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.