Anxiety Counseling depression Psychology Suicide

Talking about Suicide

Suicide | Suicide Prevention |Talking about Suicide
Black and white background, man with head in his hands, crying
We need to talk openly and honestly about suicide. Please check your triggers before reading this post. Image by Pixabay, free for commercial use image.

The real truth about suicide is not that suicide rates are on the rise, but that it has been rising for some time now.  If people did not notice before, they are paying attention now.

With the recent deaths by suicide of American designer Kate Spade and celebrity chef and culture journalist Anthony Bourdain, Social Media is gawking about why such apparently successful people would take their lives. Did they struggle with depression? Were there clues and signs given? And perhaps more important to those who live in fear that their loved ones will choose to take their own lives, could these suicides have been prevented?

Because I believe in honest and non-judgmental talk about suicide, the following post is a balance between understanding the statistics around the 10th highest cause of death in the United States, the care that providers are bound to give by license, and the personal experiences of this therapist, with any incidences or persons anonymized and depersonalized to protect the privacy of others.

Please check  your own triggers before reading the rest of this post.

Suicides Are Not Always Preceded by a Cry for Help

With some 44,000+ deaths in the U.S. attributed to intentional suicide (versus accidental death),  we need to understand that not all suicides follow a pattern of long struggle against mental health, followed by a cry for help that was not heard, ending in a suicide attempt.

Sometimes, cogent individuals take an assessment of their life and find it  wanting. From the outside, observers say the person “had it all” — wealth, family, career, idyllic circumstances, friends, and other aspects of life that people cherish.

Because suicide is not always predicated by the usual symptoms of sadness, crying, isolation, and overt signs of disintegrating health, it can be difficult to predict.


Suicide: The Familiar Pattern

What we are most familiar with regarding suicide is when it follows a recognizable pattern involving the following signs, mixed with depression and/or anxiety:

sleeplessness or oversleeping

mood swings

increased use of drugs and alcohol

talking about ways to end one’s life

talking about ways to seek revenge or make someone else feel hurt

talking about being a burden

insisting that no one would miss him or her when gone

feeling trapped or in pain that is unberable


grief and loss

financial loss or ongoing hardship

relationship stress or a breakup

depression and/or anxiety, usually for a significant amount of time

 a long bout of illness, whether chronic or terminal

social isolation and withdrawal


We can recognize the above situations to make a suicide risk assessment. For practitioners, we commonly screen new clients and our current clients whenever any of them report these difficult life experiences or changes in their normal routines. And it is now expected that we write in our notes what the answers to our questions about a person’s current thoughts are regarding risk of self harm.

As a mental health counselor,  I understand that this is a matter of caring practice; as a client, some people find the questions off-putting. “How could you even think I am contemplating suicide?”  they ask. I’m going to ask the questions anyway,  because it’s my role to err on the side of caution. I’d rather have a chance to explain myself as to why I ask, rather than to tip toe around a subject that doesn’t need to be handled that way.

We don’t need to tiptoe. We need to talk.


We Can Talk About Suicide

Today, we can talk about suicide, even when it’s painful, even if you experience a fear of being judged. We can talk about it, and people around us are thinking about it. Today, it’s not the elephant in the room. Not talking about suicide when someone is hurting — now, THAT is the elephant in the room!

Depression and suicide are no respecter of persons. As far as the statistics show,  those who have taken their lives have come from all sorts of backgrounds. They are certainly not limited to those who have experienced profound violence or poverty,  nor are there more suicides among brown and black people than white people, though many of us are trying to grapple with why the increase in suicides seems to be greatly focused on upper class white middle aged people, and particularly men.

Some of the stats may be a reflection of the method of death; that is, males tend to use guns and hanging to ensure a swift and irreversible death. Among females who chose pills, the amount of time it takes to die from an overdose allows for those individuals to be discovered and revived, and my suspicion is that some of these cases don’t get reported if the individual lives and does not seek hospital care (mandatory reporting occurs in any clinical setting).

All to say, any one of us — yes, that means, you and that means me — are at some risk of suicide just for the part about being alive in a changing, stress-filled world, and we need to understand why some of us choose to take our lives, and some of us, while struggling with the same issues and circumstances, do not.

Albert Camus wrote:

“The most important thing you do everyday you live is deciding not to kill yourself.”


If you decide not to kill yourself, he surmised,  you might as well make the related decision to really live — that is, to embrace being the most alive that you know how. And then, it’s up to you to define what “really living” is.

We can learn from one another’s stories of times we were brought to that brink of decision, whether it was once, twice, or many times. What did you feel? What did you think? What did you do? How did you decide to proceed with the act of choosing to live?

One of the options practitioners like myself do with our clients is to make a contract with those contemplating suicide. In the contract, a plan is laid out that asks the client to contact the therapist, a trusted friend, or a closer loved one and tell them of the feelings and plans they have to end their life. By talking about it, an intervention can be made to prevent that person from acting on suicidal impulses.

Does it work? Well, it does work if the the person who is suicidal commits to telling someone what they intend to do.  It does not work if the person hides their intentions, though the act of making the contract puts the known risk at the attention of others, reducing the barriers for that person to share what is going on. And the challenge with suicide prevention is one of disclosure — that is, when you are feeling the strongest about wanting to end your life, do you have the courage and willingness to hand over the control to someone else to help you get through that painful thought?

Some argue that contracting does not work because if a person wants to kill themselves, that’s what they are going to do and nothing will stop that from happening; meaning, if not this moment, then the next will be the one where another attempt at ending one’s life will be made.

I do not believe that the contract itself is the magic formula that prevents suicide. Instead, I believe it is the relationship between the suicidal person and the person s/he contracts with that wields some power. The trust that is worked between them is often what helps someone follow through with building support, limiting isolation, making connections with people, and accepting resources to help with learning coping skills and repairing the broken aspects one’s life.

In other words, it’s the relationship that heals. And it may be the relationship, the connection in that moment of need, that helps the suicidal person seek help.


Need Help Immediately? 

Call the National Suicide Prevention LIfeline —   1-800-273-8255

Text the Crisis Text Line  — Text CONNECT to 741741 in the United States

As SDC is not a crisis clinic with 24/7 monitoring, you should call or text the above numbers for immediate care from a trained crisis counselor.


Need Follow Up Help? 

I and other counselors are available to help those struggling with suicidal thoughts or the aftermath of a suicidal attempt. Because my work is all online, I do screen carefully and will refer out those who I feel need more hands-on care than my practice can offer. I truly want the best for each and every person who inquires about suicide prevention care and counseling for depression and anxiety.

You make the first step — calling or emailing — and I’ll meet you virtually or over the phone to discuss your next steps.

By Imei Hsu

Imei Hsu is a mental health counselor, active retired RN, writer, triathlete and arts promoter in the Seattle area and through online services. With 29+ years in healthcare (20+ years in mental health), Imei has a commitment to helping people discover insight into their health, relationships, and connecting. She is the owner of Seattle Direct Counseling and the blog, a presenter and speaker on a variety of psychological topics, and a positive force on the Internet. She is launched her personal project, My Allergy Advocate, in 2018. Imei is two-time Ironman Finisher (Mont-Tremblant 2016, Ironman Canada 2018), and is currently training for her third Ironman in August 2020; she also finished her first ultramarathon in 2017 and has gone on to race the 100K distance while preparing for two separate 100 Mile trail races in 2020. You can find her running everywhere and eating all the thingz, watching movies, and cooking real food.

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