Our Policy in Preventing Suicide Should Be "If In Doubt, Check It Out"

Altruistic or not, it is of great benefit to our friends, family and community to gain insight into what the person in crisis is thinking and feeling -- whether we understand them or not -- in order to intervene in a potential life-threatening situation.
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Almost every day we are confronted by what seem to be senseless acts of violence, people hurting themselves or someone else, a person very close to them, a group of strangers; it doesn't seem to matter.

And it scares us.

That these events appear to be so random, taking place at some community school or college campus, an army base or shopping center -- sometimes even in our own backyards -- helps explain part of this fear.

But maybe it is more the overwhelming sense of powerlessness that these acts bring out in so many of us that is so disconcerting, the feeling that there is really nothing you, I or any one can do about it; and we just have to resign ourselves to the fact that arbitrary acts of self-inflicted terror are now part of our daily lives and we might as well accept it.

But it doesn't have to be that way.

There are lessons we have learned in suicide prevention that can provide needed perspective on this problem that can impact our ability to reduce violent, self-destructive and suicidal acts, whether in the role of caring friend, family member or health care professional.

We begin with the understanding shared by so many students of the human condition that violence expressed outwardly is homicide, violence expressed inwardly is suicide, and there is a thin line between the two. And add the awareness Samaritans and countless other crisis response organizations have gained from talking to millions of people in distress on suicide hotlines throughout the world; namely, that people in crisis are frequently experiencing such an extreme level of emotional pain that they will do almost anything to make it stop.

This is supported by the Department of Education's Safe Schools study following the tragedy at Columbine that examined acts of violence over the previous 15 years and found that a majority of attackers had difficulty coping with their own significant losses and personal failures and often had a documented history of feeling extremely depressed, and even suicidal.

So the better we are at recognizing people who are in distress, who are depressed, self-destructive, experiencing trauma, a significant loss, etc., the better we are going to be at preventing potential crisis situations from evolving into violence and tragedy.

Now, admittedly, this isn't easy, especially if we feel that the person in crisis is behaving in a manner that we do not think is justifiable and/or stands in opposition to our own personal beliefs and principles -- including acting out in ways we consider provocative and, even, reprehensible.

So where do we find the motivation to overcome our discomfort? Simply put, self-interest! For, altruistic or not, it is of great benefit to our friends, family and community to gain insight into what the person in crisis is thinking and feeling -- whether we understand them or not -- in order to intervene in a potential life-threatening situation before it gets out of hand and people we care about get hurt.

It also helps to remind ourselves what we were like when we were depressed or in crisis; how difficult it was to deal with us when we couldn't think straight, felt things would never get better or thought life wasn't worth living -- an exercise that has helped inform the work of tens of thousands of caregivers and health providers who respond to at-risk populations in NYC and have participated in Samaritans professional development training over the last 30 years.

An exercise that reminds each of us that when we start judging other people's behaviors and responses to overwhelming circumstances that "there but for the grace of God go I," that everybody needs (and deserves) a helping hand and that when you are connected to other people you get through difficult times better than when you are left to your own devices -- what we refer to as protective factors in crisis response work, the behaviors, environments and relationships that reduce self-destructive behavior and enhance hope and resilience.

But as philosopher Henri Bergson said, "The eye only sees what the mind is prepared to comprehend," which poetically points to the fact that we do not see what we are not looking for, what we are not prepared to deal with or what we don't want to know. And that lack of seeing interferes in our ability to acknowledge what is going on right in front of us, and get involved.

The fact is, if something looks wrong, it probably is wrong. We frequently can tell when the people close to us are behaving in ways that are in stark contrast to their previous behavior. We know when there has been a traumatic event, a life-changing situation, someone has experienced a dramatic loss or is ill and has withdrawn and become completely isolated.

At these times, making contact, providing care and communicating with that person does make a difference; a concept that may sound cliché and touchy-feely but is actually supported by clinical research, including crisis hotline studies that found supportive communication does measurably reduce a callers' emotional state and level of suicide ideation.

"Enhance protective factors and reduce access to lethal means," preaches suicide prevention expert, Eric Caine, MD, University of Rochester Center for the Study and Prevention of Suicide, who constantly talks about what each and every one of us can do to reduce self-harm.

When you consider the incidence and impact of homicide, suicide, abuse, domestic and sexual violence in the U.S. (which, for perspective, is as if the number of fatalities on September 11 occurred on a monthly basis), these seeming senseless acts of violence are not so random. And, like our public education campaigns to fight the spread of AIDS, prevent drunk driving, enhance disaster preparedness or combat terrorism -- suicide and violence prevention are challenges we can face together and do something about.

I suggest we start with a slogan that confirms our commitment to taking action on an individual and community basis; something like the poignant "Silence equals death" (used by AIDS activists in the early days of the epidemic) or the call to ward off domestic terrorism, "If you see something, say something!"

It comes from a young man who took part in a suicide prevention talk many years ago who, after listening to what must have seemed to him an endless diatribe on the issues and behaviors involved in preventing suicide and saving lives, simply said, "So what you really mean is, 'If in doubt, check it out!'"

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

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