14 Things Therapists Need You to Know About Suicide
Just because someone seems fine, it doesn't mean that they are. Here are some things you should know about suicide, including how to help someone who may be at risk.
Suicide is the second leading cause of mortality in people between 10 and 34 years of age and the 10th leading cause of death overall in the United States, according to the Centers for Disease Control and Prevention (CDC). To put that in perspective, in 2018 more than twice as many people died from suicide (48,344) as from homicide (18,830). The CDC reports that another 1.3 million Americans attempted suicide and 10.7 million seriously thought about it.
Many people struggling with suicidal thoughts feel desperately alone, says Ekaterina Musok, a counselor and substance-abuse professional at Freedom Counseling in Florida.
“Suicide still remains a topic rarely discussed in many circles of our society,” she explains. “So it’s not uncommon for people to feel that they are the only one.” Whether you or someone you know is struggling with these feelings, you need help and support. That’s why we asked mental health professionals to share what you should know about suicide.
It can be hard to talk about thoughts of suicide
People can feel uncomfortable initiating discussions about painful feelings, says Musok. They may feel like they should be able to “just deal with it” or that others have it worse. They may worry that they will burden others. Or they may be afraid of being seen as weak and incapable.
So if you have a loved one struggling with depression and/or suicidal thoughts, it may be up to you to start the conversation in a loving, helpful way.
Choose words carefully when talking about suicide
When speaking about someone who has taken their own life, avoid the phrase “committed suicide,” says Jill Johnson-Young, a California-based grief counselor, author, and speaker. “This sounds almost accusatory, creates blame, and hurts those who are left behind,” she explains.
Instead, she suggests saying: “died as a result of suicide,” “died from suicide,” or even “ended their life.” Another common mistake is asking family members how exactly the person died. Don’t ask that question at all, she says.
Asking someone about suicidal thoughts will not make them more likely to attempt it
Many people fear that discussing suicide will make troubled loved ones think about it more often and increase the likelihood that they will hurt themselves. But in reality, the opposite is true, says Kara Lissy, a psychotherapist at A Good Place Therapy and Consulting in New York City.
“When someone expresses suicidal ideations or thoughts, talking about it can serve as a deterrent,” she explains. “Inquiring about these thoughts shows emotional support and care, and can often better direct the suffering person to get the help they need.”
Suicide can be an impulsive act
Interviews with many survivors of suicide attempts reveal that they often regretted their decision as soon as they made it. In one study of 515 people who attempted to end their lives by jumping off the Golden Gate Bridge, 90 percent never attempted suicide again and most reported they were grateful to be alive.
“All too often suicide happens on a whim, not a committed plan,” says Raffi Bilek therapist and director of the Baltimore Therapy Center. You may be able to help someone by “talking to them about what they’re struggling with and assisting them to get professional help,” Bilek says.
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Suicide is not caused by a bad breakup or another difficult life event
One of the major things people get wrong about suicide is thinking they can pinpoint the event that caused it. “With rare exception, suicide is because of mental illness,” says Mark Rego, MD, assistant clinical professor of psychiatry at the Yale University School of Medicine. “We often hear in the media, ‘Why did he do it?’ as if a job loss or romantic breakup holds the key to the tragedy. But these things happen daily to millions of people who do not even contemplate suicide.”
Mental pain from difficult life events may be involved with suicide, but it is usually not the sole cause.
People can be more likely to attempt suicide as their depression starts to lift
A severe depressive episode is a serious risk factor for suicide. But surprisingly, an individual may actually be at a higher risk when their treatment for depression first starts working.
“Often, the beginning phases of treatment will improve motivation, concentration, and energy levels, making it more likely for someone to follow through with a suicide attempt if their suicidal thoughts are still lingering,” says Lissy.
Substance abuse can be a warning sign
A crushing depression can make everyday life feel incredibly hard, if not impossible. So people may do whatever they can to cope with their feelings, even if that “solution” ends up making the problem worse—like abusing drugs or alcohol. In addition, some substances may also increase the risk of having thoughts of suicide. A 2014 study of adolescents and young adults in the journal Drug and Alcohol Dependence found that alcohol and cigarette use was linked to later risk of suicidal thoughts, while suicidal thoughts were linked to later risk of using drugs or marijuana.
“They see substances as a way to get relief from, or numb, the pain,” Musok says. If you have a loved one struggling with substance abuse, it’s important to realize that this puts them at a much higher risk of suicide, she adds.
Treating substance issues should also be an important part of their overall treatment plan. (Learn the silent signs of drug abuse.)
Risky behavior could be a sign someone is thinking about suicide
Do you have a friend or family member who is suddenly into driving 115 on the freeway, gambling, or having unsafe sex? That can be a sign they are contemplating hurting themselves—or hoping that fate will take the decision out of their hands.
Some people will also use risky behaviors to try to “feel alive” and to counteract the numbness of depression, Musok says.
Anyone can be at risk for suicide
It’s important to know the risk factors for suicide, but you shouldn’t use them as a checklist, says board-certified psychologist Shane G. Owens, PhD.
“While you should be on the lookout for those things, not everyone who experiences them will truly be at risk, and there are many individual warning signs that those lists miss,” he explains. “Any marked changes in behavior can be warning signs that suicide is possible.”
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Suicide does not discriminate
Some groups of people are at a higher risk for suicide including Native Americans, Hispanic Americans, veterans, active-duty military, LGBTQ youth, and people in certain professions like farming, the arts, design, sports, and entertainment, according to the CDC.
But while it’s important to understand these risks, especially if you have a loved one who falls into one of those categories, you should also know that no one is immune to suicide.
“The only ways to know whether someone is in danger are to ask, to listen carefully to the answers, and to maintain connection until the person gets help,” Owens says.
Don’t beat yourself up if you didn’t know someone was at risk
“Most people who are suicidal don’t ‘look suicidal,'” says Wayne Pernell, PhD, a counselor and clinical psychologist. People often associate depression with a certain stereotype they’ve seen in the media or assume that the person will look depressed or talk about suicide.
“Sure, that can be part of it, but a lot of it is hidden,” he says. “There’s no neon sign that says, ‘This person is thinking about suicide.’ It’s easy not to know. Even professionals miss it sometimes.”
It’s not unusual to be angry at the person
Dealing with suicidal ideations is exhausting and painful for everyone involved. It’s important to allow yourself to feel all your feelings, Pernell says.
“You might feel helpless, sad, excluded, or you might feel upset or like they are selfish,” he says. “It’s OK to experience love and anger at the same time,” he says.
All of those feelings are valid, and you’re allowed to feel them while still offering understanding and compassion. You should also remember to keep an eye on yourself when dealing with something like this since caregivers are at a higher risk for depression.
Keep in mind that a person who is at risk for suicide isn’t selfish—they often have distorted thinking that can make them emotionally detached and alter their perception of reality.
Not all suicidal thoughts mean that someone is suicidal
A variety of mental illnesses can play a part in a loved one talking about suicide or feeling suicidal. It’s only when they get to the root of these issues that they can get the proper treatment. “For instance, someone with [obsessive compulsive disorder] may have recurrent obsessive thoughts telling them to end their life with or without a desire to act on them,” Lissy says. “Similarly, a person with a psychotic disorder may have auditory hallucinations telling them to end their life.”
PTSD, schizophrenia, and bipolar disorder may also play a role. But, says Lissy, “these require a professional diagnosis and need different treatment approaches than would someone who is depressed and suicidal.” (Read one woman’s story on what it’s like to be a caregiver for someone with bipolar disorder.)
Keep their memory alive
A suicide can have a stigma in a way that other causes of death do not. That may make surviving friends and family reluctant to talk about the person, Johnson-Young says. But remembering and honoring them can be healing for those left behind.
“Use their name and do something to honor their memory related to suicide, in their name,” she suggests. “Giving back matters to anyone who has lost a loved one. Attend a suicide walk and wear their name on a shirt, donate to research or a support system, or ask the family how they would want them to be honored.”
If you or someone you know has had thoughts of self-harm or suicide, contact the National Suicide Prevention Lifeline (1-800-273-8255), which provides 24/7, free, confidential support for people in distress.
- Centers for Disease Control and Prevention: "Preventing Suicide"
- Centers for Disease Control and Prevention: "Leading Causes of Death Reports, 1981 - 2018”
- Ekaterina Musok, LCSW, a counselor and substance abuse professional at Freedom Counseling in Palm Harbor, Florida
- Jill Johnson-Young, LCSW, grief counselor, author, and speaker
- Kara Lissy, LCSW, a psychotherapist at A Good Place Therapy and Consulting in New York City
- Suicide and Life Threatening Behavior: "Where are they now? A follow-up study of suicide attempters from the Golden Gate Bridge"
- Raffi Bilek, LCSW, therapist and director of the Baltimore Therapy Center
- Mark Rego, MD, assistant clinical professor of psychiatry at the Yale University School of Medicine
- Centers for Disease Control and Prevention: "Suicide Risk"
- Shane G. Owens, PhD, a board-certified psychologist
- Wayne Pernell, PhD, counselor and clinical psychologist
- Drug and Alcohol Dependence Suicidal Ideation and Substance Use among Adolescents and Young Adults: A Bidirectional Relation?*