One of the most important things to recognize is that, like any e-motion energy in motion suicidal feelings, for the most part, pass (at least in 90,089 out of 100,000 of us in the United States!) Who amongst us does not entertain the thought now and again? During particularly stressful periods of my life, Ive encountered the urge, while crossing a bridge, to jerk the steering wheel hard right and the car over the guardrail into a 200 foot drop to the riverbed below. Within the last year, I read a news article that stated the incidence of successful attempted suicides by people in Japan is statistically much higher then here, in the U.S. The article stated specifically that the most prevalent means of attempted suicide here is overdosing on Valium, our most abundant mood-altering drug. I couldnt help but chuckle to myself, remembering the slews of young people who I picked up that, sure theyd never wake up again, found themselves alive with the increased misery of a whopping hangover for the next few days after getting their stomachs pumped. But this was a reflection of my own unwillingness to look deeper. Most of the attempted overdoses that I attended were done publicly in some way, with an element of certainty that someone would know or find out within a few hours. To be honest, unless I found around three empty bottles of the stuff right next to the unconscious person, I didnt worry much. Ive picked up many who lay in their beds, unconscious and snoring for three days after having ingested handfuls of the stuff. Care was really simple; open an intravenous line, protect the airway, and boogie to the hospital. To me, teenaged suicide was largely a call for help based on a current, perceived threat of some sort. In the US, the hope is that these calls for help will be answered. But in Japan, where pharmaceuticals are not so readily available, the substance of choice is one or another form of poison or pesticide, which are by no means as forgiving as Valium. Thats where the statistics tell a story: Where the numbers separate is that in Japan, attempted suicides are much more likely to be successful. U.S. rate of successful suicide is about 11 per 100,000 in population (average all ages and sexes), whereas in Japan, its about 25 per 100,000. That proportion sent a chill down my spine. In America, lots of kids for example, who are grappling with questions of life and death can come to a temporary, albeit, morbid conclusion, take action on it, and then get a second chance. This is not as likely over there. Thats quite sad, but I suspect that the high proportion is also a by-product of the Japanese cultural imperative to not speak of such things. I also suspect that if the kids really knew and believed that what they were doing was highly likely to do them in, they wouldnt. Here, almost every teen knows someone who has gone the Valium route and failed. My approach, as a counselor, (which, admittedly, is a hell of a lot more compassionate than when I was a medic and a direct result of having to deal with it time and again, under all sorts of circumstances -- a humbling experience to say the least!) is to first and foremost accept that the person threatening suicide is serious. No matter what I think, their lives have come to circumstances that tell them its a viable option. I honor it as such. Most people mobilize everything at their disposal to stop, deny, sidestep or avoid the patterns or actions that might promote the thought of suicide. When I start with something like, Yeah, that is an option, those with less conviction will sometimes stop in their tracks, all by themselves, and begin exploring other options. People so often discount words implying the thought of suicide ("Oh, thats ridiculous, you have a wonderful life!") that even the suicidal dont really get that its about really ending their lives. Many of them just want to end the apparent pain of the moment. Placing death clearly into the picture, and working with it as a valid possibility means it becomes real and something that can be actually worked with in most situations. A consistent underlying theme of potential suicides is they feel like they cannot have an effect on their worlds. Many cant, but that boils down to not being able to have the effect that they want to have. The opening I seek is to explore effects that they can have in the now that will be enough to get them through to tomorrow. Sometimes, the person will place a roadblock in front of every path out that I offer. In that case, I ask, Okay, were I to support you in your committing suicide, what would that look like? I open the door to discussion completely. More often than not, this approach provides a bit of leverage to work with because youre meeting, not resisting. But at all times, the most effective approach is to do what it takes to ground the person in the immediate experience of now. If the person manages to make it to you, their current reality is that they are with someone who cares enough to value them and work with them as a respected and honored human being, going through the same process of life we all face. By placing the persons attention fully on the moment that is, rather than on agonizing over what was or what they fear will be, you can help them get to the next moment. Ultimately, thats the goal: to work with the person so that they have enough experiences in the supported now to make a decision for life. Enough of these moments strung together provide a Path to the future that includes hope. Often, thats enough. Sometimes it's not enough, but only because free-will trumps all. And that's okay, too! |
