Welcome to Ask a Therapist, a monthly column where a licensed professional—not Dr. Google, not your judgmental co-worker, not your college roommate who tends to shoot from the hip—gives honest answers to the big questions that are keeping you up at night. They'll tell you when you're in a toxic relationship, how to move on from a traumatic memory, techniques to better manage your finances and worry less between paydays—and they'll also give you a no bullsh*t reality check when you have a shortcoming to confront. Here, we have Sherry Amatenstein, an NYC-based therapist, author, and editor of the anthology How Does That Make You Feel: True Confessions from Both Sides of the Therapy Couch. This month, in recognition of Suicide Prevention Awareness Month, she's taking three questions on the topic.
If you or someone you know is in an emergency, call The National Suicide Prevention Lifeline at 800-273-TALK (8255) or call 911 immediately.
Could I have stopped my friend from killing himself?
Last month my closest friend killed himself. We saw each other the night before he cut his wrists in his apartment and bled out (I can't believe I am even typing these words). He had been depressed for months. I knew he thought of killing himself but whenever I'd confront him about whether I should be worried he'd say, "Don't worry. I'll get through it like I always do." When he said that that last time I said, "Get some sleep. That will help and we'll talk tomorrow." There was no tomorrow.
I keep going over and over in my head what I could have done differently. In addition to the grief, I have tremendous guilt. Please tell me how to get through this.
I am so sorry for the enormity of your loss I am even more sorry that your grief is intensified by the awfulness of guilt.
In 2016, the U.S. Centers for Disease Control and Prevention estimates that 45,000 Americans killed themselves. Typically, someone who takes his or her life leaves behind approximately six "suicide survivors"—loved ones in shock, grief, and asking themselves questions like, "What if I had said, 'No, stay here tonight. We'll have popcorn and talk?'" "What if I had answered the phone when he called that last time instead of letting it go to voice mail?" "Why wasn't I a better friend?"
Five months ago someone I cared deeply about—I'll call him Jeff—posted psychotic ramblings on Facebook that alarmed his friends. Jeff, who suffered from bipolar disorder, subsequently spent four days in an inpatient unit at a psych hospital.
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Flash forward to a Saturday night in July. Jeff had dinner at the home of two close friends. He was clearly depressed and occasionally psychotic. His friends asked if he'd be okay. Jeff said, "Yes, I'll get some sleep and be much better tomorrow," hugged them tight, went home, slipped into his bathtub and slit his wrists.
Should his friends have convinced him to stay overnight on their couch? If they had, Jeff, who took his lithium sporadically, might have been safe in that brief window of time, but killed himself the next day, week, month.
Before becoming a therapist I volunteered at a suicide hotline. When someone called in, if I determined he or she was in imminent danger of suicide I was obligated to call 911. More often the threat was not severe enough to warrant that kind of intervention. I'd stay on the phone with the caller and we'd talk…and talk and talk, only hanging up when the person felt better. For that moment. I could not be a 24/7 lifeline.
The only person responsible for your friend's suicide is your friend. The truth is, even if the two of you had stayed up all night talking and he felt fine, as with Jeff, he might have killed himself in the near or distant future.
Our friends' suicides are tragedies but not our responsibility.
Hard as it is to accept, this person you loved is no longer here. To help you come to some kind of terms with this bleak new reality, I urge you to seek help – individual therapy and/or a support group. Here is a list of resources for suicide survivors.
If you won't do this for yourself, do it for your friend who loved your deeply and would want you to go on to lead a happy life.
Am I the only one who wants to die?
I am so depressed I just don't want to be on the planet anymore. But I feel like such a coward because I am afraid to kill myself. Am I the only one who feels this way?
One of the worst side effects of emotionally annihilating depression is the near-certainty you are alone in your torment: Everyone else is living a fulfilling, fabulous life. Everyone but you.
The reality: With one million adults making a suicide attempt each year according to the CDC, you have way too much company spending days and nights trapped in darkness.
Being depressed causes you to shrink into yourself, sink into silence. The antidote that can help disperse the shards and shards of pain is to give voice to them. That is why group therapy can be so helpful—there is comfort in knowing you are not alone.
Being afraid to kill yourself speaks to an awareness that if you are no longer on the planet, you will be depriving yourself of potentially amazing experiences. You have some hope there is light ahead once you find your way out of the darkness.
In the 2018 documentary Suicide: The Ripple Effect, Kevin Hines talks about surviving a leap off the Golden Gate Bridge. The moment in 2000 when his fingers left the rail he regretted his desperate act. He didn't want his life to end, just the torment.
The continuing stigma against seeking help for mental health issues prevents too many people from what can be life-saving therapy. Up to 80 percent of those treated for depression show an improvement in symptoms within four to six weeks via psych meds, individual and/or group therapy.
After miraculously surviving his jump, Kevin Hines sought help. That doesn't mean he never experiences darkness. Only now rather than staying silent he reaches out.
You can call The National Suicide Prevention Hotline any time at 1-800-273-8255.
I'm afraid my teen is suicidal
It feels like every time I turn around, there is another story of a young person killing him- or herself. My 16-year-old daughter has always been happy and outgoing but the past few months she seems less cheerful. When I ask whether she's okay, she answers that school is stressful, but she's fine. I believe her—maybe because I want to—but today I went into her room. She wasn't there but her laptop was open and a site was up discussing ways to kill yourself. I am terrified. I don't want to let her know I snooped and make her draw away from me but I can't let this go. What should I do?
I applaud you for being a loving, conscientious parent who refuses to bury her head in the sand. This is vital since CDC figures show that between 2007 to 2015 the suicide rate among teenage girls reached 62 percent, double that of teenage boys.
Warning signs a teen is at risk include:
- Low self esteem
- Substance abuse
- Family history of suicide
- Mental health disorders
- Lack of family and social support
- Academic stress
- Struggling with sexual orientation
- Talking about dying
While I understand your reticence at admitting you snooped, the most important thing is to initiate an honest and non-judgmental give and take. You don't have to confess, at least not initially. Say something like, "I know you say you are fine but lately you seem different, sadder and less engaged. You are the most important thing in my life and I want you to feel safe enough to say anything, if not to me, then a therapist. There is nothing you can say that will change my love for you one iota!"
Here are resources from the American Psychological Association that can offer guidance.
What you saw on her laptop is disturbing and must not be ignored. Having your teen agree to both a medical and psychological evaluation is a loving step—even if she (temporarily) hates you for it!
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Ask a Therapist: Could I Have Stopped My Friend From Killing Himself?, Source:https://www.prevention.com/health/mental-health/a29191998/ask-a-therapist-suicide-prevention/