Dr. Elizabeth Marmaras

The recent death of Robin Williams has left many of us deeply sad and puzzled as to the reasons someone with a loving family, friends, international fame, abundant privileges, and wealth chose to end his life with suicide.
Yet, Robin Williams is not alone in ending his life, perhaps as a result of being diagnosed with a terminal medical illness. It is estimated that suicide claims the lives of nearly 40,000 Americans every year. But suicide can often be prevented.
His death, however, has opened a floodgate of poignant questions about suicide such as: why do some people when faced with devastating suffering go on while others do not? Are these people simply being melodramatic or do they truly intent to end their lives and why? Are there warning signs they give away and if so what are those?
These are excellent yet also extremely complicated questions and there are no simple answers for someone who is not properly trained to help a person with suicidal ideas and/or plan. These questions might invite worry, panic, or even denial, considering being in a position to help save a loved one with suicidal ideas and/or a specific plan to end his or her life.
While we may not have clear answers, what we do clearly know is that people with such plans and ideas are in intense pain and despair.
This kind of despair distorts their thinking and perceptions and thus they cannot see or even imagine a way out. They feel hopeless, alone, rejected, uncared for, a burden, and ambivalent about living with suffering. They seem to seek a permanent solution to perhaps a temporary problem simply because they see no way out.
Suicide, although it might on the surface appear as a selfish act or even attention seeking, it is a desperate soul’s way (whether impulsive or planned) resolving their inner anguish. However it appears, it is still a way of coping with and simultaneously expressing unbearable pain while feeling alone with it.
To that person, in that moment, suicide feels like an act of protection from pain. I would encourage then to give that person the understanding and help it needs and the dignity and care it truly deserves. Suicide is often preventable if we truly listen to the cries of one’s soul.
It is helpful to keep in mind that suicide may be precipitated by several risk factors such as: depression; bipolar disorder; trauma and abuse; alcohol or substance use; schizophrenia; psychosis; impulsivity and aggression; a history of suicide attempts; family history of attempted or completed suicide(s); serious medical conditions and/or chronic pain; significant losses (ie. death, divorce, ill health, unemployment, moving away from a support system, finances); legal trouble; medications with adverse effects; exposure to a celebrity’s suicide; feelings of guilt, humiliation and shame.
Similarly to the people who have heart attacks symptoms and may die if untreated, those who die by suicide usually show some warning signs before their deaths. You may hear something like: “I’m going to kill myself.” or “I just want the pain to stop” or “I cannot go on like this any longer.” People may talk directly or indirectly about a plan they have to end their lives such as hoarding medicine or looking for ways to buy a gun. They may even talk about feeling trapped and in despair, hopeless and not seeing a way out or a reason to go on. They may begin to withdraw and isolate socially or reach out to friends and family members out of the blue; give away prized possessions; and talk about setting up a will. Tune in for such signs if someone in your life is going through an unusually distressing time. One factor that may serve to decrease suicidal risk is support and connection with family and community, so stay close and attuned.
WHAT CAN YOU DO?
If you suspect someone is a suicide risk, what can you do? First and foremost take their direct or indirect suicidal comments extremely seriously and do not try to talk them out of it. 50 to 75 percent of the people who attempt suicide tell someone about their intentions; which means such attempts can be prevented. If they are in immediate risk (for example: if they talk about a plan and intention to take their life, they have prior suicide attempts, they have purchased a weapon, they are hoarding drugs, or they feel unable to stop their thoughts about taking their life) stay calm and gentle, do not leave them alone and ACT immediately. Even if you think you can take them to the hospital it is safer to call 911 or the National Suicide Prevention Lifeline number 1-800-273-TALK (8255) for assistance and they can call 911.
Continue to talk to them calmly and non-judgmentally so that they do not act violently and hurt themselves. Making such calls might feel overwhelmingly stressful and the person might get upset with you, yet allowing qualified mental health professionals to help your loved one assures the right help. Furthermore, it might be best to allow police to remove any firearms, drugs, or sharp objects from the area; don’t try to do it alone.
Trained professionals inquire about: intensity of suicide thoughts; the method to hurt self; do they have what they need to hurt themselves; when they are going to do so; and if they are feeling capable to stop themselves from or are they fearful of losing control and acting out on their plan.
Here are some examples of questions that trained professionals ask: “Are you feeling so bad that you are thinking about suicide? “If yes, then: “Have you thought about how you would hurt yourself? If yes, then: “Do you have what you need to do it? If yes, “have you thought about when you would do it? The more planning, the greater the risk.
If they are not in any immediate danger, and they exhibit some warning signs such as isolation, or deep depression, gently express your genuine concern and say what you noticed or heard that makes you concerned. They are very vulnerable and your concern can be soothing to them. Ask directly and calmly if they are considering hurting themselves or attempting suicide, and whether they have a plan or method in mind. Most often such questions will not trigger suicide if they were not already considering it before. You can ask them to reach out to family and friends with whom they feel safe, and ask if they have a therapist or psychiatrist, and ask them to call them immediately.
It is also very helpful and supportive if you can accompany them to their appointment so that they feel supported and cared for. Being there with them and for them can help save their life, and that is simply a precious act of kindness.
Information is available at: National Suicide Prevention Lifeline 24/7. Tel. 1 800 273 TALK (8255), suicide.org, save.org, and preventsuicideny.org

Dr. Elizabeth Marmaras is a Nationally Board Certified Clinical Psychologist in New York City. She can be contacted at Talk2DrLiz.com or at 917-589-9385.