When there’s talk of suicide
Of all the topics this blog will ever address, “atypical young people and suicidal thoughts” is probably the most sensitive, emotional, and uncomfortable. Below is my attempt at shining some light on this high-stakes “elephant in the room.” If, in reading what follows, you find errors to correct or have additional information to share, please please please leave a comment.
This isn’t a random topic. Studies have shown proportionately higher suicidal tendencies in our adolescents, whether the diagnosis is ADHD, Aspergers or other autism spectrum disorders, learning disabilities, depression or bipolar disorder, or other brain differences. Social isolation and the struggles to complete even minor tasks are among the causes for the despair that often overwhelms our young people.
This post will provide general information, address how “the system” works when suicide appears imminent, and share our family’s experiences. It is not your one-stop shop for all the answers, but hopefully it will provide some insight.
First, my heart goes out to all individuals and families who are grappling with suicidal thoughts or actions. Above all, please know that help is out there. You are not alone, and you don’t have to face it alone.
Here’s some general information for coping with a crisis:
In the US, the number for the National Suicide Prevention Lifeline is 1-800-273-8255, or 1-800-273-TALK. They will counsel anyone contemplating suicide (or someone who is extremely stressed out but not suicidal). They will also talk to anyone concerned about a suicidal loved one. Your call may be routed to your nearest crisis center, where the staff will let you know what resources are available in your area.
I also found this really thorough and helpful summary of general suicide warning signs, and what to do and not to do: www.helpguide.org/mental/suicide_prevention.htm. If you only click on one link here, make it this one.
Many times, a person who is considering suicide avoids telling anyone – and therefore doesn’t get help – due to fear of being carted away and locked up. However, talking over suicidal thoughts with a counselor is often sufficient for heading off the threat, and won’t involve any drastic outside intervention.
Drastic action is required when four things become evident: that the person has the intent to commit suicide, has a plan for how to do it, has the means to carry out the plan, and has identified a time for doing it. Together, these things constitute a highly serious suicide threat.
My understanding is that, at least in California, the law requires that a person who has the intent, plan, means, and timeframe for suicide – or who is found in the midst of a suicide attempt – be taken to a psychiatric hospital for an involuntary 72-hour hold. Usually the police transport the person to the facility, in a process known as a “5150.” (Here’s a link where a police officer describes a 5150 from his point of view.)
While at the hospital, the person will be evaluated and given appropriate medication (at least in theory). At the end of the three days, the person may be released – or, if the threat is still real, continued hospitalization for up to 14 days may be recommended. A judge may order the hospitalization if the patient won’t go voluntarily.
I’m thankful that our family has no direct experience with suicide attempts or involuntary holds. However, both of our sons have expressed suicidal thoughts, which has been plenty traumatic for all of us.
Alan has voiced such thoughts a handful of times, while he was highly aggravated. He is prone to exaggeration, but given his impulsiveness we can’t just dismiss such talk. The most unnerving incident happened while he was away at trade school. He called me in the midst of a meltdown, then hung up and texted me a suicide note. Hundreds of miles away, what could we do? I left a voicemail with his apartment manager asking her to keep an eye out, just in case. Then his father called Alan, and within 15 minutes Alan had settled down to a depressed-but-not-suicidal level. Months later, when I mentioned the text to Alan, he said he didn’t even remember it.
Nathan’s suicidal tendencies have been more deeply rooted and persistent. He first expressed suicidal thoughts to me a few months before he turned 16, which was shortly after he’d had a brief, scary psychotic break (or rage incident). That was also the end of his sophomore year, when we agreed to have him placed in a Special Day Class for emotionally disturbed students. We hoped that fewer academic and social challenges would ease his pain.
Over the next two years he still talked about suicide a fair amount. During this time he had regular appointments with psychiatrists, and was admitted to a partial hospitalization program, as described here. We were advised by a couple of therapists to hide our sharp kitchen knives. Shortly before he graduated, the teacher’s aide voiced concern that Nathan was giving away some of his possessions to classmates.
After he finished high school, he indicated he’d enjoy his summer – and then end it all. Exasperated, I said I could find 50 reasons for him to keep living. He took me up on it. I worked hard on the list, generating my own reasons and reviewing what others had come up with. When the list was ready, he read it, then tossed it aside and sneered, “Is that the best you could do?”
Dark days. But, he held off.
Even though he no longer attends church, religious beliefs (or probabilities) have been one big reason Nathan hasn’t followed through. He has concluded that, because the concept has come up repeatedly around the world, there must be a God and an afterlife, although maybe not the way Christianity presents. Nathan wrestles with the idea that suicide is a sin that would land him in hell for eternity. It’s been too big of a risk, with no way to fix the situation if it turns out to be true.
I know about this because ever since he was 16, Nathan and I have had many in-depth talks about his dark, dark philosophy. He almost always started the discussions, which could last for two hours or more. Although in our first few sessions I reacted as any heartsick mother would, over time I became better at listening without offering judgment or shooting down his ideas outright. I’d sometimes point out that other people reached conclusions different from his, and I’d then listen to his counter-arguement. While these disturbing talks sometimes left me in tears, or staggering like a zombie afterwards, I was willing to be his sounding board, if that’s what he needed.
In these talks, we established that his suicidal tendencies were not because his life situation was so bad. He was also not pretending to be suicidal to manipulate his way to an easier life. His reasons were based in cold logic about the futility of existence and the stupidity, arrogance, and maliciousness of the human race. Emotions had nothing to do with it – in fact, he expressed contempt for people who commit suicide out of emotional despair.
When Nathan was 19, he told his therapist that he had three alternate suicide plans to choose from. At age 20, he chose one of the plans and had the means to carry it out. He also set a timeframe, and was determined not to flake by going past it. He rationalized that an all-loving God would not punish him for eternity.
Despite his determination, Nathan’s timeframe slipped, a couple of weeks at a time, from early fall to the end of the year. During this period, a few of his relatives called to let him know they cared, to discuss his hurt and the hurt he would bring about, and to try to understand his reasoning.
Also during this time, I saw our family counselor, who had treated Nathan in the recent past and had known his story since boyhood. We talked about what our family would do if Nathan committed suicide. Then she said,”What will you do if he doesn’t?” Now, if the subject of suicide is the elephant in the room, she had just illuminated the T. rex in the corner – the fact that even loving family members can have mixed feelings about a deeply disturbed loved one ending it all.
Her immediate advice to us was to avoid bringing up the subject of suicide with Nathan. If he brought it up, we were to briefly acknowledge it, but tell him we didn’t want to talk about that, and change the subject.
The holiday season approached. Nathan had finally resolved to die between Christmas and New Year’s. A few weeks prior to Christmas, his psychologist (Dr. M) and I had a phone conversation. Dr. M explained that professionally he was required to intervene to prevent the suicide, and the time to do that would be at their scheduled session right before Christmas. He would ask Nathan one last time about his intent, plan, means, and time. If all the answers pointed to a serious threat, Dr. M would call 911 and prevent Nathan from leaving his office, tackling him if necessary, until the police arrived. (He asked me how likely it was for Nathan to be carrying a knife or other weapon.) Nathan’s 72-hour hold would therefore involve being locked up during Christmas Eve and Christmas Day.
Dr. M said he’d had to do this a few times with other patients. It had always worked, but he hated doing it. He realized that if it happened, Nathan would never trust him (or any other therapist, or maybe even us) again.
Nathan had told me earlier that he would never let the police take him, which gave me even more to stress about. Would he try to run? He wasn’t familiar with the town where Dr. M’s office was – in fact, it was in the next county. Would he hurt someone else? Would he provoke the police to take him down (death by cop)?
The next-to-last session came and went. In the waiting room at the end, Dr. M gave me a meaningful, serious look and said he’d see us next time.
Nathan and I started the long drive back to our town. All those years of talking, trying therapies and medications – it came down to this. A few more days and our world would turn upside down.
I didn’t want to say too much, or say the wrong thing. After 10 minutes of driving in silence, I finally said something like, “I know I can’t talk you out of it, but I just need you to know, I love you, and I really don’t want anything bad to happen to you before New Year’s.”
Out of the corner of my eye I could see a tiny smile on Nathan’s face. “It’s OK, Mom. I’ve given it some thought, and I’ve decided – well, I’ve decided to hold off until – until April.”
April! He’d wait until April! In any other context this would be terrible news, but at that moment I felt as giddy as George Bailey running through Bedford Falls toward the end of “It’s a Wonderful Life” – “My son says he’ll commit suicide in April! Merry Christmas!”
Somehow I kept the car on the freeway as relief and emotion overwhelmed me. “I’m very glad to hear that,” I said as calmly as I could. I don’t remember if we said anything else.
Back at work, I told my husband the good news, and then emailed Dr. M. He called me later, saying he was very relieved – and surprised, because in the session that day Nathan had been firm in his decision to go ahead with it as planned.
Well, that April came and went, as have a few more. Nathan has spoken of suicide only occasionally since that very tense holiday season. We don’t know what he’ll ultimately decide to do or not do, but we are grateful that at least for now it is only a background issue.
It may help you to know that all the therapists and others I’ve spoken to who deal with atypical young people say they have never dealt with an actual suicide – although they have seen a few close calls.
Of course, the tragedy of suicide does occur, every day. My wish for all who are impacted is that they receive the care, counseling, and understanding they need to make it through each day.
For the rest of us who may be confronted with suicidal thoughts or actions, education and awareness are needed to make it less likely that the elephant in the room causes permanent, heart-breaking damage.