as possible, so the first piece of advice is seek help now, don’t wait for your mood to worsen. Early intervention and helping strategies can mean the difference between a short period of depression and distress and suffering that is long and drawn out and, more importantly, much harder to recover from.
2. Express: Start talking and keep talking
A typical feature of depression and suicidal ideation is concealing one’s true thoughts and feelings and withdrawing from people. This tends to grow out of habits of keeping feelings pushed down, choosing not to say what we genuinely think and feel. Over time this can result in a loss of interest in life, feelings of hopelessness, fatigue, and sensing that other people either won’t understand or won’t want to listen to your pain. This pressing down of feelings and words, especially anger and frustration – de-pressing – is what creates depression in psychological terms. Internalised anger becomes destructive: self-destructive. This is why it is important to do the opposite: to ex-press. To start getting it out instead of keeping it in. To seek help getting the anger out sooner rather than creating more destruction later. Find someone who does actually care, and will genuinely listen to your pain and whatever dark thoughts or negativity you might want to express. Talk about your feelings, your thoughts, hopes, wishes, regrets, frustrations, anger: everything. Ex-pressing is the opposite of de-pressing.
3. Not Just You: suicide devastates other people
Apart from devastating the one great thing you have ever been given – your life – suicide also devastates friends, colleagues, neighbours, families, and depending on your method, train or truck drivers, those who discover your body, even impacting emergency responders like the police, paramedics or medical staff who may have prescribed your medications or might have to attend the scene of your suicide. Suicide may seem like a quick end to pain and hopelessness for you, but it can be the horror that haunts those you leave behind. Most people who are suicidal wouldn’t wish their suffering to be inflicted upon others and may not be considering the impact that their suicide will have on other people, especially loved ones. Seeking help and channelling your energy into recovery so that you can face life with courage and determination again, rather than going deeper into depression and suicidal ideas can be the kinder solution in the long run.
3. Get help: with solutions, with recovery
Once you acknowledge that a depressed state of mind is not your normal or healthy state of mind (and is usually a very unpleasant state of mind to be in), you can begin to recognise that ideas about suicide are probably not normal or healthy for you either, but are a symptom that you are in trouble and need help. We entertain suicide as a possibility typically in an attempt at a solution to emotional pain and suffering. But there are also other solutions to pain and suffering that aren’t terminal. If you choose recovery then you can begin to focus on concrete solutions to the causes of your pain and suffering. Identifying these causes is halfway to beginning to create solutions. In a depressed or very fatigued and despirited state, this can feel like an impossible task: it isn’t. It only feels that way. With help, the burden of finding solutions and making changes to your life is much less than struggling on your own with only one option in your mind.
4. Distress is a temporary altered state, death is a permanent state
It may seem obvious in a normal frame of mind, but in a depressed, distressed or disturbed state of mind your worldview is altered and the world, your choices, your potential, your abilities: all look completely different. Seeing the world from a distressed state is like seeing it in an exhausted state, or after drugs or alcohol, or after you’ve suffered a loss or bereavement: it’s not your typical state of mind and as such making decisions about whether you live or die whilst you are depressed is like trying to drive a car safely when you’re drunk. Until we develop the awareness skills, we can actually not notice that we are depressed and that depression is a temporary state of mind. Depressed mood can and does vary from day to day and hour to hour. By seeking help, finding solutions, and doing a little bit of work, you can recover from a depressed frame of mind and learn the skills required to keep depression at bay. Life can and does feel meaningful and good again for people who have chosen to overcome depression. It can for you too if you make the choice to work through depression, grow and come out the other end. Suicide – ending the precious life that we are only given once and will never get again – is a permanent, final act with no turning back. It is the end of your freedom and your ability to experience life or make a difference. In terms of depression, ending one’s life to bring an end to emotional pain is like amputating a leg to cure an itch, or demolishing a house because you didn’t like the furniture or the location. Circumstances and the way we look at them can be changed for the better….if you choose to try.
5. You are free: suicide is always a choice
It is a fact that if you want to kill yourself and are determined to do so, no-one can stop you, other than perhaps temporarily restraining you, in which case you are likely to want to do it with even greater resolve as you push against the resistance. Each of us is free to end our life at any moment and as such, it is the last free choice a person can make. Because it is available as a choice at any time, it can also be postponed or delayed from hour to hour, day to day, week to week, or indefinitely. As you are free to kill yourself, you have the same freedom to make a whole range of other choices: you can see how it goes first, you can stick it out for a while longer and try something new or different first, you can start speaking truths that you kept to yourself – the world will cope with your anger, or pain, or opinion. Just as suicide is always a choice, and a choice that permanently ends your freedom, so life is the beginning of your freedom, full of choices that we can make to bring about change, one decision at a time. Getting help and recovering your normal frame of mind allows you to assess suicide in a balanced way, rather than as a desperate attempt to stop feeling bad, or to escape catastrophy by destroying the most valuable thing you have: your precious life; a life that you could use to help others, to help yourself, to create something new, or to change the world a little for the better with you in it.
- If you have suicidal ideas get help now, not later. In the UK call any of the numbers on my home page (also below) and start the process of recovery by speaking to someone who cares. When you make the conscious commitment to live, consider seeing a counsellor or psychotherapist who will help assess your risk, formulate a support plan in between sessions, and help you on your road to recovery. Other people have done it, so can you…
If you have a history of self-harm or suicidal behaviour, or express suicidal intent or ideation during therapy it is important to organise a support plan with you at the assessment stage, depending on the level of your intent. This could include looking at steps we can take to manage your anxieties, mood and behaviours in ways that keep you safe; putting in place Supplementary Support between sessions if necessary. It could also include plans that, for example, allow me to contact a named person if I am concerned for your safety or the safety of others. If you are in and out of crisis or have strong suicidal intent now it is important to seek crisis support early, as psychotherapy is not an appropriate service for life-threatening states of crisis.
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