Reflections: A Suicide Crisis

Every day I look into the eyes of my children, and I am thankful they are okay. Something inside us transforms the moment we become mothers; we instantly become guardians and protectors. We experience a love deeper than the deepest ocean and a compelling drive to save our children from injury, pain, and, above all, death. I remember looking at my eldest on the day of her birth and feeling a sudden pang of dread, knowing she would leave for college one day. The passing thought that she could die was something I quickly pushed away—it was more than my fragile heart could bear. We want our children near us, and we cannot imagine the pain of losing them.

But how do we really know if our children are okay? We cannot sit inside their minds and file away their every thought. We tell them, “I love you. Please come to me if you ever feel sad, lonely, or anxious. I am here for you, and I will protect you.” But what happens when they do not reach out to us—or anyone else—for help? What happens when they seem to be doing well, but something shifts and they suddenly become deeply overwhelmed?

Over the past six weeks, I learned of three tragic cases of suicide involving young people. On August 12, a 43-year-old physician mother of three young daughters died by suicide. On September 23, an exceptional 19-year-old in our community died by suicide. On September 29, a mere 13-year-old child died by suicide.

When I hear about loss by suicide, my heart is heavy with grief. As parents, we feel the empathetic pain of those grieving their own children. As a physician mom with three daughters, I look at the death of Dr. Ruple and know her daughters' lives will never be the same. They will likely struggle with painful questions: “Why?” and “How could she leave us like that?” These are likely the same questions the parents of the other three young people are asking themselves.

As a physician, I crave an understanding of the human mind. Perhaps if I understand it better, I can do something to prevent another tragedy. A 2009 study by Deisenhammer et al. explores what occurs right before a person attempts suicide. Examining 82 individuals who survived a severe suicide attempt, the authors provided critical insight into the duration of the suicidal process. What struck me most was that nearly half of the participants reported 10 minutes or less between their first thought of suicide and the actual attempt. Similarly, a 2007 review by Hawton highlights how brief this window can be: the duration between decision and attempt was less than 5 minutes for 24% of individuals, and less than 1 hour for approximately 71%.

In my medical practice, I have walked alongside parents grieving the loss of a child to suicide. Beyond their immense grief, they bear heart-wrenching guilt: “How did I miss the signs?” “Why didn’t I know they were in so much pain?” “I wish I could go back and help.” Sadly, research demonstrates that there is often little to no time for intervention in the moment.

If you are reading this and have lost a loved one to suicide, please know that you did not miss anything. Please do not carry guilt; in most cases, there was nothing you could have done. I liken suicide to a tragic accident. Much like an unintentional overdose, a person on the brink of suicide is not of sound mind. Alcohol or other substances are frequently involved, but even without them, a person in that tragic moment is not experiencing rational thoughts or feelings.

To anyone who has contemplated suicide, know that the desperate need for emotional reprieve will pass. Age and wisdom can be a blessing in this regard. Most adults who have navigated severe depression have experienced the passing of these feelings before; the memory of recovery offers hope that relief will come again. Young people—especially those experiencing their first episode of severe depression—do not yet have the gift of that memory. They cannot fathom that their pain will ever subside, making death feel like the only answer.

So, what can we do to protect our loved ones? I wish I had an answer that could guarantee safety and happiness. However, I believe open conversation is key when dealing with depression and suicidal ideation. Here are a few essential principles to keep in mind:

1. Talk openly and honestly about depression and suicide. It is common to experience suicidal thoughts, and talking about them openly can strip them of their power. Ask direct, clear questions: “Have you ever thought about killing yourself?” If they say yes, try not to panic. This is a surprisingly common thought and does not automatically mean they will act on it. Treat it as a measure of their pain and seek professional help. Panicking may make them afraid to reach out if those feelings return.

2. Eliminate access to lethal means. If you know a loved one is experiencing severe depression or a crisis, restrict access to self-harm. Remove weapons, medications, alcohol, sharp objects, car keys, and cords or ropes from the home.

3. Seek help early. Pursue treatment while depression is still mild to moderate. Interventions may include medication, therapy, social support, exercise, prayer, journaling, volunteering, and spending time outdoors. Early intervention offers the best chance for recovery.

4. Remind your loved one that painful feelings are temporary. Reassure them that even when it feels as though the pain will never end, it always subsides with time.

Seeking Help & Emergency Steps

• Suicide & Crisis Lifeline: If you or someone you know is suffering from severe depression or suicidal thoughts, please call or text 988.

• Immediate Danger & Involuntary Commitment: If your loved one is in imminent danger of hurting themselves or others, call 911 or contact your local mobile crisis team. This can initiate a 24- to 72-hour emergency hold following an emergency department evaluation, allowing time to assess risk, stabilize the individual, or petition probate court for mental health intervention.

References

1. Deisenhammer EA, Ing CM, Strauss R, Kemmler G, Hinterhuber H, Weiss EM. The duration of the suicidal process: how much time is left for intervention between consideration and accomplishment of a suicide attempt? J Clin Psychiatry. 2009;70(1):19-24. doi:10.4088/JCP.07m03861

2. Hawton K. Restricting access to methods of suicide. Crisis. 2007;28(S1):4-9. doi:10.1027/0227-5910.28.S1.4