I had a friend in high school who reached out once. Told me she was feeling down and felt trapped, as if there was “no way out”. I didn’t quite get what she meant. I was fourteen. What did I know about the parables of life? Had I paid more attention, she might still be alive. Cheryl was a year older than me. She was fun and smart and most of all confident. I envied how she won awards for “best improved in math”. I wrestled with math.
She was pretty too.
Great smile. The boys liked her. What I didn’t know was that one boy in particular liked her too much. One evening, Cheryl snuck out of her house to go to a party with the ‘popular kids’. Once there, this boy targeted her. He sexually assaulted her in the pantry in the basement. She never talked about it, but everyone else did. I guess that is what she meant when she said “I have no way out”. I watched her confidence and smile vanish. She found her egress by overdosing on her grandmother’s heart pills. No one knew for sure if she meant to die or just wanted to numb out for awhile.
I think about Cheryl often.
Since her death, I have had my own family, became a nurse and now work with highly suicidal patients in an outpatient psychiatric clinic. Cheryl was one teen of thousands who never made it to adulthood. She would never experience the developmental milestones that I was fortunate to reach.
Yes, I think of her often but at least it’s not daily like it used to be.
Interestingly, we don’t pay enough attention when “the average Joe” ends his life. On the contrary, we take heed when celebrities die by suicide. Why is that? Are their existences more important than Cheryl’s? Has suicide become common-place? Do we care more for celebrities than our own neighbors? Have we become desensitized to social media’s cyberbullying that is killing our youth? Or by the suicide pacts that are developed in front of our own eyes on the Internet? People are actually killing themselves on the web in front of live audiences.
There is an epidemic that is affecting people all over the world, and that epidemic is called suicide.
Suicide is a painful, heart-rending occurrence that shocks society, healthcare providers, families and friends. It’s a global issue. Suicide doesn’t discriminate, it affects everyone, the famous and the not-so-famous.
The World Health Organization says that there is one suicide every 40 seconds worldwide (Canadian Association for Suicide Prevention, 2011). This is expected to double by 2020.
It’s rampant. It isn’t something that is only happening to other people. Its permeating its way into our daily lives. We are not invincible in the eyes of suicide. It digs its claws into every walk of life.
If you knew who the most vulnerable populations (people at high risk) were, would you reach out to them? If you are not on this list, maybe someone you love is, or someone you work with, or talk to at the coffee shop each morning. Those most likely to end their lives intentionally are:
- People over the age of 55
- Aboriginal communities (First Nations, Metis and Inuit)
- Others also considered high risk include:
- People in jail
- The homeless
- Those with chronic disease or mental illness
- People using street drugs or alcohol
- Those with previous suicide attempts
- Those with a history of trauma i.e. sexual assaults, war victims or motor vehicle accidents etc.
- Those with a family history of suicide
- LGBTQ communities
- Military personnel and veterans
This list is far too long. We must consider every suicide as sad and tragic and preventable.
We lost about 25 celebrities over the last decade to suicide. If you google celebrity suicide, you get dozens of articles about who they were and how they died: Here are a quick ten:
- Kurt Cobain: Died from a self-inflicted gunshot wound
- Robin Williams: Hung himself with a belt at his home
- Lucy Gordon: Hung herself and left behind two suicide notes
- Johnny Lewis: Fell to his death from the roof of his home
- Marilyn Monroe: Overdosed on barbiturates
- Vincent Van Gogh: Shot himself in the stomach after years of depression
- Christine Chubbuck: Shot herself in the head during a live broadcast
- Ernest Hemingway: Killed himself by gunshot to his mouth
- Philip Seymour Hoffman: Overdosed on a combination of street drugs
- David Foster Wallace: Hung himself
Here is another list of people who died by suicide. In reading my list, do you feel the same sadness you felt when you read about the celebrities that passed away? These are people I knew who ended their lives:
- Matt (my daughter’s stepbrother): Died at 18 by hanging himself in a park in the dead of winter. He left behind three younger siblings, his parents and many friends
- Samantha: One of my patients that people called a ‘frequent flyer’ because she came to the ER department several times per week for suicidal ideation. She died in her sleep from an overdose that blew a hole through her bowel
- Angel: Another patient I treated one year prior. She barricaded herself in her apartment and overdosed on Ativan. She has three children and a family that adore her
- Amy: Was a patient I saw briefly with Dissociative Identity Disorder. She jumped from a building hours after she was discharged from a local hospital
If you came across some of these warning signs in your friends, loved ones, peers, or coworkers, would you be willing to talk to them openly about suicide?
(Any of the following could be potential signs):
- Threatening to harm or end one’s life by articulating suicidal ideation, plan or wish to die
- Pursuing or accessing means i.e. pills, rope or weapons
- Communicating no reason for living or sense of purpose, and hopelessness about future
- Participating in reckless, impulsive and risky behaviors
- Voicing a sense of feeling trapped with no escape
- Use of substances i.e. street drugs, over-the-counter medications, or alcohol
- Social isolation from family, friends and community
- Changes in sleep or mood (rage, anger, depression, sadness, anxiety or agitation)
- Giving away possessions, making a will; tidying up and preparing to not be a part of this world
With risk factors comes protective factors (things that buffer individuals from suicidal thoughts and behavior). What this means is that these factors can protect the suicidal individual from following through with their thoughts of ending their lives:
- Ensuring a strong connection to family, community, religion and healthcare
- Having coping, conflict resolution and problem solving skills
- Developing a sense of belonging, self-esteem and identity
- Being future-oriented with goals
- Seeking pleasure in hobbies and activities
- Searching for support for symptoms
- Having limited access to lethal means
Would you know how to keep someone safe?
Saving someone’s life from suicide hinges on our ability to recognize those at risk while being open to really talking about suicide. Asking them if they are suicidal won’t ‘make them end their lives’. They may be hoping that someone will ask them about it. Here are some things that you can do:
- Tell them you care enough to help
- Validate them and articulate compassion for their current situation
- Tell them that suicidal ideation is common but does not need to be acted upon
- Be sure to remind them that this too shall pass, that thoughts of suicide can be treated
- Instill a sense of hope
- Let them talk
- Do not leave them alone if they are actively suicidal with a plan and means to die
- Know when to get professional help. Call 911 if you must, a life depends on it
- Refrain from guilting them into staying alive
- Do not make promises to keep their suicidal thoughts a secret
- Connect them with people who can help, doctors, friends, employers, crisis lines or therapists
Most people have thought about suicide at least once in their lives. The warning signs were there for Cheryl. She had isolated herself from friends and family, had been victim to a recent sexual assault of which she felt ashamed and blamed herself. Even at 14 years of age, I might have mustered up enough words of hope to keep her alive. It is not your responsibility to keep the suicidal person alive, it is theirs’ but you can BE THE DIFFERENCE between life and death by providing empathy and holding their hand while they seek help.
At any given moment, try to understand the suicidal mind. Break down the barriers. Squash stigma. For crying out loud, we have all been there.
And if you are considering suicide, reach out….
“Speak quietly to yourself and promise there will be better days. Offer comfort as if you were encouraging your dearest friend”- Mary Anne Radmacher