Suicidal? Just Depressed? Be Careful How You Phrase It Online

Facebook's new "flag" policy for threats of self-harm strikes me as an efficient, measured approach that manages to offer timely help while also respecting the privacy of the people making the alleged threats. The trouble, as always, is interpreting what constitutes a threat.
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People with low self-esteem tend to use Facebook "counterproductively," a recent academic study found, overwhelming their online friends with negative information and failing to elicit the sympathy they are ultimately seeking.

The findings naturally provoked a certain amount of eye-rolling. Endless Debbie Downer status updates get to be, well, kind of a downer. One begins, after a while, to screen them out.

On the other hand, given how frequently people use Facebook as a serious cry for help, there's a legitimate moral hazard to ignoring the negative updates altogether. The study population included ordinary undergraduates, but its implications for more severely troubled people are far-ranging. In particular, people with anxiety and mood disorders tend to suffer disproportionately from low self-esteem, and people with psychiatric disorders are also at higher risk for suicide.

In fact, so many people have taken to posting suicide threats on Facebook that in December the social network announced a policy whereby friends could flag the post, and the network would then offer the poster an opportunity to chat confidentially with a crisis counselor online.

Facebook's policy strikes me as an efficient, measured approach that manages to offer timely help while also respecting the privacy of the people making the alleged threats. The trouble, as always, is interpreting what constitutes a threat. And that remains up to the people reporting the hastily dashed off wall posts and instant messages -- the "friends," who may have only the most tenuous connection to the person posting and know little, or even nothing, about his or her current circumstances or frame of mind.

Facebook, of course, gives users the option of limiting who sees their status updates. Someone with a certain presence of mind might choose to limit their dark musings, or even their outright cries for help, to those who know them well, to avoid inappropriate meddling, or simply excessive and possibly damaging disclosure.

But someone who is depressed and desperate enough may well not be thinking clearly enough to make such a call. And that's where they can find their pride hurt and their privacy compromised, even when it comes in the form of a well-meaning gesture from a well-meaning acquaintance.

I'll share the story of one man who I interviewed for my upcoming book, Dosed, about young people who grew up taking psychiatric medication. His story illustrates, I think, the way that depressed people may disclose emotions to people online in ways they would never do, or have the means of doing, in person.

It also shows how such disclosures can, in theory, end up securing badly needed help. The question is whether the ends justify the means.

This particular young man, whom I call Alex in the book, had been a withdrawn kid his whole life, but in moments of particular anxiety and depression, he had the opposite tendency -- to reach out in a panicked way to anyone who would listen to him. He would let his circumspection get the better of him.

Twenty-one years old at the time of this incident, he had been struggling with obsessions, anxiety and depression on and off since age 10. Several weeks earlier, he had quit his medications, frustrated that they didn't seem to be getting at the root of his problems. Off his meds, he soon felt himself slipping into a deep depression and, seeking validation and support, he began spending most of his time on Facebook, interacting with acquaintances he'd met through shared interest groups on the social network.

One afternoon, Alex was having a Facebook chat with someone he'd known for several years but had never met. During the chat, he never used any telltale words like "death," "suicide" or "kill myself," but his state of mind must have been clear to his friend as he typed things like "I may as well just give up" and "There's no point in going on."

His friend did his best to comfort him, but, as Alex acknowledged, there's only so much cheering up you can do via Facebook chat. Instead, his acquaintance reached out in apparently the only way he knew how.

About an hour and a half after their online conversation ended, Alex heard a knock at the door. It was the police. They said they'd gotten a report that someone on the premises was suicidal.

Alex was stunned. Yes, he struggled with depression, he stammered, but he had no plans to kill himself. His mother was a nurse, and she was home. Everything was fine. Besides, he added, he had just seen his psychiatrist that morning -- and, in fact, he had just restarted antidepressants.

At first, the police seemed satisfied, and left. But they returned a few minutes later with paramedics. The next thing Alex knew, he was being hauled off to a nearby emergency room, then committed against his will to a psychiatric ward.

He ended up spending several nights in first one psych ward, then another. He gleaned that the authorities thought he was a danger to himself. He found this ironic, especially since one of the wards was the exact same one that had refused to let him in a couple of years earlier. Back then, he had been feeling truly desperate and begged to be admitted, but they had said he needed to have a specific plan to kill himself.

In the end, the best Alex could figure was that his Facebook acquaintance knew from Alex's profile where he went to college and had contacted the university's public safety department upon reading Alex's bleak pronouncements. Public safety, in turn, contacted, the local police precinct, who sent officers to his house.

Facebook's role in the incident isn't clear, although the company has said in the past that it encourages friends to call local law enforcement if someone's Facebook activity suggests he or she is in immediate danger of self-harm.

A couple of years after the incident, Alex was still inclined to view the incident as a waste of time. Since he didn't feel actively suicidal and had already committed to restarting antidepressants when he was hospitalized, he didn't see his forced stay as helpful or therapeutic.

However, he also agreed with his psychiatrist's take on the situation. In her opinion, he was an adult, and needed to take responsibility for what he disclosed, and to whom. Even in his depressed and anxious state, he ought to have known better than to have rambled on about his hopelessness and desperation to someone he had only interacted with through a shared online interest group.

That lesson sank in fairly quickly. When Alex got home from his forced hospital stay, he found a Facebook message from his concerned acquaintance waiting for him. "How are you doing?" it asked. Alex kept his answer short. "I've decided not to talk to anyone about my issues anymore," he answered curtly. His friend seemed to get the hint.

For more by Kaitlin Bell Barnett, click here.

For more on mental health, click here.

Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.