It’s time we normalize conversations about suicide

Trigger warning: this article talks about suicidal thoughts and ideation

September is Suicide Prevention Month, and I thought I’d do my small part to write about suicide – what suicidal thoughts / suicidal ideation are, how you should support a loved one who has confided in you that they are suicidal, what a safety plan is, and why we need to talk about this more. Before we dive into this, I need to caveat that I am not a mental health professional, and if you or your loved ones are struggling with suicidal thoughts, please get the help that you need (see hotline numbers below). That said, I’ve been living with Bipolar II Disorder (or “manic depression”) for 4 years now, which results in multiple depressive episodes in a year. And suicidal thoughts come with the package, some more intense than others. 

Suicidal thoughts/ideation refers to thinking about or planning suicide. This can range from creating a detailed plan of how to kill oneself and getting your affairs in order such as creating a will, to a fleeting consideration. It does not include the final act of suicide.

There are “3 I’s” of suicide: #1: Intolerable: that one’s pain is overwhelmingly unbearable, #2 Inescapable: that one cannot see a way to escape the pain and #3 Interminable: that one cannot see an end to the pain. When these 3 conditions are fulfilled, suicide is usually seriously considered as a coping behaviour.

There is a strong misconception that talking openly about suicide is more likely to cause the person to commit suicide. Research has shown this to not be true and, in fact, has shown that asking someone if they are having thoughts of killing themselves is actually more likely to save a life.

We need to stop pretending that this is not a very real threat to society. We need to stop being afraid of having these tough conversations and we need to be there for those who are hurting deeply and silently.  Some statistics from the Singapore Psychological Society - since the global pandemic, suicide rates in Singapore reached an 8-year high. In 2020, 452 suicides were reported, a 13% increase from 2019. This increase was seen across all age groups, with suicide being the leading cause of death for individuals aged 10-29.  In an unprecedented national survey done by Singapore Management University released on 9th May 2022, the results showed that 'more than 8 in 10 Singaporeans associate suicide with stigma and only one in every three Singaporeans “will do something to help”'.  Knowledge about suicide is poor - "more than 3 in 4 Singaporeans (77%) rate their level of knowledge about suicide as below average." This shows how lacking we are as a society when it comes to understanding and supporting people who are suicidal. 

While there has been a lot of work done to normalize conversations about mental health, suicide in particular is rarely talked about because of how taboo it is in society. Many times, the act of suicide is considered to be something immoral or selfish because of the trauma caused to their loved ones. Take the language we use as an example: When someone decides to take their life, people say “they committed suicide.” We use the same term to describe crime (e.g. he committed a felony) or other negative acts (e.g. she committed a sin). However, when someone dies of cancer or a car accident, we say they died of cancer or by accident. In no other instances of death do we place the blame on the person, except when they die by suicide. Someone once told me that suicide is the most selfish thing you can do, because you are basically transferring your pain to your loved ones. To those thinking of killing themselves, this causes immense shame associated with having these thoughts and feelings. It is extremely alienating because of the strong stigma against it and the unwillingness to talk about it ultimately also leads to the unwillingness to seek professional help for it. And the loneliness just continues to build.

Kevin Hines is a famous Golden Gate Bridge suicide survivor. He said, “the millisecond my hands left the rail, it was instant regret for my actions”. The moment he made that jump, he realized he actually didn’t want to die. And I wonder if that’s the case for many who have taken their own lives? They say that when you come close to death, your life flashes before your eyes. And perhaps many who have died by suicide actually realized in that split second that their lives were worth living, and that they had made a deadly mistake and it was too late. Since surviving his suicide attempt, Hines now travels around the country to share his story with people vulnerable to suicide to offer hope and healing and to try to help them to survive the pain. He produced a documentary, “Suicide: The Ripple Effect”, which opened across the United States in March 2018. He has also authored a memoir, “Cracked Not Broken, Surviving and Thriving After a Suicide Attempt.”

People talking about wanting to kill themselves can sometimes be interpreted and dismissed by others as a mere cry for attention. We cannot afford to take that risk. If someone is making direct comments like they want to end their life, coupled with recent erratic and unusual behaviour, we need to take this seriously and treat the situation with extreme care. It can be very jarring to hear this, especially if this is the first time someone is confiding in you about something like this, and you might feel a lot of pressure and stress from holding this secret. But in that moment, your emotions are secondary. The most important thing is to remind your loved one that there is hope, that they are loved, and that someday their suffering will make sense. It’s literally a matter of life or death, and your compassion, kindness and lack of judgement will go a long way.

When it comes to suicide, there is such a thing called a safety plan. If you suffer from depression and suicidal thoughts, then it is important to develop a safety plan together with someone you trust, like your therapist or any of your “safe people” / support system. This plan then becomes the blueprint for dealing with suicidal thoughts and gives the person entrusted with the plan permission to act according to the plan. The first thing to do when creating a safety plan is to identify triggers and warning signs. For example, cognitive cues could include “why didn’t I die in my sleep” or fantasizing about a life without suffering. Behavioural cues could include lying on the bed staring at the ceiling fan wondering how it would be like being chopped up in there. Emotional cues could include hopelessness, powerlessness and great despair. The second step is to specify ways to cope with suicidal ideation. For example, if the severity is a 4 out of 10, contact your psychiatrist and increase your antidepressants as soon as possible and reach out to one or two loved ones. Keep a list of contacts you can talk to if you are unable to distract yourself with self-help measures. List names, phone numbers, or other contact information, and be sure to have back-ups in case your first or second choices are unavailable. If the severity is > 6 out of 10, call a 24-hour suicide hotline who can give preliminary advice or talk you through your experience, or check yourself into the nearest hospital A&E to get admitted. This would guarantee your safety for at least the length of your stay. Next, list out reasons for living e.g. “I am outrageously loved by my family and friends and I am never seen as a burden by them. Life will NEVER be better for them if I were to leave this world.” or affirmations like “I am good, I am kind, I am empathetic, I am loving”. This list will help you refocus your attention on the reasons to keep going until your suicidal thoughts and feelings pass.

Suicide may be an abstract concept to you, but to many, this is a reality they live through every day. Sometimes there are good days and sometimes there are very, very bad days. It is also important to realize that progress is never linear. There are peaks and troughs, and fluctuations in moods and emotions can be very dramatic. Depressed people may seem like they have gotten out of their depression, but end up taking their life years later after being triggered by something. One of my favourite authors whom I still look up to, David Foster Wallace, battled with chronic depression for decades until he finally took his life. Alyssa, the co-founder of Calm Collective lost her husband to suicide after he struggled with Bipolar II Disorder for a few years. Personally, this is very terrifying for me. I have come close to ending my life a few times but have always managed to talk myself off the ledge. But whenever I look back at those times when I’m in a better headspace, I become so petrified at how close I was to killing myself, and I always wonder whether in future I will have enough strength in me to stop myself or will I eventually succumb to the darkness.

We need to have tough conversations about suicide with our loved ones if we suspect that they are having such thoughts. And we need to be able to talk about it openly in society, to give a voice to the voiceless and to let them know that they are not alone and that there is help available. Even the most intense suffering can be made a little more bearable if there’s someone to hold our hand through it. And this is why it is high time we normalize conversations about suicide, so people do not have to suffer in silence any longer.

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Mental Health Hotlines:

Samaritans of Singapore's hotline: 1800 221 4444

Institute of Mental Health’s helpline: 6389 2222

Singapore Association for Mental Health helpline: 1800 283 7019