The Conversation That Could Save a Life

There are some conversations we avoid because we are afraid of saying the wrong thing. Suicide is one of them. We worry that asking someone whether they are having thoughts of suicide might put the idea into their head. We fear embarrassing them, frightening them, or opening a conversation we don’t know how to finish. So sometimes we say nothing. Yet when it comes to suicide, saying something may be far more important than saying it perfectly. Suicide Prevention Awareness Month (September) gives us an opportunity to talk about something that remains extraordinarily difficult to talk about:

What happens when emotional pain becomes so overwhelming that a person begins to believe the only way to escape it is to escape life itself.

Suicide doesn’t always look like despair

One of the most dangerous myths surrounding suicide is that we will somehow know when someone is suicidal. We imagine someone visibly depressed, withdrawn and unable to function. Sometimes that is what we see. But not always. A person can go to work, collect the children, answer messages, laugh with friends and make plans for the weekend while privately struggling to stay alive. This can be particularly important when we think about the men in our lives.

Men Are At Higher Risk Of Suicide

Many men have grown up with messages about coping, providing, being strong and sorting things out themselves. Emotional vulnerability may feel uncomfortable or even shameful. Rather than saying, “I’m frightened. I’m overwhelmed. I don’t know how much longer I can cope,” distress may appear as irritability, anger, drinking more, working excessively, taking risks or withdrawing from the people closest to them. And sometimes there are quieter changes.

“Everyone would be better off without me.”

“I’m just a burden.”

“I can’t do this anymore.”

These aren’t always dramatic statements. They may be said casually and quickly dismissed. But they deserve to be heard. Don’t overlook a change in behaviour or mood, and just write it off as midlife crisis or the ‘manopause.’ Be curious, be kind and open up that dialogue. Read more about the risk of suicide in men here.

Teen Troubles, Or Something More?

Men are not the only group whose distress can be hidden in plain sight. With teenagers, recognising when something is seriously wrong can be particularly difficult because many of the change in behaviour we put down to adolescence. The question for parents is often whether there seems to be more going on and whether they are losing interest in friends or things they once enjoyed. Their dialogue may have shifted to a more negative narrative where they talk about feeling hopeless, worthless or constantly feel there is ‘just no point.’

Teenagers may not always have the words to explain the intensity of what they are feeling. Sometimes their behaviour becomes the language of their distress. The answer is not to interrogate them, but remain curious, available and willing to listen. And if something does not feel right, don’t be afraid to ask directly whether they have thought about hurting themselves, or ending their life. It may be a frightening question to ask your child, but you are giving them the permission to tell you the truth and it could be one of the most important conversations that you can have. Try not to leap into solutions but allow the space for their story to be heard by you and then always look for professional support to help you take the next steps with your child.

What Sits Behind Suicidal Thoughts?

In my work as a psychotherapist, I think it is important to distinguish between wanting life to end and desperately wanting unbearable emotional pain to stop. Many people in their lives will have suicidal thoughts, with no intention to carry them out. A fleeting thought of what would it be like to not be here or a moment of thinking life is too much. However there are others whose suicidal thoughts become suicide plans. The difference is to them that death may begin to feel like the only available exit from a situation they cannot imagine changing. That situation might involve relationship breakdown, bereavement, financial difficulties, loneliness, shame, trauma, illness, addiction, workplace difficulties or a combination of pressures that have gradually become intolerable. The person’s world can become psychologically smaller. When we are emotionally overwhelmed, our ability to imagine alternatives can narrow. Tomorrow begins to look exactly like today. Problems feel permanent. Hope becomes increasingly difficult to access. That is why another human being can matter so much. Someone else may be able to hold hope temporarily when the person struggling cannot.

Ask the question

If you are genuinely worried about someone, don’t be frightened to ask.

“Are you thinking about suicide?”

It can feel like an enormous question. But asking directly about suicide does not create suicidal thoughts. What it can create is permission to tell the truth. If the answer is yes, we don’t need to immediately produce solutions. We don’t need the perfect therapeutic response. We need to listen. Try not to respond with “But you’ve got so much to live for,” or “Think about what this would do to your family.” However well intended, these responses can add guilt to pain. Trying to guilt someone out of suicide by showing them what it does will only make them come up with justifications of why their loved ones are better without them and future holds no hope,

Instead:

“I’m really glad you told me.”

“I’m here and I am going to stay with you.”

“We don’t have to do anything more tonight. We just need to get you through tonight.”

And then help them access appropriate professional or emergency support. If you believe someone is in immediate danger, don’t leave them alone and seek urgent help.

Look beyond “I’m fine”

Perhaps we also need to become more curious about one another. We ask “How are you?” constantly, but rarely expect an honest answer.

“Fine.”

“Busy.”

“Tired.”

And the conversation moves on. Perhaps the more important question is:

“No, really. How are you?”

Notice changes. Notice the friend who has stopped coming out. The partner drinking more than usual. The colleague who suddenly seems disconnected. The son who has become unusually angry. The father who says everyone would manage perfectly well without him. None of these things automatically means someone is suicidal. But they may mean somebody needs to be asked twice.

The people left behind

We also need to talk about those bereaved by suicide. Suicide leaves a particularly complicated form of grief. Alongside the devastating loss can come shock, anger, guilt and an endless search for answers.

Why didn’t I see it?

What did I miss?

What if I had called?

Could I have stopped it?

Those questions can become their own form of torment. The reality is that suicide is complex. There is rarely one conversation, one relationship, one event or one person responsible for another person’s decision to end their life. Those left behind need compassion too – and permission to grieve without carrying an impossible burden of hindsight.

We don’t need to be therapists to help

Most of us will never become mental-health professionals. But all of us can become better listeners. We can tolerate uncomfortable conversations rather than rushing to make them disappear. We can check in again when someone’s “I’m fine” doesn’t feel convincing. We can tell the men and women in our lives that needing help isn’t weakness. We can stop assuming that the person who appears strongest needs us least.

And perhaps most importantly, we can make it easier to say:

“I’m not coping.”

Because those three words should never be a source of shame. They should be the beginning of a conversation.

One conversation

This month being Suicide Awareness Prevention Month, there will rightly be campaigns, statistics, helplines and messages encouraging people to reach out. But awareness also happens somewhere much smaller.

Across a kitchen table.

During a drive home.

Over a cup of coffee.

In a text saying, “You’ve been quiet lately. Are you okay?”

We may never know which conversation mattered. We may never know that the phone call we made, the question we asked or the extra ten minutes we stayed gave somebody enough connection to make it through another night. So don’t worry about finding the perfect words.

Notice.

Ask.

Listen.

Stay.

Sometimes the conversation we are most afraid to have may be the conversation that saves a life.

• • •

If this article has raised concerns about you or someone you know: In the UK and Ireland, Samaritans can be contacted free, 24 hours a day, on 116 123. If someone is in immediate danger or has seriously harmed themselves, call 999 or go to the nearest A&E department.