Suicide and Suicidality: A Therapist's Perspective

One out of every three therapists will lose at least one client to suicide during their career. One third. Thirty-three percent. That likelihood will increase if a therapist works with marginalized and at-risk populations. There have been over 20 suicides on the Pine Ridge Reservation during 2015. One out of six high school students seriously considered suicide in the past year and the rate of suicide among LGBTQ* youth is 4-8 times higher than cisgender/heterosexual peers. Rates of suicidality vary by race (and socioeconomic status), and increase for victims of violence/abuse, people with traumatic brain injuries, people with chronic sleep disturbance, and people with chronic pain. There are numerous other risk factors, but this blog is not about statistics.

[image description: Text: Need help? United States: 1 (800) 273-8255 National Suicide Prevention Lifeline. Hours: 24 hours, 7 days a week. Languages: English, Spanish. Website: www.suicidepreventionlifeling.org] Don't use a voice phone or don't want to use an interpreter? Here is information about the recently-launched text crisis line. It includes information about other types of crisis services (i.e. domestic violence, self-harm, etc.).

[image description: Text: Need help? United States: 1 (800) 273-8255 National Suicide Prevention Lifeline. Hours: 24 hours, 7 days a week. Languages: English, Spanish. Website: www.suicidepreventionlifeling.org]

Don't use a voice phone or don't want to use an interpreter? Here is information about the recently-launched text crisis line. It includes information about other types of crisis services (i.e. domestic violence, self-harm, etc.).

Suicide is a topic that can be approached from many different lenses and angles—spiritual, existential, systemic, interpersonal, intrapersonal… But before I enter that web, I want to stop, and breathe. This topic gets personal very quickly, and this post contains self-disclosure.

I can already feel the heaviness of the topic weighing my shoulders, bubbling behind my eyes, and churning my stomach. I can feel the temptation to intellectualize the topic. In the past, if I stopped long enough to set the intellectual process aside, my somatic and emotional process felt like it would consume me. And then I started breathing. I encourage you to stop and take a breath with me. Feel the weight (or tension or speediness or softness) settle in your body. Take as much time as you need before reading on.

It is hard to fully stay present with the content of this topic without going into my head or distracting myself. Maybe you have a similar experience. Or maybe it feels overwhelming. Because when it comes down to it, the topic of suicide is about pain and suffering.

What if we are only as beautiful as the severity of our pain?
— Client

Before becoming a therapist, I lost my only sibling, my brother, to suicide. For me, the most difficult part of the process has been acknowledging and feeling the severity of his pain before he decided that he could not handle another day. He had severe chronic pain, a diagnosis of bipolar disorder, and appeared to be developing Multiple Sclerosis. As his pain (emotional and physical) increased, so did his sense of isolation.

I realize now I didn’t really want to die. I just wanted to stop the hurt and pain.
— Latoya Jackson

Later, my family learned that my brother "never mentioned suicide" to his therapist. And based on that wording, apparently, his therapist never asked. Many therapists (and friends, and siblings, and parents, and children, and coworkers...) don't ask. We don't ask for many reasons, and one of the biggest ones is that we are afraid. We are afraid to confront that degree of pain, and we are afraid that we might not be able to help it. We feel helpless, hopeless, afraid, stuck...and that is uncomfortable (and potentially a vicarious, existential trauma response--even the topic of death/suicide can feel like a psychological threat to our own life). So we don't make space for it. Unfortunately, someone experiencing suicidal ideation is also feeling the discomfort of helplessness, hopelessness, fear, and being frozen in one thought process of despair.

[image description: On a black background there is a white sketch of a human head. Inside the head, the brain is thinking "SUICIDE." There is a speech bubble coming out, saying "I'm fine." Unknown source--Thanks Google Images].

[image description: On a black background there is a white sketch of a human head. Inside the head, the brain is thinking "SUICIDE." There is a speech bubble coming out, saying "I'm fine." Unknown source--Thanks Google Images].

Now, as a therapist, I believe my primary role is to be able to stay present my clients' pain, and to make space for its fullness. It is simultaneously the most painful and encouraging part of being a therapist and of being a human. It is a deeply intimate, raw, and vulnerable thing to witness someone else's pain. 

In order to make space for that pain, I may ask hard questions. My job is to look you in the eye and welcome your pain, because the typical impulse is to hide it, avoid it, or dismiss it. Society even encourages that you deny your pain (see Andrea Gibson poem below). And then you have to bear it alone. One of the biggest preventative measures for combatting suicide is combatting isolation. You don't have to do it alone. Therapists, hotlines, online support groups, and people in your community are available.

[image description: There is a dark hallway with some light in the background. There is a dark silhouette of a person sitting in a chair, hunched over, with their head down. Their hands are clasped and they are wearing a hat. Thanks recovery.org.]

[image description: There is a dark hallway with some light in the background. There is a dark silhouette of a person sitting in a chair, hunched over, with their head down. Their hands are clasped and they are wearing a hat. Thanks recovery.org.]

Another experience during suicidal ideation, or supporting someone through suicidality, is confusion. Sometimes we don't understand our own pain. We become our own pain-police and criticize whether we have valid reasons for our emotions. As a therapist, I don't need an explanation. I've been told on numerous occasions, "But I'm sad for no reason." Let's go back to the first half of that sentence, "I'm sad." Let's start there. Perhaps the reasons will unfold. For example, in Joanna Macy's work, you might discover that living is fraught with innumerable reasons for grief, sadness, and pain. According to the author, John O'donahue, the essence of living is riddled with obstacles that feel confusing and painful.

This process of self-discovery is not easy; it may involve suffering, doubt, dismay. But we must not shrink from the fullness of our being in attempting to reduce the pain.
— John O'Donohue, Anam Cara

When it comes down to it, whether you have experienced suicidal thoughts, suicidal impulses, suicidal attempts...or whether you haven't, we all prefer to avoid the painful parts of ourselves. They are scary. They are the monsters hiding under the bed. This is what Carl Jung referred to as shadow work. What happens when we enter into the painful parts of ourselves or of others? What happens when we feel the validity of that sadness and pain? At the very least, it informs us. It informs us of what isn't working for us, of injustice, of how we desire to live vibrant lives, of how we yearn to be seen and loved for who we are. Perhaps the universal experience of pain will connect us to each other as humans. At the most, it transforms us. 

What you say of your life—that its most painful event was also its greatest—that is, so to speak, the secret theme of these pages, indeed the inner belief that gave rise to them. It is the conviction that what is greatest in our existence, what makes it precious beyond words, has the modesty to use sorrow in order to penetrate our soul.”
— R.M. Rilke, Letter to Madame M-R, January 4, 1923

In the Shambhala tradition of Buddhism, there is a concept of being a warrior, a bodhisattva. In this tradition, a warrior does not fear self or other. It is a practice--one that is at the core of my work as a therapist. If I am not afraid of my own pain, nor of your pain, I can stay present and in relationship. In relationship, we heal.  

P.S. It's okay to be afraid. We are talking about life and death, after all! If you want to practice overcoming that fear, and practice being able to chat with someone about their pain and suicidality, I recommend getting at least one training (i.e. ASIST). Exploring your fears with someone close to you and/or a therapist may also be helpful.

[Image description: Link to a video of Andrea Gibson performing "The Nutritionist" at Western Connecticut State University. Transcript attached here.]