There are few things that hold the same weight, pain, and confusion as losing someone to suicide. Much like mental illness in general, when someone we know suffers with suicidal thoughts, we can feel helpless to know how to support and care for them.

September 8-14 is National Suicide Prevention Week, a week dedicated to bringing the subject of suicide into public consciousness. As a culture, we have much to learn about why people experience suicidal thoughts and how to support them, as well as how to care for and support those who have lost someone to suicide. It’s a subject that often holds a certain stigma, and one that leaves people unsure of how to communicate their feelings. However, when the issue is brought to light, people often reveal that they have been affected in one way or another by suicide.

Suicide is the 4th leading cause of death in the U.S. for adults between the ages of 18 and 65 years, and it’s the 10th leading cause of death in the U.S. overall. Men seem to be especially at risk and have nearly four times the suicide rate as women. Suicide occurs across all ages, economic, social and ethnic boundaries; and one in five people have been personally impacted by a suicide.

Ninety percent of all people who die by suicide have a diagnosable psychiatric disorder at the time of their death. These disorders include clinical depression, anxiety, psychosis, schizophrenia, personality disorder, bipolar disorder, PTSD, postpartum depression, or something similar. These disorders can lead to a chemical imbalance, which can lead to incorrect thinking and incorrect perception of self within the world.

The number one cause for suicide is untreated – or incorrectly treated – depression. More than fifty percent of people with depression have suicidal ideation (SI), thoughts of suicide. These thoughts can range in intensity from an obscure wish to be dead to active suicidal ideation with a specific plan and intent. Like depression, the suicidal state of mind is temporary. And many people who have these thoughts will not act on them. The important and critical factor in helping people who have depression is engaging them to get an idea about where on the continuum they are with these thoughts.

How You Can Help Someone Who Is Suicidal

The most dangerous myth surrounding suicide is the idea that talking about or asking someone if they are suicidal will plant the idea in their head. This couldn’t be further from the truth. If someone is experiencing SI, the best thing you can do for them is to let them know you are there to help. Don’t try to argue with them or point out why they shouldn’t be having these thoughts. Show them compassion and encourage them to share what they are feeling. Tell them you are there to help them find help for the pain. Ask them if they have a plan for taking their life. If a plan is in place such as a day, time, or means to take their life, then this is the time to get professional help immediately. Do not leave them alone; and take away any firearms, drugs, or objects they could use to hurt themselves. Take them to a doctor, mental health professional, or hospital emergency room, or call 911.

See this list of Helper Tasks for more on how you can help someone who is suicidal.

Understanding the Emotion Behind Suicidal Ideation

Hopelessness and helplessness are often the two fueling emotions behind SI. Conditions that can lead to suicide involve a person feeling that they are a burden and that they are disconnected or alone. People with SI are experiencing intense emotional and/or physical pain, and their judgment can be clouded by that pain. People contemplating suicide are wanting to end that pain and often confuse ending that pain with taking their own life. They are usually listening only to the self-destructive, critical part of self and seeing the world through a negative and distorted filter. They are in a battle between this helpless, self-critical place and with the real, true self. It is in this battle that a person with SI experiences ambivalence.

The truth is that most suicidal people desperately want to live, but they are unable to see alternatives to the problems they are facing. The goal for any person trying to help someone who is suicidal is to support them in seeing that the unbearable pain can be made bearable. The goal is to connect them and reorient them with the part of themselves that wants to live and to promote future-oriented thinking. The goal is to help them to see the vision that they are loved beyond what they could know, that their life is of immense value, and that restoration and better days are ahead.

Warning Signs that Someone Might Be Experiencing SI:

* Isolation

* Changes in behavior such as mood swings, reckless actions, increase or decrease in sleep

* Recurrent thoughts of death or suicidal ideation

* Verbalization that they feel they are a burden, trapped, or that they feel guilty

* Verbalization of desperation; saying things like they can’t stop the pain, they can’t think clearly, they can’t find a way out, or they can’t make the sadness go away

* Elevated mood. This is known as the “amazing reversal.”  Often when a person who has been in a lot of psychological pain suddenly appears to be feeling better, it may be a sign that they have come up with the “perfect solution” to end their lives. This is a time to ask again whether they are thinking about suicide and not assume that the crisis has passed.

* Giving things away

* Preoccupation with the past and lack of futuristic thinking

* Expressed wish to join a deceased loved one

* Talking about escape, or drastic changes in their life trajectory

* It is also important to know that if a person has attempted suicide before, then future attempts are more likely.

Losing Someone to Suicide

Suicide bereavement is one of the most intensely painful experiences for anyone to go through. The truth is that no matter how hard we try, we cannot point the way out of darkness for some people. And the pain of the loss can often be compounded by the aftermath of the suicide. Those who have lost someone to suicide may find that people say things to them that are not helpful. They may not know how to tell people that the death was a result of suicide, fearing judgment, rejection, or unsolicited advice. There are so many emotions that losing someone to suicide evokes.

Guilt – Often survivors feel guilt that they could have done or said something to keep the person alive.  This is often referred to as  “survivors guilt.”

Sadness – Sadness not only about the person’s life being over,  but about the future potential of that person’s life and the sharing of life with them.

Fear – Fear that another loved one will die or that they themselves will become suicidal.

Relief – Often the years or months leading up to the suicide were filled with dread, confusion, hyper-vigilance, fear and uncertainty watching their loved one suffer with their inner-turmoil and pain.

Deaths to suicide are often a “permanent sad,” and the intensity of the emotions can be triggered by holidays and special occasions. There is no right or wrong way to feel after losing someone to suicide, and it is important to claim your right to grieve no matter how long it takes or in what way you choose to do it. Let others know how they can help you, and connect with other survivors who can walk with you as you grieve.

There are many ways to become more informed about suicide as well as ways to support survivors of suicide.

* Participate in or donate to an Out of the Darkness Walk. Men and women walk to break the silence and bring the issues of depression and suicide into the light. Net proceeds from the Out of the Darkness Walks benefit the American Foundation for Suicide Prevention to fund research, education, survivor and awareness programs – both to prevent suicide and to assist those affected by suicide. The 2013 Central Iowa “Out of the Darkness” Community Walk will be held Sunday, September 15, at DMACC Ankeny Campus. Donate or register HERE.

* Donate to the American Foundation for Suicide Prevention (AFSP). The AFSP is the “leading national not-for-profit organization exclusively dedicated to understanding and preventing suicide through research, education and advocacy, and to reaching out to people with mental disorders and those impacted by suicide.”  Check out this website to learn more about suicide, to find out about community events, local chapters, and support groups.

* Donate to To Write Love on Her Arms (TWLOHA), “a non-profit movement dedicated to presenting hope and finding help for people struggling with depression, addiction, self-injury, and suicide. TWLOHA exists to encourage, inform, inspire, and also to invest directly into treatment and recovery.” This is another great website for information and events.

* Light a candle in your window for World Suicide Prevention Day to show your support for suicide prevention, to remember a lost loved one, and for the survivors of suicide.

With the right combination of things like education, support, mental health counseling, and/or medication, it is possible to help someone who is struggling with SI. If you or someone you know is in crisis or in need of immediate help, call 1-800-273-TALK (8255). This is The National Suicide Prevention Lifeline, a free hotline available 24 hours a day to anyone in emotional distress or suicidal crisis.

Meet Guest Blogger Sarah Morris Fleming, LICSW

Sarah Morris Fleming, LICSW, LISW has a private practice in downtown Boston providing psychotherapy and life coaching services. She also provides video-based therapy to residents in both Massachusetts and Iowa.  She received her Masters of Social Work and Family Therapy from the University of Iowa; and her areas of focus are anxiety, depression, trauma, grief, and spiritual growth. Sarah utilizes traditional talk therapy along with expressive art modalities. She takes a holistic approach to therapy, addressing the mind, body, spirit, diet, social network, and emotions as equally integral components that profoundly affect one another.