Suicidal thoughts: what to do if you want to kill yourself

“I’ll jump off the roof and die, I’m sure everyone will feel better,” the girl said in a trembling voice as she entered the psychologist’s office.

Suicidal thoughts are a fairly serious risk factor; in most cases they do not lead to suicide, but their presence is frightening.

You can live a completely wonderful life, have a family, a good car, a loving person, but one day you feel an irresistible desire and, unexpectedly for those around you, break down.

Thoughts about suicide can be episodic or obsessive, unformed or in the form of detailed planning.

Such thoughts bring a lot of discomfort into a person’s life. Possible sleep and appetite disturbances. These thoughts are mentally and physically exhausting.

The sages say that everything in the world has a reason. And suicidal thoughts are no exception. This kind of thoughts can be a consequence of mental disorders of organic origin, as well as a consequence of traumatic or shock situations.

What are the thoughts of suicide?

The world is terrible, full of evil, there are very few good people;
My situation is hopeless;
Life is scary;
I won't be able to achieve that in life;
I will never be happy;
Non-existence is a good break from life;
Suicide is the only way out;
By committing suicide, I will unite with my loved one who is already THERE.

Have you ever felt the urge to commit suicide? Perhaps you have heard such a desire from your loved ones or friends?

“I want to die” is often said in a situation of hopelessness, despair, or unexpected news. “I’m leaving you,” “your mother has died,” “you’re fired,” it’s so difficult to agree with this and it’s difficult to live and feel all those feelings that come at the moment of news.

Symptoms

Suicidal thoughts are accompanied by a number of symptoms such as:

Loss of appetite or, conversely, gluttony
Insomnia
Physical and mental fatigue

Suicidal ideation most often involves two or more types of thought patterns, such as:

1. Obsessive fixation on the thought of planning an act of suicide.

2. The belief that there is no hope, and the only way to get rid of pain is by dying.

3. The belief that existence is meaningless or uncontrollable.

4. The feeling that thoughts are as if in a fog and it is difficult to concentrate on what is happening.

To date, quite a lot of calls related to suicidal thoughts have been recorded in Russia. In the latest study by the Institute of Public Opinion Questionnaire, 39% of Russians have ever had thoughts of suicide. Children are least likely to experience suicidal thoughts. A study has shown that thoughts of suicide are more common in women than in men.

In children, suicidal thoughts in a child (before the teenage crisis) are rare, because children have an instinctive fear of death. Here he either watched enough films with suicide attempts, or somewhere he heard conversations about such things. Less often, a child wants to die because of the death of one of his loved ones, believing that in this way he will be reunited with them.

Ideas to commit suicide are common among teenagers. This is due to the age crisis and hormonal surge.

As you can see, the statistics are quite critical.

I have suicidal thoughts among people of different ages, status and gender, and do not depend on their financial status. The appearance of such thoughts is difficult to predict; they are often a reaction of the psyche to various kinds of stress and are not satisfied with the quality of life.

What is fear of death?

“Phobias are an irrational, uncontrollable fear of someone or something, or of certain situations,” says psychotherapist Sergei Prokin.
– It should be emphasized that this is a fear that cannot be explained logically. Thanatophobia is the fear of death, which is based on the uncertainty of what will happen after death. What distinguishes a phobia from the ordinary fear of death and thoughts about it is its irrationality - the fear is not supported by real reasons, it is also accompanied by unpleasant sensations and interferes with normal life. People are afraid of dying in principle or in certain situations (from an accident, a heart attack, a criminal), and therefore they protect themselves from possible contacts and can isolate themselves from society, work, and communication.

Causes

The thought of suicide is like a beacon that what is happening is not suitable and the only right decision at this moment seems to be death.

Our psyche is structured in such a way that we react to every event in one way or another. The appearance of obsessive ideas about leaving life is the result of the fact that a person does not find a way out. The psyche perceives the critical situations described earlier as irreversible, as a result of which the purpose of life disappears. And the more traumatic the event that led to such a desire, the more difficult it is to cope. Thoughts are the same reaction as words or body movements. The topic of suicide is quite delicate and it is best to explore it accompanied by a psychologist. But it is not always possible and resources to reach a specialist, which is why today we will talk about methods of introspection and self-help when thoughts of suicide arise.

The process of experiencing certain life difficulties can provoke suicidal feelings, for example:

mental health problems;
bullying or restriction of rights on any grounds by others;
domestic abuse;
death of loved ones;
separation from a partner;
long-term physical pain or illness;
inability to accept drastic changes in life, such as becoming disabled, expelled from school, or fired;
money problems or loss of housing;
rejection or feelings of loneliness;
imprisonment;
feeling like a failure.

Causes of thoughts about death

The reasons for misunderstanding how to live can be due to various factors. The main reasons for this problem are presented below:

genetic factor, biological causes, environmental factors;
psychological trauma experienced in childhood or adulthood;
negative life experiences (for example, a series of defeats or stresses experienced that resulted in a negative vision of the present and future);
depression;
false ideas about one’s “badness” or worthlessness;
family problems;
depressed mood;
tendency to get stuck in worries about unfavorable events;
negative influence of the media.

Where to contact

If you have thoughts of suicide, make an appointment with a psychologist or psychiatrist in your city. If this is not possible, call the hotline of the psychological assistance center in your city. Your call will be completely anonymous, and you don’t have to worry about anyone finding out about your suicidal thoughts. You will not be asked to change your mind about dying or not to think about suicide. They will listen to you, support you, share your feelings and thoughts, this will reduce the level of tension and anxiety when such thoughts arise.

Perhaps in the process of dialogue you will become more clear about what pain you want to “kill” by committing suicide. Or maybe you want to attract someone’s attention or someone you want to punish with your death.

How to get rid of the fear of death for adults

“In thanatophobia,” explains psychotherapist Sergei Prokin, “there are biological, psychological and social prerequisites.
Biological is often a certain predisposition of the nervous system to respond with generalized reactions. Illness, insufficient sleep, intoxication, and congenital characteristics of the nervous system may predispose to this.

Psychological ones are primarily violations in the education system. Education in the style of increased anxiety, often in hyperprotection.

Social is the inability to react correctly (rationally) to various situations. First of all, they require active action and the ability to make quick decisions.

Psychotherapists work with all possible prerequisites at once, so it is important to contact a specialist.

Suicidal ideation in terminally ill people

Contents Who is at risk?

What can be a harbinger of suicidal thoughts?

“Bad” signals - what are they? What to pay attention to.

What to do if there are signs of suicidal thoughts?

Bad option: a seriously ill person attempted suicide. What to do?

Does it happen that “nothing was foreshadowed”, but a person attempted suicide?

According to alarming statistics: with a high frequency of depression in palliative patients (and this is one third of all terminally ill people), the proportion of suicide attempts in the terminal stages is 86% (source: “Depression in somatic and mental illnesses” by A.B. Smulevich). Humanly speaking, this is understandable. We all know that someday we will finish our earthly journey, but when the doctor “starts the countdown” by transferring the patient to palliative care, this abstract “someday” takes on the concrete outlines of days, weeks, months.

During this period, patients especially need the help of specialists who can reassure and support the natural desire for any person to live as long as possible. But the attention and support of loved ones and those caring for him are no less important. For those who are close to a terminally ill person, we have compiled a short guide on how to recognize suicidal thoughts or intentions in them and help them cope with them.

Nadezhda Lustenko , a psychotherapist at the Moscow Multidisciplinary Center for Palliative Care,
helped compile it Who is at risk?

People suffering from a concomitant mental disorder - primarily depression;
People with certain personal characteristics: hot temper, a tendency to impulsive actions, violence or total control;
People who are addicted to alcohol or drugs;
People with a family history of suicide attempts in relatives;
People who have experienced the severe loss of loved ones.
Anxiety and depressionHow to Help a Patient Cope with Disorders Bruce Cleminson
Symptomatic treatment

A serious, incurable illness is in itself a factor that can cause thoughts of suicide.

Depression is a serious mental illness. It has many different symptoms, which can manifest differently in each individual case. In mild forms of depressive states, people are characterized by depression, apathy, isolation, and a persistently bad mood. If a strong feeling of melancholy or anxiety does not leave a person for more than two days, you need to pay attention to this and take action. Symptoms usually appear gradually and develop over a long period of time.

Clinical depression is a rapidly increasing set of symptoms that appears suddenly or gradually develops from a mild form. In addition to psychological discomfort, physiological discomfort is also added. In this case, such a “traditional” marker as a depressed mood may be absent. Sometimes this misleads the patient’s loved ones and they miss the moment when the person can no longer cope without qualified help. Experts call this type of disease “smiling” or masked depression.

Symptoms of clinical depression:

Sudden decline in mood

. The person feels useless and helpless. He suffers from feelings of guilt, self-abasement and various fears.

Behavior change

. In a normal situation, a person begins to behave inappropriately - cry, get angry, show aggression.

Loss of interest in the world.

The emotional reaction to something disappears or sharply decreases. Sometimes visual, auditory, and taste perception worsens.

Physical manifestations.

Appetite decreases, sleep is disturbed, weakness, pain in muscles and joints occurs.

In severe clinical depression, mental disturbances may occur, including hallucinations and delusions.

Severe somatic manifestations: pain, partial or complete loss of mobility, shortness of breath.
What can be a harbinger of suicidal thoughts?

Insensitivity to treatment - therapy, procedures, medications do not help;
Diseases or operations that mutilate the appearance (mainly the face and neck), ostomy;
Insomnia. Especially long-term;
Social isolation - loneliness.

“Bad” signals - what are they? What to pay attention to.

Depressed, depressed mood.
Behavior change. Even for the better. If a withdrawn person begins to show unusual gaiety, you should be wary.
A person begins to “play” with drugs - take medications at his own discretion or refuse them altogether.
Conversations about unwillingness to live, including those of a passive nature (for example, “I wish I could fall asleep and not wake up”)

Important You should be extremely wary of any statements a person makes about not wanting to live.
A smile or apparent criticism should not reassure. What to do if there are signs of suicidal thoughts?

Be attentive to the words of a seriously ill person about dying. It should not be assumed that he is driven only by a desire to attract attention. It happens that this is the only way for him to show how much he suffers. To some extent, this is indeed attention-seeking, but not in the sense of posing or manipulating others. Rather, it means that the person is not receiving enough care or medical attention. And if action is not taken, he may move from statements to actions.
Talk about this in a confidential conversation. Ask a direct question whether the person has thoughts about not wanting to live.

It’s not easy to decide on this - we’re not used to talking about the end of life. By postponing, fearing an honest conversation on this topic, we ourselves are often unable to figure out what is stopping us: concern for a loved one or our own fear of death. And yet, such a question can become a kind of “permission” for a seriously ill person to speak out, put into words what has been “boiling up” for a long time, ease the soul and finally become heard.

Give your loved one a chance to express their feelings. Even if there are relatives nearby, the disease “drives” him into loneliness.

He tries to be strong, and often everyone around him convinces him that everything will be fine and that he must hold on. Talking about how bad he feels, he is afraid of upsetting his family, afraid of becoming a burden for them. In this state, the person becomes even worse.

Webinar: “Communication with a dying person” Nursing expert Lena Andrev on the peculiarities of communication with a dying person. Lena Andrev

Communication

You may not have anything to say back to phrases like “you don’t know what it’s like for me” or “I’m a wreck and dying.” Your task is to listen, observing three rules: do not devalue, do not argue and do not lie. Just be there, take your loved one by the hand, listen to him and tell him that you love him and it is important for you that he be with you as long as possible.

Don’t be afraid to provoke a person into action with questions. Most often, people want to be convinced to live, because this is a natural desire for any of us.

Seek help from a psychiatrist . He will assess the person’s condition from a professional point of view: dangerous symptoms that are obvious to the doctor may not be noticed by relatives. There are two types of patient monitoring: dispensary and consultative-therapeutic. Both types assume that the patient is at home, but in the first case, the doctor checks the patient’s condition at certain intervals, and in the second, he only provides consultations upon request. Depending on the severity of the disorder, the psychiatrist may refer the person to a psychotherapist or prescribe medication.

We can talk about hospitalization only if a person is dangerous to himself or others.

Important Talking about unwillingness to live is a “cry for help” from a seriously ill person. They should never be ignored.

Olga Osetrova, chief physician of the Samara hospice, says:
Vitaly came to us after a suicide attempt. A 70-year-old man had liver cancer and developed severe jaundice and very severe itching. It was the itching, which doctors could not cope with, that became the reason for the tragic decision to end his life. Vitaly scratched himself until he bled, did not sleep for days, and suffered from unbearable pain. However, he refused his relatives’ offer to go to a hospice. One day, when his wife went out for a walk with the dog, Vitaly decided to hang himself. He was saved by a miracle - the dog, as if sensing something, went down with its owner to the first floor, but then persistently pulled her back.
After everything that happened, the man no longer objected to the hospice, and we were able to help him - the itching was relieved. Finally, Vitaly was able to rest. Afterwards, having come to his senses, he recalled this story with horror. Unfortunately, this is typical for many palliative patients who do not receive care on time.

Bad option: a seriously ill person attempted suicide.
What to do? In this case, contacting a doctor is mandatory. All patients following a suicide attempt should be assessed by a psychiatrist. He will make a diagnosis and determine further treatment tactics. If you refuse an examination, Article 29 of the Law of the Russian Federation No. 3185-1 “On psychiatric care and guarantees of the rights of citizens during its provision” comes into force, providing for a psychiatric examination on an involuntary basis.

Important Concealing information about a suicide attempt by relatives from medical workers is considered from the point of view of the law as “leaving in danger” (Article 125 of the Criminal Code of the Russian Federation).
Does it happen that “nothing was foreshadowed”, but a person attempted suicide?
Unfortunately yes. There are very closed people whose intentions to die cannot be noticed even with careful observation either at home or in the hospital. But this rarely happens. In most cases, if there are caring, attentive people next to a seriously ill person, if he receives a sufficient amount of painkillers, and doctors do everything possible to relieve other, severe symptoms, the tragedy can be prevented. This means going through life’s journey to the end without pain, fear and loneliness.

Olga Osetrova, chief physician of the Samara hospice, says:
I met Elena in one of the palliative care departments that I sometimes visit. She was 40 years old. Initially, she was brought to the hospital with severe bleeding, from there she was sent to the oncology center, where she was diagnosed with advanced cervical cancer. Elena was admitted to the palliative department, without, however, being told about the real state of affairs. They even reassured her: they said that she would soon recover, although the doctors understood everything perfectly.
Lena ended up in the ward with three other women. One was unconscious, the second was “out of her mind.” Both, like Lena, had gynecological cancer.
When I first entered their room, Lena had already been there for several days. She looked scared. We started talking, and suddenly she asked me:
—Are you a believer? I've saved up five Relanium tablets here. I want to save 10 and finish it all. Tell me, is this a sin? Even though they tell me that everything will be fine, I know that I will soon die. And I don't want to become like these women.
“I think it’s a sin,” I answered, “but you and I can pray together that the Lord will not allow this.”
Then we talked with Elena several more times. I left her my phone number, and she called when she felt the need to talk, talk about her fears and experiences. Most of all, Lena was afraid of “becoming like those women,” and it was very important for her to live her fear not alone, talk about it, rely on someone’s support and find strength in her to live.
She died three weeks later. “Like those women” she did not.

Prepared by Evgenia Rezvan

The material was prepared using a grant from the President of the Russian Federation for the development of civil society provided by the Presidential Grants Foundation.