If you feel this way yourself, remember: you are not alone. Please talk to someone.
Here's a short list of numbers and websites you can consult:
- 1-800-272-8255 American Suicide Prevention Hotline
- +81 (0) 6 4385 4343 Suicide Prevention Centre, Osaka
- 08357 90 90 90 / 116 123 The Samaritans, UK
- 13 11 14 Lifeline Australia
- American Foundation for Suicide Prevention
- IMAlive Online Crisis Network
- Canadian Association for Suicide Prevention
- 988 988 Suicide & Crisis Lifeline
This is a Useful Note. Its purpose is to explain how things work in Real Life so that you can compare it to how it's used in fiction. Media as a whole has the unfortunate habit of romanticizing, stigmatizing, playing for laughs, or otherwise inaccurately portraying suicide, so this page will help you better understand who might die by suicide, why they might do it, and what can be done to help these people.
We would be remiss if we didn't remind you that TV Tropes does not employ any medical, law enforcement, or mental health professionals, and this is absolutely not the place to be if you or someone you know is actually suicidal and wants to learn what to do. That's what the above hotline numbers and websites are for. That being said, this is quite an extensive page, and we do hope you learn something. In fact, many lives could have been saved had people understood suicide correctly and not been laboring under misconceptions wrought by popular culture and media. If nothing else, suicide is not easy to write convincingly without the risk of being melodramatic or unintentionally funny, and this page can help with that as well.
Part of the problem with an in-depth analysis, though, is that no two people are alike, and what applies to one person may not apply to another. Some of the things you read in this page may even seem a little self-contradictory, but it's just a way of emphasizing that not everything applies to everyone. Bottom line: (a) learn all the facts, (b) remember that there is no magic solution that applies to every case, and (c) knowing what's wrong is only half the battle — someone who's suicidal needs to seek professional help (and if the professional is controlling or abusive, keep looking).
We have to start by talking about depression, which is one of the single most common reasons behind suicide, although by no means the only one.
Most cultures have a negative view of depression, but how negative that view is can vary significantly between cultures. Western societies tend to view it as an illness or condition that requires professional treatment and support. Eastern societies tend to trivialize it and may not bother to treat it at all, creating a serious social stigma around it. Some cultures may even glorify suicide and thus amplify the stigma of seeking treatment for depression; Japan, for instance, with its elaborate tradition of ritual suicide, has the ninth-highest suicide rate in the world. But any way you look at it, depression is stigmatized so much that sufferers are reluctant to seek help for it. They may even insist that they feel normal and refuse help if offered. In fact, persistent refusal of help is as much a warning sign as directly asking for it.
It is extremely important for family and friends of someone who is suicidal need to be as supportive as possible. If a person is suffering from depression — and is thus already under considerable mental stress — ignoring or dismissing their problems, once discovered, can reinforce feelings of worthlessness already caused by the social stigma and make the sufferer feel even more suicidal than before.
Bipolar depression, the low mood phase of Bipolar Disorder, is especially deadly. People with Bipolar might be up to three thousand percent as likely to attempt suicide as the general population. Getting professional help for Bipolar Disorder is therefore as important as getting professional help for heart disease or cancer - if untreated it is often progressive and lethal.
Signs of depression include:
- Widespread changes in brain activity — clinically speaking, becoming agitated (constant irritability, stress, and anxiety) or lethargic (mentally and physically). Either way, it leads to an inability to feel "normal".
- Over-general memory, or the inability to pinpoint specific periods of happiness or depression, leading to understatement of the former and overstatement of the latter. It's not necessarily caused by depression, but it correlates with it strongly.
- Disruption of normal sleeping patterns — usually insomnia, but sometimes hypersomnia (excessive sleeping) or changes in sleep cycles.
- A weakened immune system, which can manifest in interesting ways, such as taking longer to heal than normal.
Depression can be exacerbated by actual bad things happening to someone. One way to think of depression is as an inability to cope with other pain or trauma. But this just reinforces the importance of a person's family and friends being as supportive as possible, because dismissing these feelings as the result of something external to the sufferer will again reinforce that person's feelings of worthlessness. Financial loss is actually a particularly nasty exacerbator, as not only is it bad in and of itself, but it also often leaves a sufferer unable to afford treatment for their depression.
It's tempting to solve the problem with medication. Drugs are actually pretty good at treating depression, as they can correct the chemical imbalances in the brain that can lead to depression, but they're never a solution in and of themselves. A balanced treatment of depression involves therapy first, and medication second. Even without the physical recovery of a suicide attempt, getting over depression can take anywhere from months to several years.
While depression is the most common cause of suicidal thoughts, there are several other mental illnesses that can lead to suicide:
- Anorexia nervosa, which may not be the most common cause of suicide, but is the mental illness most likely to lead to suicide if you have it. Most anorexics suffer from extreme perfectionism and can be driven to suicide out of failure to meet their unreasonably high standards.
- Schizophrenia, which if untreated (or badly treated) also causes suicide at a higher rate than depression. Even the treatment for schizophrenia can lead to suicide; schizophrenia medications can have horrifically nasty side effects, including crippling sedation, massive weight gain, NMS, and tardive dsykinesia (in Layman's Terms, very bad medical things). Sufferers are often left with the choice between not taking the meds (and risk getting sectioned or becoming a bag person) or taking the meds and dealing with all the side effects. Suicide may appear to be the best possible option here.
- Post-traumatic stress disorder and complicated grief, although that's at least in part because depression is often co-morbid to both.
- Borderline personality disorder, as the labile moods and extreme mood swings, lack of a "self" to temper irrational thoughts, predisposition to feel hated and "evil", and extreme impulsivity all tend to lead to chronic suicidal ideation and spur-of-the-moment attempts.
Who might commit suicide
- Misconception: Only men are serious when they attempt suicide; women just do it for attention. A downright dangerous line of thought — every attempt at suicide should be seen as a cry for help. This misconception derives mostly from stereotypes of the Hysterical Woman who always throws invented problems at you. Sadly, this line of thought can be seen even in older professional handbooks, and media has been persistent in perpetuating the Double Standard. It is true that statistically, women attempt suicide more often than men and men succeed more often than women, but this can be chalked up to a few factors which are also rooted in traditional gender mores:
- Women tend to be more subject to physical and emotion trauma, which can exacerbate existing depression or drive someone to suicide;
- Women tend to be diagnosed more often with personality disorders that have a manipulative component to them (like narcissistic personality disorder or borderline personality disorder), meaning that while a big chunk of them might actually just be doing it for attention, there's an equally higher proportion of men doing the same thing who fly under the radar; and
- Women tend to use less violent methods of suicide like drugs or knives, which also tend to be less successful; they're more elegant and leave less of a mess, and societal norms have taught women to care more about such things. When men do it, more often they try to make it count — they like to use firearms.
- Misconception: Old people don't commit suicide. In fact, in many countries (including most Western countries), elders commit suicide at a much higher rater than younger people. Contrary to conventional wisdom, it's not due to age or health, but mostly due to longstanding depression (fighting it for that long can be exhausting). Financial stress is also a bigger factor for older people, as they need to earn a living to support themselves — and likely also spouses, children, or parents. Health and age can definitely be factors, however - people who have a weak or nonexistent support network who are beginning to accept that they can no longer care for themselves, or people who fear being placed in assisted living may have every reason to try and kill themselves, while people who have seen all of their friends and loved ones die or deteriorate to the point where they're no longer the person they remember may try to end it out of the belief that there's nothing left for them.
- Misconception: Teenagers aren't serious about suicide. Teenagers are often seen as the ultimate contrarians, desperate for attention and to make you sorry for ignoring them. That's occasionally true — but many teenagers are genuinely suffering, and they might be even more susceptible to trauma and depression than adults because they take things so seriously. Bullying is a serious and common cause of suicides among teenagers, and while there is a temptation to see bullying and hazing as mostly harmless and a way to toughen up young people, take a look at some teen suicides — a lot of bullies go way too far. Teenagers can also suffer from depression and mental illness just like adults do, but with less opportunity to diagnose it. All of this adds up to a dangerous refrain — if they're not taken seriously because they're teenagers, their suicidal thoughts could be exacerbated, they will be disinclined to open up to adults, and they may feel the need to prove that their feelings are real — sometimes fatally.
- Misconception: All right, but preteens definitely aren't serious about suicide. Even preteens can be genuinely suicidal. Again, it doesn't matter how old you are, depression or mental illness could manifest itself. And serious, over-the-line bullying can be an issue even for pre-teens.
Why someone might commit suicide
- Misconception: All suicides are caused by a traumatic event. This line of thinking derives from media's love of Driven to Suicide, where a single and severe emotional trauma provides a clear reason for someone to commit suicide. But there are many other reasons one can commit suicide:
- A long string of lesser humiliations or disappointments, or even a not-so-long string if they all seem to pile up on each other;
- Bad luck with genetics, including a family history of depression; or
- A mental disorder like anorexia or bipolar mania that doesn't show any outward signs of depression.
- Misconception: Well, then, nobody can be Driven to Suicide, and all suicidal people are crazy or psychotic. This is Hollywood Psychology in action. While mental illness is a frequent factor in suicide, it is possible to be Driven to Suicide. You see it where someone has suffered abuse so severe that it has entirely destroyed their self-concept or their will to live. You see it where someone suffers chronic pain and can't stand it anymore. You see it where someone suffers immense financial loss from which they have no realistic prospect of recovery. There is a proverbial "edge", and you can be driven over it.
- What?! So then what am I supposed to think? As unhelpful as it is, both are true — suicide can be caused either by trauma or mental illness. In fact, it's common for suicide to be caused by both trauma and mental illness, if only because someone who is depressed to begin with is more likely to commit suicide after suffering trauma.
- Misconception: Well, regardless, suicidal people are dangerously violent. The vast majority of suicidal people are not violent toward others. In fact, most suicide attempts happen in privacy or isolation at least in part because the sufferer doesn't want anyone else to get hurt. This is a dangerous line of thought, because treating suicidal people as violent is likely to alienate them further and exacerbate the problem. The few who are violent will likely be outwardly so and will not be shy about showing people that they will harm anyone who tries to stop them.
- Misconception: Suicide is shameful. This is a very pervasive stereotype, and also one of the most untrue. We've just gone through a bevy of reasons why people might commit suicide, ranging from depression to mental illness to serious trauma. The best way to prevent it is to get suicidal people the help they need — and telling them that they're being "selfish" or "inconsiderate" is far from the right way to do that. Suicidal people often believe the opposite — that it would be selfish of them not to die, because they believe they're The Load on society and the world would be better off without them.
How someone might commit suicide
- Misconception: All suicides are planned for a long time. It's often totally impulsive. Impulsive suicide is especially common among severely traumatized people (especially from a single event like a rape or an accident), people who self-medicate with drugs (they tend to crash eventually), and sufferers of bipolar disorder. It's difficult to deal with this sort of thing, because it means you're not suicidal all the time, and you don't know when the impulse will strike. Survivors have also been known to regret the attempt almost as soon as it was underway.
- Misconception: All suicides are intentional and planned. It's entirely possible for a suicidal person to kill themselves without specifically intending to kill themselves. The gist of it is that they've stopped caring whether they live or die. This can manifest itself in everything from unsafe sex and sexual practices (e.g. unprotected casual sex, Erotic Asphyxiation or other "edge play" without a Safe Word), to dangerous use of drugs or alcohol (e.g. drinking until blackout, intentionally going near overdose range, using dirty needles), to extreme levels of self-harm resulting in death, or even to unsafe driving or work practices. Suicidality for these persons can be thought of as a spectrum of self-preservation — turns out the world can be a pretty dangerous place. This also factors into how suicide can often be impulsive. And this doesn't even get into the Suicide Dare, or even a suicidal dare — i.e. do something stupid and dangerous and nominate yourself for a Darwin Award.
- Misconception: All suicides leave suicide notes. Most suicides don't leave notes. It's an especially stupid misconception because it perpetuates the notion that if they didn't leave a note, then it wasn't really suicide. In most countries, less than 10% of suicides leave notes — in the U.S. it's more common, but that's largely attributed to Pop-Cultural Osmosis.
How to help someone who's suicidal
- Misconception: It's easy to tell when someone is suicidal. You'd think someone who's suicidal will by definition be outwardly unhappy about it, but there are a couple of ways this can shake out:
- A suicidal person often isn't going to want to show that they're suicidal. This is often because they don't want to burden others with their problems, especially if they're dismissive of such problems and think they can solve them on their own (or that they'll go away on their own). As such, they'll often force themselves to look happier than they really are.
- A sudden lift in a depressed person's spirits can paradoxically mean that they're about to commit suicide. This is because they believe that they have finally figured out a way to escape their angst, and are therefore feeling hopeful for the first time in ages. In some cases, severe depression can cause lethargy so strong that a suicidal person can't even work up the energy to actually commit suicide. The same can happen with manic episodes — they're still suicidal, they just now have the energy and focus to actually go through with it.
- Misconception: Drugs will always help! As noted, drugs are very helpful in correcting chemical imbalances caused by depression (unless it's a much rarer form of depression caused by an uncommon chemical or physical brain injury), but you can't rely on medication alone, and this kind of thinking leads to the believe that mental illness is something you can just "fix". Among the issues:
- As noted above, suicide is often but not necessarily caused by depression or mental illness, so drugs aren't necessarily going to be the solution. This is especially true when people suffer trauma or loss that's totally unrelated to mental illness, like abuse or extreme financial loss. Especially in cases of abuse, the solution is not medication but getting the person out of the abusive situation.
- Co-morbid depression originating from abuse, trauma, grief, or PTSD is very difficult to even treat, much less cure, because the space between "correcting chemical imbalance" and dealing with legitimate emotions from a horrifyingly traumatic experience is very difficult to define. That doesn't mean recovery is impossible, but it does mean that it takes a long time and mostly comes from talk therapy. Medication is very limited in those contexts, as most legal medications can't actually make painful experiences or memories any less so.
- Antidepressants can paradoxically make it more likely for some people to commit suicide, in that they don't help enough to end the suicidal thoughts, but they do work enough to stop the lethargy associated with depression — and motivate the sufferer to finally go through with their suicide. The same can happen if the person is self-medicating with an illegal drug like cocaine or methamphetamine.
- It can take a couple of weeks for medication to take a full effect. But in this era of instant gratification, people want something that can work now, and this leads to them concluding that the medication isn't working and asking for a higher dose or a stronger alternative. Healing the mind and the body takes time, and you have to have faith in the treatment — do not give up just because it's slow.
- Neuroleptics are generally considered a last resort in treating depression. They're commonly called "antipsychotic drugs", but that's a misnomer and creates an unwarranted stigma around them. But they are very powerful and often have severe side effects, including heavy sedation, extreme obesity, and diabetes, and can make unipolar depression even worse on top of that.
- There's a risk of misdiagnosis, and you don't want to mistakenly prescribe antidepressants or neuroleptics. Some symptoms associated with depression are not always caused by depression, but can instead be caused by something else, like anemia or hypothyroidism.
- Misconception: Hospital will always help! This leads to thinking that suicidality is something that can be "fixed", in this case by just tying a person to a bed and letting it blow over.
- Hospitalization assumes mental illness, when that isn't always the case. This is especially true in cases of abuse — victims tend not to see being trapped in a hospital bed as much different than being trapped with their abuser, especially if their abuser is part of their hospital treatment. And people suffering from financial trauma are unlikely to be able to afford hospital treatment anyway (in countries where that's an issue). In such situations, the sufferer may still need medical help, but it's better to give them the freedom to choose the option that's best for them.
- Hospitalization can be a traumatic and painful experience in and of itself, especially when it's forced. This is especially true where the sufferer is an abuse victim (where the abuser might insist on it as a punishment), or even in mental health contexts. While modern mental hospitals have generally moved beyond the Bedlam House of One Flew Over the Cuckoo's Nest, not every professional employed by such hospitals is necessarily understanding, and the "psychiatric survivor" and "mental health consumer" movements have some very good commentary on the subject. Forced hospitalization is only a very last resort, akin to calling the police, and you should do your research to find a hospital where patients are treated with kindness and respect.
- Emergency rooms can make things much worse during the intake process. While there are plenty of understanding doctors and nurses out there, there is also sadly a perception in emergency medicine that people brought in for suicide attempts are a waste of time relative to patients with "real" injuries. In fact, it's not unheard of for emergency departments to subject patients brought in for suicide attempts to painful and humiliating intake procedures as a way to discourage them from coming in ("officially" they're "better safe than sorry" measures, but there's no need for them).
- In both emergency rooms and psych wards, there is a particular contempt for "frequent flyers" — i.e. people who have come in multiple times, and especially if they have a record of treatment noncompliance or clashes with staff. People diagnosed with borderline personality disorder (which has an extremely high suicide rate), in particular, face so many issues in psych settings (as it has an incredibly strong stigma) that many mental health practitioners actively try to avoid the diagnosis to avoid such issues for the patient.
- Misconception: Therapy will always help! A bad therapist is worse than no therapist at all. Bad therapists tend to be judgmental, controlling, patronizing, or dismissive, and focus more on trying to make someone "behave" or feel "normal". They might be overly clinical about it, classifying the patient as a DSM problem to solve rather than a human being in pain. They may use threats of involuntary hospitalization as a means of forcing compliance. They might see themselves as saviors protecting crazy people from themselves and see any disagreement as lack of insight. They could have personal biases — they could dismiss patients based on prior difficult cases, they could be a Heteronormative Crusader (especially in religious contexts), they could be dismissive of poor clients or rich clients. A bad therapist can have a very negative effect on the patient and could cause them to refuse to seek professional help ever again.
- Misconception: The cops will always help! Calling the police is usually the last resort, and should only be done if someone is threatening to harm someone else. If you have any sort of friendship with someone threatening suicide, it's better to try to talk to them (or get them to talk to someone else). Reasons abound:
- Police involvement, especially if it ends badly, can convince the sufferer to shut off communication and refuse to open up to anyone — a very bad thing when what they need most is to talk to someone.
- Not all police officers are sympathetic to suicidal people, especially high-risk groups such as women, the mentally ill, or LGBT people, and especially members of those groups with whom they may have a history. Even if they're not dismissive of the suicide attempt, they might just have no experience with suicide and might accidentally make things worse. Some might be understanding, but you have no idea whom you're going to get.
- Police involvement can raise the risk of violence. They don't want a situation to turn violent (well, most don't), but they don't mess around with possible threats to themselves or others, and calling the police risks an unstable but non-violent person being killed or seriously injured when police perceive a threat that doesn't exist. And if the sufferer is violent, a confrontation with police can push them over the edge.
- Misconception: Oh. Well then, never call the cops on a suicidal person. If someone is an immediate danger to themselves or others, you call the emergency services. That gets not just the police, but the paramedics on the scene as well. Don't get the idea in your head that an untrained person can "talk someone down" if they've already committed to harming themselves or others. And never prioritize avoiding police involvement over getting medical attention. It's also useful to call the police when you have good reason to suspect that a suicide threat really is just a way of guilting you, because if you guess wrong and they are serious, they can help out — but this is a very tricky situation to navigate.
- Misconception: God will always help! No religious belief will cure depression, anxiety, or indeed any illness in and of itself. People from every religion suffer abuse, depression, anxiety, mental illness, grief, trauma, and all other reasons to feel suicidal. Among the issues:
- Religious belief and prayer can have a positive effect on depression, but only if those people can consider themselves members of a community, have other members of that community talking to them and making them feel valued, and if their faith can help them grasp the source of their suicidal thoughts and talk themselves down (in a sense). If you're expecting Divine Intervention, that's not going to help.
- Some religious groups can cause trauma and abuse that leads to depression or suicide. They might claim that certain thoughts and actions are "sinful" and that you need to stop doing them (especially with LGBT persons), which can exacerbate suicidal thoughts from someone who believes them. They can also be abusive and controlling, leaving the sufferer socially and financially dependent on them and eroding their self-worth. They can even do this unintentionally — e.g. by adding religious layers to suicidal thoughts ("God hates me" or "I deserve hell") or by convincing people who can't shake their depression that it's because they lack faith.
- People who are prone to religious ideas or thoughts are vulnerable to scam religions and similar groups who actively recruit mentally ill or suicidal people, either to siphon all their money (while promising to cure their depression) or by taking advantage of their fragile state of mind to reprogram them.
- Misconception: Going cold turkey will always help! Even when depression or suicidality were caused by alcohol or drugs, it's not always the case. While getting sober is healthy and important (and sobriety support groups like Alcoholics Anonymous can provide the necessary social support as well), it's not an instant cure-all for depression. In fact:
- The "crash" associated with the withdrawal symptoms are a very good way to induce horrific suicidal depression in some people, even those who weren't depressed to begin with. And delirium tremens or uncontrolled opiate withdrawal are fatal by themselves, while cold turkey speed withdrawal will just make you wish you were dead.
- It won't help if you're self-medicating, because that implies there was an underlying problem like depression or mental illness that still needs to be treated.
- Total sobriety is not always a good thing for suicide prevention — sometimes, the underlying problem can only be treated with drugs. Sometimes they're prescription drugs, but other times they're not. Self-medicating with alcohol or drugs and induce the depressive lethargy that can sap the will to even attempt suicide — it's bad, but it's the Lesser of Two Evils. Cannabis is also a useful drug in many situations, as it's (a) nearly impossible to take a lethal overdose, (b) good at mitigating trigger-induced suicidal impulses, and (c) a relatively safe drug (media portrayals notwithstanding), which makes it particularly popular with PTSD or complicated grief sufferers, as well as people with chronic pain.
- Misconception: Going all natural will always help! While some aspects of an all-natural lifestyle can help with depression and suicidality, it's usually not for the reasons its advodcates think:
- "Natural" implies Drugs Are Bad, but that brings with it all the issues with cutting drugs out of one's treatment listed above.
- Fresh air, good diet, and exercise can help — it will make you feel like you're doing something valuable and helpful, and exercise in particular has been proven in studies to be as valuable in overcoming depression as SSRI antidepressants. But that's because exercise can change the chemical balance in your brain. And none of this is a cure-all — one might still need years of therapy.
- It encourages isolation (like moving to the countryside), which can worsen suicidal thoughts because you have so few people to talk to and you can be very far away from help. (And also it can be more expensive and you're exposed to all these chemicals, firearms, and farm machinery.)
- Like exploitative religious movements, there are numerous abusive or fraudulent natural living groups or communes that deliberately seek out mentally ill or desperate people to exploit or reprogram them.
- Misconception: The power of positive thinking will always help! This is, in fact, one of the most damaging and counterproductive misconceptions there is, because it's Victim-Blaming — it implies that the only reason a person is suicidal is that they haven't followed a specific lifestyle or mindset, and if you're not happy, you're a black hole of negativity and it's all your fault. A suicidally depressed person physically cannot maintain positive thinking any more so than they could wish away a broken arm — especially if there's realistically not very much to be positive about. Happy thoughts are not going to solve a person's financial situation, erase a past trauma, or correct a chemical imbalance in the brain. It's like telling a guy who's lost his leg that he can get it back by running a marathon. Incidentally, it's possible to be suicidal from too much positivity — it usually manifests in bipolar 1 manic episodes, in which people lose touch with reality, think they're invincible, and do suicidally dangerous things that prove otherwise.
- Misconception: Okay then. So there is nothing a non-professional can do to help prevent a suicide. There are things a relatively untrained person can do, especially a friend or significant other, if they know that a person is suicidal and they aren't imminently going to kill themselves. Professional help is a good idea, but often it isn't enough, and it's often a layperson who can do other very important things. These include:
- Talking and listening to the person, in their capacity as someone who cares about them. The sufferer may be more likely to talk to a friend than to a professional, and it also helps combat the feelings of worthlessness common in depression. In fact, refusing to talk to a suicidal person and making a professional handle it can make such feelings worse, as it gives the impression that you're just punting them to a specialist and further divorces them from society at large.
- Talking and listening to the person about things totally unrelated to their suicidality. Distract them — suicidal is often an impulsive act, and you can head off that impulse by giving them something else to think about (and also more proof that you care about them).
- Talking and listening to the person in your capacity as a member of the same community, especially "at-risk" communities (e.g. military veterans, LGBT people, minorities, sex workers, some artists). People in those groups are unlikely to trust professionals because they feel those professionals can't relate to them and what they're going through. If you are part of the same community, they'll be more likely to open up to you. They may get professional help eventually, but they may need that familiar outlet throughout the process.
- Removing access to methods of suicide, like knives, razors, drugs, or especially firearms — shooting yourself in the head carries a less than 10% chance of survival (and that 10% is often left with permanent and severe injuries). Also make sure they can't access places where they can jump from or hang themselves, and definitely don't give them access to a vehicle. Do this if the person is exhibiting suicidal thoughts — or even if they're not, but has recently been through trauma, or is very drunk, very high on stimulants, or in a manic swing.
- Be ready in case impulsiveness strikes. Remember, many suicides are impulsive, especially when they arise from a single trauma or the sufferer is prone to crashing (e.g. bipolar disorder or drug abuse). If you can reliably keep sufferers away from triggers or temptations, do so. And be willing to babysit sufferers if you can tell that an impulsive period is coming (e.g. they're coming down from the high, or it's a date connected with a past trauma) — keep them in a relatively safe environment, stay with them without judging them, and wait for the impulse to subside. Such sufferers may be willing to help you make an "emergency plan" with them during their non-impulsive phases.
- Misconception: Everything goes back to normal right away. This is one of the hardest things for someone to deal with — even though you may have saved a person's life, you haven't stopped what caused the suicide attempt to begin with. Things you need to think about include:
- Nearly half of all sufferers of major depression who attempt suicide and survive try it again within a year. You're dealing with serious chemical imbalances in the brain, and just keeping them alive isn't going to solve that.
- Therapy, while vital to the healing process, is a long and slow process that can take years, and many people are not ready for all that work to come back from a single suicide attempt.
- Many suicidal people might believe this misconception themselves — and when they discover it's not true, they start the cycle all over again, hiding their depression and pretending that everything really is back to normal. It's doubly serious if no one took the attempt seriously to begin with.
- People who survive a suicide attempt often manifest a very twisted form of Survivor Guilt — either because they wanted to die but couldn't even do that right, they feel guilty burdening their loved ones with financial and emotional stress (which is sometimes the exact thing they wanted to avoid), or they're now in legal trouble as the result of their attempt. It's one of the hardest and most confusing things for loved ones to deal with.
- Botched suicide attempts can leave people with debilitating irreversible physical damage; traumatic brain injury (from botched firearm suicides), paraplegia (from botched jumping or vehicular suicides), multiple organ failure (from botched overdoses), the list goes on. Survivors of suicide attempts are rarely left functionally unscathed, and the new physical trauma they're dealing with might be a Fate Worse than Death — giving them more reason than ever to try again.
- In the worst case scenario, assuming that everything is okay because the person survived can cause that person to be left in an abusive or traumatic situation — likely the same one that precipitated the attempt to begin with. It's especially common with people who aren't socially or financially independent (e.g. minors, human trafficking victims, or many sufferers of domestic abuse). This is why people who stop such an attempt should immediately take an inventory of any possible abuse the person may have suffered, as that may be their only opportunity to escape that abusive situation.
- Persistent feelings of sadness or worthlessness ("Persistent" meaning at least two weeks — obvious sign of depression) A common description by sufferers is that they feel "empty" or "hollow" inside. It's an issue when expressed by teenagers, who always seem to be "empty" inside; this symptom is dismissed as typical moodiness when it really shouldn't.
- Persistent lack of interest in previously enjoyed activities ("Persistent" meaning at least two weeks — obvious sign of depression) There's a spectrum here — it can range from just not participating in their hobbies, to actively disposing of things related to their hobbies, to outright retreating into their homes and not leaving the house. An extreme sign is when the person is trying to enjoy themselves but cannot even feel anxious about their lack of enthusiasm.
- Intensely elevated mood for no apparent reason, combined with a general feeling of invincibility or grandiosity (obvious sign of bipolar mania) An extreme sign would be someone acting as if they are on a constant cocaine or methamphetamine high without actually taking it, and taking risks like walking into traffic or gambling away all their money thinking they can't lose. It's related to the "risk-taking" element below.
- Frequent breakdowns and crying episodes (known but exaggerated) This is rarely witnessed firsthand, despite common media depictions (the Rule of Perception means that if a person is depressed, you have to see it on screen). In Real Life, depressed people will more often actively seek out quiet and isolated places during such episodes, either because they don't want attention or because they want someone to notice that they're missing. In fact, such a desire to be found can be unconscious, as this would both validate their feelings and give them "proof" that someone cares about them. It happens to both males and females, despite societal perceptions to the contrary.
- Unusual or constant anger, irritability, or irrational rage: This is more common in male sufferers (many cultures view anger and violence as a more acceptable outlet for men than crying, but there's also an element of how the male brain is wired — men are hormonally less prone to crying episodes), but it can also be common as a result of mixed states in bipolar disorder, or in bipolar people who are heavy drinkers or stimulant users.
- Absolute lack of displayed emotion: This is also more common in male sufferers of depression, but it's also highly common in victims of abuse or other PTSD sufferers, and far more rarely, it's one of the cardinal "negative" symptoms of schizophrenia. An extreme case is where a person becomes totally incapable of expressing emotion, even in a legitimately emotional situation, or if they outright lose the ability to speak — this is a major sign of something being very wrong.
- Sleeping too much or inability to sleep (known but may not be recognized as a symptom in itself) This is frequently due to the chemical imbalances that cause major depression. Bipolar mania or mixed states can also produce insomnia.
- Frequent unexplained aches or pains (little known and overlooked) This is due to the immune system shutting down. A variant of this is when minor injuries or illnesses take too long to heal, such as a cold persisting for a month or scrapes and bruises lasting for days. Those with no medical experience often cannot connect this to depression.
- Feeling cold in inappropriate weather (little known and overlooked) This is one of the most frequently overlooked symptoms, as wearing sweaters in warm weather is not uncommon in some places, and even the sufferer themselves may not realize that it's a symptom. It's also a possible explanation for why the Emo Teen always wears black — it's warmer because dark colors absorb and retain heat better.
- Changes in appetite and subsequent weight gain or loss (little known and overlooked) Again, this is related to the chemical imbalances in the brain, which affect a person's appetite. Sufferers will often notice this and try to hide it (or joke about it) or even force themselves to eat normally — as such, it's difficult to ascertain from the outside. Extreme weight loss, being dangerously underweight, and extreme attempts to suppress appetite are also primary symptoms of anorexia, and sudden unintentional weight gain in someone with anorexia can also inspire suicidal thoughts out of disgust at their "lack of control" over their body.
- Sudden loss of care for dangerous activities, beyond what can be explained by apathy or experience, particularly getting into physical altercations or reckless driving. It's related to the above feeling of invincibility described as a symptom of manic episodes of bipolar disorder. Some sufferers will take up dangerous hobbies, or even if they're already experts will start throwing safety precautions out the window. It's important to distinguish this from an expert at something dangerous just being confident (or cocky) and knowing how to do it right without the safety features — a sufferer will thinking nothing will happen even if they do it wrong. It shows that they don't care if they live or die.
- Changes in consumption of alcohol, recreational drugs, work hours, or forms of escapism: This is a more recently recognized sign, and it appears to be more common among high-stress and high-income professionals like athletes, entertainers, musicians, doctors, lawyers, law enforcement officers, and high-level business and finance workers. Much like with eating and sleep patterns, this could go either way — either you lose total interest in your work or you start working like a maniac, or either you become an alcoholic or you stop drinking entirely and begin self-recrimination. The key is that such changes either way are not connected to any apparent reason or obvious triggering event.
A few things to remember about these symptoms:
- Everybody's different. Not everybody will have the same symptoms, and certainly few people are going to have all of them. These are just the major signs, and there may be more symptoms that are harder to detect.
- Many of these symptoms — particularly those involving weight gain, temperature control, sleep cycle, or the immune system — could also be symptoms of a serious thyroid problem. Persons who suffer from such symptoms should absolutely see an endocrinologist or oncologist to rule out a thyroid problem, which can be fatal in and of itself.
- Depressed people are good at hiding or denying their symptoms. A lot of suicide and depression involves appearances and self-imposed pressures — depression stems from both an inability to express emotions and the underlying (if warped) desire to protect their loved ones from "wrong" or "unsafe" emotions. In fact, seeing what a depressed or suicidal person really looks like can be a huge shock for someone who only knows the TV version of it, and naturally such people will want to prevent that shock.
- There are some things that depressed or suicidal people will only admit to professionals. Part of it is that friends and family members, while often well-meaning, are too emotionally involved — they need to talk with someone who understands what they're going through, either one-on-one or with a group of fellow sufferers.
If you're looking for good numbers, keep looking. Suicide statistics and official reports of deaths from suicide are often very skewed and inadequate. Deaths from suicide itself tend to be undercounted. Accidental suicides are often listed as just accidents, particularly when they arise from car or work accidents. Risky behavior might occasionally be thought of as bravery or heroism rather than suicidal behavior. Stress deaths should also attributed to suicidal behavior if they arise from overwork.
- Cases of Suicide by Cop or other deaths in police custody called suicides that are actually the result of Police Brutality or negligence;
- Murders that are set up to look like suicides;
- Suicide pacts and kinks Gone Horribly Wrong;
- Knowing that a person is suicidal and encouraging them to do so or providing the means for them to do so.