One More Reason to Ask About Suicide

It's always dangerous to listen in when psychiatrists and therapists talk among themselves. I used to do a whole series, OMGThat'sWhatTheySaid, devoted to overhearing what they say about us. More than one post was devoted to their discourse about suicide.

There's been lots of opportunity to overhear in the last several days since the Meghan Markle interview. The clinicians weighed in on Stacey Freedenthal's New York Times article where she dared to repeat what some doctors and therapists have told her (an expert in the field of suicide and suicide prevention), that they fail to ask the question about suicide. There have been proclamations about professionalism, training, protocols, risk-assessment, and - God help us - malpractice.

I started to write a post reporting my own experience of risk-assessment and the failure of my doctor and therapist to ask, even as they told me they were concerned about me. Concerned about what exactly?

But I began to feel -- empty. Like the whole conversation, including my part in it, was missing the boat.

The boat is pain.

What is at stake is whether we have a safe place to talk about our most painful feelings.

Let me repeat that.

What is at stake is whether we have a safe place to talk about our most painful feelings.

It's not about whether you can be the hero that intervenes when we are at the brink of killing ourselves. It's not.

Before I returned to my dreary post about risk-assessment yesterday morning, I found Indigo Daya's Twitter thread that did not miss the boat. She speaks to the real issue, pain, and whether you will give us permission to talk about it. She has allowed me to repeat it here.

Indigo Daya:

I'm not a fan of risk assessments.

But I am a fan of being able to talk frankly about suicide followed by empathetic, rights-based support.

This thread [another by Freedenthal] does some good myth busting on that. And yes, self-injury is different.

Here's a few bits I'd add from lived experience...

If we say we're thinking about suicide, don't panic.

It may or may not be a crisis. It may feel odd to you--but some of us have thought about suicide for decades, regularly.

I consider myself largely healed but I still have regular suicide thoughts.

(Don't panic, I'm OK)

It's helpful to understand the different nuances of how we are thinking about suicide...

Are thoughts abstract or occasional... or a lot, or increasing? For how long?


Is it a thought ('I could') or a desire ('I want') or an urge ('I need to') or a plan ('I'm ready').

The big question is why.

Suicide is not a meaningless sign of 'mental illness'.

Typically it's a sign of 2 things:

1. The person is feeling unbearable pain (any type)


2. The person has lost hope it will change.

If you want to help, you need to understand the whys.

More than that, you need to listen really well, stay out of judgment and demonstrate some excellent empathy.

We are not going to talk to you if we think you don't care. You should care. And you should show it.

Know that the simple (not really simple) act of listening can have healing value all by itself.

Often not enough, but sometimes it's enough.

So do some really good listening.

You need to do something if we want you to. You should ask if we know what would help. Then help us to get that.

Sometimes we'll know, sometimes we won't.

Please don't suggest we try a bubble bath. It's a really dumb idea if we're wanting to die, for so many reasons.

If we're not sure what might help, focus on exploring with us ways to alleviate the unbearable pain. Right now & short term. Long term later.

You could talk about hope, but that's a much tougher gig when we're in this place. Alleviating pain will help with the hope anyway.

You might ask if there are people or places that feel safe or comforting to us, maybe we could access those supports.

We may feel too ashamed to ask for support so we might need a hand.

Or not. Ask.

Please don't call the cops, the ambo, or a CATT team.

Unless of course we want you to. Then do.

Forcing us into a carceral system at our darkest hour can really add to unbearable pain & hopelessness.

Kinda the same with psych drugs.

Ask if folks find them helpful. Sometimes drugs can really help in a crisis, sometimes they can make everything worse.

Rights-based support recognizes that people can & should make their own choices about what happens to our bodies.

Think & ask about trauma, adversity & existential crisis. Most often, there is a reason out in the world at the base of our distress.

Be an ally in naming these structural issues. Help break them down, if you can.

Don't just individualize the issues in us.

I've had so many suicidal crises over the years. I've had coercion, judgment, compassion & sometimes nothing at all.

What sticks with me most are those folks who could just be with me, in the pain. Not trying to fix me & not leaving me stranded.

Be with people. Be allies.

BTW this is not a comprehensive list, and I'm a bit tired... but it's what comes immediately to mind.

Yup. I'll endorse every single thing Indigo Daya says here.

And I notice she does what I do, what most of us do, when we talk about our suicidal thoughts. First, we take care of you. (Don't panic. I'm okay.) Frankly, that's tiresome. But we do it. Because we know the first place you're going to go is to wonder if you need to call 911. 

Please don't call 911, unless, as she says, we ask you. And when 988 comes on board, don't call that either, unless we ask you.

You can get to those questions about thought/desire/urge/plan. But don't let those questions take the place of deep listening to the pain. Don't stop listening once we have alieved your anxiety.

Hey, you can read more of Indigo Daya at her website and on Twitter, @IndigoDaya.

Right now I am, as Fannie Lou Hamer said, sick and tired of being sick and tired. Not just sick and tired of being mentally ill, but sick and tired of this struggle for human dignity. Oh, I'll keep at it. That's what I do.

But I wonder if I can find something silly to post next week?

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