The question of suicide:
Keep it a question.
It's not really an answer.
Peter McWilliams
Suicide intervention is a life-and-death crisis. Bobble it, and we may not get a second chance.
Before he became a pastor, a man we'll call Terry was at work one day when he received a phone call. The caller, Howard, was the 34-year-old son of a fellow worker. Terry knew of Howard's continuing problem with drug abuse, and he remembered that Howard had been hospitalized a while back for psychiatric problems. Howard got right to the point: "Look, I called so you can help my mom. You'll need to talk with her soon, because she's going to find me dead."
What's Terry to do?
Saving a Life
It's remarkable that even most of the suicidal don't want to die. That's why the calls. They're using their next-to-last trick from a bag that's nearly empty. Our task: keeping a precious life intact.
Engagement. The initial moments of the conversation are terribly important. If the caller is absolutely serious about suicide, he controls the interaction. He can hang up abruptly, parcel out or withhold information, get angry and accusing, tantalize, manipulate, or string you along. He can even carry out his intent while you listen.
That's why engaging the caller in conversation is so crucial. Gary Gulbranson, pastor of Glen Ellyn (Illinois) Bible Church, offers advice for this tricky task: "Let the situation play you; don't dominate it. The person calling for help has likely been pushed around by life, pushed to the point of feeling out of control. A suicide attempt is one way to be in charge. When they make that last call, they need to play out their frustrations." So at the beginning of the conversation, Gary doesn't attempt to interrupt them or ask too many questions or argue with their logic. He first listens actively and absorbs their story. That begins to build a bond; the caller feels in some kind of control.
In Crisis Counseling, Norm Wright suggests positive statements to build up the caller, such as "You did the right thing by calling," or "I'm glad you called." This can get the caller thinking, For once I did something right. It's a small step, but it can both keep the person on the line and begin to rebuild a fractured spirit. The suicidal person is convinced that life is worthless, that probably no one really understands or cares. When into that misperception a warm and caring voice says, "I care!" another door is cracked open.
Pastors have a distinct advantage here because Christianity, above all religions, values the individual. Without fingers crossed behind our backs, we can tell anyone, "You're a precious child of God, the pinnacle of God's creation."
Inquiry. Once the person appears willing to talk, several items of information will prove greatly helpful. The trick is to charm this information from someone often unwilling to part with it.
If medical necessity doesn't dictate haste, spacing out the questions amid casual conversation is often the best tactic. That way the caller doesn't become edgy from getting the third degree. As much as possible, it's good to ask the questions somewhat offhandedly without giving the feeling you are intent on solving the puzzle so the police can break down the door. What information people won't give directly, they may let slip inadvertently: "You sound a little sleepy. Are you on any medication?"
The most vital information is the seriousness and extent of the suicide threat. Some helpers fear bringing up the word suicide when a caller makes vague references about life not being worth living. They don't want to plant the idea. But crisis hotline trainers say that is not the case; the idea will already be there, but the caller may not bring it up for fear of the reaction.
Naming the dragon may well be the first step toward slaying it. Straightforward questions often work best: "Have you ever felt like taking your life?" "When you say you want to 'end it all,' do you mean you're thinking of suicide?" The fact that they can talk to you about suicide without your going to pieces lends an air of stability to their tumbling world.
"Have you already done anything to hurt yourself?" is another logical question. Here specifics are important: What kind of pills, and how many? How long ago? How much blood have you lost? Can you smell gas in the room? These facts ought to be jotted down. They become crucial in short order.
If the person hasn't yet done anything rash, questions center on intentions: If you were to take your life, how would you do it? Have you made any plans? If the answer is to use a gun, even more specific questions follow: Do you have a gun with you? What kind is it? Is it loaded? Do you know how to use it? (This information is also vital for the safety of police officers who may be summoned.) The idea is to find out what steps have been taken to carry out the suicide plan. While pointing out loopholes in a plan wouldn't be advisable, merely talking about the plan doesn't further its course.
The name, phone number, and location of the person calling need to be determined as quickly as possible. But the sense that the helper is after such information may spook some callers. They want to remain anonymous and untraceable.
Some helpers give their name at the beginning of a conversation, and then turn the question naturally to the caller: "And what's your name?" If it is given, it's a good idea to write it down. If the person balks, counselors can say, "It would be easier if I had a name to call you. Could you give me your first name? I'd feel better if you would."
Discovering the location of the caller is especially important if the person is in danger. If direct questions don't work, indirect ones may shake out bits of information, such as the general area of town, or if the person is at home or in a public place, has people around or not, is nearby or far away. All are facts that may come in handy should direct intervention prove necessary.
Another bit of information you'll want to note is the resources at the caller's disposal. Is anyone nearby who could offer assistance? Is the person emotionally close to family and friends, or is he or she psychologically alone? Are other people contributing factors? Is the person a Christian? What self-understanding is evident? Can the person think straight, or have emotions limited the natural coping mechanisms? Callers often will let facts slip as the trust level builds throughout a conversation.
Appraisal. Gathering the information is more than a stalling tactic. This information determines the action to take.
One of the first considerations is: How urgent is this? A suicide in progress is greatly urgent. A vague reference to "ending it all someday" probably isn't as urgent, although it is serious. Other factors pointing toward urgency include: a valid, specific, and lethal suicide plan; means readily available; agitated depression; a lack of a support system; a history of suicide attempts; and, surprisingly, a sudden turn for the better after a period of melancholy.
Another consideration: What has led to this point? Why is ending it all the only apparent solution? The helper often can identify several options far less drastic than suicide. But because of the accumulation of crises or the fog of depression or the immediacy of upset, the caller has been unable to chart those escape routes.
What is the person's understanding of suicide? As strange as it may sound, some people don't really understand the finality of suicide. Teenagers may see it mainly as a way "to show them" or to get attention. They don't think beyond the climactic moment to the fact they won't be there to savor it.
It's good gently to probe for the theological understanding of suicide, as well. Do they consider it wrong? What do they think will happen to them after death? Have they even considered the morality of it all? Deeply held moral beliefs, or even fears, may be allies in the push toward life.
Action. The person has called; the suicide attempt is transpiring or at least imminent; the facts are in. That means it's time to act. What can you do?
A drastic strategy: Determine where the person is and get help to him or her immediately and in whatever form necessary, including getting the police involved. This is the course to take when a suicide is in progress or when a lethal and workable plan is likely to be put in effect.
Most of the social rules go out the window at a time like this. The helper may worry about breaking confidence or losing the person's trust by initiating precipitous measures the caller has told the helper not to try. (It's a good idea not to promise complete confidentiality from the start. Promise instead: "I won't do anything to harm you." Many callers will accept that in place of a promise not to tell anyone.) But even if one has promised not to call the police, strict honesty will mean little at the person's funeral. As Gary Gulbranson put it, "You can worry about putting the emotional pieces back together later; you've got to get help now to save a life!"
It's a good pre-emptive strategy to work out a distress signal to bring a secretary or your spouse into the room where you take such calls. Then a hastily jotted note can send them to another phone to have the call traced or to dispatch an emergency team. The universal distress signal — three raps on the wall or loud thumps or buzzes on the intercom — is one way to summon help for you, the helper.
A pretty good strategy: Keep the person talking. As long as the caller stays on the line and talks, chances are the suicide won't take place (unless the attempt has been made and is now taking effect).
Talk is an antidote, healing in itself. Just the fact of another human dropping everything to listen — really listen —can dissipate noxious emotions. So talk away. It's a good first strategy.
A better strategy: Obtain some kind of commitment from the caller. After a long, wrenching conversation, it's not uncommon for the caller to feel somewhat indebted to the helper. Or maybe there's a prior attachment that made the person call in the first place. Either of these debts can be used by the helper.
Charles Lake, pastor of Community Church of Greenwood, Indiana, advises, "Make a pact with them and hold them to it. I tell them, 'You know, after all we've been through together, don't you think you owe it to me to at least give me a call before you do anything drastic? Promise me you'll do that one little thing for me.' And they do it. The very fact they feel obligated to call me before they pull the trigger keeps them from following through with their plans. They either call, giving me another chance to stay their course, or they put the gun down. It's an odd sense of duty, but it seems to work."
An even better strategy: Work out a plan. The suicidal person has been working on a suicide plan; now's the time to advance a life plan. It can begin with eliminating tools that would make a distinct suicide plan feasible. That may mean getting someone else to keep the firing mechanism for a gun, purging the house of lethal medications, or disposing of a hose that would attach to the automobile exhaust.
But a life plan goes farther. It helps the caller begin to walk toward life and health. The first steps may be tiny, such as trusting the helper enough to divulge one's name, or scheduling an appointment together in person and promising to keep it. It may encompass a contract to call each other daily or more often if necessary. It may start with a promise to make an appointment with a physician. Sometimes it will involve a step toward Christian faith, such as reading a Christian book or meeting together to discuss being born again. The life plan eventually ought to get more complex, branching into a complete therapeutic program involving health, psychological, and Christian professionals.
An overriding strategy: Prayer. Most people can pray and listen at the same time. Bringing the power of God into the situation is absolutely necessary. It's not right to think, All I can do is pray. In reality, it's a case of the best I can do is pray, and that's a lot!
Aftercare. Eventually the crisis fades, but people who have once threatened or attempted suicide are at risk to repeat. Many live in a state of low-grade crisis. They need extended care.
Often such care needs to come from mental health professionals. An acutely suicidal person presents high counseling risks. Many times clinical depression is present, and that needs the expert care of physicians able to administer antidepressant medications. (The physiological basis of many depressions has been getting much research lately, and several effective prescription medications work to restore depressed people to normal lives. Getting a depressed person to a medical specialist in depression can be one of the most effective ways to help that person.)
Other deep-seated emotional problems also need extended counseling, and most pastors don't hesitate to refer suicidal counselees to competent psychological or psychiatric care. But they then supplement the secular care with the rich resources of the church.
A congregation can provide what family or neighborhood haven't: love and esteem. A church is a place to belong, to be valued, to contribute. Along with medical and psychological care, a suicidal person needs the loving social and spiritual care of a church family. Crisis intervention is complete when the family of faith wraps loving arms of support around a nearly lost member.
All the Right Moves
We left Terry on the phone with Howard, who had made a clear reference to intended suicide. Terry knew the call could terminate suddenly at any point, so he took care to engage Howard in conversation by being warmly diplomatic and not letting his alarm show. He barely knew Howard, so he had little relationship to draw from. He used active listening to gather information.
Howard was, at first, highly agitated: "I don't know why I'm talking to you. I ought to be just doing it. But I wanted you to be able to help my mom. She's going to be really upset, and she'll need your help. Promise me you'll come over here with her after it's all over. Man, will she be freaked out! But that doesn't make any difference to me. I've made up my mind. This is it, baby!"
Terry let him rant. He could hear the rage and confusion crest and subside in Howard's voice. Obviously Howard was ambivalent about living. If he really wanted to die, he wouldn't be spending this time venting his double mindedness and perhaps foiling his plot. Yet the frustration and helplessness were nearly enough to push him over the edge.
"Howard," Terry said with calm warmth, "you sound upset, but I think I can help you. We need to get together and talk this through. How about if I come over to talk? I'd like to help you."
"You're not coming over here! No way. Don't you try. I'm warning you."
"Howard, I wouldn't do anything to hurt you. Can you trust me? I want to help."
"Well I just don't want anybody meddling. I only wanted to take care of Mom. She's going to be hurt by this, but it's my decision."
"What is this decision you're talking about? Are you considering suicide? Is that what you're telling me?"
"You're darn right I'm talking suicide. I've had it with life, and I don't have to take it any more. I'm checking out of this hole."
Terry needed some vital information quickly, so he took a direct approach. "Howard, what are your plans for 'checking out'?"
"They aren't plans anymore. I've already done it. I took a bunch of pills, and I'm sitting here holding a big, black gun. As soon as we're done — I'm done!"
"Wait a minute, Howard!" Terry warned. "Do you know how final that is? Your life is precious. People care about you. Your mother cares. I care! Let's talk about what you're doing." Terry was trying to buy time. He had to keep Howard talking.
While talking with Howard, Terry had gotten the attention of his secretary. When she came over to his desk, Terry scribbled a note asking her to get Howard's mother, Nora. When Nora arrived at his desk, Terry filled her in on the conversation by scratching out notes. Then he wrote, where is howard? Nora assumed he'd be at his apartment. how far from here? About fifteen minutes, Nora thought, and she started to go. careful, he's got a gun! Terry wrote. As Nora rushed out, Terry asked his secretary to call the police and have them meet Nora outside the apartment.
By allowing Howard to vent his anger and by deftly manipulating the conversation to keep him talking, Terry provided Howard a way to do what he really wanted to do that day: get help. Howard calmed down considerably and became less belligerent as time went on. He got a little maudlin. Terry kept him talking. Then, abruptly, Howard said, "Hey, I've got to go."
Terry couldn't let that happen, so he played on Howard's common courtesy. "You can't just hang up on me. That would be rude. I'd like to hear more of what you have to say. I've got all day."
"No, I've got to go. You've been great, but I'm going to hang up now."
"Okay, but would you promise me one thing? Would you give me your word of honor that you won't use that gun without first calling me back? I want you to promise me just that one little thing. You owe it to me to at least offer that courtesy."
Howard said he wouldn't "do anything else stupid" without first calling back. Then he hung up.
At this point, Terry could concentrate on what had been a third activity behind the phone conversation and urgent notes: prayer.
Nora reached Howard's apartment and found him quietly sitting on the couch. The gun was on a table across the room — loaded and lethal, but unused. Howard told Nora what pills he had taken, and she scooped up the nearly empty baggies as she and paramedics hustled him to the hospital to have his stomach pumped. Terry went to the hospital to offer emotional support to Nora and to begin to minister to Howard.
In the weeks that followed, Terry helped get Howard into a halfway house. Howard got off of drugs and started rebuilding his life. He found a job, began working, and re-entered normal life. Terry met with him several times but realized before long that Howard was out of danger.
A Sadder Task
Not all suicides can be stopped; indeed, not all suicidal people give an indication of their intentions or the opportunity to hinder them. The crisis, then, is for those around them.
The day one pastor we'll call Chad candidated for a new pastorate, a young man slipped out of the worship service about the time Chad got up to preach. The 21-year-old was from a family active in the church. He'd been president of the local Young Life club when he was in high school.
But on this day he went home, wrote several notes, attached a hose to the car's exhaust and ran it into the car in the closed garage, started the ignition, and calmly asphyxiated himself. His parents, on returning from the happy occasion of calling a new pastor, found their son dead in the car.
Chad first heard about it when the church received a phone call from the parents. Since he was the only pastor the church then had, Chad rushed to the people's home, praying for calmness in his spirit and the ability to comfort the family he hardly knew.
At the home, Chad passed the emergency crew ready to wheel the dead boy off to the hospital and met with both parents, deeply in shock. Chad could do nothing about their son's death, so he resolved to provide a loving, helping presence in their time of need.
Before other questions could be asked, somebody had to go to the hospital with the body. Chad accompanied the father and lent support and suggestions as he filled out forms and decided about the disposition of the body and other legal matters.
Back at the home, a woman from the church had arrived. She made it her role simply to sit beside the weeping mother with her arm around her shoulder. A communication far beyond words took place in that simple act. The woman didn't cry. She was just there, caring and mostly silent.
Later Chad counseled with the parents, who naturally were ruminating about why their son would kill himself. "I tried to help them recognize that although their son had made a bad choice, that one choice shouldn't completely define his whole life," Chad recounts. "In the flow of life, we all make many bad choices. His life was made up of many accomplishments and pleasures and good memories as well. I wanted the parents not to dwell on the one fatal mistake he had made."
Those who remain often face problems of guilt, anger, and dreadful loss. They wonder if they might have done anything to prevent the suicide, and often mentally rehearse their actions leading up to the suicide, looking for clues. A sense of rage often accompanies grief: "How could he do this to us! If he weren't dead, I swear I'd kill him myself!" And loved ones face the grief of loss compounded by the circumstances.
The survivors need to talk about their reactions to the suicide. Many acquaintances avoid the subject, if not the survivors, themselves. Pastors offer a tremendous service merely by listening compassionately and validating the survivors' grief.
That's what Chad did for the young man's family. Five years later, healing for that family is still continuing.
Quickscan SUICIDE
Immediate concerns:
1.If there is any indication of a suicide attempt in process or imminent, call in the police, paramedics, or mental health team, or intervene yourself.
2.Try to determine where the person is as quickly as possible.
3.A suicidal person may be dangerous to others; find out what weapons or other dangers (gas, carbon monoxide) may be present.
Keep in mind:
1.Your primary goal is to keep someone alive. Only later have you the leisure to work on bettering the person's motivation or theology.
2.The person contacted you for a reason. Diplomacy and warmth may maintain that contact; hope and caring may forestall a suicide attempt.
3.Any threat of suicide ought to be taken seriously.
4.You didn't cause the person's problems, and you may not be able to fix them. Your responsibility is to try to help; you cannot be held responsible to succeed. The person may die.
Things to do or say:
1.Keep the person talking. It's hard for him or her to talk to you and follow through on suicide plans.
2. Show love, compassion, concern, respect; absorb anger, accusations, bitterness, manipulation.
3.Defuse the suicide plan if possible. Have the person flush drugs down the toilet, unload or dismantle a firearm, seek company, promise to call you before doing anything rash, etc.
4.Offer better options than suicide. You can probably see many where the caller sees none.
5.Remember to pray the person to safety, too.
Things not to do or say:
1.Do not make light of the situation. This threat could be a final try for help, even if it appears far-fetched.
2.Do not load on guilt over thoughts of suicide. Most suicidal people carry a heavy load already.
3.Do not leave the person alone. A relative, friend, neighbor, or fellow church member needs to remain with him or her.
4.Do not allow your anxiety to show. The caller needs a calm, controlled, capable presence to counter his or her emotional imbalance.
For further study:
Baker, Don, and Emery Nester. Depression: Finding Hope and Meaning in Life's Darkest Shadow. Portland, Oreg.: Multnomah Press, 1983.
Collins, Gary. How to Be a People Helper. Ventura, Cal.: Vision House, 1976.
Hart, Archibald. Counseling the Depressed. Waco, Tex.: Word Books, 1987.
Lum, Doman. Responding to Suicidal Crisis. Grand Rapids, Mich.: William B. Eerdmans Publishing Co., 1974.
Pretzel, Paul. Understanding and Counseling the Suicidal Person. Nashville: Abingdon, 1972.
Copyright © 1989 by Christianity Today
