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

diseases combined.

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

live for.

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

may change.

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:


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.


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:

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

For several good articles, visit If you are thinking here

For a national hotline, call: 1-800-333-4444

For a directory of local hotlines, visit

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

this series.)

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

physical appearance.

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,



Five things to say to a severely depressed or possibly suicidal


1."I hear you."

2."I understand."

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.


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  Read his many articles there at
John also writes and produces The Biweekly Depression and Bipolar Newsletter.  For subscription information please contact him at [email protected]  


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