What help can we be when someone is suicidal?

You cannot be a therapeutic psychologist without encountering a wide variety of approaches to life.  It is a privilege to be allowed to relate deeply with so many individuals.  And one of the teachings this brings me, is that there are an infinite number of ways to approach the value of human life.

Sure, in our daily lives, we amble along apparently sharing a general view that ‘yes, of course human life is valuable, and we must do all we can to preserve it’.  But then we ignore our neighbours who need help; we ignore people overseas with insufficient resources to live; we ignore inequalities of wealth that cause the death of many, and the survival of few.

So we are inconsistent.  Or rather, if you prefer, life presents us with complexities which belie our glib general assertions about the value of life

Now and again, I encounter clients who question whether they wish to continue living at all.  I am a person-centred counsellor, who prioritises the client’s world view.  This means that I need to explore, with the client, what they mean by their wishes, and in what sense life has become something they may not want any more.

Each individual is different, but perhaps I can offer a few different ways in which people approach the idea of ending their lives.

1. A wish to end personal suffering.  Many tortures involve taking people to the point where suffering is unendurable, so it is a known part of human nature that we have limits to our endurance.  If someone’s context puts them under enough agony, they may seek to contextualise that agony as something that can end, and frame suicide as a way to end pain.
2. A feeling that life is done.  Even withour personal suffering, a person may simply feel that they have done all they wish to, and that is that.  Observing the age cycle, we can see that, in general, people start life with urgency, and finish it with less urgency.  This may give us insight into the possibility of a person feeling, particularly later on in life, that it’s time to go.
3. A burden of guilt or regret.  This is akin to personal suffering, but is of a type.  Guilt is bound up in a person’s world of meaning.  You can only feel guilty where you have contradicted your own felt values.  Therefore, we cannot understand someone’s personal guilt, unless we understand what they value, consciously or unconsciously.  And guilt can be paradoxical: you can feel righteous and guilty at the same time.
4. Panic, psychosis, and other disruptions.  Sometimes our feelings, and hence our thought processes too, become severely disrupted, to the point where we experience confusion, wild variations in mood, and temporary delusions.  We may have thoughts, and enact behaviours, which would be uncharacteristic of us at other times.  Our decisions may not be carefully considered, but they may still be deeply felt, albeit chaotic.

When we encounter valued others who are experiencing a wish to end their lives, we are faced with some important behavioural decisions.  Here, to finish, are a few suggestions as to how we can act in response.  They are based on things said to me by those either experiencing, or reflecting on, suicidal thoughts.

• Try to listen.  Be there, and listen.  It is a very lonely business dealing with one’s own personal suffering.  Sometimes the blind optimism of others, however well intentioned, isn’t helpful.  Sometimes, after days of masking how they truly feel, a person wants to ‘offload’, to talk, to bring their inner mind where it is accepted.
• Don’t judge.  Many people enduring mental distress already have enough self-judgement to last them a lifetime.  They don’t, at this point, need someone else judging them.
• Be peaceful.  One of the problems with many mental health systems, is that at the extremes they are based around emergency.  When you are an urgent case, you get helped dramatically.  When you become less urgent, you are left alone.  This rewards emergency, and starves individuals of true care.
• Offer what support and foundations you can.  While a person is experiencing suicidal thoughts, they may need their environment to be protective.  Therefore, be a little bit practical.  Offer points in the diary when you will talk or meet.  Be clear what channels of help are available.  In extremis, it may be that pharmaceutical or medical assistance is suitable.  But the way this is offered can make a huge difference.
• Be low-pressure.  Personal suffering, guilt, panic, and to some extent psychosis, can all be made worse by pressure.  Therefore, try to be supportive, but in a way that does not add the burden of a new set of decisions.

This is by no means a complete account of the issue.  But it seeks to offer some ways in which a person can help another who is experiencing doubts over whether they want to live.  That person is not an ‘other’ who is being weird.  They are another version of you, with whom you have a lot in common, who could probably do with your help and understanding right now.