Is your pal feeling suicidal?

A psychotherapist tells you what you can do to help a friend who is showing signs of wanting to ‘end it all’

Editor's note: In the wake of the apparent suicide of the much loved Oscar-winning actor and comedian par excellence Robin Williams, we are publishing this article before its scheduled date. We believe that readers will find it highly relevant and useful.

I have counselled a number of people who have come to me with feelings of guilt because their close friend has committed suicide. They feel as if they have failed their departed friend by not doing enough to save them. They mull over whether they could have done something.

If you have a severely depressed or suicidal friend, you may find yourself in a very precarious position, where you want to urgently do something but see that you are helpless in the face of severe clinical depression.

So is there any kind of intervention that you can offer to a friend, to stop their downward spiral? And what are the limitations you must accept in such a scenario?

Psychological factors

After the recent suicide of a well-known model and actress, there has been a lot of discussion about what makes human beings so emotionally disturbed that they decide to end it all.

Flexibility

This is the first principle of emotional health. It is a ‘demanding’ philosophy which is at the core of all emotional disturbances. If we did not hold on to rigid demands that things must only be a certain way, life would not be hard. It is perfectly okay to have desires and preferences of how you would like your life to be. It is only when these desires are escalated to ‘absolute must haves’ that they become a problem.

Perspective

If a person thinks that every moment of their life is a catastrophe instead of keeping things in perspective, they come down a lot harder on themselves. For instance, if I view every unpleasant situation as ‘awful’, or every disappointment as a ‘disaster’, I would find it untenable to continue to live. So taking the disappointments, inconveniences and discomforts of life into context is the next requirement for emotional health.

You need to accept your shortcomings and realise that neither you nor anyone else is ‘perfect’.

Objectivity

Most youth today have very low frustration tolerance and quickly label a ‘discomfort’ or something that they don’t like as ‘intolerable’ or ‘unbearable’. But we all survive so many discomforts and disappointments and live to tell the story. It’s when we do not realise our capabilities of handling difficulties and frustrations, that we tend to engage in self-defeating self-talk. We begin to feel hopeless and resigned, and we start to behave in ways that are anti-life.

As a mental health professional I feel it is imperative that everyone understands that human beings can both construct and destroy. We have the ability to problem solve as well as to self-sabotage, and therefore you must know that it is one’s ‘conscious choice’ as to the kind of self-talk one chooses to engage in, because that is what determines how you face the many challenges life throws your way.

External factors and internal factors

There is often a debate about whether people become suicidal because of their circumstances, or because of internal factors [their psychological state or their genetic makeup]. The truth is that both factors play a role. Environmental factors like social isolation, poor family support, sudden loss or abusive relationships increase the risk of suicide. However, not everyone exposed to such situations wishes to die. Therefore internal factors clearly play a part. If one is genetically predisposed to depression, is clinically depressed, has high expectations from oneself, or has a tendency to suppress emotions, the risk of suicide definitely increases.

Bio-Psycho-Socio intervention

If a person is identified as being at risk of  self-harm, an intervention should be had to tackle both the internal and external factors, i.e. at a biological, psychological, and sociological level.

Biological: A psychiatric assessment is required to give a person suffering from depression anti-depressant medication. This should be done by a psychiatrist in a hospital along with the support of a parent/partner/friend/volunteer at home. Resources like a suicide helpline, psychiatric emergency team and family doctor should be available on call to prevent a suicide attempt. Do not leave the depressed person alone and keep weapons and dangerous substances away.

Psychological: Teach the depressed individual the principles of flexibility, keeping things in perspective and objectivity to change their self-defeating self-talk, and help them to ‘consciously choose’ pro-life beliefs irrespective of their circumstances.

Sociological: Help to negotiate changes in the environment e.g. relationship counselling in the case of poor family relationships or empowering them to get out of abusive relationships, cajoling the individual to create a support system by associating with a group of friends, a religious group, or any forum, and engaging in activities on a regular basis to reduce the social isolation.

In case of some kind of loss [whether the death of a loved one or the ending of a relationship, loss of reputation or finances, or a loss of a dream/life envisioned for oneself], facilitate the ‘grieving process’ and then discuss the fact that there is life beyond that event, and encourage the individual to act against his/her withdrawal impulses.

Do your best and leave the restis-your-pal-feeling-suicidal-2-280x205

Coping with depression and suicidal thoughts is about remaining in the driver’s seat at all times, and not being a slave to your genes, your thoughts, or even your circumstances. Therefore, if you have a depressed/suicidal friend, the best thing you can do is:

  • Express your genuine concern about their emotional wellbeing
  • Suggest professional help in the form of a psychiatrist [who would medicate if necessary] and a psychotherapist [who would help to reverse depressive thought patterns]
  • Fix an appointment for your friend and accompany them for the first few appointments
  • Talk to the family of the friend, expressing your concern and ask them to be involved in the process by monitoring the medication and therapy sessions
  • Keep in touch with your friend; encourage and invite them to socialise with a few close friends so that isolation is prevented
  • Encourage your friend to be involved in a creative pursuit, some fulfilling work or a social/religious group to keep them constructively occupied
  • Help create a support system with a combination of family, friends, volunteers, and helpline numbers that the friend can turn to whenever they are feeling particularly down
  • Listen to your friend patiently whenever they call and motivate them to remain engaged in therapy and to take the prescribed medication sincerely
  • Help with accessing a psychiatric team or with hospitalisation procedures if ever necessary in an emergency.

If you have dared to care for your friend, extended your help and support in all the ways mentioned above, then know that you have done your best.

And if, in spite of your best efforts, your friend decides to end it all, then simply pray for them and make peace with the fact that we are ultimately responsible for all our own choices, and that no one can or should assume responsibility for others.

How Rohan helped Seema come out of her depression

Seema was an ad-film director in a production house. She had a breakdown on the sets on more than one occasion. Her producer Rohan expressed his concern about her emotional wellbeing and told Seema to use him as a sounding board if she ever needed someone to talk to. Seema started sharing some of her troubles regularly while he listened with empathy. One night she called to say she thought she was having a heart attack. He rushed over and took her to a nearby hospital, but all medical investigations were normal, it was diagnosed as a panic attack.

These attacks started happening frequently and he would help to calm her over the phone, but kept insisting that she should urgently see a professional counsellor to resolve the deeper issues that were troubling her. She refused and said she preferred to talk only to him. One day she called hysterically crying and said that she didn’t want to live any more and planned to end her life. He rushed to her home where she lived alone and found her in a very distraught state. She had overdosed on anti-histamine medication. He called an ambulance and took her to a hospital. Her stomach was pumped and he stayed with her overnight.

The hospital psychiatrist paid her a visit and asked her to take some anti-depressant medication; through all this drama Rohan stuck around. When she was discharged, Rohan insisted that she see a psychotherapist along with continuing to take the medication. So he made an appointment for her to see me and even accompanied her for the session. He came in first to brief me about her reluctance to visit me. We then had several sessions and he would continue to accompany her, sitting in the waiting room during the session. He called her mother in Pune and informed her about the gravity of the situation and suggested that she live with Seema for a while to ensure that she took the medication and also to ensure that she did not make another suicide attempt.

Soon the medication and therapy empowered Seema with better coping skills. Rohan now no longer accompanied her to the sessions with me but kept in touch via email to check whether she was keeping her appointments.

Rohan had correctly recognised the need for professional intervention and had stretched himself to ensure that she got the right kind of help and family support. He also recognised his own limitations, which could not go beyond being an empathic listener. His timely intervention averted a possible successful suicide attempt.

Comparing anti-life beliefs to pro-life beliefs

Choosing pro-life [PL] beliefs over anti-life [AL] beliefs ensures emotional health.

AL – I need love and approval and must avoid disapproval before I can accept myself and be happy.
PL – Love and approval are good to have, but they are not necessities. There will always be times when they are not forthcoming, so I’d better learn how to accept myself independently of what others think.

AL – To be worthwhile I must succeed at everything I do.
PL – It’s okay to strive for success, but it’s not realistic to demand it every time.

AL – I should always act correctly, because when I don’t, it proves how useless and unworthy I am.
PL – No human is perfect. By thinking that I should never put a foot wrong, I am trying to make myself super-human.

AL – I deserve to be depressed because of the type of person I am.
PL – Who says I ‘deserve’ to be punished with unhappiness? It is better that I learn from my errors and get on with striving to make better decisions in life.

AL – The world must treat me correctly and justly.
PL – I would prefer things to be the way I want, but there is no reason they have to be this way. This is the world I have, and I can live and even learn to enjoy life despite it.

AL – I can’t do things unless I want to or feel like doing them.
PL – If I got started, the activity itself would give my mood a lift.

AL – I am unhappy because circumstances are outside my control, so there is nothing I can do to help myself feel better.
PL – It is true that there are many things that are outside my control. But external events and circumstances do not cause internal feelings, my thoughts do—and I can learn to think more functionally.

This was first published in the August 2014 issue of Complete Wellbeing.

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Minnu Bhonsle
Minnu R Bhonsle, PhD, is a Mumbai-based consulting psychotherapist and counsellor. She conducts training programmes in Personal Counselling [Client-centred Therapy] and Rational Emotive Behaviour Therapy, and also workshops in Stress Management, Art of Listening, Couple Therapy, and Communication Skills. Minnu has co-authored the book, The Ultimate Sex Education Guide along with Dr Rajan Bhonsle.