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Suicide in Practice

Suicide: How to Diffuse a Clinically Intense Situation

“Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy.”

In his essay The Myth of Sisyphus, Albert Camus argues that the only philosophical issue that needs addressing is suicide.

The topic has been debated for centuries, by philosophers, politicians, and religious leaders. Suicide has been viewed differently across history, beginning with the ancient Egyptians, who did not judge the act as forbidden or unacceptable. They perceived suicide as a way to stop unendurable suffering.

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The morality of suicide was first debated 400 years before the birth of Christ by the Greek philosopher Socrates. In his eyes, people owed their lives to the gods and had no right to take away a life that ultimately did not belong to them.

Fast forward several thousand years, and suicide is still a hotly debated topic. The morality of the act and the proprietary rights over the vessel through which it is carried can be argued until the end of time. Or the Rapture. Whichever comes first.

While the debate rages on, a more alarming statistic arises.

The number of Americans who die by suicide now outnumber those who die in car accidents.

According to a recently published government report by the Centers for Disease Control and Prevention (CDC), as of 2010 (the most recent year data is available), 38,000 people took their own lives while 34,000 died in a car crash.

The CDC report also found that suicide rates increased significantly among individuals aged 35-64. The number of suicides in this population rose by almost 30% between 1999 and 2010.

The question that naturally follows is: Why are more people committing suicide?

Albert Camus would answer this question with “the absurd.” Camus believed that life’s primary concern lies in the internal struggle we experience between what we want from the universe and what we actually find in the universe.

What Camus highlights is the eternal ontological conflict of attempting to construct meaning in the space between hope and reality.

That meaning can translate into a complex issue of finding an abstract purpose in life or can be as simple as trying to put food on the table.

Some reach a point where they lose all hope in the face of reality. Many individuals are unable to find meaning, even in suffering. As a result, these people edge closer toward the precipice of an abyss, out of which they can never climb again. A dark chasm that is permanent and absolute.

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The weight of hopelessness and despair one must feel to willingly cross the proverbial point of no return is unbearable.

So the more important question, then, becomes: How do we help people in despair find hope?

This is true, at least from my perspective as a mental health professional.

When clients with active suicidal ideation walk into my office, my job is not to argue whether or not they have that right.

My job is to protect my clients from imminent harm to themselves. My goal is to help people in despair find a glimmer of hope, a semblance of meaning. I want to provide those in need with a hand they can grab onto before falling down that abyss.

How exactly does a mental health clinician do that? It would be nice if there were one neat manual that provided exact instructions on how to instill hope. While there are numerous books, workshops, and classes on how to treat severe depression and suicidal ideation, there is no single technique that every provider can successfully use with every client.

This is true because therapy is a highly individualized process. Every client has a unique story. An individual set of values, ethics, likes, dislikes, worldview, thoughts, and behaviors that are cultivated in personal experiences.

Hope means something different to each individual. To standardize such a construct would sanitize the human experience.

In a crisis, however, when a person is sitting across from you, telling you he or she wants to die, you tend to forget all these philosophical notions.

How do you help diffuse the situation?

  1. Develop rapport: Like with any other therapeutic relationship, rapport is key. Establishing the trust between you and your clients is essential in validating their experience
  2. Assess Risk: After you have created a safe environment for your clients to open up, you must now assess for suicidal risk severity. Gather information about active thoughts, presence of a plan, access to means to carry out the plan, previous attempts, and family history of suicide. If a high risk level is detected, you must take the appropriate steps to ensure the safety of your client. Hospitalization may be necessary.
  3. De-escalate the Situation: Using your therapeutic skills, particularly empathy, validation, and active listening, try to diminish the emotional crisis as much as possible. For many people experiencing such inner turmoil, having a safe and judgement-free space to talk and be heard is enough.
  4. Validate Reasons for Living: When people are in a state of crisis so deep they see suicide as the only situation, finding reasons to live can be difficult. Part of your job is to help broaden the picture for your clients. Finding any reason to live, even one, can be extremely helpful. Reminding people of the loved ones they will leave behind, possible opportunities to which they can look toward, and that negative situations can be handled better with a clear head can all help.
  5. Contract a Safety Plan: Safety plans are vital with suicidal individuals. They play a pivotal role in keeping clients safe when they are feeling extremely distressed or suicidal. Collaborating with clients and their family members is key when creating a safety plan. Make sure client keep copies of their safety plan in a place where they are easily accessible in times of distress

Hope-2-570x379It is also important to pay attention to risk factors that are associated with suicidal behavior. With a client, friend, or loved one.

Warning Signs of Suicide (save.org)

These signs may mean someone is at risk for suicide. Risk is greater if a behavior is new or has increased and if it seems related to a painful event, loss or change.

  • Talking about wanting to die or to kill oneself.
  • Looking for a way to kill oneself, such as searching online or buying a gun.
  • Talking about feeling hopeless or having no reason to live.
  • Talking about feeling trapped or in unbearable pain.
  • Talking about being a burden to others.
  • Increasing the use of alcohol or drugs.
  • Acting anxious or agitated; behaving recklessly.
  • Sleeping too little or too much.
  • Withdrawn or feeling isolated.
  • Showing rage or talking about seeking revenge.
  • Displaying extreme mood swings.

Additional Warning Signs

  • Preoccupation with death.
  • Suddenly happier, calmer.
  • Loss of interest in things one cares about.
  • Visiting or calling people to say goodbye.
  • Making arrangements; setting one’s affairs in order.
  • Giving things away, such as prized possessions.

If you or someone you know is suicidal, please get to a doctor or mental health professional as soon as possible.

In case of an emergency, you can call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or visit the nearest emergency room.

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