Silently suffering

September is the suicide prevention awareness month for suicide which is ‘an act of killing oneself.’ Over the last few years of my practice, I have worked with quite a few clients who had suicide ideation which means thoughts or ideas around suicide, and those with intent who had attempted to commit suicide but had survived.
As a therapist, my biggest fear is losing a client to suicide. A part of me starts feeling anxious working with a client who discloses that he wants to harm himself. The tricky thing is that there is a fragile line between suicide ideation and suicide intent. A therapist is bound by confidentiality, and one of the exceptions to breaking that confidentiality is if I assess that my client can cause serious harm to himself or others. Law comes before confidentiality. A usual question I would ask if a client expresses his distress to end his life is, ‘do you know how you want to do that?’ and assess his state of mind if there is a detailed plan. Having said this, there are other ways a mental health professional evaluates the risk. The question here is not how a mental health professional will deal with it. They are trained to assess and identify the suicide risk as much as possible, but at the end of the day, how many people, young and older, will seek a mental health professional’s help if struggling with a wish and plan to die?
And then the scariest part is how suicide is perceived as a taboo issue, and no one wants to talk about it. When a family loses a loved one to suicide, they hesitate in calling it one and usually call it an accident. Why? Why do we avoid honesty around it?
In my two cents, when someone takes their life, the family and friends feel responsible and guilty, and disclosure means their bond with the deceased will be questioned. The hiding is a defensive move because I imagine they are struggling with grief and guilt, and the last thing they want is to be challenged by others as the family system comes under fire and is probed as to what role they played in driving a person to end his life.
How can suicide be prevented? Firstly, if a family member or friend talks about dying, wanting to, or feeling empty and hopeless, make sure you take that seriously. Expressing real-life struggles that might seem insignificant, socially withdrawing, or isolating himself should be taken seriously. We tend to project our coping mechanism onto others or make light of the situation because it doesn’t fit in with our view of a grave issue. This is where empathy needs to be practiced and an intention to understand and meet the other where he is. Also, if the person expresses any guilt or shame around something is a red flag too. It can also be as simple as the individual giving away his items or suddenly expressing a lack of interest in what they loved earlier. Also, it’s a given that anyone who is known to be suffering from depression is at a higher risk of self-harm as well as anyone with a history of self-harm, including cutting, for example.
Even if you suspect that the situation is not urgent, but you suspect someone is suicidal, talk to them about it. It’s a misperceived notion that mentioning suicide or discussing it will push someone over the edge and make them take action. Talk to this person privately, listen without judgment, hold the space for them and be compassionate. Ask them if they are considering suicide rather than beating around the bush.
Also, suggest they get professional help and offer them options to make it easier, but do it at a comfortable pace and cater to the gravity of the situation. Provide a national suicide hotline number and find out whom they might feel most comfortable talking to, such as a trusted person and, ideally, mental health professional. Also, seek the help of other loved ones if you are struggling to get through to someone who seems suicidal rather than trying on your own again and again.
Start paying attention to those around you. Many are silently suffering and waiting to be asked how they are.

The writer is a BACP (British Association For Counselling and Psychotherapy) accredited individual and couple psychotherapist based in Islamabad. She can be reached at or her official website.

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