Suicide is a scary word and if you work in the mental health field it is a word that conjures up panic in the hearts of dedicated professionals who are trying hard to support, enlighten, inform and protect individuals who might be tormented or tempted by the distorted lure of an end to their suffering.
An end to suffering. It was what we work for, what our clients wish for and if we are not careful, it is what they die for.
I think I can say with confidence that pregnant and postpartum women in despair do not want to die.
They might, however, believe that their baby would be better off without them. They might misinterpret their hopelessness as a permanent state, rather than a symptom that can be treated. They might pay too much attention to the intrusive thoughts screaming in their head and think they cannot possibly be a good mother. They might, through the lens of depressive thinking, believe that they have no other option.
In a recent piece written by Rich Larson, “It’s Not What You Think”, he poignantly and skillfully describes the misunderstood and unpredictable nature of depression and suicide after the death of an adored musical artist, Chris Cornell. In this piece, Larson writes:
…it’s really about depression and cynicism. Those two go hand-in-hand, along with their nasty little sister, anxiety. When the three of them get going, they just eat hope as quickly as it can be summoned. That leaves despair and despair is exhausting, not just for those who experience it, but for the people around it as well. So we keep it to ourselves because we don’t want to be a burden. And then it gets to be too much. Doesn’t matter if you’re a student, a mom, an accountant or a rock star. It doesn’t matter if you’ve written about it your entire life as a means of keeping it at bay. It doesn’t matter if the music you made about it brought in fame, respect and millions of dollars. It doesn’t matter if your entire generation has suffered from it. Depression makes you feel totally alone. You hit the breaking point, and then, like Chris Cornell, you die alone in the bathroom.
This was a well-respected member of his community; a beloved musical hero who seemed to have it all together. This could have been any of us. And brothers and sisters, if it’s you, don’t mess around with it. Please find some help.
This scares us. As well it should.
Which is why we teach novice therapists to take any mention of suicide very seriously. While that may seem too obvious to mention, we forget, sometimes, because postpartum women are so good at looking good, because we believe they don’t really want to die, because we believe that passive thoughts are transitory and less dangerous than active thoughts or plans.
Still, some therapists wonder: When should we intervene? How bad does it have to get? What if we insult her by presuming the worst? What if we are wrong? What if we are overreacting?
I say, overreact. Protect her. Prepare for the worst scenario because, well, severe symptoms of depression are unpredictable, they are volatile and they are seductive. They can convince the most loving and precious mother that the opportunity to disappear forever is the only and the best option.
Passive thoughts of suicide should alert every therapist to the possibility that darkness is looming. She should not be expected to stay there too long without a lifeline. Get in there with her and sit with her suffering. No matter how good or healthy she looks, do not be tempted to let her sit there alone with these thoughts.
- Sharp objects, weapons removed.
- Medications should be out of reach.
- Reduce access to potential means of harm.
- Make phone calls; instruct loved ones to stay close. She should not be alone.
- Implement a safety plan.
- Be clear about your intention and ability to safeguard her.
- Let her know she is safe with you and that the option to hurt herself is NOT the only option; It just feels like it is.
- Let her know that a decision to kill herself will have permanent and tragic consequences on her children and her entire family.
- Let her know that you will do whatever you can to help her pass by this open window and not jump, today. Delay the impulse.
- Remind her that these are distorted thoughts. When the symptoms are treated, she will no longer feel this way. Tomorrow is an option.
Do not underestimate the power of depressive thinking. Do not presume she will be okay because she has convinced you that she is fine. Do not presume she does not have a weapon in the house because she doesn’t look like someone who would.
Ask the hard questions. Then, ask again. Do not let her suicide note be her first opportunity to express her suffering.
Karen Kleiman, MSW