Having someone close to us reveal that he/she is struggling with severe depression or worse yet, thoughts of suicide, can be overwhelming. Indeed, even for trained clinicians, working with suicidal clients is one of the most challenging and disconcerting situations that can arise. When the specter of depression, self harm and/or suicide presents itself, there are strategies for dealing with the initial shock, the fear, and the perceived loss of control in ways that will help you help your friend or loved one access the help that the/she needs.
Do
• act as the first link in a chain of support
• allow the person to fully experience and express her pain
• assist the person in locating resources
• take the threat of self harm seriously
• trust your instincts
Don't
• assume that one can pull oneself out of a depression
• ignore that depression involves emotional, physical, and cognitive symptoms
• shy away from the other’s pain
• assume that suicidal thoughts or self harm are simply a cry for help
• keep secrets
Do
• act as the first link in a chain of support
• allow the person to fully experience and express her pain
• assist the person in locating resources
• take the threat of self harm seriously
• trust your instincts
Don't
• assume that one can pull oneself out of a depression
• ignore that depression involves emotional, physical, and cognitive symptoms
• shy away from the other’s pain
• assume that suicidal thoughts or self harm are simply a cry for help
• keep secrets
Do
Do act as the first link in a chain of support
Research suggests that those struggling with depression often report a perceived lack of social support. Note that phrase: “perceived lack of social support”. This means that, although you may not objectively understand the person’s feeling of isolation and non-support, he senses it profoundly. Let the person know that you are available and willing to serve as a source of support. Ask him if the two of you can include other close friends or family members in forming a chain of support. An ongoing dialogue focusing on who is available to him can serve as the first step in altering the perception of lack of support. The construction of a support network of intimate friends and family is an important component in the treatment of depression.
Do allow the person to fully experience and express her pain
It’s difficult to sit in or be near another person’s pain. Our instincts often instruct us to either fix it or avoid it altogether. As mentioned above, part and parcel of struggling with depression is a sense of being isolated from others; separated and simply not fitting in.
Our well-intentioned attempts to cheer her up, to distract her, or when we really drop the ball, to avoid the situation outright only serve to exacerbate her sense of isolation. This is not a time for pep talks and cheerleading. This is a time to sit with your friend and to simply listen without judgment and without any attempts to fix the problem. Just share her experience.
Do assist the person in locating resources
While your role as the first link in a growing chain of support is a crucial one, you are not an expert. A person struggling with depressive symptoms and/or thoughts of suicide requires professional help. As part of your show of support, sit down with him and start the process of locating an appropriate mental health professional. Whether it be through the local county health department or a private practitioner, prompt implementation of treatment is called for.
Do take the threat of self harm seriously
While the mention of suicide or self harm doesn’t necessarily predict an attempt, research suggests that suicidal individuals often express their intent either directly or indirectly. Pay attention. Listen. Be prepared to act to protect her.
Do trust your instincts
If you feel that a threat to your loved one is imminent, don’t hesitate to contact authorities. Dial 911, involve police and paramedics so that your friend will be safely transported. People often hesitate in profound crisis situations such as this for fear of damaging the relationship. If your instinct tells you that his safety or his life is at stake, it’s better to act immediately and to do damage control later if necessary.
Don't
Do not assume that one can pull oneself out of a depression
There’s a big difference between being sad or down in the dumps and being depressed. There are neurological and biochemical causes behind depressive symptoms. Frustration at your friend’s inability to “suck it up” is misplaced and inappropriate. We are often frustrated at ourselves for feeling helpless to assist. It’s easier to turn that frustration outward. Don’t lose sight of the fact that your friend can’t become “un-depressed” by sheer will.
Do not ignore that depression involves emotional, physical, and cognitive symptoms
Depression can become a total state of being for an individual. It involves sadness, yes, but the emotional component extends further to shape the individual’s worldview. The sadness is often fueled by feelings of hopelessness - the sense that the sadness is without a solution, a lack of self worth or ability, and a generally pessimistic view of the environment.
Physically, depression can manifest itself as suppressed appetite, disturbed sleep patterns, muscle tension and vague complaints of physical pain. Cognitively, severe depression is marked by what is referred to as Cognitive Constraint - that is, a state wherein one’s thought patterns become narrow and problem solving becomes difficult. Within it one tends to fail to consider a range of options. For instance, a suicidal person will sometimes only see two options; live in pain or die.
Do not shy away from the other’s pain
This bears repeating. Don’t shy away from the other’s pain. It’s uncomfortable and disconcerting to be close to another’s pain. Avoiding it, minimizing it, or diverting attention from it only serves to deepen the other’s feelings of isolation, being misunderstood, and not fitting in.
Do not assume that suicidal thoughts or self harm are simply a cry for help
This is no time to play amateur psychologist. On one hand, not everyone who expresses a suicidal thought will act on the urge. On the other hand, those with an intent and a plan often make their intentions known on some level. This is why accurate, professional assessment is crucial.
The research suggests several historical and environmental factors that tend to be predictive. For instance, a substance addiction raises the probability that a person might act on the initial urge. A prolonged sense of hopelessness is also predictive. One of the most pronounced “red flags” for the potential of a suicide attempt is a history of previous attempts. If any of these factors exist, one should act quickly on behalf of the individual.
Do not keep secrets
The revelation of self harm or suicidal ideation should not be kept confidential. It’s always better to err on the side of caution and in the best interest of your loved one.
Summary
We want to think that those whom we love and care about will lead happy, healthy and fulfilling lives. When we are faced with the reality that someone close to us is in pain, unable to function, losing hope, and ultimately tired of life itself, we can easily be overwhelmed. Without proper training, it’s difficult to know what to do or how to act.
Our loved one needs help desperately and, while we may not be the ones to remedy the underlying problem, we can serve as a valuable resource in moving them toward the help they need. The challenge is to face the situation with eyes wide open and to accompany them as they begin their journey to wellness.
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