I’m no stranger to suicide. There are days I ask a dozen or more people:

“Do you have thoughts of killing yourself?”  
“Are these more than thoughts?”
“Do you have a plan?”

It’s a “suicide ladder,” a series of questions that lets someone discuss their thoughts, plans, and history of self-annihilation and how close they are to irrevocable action.

But it’s not just for patients. I’ve had my own dark days and been touched by friends and family who’ve ended their lives. Yet suicide —on the rise nationwide and one of the ten leading causes of death in this country— flies below our radar. We don’t discuss it, even though recurrent findings indicate that one in five high school students contemplate suicide every year and there are dismal statistics around high-risk groups such as LGBTQ youth and older white men.

But the recent celebrity suicides —Kate Spade and Anthony Bourdain— have flicked on the spotlight and raised important questions. If people who had so much —wealth, career success, friends, celebrity— viewed death as a solution to their problems, what does that mean for the rest of us?

I’ve known people who ended their lives, and it was often in the midst of a crisis, the nature of which varied —legal, financial, marital, health, school bullying, mental health, occupational. Some had histories of mental illness and substance misuse. Others did not, but that’s misleading —most mental-health and substance-use problems go unidentified and untreated. In the case of substance misuse, from alcohol to opioids, which increase a person’s risk of suicide six-fold, less than 10 percent seek help.

For someone on the verge of suicide, death appears preferable to what has become unbearable suffering.  I’ve seen it in cops, firefighters, G.I.s, and paramedics who’ve witnessed or been victims of unimaginable trauma. I can rattle off symptoms of PTSD, but that doesn’t touch the reality of what it’s like to be tortured by intrusive thoughts that force you to relive heartbreaking scenes over and over or to have your nervous system triggered into adrenalin-pumped panic by innocuous situations. Worse still are the dangerous thoughts that your current pain will never improve. With that sense of hopelessness comes a logical leap to… what sort of life is that? Is it worth living?

The death of hope seals the deal. If you can’t see a future, why bother?

“Why didn’t I see this?” “What did I miss?” “Why didn’t they tell me?” “Why didn’t I do something?”  For family and friends, the guilt is a torment.

Yet there are answers, and there is help. Suicide, like heart disease, stroke, and cancer, involves identification of a problem — easier said than done in a culture that discourages and stigmatizes self-disclosure of anything mental-health or substance related. But there are paths back to hope, and they are well trod.

The bully, the out-of-control drug problem, the untreated depression, homelessness, financial, health, or legal crisis that has robbed someone of their perspective —those can be faced down and conquered. Some people can rediscover faith in a higher purpose or power that for a time has been lost. Even the act of sharing —the truism that a burden shared is a burden halved— can catch someone on the brink and pull them back.

The crucial first step is to talk about it, whether to a family member, trusted friend, faith leader, or a professional. “I’m not doing well right now. I need help.” That takes guts. More than that it requires an openness and willingness on the part of the listener to hear what’s said and to not shut it down. “I’m glad you told me. And I’m so sorry you’re going through this. I want to help. Will you let me do that?”

From there, connect the person in crisis to skilled help —your area’s Crisis Center, to the National Suicide Prevention Lifeline, even 211.

You might want to accompany that person to their first visit with a mental-health professional or be that supportive shoulder that helps them slog through concrete aspects of their current difficulties. The option of suicide will recede as the unique situations and circumstances that brought them to the edge diminish.

I again picture those I’ve known who ended their own lives. In hindsight, all their suffering and crises had other solutions. But they chose death, a permanent and irrevocable answer to temporary problems.

If you or someone you know struggles with depression or has thoughts of harming themselves or taking their own life, get help. The National Suicide Prevention Lifeline (1-800-273-8255) provides free, confidential, 24/7 support for people in distress and can link them to professionals in their community.

To show your support for mental health and substance misuse recovery join CMHA’s 5K Run for Recovery, June 23rd  at the New Britain Stadium, for more information see this.

Charles Atkins, MD, is the Chief Medical Officer for Community Mental Health Affiliates, a multi-site behavioral health and substance abuse agency in New Britain, Torrington, and Waterbury.  

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