Can We Talk…About Suicide?

I worked for comedian Joan Rivers while enrolled at UCLA, and she was famous for saying, “Can we talk?” When it comes to suicide, the answer is: “Yes.” 

We not only can; we must. Lives depend on it. 

Joan Rivers and I each lost a family member to suicide. The sudden and tragic loss of a loved one to suicide is uniquely heartwrenching. The questions and “if onlys” can be haunting…thoughts of how this might have been prevented…the relentless longing for a different outcome. The unimaginable loss of my 27-year-old son Wiley, such a bright light and loving human being, was devastating.

September is Suicide Prevention Awareness Month, and The Jed Foundation (JED) has chosen a theme this year of “It’s OK to Say Suicide.” JED is devoted to protecting youth mental health and suicide prevention, and their work on campuses and in communities is making a notable difference. Yet suicides are still happening, and the magnitude of the problem is deeply concerning. In 2020, in the United States alone, nearly 46,000 people died by suicide. Additionally: 1.2 million people attempted suicide, 25.5% of young adults reported having seriously considered suicide in a single month, and there was a 31% increase in mental health-related ER visits for young people ages 12-17.

It can be awkward and uncomfortable to discuss suicide, but avoiding the conversation does more harm than good. It is imperative that we create a culture where we can openly discuss suicide, without shame or judgment, and that we don’t pathologize human suffering. Talking allows us to support and learn from each other, reduce stigma associated with suicide and mental health problems, and reminds us how critical it is to prioritize taking care of our mental and emotional health. 

While we can’t “fix” each other’s pain, feeling less alone with it certainly helps. And we are not alone: More than 50% of Americans will be diagnosed with a mental illness or disorder at some point in their lifetime. In 2020, 1 in 3 young adults between the ages of 18 and 25 experienced a mental, emotional, or behavioral problem. 

Anyone can struggle with mental health issues: us, our neighbors, a family member, a friend⁠—someone who seems to be facing enormous challenges, or even someone who may outwardly appear to have it all together. But all of us grow stronger when we bravely share the truth of our experiences and show up for one another with understanding and compassion. 

What causes suicide and what is suicidal thinking

Suicide is a desperate action taken to escape what is perceived as unendurable pain, when a person’s anguish and sense of hopelessness overpowers their will to live. Suicide happens when part of a person’s mind, sometimes referred to as a “suicidal self-state,” becomes convinced that ending life is the only or best way to be free of some unbearable suffering. 

Suicidal ideation is not uncommon. In 2020, it was estimated that 12.2 million Americans seriously thought about suicide. Life can be extremely challenging, and sometimes people feel like they just can’t go on. Fortunately, most of us have other parts of ourselves that keep us going⁠—hanging in there until the “storm” passes. Some part of us knows it will not always be as awful as it currently feels, and we hold on to that thread of hope for better days ahead. 

But when suicides occur, it is often as if a suicidal self-state temporarily “hijacks” the mind, and the person loses contact with all other parts of themselves. In that state, positive thoughts are not simply disregarded, they seem to be inaccessible. This captures one of the more challenging aspects of dealing with suicidal ideation; it is impossible to predict if or when a suicidal self-state might completely overpower the rest of the mind. 

What to do about suicidal feelings 

One study found that almost half of people who try to end their lives do so impulsively, which means that there is not much time to intervene when help is most needed. If someone is struggling with suicidal thoughts, it is imperative that they get the support they need to survive a “hijacking,” before they lose total access to the more hopeful and healthy parts of themselves.  

It is inherently difficult for someone to fight against constricted, inflexible, impulsive, and hopeless thinking on their own. Loved ones and trained professionals can look for warning signs and help guide someone through periods of acute distress; however, the suicidal individual also needs to be willing to accept help and call for reinforcements when battling a suicidal self-state. Sometimes we need to rely on another’s hope and determination until we can rediscover our own. 

Remember that the suicidal self-state cannot be trusted. It might try to convince someone that it will be better for others if they are gone. Don’t be decieved; in all my years of running groups for people who have lost a loved one to suicide, I have not found this to be true. Those left behind typically experience a horrible sense of loss and regret, desperately wishing that they could still do more to help.

What resources are available

Each individual suffering psychic pain has their own complicated set of factors that contribute to their troubled state of mind. It often takes considerable time and effort to effectively address the root causes of one’s suffering. 

It is important to find the right combination of resources to: 

1. Get help with the immediate crisis of an activated suicidal self-state
2. Understand and address the sources of pain and suffering

Those who need immediate support can text “HOME” to 741-741, call or text 988. Another protective and preventive resource is therapy; talking with a professional on a regular basis can help people understand and work through their difficulties, develop effective coping strategies, and build upon the things that make life feel worthwhile. 

Dealing with suicidal ideation can be exhausting and scary for everyone involved. Yet with enough compassion, persistent effort, and help, it is possible to navigate life’s challenges, constructively address pain and suffering, and create or rebuild meaningful lives. Despite the enormity and complexity of the problem, there are reasons to remain hopeful. 

Let’s keep talking. 

Celeste Birkhofer, PhD, PsyD, is a Licensed Clinical Psychologist with a private practice in Northern California. Dr. Birkhofer is a member of the Adjunct Clinical Faculty at Stanford University Medical School, Department of Psychiatry and Behavioral Sciences, where she teaches and supervises psychiatry residents. She is a Training and Supervising Analyst at the Institute of Contemproary Psychoanalysis, and she volunteers at a grief center, co-leading groups for people who have lost a loved one to suicide. Dr. Birkhofer is on the  Advisory Board of the JED Foundation.