September 19th, 2022

Prairie Doc® Perspectives for week of September 18th, 2022
Ask, then act
By Debra Johnston, M.D.

One summer during my college years, I had a roommate who suffered from suicidal thoughts. She’d attempted suicide before we met, and been hospitalized, but continued to struggle. Back in the late 80s, there was very little public understanding of mental health issues, and the stigma was even stronger than it is today. Our other roommate and I didn’t know what to do, or where to turn.
Not surprisingly, we didn’t handle it well.
However, we did one thing right: we restricted access to lethal means. We secured the knives, and took control of her medications. Back before Prozac, the best treatments were lethal if used to overdose.
It’s tempting to view people with mental illness as somehow different from the rest of us. On some level, I think we expect that to mean we can’t be affected. We want to believe it won’t touch us.
However, suicide crosses all boundaries. Anyone can develop suicidal thoughts, so everyone needs to be able to recognize the danger signs, and know what to do.
Risk factors for suicide include a previous suicide attempt, a family history of suicide, and a personal or family history of mental illness or substance use. Living with chronic pain or having experienced violence or abuse in the family are also significant risks. Other stressful life events, such as incarceration, a job loss, a break up, or bullying, make a difference as well.
There are often, although not always, warning signs. Watch for talk about being a burden, about feeling hopeless or worthless, about unbearable pain, and about death. There may be mood swings, anger or anxiety, withdrawal from loved ones or activities, or unusual risk taking. Sometimes the signs are more dramatic. There may be overt talk of suicide and actions that suggest preparation for death: saying goodbye, giving away treasured possessions, drafting a will. A person might research methods of suicide and take steps to implement a plan, such as buying a gun. Don’t consider talk of suicide to be a bid for attention. It is a cry for help.
Of course, recognizing risk isn’t enough. We need to know what to do. The first step is to ask the question: Are you thinking about suicide? Asking won’t “plant the seed.” It’s ok, in fact it is crucial, to ask. Try to keep the person safe by reducing access to means of suicide. Listen, and try to understand what they are thinking and feeling. Connect them to help, via the crisis line or another source of support and assistance. Stay in touch.
Emily, if you ever read this, your life matters. I wish we’d understood how to show you that.