Effective suicide prevention conversations involve empathy, validation and surrendering control
September is National Suicide Prevention Month. Talking about suicide can make everyone involved feel uncomfortable — but experts say not talking about it does nothing to diminish its impact and allows the shame and stigma around it to persist.
"Sometimes we feel like by not talking about something, by not mentioning it, by not speaking of it, that somehow makes it better," says Central Texas neuropsychotherapist Bella Rockman.
But that doesn't make it go away. According to the most recent statistics available about suicide from the Centers for Disease Control and Prevention, someone dies by suicide every 11 minutes in the United States.
Rockman also challenges the myth that asking someone if they are contemplating self-harm might make them more likely to carry it out. She says opening up that conversation may actually bring them some relief and dispel shame.
"A lot of times people are so embarrassed that they're even thinking about it, and they don't feel like anyone wants to bring up the elephant in the room," Rockman says. "And so then they become very relieved when someone just says it."
So, how can someone broach the topic of suicide with a loved one they are concerned about?
Rockman says some effective questions to ask don't necessarily need to directly address suicide. She says some of those questions can include:
- Are you feeling unsafe?
- Are you feeling like you can't trust yourself to be alone right now?
- Are you feeling like you want to harm yourself?
- Is it OK if I check on you again later on today?
- Is it OK if I just come by and sit with you?
There are also resources available for people who may be thinking about suicide:
- Text "home" to 741741 to be connected with a crisis counselor at the Crisis Text Line.
- Call or text 988 to reach the Suicide and Crisis Lifeline.
Listen to the interview above or read the highlights below to hear more from Rockman about discussing suicide both with those thinking about self-harm and those impacted by suicide.
This interview has been edited lightly for clarity.
KUT: Why do we find it so difficult to talk about suicide?
Bella Rockman: Sometimes we feel like by not talking about something, by not mentioning it, by not speaking of it, that somehow makes it better. About every 11 minutes, there is a person dying because of suicide. So by us not talking about it, it doesn't make it go away. I think death and dying in particular is a very scary subject for a lot of people. And I think the idea of self-harm, although we have a lot of integrated violence in our country, in our media, in our entertainment and in our news, I think that the idea of violence toward oneself is also very uncomfortable for people.
I wonder if another reason that suicide can be so difficult to talk about is because when someone we know dies by suicide, we might blame ourselves or think that we could have prevented it.
Because I work from a neuropsychotherapeutic perspective, I think about the brain. I think about how the brain can become hijacked by fear. And when our brain is hijacked by fear, our amygdala is overactive; we're hypervigilant, almost like seeing red. We can't think clearly. Our executive function is offline. The front part of our brain, basically the logical part of our brain, is offline. And so we're making these heightened decisions out of this place of fight, flight, freeze or fall.
I think a lot of times when a person actually does move toward harming themselves in a permanent way, their brain is already hijacked by that fear. They are already completely convinced. And there is oftentimes nothing that a cousin, brother, sister, coworker, mom, dad [or] partner could do to stop that. That's a very difficult thing for most people to accept. That it's not your fault and that it's not your responsibility.
Can you dispel some of the myths about talking about suicide? For example, is it true that asking a loved one if they're contemplating suicide might encourage them to carry it out?
No. And I think it's also okay if you don't want to specifically say suicide. You can also ask a person, "Are you feeling unsafe?" or, "Are you feeling like you can't trust yourself to be alone right now? Are you feeling like you want to harm yourself?" Because there's also forms of self-harm that folks get involved in that are not necessarily always immediately going to suicide.
Sometimes when you actually just ask the question, it dispels so much of the shame. A lot of times people are so embarrassed that they're even thinking about it, and they don't feel like anyone wants to bring up the elephant in the room. And so then they become very relieved when someone just says it. They're like, "I'm so glad that you just asked me about this because I feel like no one actually wants to say it."
It's just like asking the question, "Are you feeling depressed or have you eaten today or have you hydrated? Is it okay if I check on you again later on today? Is it okay if I just come by and sit with you?" It can help so much because I think a lot of shame drives addiction. A lot of shame drives abuse, and, of course, self-harm and suicide is one of the highest forms of abuse. So if we can remove some of that shame, we can do a lot to help.
I think validating them, normalizing what they're experiencing, and then helping walk them through, giving some crisis support if they're thinking on acting on it and letting them know, "Hey, overnight while we're resting or whatever, if you're thinking about this again, please text 741741 or call 911. It's okay to get crisis support." That's where we have to kind of draw the lines for ourselves and realize that we're not necessarily equipped or trained to help navigate through that crisis, nor should we put that pressure on ourselves to be that for them.
Can you offer us some guidance for how to talk with people who have lost a loved one to suicide?
There's this acronym called BELIEVE, and this goes for folks who are thinking about self-harm but also for those who have been impacted by it.
So the "B" is believe that the suicidal comments or gestures are serious. The "E" is engage in conversations about thoughts and feelings. The "L" is listening without judgment or arguing, and that goes for folks who are experiencing the thoughts of self-harm or for those who are left behind in the aftermath. The "I" is investigating intent and access to lethal means. The "E" is for expressing empathy for the person in the situation. The "V" is for validating how difficult and painful this is for them. And the "E" is for encouraging them to seek support and, if you need to, escorting the person to access help.
But I think that's true for folks who are thinking of self-harm, but also those who are left behind. When we have really bad things happen in our life, our brain scans for answers, for resolution, and if we can't find resolution, we often tend to self-blame. But I think that's where surrendering some degree of ego comes in. The only thing that I can control in this world is my reaction to things, not the things that happen around me. I'm in so little control of other people's responses, actions, decisions and choices. The biggest locus of control that I have is within myself, which is my reaction. And it's a difficult thing because it's surrendering a lot of the perceived control that we have.
So if you're validating the person who has reached out for help or that has an outcry, if you're empathizing, if you're being in the trenches with them and offering to escort them to safety or to get the support that they need, the best that you can do is show up the fullest and most authentically that you can and then release some of the attachment to the outcome, because in the end, it's not on you.