I'm watching my nephew for much of the day today, and yet it's almost easier to attempt to blog when TK has a playmate. We'll see if I can fit it all in. What I have to blog about today has been on my mind for some time and requires some extra thought and planning. It's a topic I don't want to mess up.
What I have to discuss is suicide. It's not on my mind because of anything specific to me, but NPR has done a slew of articles about it recently and it's really caught my attention. They've reported on suicide in the Native Arctic communities in Greenland where the suicide rate is the highest in the world (here's a spoiler: they don't think it's due to the darkness), and they did a followup with questions from listeners and readers here. They talked about suicide rates climbing in the U.S., particularly among female adolescents. PRI reported on the CDC's investigation of a cluster of teen suicides in Palo Alta.
It's hard to read about suicide. I'm not going to deny that. But I think it's great that the media is sparking some conversations about it. It's something that we as a society feel shame to talk about yet it's so important to do so. I strongly feel that the best way to confront the issues of mental illness and suicide and substance abuse is to talk about them and keep working towards ways to improve outcomes (which you can't figure out unless you talk about it), with legislature to follow the best we know based on research. More on that another day. Today I want to start the discussion about suicide.
NPR had one article on "How Do You Help Someone Who Is At Risk Of Suicide?". I thought it was pretty well done. I think I expected more from the title of the article than it gave. But there are some useful things it included which I'll paste below, hmmm, maybe it's most of it. For some background, NPR talked with Dr. Jill Harkavy-Friedman of the American Foundation for Suicide Prevention and Dr. Jitender Sareen of the University of Manitoba, both psychiatrists, about what is known about youth suicide and best practices for preventing suicide. The article follows a question and answer format.
"In Greenland the highest rate of suicide is among young people between ages 15 and 25. How does that compare with the U.S. and worldwide?
Dr. Jitender Sareen: In native communities here in Canada and in the U.S., unfortunately young people have a much higher risk of suicide — often five or six times as high as the general population. Men commit suicide more often than women — that's true almost everywhere. [Although it's unclear why this is, it may be related to access to weapons or greater impulsiveness.] We've also seen instances where multiple young people enter suicide pacts, and there can be a contagion effect especially among youth. The underlying issues that lead to those crises are related to lack of basic things like clean water, housing and jobs. A lot of young people are impoverished and do not see any path to a good future.
Dr. Jill Harkavy-Friedman: It's also important for people to understand that suicide is not native to any culture. It's what happens to people when they're in situations of increased stress. So the high rate of suicide in Greenland, for example, doesn't say anything inherent about the culture. Actually, in the United States and most places, the highest-risk group for suicide are middle-aged [people] and the elderly. Fortunately, teen suicide rates in the U.S. are significantly lower, though teen suicide is still of concern.
Are there specific things a parent or friend should say — or not say — to a young person who they believe is potentially suicidal?
Harkavy-Friedman: If you're worried about somebody, ask. It's a little scary to ask, and you don't start off with, "Are you thinking about suicide?" You want to base your questions on what you've seen and what you notice. Like, "You seem very down lately and you're not with your friends. Is something going on? Are you feeling OK?" or "You look kind of sad. Are you?"
Then the next step is to just listen to what they have to say and try to really hear them, and interact with them so they know you've heard and understood. These are not quick-fix problems, so even though as parents and friends we want to say, "Just snap out of it!" or "It's not that big a deal!" to that person at that time, it is a big deal.
Sareen: In Native communities, one thing we've found is that messages that are based in culture are often more effective, but culturally sensitive communication is complicated. You can't assume that everyone in Native or First Nations has the same Native culture. For example, some Native people may feel cut off from their traditional culture and religion, while others are practicing Christians, and you need to remember that when you talk to them about their problems. This is one challenge for researchers and doctors who want to help in Native communities. Before you can help, you have to build a trusting relationship and understand the place, which can take years.
What if the person you're worried about doesn't want to talk?
Harkavy-Friedman: It's not uncommon, particularly with teens, that they don't want to talk. Or, they don't want to talk to you. If you're the parent, for instance. The key is that there may be somebody they can talk to, and it's not a time to stand on ceremony and say, "You must talk to me because I'm your parent." Find somebody they do feel comfortable talking to, and try to help them engage with that person.
Is it ever dangerous to ask someone about suicidal thoughts?
Harkavy-Friedman: Talking about suicide with someone will not make them suicidal. In fact it will make people feel better more typically, because they're holding [painful feelings] inside, and when you ask them, that's an opportunity to address it and problem-solve and feel better. So you're not going to make someone suicidal if you say, "Are you feeling like you want to kill yourself?" Talking to someone really helps; we have data to show that.
Is there such a thing as talking too much about suicide?
Harkavy-Friedman: It's not so much that a person can talk too much or too little. It's more about talking to someone who can help versus someone who can't. If you're talking to someone who can help you, then it's good. And, unlike maybe even 20 years ago when there was nothing available and no one was talking about teen suicide, now there are lots of tools and interventions available.
Sareen: I would say there is a balance when you're talking to teenagers, especially in very small towns. What we're facing, often, in the small communities is there's almost too much talk about suicide. When a suicide happens, in a larger community you might not hear about it, but in very small communities youth are kind of exposed to suicide and there's a lot of talking about it. It may inadvertently positively reinforce suicidal behavior. An overresponse of the media and overresponse of the community can actually lead to a clustering effect. That's one of the challenging parts of making suicide more publicly discussed ... that youth might see it as a way to escape their difficulties."
I have such a hard time with the last part, that talking about suicide and giving it exposure can "inadvertently positively reinforce suicidal behavior". I can see why that would be but we need to figure out if there are specific ways we can report it that wouldn't do that. I think talking about suicide too much with a higher-profile death, Robin Williams for example, could lead to a clustering unfortunately, but I really don't have anything to back that up other than what my gut says. My gut says that talking about it in a manner that NPR and PRI have been doing lately is the right way to do it. I don't feel like they're glamorizing suicide in any way, and they're presenting the facts, the issues, the statistics. I feel unsatisfied in most of these articles in regards to what's currently being done about these issues. I don't think that's a failure in the articles; I think that's a failure in society. Suicide isn't a high profile "cause" for most people unless they've been personally affected by it. But then there's the added societal stigma that comes with mental illness and suicide, and no one wants to talk about it.
The one unifying theme that I've found in suicide research, it's the idea that suicide is preventable. I also want to recognize that we should be careful when saying that because that can cause shame and guilt in survivors, those who have lost loved ones to suicide. Many things can help prevent suicide though: the support network looking for warning signs is probably number #1, medications, therapy treatment just to name a few. We should be doing all we can to prevent suicide considering how "preventable" it is.
I've said before that I don't really consider suicide to typically be a "selfish" act, although I know that's a common belief. The reason is, when I've felt "suicidal" (and there are degrees of "suicidal" ranging from thoughts of helplessness and hopelessness to planning and attempting. I've been on various points on the scale in the past, typically much closer to the safer end and I've never attempted.), the "reasons" (however irrational) for my thoughts are that everyone would be better off without me, I'm a horrible person. It's selfish in the sense that it's very centered around the self, but it's not selfish in the sense of "I don't care about anyone else", etc. I don't know who's right when it comes to it, but I think it's important to educate yourself on what suicidal feels for a person, before making judgments on them. It always come back to trying to empathize with others. Putting yourself in their shoes, trying to understand the thoughts and fears and struggles other people have. I'm not going to go on an empathy rant again, I've done that before, But, if you haven't yet seen the Brené Brown cartoon clip on empathy, you should watch it now. Or re-watch it.
I guess my biggest thing about helping someone who may be suicidal, if they're willing to talk to you about it, please just be open and empathetic (NOT sympathetic) in your conversations with them. It is not your job to tell the person that their thoughts and emotions are irrational or that they should "snap out of it" or that it's not a big deal. Those kind of comments can have the opposite effect. Instead you can say things like "that sounds hard" or "I'm sorry you're going through that" or "is there any way I can help?". And please please don't take offense if a friend or loved one doesn't wish to talk with you about it. It takes an incredible amount of vulnerability to open up to someone about this kind of "tough stuff" (although I do think it gets easier with practice), and sometimes the fear that it will hurt more than help can close people off. All you wonderful support people out there, it usually takes a lot of patience, and understanding, and again, empathy.
