One of the most dangerous misconceptions about suicide is that asking a loved one if they are suicidal will increase the odds that they will attempt suicide. Today Dr. Nate Ivers of Wake Forest University discusses the importance of making “the covert overt” by asking blunt, straightforward questions of those you suspect may be thinking about suicide. What words should you use, and if the answer is yes, what should you do next? And why are we so uncomfortable about asking these potentially lifesaving questions?
Find out on this episode.
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Guest information for ‘Discussing Suicide’ Podcast Episode
Dr. Nathaniel Ivers is the department chairman and an associate professor in the Department of Counseling at Wake Forest University. His research interests include bilingual counseling; culture; terror management theory; existentialism; counseling with Spanish-speaking immigrants; and wellness.
Computer Generated Transcript for ‘Discussing Suicide’ Episode
Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: Welcome to the Psych Central Podcast, where each episode features guest experts discussing psychology and mental health in every day plain language. Here’s your host, Gabe Howard.
Dr. Nate Ivers: Hello everyone and welcome to this week’s episode of the Psych Central Podcast. We are here today talking with Dr. Nate Ivers, who is the department chair and associate professor at Wake Forest University. Specifically, we are going to be discussing how to openly talk about suicide in our communities. Nate, welcome to the show.
Dr. Nate Ivers: Thank you so much for having me. I appreciate you inviting me to be here and for allowing me to talk about something so very important.
Gabe Howard: Well we appreciate you being here as well. Suicide is one of those things that absolutely everybody has heard of. We all know about it and believe it or not we’re all talking about it just generally incorrectly. You’re a doctor who studies and research is this. Why do people get it so wrong? Because it’s not a concept that people are unfamiliar with.
Dr. Nate Ivers: Right. I think everybody unfortunately has been affected or touched by suicide. But yes there are lots of misconceptions. I think one of the major misconceptions is the thought that those who commit suicide really wanted to die. I think there are some instances where people do indeed want to die but most often the reason why people decide that they are going to go forward with committing suicide is because they feel so much pain and they feel so much hopelessness and helplessness related to their situation and they just want that pain to go away.
Gabe Howard: I can really relate to that as someone who has had bouts of depression and been suicidal myself. I’ve said that since I reached recovery it’s not my life that I wanted to end it was the pain that I wanted to end and I saw no path forward.
Dr. Nate Ivers: Right. Yeah. Yeah.
Gabe Howard: And that’s one of the reasons I’m so interested in how to discuss suicide and wanting to die with the public because there’s many many many misconceptions floating around and one of the biggest ones that persists is that asking someone if they are suicidal will put the idea in their head and make them want to do it. How do you respond to that?
Dr. Nate Ivers: It is a great question and I think that’s one of the fears that sometimes we have about trying to help someone who’s going through this sort of pain but all indicators suggest that talking to someone about suicide is not planted in their brain. In fact it’s the opposite when people are experiencing such pain to the point where they’re considering suicide. They very often are reaching out for help. Sometimes they’re doing it very directly by saying I am considering harming myself and so they broach the topic, they name the taboo. But many times it is sort of metaphorical they’ll say I just I just can’t keep doing this. I feel like I keep digging a hole and I can’t get out or I just want to walk into the ocean I just want to keep walking instead of turning around and then if we’re able at that moment to name that taboo or say it sounds like you’re really hurting right now and I’m concerned about you and sounds like you might be having thoughts as well of killing yourself is that correct. That sounds hard to say but in the moment that’s oftentimes what we do need and that is what we do need to do because it helps bring the cover to the overt and when we do that we can actually do something to work on it with that person and sometimes I think it brings relief to the person as well that finally this thing that’s so taboo that even they have ambivalence about has come out into the open.
Gabe Howard: It’s fascinating to me that this is one of the myths that persist because we have all sorts of safety precautions in our society. You know, for example, nobody says that smoke alarms give people the idea to burn their house down.
Dr. Nate Ivers: Right.
Gabe Howard: Or that wearing seat belts gives people the idea to drive recklessly. Yet for some reason people feel that thoughts of suicide are so outside of the norm that they must not be able to come up with this on their own and that just even raising the name, it’s like Beetlejuice if you say the word suicide it will appear.
Dr. Nate Ivers: Mm-hmm, right.
Gabe Howard: Otherwise nobody’s thinking about it. And we’ve learned through research and understanding that as you said that’s just not true. People have come up with this on their own and by nobody talking about it it gives it space to grow.
Dr. Nate Ivers: Yeah I think that’s a really good point. Going back to suicide is a taboo subject. We’re unwilling to even consider that someone would go that far as to think of suicide and it’s easier to just ignore it in ignoring it. I think it does fester. I think it grows and I think it affects people much more than it might otherwise. The heart of it is and it’s actually really hard for a counselor sometimes to what we call name the taboo and one of the things we do in our training programs is really work with our students to get comfortable with asking that question because they even bring in with them. These misconceptions that if I bring this up I might be priming my client to consider suicide when they may not have otherwise.
Gabe Howard: And we’re back talking to Dr. Nate Ivers about discussing suicide in our community. Aside from all the misinformation or worry of putting the ideas in people’s heads et cetera I think that another common reason that people don’t ask people if they’re suicidal is because we don’t know the warning signs. Maybe we are comfortable enough to ask our loved ones if this is going on. We just assumed our loved ones are fine.
Dr. Nate Ivers: Yes.
Gabe Howard: What are some of the warning signs? What should people be on the lookout for for their friends, family, co-workers, so that they can provide that care that people may need?
Dr. Nate Ivers: Yeah I think that’s a really really good question. I think it also is tied to one of the other misconceptions about suicide is it to be suicidal one must be crazy one must be seriously mentally ill to be suicidal and so I know my friend, I know my co-worker, I know my son and my daughter, I know this person can’t be at a level of serious mental health issues and so I’m not even going to go there with them, and we know that that’s not true. Very few people who have serious mental health issues such as psychosis or schizophrenia are actually suicidal. It’s much more common for the common person to have a crisis and to struggle with some situations and then have these thoughts of suicide and so I think disassociating it from the idea of it being a psychosis may help us recognize that no it’s much more common than we might think but some of the some of the warning signs of suicide I mean one of the obvious ones is that someone is stating that they want to die even when someone says that I think we can we can sometimes discredit it. Maybe by saying, “That’s not true. You really don’t feel that way. I know you’re going through a hard time but that’s just a saying, you’re not really meaning that.” But that’s one of the more obvious ones. Another really really obvious one that we may not consider as obvious is just the enduring sense of hopelessness and despair. So I would say if you’re thinking if you’re worried about your friend or you’re worried about your co-worker or family member if they are experiencing this hopelessness that doesn’t seem to go away. That’s why I might start wondering maybe I should ask him or her this question maybe I should say, “Hey how are you? I have noticed that you’ve been really down lately.” That might start the conversation. When someone expresses that he or she is feeling like they’re a burden that sometimes is a good indicator that you might want to ask more doesn’t necessarily mean in any of these instances whether they’re feeling hopeless or whether they’re feeling like they’re a burden that they necessarily are suicidal. But it is a potential sign that they are changes in behavior can be a sign of this as well. So an individual for example who is punctual at work more recently has been coming in and doesn’t seem like he has his or her stuff together quite as much as someone who’s always well groomed and well dressed and seems put together and then comes in a little bit tattered in his or her appearance.
Dr. Nate Ivers: That might be something it might not but that might be an indication as well. Other changes of course are drinking more or sleeping more or sleeping less being more irritable and usually you seem to be fairly easy going. Lots of different things like that just kind of really focus really recognizing some of the behavioral shifts that someone has. On the flip side of this, which seems a little bit contraindicated, is individuals who have generally seemed fairly depressed or anxious or irritable who all of a sudden seem like they’re much more content or happy or that might that might be a sign that they are considering suicide and they’ve kind of made up their mind about that and now they’re feeling this sense of pain is going is going to go away. They have a sense of peace. And so that’s another thing that one might want to keep his or her eye on whereas we might think oh finally so-and-so is feeling better but it might be that they’re actually closer to wanting to move forward with the suicidal plan.
Gabe Howard: Now of course all of these that you just mentioned, they are signs. They’re not guarantees, they’re just signs.
Dr. Nate Ivers: Right.
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Gabe Howard: And we’re back with Dr. Nate Ivers talking about how to discuss suicide in our communities. So, we move into the next step which is you sort of want to broach the topic with the person who you’re concerned about this, how do you broach the subject of suicide with somebody who you see these warning signs in?
Dr. Nate Ivers: There is not a perfect way to do it obviously and some of it depends on your relationship with the person. But I think the first thing that you do is you help them recognize that you notice their pain. You help them recognize that you notice that they’re going through something, that there’s something different in their life. There are few things you can say that you know I just wanted to check in with you for a moment. I notice that you have been coming in late to work lately and you know there’s no judgment here but it just seems like there’s something on your mind or that there is something not quite right with you right now. I wondered if you wanted to talk about it? That is sort of a soft in, but in doing that you’re opening up a door and you’re also doing us what we said earlier is I care about you enough to stop and ask you how things are going in your life. So in its own way it’s kind of an intervention if the person then responds and says Yeah yeah things have been really really difficult lately and let’s say get to the point where they say it feels very hopeless. I just I just can’t keep doing it. I can’t keep living like this. Something’s got to happen. And at that point that’s where you might get a little bit scared because it looks like it’s getting a little bit closer to that taboo. And that’s where you want to maybe express that feeling. It sounds like you’re really sad right now. Things feel really hopeless at this moment. And again, you might you might be thinking, “Oh, no. This might do it. Did I just make them feel hopeless?” No. What you’re doing is you’re creating a connection you’re expressing that you’re hearing and someone actually understands to at least a degree what they’re going through. And as it gets deeper or closer to it than you say I just want to check. Are you having thoughts of killing yourself?
Gabe Howard: And you should just be that blunt? You should you just look the person in the eyes and say it?
Dr. Nate Ivers: Absolutely. Yeah. Yeah.
Gabe Howard: Why does that work? I mean it seems very scary just to ask somebody. I mean I can see why people are going to take a deep breath and think oh I could never ask somebody that it seems so insulting.
Dr. Nate Ivers: Yes. Well I think that’s one of the reasons why it’s so hard is because it’s not something you usually ask in polite conversation even things that are a little bit less taboo than that. Are you having a hard time with your drinking? How is your sex life? You know stuff like that you don’t you don’t really broach those topics very often it seems like it’s very private.
Gabe Howard: Yeah, we’re trained to avoid them.
Dr. Nate Ivers: Yeah you have to transcend your conditioning just a little bit in these instances to really provide the care that you want to provide. And in the instances where I have asked that question most of the time when I’ve asked the question is when in a counseling relationship and so it’s a little bit easier because there’s more of an expectation but other times where I have had to ask that question of a friend if they weren’t suicidal they very quickly told me Oh no no no no no I’m glad you asked that, but no. Yes I’m feeling very terrible right now. Life is hard. But here are all the reasons why wouldn’t do that. And then we move on. I believe them. In other instances where they are feeling a lot of pain. There’s usually some silence maybe a second or two. It might come with tears after that and then all of a sudden here it is. They lay it out.
Gabe Howard: Let’s say that you ask the question you say to somebody are you thinking about killing yourself. And the answer yes. Yes I am. And then you try to help them but they refuse all help. What do you do then?
Dr. Nate Ivers: That’s when it gets really really difficult. I would say if they if it seems imminent, and what I mean by that is they say that yes I’m having thoughts of killing myself and I’m scared that I really could do it at any point in time. And they have sort of a plan in place for it. And the means to carry it out. I would say what you do is you don’t leave them alone. At that point as much as you can avoid whatever else you need to do I would say stay with that person. And I would also recommend calling a crisis line. I would say look can we call the National Suicide Prevention Lifeline together and they’re going to ask you some questions and I’ll be here to assist you through that. And then we can get a better sense of what the resources are in the community and what your options are at this time to maybe help reduce this pain because I think what you want to do is help them know that I’m not just trying to keep you from committing suicide I’m trying to help you get to the point where this pain can go away. A lot of what you’re trying to do without minimizing what they’re going through is help them realize that there can be some hope there can be even a glimmer a small light at the end of the tunnel. And so that’s what I would probably start with is the National Suicide Prevention Lifeline. It may affect your friendship for a while especially if they’re not happy that you did that. I would say stay with them and say you know what we’re going to make this call together because I’m really worried about you. I can’t help you if you die. And if they leave and they say, “You know, I don’t want to talk with you anymore. I’m out of here.” Then I would call 911 and just let them know in what direction the person was in and the information that they shared with you and why you’re worried about them. I think one of the fears that a friend would have is am I doing this too preemptively? Am I calling in too much help too soon? And could that cause harm? And I would say no. I mean when in doubt, do it you need to do to help them but it may be helpful to get additional assistance. And I would say that’s what the hotline would be for.
Gabe Howard: One of the best statements that I ever heard in suicide training that I attended once is that you can apologize for overreacting as long as a person gets the help that they need. You can’t apologize for under reacting if the worst case scenario occurs. It’s sad to think about it that way. It’s scary and traumatizing to think about it that way but yeah as long as that person is alive, I can repair our relationship.
Dr. Nate Ivers: Right. That’s right.
Gabe Howard: Let’s switch gears for a moment because we know that no matter how hard we try no matter how much education there is no matter how much training unfortunately somebody will die via suicide. How might the grieving process differ for those whose loved ones have died by suicide than if they pass away for any other reason?
Dr. Nate Ivers: I appreciate your asking that question. It’s there are similarities of course. Someone has lost someone whom they love but there are differences as well. I think the differences are sort of all coalesce into one thing. It’s the taboo that we talked about earlier individuals whose loved one has died by suicide. Oftentimes experience some ambivalence associated with it. That’s not to say that people who lost a loved one from other causes also aren’t ambivalent. I would say that the swings are probably greater in terms of that going from extreme anger and frustration at the person who died to just really guilt ridden and sad about the experience as well. It’s also hard I think for the for the individual sometimes to really talk about the grieving process. Whenever someone experiences something traumatic it can be therapeutic for them to tell and retell their story. When the death is by suicide oftentimes the loved one sometimes to protect the memory of the one who died or other times just to reduce the amount of judgment that they feel from the community doesn’t feel like they have an outlet to fully discuss these situations. And so it’s difficult for the person trying to provide support for the individual whose loved one died by suicide but it’s really difficult for that loved one as well because there’s all of that ambivalence. And then there’s the fear of how it how it looks potentially to one’s community.
Gabe Howard: And what recommendations do you have for the survivors? The person who lost a loved one to suicide?
Dr. Nate Ivers: Well they have to be aware of some of the signs. Some of the behaviors that they may be engaging in that could be exacerbated in a situation one is isolating themselves too much. So although that may be their knee jerk reaction is I really can’t I really can’t do this with people right now. I really can’t speak with others about this. Staying engaged with others I think is really important and I think it’s really important if you know a family or you know a loved one who’s dealing with the death of his or her loved ones is just really keep tabs on that person. If it’s from a religious or spiritual perspective I continue to minister to them after the funeral after the memorial service after everybody else has gone home. Check in with them because you’re right it’s not it’s not a linear process and there’s certainly not a timetable on it. People will be experiencing things for years to come. I would say especially checking in during important dates like anniversaries or birthdays or holidays. I’d say recognizing that there’s no one size fits all model for grief and so knowing that the way that someone died maybe in that shocking or traumatic sort of way and then that it happened at their own hands by suicide recognizing that it’s going it can take a really long time and giving yourself the freedom to grieve allowing yourself to be sad for longer than is expected in American culture. Allowing yourself to be angry and allowing yourself to feel guilty and allowing yourself to have those emotions I think is very important. Preparing yourself for reminders. We think about this a lot when people have post-traumatic stress disorder that they’re going to have triggers but grief has a similar element to that. But being aware that there will be things that come up that will trigger their intense emotions. I would say having sort of a plan in place to handle those situations when a certain public or when it’s at work. And lastly which I think is the really important one is there are support groups for individuals and families affected by suicide. And so there are lots of grief and loss groups but I would say finding one that is specific to the type of loss that you’ve experienced which is your loved one died by suicide because you will be amongst individuals who will be speaking a very similar language who will be able to empathize with your situation in a way that’s different from those who have lost loved ones in other ways.
Gabe Howard: Dr. Ivers, I can’t thank you enough for being on the show and I can’t thank you enough for the work that you do to help demystify the warning signs the symptoms and everything that surrounds suicide. As we said at the top of the show it’s one of those things where everybody’s heard of it but nobody seems to understand it or know how to prevent it or know what to do about it. And I really think that the work that you’re doing will absolutely save not only the lives of the people who are contemplating suicide but the relationships of the people around them. The amount of misinformation that gets tacked on to this already misunderstood thing is just incredibly massive and it makes a scary thing all the worse.
Dr. Nate Ivers: Thank you so much for having me, and for giving us a platform to share a few pieces of information to hopefully help people who are trying to figure out maybe for themselves what they need to do or for their loved ones or for a friend of a friend. I appreciate your willingness to bring up the topic is so important and for some so difficult to broach as well.
Gabe Howard: Again thank you, Dr. Ivers, for being here and thank you everybody for listening. And if you are listening interested in learning more about a master’s in counseling degree from Wake Forest University, I highly recommend that you head over to counseling.online.WFU.edu and see everything that they have to offer. And remember you can get one week of free, convenient, affordable, private online counselling anytime, anywhere simply by visiting BetterHelp.com/PsychCentral. We’ll see everybody next week.
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