Suicide remains one of society’s most fraught taboos. Indeed, for a time, this newspaper refused to use the word “suicide” in headlines.
Though social attitudes have evolved to become less condemnatory, suicides still inspire a kind of society-wide acrophobia. Talking about suicide – glimpsing fellow humans’ deep, sometimes unfathomable despair and witnessing the fragility of life’s meaning – can produce a phobia even in nonsuicidal people, who, confronted with a terrifying philosophical ledge, irrationally fear they might jump.
Yet, averting one’s eyes from the problem of suicide increases the chance a person will die by it.
Harlene Russell, suicide prevention program coordinator for Southern Ute Community Action Programs, told the 15 people attending suicide-prevention training at the Durango Public Library on Thursday the taboo of suicide remains powerful. For many regular folks, thinking about suicide at all – let alone confronting someone they fear is suicidal – can induce queasy feelings of overstepping boundaries, embarrassment and inadequacy.
“But courage is not the absence of fear,” she told attendees. “It’s the conquest of it. Do it afraid.”
She said directly asking the question, “Are you thinking about killing yourself?” saves lives.
“The myth is that confronting a person about suicide will only make them angry and increase the risk of suicide. But the fact is that asking someone directly about suicidal intent lowers anxiety, opens up communication and lowers the risk of an impulsive act,” she said.
This insight – that suicidal people actually want to talk about what they’re going through – is the premise of QPR – Question, Persuade and Refer – which is akin to psychological first aid.
“QPR is like Heimlich or CPR,” Russell said. “The fundamentals are easily learned, and it may help you save a life.”
The program is radical, treating lay people as the first line of defense against suicide.
A forever decision
Suicide is uniquely human: The rest of the animal kingdom doesn’t do it.
Our species has made staggering advances in science, medicine and psychiatry in the last half century – discovering the Higgs boson, reprogramming human stem cells and popularizing anti-depressants. But no invention has stymied rates of suicide. Indeed, after holding more or less steady since 1942, the U.S. Centers for Disease Control and Prevention now warns of “substantial” increases in the national suicide rate.
Every year, about 1 million American adults make a failed attempt at suicide; tens of thousands succeed.
Some demographic populations are more at risk than others. The rate at which middle-aged Americans kill themselves has jumped 30 percent since 1999. In 2012, suicide killed more active-duty U.S. soldiers than combat.
Others groups at higher suicide risk include people with mood disorders, substance abusers, elderly white males, young Native Americans, adult victims of child abuse, gay and transgendered youths, people with access to guns – and residents of the Southwest.
La Plata County’s high rate
Coloradans kill themselves much more frequently than their fellow Americans. In 2010, the most recent year CDC data is available, 38,000 Americans died by suicide, a rate of 12 per 100,000.
In 2012, 1,053 Coloradans took their lives – a rate of 20 per 100,000, nearly double the national average.
In La Plata County, the situation is even worse: At 30 suicide deaths per 100,000, it’s triple the national average.
At the QPR training, La Plata County’s suicide rate was palpable. When it came to suicide prevention, many attendees seemed both open and broken hearted.
SUCAP coordinator Peter Tregillis spoke of losing a dear friend to suicide last year; no one had seen it coming, not even his friend’s family. Later, Mary Alice Hearn, a hospice worker, fighting tears, apologized, saying, “It makes me so emotional. A boy I knew in high school killed himself after breaking up with his girlfriend. I’ve been thinking about it so much, even though that was like 100 years ago.”
Listen, watch for clues
While suicide haunted the room – beyond comprehension and tragic – Russell emphasized the practical, dispelling another myth: Most suicidal people keep their plans to themselves.
“Fact: Most suicidal people communicate their intent sometime during the week preceding their attempt,” she said.
She said stray comments – “I wish I were dead,” “I’m tired of life, I just can’t go on,” “I want out,” “My family would be better off without me” – can tip off friends, colleagues and strangers to someone’s potentially fatal anguish.
There are behavioral clues, too: someone stockpiling weapons; exhibiting a sudden interest or disinterest in religion; giving away prized possessions; abusing drugs or alcohol – especially a relapse after a period of recovery; battling depression or hopelessness; succumbing to bouts of inexplicable anger, aggression or irritability.
And there are situational indicators, like someone’s being fired from a job or expelled from school; having to relocate; anticipating financial insecurity; worrying about becoming a burden to others; the loss of a major relationship; the death of a spouse, child or best friend – especially if from suicide; the diagnosis of a terminal illness; the sudden unexpected loss of freedom or fear of punishment.
The biggest single risk factor for suicide is a previous attempt: About 7 percent of people who have survived a suicide attempt later take their life, more than 30 times the rate for people who have never tried.
In her essay on suicide for The New York Times Magazine, Kim Tingley writes, “Trying to study what people are thinking before they try to kill themselves is like trying to examine a shadow with a flashlight: the minute you spotlight it, it disappears. Researchers can’t ethically induce suicidal thinking in the lab and watch it develop.”
Meanwhile, doctors can’t interview people who die by their own hand: their ideal research subjects are dead. The result is doctors know almost nothing about how to prevent suicide. No policy, treatment or drug reliably reduces suicide risk.
But we do know something: In studies of people who’ve jumped off the Golden Gate Bridge, the rare, miraculous survivors often report recovering their desire to live, sometimes midair.
This is why lay people and QPR can make a difference. Like heart attacks, suicidal thinking is a medical crisis. If you can get someone through its most violent throes and keep them alive for just a few more minutes, the immediate danger often passes; near-victims can go on to live beautiful lives, dying decades later of altogether different causes.
How QPR works
To help someone survive a suicide emergency, QPR provides three simple steps: the first is asking the question, “Are you thinking about suicide?”
If you’re not initially comfortable being straightforward, ease in with questions like, “Have you been unhappy lately?” or the more euphemistic, but still clear, question, “Do you ever wish you could go to sleep and never wake up?”
If the person demurs, be persistent. Ask whether they have a plan – often, they do, one that’s detailed, involving a specific place, particular method and preconditions.
When asking someone about suicide, don’t be judgmental, the QPR method advises. For instance, here’s how not to ask the question: “You’re not suicidal, are you?” For someone in agony, such phrasing only communicates that her feelings are invalid, that you’re not really interested in hearing her answer.
The second step of QPR is persuasion. If someone tells you he’s suicidal, you’re first instinct might be to tell him life is wonderful, he has so much to live for. But such assertions won’t be convincing to the person who’s in excruciating psychic torment.
Russell said to be actually persuasive, it’s vital to understand that suicide itself is not the problem: For suicidal people, suicide is the solution they perceive to larger, more insoluble problems, like their mounting debt, terminal illness or ruptured relationships.
That means you have to prod someone who’s suicidal to talk about the underlying, intractable and overwhelming issues they’re wrestling with and listen to them – carefully and without rush. Offer hope in any form.
The third and final step is referral. Ask, “Will you go with me to get help?” “Will you let me get you help?” or “Will you promise me not to kill yourself until we’ve found some help?”
Save the national suicide hotline number in your cellphone, call it and hand over the phone. Get the suicidal person to the emergency room, to a pastor, a rabbi, a doctor, a counselor or a family member. Follow up. Throughout, tell them you care about them, that you want them to live.
cmcallister@durangoherald.com
Resources
Hotlines
National Suicide Hotline: (800) 273-8255.
Axis Health Crisis Hotline: In La Plata and Archuleta counties, call 247-5245. In Montezuma County, call 385-2255.
Support
Heartbeat Durango: Heartbeat is a support group for those who have lost a loved one to through suicide. It meets in Durango every second and fourth Wednesday at Durango Fire & Rescue Authority Station 1, 142 Sheppard Drive. For more information, call 403-4103 or 749-1673, or visit www.heartbeatsurvivorsaftersuicide.org.
Survivors of Suicide: Call Amie Bryant at 247-6328 or email arbryant@fortlewis.edu.
Websites
Befrienders International (The Samaritans): www.befrienders.org.
Suicide Awareness Voices of Education: www.save.org.
Suicide Prevention Advocacy Network: www.spanusa.org.
