Abrupt suicides, such as the recent suicide of dancer Stephen tWitch Boss, startle society with the unresolved grief from deaths we can’t understand.
The abrupt suicide of someone we know, either as a family member, friend, or just acquaintance yearns for psychological treatment to address the unresolved grief. This is especially so when they appear, by all accounts, to be doing well. What went wrong? What did we miss? What can we do?
As a clinical and forensic psychologist, I have always maintained we will never stop all suicides, but our impossible goal should still be to try. It is a human and moral argument to seek zero suicides even based on the reality that it cannot be attained.
Overall, suicide has increased and especially in many segments of society. Extensive and prolific data and discourse are provided by Princeton economist Anne Case and Nobel Prize Winner Angus Deaton in describing deaths of despair:
Here are some basic signs that mental health professionals have learned from assessing suicide. Suicide is most likely to occur when:
- the person’s depression lifts as they have more energy;
- the person expresses feelings of hopelessness;
- the person suddenly becomes more cheerful and reports everything is going to be fine;
- the person gives away belongings;
- the person stops doing things they really like to do;
- the person has no support system;
- the person has previously attempted suicide;
- the person has access to pain meds and guns;
- the person’s mood is unstable per a mood disorder or a serious mental health disease.
Here’s where you come in. We seek a public discourse with suicide researchers, clinicians, and experts.
Would you please respond with a comment in this LinkedIn post to address some or all of the questions below about suicide? We plan to share the results in as cohesive a format as we can.
1. Have you had any type of experience with an abrupt suicide?
2. Would you posit any reasons for an abrupt suicide, distinct from a suicide where there are warning signs?
3. From your experience, direct or indirect, what can you recommend as a societal message with regard to abrupt suicides?
4. Do you believe that, in general, there is always a warning sign for a suicide?
Written by Dr. Jay Slosar
Commentators
- A Badge of Honor Samantha Horwitz
- Agustín Alejandro Batto Carol
- Al Levin
- Alan Krawitz
- Anthony Hurley, MEP, CPP®, PCI®, PSP®, CPD, F.ISRM
- Azim Khamisa
- Barbara Rubel, Compassion Fatigue Speaker
- Becky Lomaka, MA, CT
- Brian Wall
- Brian S McCallum
- Candance Camper
- Chad Michael Bruckner
- Charles R. Nunn
- Christina Harrington-Stutzmann
- Christy Kobe, LCSW EMDR Certified Trauma Therapist Polyvagal Theory Anxiety and Stress Therapist
- Dana Milakovic PsyD
- Danny Ray Crum Jr.
- Diamond M.S.,Psy.D. Clinical Psychology Doctoral Trainee
- Dr. Jay Slosar, Psychologist
- Dr. Daniel Roberts
- Elreacy D.
- Jen Libby, MSW, LCSW
- Jenny Thrasher
- Jim Nico
- Joan Childs, LCSW
- Johanna Courtleigh, MA, LPC, CHT
- Joseph Belliston
- Karina Kim, PhD, LCSW, LCADC, CCS
- Kathryn L. Goetzke, MBA
- Kriss Kevorkian, PhD, MSW
- Kristen Jacobsen, LCPC
- Leslie Baker MFT, NCC, RPT-S
- Melanie Weller
- Michael Puldy
- Moniqua C.
- Murat Arslanoglu
- Olga Nikolajev (she/her) RN, MA, FT
- Paty Lopez
- Peter Getoff
- Phyllis Mogielski Watson, MS, PsyD (AZ/IL/CO)
- S. Frances Robbins
- Sarah Tomer
- Stephanie Rodriguez, GCCA-C
- The Psych Effect Podcast
- Tori M. Kelly OBHP
- Traci Ippolito M.S., MFT
- Travis D. Johnson, MHR
- Veronica J. Kovach-Dodd
As a possible solution I would make front line experience in dealing directly with suicidal patients as a must for clinicians. Not just training, they can get and ignore, but direct experience with suicidal patients/clients--.as a minimum--time on a suicide hotline should be required.
With my 20 years of experience as a crisis intervention expert--I saw an incredible amount of ignorance, neglect, and fear in regard to the symptoms of possible suicidal ideation. Tere were always signs! Granted some of the signs were subtle--but the fear among clinicians of talking about and facing suicidal risk just exacerbated the whole problem. The slow suicide of drug and alcohol abuse, though, not abrupt--just as deadly.
As someone who is currently in training (last year) and into trends I have found many things that I would love to research. I work with trauma and the SMI population. I have stopped my clients from attempting again and or cutting. I believe first and foremost I create a genuine connection (therapeutic alliance) but past the DSM, and the lingo/ and how we are trained or suppose to be. I treat them as a person. I also provide psychoeducaion on the data we found and ask them one important question. Are you trying to die or are you trying to stop the pain? I explain the stats which open many of my clients eyes. I track a daily card, essentially data for me . I am able to see that during suicide ideation , hopelessness, anxiety is high, wanting to hurt others is low, feelings of worthlessness is high, depression is low. My clients have stopped cutting and stopped attempting whether its long term I dont know, whether its something I am doing, i dont know that either. I believe we are missing anxiety and impulsively because we are so focused on the act of suicide itself and depression. I'm a big believer in it only takes one person to make someone feel cared for even if it's your therapist. As humans we want to connect .
In 2009, I lost my first wife to suicide. Because of her mental state, I was aware of this possibility, but only a few signs of suicide described above were visible. We talked about it, she wasn't giving away possessions, and there were levels of hope; however, she was ignoring her support system, she was frozen with indecision on the right next steps in her life, much less her day, and I had no idea how many meds were in her possession until after her death. In retrospect, I should have performed a complete search of the house for meds. Unfortunately, even with excellent training and knowing the signs of possible suicide, I don't believe there's any magic bullet here. Different people respond and react differently. I have discussed this with both professional therapists and as part of group therapy sessions with those who lost a loved one.... there is no true clear pattern. On the flip side, it feels like all suicides are "abrupt." Nevertheless, I have seen through communication and education, plus open discussions like this, we are getting through to people who are either in a depressed state or know someone who needs help. Lives are absolutely being saved.
What is compelling to me is that being boots on the ground with teens for 20+ years - I think the “means” has changed - In my suicide assessments of teens, previously overdosing was the most common method reported to me and a shift happened around 2010 where kids reported going to YouTube to learn how to “tie a noose” - remarkably, YouTube continues to keep the how to hang myself and how to tie a noose videos up despite the rising rates of suicide in young people by hanging. They are well aware of my concerns as I have repeatedly spoken to the YouTube team and members of Congress on this issue with Rep. Susan Wild leading the push against YouTube, having lost her partner to suicide in 2019. We know delaying access to the “means” will prevent impulsive suicides - how YouTube refuses to provide any reasonable action here is beyond comprehension. I do have experience with abrupt suicide losing a friend in high school which became much of the reason to become a therapist for teens and now built the Promly app for 13-19 year olds - (Promly.org) to help get ahead of the teen suicide and mental health crisis with an empowering social network that also provides accessible mental health support for all kids.
Most clinicians have had some experience with an abrupt suicide. It unfortunately comes with this field of practice. The reality is that if an individual wants to kill themselves & makes that choices there is nothing that will be able to stop that. Which is what leads to the abrupt suicide. The warnings come when people are ambivalent & that's why they have to be taken seriously. And since there are those that aren't ambivalent, when you have someone that is you are seeing someone that is asking for help. It's important to do that. Those people can be brought back from suicidal ideation.
I am a suicide survivor! Multiple ideations and attempts over a 20 year duration. None in last 10 years. Effective psychiatric care and family support are paramount! I owe a debt of gratitude to my VA Psychiatrist of over 11 years. She provided me with the former despite lack of the latter.
Hi, I will answer from my experience in Thanatology (Grief Counselor), btw, I'm happy to see the interest on this topic, and the importance of attending it before it's too late: 1. Yes, I have. 2. Every case is different, however, in some cases there is a specific trigger related with an unsolved issue, and when it is added to a previous suicide attempt, the effect of the trigger is stronger. 3. They can be prevented with a strong social network. That's why it's important to leave the phone in the other room and provide time (real time), attention, active and honest listening, and empathy to those who surround us. You never know who faces a situation that may push them to an abrupt suicide. 4. I don't believe that there is always a warning. In some cases there might be, however, sometimes individuals tend to become experts on hiding real feelings (sometimes it's related to the root of the problem). If there is, it may need a 24/7 follow-up to identify it, since we need to observe the day-to-day environment and the individual's response to it. Plus, there are cultural differences that we need to observe (i.e. LATAM vs. North America dynamics).
Thank you for your work, it’s highly important that we discuss suicide and that it gain more viability, specially in a social network about work. Where people only post succes content.
As a Grief Counselor, I've worked with those who have considered or survived suicide themselves, as well as the loved ones of those who have completed suicide. In both instances, I've found that what may seem like an "abrupt suicide" often isn't at all. At least it isn't an "abrupt" decision in the mind of the person making it, despite the fact that the completion of the act may seem abrupt to those around them. Here in the United States, we live in a death-denying, grief-phobic society which makes it difficult to talk to each other honestly about death in general, much less about suicide specifically. And yet, it is only in honest discussion that we can hope to identify the "warning signs" specific to each life, to each individual human being -- signs that go beyond any general list, however well-intended that list may be. What I've found to be in starting this discussion is asking not, "Are you having thoughts of suicide?", but rather, "Do you feel like you don't want to go on living?". A subtle difference or just a matter of semantics some may say, but I find that the latter leads to honest discourse more often than the former. And that is, at least, a good beginning.
First and foremost, I believe we as a society have to get back to valuing life and promoting well being. We have to continue to link medical and mental health wellness and teach people the value and importance of the connection of the head and body, the heart and the brain, feelings/emotions and physical health. In my years of experience, it is this disconnect that pushes people into the state of confusion, despair, and the inability to see resolution to whatever “catastrophic” perception they are having at that moment … when they decide it is the end for them. The distortion of thought, personal disappointment, perception of weight of the world seem to be exacerbated by internal or external conflict, stressors and worries, poor nutrition, sleep deprivation, medication, other perception altering chemicals, combined with despair are the recipe for abrupt suicide. This is a complex human process filled with even more complexities for anyone trying to assess risk of harm - threat of death. Perhaps this is why I was trained to take all fantasies, threats, or actions toward suicide seriously and act accordingly; do the best one can to ensure safety. Even so, some people hide it so well their actions still surprise us.
Personally I have experienced grief due to suicide death and professionally as a Thanatologist the study of suicide is very multi faceted and interesting. I do not view all deaths as abrupt as we can prepare and plan for a death that is anticipated. From what I have observed we have been taught as society to be aware of the signs and put in place prevention in order to disrupt the suicide which as you say is a good thing. Some people do not show "signs" of distress and may or may not show signs of their suicide intention through the behaviors mentioned which leaves the bereaved experiencing compounded grief: loss of the person and loss of not being aware. Suicide deaths and grief as a result of this type of loss is complex and therefore often difficult to talk about, learn about and teach about. Thanks for asking for my input.
I think it's important to revisit psychologists Edwin Shneidman's concept of "psychache," the unrelenting mental anguish, that can be a driver of suicide. Also, psychiatrist Viktor Frankl's calling attention to the "existential vacuum" and loss of meaning as a contributor to one's self-destruction is important to keep in mind. Suicidologist Thomas Joiner's model of suicide - - with its emphasis on thwarted belongingness, acquired ability to enact lethal self-injury (by habituating to pain and overcoming fear of death), and perceived burdensomeness to others - - is likewise of relevance.
From what I've observed... When someone seeks help from mental/medical health professionals, those professionals don’t often create the space to listen b/c they’re busy considering all the interrogating questions they need to ask in order to cover their butts just in case the person does harm themself. Ram Dass used to say that we should be able to answer the same questions we’d ask of our clients. But how many professionals do that? I don’t know anyone who hasn’t thought about suicide in some form or another, or felt safe to explore their thoughts with someone else out of fear they might be “sent away.” If we aren’t willing to openly speak about suicide, how are people considering suicide going to feel safe enough to share how they are feeling? I speak about suicide in grad psych classes I teach. If students hear about it in other classes, they're taught what they should do if they have a client who is “suicidal” but there’s no discussion about how to listen to someone who is considering suicide. Given all the challenges we’re dealing with today, isn’t it reasonable and perhaps even a “normal” response for some people to experience a psychache as Dr. Edwin Shneidman discussed in his work? Just my two cents…
I experienced an an abrupt suicide attempt involving an older family member this past Feb. While there was talk of feeling depressed, as well as a previous attempt going back 30+ yrs. I never thought this person would ever attempt it again because they had received treatment, had ongoing access to treatment and medication, was physically active, and displayed a somewhat positive outlook. What I missed was the constant comparing to others in the same age bracket who seemed to be doing "better." Damned social media! I'm a fmr first reponder and now work in the first responder and veteran space. We are great at masking our emotions. But I believe there are always signs of some sort. From showing up late to work when usually punctual to someone's uniform being out of sorts when always neat. As trained observers, e need to take the time to "notice" our bothers, sisters, and battle buddies. Ask if the'ye doing okay pointing out the specifics of what's out of place and for goodness sakes if they respond with the words, "I'm fine," help them open up whatever it takes. "I'm fine" is code for "I'm not fine at all and I'm scared to say anything, but please help me."
This is an important although distressing topic because of the lack of answers. Even after all the research and prevention programs, we still don't know why suicide rates continue to increase since the turn of the century. We do know some ways to decrease suicide, but there is no conclusive evidence as to why it keeps going up. I'd like to offer some personal yet unpopular suggestions as to why suicide rates are increasing and how I believe we could dramatically reduce the amount of suicides especially among our teens. We know that that suicide usually occurs within a 90 day individual crisis period. If one who is contemplating suicide can get through that 90 day window, they are statistically far less likely to take their own life. What is missing in that 90 day window, however, is support and hope. With the rise of mothers working outside the home, more kids in day care, and the continuing decrease of faith in God, no wonder we see a rise in suicide. If kids feel neglected at home, and won't turn to God for help, feelings of isolation, loneliness, hopelessness, and unimportance can take over, and it's very difficult to reverse those thoughts and feelings.
I have lots of experience transforming this in my patients. This is strictly and input-output issue that has the vagus nerve in mechanical lockdown so the brain cannot receive clear input and it slows the visceral motilities (in an osteopathic visceral mobility sense) making the person feel energetically dead - they are just trying to match on the outside what is happening on the inside. It is measurable biomechanically.
As a school psychologist I’ve unfortunately had several experiences with abrupt suicides involving youth. With teens and children it is difficult to know when a suicide will be completed as those who are troubled tend to threaten suicide frequently and all must be taken seriously. I’ve had to sit with parents who’ve lost their child from suicide and it is nothing short of devastating. Taking care of them and yourself is vitally important. I’ve seen suicides completed by youth where there were signs and some with no signs at all. Those who threaten suicide offer us a vital chance to intervene while we are often helpless in the face of a child’s abrupt suicide. I think the most important societal message is one of compassion towards todays youth and the mental health challenges they face. Having one caring adult in a child’s life can transform their life experience into that of feeling cared for and having importance. No I don’t believe there is always a warning sign making abrupt suicides tragic and a mystery with which to make sense.
Sometimes there aren't any obvious signs or warnings in instances of abrupt suicide. Sometimes indicators and rationale become more apparent when performing a psychological autopsy. Everyone has their own limitations and threshold for psychological and emotional pain. What might seem tolerable to one individual may be too much to bear for another individual. I think there should be greater consideration of what Shneidman theorized regarding unresolved psychache and unfulfilled needs when seeking to understand abrupt suicide. Our societal message should be that any and every risk of suicide should be taken seriously. We all have the potential to save someone's life. Similarly, none of us are immune to death by suicide. We need to be more mindful that everyone has this capability and become more proactive in how we reduce the stigma surrounding suicide and the factors that drive its likelihood. Not everyone will exhibit the exact signs we associate with an increased risk of suicide and sometimes warnings manifest in ways that we might not anticipate. Likewise, there are many individuals who privately suffer from untreated psychiatric conditions, trauma, and unresolved pain while their social circle remains entirely unaware.
There are not always definitive warning signs for suicide, abrupt or otherwise. While it’s possible for those closest to the person who has completed suicide to reminisce and dissect interactions and circumstances, sometimes pain, despair, and hopelessness are known to that person alone. Through my experiences as a Certified Christian Life Coach, Thanatologist, and with further specialization in Pastoral Thanatology, I am reminded that those who are suicidal may or may not have their own timeline or agenda. Someone truly contemplating taking their life may be experiencing a mental health crisis, a crisis of faith, or a lack of lasting purpose. Experiencing an “epidemic of loneliness,” our society sometimes lacks true and lasting connections with each other. We cannot underscore the role of isolation, and the toll it takes on people – who may or may not exhibit outward signs or symptoms of needing help. This is when we are called to look inside to embrace mankind and take measures to share love, care, and serve those around us.
1. Have you had any type of experience with an abrupt suicide? Yes, I have had an experience. He was my class mate from college and school mate from university. 2. Would you posit any reasons for an abrupt suicide, distinct from a suicide where there are warning signs? He was vessel machine engineer who was sailing during half of the year at least. In my opinion, working and life conditions without family support, at least on sailing. In this point I also would like to point out that recently perception management technics are quite popular and effect people life. These technics directly aim person social and business life. After regular continues application, person reach the loss of awareness and is not able see difference between reality and sensation. 3. From your experience, direct or indirect, what can you recommend as a societal message with regard to abrupt suicides? Family support and of course mental support by medical professionals are very important. However , other reasons like perception management technics should be study by academically for preventing more losses. 4. Do you believe that, in general, there is always a warning sign for a suicide? I don't believe, but signs possible.
1. As an adult psych nurse practitioner, I frequently encounter folks in mental health crises and have experience with abrupt suicide. These instances are deeply distressing, impacting the professionals, families, and communities involved. 2. "Abrupt" suicides happen without clear warning signs or known suicidal ideation. Reasons could be individuals concealing their distress, impulsive decisions due to life events or substance use, or untreated mental health issues. Each situation is unique and complex. 3. It's crucial to promote open conversations about mental health. Encouraging individuals to seek help when needed, promoting mental wellness, increasing access to mental health resources, and reducing stigma are vital. Understanding that absence of signs doesn't guarantee mental well-being can prevent tragedies. 4. Warning signs often precede a suicide but might not always be present or recognized. People vary in behaviors, and some may hide their intentions. Recognizing potential warning signs is essential, but promoting mental wellness and accessible resources holds equal importance.
1. Yes, my own daughter, a clinical psychologist, who plunged to her death when she was 34 years old. 2. I don't believe it has been thought out by the individual. I believe it is either an impulsive choice by an act of being triggered by a past trauma or an episode related to undiagnosed depression or mania. This is often the case with teenagers. They take a temporary problem and solve it with a permanent solution 3. In the case of my daughter, I spoke with her just two nights prior to her suicide. I asked her directly if she had any suicidal ideation. She firmly denied it. I thought she might have lied. Her psychiatrist did not believe Pam was suicidal, however, psychotic. I told the psychiatrist that she may have a delusional demand to kill herself. Pam never made it to her appointment. She jumped out of a window the morning that she was to see her. From my personal experience, I doubt we are capable of thwarting an abrupt suicide unless we are there in the moment of attempt. 4. Yes, of course in most cases. In abrupt suicide, I think you have to be clairvoyant. I believe in the destiny of an individual. PS I had to delete your questions to provide adequate answers. I could not write my entire response.
As a mother of five, psychotherapist since 1978 and an author, I have had both personal and professional experience with abrupt suicide. My book, WHY SHE JUMP? My Daughter's Battle with Bipolar Disorder chronicles her struggle with bipolar disorder, her abrupt suicide and my grief. Pam was a clinical psychologist and thought to be a "wizard" therapist by her colleagues.
As a certified thanatologist working in a mortuary, I have experienced working with many families whose person suicided. It's interesting that, initially, families feel that the suicide was abrupt yet during an intentional conversation with them and asking about not only the death of but also the life of their person, they begin to share subtle warning signs. Regarding reasons for an abrupt suicide distinct from suicide with warning signs, there tends to be a recent significant loss (job, relationship, medical diagnosis) along with isolation and substance abuse. As far as a recommendation for a societal message, we need to stop the stigmatization of mental health issues and provide needed resources starting early. We need to help people realize that hope and hopelessness are not an "either/or" rather a "yes/and". Suicide, including abrupt suicide, can elevate the risk for complicated grief of the bereaved. They frequently report feelings of intense guilt, feeling unloved by their person who suicided, anger, and an intense loss of their assumptive world. At this point the work begins to help the bereaved "find their North" and learn to discover a new versions of themselves now that grief has touched their lives.
In my thirty-plus years in practice, I have lost one then-ex-client to suicide. She came from an extremely abusive family, and after years of suffering and hard work had finally settled into her body and a quieter mind, allowing herself nourishment, love and a partnership with a beautiful man who was deeply devoted. They had been on vacation, and having had a wonderful day, when he went out to pick up some dinner, she locked herself in their hotel room and killed herself. There had been so many times she had teetered full self-destruction, and now happier and healthier than she'd ever imagined possible for herself, I can only imagine wanted to go out on a high note, the end of a perfect day. Her partner called me, frantic. She was gone and he was desperate. So, yes, abrupt suicide can come out of nowhere. On the best day. On the last day. No warning signs. Simply happy and not believing that could actually endure. Johanna Courtleigh, MA, LPC
Years ago, during the holidays, I received an unusual call from someone that was dealing with a divorce. To this day I cannot explain why I knew that they were in the final stage of committing suicide, but during the call I saw 'Red Flags'. I was out of town at the time, but was able to get a Sheriff headed to their location. Through the grace of god, a trusted friend, and a very calm and patient Deputy Sheriff, this individual agreed to voluntarily check themselves into the hospital. The help they received was instrumental in their mental recovery, and gave them the tools to live life. I am glad to say that they survived. Longest day of my life.
When I think about messaging related to suicide or mental health in general, I focus on the need for what I would term a "personal safe space". As noted in one of the other comments, this is where you can be your authentic self. That may mean that you are honest to a fault with someone without feeling judged, or it may be a relationship in which you can say nothing and are not pushed to do so BUT that person knows your silences well enough to judge when they need to reach in instead of expecting you to reach out for help. We message so much that people need to "ask for help" or "I'm always here" but when you feel hopeless, the perception is often that those messages don't apply to you. We need to help the public understand that kindness and simple (authentic) questions around leaning in are vital to the support of individuals coping with mental health needs, especially depression.
I agree with the indicators listed above but I'm surprised to see two glaring omissions. The two leading indicators of suicide, as stated in the National Strategy, are sleep disturbance and financial instability. Number three is the lack of community/purpose. For otherwise healthy adults, 1-2 nights of poor sleep quality provide some impact on daily activities. When a person begins to have 3+ consecutive nights of sleep disturbance, the person starts to lose their ability to problem solve. If it continues, nearly any problem can become 'unsolvable' and permanent solutions become more attractive with suicide as a real possibility. It really sucks when someone gets an unexpected bill of $150 and can think of no alternate solutions. I've been personally impacted by suicide 13 times. Those friends and colleagues chose to end their suffering and send shockwaves through their communities. As a veteran, suicide prevention is on all of our minds. Many of us have daily, weekly, monthly, and quarterly check-ins with other veterans, community, and family members. This helps us as veterans and helps us keep tabs on others who are important to us. How can you help? Engage with your community! Call or text 988 the suicide hotline!
1. Have you had any type of experience with an abrupt suicide? Yes, as licensed clinician this has been an issue in my career, & with friends. It was shocking at the same time my colleagues and I were able to review and discuss the situation in a way that allowed for a deeper understanding of suicidal behavior, pain and suffering. 2. Would you posit any reasons for an abrupt suicide, distinct from a suicide where there are warning signs? In my experience and in the research particularly regarding children and adolescents much of abrupt suicide is linked to impulsive behaviors. I definitely see suicidal thoughts and behaviors linked to impulsivity in practicing with youth. The research also posits a link to substance use and the connection to mood swings & brain development and emotional processing. 3. From your experience, direct or indirect, what can you recommend as a societal message with regard to abrupt suicides? Develop an understanding that many people do provide risk factors, warning signs and protective factors. Be aware of potential risks of abrupt suicide, like impulsivity, substance use and warning signs. 4. Warning signs aren’t always there, so Ask directly. Are you thinking of killing yourself? Help- 988.
1. Personally, I have not had experience with an abrupt suicide but my mother attempted suicide 7 times. Professionally, I have experience with one of my student-client's stepfather. 2. I would be incredibly hesitant to posit any reasons for an abrupt suicide, distinct from a suicide where there are warning signs. Dr. Midkiff once said that 'good' psychology often raises more questions than answers. 3. Again, I'm hesitant to recommend a societal message with regard to abrupt suicides because I cannot guarantee the reliability of my experience to the rest of the world so to speak (i.e., my experience may not generalize because no two people are exactly the same and no two perspectives...even those of the most highly experience...may yield same, similar or reasonably consistent interpretations or insight.) 4. I believe that there may be signs for a suicide but I don't believe I can definitively say the same are 'warning' signs.
Thanks for this post. So important. 1. Yes. I lost my dad to suicide and had my own attempt in my 20s. I have regular suicidal ideations, yet the difference is now I know how to manage them. 2. Sometimes yes, sometimes no. Here is the challenge: Hopelessness is the SINGLE consistent predictor of suicide. And the problem? We ALL experience moments of hopelessness all the time, it is how we manage the moments that matter. 3. That we can end suicide. And must ensure every single person is taught what hopelessness is, and how to manage it. 4. It is impossible to predict who will die by suicide, as we all experience moments of hopelessness. There are signs, sure, yet you will never really know. All we can do is teach the skills, the work is up to the individual. I can't save a person long-term, no matter how much I want to do so. Maybe for a moment, yet I must equip with skills. I can only truly save myself. We are taught to manage our blood sugar, regardless of if we have diabetes. Why are we not taught how to manage hopelessness? People don't want to die, they want hopelessness to end. Anyone has the power to do it, they just need to be taught how. What I call the 'how' of hope. #ShineHope
As a neuroscience therapist dealing with community, health, law enforcement and military populations, what I learned is that when multiple stressors build up, ie from work, relationships, financial issues, family, etc. there is a much higher chance of client spiraling down the waterfall of depression into suicide. Key to preventing this is a “battle or life buddy” that you meet with regularly (weekly is best, virtually or in person) and be brutally honest about what’s going on in your life, good or not so good. I created the acronym “HELPS”, meaning talk about your purpose in life (and what you look forward to), emotional regulation, (have you been moody and why?), label negative emotion and create a plan to resolve and initiate plan (ie meet w/ Buddy, journal, walk the dog, call your therapist). Kindness and grace for others in routine interactions can also make a big difference as you never know what is going on with someone. Support groups are vital, whether that be a hiking, meet-up, church, mosque, temple, or other social group. We are made for connection and need it to survive and to be healthy. Re: Twitch’s abrupt suicide”, I don’t feel he committed suicide yet it was a sinister homicide as 2 people were in the room.
I do not believe that there is always a warning sign for suicide. I work in the Veteran field and many are very, very good about hiding what is going on inside them. There are few people that they can trust with their stories and feelings. They might be afraid that their fellow service members will think they are weak and they feel that civilians won't understand. They might let things bubble and bubble inside until they break down one day and die by suicide.
My father died by suicide while I was in the hospital giving birth to triplets. The abrupt nature of a suicide can complicate the mourning process, bringing about disenfranchised grief. As a thanatologist, I recognize that all deaths are abrupt, no matter the manner of death. With suicide, in particular, it's abrupt, no matter how many warning signs or risk factors are known. The societal message about abrupt suicides is to ask the right questions concerning this stigmatized death and often ambiguous loss: Did the person who died perceive that they were a burden to their family? Did they come to a place in life where they felt that they no longer belonged? Did they no longer fear death? Clearly, suicide would not be a public health problem if there were always a warning sign.
Suicide is obviously incredibly complicated and complex. I believe that one of the most important issues in order to prevent the non-abrupt suicide attempts is to normalize conversations around suicide and mental health. The research shows that, on average, people live with depression for ten years before reaching out for support. We need to remove barriers and make it easier for people to reach out for help when struggling. I think, as in my own case, there can be a time of contemplation over suicide. People need to know how important it is to reach out for help when it gets to that point. I found myself, when deeply depressed, sitting in my dark bedroom, alone, with my laptop on my lap doing a google search on suicide. The very first site I go to showed a list of methods along with a chart to show how long until the impending death and how painful on a rating of 1-10. I slammed my laptop shut not understanding how I could have ever gotten to that point. Yet...I still didn't reach out for help at that point. As far as the abrupt-suicides, it seems to me, that in most cases (this is only anecdotal), many friends and relatives of those who have died seem to believe that there were surely signs when looking back.
I'm a licensed therapist who has done numerous suicide risk assessments and inpatient hospital admissions. I think the suicide feels abrupt to the loved ones of the person who completed suicide, but it's likely that person had been battling with depression or some other mental health concern for a very long time. Although it's improving, there is still a lot of stigma surrounding mental health concerns. I think the pandemic brought mental health treatment to the forefront of the conversation and has normalized it a lot more, but it takes time to change old belief systems. Many people don't feel comfortable seeking out mental health treatment to intervene before it reaches the point at which they contemplate suicide. The warning signs listed above are definitely things to look out for, but we can't always know what's going on for someone internally.
1. Have you had any type of experience with an abrupt suicide? Yes. On several occasions as a clinician and most recently with an extended family member. 2. Would you posit any reasons for an abrupt suicide, distinct from a suicide where there are warning signs? In my experience there are times that the individual offers NO signs of suicidal ideation or a plan to harm themselves. I also believe that sometimes individuals can act on an emotion in such an extreme way and have no long term intentions of actually dying by suicide. However, sometimes their efforts leave an undesired outcome. 3. From your experience, direct or indirect, what can you recommend as a societal message with regard to abrupt suicides? Focus on developing a reliable support network in which you have at least one person that you can be raw and brutally honest with at all times. Also, be intentional about chasing your "Why?" and never be apologetic about self-care. 4. Do you believe that, in general, there is always a warning sign for a suicide? No, I do not. I try to avoid thinking in extremes and "always" seems to most often "never" exist. ?
Important topic, Jay. I have lived experience with suicidal ideation and it stemmed from a perceived lack of control and hopelessness. I went through a event that caused depression and poor coping strategies. I also was processing trauma from the military and policing. Add a dash of toxic levels of stress and it was a powder keg. Luckily, with the assistance of many I was able to recover. This is a passionate topic for me. It’s hard to put into words when I see someone with tons of potential that isn’t being developed and invested in. We are social creatures and without routine connection to things and people that are important to us, our emotional health suffers. That’s what happened with me. I felt more valuable to my family by not being alive because I was letting them down. That’s what I perceived, it’s flawed reasoning that I didn’t see in the middle of it. I was a peer support officer and that experience helped me tremendously. Thanks for starting these conversation. So important. I’m finishing a very personal and powerful book where I talk about this a lot so it’s cathartic for me. Thank you!
I'm not a clinician and haven't done much research into the issue of abrupt suicide but I think that there are usually signs that someone is contemplating taking their own life. In my job, I'm exposed to people who take their own life with some regularity and I always wonder why, even when colleagues (many who've become de-sensitized to it) just accept it as part of our job. Personally, I think it's usually a major, negative life event that triggers it (death of loved one, loss of job, divorce, etc.) but more than that it's people around the person in trouble fail to pay enough attention to the signs, which I think are usually there. Everyone is busy and has their own issues to deal with but sometimes, if we just pay closer attention to someone else's troubles, it might just save a life.
1. Have you had any ... experience with abrupt suicide? I conducted psychological autopsies on ppl who died by suicide on railroads. Many who died on train tracks took alcohol and/or drugs (not all had substance use disorders but likely needed these for courage to die by suicide), lost love or didnt have love, had mental health issues (i.e. uni/bipolar depression), $ issues. 2. Would you posit reasons for abrupt suicide, distinct from suicide w warning signs? I believe that losing love/not having love and changes in relationships is a major life issue that contributes to abrupt suicide. 3. ... What can you recommend as a societal message with regard to abrupt suicides? Having love is essential to life like water. People can find support and work on themselves with or without love by having a life worth living with hobbies, passions, & relationships that are meaningful until finding love. 4. Do you believe ... there is always a warning sign for a suicide? There are warning signs of hopelessness. Homelessness, loss of job, loss of a partner, & a lack of support, can be warning signs. It takes courage to die by suicide. It takes courage to ask tough questions if one is suicidal. Ask tough questions to prevent suicide.
As a society we need to focus on collective grief associated to abrupt suicides.Systems are dysregulated,and we need to make a plan.Is it more about the acceptance of the world we thought we knew?Individuals can be egocentric.The more time that we invest in OUR need to understand abrupt suicide may be unrealistic.We are never going to know everything,we need to accept this. Maybe our time is better well spent on increasing our abilities in being more compassionate for suffering or the possibility that something greater then ourselves is operating here?Who are we to say,"What went wrong?"verses acceptance that they finally found their"peace".Our inquisitiveness is missing the opportunity together to connect to our experiences of grief to help normalize unknowns.We need to focus on what we can control,then what we can't.Is this about changing our words which will change our mindsets?Recognizing that our collective suffering in not having all the answers enables us to be together in those similar ways.Are we missing this point on all accounts?Aren't we all really grieving are own definitions of what is"normal"to us? Our brains are wired for connecting, who are we to say what people should be connected to or"how"people connect.
Abrupt suicide may occur when a person comes face to face with major life-altering consequences like being served with divorce paperwork or getting the last in a series of DUIs that will result in major consequences. Those most likely to die by suicide are usually white male individuals with access to a firearm. Unfortunately, there are not always warning signs of someone’s plan to end their life by suicide. Also, grieving the loss of a loved one who died by suicide is usually much more complicated grief and even traumatic than grieving someone who died after a long fight with cancer or chronic health conditions.
Christy Kobe, LCSW EMDR Certified Trauma Therapist Polyvagal Theory Anxiety and Stress Therapist
I have worked as a consultant, trainer, supervisor, and psychotherapist in the clinical/community social work arena for over forty years. I have conducted dozens of suicide-risk assessments, I have treated scores of suicidal individuals, and have unfortunately been in the position as part of a team conducting psychological postmortems for suicide victims. I don't conceptualize the problem in terms of "abrupt suicide" separate from other kinds of suicide. I believe it is a profoundly sad and tragic event when a fellow human being takes their life. Yes, since the beginning of time human beings have been engaging in this behavior. But why do they continue to do it?-yesterday, today, and tomorrow. The solution?-because I wish to keep this comment brief I will say that it may sound like a cliche but we need a national, federally-supported commitment, supported by big bucks to expsnf services that will indirectly and directly address the multi-faceted causes of suicidal behavior (successful and unsuccessful) Peter Getoff, MA, MSW, LCSW Human Equation, Founder Consulting/Training/Clinical Services West Los Angeles Offices Remote services available nation-wide. Business cell 310 729-6460 www.humanequation.net [email protected]
In the 20+ years that I’ve been trying to understand suicide I’ve learned that there are 3 factors that put someone at the greatest risk for suicide. When we understand these 3 factors, we understand that it can happen to anyone as well as how to actually intervene and help someone in need. You can read more about it in the following blog post. https://www.allthatweare.com/post/the-3-factors-that-put-someone-at-greatest-risk-for-suicide
In my personal experience and extensive research, I have witnessed the despair that arises from broken systems and the frustrating tangles of bureaucracy. The lack of funding, affordable housing, shelters, and job opportunities has left countless individuals feeling trapped and hopeless. It's a harsh reality: Who will give a chance to the homeless or those who have fallen on hard times? Moreover, the closure of rehabilitative mental health facilities has only exacerbated the situation. The consequences of shutting down these facilities have been devastating, leaving vulnerable individuals without the crucial support they need. It's disheartening to admit that our government, politicians, non-profit organizations, and various institutions have failed their own country people. How can U.S. support other countries when our own country people are dying off in record numbers. I recall a profoundly disturbing conversation w/the U.S. Homeless Coalition, a few years ago who revealed homelessness has persisted for over 35 years. I experienced firsthand the apathy of those who could have made a difference. It became clear to me that, many suicide victims aren't strong enough to weather the storm, and will die off with no support!
To answer questions 1 No 2. Ruminating thoughts, increased anxiety, impulsivity. 3.Societal message- Show more compassion we need to start validating people's pain and trauma. Start teaching coping strategies other than giving out a 1800 number. Also help them build a support system and find their purpose and use what they value (spirituality) etc. 4. I feel what some one feels about suicide is valid , that's all they see at the moment, but it's ineffective of course. I'm sure there are warnings signs we haven't found. We previously thought this about mild traumatic brain injuries and the research we did we believe also is a start to tracking biomarkers in the body. I believe the same is true for Suicides. Possibly low Vitamin D and hormones. We will never know unless we come together as professionals and start sharing what we know without trying to get credit for the input we gave. All we need to know is that it can save lives and that should be our motivation. After all that's what we signed up for to provide "hope" , even if it's one person.
Two points here. First social networks are important --but today people think that means their online network. Loneliness has emerged as a rising factor and concern. Second, cultural differences and cultural awareness are extremely important. Certain situations have significant meanings in different cultures including divorce, losing a job and the famous slap in the face that caused a revolt in Tunisia.
Dr. Jay Slosar, Psychologist True. It is important to talk about social 'offline' networks.
We should be talking about it in the schools.
I have found that when I ask are you having thoughts of suicide, many often respond no but many times they don't feel like going on and don't care if anything would happen to them.. This does lead to honest discourse
Clinically, you can do a risk scale for suicide but that doesn't account for how the person is feeling who is in front of you--right now. Someone may not have history or risk factors but be in a really bad place. I see many young adults who are out there functioning every day and seem ok, but are lost, without feeling of purpose or direction and internally in bad shape.
These are great deeper references and models. Everyone should read--and I hope schools still recommend it--Frankl's Man's Search for Meaning and his model of Logotherapy. It makes me wonder today with all the deaths of despair if our society is in an existential vacuum.
I think self exploration about your own deeper feelings is essential to effectively responding to others.
A family loss as you had is something that really jolts you and sends you into deep introspection. With regard to social media there is a term for social media reaction that leads to anxiety and depression. FOMO--Fear of missing out.
School age children can be so unpredictable. Even of more concern is a contagion effect when after one student tries or commits suicide others follow.
Some people are very sensitive and reactive. They are more susceptible to attempt or carry out a suicide. Those are tough cases if you are working with them and cause for setting more safeguards.
yes the surgeon general speaking out about loneliness was eye opening. It seems to me all the digital "communication" does not connect us enough to still feel isolated and lonely. This has more to do with attachment and intimacy.
One's perception or outlook is significant and why therapy can be so helpful.
Open discussions are important. Many people are afraid to talk about and address suicide.
you can post a 2nd response if you want. Teens are especially difficult. You can have a great session on Thursday but then over the weekend something emotional happens and they attempt suicide. This impulsivity is developmental and separate from delusional psychotic voices or a manic episode. Hope you are coping ok.
Thank you so much for sharing this. Bipolar Disorder is often behind many tragic suicides, accidents and unexplainable aggressive outbursts. I am sure your story has been helpful for others. All the best, Jay Slosar
"finding their north" being able to move forward the hardest time is when the funeral is over and everyone leaves the guilt from a suicide is so hard and why professional help and support groups are invaluable,
Well said Becky. Best wishes.
so hard to cope with that for the loved ones.
That is a very encouraging story. Makes me want to be very proactive with heightened awareness. Thanks.
I think discussing about how to respond or what to do when having suicidal feelings/thoughts can be preventative and critically important. in moments of despair people often go to a place that has meaning for them.
This is VERY important regarding sleep and thank you so much for bringing it up. I use sleep as a barometer and measurement stick in treatment. When sleep improves, the person gets better. I have also seen when a person can't sleep because of pain, after a while they just have had it and commit suicide. Sleep quality is definitely correlated to suicide and an important risk factor. Financial instability relates closely to all the research by Case and Deaton as cited above--Deaths of Despair.
Directness and not avoidant is crucial.
I think some schools are having classes about mental health and suicide so kids can recognize, intervene and alert adults to a peer who is pre suicidal. I think all schools should put this in their curriculum.
community bonds and social connections as you point out are preventative.
yeah I felt uncomfortable as a civilian saying that --like maybe it was a cliche I'd more likely buy them a coffee or drink
Yes. I think the veterans also feel not just that "civilians" won't understand but they don't care. Its sort of an us vs them outlook. I do hear many people now saying "thank you for your service". I wonder how Veterans react to that.
Dr. Jay Slosar, Psychologist most veterans appreciate being thanked for their service. For some, who have guilt for what they were forced to do overseas, it can be like rubbing salt in the wound. It is a painful reminder of something they are trying to forget. There is no way a civilian can know that, which further increases the gulf between the veteran and civilians.
wow what an experience from giving birth to a father's concurrent suicide. Its hard for me to grasp the experience.
Awareness of discontent building or low level depression in my experience may also be related to attaining a breaking point when life becomes stressful and more difficult. The risk factors we see--loss of job, financial failure, injury, divorce and similar.
So true, I don't think we have fully taken in the impact of the pandemic on anxiety, depression and suicide.
wow ten years did you develop social relationships or friendships with anyone in the group?
Brian I agree with you. I have had experience with both abrupt and not abrupt suicide. I don't think there are always warning signs. In fact it might be shocking in a sense that everything is going well in their life. In both abrupt cases they had a clear intention of dying as there would have been no possibility of survival. But I do agree with individuals acting on an emotion in an extreme way and not really having the desire to die, but more of a desire to make the pain, and negative thoughts go away. I like what you said about avoiding black or white thinking, in this case with "always". My societal message is to normalize asking someone if they are thinking about "killing themself." Being direct not saying things such as "are you wanting to harm yourself". People don't talk about wanting to kill themselves, in my opinion, because we as a society can't even use the language that is necessary. I worked for Marin Suicide Prevention about 23 years ago and that was an important takeaway.
Having someone you can bare all to is really important. I agree some suicidal acts are impulsive and without warning. There is some research evidence that perfectionistic persons can be suicide prone.
As far as having "at least one person with whom you can be raw and brutally honest", I am a huge believer in support groups. The day before I checked myself into a partial hospitalization program, I participated in a men's group for anxiety and depression. I cried my eyes out sharing, feeling that I finally had a space where I could share what I was going through without being judged. Ten years later, I still attend the support group every other week even though I have been quite mentally healthy since then.
Thank you! Ir sounds like a lot of things and cumulative factors but you reached out. Peer support groups in high risk professions are a great preventative approach. Good luck with your book. I am sure it will help others.
The increase in suicides is a call for a societal effort. There is some return of the 800 number hot lines that have been shown to be helpful and preventative.
thanks for info on psychological autopsies. I think there should be more of these conducted so we can learn more. Your last point identifies risk factors.
Drugs and Alcohol are coping mechanisms for many of people to run away from the pain or their situations. As well being a pharmaceutical researcher and certified homeless women's advocate; I've spoken with many whom stated if they can't get the prescription drugs they turn to the street drugs to cope. Any human being subjected to living outside in survival mode 24hrs a day, 365 days a year would become mentally unstable needing some type of numbing coping mechanism. As well; if your less fortunate and homeless and on prescribed medication, How can the medication work properly? The patient isn't eating, drinking water or bathing properly! Professionals should look deeper into the reasonings behind why people are increasingly wanting to commit suicide. Acknowledging a portion is due to systematic failures.
Wow there is so much here. My thoughts in presenting this topic was to try to develop awareness and response and yes increase compassion. As I noted above the 800 numbers at least might be a lifeline for those in despair. But addressing the suffering and despair that is out there is a powerful point. The polarization we have today in society seems to me to end up for some as despair and a feeling no one cares. Or people just feel like failures. As for society overall--the deaths of despair by Case and Deaton look deeply at our society and the super powerful capitalistic world we live in every day. Thanks for this thoughtful response. https://press.princeton.edu/books/hardcover/9780691190785/deaths-of-despair-and-the-future-of-capitalism
The immediate trauma of losing it all is important. When one is arrested or at a point when they feel their life is ruined or over they take their lives. I think those in law enforcement recognize this when they arrest someone who feels their life is over and is faced with shame.
Yes, an individual feeling like they have lost everything is a key risk factor for someone dying by suicide. From what I’ve seen, I would like to see some law enforcement officers demonstrate more awareness and sensitivity around issues like this when an individual is being arrested or when someone is reaching out to police during a crisis.
Christy Kobe, LCSW EMDR Certified Trauma Therapist Polyvagal Theory Anxiety and Stress Therapist
Thank you Peter. You are right --the goal is to prevent suicide and a national call to action would be warranted. Thanks also for referencing unsuccessful suicides.
So true here is an increasing problem and a declining response!! And the problem is about life and death. As a society have we become immune or cold? Did all the COVID deaths make us immune to death?
As human beings; living a human experience we all deserve to live a fruitful happy, healthy, peaceful life, while here on earth. Society has become a deceitful, manipulative, self preservation society, having no sympathy nor regard for their fellow human being brothers and sisters, whom are less fortunate. America and some it's country people are dysfunctional, and not taking care of one another nor their home United States. Allowing America to burn from within; due to generational curses, ideologies, thought patterns that still plague our country. As well; covid or No covid No human being is immune from death! All human beings were born and we'll all leave the earth when it's our time to go! ....And we don't know when that day will come!! Unfortunately, in an attempt to deflect from their own discomfort, some individuals tend to resort to labeling and blaming the less fortunate for their circumstances, thereby looking down upon them and dehumanizing their experiences. Instead of supporting the less fortunate helping them to rehabilitate their lives, it's easier for people to consciously deflect to not have a guilty conscience.
Allow me to emphasize that understanding the complexities of life goes beyond analyzing problems from an outsider's perspective. As the old saying goes, "If you haven't walked the walk, you can't talk the talk," and this wisdom extends far beyond formal education. True comprehension arises from lived experiences, genuine connections, and firsthand encounters with disparity, which cannot simply be found within the pages of a book.
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