Suicide is the clinician’s worst nightmare and it is the utmost fear of any family or friend of a person who is depressed.
This horrific act brings the universe of emotions down upon us in overwhelming proportion and we all need more ways to help and to clearly recognize signs that an individual has reached the point of taking his or her life.
A suicide occurs once every 40 seconds world-wide and scientific research has demonstrated that treatment for depression in all of its forms is far from effective.
We still don’t know the cause and we have no cure. New drugs, new combinations of drugs and efforts to find the “cure” for depressive states have not given professionals or families a Golden Pathway towards understanding the roots of depression.
A recent article in the British Journal of Clinical Psychology even purports to have found the cause and cure in “ prospective thinking” (expecting disasters in future events) and cognitive therapy.
This approach is not backed by scientific evidence and doesn’t go far along the road to picking up the flashing signals that desperately depressed individuals hide and others miss and then deny.
Look at Ourselves
Our first step in this journey towards understanding and helping people who are in extreme emotional distress and are high risk for self harm is to look at ourselves and the vital part that we play in the situation.
Suicide is not an independent act; other people and situations are involved and interact in the dynamics that lead to the act of suicide.
When we include ourselves; either as clinicians or family and friends of the depressed individual, we are relying upon the perspective of older cultures that believe we are all interconnected and inter dependent and we all play a part in both positive and negative scenarios.
With this perspective, we need to put our Western cultural views on the shelf but we will come to a better understanding about severe depression and what we need to do to intervene and to help.
In Western culture, there is formidable social and psychological pressure to conform to the norms that are embedded within the institutions with whom we interact.
For most of us, the ‘rules of engagement” are the assumptions and the “should” that we take for granted.
The most relevant for our purposes here are: an individual in this culture is “normal” in mood and behavior; happy, productive, hard working and progress-oriented.
We should be independent in functioning, able to solve problems quickly and efficiently. We should perceive the future as a situation that requires planning and accumulation of resources.
On the other side of the coin, if we find that we are “abnormal” (unhappy, fearful, angry or in extreme emotional distress) we should seek medical help because the problem is located within ourselves.
These assumptions are reinforced by media, political and economic institutions and the domain of psychology itself.
The newly re-discovered “positive psychology” and many interventions in cognitive and other forms of treatment focus upon channeling thinking and feeling into positive realms and deconstructing negative cognitions and emotions.
Therapists as well as non-therapists are influenced by these assumptions and this bias is, in turn, nurtured by the human tendencies to follow herd, to be rewarded quickly, to ignore information that does not fit into the general cultural template, to defend the status quo and to prefer things that are familiar rather than unfamiliar.
As a consequence of these constricting and defining rules and tendencies, the individual who brazenly confronts, questions and seeks to change the status quo is often greeted with criticism and even expulsion from the in-group.
The conformist, however may well find him or herself overwhelmed with demands, isolated in his pursuits, feeling ashamed and weak when he cannot succeed or when he is “abnormal.” The person who is influenced by these rules will go to extremes to solve problems quickly and that usually involves pills, potions, programs.
There is a harsh stigma attached to being “abnormal” and failing to meet the cultural standards.
For professional clinicians, this bias and the fear of being stigmatized may lead to denial of their own conforming blindness and to missing the important signs that a high risk client is exhibiting.
Putting Bias Aside
Looking now at Depression and suicidality and attempting to put our bias aside, we may take the second step and that involves putting some new information together. These insights emerge from research on (linguistics) language, on emotions and prospective thinking.
The clues involve the depressed person’s overuse of the pronouns “ I” and “me” instead of “we,” the anxiety that is inferred when the person talks about social situations and predictions of a dire and distressful future.
Here we have the clues of “negative self-reference,” “social anxiety,” “negative prospective cognition.” These three factors can be the focus of our attentive listening when we are in contact with a seriously distressed person.
They signal that the individual may be close to the precipice where hopelessness in the past, present and future combine with shame, the negative self-image, and anxiety to provoke a desperate act. The clues may be seen in such simple narratives:
“I won’t go there again. I was so stupid the last time that I totally messed up the meeting. I have a habit of forgetting what I am supposed to say. I think that I am just not cut out to be anything more than a waste and a burden on my family. I am afraid of doing more harm in the future.”
Here is another example from someone who is writing on his blog;
“I have no family and no friends, very little food, no viable job and very poor future prospects. I’m totally useless”