Talking with Suicidally Depressed People
Last updated 2004-06-28 by Roedy
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Overview
I am not a psychiatrist or a psychologist, but I have been suicidally depressed.
Various well-meaning friends have tried a variety of techniques to help me snap
out of it. I want to explain what these feel like from the point of view of the
depressed person.
There are four components to feeling depressed:
-
Life circumstances are intolerable and you can see no way they could improve.
-
You feel inadequate, useless, unlovable, lazy, an outcast. You are a parasite on
society.
-
You believe you are absolutely obligated to do something utterly impossible, e.g.
pay bills, care for someone disabled or finish some project by a deadline.
Others may have great trouble seeing why the obligation is so absolute or the
task so impossible.
-
You feel ashamed and embarrassed about being depressed and how it affects your
work and relationships.
Just Snap Out Of It
Talking to a depressed person can be very frustrating. They are so negative.
They see everything through a negative filter, seeing only the bad in the world,
blind to the good. They are deluded and have silly fears. In frustration you
want to shout at them and smack them to just snap out of it.
In the movie The Best Years Of Our Lives this is the approach Fred's
wife uses. Fred withdrew from her because she had so little understanding of how
it looked from his point of view.
You Should Feel Grateful
The intent is to show the depressed person all the pleasant things they are
overlooking, but it often comes across as just more condemnation. This
ingratitude is one more reason they have no right to live.
Couldn't You At Least Smile?
This just piles on guilt. The depressed person does not want to bring anyone
else down so deepens the withdrawal.
You Have No Right To Feel That Way
Different people get upset over different things. Logic has little to do with it.
If you tell the depressed person they have no right to feel upset over something,
they will just see you as insensitive and will withdraw from you. They are not
about to share with you only to have their feelings condemned. They have enough
self-condemnation going already.
False Promises
Eat this pill, say this prayer, read this book and all your problems will
disappear!!! You know perfectly well that is a lie. It is especially
important not to lie or exaggerate. To gain rapport and credibility, you will do
better with a pessimistic viewpoint. The depressed person is not demanding
perfection, just relief from enough of the pain that is making life intolerable.
You Are Selfish
One very commonly used tactic is to say in an angry voice All people who
commit suicide are selfish cowards and whining complainers. Since the
depressed person has obsessed about suicide, he is in your eyes, a selfish
coward -- all the more reason to bump himself off.
In a similar way it is probably not the best policy to point out how immature,
illogical, self centered and demanding he is being. He will feel a pariah and
abandoned -- all the more reason to die. If you can't deal with him, back off
and allow others with more patience to.
Think of All The People Worse Off Than You Are
This is a real winner. Contemplating all the suffering in Africa, and all the
suffering going on around him just makes him want to check out of the entire
universe. It is totally overwhelming. Further, it adds to his shame about be
unable to cope with his lot, all the more reason to bump himself off.
How Would You Do It?
This helps you gauge how close the person is to actually committing suicide. If
they have a precise plan for killing themselves they are closer. It is a great
relief for the depressed person to talk about this taboo topic. They may be
unwilling to share details fearing you might interfere with their only escape
route.
What Are Your Reasons For Staying Alive?
Suicide basically comes down to a balance between reasons for staying alive and
reasons for dying. Try to gently get the depressed person to elaborate and come
up with more reasons for staying alive. Non judgementally get them to think
about other people's expected reactions to their suicide. Don't put them on the
spot and make them feel stupid for being unable to think of reasons to live.
Gently suggest some possible reasons, but don't demand that they accept them as
sufficient or even important. You may have much more effect than you realise
when the depressed person goes off later to ruminate on what you said.
The reasons may be rather mundane. He will get to see how some political
situation works out, he will get to see some sporting event, he will get to see
some invention rumoured in the pipe, he will get to see next year's model car or
computer, he will get to visit some pleasant place, he can visit some friend or
relative, he can read some book, he can see some new blockbuster movie coming
out. He can look back over the past year and see what he would have missed had
he died a year earlier. These can be as minor as freakish news stories. You have
to tune your suggestions based on what you know this person has enjoyed in past.
Be prepared for them to say that nothing has any interest any more. You
still can have a beneficial effect. Don't demand they agree these activities
would be pleasant.
He may miss out on future love. Think of how many times is past it looked as
though love would never come his way again.
He may want to stay alive just to support some cause or charity, to speak out
for those whose voice is not being heard.
What Are Your Reasons For Dying?
Suicide is a permanent solution to a temporary problem.
-- Joyce Cousins
You can't ask these right off the bat. If the depressed person thinks you are
going to trivialise these, or condemn him for feeling them, he is not going to
tell you. He will tell you some more respectable secondary reasons instead. Just
listen. Don't leap in with an immediate fix. Don't try to argue him out of his
reasons before he has even stated them. Show some respect. Don't treat him like
a child who afraid of monsters under the bed, even if you think his reasons are
that foolish. Encourage the person to have a good cry, nature's way of learning
to accept the unacceptable parts of life.
If you find out the insoluble problem that the person feels so obligated to
solve, you can suggest getting help with it from someone who knows how to deal
with those sorts of problem. Here is where you can really help -- offer to set
up the appointment. To the depressed person, asking for help is extremely
difficult, shameful and embarrassing. He would sooner die. Please just trust me
on this, even if to you there is nothing whatsoever difficult, shameful or
embarrassing, it is to the depressed person.
It is quite ok to suggest practical things you might to do better the situation
if you were in his shoes. Keep in mind, his emotional energy is almost zero, so
things you might consider fairly easy to do, he will consider very difficult.
Don't demand he do them, but encourage him to take one simple action to better
his predicament. You have put in the back of his mind he really has to at least try
these ideas before he gives up and uses suicide. Suicide is the last resort.
Look on the Bright Side
Often the person contemplating suicide is facing some major life change, e.g. a
divorce, a loss of job, an illness, or a move. They are focussing on all the
negative aspects of that change. You can point out some of the positive aspects
as well to help counterbalance the negative ones.
Emotional Distance
To help him gain some emotional distance, ask questions like this: What
percentage of people would recommend suicide in a situation such as yours? If
you knew someone in a similar predicament as you, what would you recommend? You
want him to see it is his reaction to the situation, not just the situation that
is the root of the problem.
Big Picture
To help him see the bigger picture, ask questions like this: How do you think
other people would react to your suicide? Who will be negatively effected by
your suicide?
Why Suicide?
In primitive times, suicide was thing you might do in tough times to help your
group survive. The intent was to conserve food. In modern times people can feel
useless and hence feel a duty to die. Just having a big meal can sometimes
defeat that ancient unconscious logic.
Avoiding Being Conned
It has been said that suicide is a cry for help. The person may consciously or
unconsciously be trying to blackmail you into offering help. To deflect demands
for help you are not prepared to give say something along these lines.
"Only you know all the facts. You are the one who has to bear the pain. You
are the one who has to make the decision. You are the one who has to go through
this ordeal. I can help you by ..., but I can't solve it for you. "
How Big A Miracle Would It Take To Make Your Life Tolerable Again?
Here you can help gently dispel some of the blacker delusions of hopelessness by
showing how only some fairly small "miracles" would be needed. Get him
to review his life to see that, even for him, such "miracles" have
happened before, and so could happen again.
Hugs
Depressed people isolate themselves. They are starved for warmth. It may be
available but they won't take it. A hug reaches way down inside and says I
love you; you are fine with me far better than any words. Reassurance with
your hugs that somehow things will muddle through, even if painfully, is
probably the most useful thing you can do. Knowing he does not have to face the
unfaceable totally alone gives courage. Anything that gets the person
interacting with others will help.
