8.13.2009

How do suicidal people talk about suicide?

Something that I have heard relatively frequently is that people who really want to commit suicide won't tell anyone about it and that anyone who tells another person about their desire to commit suicide doesn't really mean it. I guess this sounds good and maybe it even sounds like it makes some sense, but, to me, this doesn't make sense and basically amounts to blaming the victim, who is suicidal and probably already suffering enough.

(Note: I don't doubt that some people would tell someone of their plans to commit suicide because they are ambivalent about it or want that person to talk them out of it. It is the assumption that everyone who tells someone about their plans to commit suicide is ambivalent that I take issue with. I also don't doubt that there are people who talk about their desire to commit suicide who do so in a manipulative way to get attention, but I take issue with assumption that everyone who talks about their desire to commit suicide is doing so in a manipulative way.)

Obviously it is going to be easier to commit suicide if you don't tell anyone because you won't run the risk of being locked-up. I'm guessing that fact is the primary basis for this misconception. But what about other situations? If I want to rob a bank, this logic says that if I really intend to rob that bank, I won't tell anyone because that might compromise my ability to actually rob that bank. I've never heard anyone question the potential robber's intent to rob a bank on the basis that he told someone about it in advance. We explain this by saying that the potential robber was stupid or that he misjudged his confidant or something else. Why does this "if you tell someone about your plan than you must not really mean it" logic apply to suicide but nothing else?

So why might someone who is genuinely suicidal, someone who genuinely believes that suicide is there best option and has no ambivalence about going through with it, tell someone else about this even though that might prevent them from committing suicide?
  • They might want to soften the blow to their loved ones. Even though the suicidal person knows that they will cause their loved one's grief, they might try to mitigate that by warning them, explaining the deep extent of their suffering, or telling them that it isn't their fault.
  • Many people, generally, alleviate stress by talking about things. If the suicide is not immediate, the suicidal person may talk about his plan in order to alleviate stress between then and the time of their planned suicide.
  • The suicidal person may confide in someone about their plans, someone who they think will be understanding and sympathetic to his situation, yet who will not try to get him hospitalized. The suicidal person may be wrong about their chosen confidant.
  • I'm sure there are as many different reason for this as there are people who have done it.

I have also frequently heard people who tell someone else about their intent to commit suicide said to be "playing a game." The first time I heard this I was already in the hospital and I was brusquely told, "this is not a place for playing games." I was very confused. I understood that "playing a game" meant being manipulative by doing things like saying I am suicidal just to get sympathy or attention. But I wasn't playing that game; I was genuinely seriously considering the merits of suicide. (Additionally, if you are going to lock up everyone who says they are suicidal while assuming that anyone who says they are suicidal is "playing a game," how can you say the hospital is not a place for playing games? The hospital is the place for playing games because you have just rounded up all of the game players.) The idea that all patients who say they are suicidal do so in order to manipulate people is just plain mean.

Even if a suicidal person is telling someone else about it because they are ambivalent about suicide, what is wrong with that? Isn't that precisely the best thing for them to be doing, if you believe all suicides should be prevented? How is it manipulative to say, "I'm considering suicide because my life is super awful for reasons for x, y, and z. Right now, that is looking like my best option for relieving my suffering, but if there were a way to relieve my suffering without dying, if there were a way to enjoy life again, I would consider it"? Most people who are actively considering suicide are not able to express their desire for help in such a level-headed way, but that doesn't mean that they are manipulative when they express their desire for help in a mixed-up desperate way. I think that mixed-up, desperate people often get interpreted as being manipulative because they are changing their minds so much that, even though they are being sincere, they seem duplicitous because most of the time when people contradict themselves like this, they are lying. (Reading my old journals from when I was depressed is embarrassing because I changed my mind so many times and thought I found the secrets to the universe so many times. There are a lot of things I did during that time that were extremely ill-advised and may have come off as rude or contradictory or grossly inappropriate, but I did all of those things completely sincerely. This was a product of adolescence, but also a product of being out of my mind desperate for an end to my depression and anxiety.)

I can understand that it might be very frustrating to work with people who are constantly contradicting themselves and changing their minds. I can understand that it might be hard to distinguish who is doing this sincerely and who is doing this because they cannot keep their lies straight. I can understand the temptation to paint them with a broad brush as all being manipulative liars because they are all equally frustrating. I can understand the difficulty of distinguishing these two groups from each other and the high stakes for mixing up the two groups. I cannot understand the refusal to acknowledge, or the simple lack of acknowledgment, that some of these people are being genuine, not manipulative, but are having such a hard time within themselves that they contradict themselves and change their minds incessantly. I cannot understand not trying to distinguish those who are sincere from those who are manipulative and instead treating them all equally brusquely as people who are manipulative.

This post is partially a response to a comment on Bruce's post "Christianity and Mental Illness Part Three".

10 comments:

  1. I can understand it. Some of the professionals (and volunteers) who work with very distressed people are very poorly trained. They do not have sufficient training to cope with risk, uncertainty and shame. Therefore their priority is to protect their own feelings at all costs, regardless of how that affects the people they are supposed to be helping.

    "People who really want to commit suicide won't tell anyone" and "intent to commit suicide is playing a game" are lies that comfort poorly-trained professionals by shielding them from reality.

    Personally, I have never known anyone take their own life without telling anyone. I think it's very often impossible to distinguish sincere from manipulative, so I assume that anyone who talks about suicide is sincere at the time. Perhaps I have been occasionally been manipulated — so what?

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  2. I don't understand why, if someone ends up prioritizing himself over the people he is trying to help, he would begin to work with mentally ill people at all or would continue once he realized what was happening. I'm assuming here that the people who work with the mentally ill do so because they genuinely want to help, rather than for sadistic reasons. Are they sliding into this gradually and not realizing that they are putting their feelings above those of their patients, when the cost to their patients is much greater than the cost to them would be if they put the feelings of their patients first? I can see that happening, I can sympathize with it, but I do not think that people with so little self-awareness should be working with mentally ill people, especially when they are trying to teach self-awareness to their patients.

    I have thought about this attitude as something people use to shield themselves from seeing the full extent of the suffering of their patients. This attitude allows them to believe that no one they meet is actually suicidal, that no one they meet is suffering so much as to really consider suicide. The people who are suffering that much are the people who aren't talking about suicide, and even those people aren't suffering so much that suicide would make sense because (these people believe that) there is no amount of suffering that makes suicide make sense. Again, I can sympathize with wanting to shield yourself by believing that, but the people who do so are probably not people who should be working with the mentally ill.

    I understand that sometimes the stakes are high for believing someone to be sincere when they are actually just manipulative, but I don't think that this is generally the case. I would rather see people err on the side of being overly compassionate and getting manipulated than err on the side of brusquely treating people who are out of their minds with suffering.

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  3. "The confidence trick is the work of man but the want of confidence trick is the work of the devil" (Forster in Howard's End)

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  4. My background is limited to dealing with one suicidal person, who made a number of attempts that landed her in ICU before she finally did die one night. Following her death I spent some time hanging out in a survivors of suicide group telling my story and listening to others.

    Suicidal people are hard to understand because they are in a much different frame of mind. I couldn’t understand that frame of mind because I had never been that sad, never been that hopeless, that death seemed like a good idea. People that are suicidal do tell others they want to die. Unfortunately, people that aren’t suicidal say the same thing. There are a lot of reasons, such as wanting to be the center of attention, or crying out for help, or trying to change the outcome of some event, or influence people to behave in a certain way.

    It’s pretty hard to tell the difference at a surface level. Suicidal people will probably exhibit different behaviors such as giving away possessions, writing suicide notes over and over and over trying to get them right, and perhaps slipping to a point where they aren’t crying out for help anymore.

    There are statistics to look at. The largest numbers of suicidal people tend to be between ages 20 something and 30 something. Most of them suffered from some sort of depression and were on some types of medications. Many also suffered from ADD or other inflictions that caused for more medication. Then you hear about how they just wouldn’t stay on the medicine and slip in and out of reality.

    But then, sometimes it’s just a teen age girl that breaks up with her boyfriend and takes and overdose of sleeping pills waiting for prince charming to come to her rescue, and dies in the process.

    I remember listening to one couple talking about their son’s suicide. He was in Florida, wrote a note, shot himself with a gun. But they couldn’t figure out why the suicide note had the wrong date on it. They didn’t think much about it, but started talking to one of his friends and found out the night of the note where he lived issued a voluntary evacuation do to a hurricane that coming on shore. So he evacuated and returned when all was safe and then killed himself.

    I thought to myself, that makes no sense what so ever. That just makes no sense. Then it dawned on me. You know, from our perspective suicidal people do not make sense. We are not them, we are not that frame of mind.

    So when someone cries out “I’m going to kill myself”. We start thinking in our rational minds, is this the boy who cried wolf? Is this the fairy princess that wants to be the center of attention? Or, is this someone that’s going to climb in a car and kill themselves and possibly others.

    It take a lot of love in your heart and a lot of listening, and a lot of putting up with crap and really scary shit to figure out the difference.

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  5. "People who really want to commit suicide won't tell anyone" and "intent to commit suicide is playing a game" are lies that comfort poorly-trained professionals by shielding them from reality."

    There is a grain of truth in both these statements. When a genuinely suicidal individual tells someone about their intention to end their life I do think it indicates an uncertainty on their part about whether all the options have been exhausted. Part of them at least wants a reason to live and wants you to explain to them why they should do so.

    As for "playing games" we all play games, all of us all of the time, life is a game a game of survival sometimes. It's like describing someone's behaviour as "manipulative". If behaviour wasn't "manipulative" on somelevel there probably wouldn't be much point to it.

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  6. elbogz -
    I know there are definitely people who are not suicidal, but who say they are for any number of reasons. It is really really hard to tell who is who from the outside, I agree. Some people seem to want to deny help or care for those who say they are suicidal but aren't actually suicidal. I don't understand that. Even if you aren't suicidal you still deserve care and help for your difficulties; I don't understand why anyone would want to deny someone that. But because people do want to deny people help when they say they are suicidal but really aren't, they risk also denying help to those who genuinely are suicidal. Of course, most people who say they are suicidal get "help" in the form of being locked up in a hospital, but fewer get real help beyond that. To me, it doesn't matter if this is the boy who cried wolf. I would rather give help to extra people who don't deserve it (and I very much doubt anyone really doesn't deserve it) than withold help from extra people who desperately need that help.

    E -
    My position is that when someone says they are suicidal, it MAY indicate that they are ambivalent about the matter, but that this is not NECESSARILY the case. To that end, there is a grain of truth in the statement, "People who really want to commit suicide won't tell anyone," just as much as there is in any stereotype -- it is true some of the time but not all of the time, even though the stereotypes claim exclusivity.

    Your point about manipulative behavior makes me think... could "manipulative behavior" also be termed "goal directed behavior"?

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  7. When someone is sitting in your living room, and says, they are suicidal; when someone is sitting in your car in a strange town, and says they want to die; when you find a suicide note, what do you do? If someone wants help then there is not problem, any emergency room will admit them, most psych hospitals will take them. But what if they refuse treatment?

    You can’t force someone against their will into medical treatment, so it becomes a matter for the police. When it’s a loved one; that is a hard choice. It’s a choice with long-term consequences. (Although not as long term as dead)

    You probably know more about it than I do, but you are confining someone against his or her wishes to do a medical evaluation. You can’t just call someone and say I need help with suicidal person. If they are not already in medical care, or have not made a significant attempt to commit suicide, no one will intervene except the police.

    I agree with you, all people that threaten suicide need help. I think what communities need is a branch of the police that are specifically trained to respond to suicide threats. They can bring with them professional training and make decisions for forced care, or point people to voluntary care.

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  8. To be clear, when I say that I don't want to refuse anyone the help they want or need, by "help" I don't mean hospitalization. I mean real help. Talking to them, helping them figure out solutions to whatever problems they are facing, medication, whatever they think will be helpful. This sort of help is still refused to people even in the hospital when the professionals think that person is being manipulative. I would not call the confinement "help", perhaps a means to providing help, but confinement itself never seems particularly helpful and is often counter-productive in giving help.

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  9. I thinkt he idea has been discredited pretty thoroughly, I was always taught that most people DO give signs - the ones who don't at all are rare.

    I once finally, after months, broke down and admitted to a shrink how suicidal I was. My GP encouraged me to. He didn't react. I finally asked, "What? Do you think this is some kind of manipulative thing or something?"

    "It would only be manipulative if you were doing it consciously."

    Unfortunately, it took me another several months to get the hell out of his treatment.

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  10. I am suicide in so many ways and have tried to commit suicide so many times. I have lost my jobs. I have lost my freinds. I have lost my girlfreinds. I have lost my places of resadence. I have given away my personal things and have thrown them a way as well. I have lost everything because of my depression. I cant seem to make right decision because of my mental state of mind. I keep trying to get help but they give me pills that make me moor suicidal or i cant seem to take them when i should. I need help. I go to the hospital and they put me on a 72 hour hold and give me pills and i tell them i am not well and cant do it on my own and they reales me and i am just getting worse. I have only one sibling and she is bipolar as well as me but she has a boyfriend. I have lived there with them to get help and i could not stay there because it was making me even moor depressed. So would keep going back to Sacramento to go work and find my self and i would be okay for a mounth or so and then i would be even mooe depressed. I would just abandoned my job and not eat or sleep. I would go back to my sister houes and do it again by going back to Sacramento. I have done this about 5 times now. Now i am back in Monterey and her boyfreind will not let me stay there and now i am on the streets homeles and know where to. Every one has given up on me and so have i. I have lost so much waight and i am scared to commit suicide by doing self harm to my self. I always take pills but i cant seem to die. I am suffring so bad that i am at the ocean and i cant swim and its cold out here so i know this time i am at my end and i hope i
    can jump in and not die by hunger and dehydrashion its so painful. I have know health insurance
    and i think this is why the hospitals will not help me. Words from a man in so much pain and lost hope and despair.

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