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Subject: Suicide - Frequently Asked Questions
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Summary: General information about suicide and suicide prevention.
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Suicide is a significant cause of death in many western countries, in some
cases exceeding deaths by motor vehicle accidents annually.  Many countries
spend vast amounts of money on safer roads, but very little on suicide
awareness and prevention, or on educating people about how to make good life
choices.

Attempts at suicide, and suicidal thoughts or feelings are usually a symptom
indicating that a person isn't coping, often as a result of some event or
series of events that they personally find overwhelmingly traumatic or
distressing.  In many cases, the events in question will pass, their impact can
be mitigated, or their overwhelming nature will gradually fade if the
person is able to make constructive choices about dealing with the crisis when
it is at its worst.  Since this can be extremely difficult, this article is an
attempt to raise awareness about suicide, so that we may be better able to
recognize and help other people in crisis, and also to find how to seek help or
make better choices ourselves.


Help and resource information:

This posting is accompanied by a companion posting containing information
primarily about crisis and suicide prevention resources available on the
Internet, and other national resources available in various countries.
It should be available in the same newsgroup, but is also available from:
    ftp://rtfm.mit.edu/pub/usenet/news.answers/suicide/resources

The information here is updated periodically, and is intended to be
informative rather than authoritative.  Readers are encouraged to offer
feedback, suggestions, criticisms and any comments on ways you may have found
it helpful.  The latest version is also archived at:
    ftp://rtfm.mit.edu/pub/usenet/news.answers/suicide/info


Here are a number of frequently asked questions to help raise awareness and
dispel some of the common myths about suicide:


1. Why do people attempt suicide?

People usually attempt suicide to block unbearable emotional pain, which is
caused by a wide variety of problems.  It is often a cry for help.  A person
attempting suicide is often so distressed that they are unable to see that they
have other options: we can help prevent a tragedy by endeavoring to understand
how they feel and helping them to look for better choices that they could
make.  Suicidal people often feel terribly isolated; because of their distress,
they may not think of anyone they can turn to, furthering this isolation.

In the vast majority of cases a suicide attemptor would choose differently if
they were not in great distress and were able to evaluate their options
objectively.  Most suicidal people give warning signs in the hope that they
will be rescued, because they are intent on stopping their emotional pain, not
on dying.


2. Aren't all suicidal people crazy?

No, having suicidal thoughts does not imply that you are crazy, or necessarily
mentally ill.  People who attempt suicide are often acutely distressed and the
vast majority are depressed to some extent.  This depression may be either a
reactive depression which is an entirely normal reaction to difficult
circumstances, or may be an endogenous depression which is the result of a
diagnosable mental illness with other underlying causes.  It may also be a
combination of the two.

The question of mental illness is a difficult one because both these kinds of
depression may have similar symptoms and effects.  Furthermore, the exact
definition of depression as a diagnosable mental illnesses (i.e. clinical
depression) tends to be somewhat fluid and inexact, so whether a person who is
distressed enough to attempt suicide would be diagnosed as suffering from
clinical depression may vary in different peoples opinions, and may also vary
between cultures.

It's probably more helpful to distinguish between these two types of depression
and treat each accordingly than to simply diagnose all such depression as
being a form of mental illness, even though a person suffering from a reactive
depression might match the diagnostic criteria typically used to diagnose
clinical depression.  For example, Appleby and Condonis[1] write:

    The majority of individuals who commit suicide do not have a diag-
    nosable mental illness.  They are people just like you and I who at a
    particular time are feeling isolated, desperately unhappy and alone.
    Suicidal thoughts and actions may be the result of life's stresses and
    losses that the individual feels they just can't cope with.

In a society where there is much stigma and ignorance regarding mental illness,
a person who feels suicidal may fear that other people will think they are
"crazy" if they tell them how they feel, and so may be reluctant to reach out
for help in a crisis.  In any case, describing someone as "crazy", which has
strong negative connotations, probably isn't helpful and is more likely to
dissuade someone from seeking help which may be very beneficial, whether they
have a diagnosable mental illness or not.

People who are suffering from a mental illness such as schizophrenia or
clinical depression do have significantly higher suicide rates than average,
although they are still in the minority of attemptors.  For these people,
having their illness correctly diagnosed can mean that an appropriate
treatment can begin to address it.

For more information about clinical depression, see the alt.support.depression
FAQ, available from:
    ftp://rtfm.mit.edu/pub/usenet/news.answers/alt-support-depression/faq/


3. Doesn't talking about suicide encourage it?

It depends what aspect you talk about.  Talking about the feelings surrounding
suicide promotes understanding and can greatly reduce the immediate distress of
a suicidal person.  In particular, it is OK to ask someone if they are
considering suicide, if you suspect that they are not coping.  If they are
feeling suicidal, it can come as a great relief to see that someone else has
some insight into how they feel.

This can be a difficult question to ask, so here are some possible approaches:
    "Are you feeling so bad that you're considering suicide?"
    "That sounds like an awful lot for one person to take; has it made you
     think about killing yourself to escape?"
    "Has all that pain you're going through made you think about hurting
     yourself?"
    "Have you ever felt like just throwing it all away?"

The most appropriate way to raise the subject will differ according to the
situation, and what the people involved feel comfortable with.  It's also
important to take the persons overall response into consideration when
interpreting their answer, since a person in distress may initially say "no",
even if they mean "yes".  A person who isn't feeling suicidal will usually be
able to give a comfortable "no" answer, and will often continue by talking
about a specific reason they have for living.  It can also be helpful to ask
what they would do if they ever were in a situation where they were seriously
considering killing themselves, in case they become suicidal at some point in
the future, or they are suicidal but don't initially feel comfortable about
telling you.

Talking exclusively about how to commit suicide can give ideas to people who
feel suicidal, but haven't thought about how they'd do it yet.  Media reports
that concentrate solely on the method used and ignore the emotional backdrop
behind it can tend to encourage copy-cat suicides.


4. So what sort of things can contribute to someone feeling suicidal?

People can usually deal with isolated stressful or traumatic events and
experiences reasonably well, but when there is an accumulation of such events
over an extended period, our normal coping strategies can be pushed to the
limit.

The stress or trauma generated by a given event will vary from person to
person depending on their background and how they deal with that particular
stressor.  Some people are personally more or less vulnerable to particular
stressful events, and some people may find certain events stressful which
others would see as a positive experience.  Furthermore, individuals deal
with stress and trauma in different ways; the presence of multiple risk
factors does not necessarily imply that a person will become suicidal.

Depending on a person's individual response, risk factors that may contribute
to a person feeling suicidal include:

    - Significant changes in:
        - Relationships.
        - Well-being of self or family member.
        - Body image.
        - Job, school, university, house, locality.
        - Financial situation.
        - World environment.

    - Significant losses:
        - Death of a loved one.
        - Loss of a valued relationship.
        - Loss of self esteem or personal expectations.
        - Loss of employment.

    - Perceived abuse:
        - Physical.
        - Emotional/Psychological.
        - Sexual.
        - Social.
        - Neglect.


5. How would I know if someone I care about was contemplating suicide?

Often suicidal people will give warning signs, consciously or unconsciously,
indicating that they need help and often in the hope that they will be rescued.
These usually occur in clusters, so often several warning signs will be
apparent.  The presence of one or more of these warning signs is not intended
as a guarantee that the person is suicidal: the only way to know for sure is
to ask them.  In other cases, a suicidal person may not want to be rescued,
and may avoid giving warning signs.

Typical warning signs which are often exhibited by people who are feeling
suicidal include:
 - Withdrawing from friends and family.
 - Depression, broadly speaking; not necessarily a diagnosable mental illness
   such as clinical depression, but indicated by signs such as:
    - Loss of interest in usual activities.
    - Showing signs of sadness, hopelessness, irritability.
    - Changes in appetite, weight, behavior, level of activity or
      sleep patterns.
    - Loss of energy.
    - Making negative comments about self.
    - Recurring suicidal thoughts or fantasies.
    - Sudden change from extreme depression to being `at peace' (may
      indicate that they have decided to attempt suicide).
 - Talking, Writing or Hinting about suicide.
 - Previous attempts.
 - Feelings of hopelessness and helplessness.
 - Purposefully putting personal affairs in order:
    - Giving away possessions.
    - Sudden intense interest in personal wills or life insurance.
    - `Clearing the air' over personal incidents from the past.


This list is not definitive: some people may show no signs yet still feel
suicidal, others may show many signs yet be coping OK; the only way to know for
sure is to ask.  In conjunction with the risk factors listed above, this list
is intended to help people identify others who may be in need of support.

If a person is highly perturbed, has formed a potentially lethal plan to kill
themselves and has the means to carry it out immediately available, they would
be considered likely to attempt suicide.


6. I'm a bit uncomfortable about the topic; can't it just go away?

Suicide has traditionally been a taboo topic in western society, which has led
to further alienation and only made the problem worse.  Even after their
deaths, suicide victims have often been alienated by not being buried near
other people in the cemetery, as though they had committed some utterly
unforgivable sin.

We could go a long way to reducing our suicide rate by accepting people as they
are, removing the social taboo on talking about feeling suicidal, and telling
people that it _is_ OK to feel so bad that you'd think about suicide.  A person
simply talking about how they feel greatly reduces their distress; they also
begin to see other options, and are much less likely to attempt suicide.


7. So what can I do about it?

There usually are people to whom a suicidal person can turn for help; if you
ever know someone is feeling suicidal, or feel suicidal yourself, seek out
people who could help, and keep seeking until you find someone who will listen.
Once again, the only way to know if someone is feeling suicidal is if you ask
them and they tell you.

Suicidal people, like all of us, need love, understanding and care.  People
usually don't ask "are you feeling so bad that you're thinking about suicide?"
directly.  Locking themselves away increases the isolation they feel and the
likelihood that they may attempt suicide.  Asking if they are feeling suicidal
has the effect of giving them permission to feel the way they do, which reduces
their isolation; if they are feeling suicidal, they may see that someone else
is beginning to understand how they feel.

If someone you know tells you that they feel suicidal, above all, listen to
them.  Then listen some more.  Tell them "I don't want you to die".  Try to
make yourself available to hear about how they feel, and try to form a
"no-suicide contract": ask them to promise you that they won't suicide, and
that if they feel that they want to hurt themselves again, they won't do
anything until they can contact either you, or someone else that can support
them.  Take them seriously, and refer them to someone equipped to help them
most effectively, such as a Doctor, Community Health Centre, Counsellor,
Psychologist, Social Worker, Youth Worker, Minister, etc etc.  If they appear
acutely suicidal and won't talk, you may need to get them to a hospital
emergency department.

Don't try to "rescue" them or to take their responsibilities on board yourself,
or be a hero and try to handle the situation on your own.  You can be the most
help by referring them to someone equipped to offer them the help they need,
while you continue to support them and remember that what happens is
ultimately their responsibility.  Get yourself some support too, as you try to
get support for them; don't try to save the world on your own shoulders.

If you don't know where to turn, chances are there are a number of 24 Hour
anonymous telephone counselling or suicide prevention services in your area
that you can call, listed in your local telephone directory.

The crisis resource posting mentioned at the top of this posting also lists a
number of Internet resources which provide support for people in crisis.


8. Help?  Counselling?  But isn't counselling just a waste of time?

Certainly it is true that counselling is not a magic cure-all.  It will be
effective only if it empowers a person to build the sort of relationships they
need for long-term support.  It is not a "solution" in itself, but it can be
a vital, effective and helpful step along the way.


9. Talk, talk, talk.  It's all just talk.  How's that going to help?

While it's not a long-term solution in itself, asking a person and having them
talk about how they feel greatly reduces their feelings of isolation and
distress, which in turn significantly reduces the immediate risk of suicide.
People that do care may be reluctant to be direct in talking about suicide
because it's something of a taboo subject.

In the medium and longer term, it's important to seek help to resolve the
problems as soon as possible; be they emotional or psychological.  Previous
attemptors are more likely to attempt suicide again, so it's very important to
get unresolved issues sorted out with professional help or counselling as
necessary.

Some issues may never be completely resolved by counselling, but a good
counsellor should be able to help a person deal with them constructively at
present, and to teach them better coping skills and better methods of dealing
with problems which arise in the future.


10. How do telephone counselling and suicide hot-line services work?

Different services vary in what they offer, but in general you can ring up and
speak anonymously to a counsellor about any sort of problem in a no-pressure
context that's less threatening than a face-to-face session.  Talking the
situation over with a caring, independent person can be of great assistance
whether you're in a crisis yourself, or worried about someone else who is, and
they usually have connections with local services to refer you to if further
help is required.  You don't have to wait until the deepest point of crisis or
until you have a life-threatening problem before you seek help.

Demand for telephone services vary, so the most important thing to remember is
that if you can't get through on one, keep trying several until you do.  You
should usually get through straight away, but don't give up or pin your life on
it.  Many people that feel suicidal don't realize that help can be so close, or
don't think to call at the time because their distress is so overwhelming.


11. What about me; am I at risk?

It's quite likely that some people that read this will one day attempt suicide,
so here's a quick suicide prevention exercise: think of a list of 5 people who
you might talk to if you had no-one else to turn to, starting with the most
preferred person at the top of the list.  Form a "no-suicide contract" with
yourself promising that if you ever feel suicidal you will go to each of the
people on this list in turn and simply tell them how you feel; and that if
someone didn't listen, you'd just keep going until you found someone that
would.  Many suicide attemptors are so distressed that they can't see anywhere
to turn in the midst of a crisis, so having thought beforehand of several
people to approach would help.


12. How does suicide affect friends and family members?

Suicide is often extremely traumatic for the friends and family members that
remain (the survivors), even though people that attempt suicide often think
that no-one cares about them.  In addition to the feelings of grief normally
associated with a person's death, there may be guilt, anger, resentment,
remorse, confusion and great distress over unresolved issues.  The stigma
surrounding suicide can make it extremely difficult for survivors to deal with
their grief and can cause them also to feel terribly isolated.

Survivors often find that people relate differently to them after the suicide,
and may be very reluctant to talk about what has happened for fear of
condemnation.  They often feel like a failure because someone they cared so
much about has chosen to suicide, and may also be fearful of forming any new
relationships because of the intense pain they have experienced through the
relationship with the person who has completed suicide.

People who have experienced the suicide of someone they cared deeply about can
benefit from "survivor groups", where they can relate to people who have been
through a similar experience, and know they will be accepted without being
judged or condemned.  Most counselling services should be able to refer people
to groups in their local area.  Survivor groups, counselling and other
appropriate help can be of tremendous assistance in easing the intense burden
of unresolved feelings that suicide survivors often carry.

The suicide-survivors mailing list provides such a group via electronic mail.
See the resource list companion posting mentioned at the top of this posting
for more information.


13. Hang on; isn't it illegal though?  Doesn't that stop people?

Whether it is legal or not makes no difference to someone who is in such
distress that they are trying to kill themselves.  You can't legislate against
emotional pain so making it illegal doesn't stop people in distress from
feeling suicidal.  It is likely to merely isolate them further, particularly
since the vast majority of attempts are unsuccessful, leaving the attemptor in
a worse state than before if they're now a criminal as well.  In some
countries and states it is still illegal, in other places it's not.


14. But don't people have the right to kill themselves if they want to?

Each of us is responsible for our own actions and life choices. In a sense
then, an individual may have the right to do as they wish with their life,
including to end it if they so desire. Western societies in particular tend
to emphasise individual rights over communal rights and responsibilities.

However, every person exists as part of a larger network of relationships of
various types which set the context in which an individual's rights and
responsibilities exist. People who feel lonely, isolated, distressed and
hopeless about their future can find it extremely difficult to recognise
supportive relationships which may exist around them. This often causes them
to grossly underestimate both the degree of support which could be gained
from those around them, and the impact that their suicide would have should
they complete it.

Discussions regarding rights can become emotive, particularly when there
is a conflict between individual and communal rights and responsibilities.
For example, people who have been emotionally devastated by the suicide of
someone close to them could equally assert their right to not devastated by
someone else's suicide. It should be reiterated however that a person
contemplating suicide is more likely to need understanding than a lecture on
their responsibilities to other people.

Ultimately, helping people to deal with their problems better, see their
options more clearly, make better choices for themselves and avoid choices
that they would otherwise regret empowers people with their rights rather
than taking their rights away.


Footnotes:
1. "Hearing the cry: Suicide Prevention", Appleby and Condonis, 1990.
    ISBN 0-646-02395-0


Copyright 1994, 1995, 1996 by Graham Stoney <[e-mail]>.
This article may be freely redistributed for personal use or via Usenet News
provided that this copyright message remains intact.  Any other form of
commercial distribution requires explicit permission from the author.