Managing Against Tomorrow - Suicide
by John McManamy
"Notwithstanding all we have to live for, the brain in crisis has
a perverse way of having us think the very opposite."
Depression kills. Simple. Some fifteen percent of us who suffer from
major depression will die by our own hand. Many more than that will
make the attempt. And many more still will die by "accident" or "slow
suicide" through reckless behavior or personal abuse and neglect.
According to the Centers for Disease Control, suicide is the ninth
leading cause of death in the US (more than 30,000 a year), well
above homicide (at about 20,000 a year). Women will make the most
attempts, but men will be by far more successful, by a margin of four
to one. In teens and young adults, suicide is the third-leading cause
of death, after accidents and homicides, more than all natural
Suicidal depression does not discriminate. It afflicts both the strong
and the weak, the rich and the poor. War heroes have been taken
down. So have survivors of the Nazi death camps. As have successful
business people and artists and mothers and those with everything to
We are talking epidemic numbers. At any given moment, five percent
of the general population is suffering from a major depressive episode.
Over the course of a lifetime, major depression will strike twenty
percent of the population, numbers comparable to cancer and heart
We are talking battlefield odds. Those with major depression have an
85 percent survival rate, but the prospect of finding ourselves in the
lucky majority brings us only small relief. The experience has
exposed us to our worst vulnerabilities, and deep inside we no longer
trust what tomorrow may bring. We may still be walking and
breathing, but we have been as close inside death as this side of life
permits, and our minds will never let us forget it.
We ponder the fates of the unlucky minority, and sometimes we say
a prayer. We contemplate the tortures their brains exposed them to,
and know for a fact that no God would ever hold judgement against
them. For the time being we are the lucky ones, but tomorrow that
Still, we do have a certain amount of control in managing tomorrow.
We who have survived know what we are up against, and can plan
accordingly. Following are some common sense guidelines:
IN THE LONG TERM
Cultivate friends or family members you can call on
should you find yourself in crisis. If you have no friends or
family you can trust, then seek out a support group, live or on
About posting your cry for help on the Internet: Choose
your site or mailing list very carefully. If you are new and
posting to a very busy list, your appeal may be lost in the
shuffle. At the opposite end, your message may go completely
unread on bulletin boards with little or no traffic. It may take a
few weeks before you establish a presence on a particular list
or board. By then, you will probably be on email or ICQ terms
with some of the members.
Look up the numbers of various local suicide hotlines
and keep them where you can find them. Familiarize
yourself with the Internet crisis and suicide sites and
bookmark the ones you like. (See the list of links on this
Establish a close relationship with your doctor or
psychiatrist. Ask yourself: is this someone you can call on in
the middle of the night? Or, if not, will someone be there to
respond to your call?
Remove all guns and rifles from your home. According to
the Centers for Disease Control, 60 percent of all suicides are
committed with a firearm. This is not an anti-NRA message.
We're just being sensible, that's all.
The same principle that applies to firearms applies in
part to medications. The tricyclic and tetracyclic
antidepressants can be fatal in overdose. You may want to
switch to a different antidepressant if you don't trust yourself. If
you must keep certain medicines in the house, it may be
advisable to turn them over to a loved one.
Watch your thoughts and feelings very carefully. You may
be able to pick up subtle signals in your mind, before a
full-scale crisis overwhelms you. Actually visualizing the act
should set off every warning bell.
IN AN ACTUAL CRISIS
All too often, a suicidal depression catches us alone and off-guard.
Notwithstanding all we have to live for and all those who care for us,
the brain in crisis has a perverse way of having us think the very
opposite. To those of you who are in this state right now:
Promise yourself another 24 hours.
Check this web page right now: http://www.metanoia.org/suicide/
Now call a trusted friend or loved one or a crisis hotline.
Remember, there is no shame in reaching out.
Finally, take comfort in the fact that help is on the way.
Your brain at the moment may not allow you to think
hopeful thoughts. But it cannot keep out the knowledge
that others are hoping on your behalf. This may be that
precious one inch of life you can hold onto at the
moment, the one that can eventually lead you to a
tomorrow worth living.
For access to counseling, visit Suicidal.com
For several good articles, visit If you are thinking ....read here
For a national hotline, call: 1-800-333-4444
For a directory of local hotlines, visit About.com
Leave a memorial at our suicide wall
"...75 percent of all those who commit suicide indicate their
deep despair beforehand."
Hey you! You with the teen-age girl who's driving you nuts. And you,
over there! The one with the co-worker who's been acting a bit strange
lately. You, too, with the husband who's just made out his will for no
good reason. Yeh, and you with the ageing parent who's just come
back from the doctor.
Have I got everyone? Wait, you over there, the guy who keeps telling
his wife to snap out of it.
You, all of you - listen up good.
Depression kills. Sure, you may never have suffered from major
depressive illness yourself, but chances are it will strike at someone
close to you. Should that happen, the odds are heavily in favor of your
friend or loved one making it through, but how you respond can
greatly increase or decrease those chances.
Following is some common sense advice:
According to studies, 75 percent of all those who commit suicide
indicate their deep despair beforehand. All but maybe ten percent are
sane people who might have responded to help.
Take very seriously any possible signs of major
depressive illness. These may include fatigue, weight gain or
loss, and feelings of hopelessness and worthlessness. A child
or teen-ager may feel more hyper or agitated than usual. (For a
more complete list of symptoms, see the March 23 article in
Keep in mind that any number of situational events can
bring on thoughts of suicide, with or without major
depression, events such as: marriage breakup, death in the
family, difficult birthdays or anniversaries or holidays, or loss of
Watch out for sudden changes in behavior. These may
In your child, declining performance in school.
In others: declining interest in previously enjoyed
activities, neglect of personal welfare, deteriorating
In the elderly, self-starvation, dietary mismanagement,
disobeying medical instructions.
Take very seriously any signs of suicidal behavior. These
may include: explicit statements about suicide, acting-out
behavior such as rehearsals or mini-attempts, self-inflicted
injuries, reckless behavior, making out a will, giving away
possessions, inappropriately saying goodbye, and odd verbal
behavior (such as "you won't have to worry about me,
THINGS TO SAY AND NOT SAY
Five things to say to a severely depressed or possibly suicidal
1."I hear you."
3."I love you."
4."You're not alone."
5."Would you like me to get help?"
Five things not to say to a severely depressed or possibly suicidal
1."You'll snap out of it."
2."It's just a phase."
3."Stop being so selfish."
4."You're just trying to get attention."
5."You gotta pick yourself up by your own bootstraps."
Advance knowledge is excellent prevention. Read the previous article
on what a depressed person can do, and think what you can do to
help that person. If your friend or companion needs someone to call
on in a crisis you can be that someone. If you are living at home with
a depressed person, you can cooperate in making the house as safe
as you can.
IN AN ACTUAL CRISIS
Listen. Do not be judgmental. Allow the person to vent his or
her anger or frustration.
Ask if he or she is planning to commit suicide, or has a
plan. This gives the person another chance to vent his or her
concerns and allows you to gauge the nature of his or her
intentions. This question is a fairly standard one, and
apparently will not trigger an actual attempt.
Do not leave the person alone, once you have
determined he or she is suicidal.
Try to convince the person to seek help. The fact that he or
she is talking to you is a start. Offer to make the necessary
arrangements if you think that will get the ball rolling.
Remind the person, if necessary, that seeking help for
depression no longer carries the stigma it once did, that
going for help is not a sign of weakness, and that the chances
for recovery are excellent.
Keep in mind, one day it could be me.
John is depression editor at Suite101.com. Read his many articles there
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