By Wayne Rosenfield, PhD
“Please don’t be angry with him.”
That’s how my friend Sam’s sister began her tearful eulogy. There was a low murmur in the room as all of us assembled at the funeral home shook our heads in agreement. We thought “of course not,” although I and many others were too grief-stricken to actually voice the words.
This was the first time that I had attended the funeral of a suicide. My feelings were mixed, and my thoughts were confused. What was I supposed to feel? I lost my friend, so I should be sad. I recalled the good times that Sam and I shared, and I felt sorry for myself that we would not have fun together again. But the guy in the box at the front of the room wanted this; he wanted us, his family and friends, to be here. So, should I be pleased? There was no doubt that Sam ended his life purposefully and with clear intention. For me it was a very emotionally confusing and conflicted funeral service.
But did Sam really want us to be here for this occasion? Did he really want to be dead? I’ve thought about Sam many times over the course of my career as a psychologist, trying to understand the mindset he experienced, and the motivations for suicide. Twenty years ago, around the midpoint of my career so far, I began working as the crisis clinician in hospital emergency departments. I saw how the pain of unbearable existence translates into desperation. And I saw how the pain of the individual and its resulting behaviors propagates through families and social networks.
Yet suicide remains a touchy subject, and many people are afraid to bring it up. For one thing, what do you say to survivors, the people who have suffered such a loss? Unlike other scenarios that end with death, there may be no chance of preparation for the survivors, just as I experienced with Sam. The pain that initially belonged to a single person touches everyone who learns of the story: family, friends, and even strangers. Confusion, guilt, anger, remorse, and even relief can be part of the picture, but the list of possible reactions can be as many as the number of people affected. There is no predictable script. The whole subject, whether or not the suicide attempt resulted in a death, is going to be intense and raw.
An even scarier question is, “what should I say to someone who may be at risk?” What can we do, before we ever have to confront the reality that someone has died intentionally? We know that suicide risk is predicted by hopelessness, even more than depression. The person without hope does not see the current situation as temporary. The person has not accepted that suicide is a permanent solution to a condition that may only be temporary. Perhaps the person has even received the best evidence-based treatment and is still acutely distressed.
Changing a person’s outlook and making a meaningful impact requires the knowledge, credibility, and finesse of a professional. But the subject should not be taboo in everyday life. Asking a person about suicidal thinking does not implant the idea. Trust me, the thought is likely already there, even if an emergency does not currently exist. Asking a person about feelings and even about suicidal thinking demonstrates that you care. The conversation shows that you are willing to make a connection, even though you may be very scared. The suicidal person may also be scared, especially of not having a solution to the distress. Ignoring the issue does not make it go away. Engage with the person you are worried about. Acknowledge feelings and say that you will be there. Call for professional help sooner rather than later.
I found that I could cope with immersion into these situations. And, with the addition of considerable professional preparation, I could be the psychologist in hospital emergency departments, dealing with suicidal behavior multiple times each day. At my high school reunion someone who last saw me as a teenager asked “So, you’ve been a psychologist all these years. Have you seen it all? Does anything surprise you anymore?” My answer required little thought. “Every day is different,” I said.
The complexity and uniqueness of these situations cannot be understated. Yet there are certain commonalities. Everyone has changes in mood, and many people struggle with depression or mania, or with disturbing thoughts or perceptions, or with painful losses and other life experiences. Suicidal thinking is surprisingly common. But suicidal behavior is far less common, fortunately, and even less often successful.
In the emergency departments it was always great to be able to tell parents and loved ones that we were not in an acute emergency at that moment. But sometimes the situation was dire and very dangerous, and immediate intervention was required. I have known people who eventually intentionally died. But I have known many more people who thanked me later for intervening when it was within my power to do so.
Don’t be silent. Take action for yourself or for someone else.
Dr. Wayne Rosenfield is a psychologist who has worked extensively with high risk and impaired populations. He is presently a professor in a graduate program of National Louis University. He performs assessments for a group psychological practice and is a co-investigator in a research addressing combat post traumatic stress. He is a frequent speaker in the field of rare diseases. His book Great Necessities is available on Amazon.com, you can purchase it here.
My name is Abby, my life has been touched many times by loss and grief. This life has led me to helping others navigate their own grief. I have become a INELDA trained End Of Life Doula and a hospice volunteer. I am not a professional counselor or psychologist and all advice given should be treated as advice from a friend.