Suicide and society: Where does responsibility for preventing suicide lie?

Every time a well-known person commits suicide, I brace myself for a torrent of well-meaning but patronizing advice to suicidal people on various social networks and blogs as the friends of the victim try to find something – anything – positive to do in a situation that is by definition past all help. Most often this takes the form of lecturing people to talk to their friends or family if they are feeling depressed or suicidal, mixed with a little “If only they’d known how much we liked them, they would have stayed alive!” That sentiment in particular is infuriating to many people who have been suicidal, since they are often aware that people love or depend on them and feel more guilt for knowing they are letting them down. It also trivializes suicidal feelings – oh, cheer up, people love you, okay!

For many depressed people, telling them “You should talk to a friend!” is worse than useless advice and may actually make people more suicidal. I argue that we, as as society, should take more responsibility for making people’s lives bearable, and focus on supporting more concrete ways to prevent suicide, like helping people contact professional help, supporting research and treatment of depression, and fighting for social justice.

Edited to add: This comic from Hyperbole and a Half does a much better and funnier job of getting across what’s wrong with “You should talk to a friend!”

What’s wrong with the advice we give to suicidal people?

Why is the “just talk to someone” advice so harmful? First, being told you need to talk to someone induces feelings of guilt and responsibility at a time when you are most unable to deal with an added burden. When you are depressed or suicidal, the very last thing you want to do is talk to people, especially if you have to do the reaching out, and if it is about something unpleasant. I wonder if the “Talk to a friend” advice comes from people who have never experienced that level of depression, or can’t clearly remember what it was like.

If that advice makes sense to you, I invite you to imagine the following:

For weeks, you’ve been dragging your way through life, filled with unending despair. Just thinking about talking to another person fills you with dread. When the phone rings, your stomach immediately leaps into your throat and you think, “Let it be a telemarketer.” Usually you just don’t answer the phone, or your email. Waking in the morning, your body feels like it is made of lead, and getting out of bed is a major accomplishment. When you do have to be around people, you frantically fake being normal, creating another reason to avoid society.

You’re afraid that if you talk to anyone about your feelings, you’ll be hospitalized (potentially a cure worse than the disease). The person you talk to might react by being so emotionally upset that you find yourself comforting them. In any case, you know talking about suicidal feelings will make them feel unhappy and sad, and probably won’t help yourself at all.

Say about this time you read on Twitter or Facebook, “So sad X died. Remember, if you’re feeling suicidal, talk to a friend!” What’s your reaction?

If it’s not anger, rage, and despair, try reading the paragraph on what it’s like to be suicidal again. Then there is “R U Okay Day“, an initiative to actively go out and ask people, “Are you okay?” I wouldn’t be surprised if it is useful for some set of people who are already close to asking for help for some life difficulty. But for many depressed people, it’s just another obligation, a requst to fake it for a well-meaning friend.

Simply put, talking to a friend with no expertise in depression or suicide is often worse than useless for most suicidal people. This friend is highly unlikely to have any training whatsoever in responding to suicide – the best you can hope for is that they know this and immediately help you contact a professional. And there are active reasons not to talk to a friend: they may react by being so distressed you have to take care of them, they may become depressed themselves, they may make ultimatums and threats, they may try to get you committed against your will. Hospitalization is a last resort: besides the unspeakable expense, danger to your career, loss of autonomy, exposure to potential abuse, and coercive medical treatment which may make you worse, you also lose your only comfort: the knowledge that if it gets too bad, you can make the pain stop and you are not trapped forever.

Your friend may react insensitively with useless advice like “Just get up earlier in the morning, I know when I sleep in I’m a little foggy the rest of the day.” They may try to guilt you into staying alive by reminding you of the people who will be hurt if you die, which just adds to the bad feelings. All of these responses are based on fear: I’m afraid this person will die and it will be my fault, I’m afraid because I don’t want this person to leave me, I’m afraid because I might be suicidal myself and this might push me over the edge. Often a friend’s reactions are designed to assuage the friend’s feelings of fear, not serve the suicidal person’s needs. The closer someone is to a suicidal person, the more likely they will have strong feelings that take priority over helping the other person.

What we should be doing to prevent suicide

Here’s what works for preventing suicide: medication, professional help, changes in societal views of depression and suicide, and supporting research and prevention. If you’re looking for a general purpose, day-to-day way to reduce suicide risk among your friends, you have many options other than inducing more feelings of guilt and worthlessness in your depressed friends.

Don’t stigmatize depression and mental illness: Don’t mock or make jokes about mental illness. Learn compassion for people whose brains are not working well. View it as what it is: a physical disease of a body part, the brain, that impairs the very ability to fix the problem. Talk about your own experiences with depression or other mental illness as openly is as safe for you. I deeply respect several of my colleagues who have gone public with their bipolar disorder or depression, but that isn’t an option for most people. But many more people can tell their friends about their experience privately. I can’t count the number of times I’ve seen one person reveal that they are taking an anti-depressant, and then several other people (sometimes the majority) pipe up and talk about their own mood problems and treatments. So many of us are faking being okay, and when you realize you aren’t the only one it’s a huge relief: It’s not just me! Other people are going through this! Maybe there is hope and support.

Share information on contacting a trained counselor: The average person has no clue on how to respond to a depressed person, and frankly it’s a huge burden to dump on an unqualified person’s shoulders. Anything from a suicide prevention hotline number to a listing of counselors in your area to the email address or phone number of a professional therapist you trust can help. Finding a trustworthy therapist is often too much of a challenge for someone who is depressed (partly because there are unqualified, actively harmful therapists out there happy to take your money). If a friend asks for help, helping them find professional help is often the best thing you can do, especially finding ways that they can afford it since it’s usually incredibly expensive. Often there are programs to provide free or cheap mental healthcare to students, low-income folks, and similar – just keep asking.

Call for and support more research into prevention and treatment: Anti-depressants are big business, but they only mainly work for unipolar depression, have lots of side effects, and can cause suicide in rare cases. For some reason, drug companies don’t develop drugs directly for bipolar disorder, perhaps because the risk of death and therefore lawsuits is so high (lifetime risk of suicide in bipolar disorder is somewhere between 10-20%), so most of the drugs for it are off-label anti-siezure medications with major side effects. We still don’t understand what causes depression or bipolar disorder in any meaningful way. Drug development for bipolar disorder is unlikely to occur in for-profit pharmaceutical companies, so government grants and private foundations like The Bipolar Foundation are likely the only source.

When suicide is justified

Finally, I want to put in a word for suicide as a legitimate, reasonable option in some cases. If you can’t imagine a situation in which killing yourself seems like the best option, you simply haven’t suffered very much. Suicide is, in a sense, the last form of protest against suffering that is too strong to make life worth living. Sometimes that suffering is purely organic – there’s something wrong with your body and it’s caused by nothing related to society. But sometimes, suicide is a protest against being forced to function and give support to a society that is so unfair and unequal that it’s not worth staying alive.

Suicide as protest can unite an entire people and bring down governments – see the entire Arab Spring and the ongoing Tibetan protests. That’s part of why oppressive regimes often punish suicide so severely. A few examples: in medieval law in Europe up through at least the 17th century, the estate of a person who committed suicide was confiscated by the local government and not allowed to go to the heirs. Suicide was only decriminalized in the U.K. in 1961, and in most U.S. states in the second half of the 20th century. Many examples outside the Western world exist but tend to arouse “that’s a problem for them, not us” reactions in the people most like to read this blog, so I won’t mention them directly.

Suicide is a complex problem with many facets. Rather than subscribe to a self-centered fear-based worldview in which we believe suicide is always wrong for all people, we should educate ourselves more about the causes of suicide and how best to support people at risk of suicide. A blanket belief that suicide is always wrong, or okay only in cases of severe pain in end-of-life situations, is saying that suffering people have a responsibility to their family, friends, and society to continue to live in unbearable conditions, rather than saying that society needs to work harder to make people’s lives bearable if it wants people not to commit suicide.

How to help

If you want to help, you can:

  • Educate yourself about the causes of suicide
  • Develop compassion and empathy for depressed and suffering people
  • Treat depressed and suicidal people with respect
  • Fight stigmatization of mental illness
  • When safe for you, share your own experiences with depression and suicide
  • Research hotlines and qualified professionals
  • Help suffering friends by assisting them with tasks that are difficult
  • Call for more research into causes and treatment of depression
  • Donate to foundations doing that research
  • Support social justice movements that reduce suffering
  • Oppose punishment for suicide, either by law or society

I hope we can remember in the aftermath of a suicide: If you really want to help, don’t do things because they help salve your personal feelings of loss and guilt, do things that lessen the suffering and illness that cause suicide.

27 thoughts on “Suicide and society: Where does responsibility for preventing suicide lie?

  1. Great response. There’s often such cloyingly awful, well intentioned but ignorant discourse around the topic. Of everything I’ve read out there today, it’s to this that I can simply say: yes, exactly this.

  2. Just a thought that crossed my mind: When you say “Talk to someone!” or “Talk to a friend!”, what the suicidal person might hear is: “Don’t talk to me.” I.e, the referral to a third person might be seen as a rejection by the person you’re currently confiding in. Am I making any sense?

    1. I don’t think that situation is very common, but agree with that in a way – see, most people don’t have the emotional capacity to counsel a suicidal personal for any length of time, much less the years it often lasts (and shouldn’t, it is a rare gift). So even if you are saying explicitly, “Talk to me if you are feeling depressed,” the reality is that most people can’t handle listening more than three or four times without being harmed themselves. Anyone with experience with depression knows that this is a well-intentioned but ultimately not useful offer the vast majority of the time.

  3. “A blanket belief that suicide is always wrong, or okay only in cases of severe pain in end-of-life situations, is saying that suffering people have a responsibility to their family, friends, and society to continue to live in unbearable conditions, rather than saying that society needs to work harder to make people’s lives bearable if it wants people not to commit suicide.”

    Yes. And I also have experienced many times admitting my suicidal ideation and then having to respond to a difficult response, reassuring the person, as you say, taking care of them, feeling guilty for upsetting them, etc. The best thing that happened to me in one of my bad times was meeting someone who was having similar ideation and somehow making it a running joke, calling it “my little friend” as in, “my little friend was hanging out with me last night”. We met in a support group so maybe that was part of the help, but somehow comparing suicidal fantasies and just being able to talk to someone who took talk of suicide as a familiar matter of course took some of the scariness out of it. But that might not work for someone who is closer to the brink.

    Sometimes I would say to myself, “Your body is an animal, just like a cat is. Would you kill a cat? Stop threatening it. You’re scaring it.” But the feeling that dying is the only way you’ll stop letting people down is so attractive… It’s lucky we know we’ll die someday. That promise is the only thing that keeps some of us going! Thanks for the article. Beautifully done.

    1. It’s lucky we know we’ll die someday. That promise is the only thing that keeps some of us going!

      Great quote! If you can’t understand this sentiment, you have no business giving advice about depression.

      I appreciate you sharing your experiences this way, and the kind words. Thanks!

  4. Interesting article, thanks, it’s made me think.

    One thing though, I think certain bits are US specific though, and aren’t (apparently to me) flagged as such. Mostly around money. I’ve no idea if living somewhere where you don’t need to pay for support / medication / counselling makes it better or worse though…

      1. …and is it someplace where that counseling and therapy are useful to everyone, including non-neurotypical people, trans people, queer people, people of all ages, disabled people, and people of color? If so, I would also like to know about it.

      2. In most of western Europe, acces to psychiatrists is free or cheap, because most of the cost is paid through taxes. I’ve been depressive, and it was hard enough for me to get to contact a psychiatrist, without having to think about the cost. I don’t know if I could have made the effort if the cost was significant.

  5. Sorry to nitpick about a great post, but “antidepressants only work for unipolar depression” isn’t quite true (disclaimer: I am not a medical professional). I’m bipolar and am taking an antidepressant in addition to a mood stabilizer. I’ve tried both antidepressants alone, and a mood stabilizer alone, in the past, and neither one worked. I asked my psychiatrist about this just last week, and he said that in his experience, most bipolar people who try antidepressants get some benefit from them, even though a significant minority can’t take them because they swing manic as a result.

    For anyone else reading this who *doesn’t* already have good mental health care, this is why it’s important to seek out psychiatrists/therapists/anyone who have a good understanding of your particular mental health issues. Just because someone is a psychiatrist doesn’t mean they’ll be able to handle anybody who needs medication for a mental health issue, and just because someone is a licensed therapist doesn’t mean they can handle everyone’s counseling needs compassionately.

    1. Thanks for the correction! I wasn’t actually aware of that and I’m glad to not be spreading the wrong information. It’s important to be as accurate about medication for depression as possible because getting it wrong can have major consequences (and we have so much financial pressure to take whatever drug is still in patent in the U.S.). I corrected the main article to reflect this.

  6. Also, I think that the worst thing to say to young people who are suicidal is “But you have your whole life ahead of you!” “Yes, thank you, that’s the problem.”

  7. Great post. I am bipolar, but that provide me with a lot of insight into how to deal with someone else who’s suicidal. My suicidal episodes have happened in isolation; some simple switch goes off in my head and I feel the usual, things are empty, things will never get better, things never really have been good, a yearning to “get off” the ride. I’ve been stood in the middle of highways and sat down with bleach and other nonsense. It’s never a horribly sad feeling, quite lucid and calm, I just feel like my juice has run out and so the logical thing is to stop. I’ve stepped out into roads in more “typical” bipolar episodes of bottomless sadness with a wet face and aching heart, but that, for me, is somehow easier to manage and predict: I can recognise situations that make my emotions seesaw and avoid them (unfortunately this pretty much means ‘being in love’), and if I want, I can research how to treat them chemically, if I don’t want to avoid certain experiences. But the sudden switch flick in my head that can go off sometimes is the most startling, hard to describe to people and to have anyone take it seriously. The more frantic upset and wet faced depressive plunges make me quite unreachable, I really have no idea how to handle someone else like that. But at least, above all, creating an open and aware environment that accepts the reality can only be positive. Talking freely in such feels therapeutic for me, pitting it into words gives you some power over the things. Sorry about the convoluted comment. Think I spilled my brain juice on your beautiful text.

  8. This is an important issue to talk about. Thank you for your insight sand your suggestions of what people can do if they are interested in effecting change – I agree 100%..A mother whose daughter took her own life asked me not to say “committed suicide” but to say “took ones own life” or “death by suicide”. The problem with “commit” for her is that is what criminals do. People are committed to institutions. So, to help remove the stigma associated with suicide being something criminal or punishable, we need to change the way we speak of it. What do you think about that?

    i also agree with the comment above about bi-polar disorder and antidepressants. I have also had Psychiatrists prescribe mood stabilizers along with antidepressants for me because antidepressants alone can cause me to be hypo-manic if dosed too high. I’m only sub-clinically bi-polar with occasional sub-clinical hypo-mania, so actually these drugs do more harm than good for me personally – nasty side effects. I agree that having the mood stabilizer along with the antidepressant can be helpful for people with bi-polar disorder. Lithium is nasty – dry mouth yuck! So, it is helpful to have other alternatives.

  9. Very interesting post with good thought provoking ideas. Ireland is at the moment suffering from an outbreak of suicide, affecting very young people. Many of us are at a loss as to how we are going to deal with this. The media is full of the platitudes you highlight – including talking to friends. However, as you point out, the approach to suicide provention needs to be very broadly based. In Ireland there is too much focus on the horror and tragedy of the specific incident rather than the overall personal and societal context in which the suicide occurs.

  10. Even simpler than the scenario you are asking readers to imagine is another reason that “just talk to somebody” is worse than useless:

    In most cases of depression, you are already feeling like a worthless waste of everyone else’s oxygen and guilty for being a burden on others. In that situation, how does telling you to effectively lean on others going to be any help? That is exactly what you rather would not! Even accepting useful help at all is difficult for that reason (among several more) – let alone asking someone to go out of their way for you.

  11. Reblogged this on Mm172001's Blog and commented:
    I read this on my Zite the other day after the suicide of some some-what famous guy I had never heard of. I inteded to summarize the (what I thought was article) for a resource. Glad to see it was a blog I can re-blog. I especially like the section at the end on “How to Help.” check it out.

  12. Reblogged this on The Life You Save May Be Your Own and commented:
    THIS. THISTHISTHISTHIS THIS. She says exactly what I wish I’d known how to say to people for most of my life.

    I would, however, add the caveat that most counselors and therapists aren’t even comfortable dealing with suicidal people. Nearly all of them panic and hospitalize you if you have a plan and intent.

    1. Just a note that I’m aware of a good many therapists and counselors that are comfortable working with people with suicidal thoughts, but each has their own personal rules of thumb or code of ethics (in addition to any applicable local laws) to decide what to do in each specific case. It’s possible to sound out any healthcare professional on their theories of treatment to see if they are compatible with yours before putting yourself in a position of vulnerability – we’re just discouraged from doing so. Trust all medical professionals! Except when they make errors, in which case you should have noticed and prevented them! Definitely don’t sue! No hypocrisy here!

  13. I agree, so deeply and wholeheartedly, with so much of this, but I hope you will add some nuance here:

    “Hospitalization is a last resort: besides the unspeakable expense, danger to your career, loss of autonomy, exposure to potential abuse, and coercive medical treatment which may make you worse, you also lose your only comfort: the knowledge that if it gets too bad, you can make the pain stop and you are not trapped forever.”

    This is unquestionably true but it is not the whole story. In at least two cases that I know of, hospitalization helped stabilize people who were otherwise in grave danger of harm, and marked a significant improvement in the course of their illness. Of course it has to be a good hospital with good practitioners and good practices, but such places do exist and I believe that they save lives.

  14. My take on hospitalization is probably the same as yours; this post is advice for non-depressed people who are trying to help depressed people without understanding the risks and costs involved. It’s easy to think, “Oh, if someone felt like they were going to kill themselves, there’s always hospitalization,” and another to realize, “If I am hospitalized, I will go bankrupt and I may never get another job in this field, which would cause me to be more depressed.” If hospitalization is even an option, which it isn’t for many people.

    I stand by my “last resort” phrasing – it’s the rare person who can opt for hospitalization without major sacrifices in their long-term quality of life.

  15. Sobering thoughts.
    I wonder what your feelings are at taking community approaches to suicide and major depression. I think in the Open Source community we’ve had a few high-profile losses in the last 2 years, and I want to see what we can do to reduce the harm.

  16. Thanks for this. I feel very trapped, anxious and alone in my situation of lifelong mental health problems and hopeless pathetic living condition. Every time I hear the hokey ‘Talk to someone!’ it makes me very angry. I think lines like this, based on attitude rather than real world factors, have become popular because we have basically given up on solving people’s real problems as we know that government won’t pay for helping little people.

    I’d be happy to never hear ‘Talk to someone!’ ever again. (I’d also like to get rid of ‘deeply saddened’. It used to be the line of evey insincere politician. Now everyone and their brother pulls it out at the drop of a hat…)

    It’s important that you mention social justice. The disasterious policies that both electable parties (I know UK and US best) follow now, are destroying people’s lives left and right. Unless we fight for a right to a decent life (job with liveable wages and future, home, reasonable holiday time, an understanding that people are fallable [and not machines]), our countries will start looking like China in the not too distant future.
    The rich and the politicans won’t support positive change, people have to…

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