This is probably one of the most frustrating questions family and friends (F&F) have when dealing with suicidal patients. Unfortunately, the answer is not at all clear and probably different for each of us. That’s not of much help; but, hey, no one ever said this was an easy disease. I will try to list some of the thoughts I’ve had over the years. If I end up contradicting earlier posts, just keep in mind that I am in a fairly good mood now, which may not have been true when I wrote the previous comments. And, in any mood, I am full of contradictions. (I am losing weight, but I am still large enough to contain multiples, if not multitudes. Perhaps when I get down to 190 lbs. I’ll be of a single mind!)
There is one thing I must say emphatically before giving any useful advice (such as I might give): do not try to convince your loved one that they shouldn’t be depressed! Spewing a list of reasons someone shouldn’t be depressed or suicidal to someone who is depressed or suicidal, will only cause anger and resentment. Why? For you warm and fuzzy types, acknowledging our current state of mind validates our humanity and reality (subjective though it may be) giving us the feeling that someone understands us — in particular, that our thoughts are crazy, but we are not. For you logical folks, I’m affraid a somewhat longer-winded explanation is necessary — a very quick lesson in brain structure.
For our purposes, the human brain can be roughly divided into the ancient/animal brain and the new/rational brain. As you might guess, the animal brain controls our most basic functions, emotions, and responses — “Ug must eat, Ug envy Og for food, Ug must club Og to get food.” (Grammar apparently wasn’t very sophisticated in Ug’s and Og’s day.) As you might further surmise, this part of the brain is not too concerned with mitigating circumstances. The new part of the brain, is much more nuanced — “I certainly am hungry and Mr. Og Jones has quite the bounty. I am much stronger than Og, so I could just take his food. But, Og trapped and prepared that food making it rightfully his. If I simply took his food, then there would be no trust amongst neighbors and therefore no basis for a civic life, no basis for ethical behavior…” So Og is safe because we have logic to save us from fight or flight, right? Well, not quite.
Here are the other facts you may not know: the animal brain is incredibly fast and tends to deal with the most urgent needs like eating; the new brain is much, much slower and tends to deal with more esoteric needs such as the meaning of life or the condition of man. As it turns out, the newer brain is incredibly powerless against the old brain when strong emotions and the impulsive actions they drive are in question. This is as it should be because “Tiger! Run!” really ought to win over “Why must the tiger eat meat? What is its motivation?”
So, when you tell us, “you have nothing to be depressed about; you have food, a lovely family, a good job, a nice car, …” when we are contending with “everyone hates me and I have no reason to live, so I should club myself, …” your words just don’t have a chance. Our subjective reality has hijacked our psyche and no amount of evidence from your absolute reality will change that. Much better is to accept the fact of our crisis, help us through it, and only afterwards bring us back to your world of facts and statistics. And with that, I shall begin my list:
Suggestion 0: Acknowledge how the patient feels right now and save the debate for Hanity and Colmes.
Suggestion 1: Stick to the script on the safety plan. (Remember suggestion 0, don’t argue! Just stick to the script.) Don’t have the safety plan? Then, you aren’t on the patient’s list of go to people; get over it. If they don’t have a safety plan, then suggest they formulate one with their therapist before the next crisis comes.
Suggestion 2: Ask the patient what you can do to help them, but don’t expect a good answer. Then, make suggestions of things you think might help. This will hopefully spawn a constructive conversation that, in and of itself, will be helpful and may even yield useful actions for you or the patient or both.
Suggestion 3: Don’t belittle us, don’t guilt trip us (yeah, well, it’s a verb now!), and don’t compare us to Middle-eastern Jihadists. Suicide may be immoral and stupid in your mind, but obviously it isn’t in ours. Appealing to our sense of guilt and shame is almost always the exact opposite of what we need to hear. I have never thought to myself, “Gee, you’re right. Suicide is an unforgivable sin. What kind of a man takes the coward’s way out? What kind of father would even consider abandoning his kids like this? I hate myself for who I have become. Won’t you please take this gun out of my hand?”
Suggestion 4: Be yourself, and no one else. Be a friend that cares for us; be a family member that cares for us (rare, but it happens); just don’t try to be a savior. You aren’t likely to save us — something only we can do — so your efforts will at best fall on deaf ears and at worst make us feel pathetic. Save your cable t.v. psychobable for the singles bar because it will probably do more harm than good in a real situation. (Sorry to be so blunt, but we are paying someone else $150/hr. for their years of training and education in this area; your arm chair psychology is worth … well … what we paid for it.)
Suggestion 5: Actually listen to what we have to say. Don’t call us with your generous offer of support, then get engrossed in a football game while we are opening up to you (rare, but it happens). Do you know the old song, “Mister Cellophane“? Most suicidal people feel like that. Don’t add to the problem.
I’m all out of suggestions for now. I could think of more I suppose, but it’s 1:30 am and I am thinking about getting back to work after seven weeks off, so I’d better choose sleep over profundity. Hopefully, we will get a lot of comments so the F&F can get a sense of what they might do to help. We know you care, so read up and show us how much you care.
Good night everyone (that wasn’t a euphimism, so don’t get depressed). I am looking forward to reading the comments of other silk folk and the thoughts of their F&F. I know this is not easy for F&F — it may even be the hardest thing you ever have to do in a relationship (sexual acts not withstanding) — but you can do it.
-Ashley
