Talking Openly About Suicide

How to cope when someone you love completes suicide and how to help someone at risk

Brandy Lidbeck was just 10 years old when her mother completed suicide. After what she believed society considered an "appropriate" period of grieving – about a year – Brandy tried to put the death out of her mind.

Once the initial shock wore off, Lidbeck's family didn't talk much about her mother or how her death affected everyone else – the "suicide survivors." Others in the community didn't bring it up either, tiptoeing around the subject whenever it came up. "We moved shortly after she killed herself, so the family photos came down and never went back up," says the California resident, now 35 with three kids of her own. "I shut it all up inside me. And any time I did start to feel emotional about it years later, I would think, 'What's wrong with me? I should be over this by now.'"

It wasn't until Lidbeck was in her early 20s that she went to see a therapist, on the advice of a friend who'd lost her father to suicide. "I didn't see the point, but I agreed to go to one session," says Lidbeck. What she thought would be a waste of time turned out to be immensely helpful. "It helped me unpack so much sadness that had been hiding behind anger. I went back every week for five years."

In 2008, her cousin took his own life after returning home from a tour in Iraq. "I remember thinking, 'How could he do this to us? He knows the pain that suicide has caused us,'" she says. "But this time, I was better able to understand that it wasn't actually about us or his feelings toward us, and why we needed to talk about what had happened." So instead of refusing to acknowledge what happened, she encouraged her family to face their difficult emotions, like grief, anger, guilt, and shame.

Suicide rates are rising, and all age groups are at risk

Today, suicide affects more people than ever in the United States. Until recently, adults age 65 and older were considered the group at highest risk for suicide. But last year, the Centers for Disease Control and Prevention (CDC) announced that suicide rates increased between 1999 and 2014 for every age group younger than 75. Some of the sharpest increases were in middle-aged men and women, and in girls ages 10 to 14. In the United States, suicide is one of the top causes of maternal death.

Overall, age-adjusted suicide rates in the United States have increased 24 percent since 1999, according to the CDC. "It's really startling," says Barbara Stanley, PhD, professor of medical psychology at Columbia University Medical Center. "In all the years I've been doing suicide research, it's like nothing we've seen before."

There's no widely accepted explanation for this increase, says Stanley. Some experts cite the 2008 economic crash as a contributing factor, she says, but suicide rates were rising steadily even before that. Others point to corresponding increases in rates of depression, anxiety, midlife stress, and teen cyberbullying. 

"Part of the problem is that we as a society don't put a whole lot of resources into trying to figure this out or trying to help suicidal people," she says. "There's still a stigma attached to talking about mental health problems, and if you look at the amount of money devoted to suicide versus any kind of physical health problem, it's much less."

Christiane Manzella, PhD, a senior psychologist at the Seleni Institute, agrees that this stigma has serious consequences – both for people who are suicidal and hesitant to get help, and for the grieving friends and family left behind when suicides are completed.

It's also important for society to understand that being suicidal is not something that people choose willingly. "Suicide is not an action that has intentionality," says Manzella. "It's an action that comes out of deep hopelessness and despair. It's not about being selfish or self-absorbed. It is about experiencing the most intolerable psychological pain you can imagine."

That's why Manzella and many other advocates for suicide prevention, don't use the phrase 'committed suicide.' "That phrase implies that there was a choice," says Manzella, and uses legal language rather than "acknowledging that the person who attempted or completed suicide was in unbearable psychological pain."

How to cope if you've lost someone to suicide

Losing a loved one can be overwhelming no matter what their cause of death, especially if it's unexpected or premature.

When a person dies by suicide, "it can have this additional mix of guilt and shame and sometimes even anger at the person who did it," says Stanley. These are natural feelings, says Stanley, but they need to be acknowledged and understood in context. "The reality is that this person did not take [his or her] life because of anything you did or didn't do."

Survivors of suicide may also be hesitant to talk about their loss with other friends or family – or may be outright discouraged from doing so. "Suicide is not understood, and survivors are disenfranchised grievers," says Manzella. "[This] means that there are social pressures to move on and not openly grieve or even acknowledge the suicide. This stigma and pressure not to speak places survivors at risk for complicated bereavement."

Instead, says Manzella, family and friends "need [an outlet] tell their story and be heard because they are also victims."

Seek out a knowledgeable therapist or a support group – either online or in person – specifically for surviving family members of people who have completed suicide. It can be a supportive place to work through the conflicted feelings and thoughts that are so often connected to shame and guilt. The American Foundation for Suicide Prevention and the American Society of Suicidology websites are good starting points. These and other resources can be helpful to people who have lost someone to suicide and to those who are worried that a loved one may be at risk. 

A few years ago, Lidbeck started a blog and online support group for suicide survivors, and eventually wrote a book by the same name – The Gift of Second. The name refers to "the gift of going second," meaning behind others who have already been down a similar path, and speaks to the advantage of joining such a community, she says.
Survivors can carry guilt and shame for their entire lives, she says, and this is something she knows firsthand because she is one of them. "I was finally able to come to terms with the fact that my mother's suicide spoke only to her own mental state and not, as I felt for so many years, to my value as her daughter," she says. "And that's something that everyone who's lost someone to suicide deserves to understand."

Warning signs of suicide and how to offer help

A suicide can occur seemingly out of the blue, leaving friends and family confused and angry that they didn't see it coming. But according to the American Foundation for Suicide Prevention, most people who take their life exhibit at least one warning sign before making an attempt. That could be something the person said, a person's action, or even something as subtle as a change in mood.

If a loved one seems anxious, depressed, angry, or alienated from friends and family, asking them about their feelings may help you determine the extent of their distress, says Manzella. If a friend or family member talks about being a burden to others, feeling trapped, being in unbearable pain, or having no reason to live, take your loved one seriously.

"It's usual that most everyone has had at least some passing thought that 'I'd be better off dead,' but these are usually fleeting thoughts in response to some stress or disappointment," says Manzella. "When someone feels life has become intolerable and life has lost all sense of meaning, that's [when it's time to] think about getting some help."

Behavior changes can also indicate that a person may be thinking about suicide. If he or she is acting recklessly – abusing drugs or alcohol, for example – or withdrawing from their normal activities, they may be at increased risk. That's especially true if they've recently been through a stressful event or have a history of mental health problems. 
If a loved one says they've thought about suicide, ask them if they have a plan. "Be direct," says Manzella. "Saying the words: 'Are you thinking of killing yourself?' will not increase that person's risk of actually completing suicide. In fact, we know that talking about suicide has the possibility of reducing their risk."

You can further reduce that risk by eliminating that person's access to guns, pills, or other instruments that could be used for a suicide attempt. (If someone is in immediate danger of taking their own life, call 911.)

Sometimes just listening without blame or judgment can make a difference, Manzella adds. And while you can't force anyone to seek treatment, you can strongly encourage it. "Say to them, 'I love you. I know you're in pain, and I want to help you get help.'"

In that sense, she says, many suicides can be prevented. "I've worked with people who have been suicidal and who have worked through their story and found hope again and come through on the other side," she says. "If we can find ways for people to connect with themselves and other humans in meaningful ways, we can empower them and get them the help they need."