Living well requires preparing for - and managing - the worst.

by John McManamy


DEPRESSION and bipolar kill. Simple. Some fifteen percent in the highest risk category of major depression and 20 percent untreated bipolar victims will die by their own hand. A great many more than that will make the attempt. And many more still will die by "accident" or "slow suicide" through reckless behavior or personal abuse and neglect.

According to the Centers for Disease Control, suicide is the ninth leading cause of death in the US (about 30,000 a year), well above homicide (at about 20,000 a year). Women will make the most attempts, but men will be by far more successful, by a margin of four to one. In teens and young adults, suicide is the third-leading cause of death, after accidents and homicides, more than all natural diseases combined.

Thankfully, the youth rates are dropping. The CDC reports teen suicides in the US declined 25 percent between 1992 and 2001. Still, approximately 4,200 US teens and young adults die by suicide annually, with an additional 124,000 making an attempt serious enough to land them in the ER.

Suicidal depression does not discriminate. It afflicts both the strong and the weak, the rich and the poor. War heroes have been taken down. So have survivors of the Nazi death camps. As have successful business people and artists and mothers and those with everything to live for.

We are talking battlefield odds, but the prospect of finding ourselves in the lucky majority brings us only small relief. The experience has exposed us to our worst vulnerabilities, and deep inside we no longer trust what tomorrow may bring. We may still be walking and breathing, but we have been as close inside death as this side of life permits, and our minds will never let us forget it.



We ponder the fates of the unlucky minority, and sometimes we say a prayer. We contemplate the tortures their brains exposed them to, and know for a fact that no God would ever hold judgment against them. For the time being we are the lucky ones, but tomorrow that may change.

Still, we do have a certain amount of control in managing tomorrow. We who have survived know what we are up against, and can plan accordingly. Following are some common sense guidelines:

For Patients

In the Long Term

Cultivate friends or family members you can call on should you find yourself slipping into crisis. If you have no friends or family you can trust, then seek out a support group, live or online.

Keep in mind, support groups, live or online, are places to be talking to people before a crisis develops or when you’re pulling out of one. In an actual crisis, you need to be talking to a professional, or someone you trust to get yourself into the hands of a professional.

You may want to call a suicide hotline, but again, you need to be talking to a professional.




Establish a close relationship with your doctor or psychiatrist. Ask yourself: is this someone you can call on in the middle of the night? Or, if not, will someone be there to respond to your call?

Remove all guns and rifles from your home. According to the Centers for Disease Control, 60 percent of all suicides are committed with a firearm. This is not an anti-NRA message. We're just being smart, that's all.

The same principle that applies to firearms applies in part to medications. Some may be fatal in overdose. You may want to switch to a different ones if you don't trust yourself. If you must keep certain meds in the house, it may be advisable to turn them over to a loved one.

Watch your thoughts and feelings very carefully. You may be able to pick up subtle signals in your mind, before a full-scale crisis overwhelms you. Actually visualizing the act should set off every warning bell.

In an Actual Crisis

All too often, a suicidal depression catches us alone and off-guard. Notwithstanding all we have to live for and all those who care for us, the brain in crisis has a perverse way of having us think the very opposite. To those of you who are in this state right now:

Promise yourself another 24 hours.

Now pick up the phone. Time is of the essence.

Be persistent. Do not be put off by the bad practices of some of the health system's gate keepers. You are there to get help and you are there to get it NOW.

Finally, take comfort in the fact that help is on the way. Your brain at the moment may not allow you to think hopeful thoughts. But it cannot keep out the knowledge that others are hoping on your behalf. This may be that precious one inch of life you can hold onto at the moment, the one that can eventually lead you to a tomorrow worth living.

Faking Out the Brain

Susan Rose Blauner, author of “How I Stayed Alive When My Brain Was Trying To Kill Me,” advises there is a difference between a true death wish and behaving dangerously, though all too often the result is tragically the same. Suicidal is not a feeling, says Ms Blauner. Anger is a feeling, along with sadness or loneliness.

According to the author: "Suicidal thoughts, I learned, were an indication that some deep feeling or need was being triggered or stirred. I had to figure out what the feeling or need was and address it."

Driving a wedge between your feelings and your suicidal thinking creates the breathing room that allows you to put all your coping skills to work. One of these is "faking out the brain." For instance, if the brain says don't call Sam, call Sam.



For Friends and Loved Ones

Be Aware

According to studies, 75 percent of all those who commit suicide indicate their deep despair beforehand, who probably would have responded to help.

Take very seriously any possible signs of major depression. These may include fatigue, weight gain or loss, and feelings of hopelessness and worthlessness. A child or teen-ager (or someone with bipolar or anxiety) may feel more hyper or agitated than usual.

Keep in mind that any number of situational events can bring on thoughts of suicide, with or without major depression, events such as: marriage breakup, death in the family, difficult birthdays or anniversaries or holidays, or loss of employment.

Watch out for sudden changes in behavior. These may include:

In your child, declining performance in school.

In others: declining interest in previously enjoyed activities, neglect of personal welfare, deteriorating physical appearance.

In the elderly, self-starvation, dietary mismanagement, disobeying medical instructions.

Take very seriously any signs of suicidal behavior. These may include: explicit statements about suicide, acting-out behavior such as rehearsals or mini-attempts, self-inflicted injuries, reckless behavior, making out a will, giving away possessions, inappropriately saying goodbye, and odd verbal behavior (such as "you won't have to worry about me, anymore").

Things To Say and Not Say

Five things to say to a severely depressed or possibly suicidal person:

1. "I hear you."
2. "I’m listening."
3. "I love you."
4. "You're not alone."
5. "Would you like me to get help?"

Five things not to say to a severely depressed or possibly suicidal person:

1. "You'll snap out of it."
2. "It's just a phase."
3. "Stop being so selfish."
4. "You're just trying to get attention."
5. "You gotta pick yourself up by your own bootstraps."

Planning Ahead

If you are living at home with an individual with a mood disorder, you need to have firm understandings in place as to when you have permission to assume executive control. These understandings need to be the result of long discussions and should be in writing.

In an Actual Crisis

Listen. Do not be judgmental. Allow the person to vent his or her anger or frustration.

Ask if he or she is planning to commit suicide, or has a plan. This gives the person another chance to vent his or her concerns and allows you to gauge the nature of his or her intentions. This question is a fairly standard one, and apparently will not trigger an actual attempt.

Do not leave the person alone, once you have determined he or she is suicidal.

Try to convince the person to seek help. The fact that he or she is talking to you is a start. Offer to make the necessary arrangements if you think that will get the ball rolling.

Remind the person, if necessary, that seeking help no longer carries the stigma it once did, that going for help is not a sign of weakness, and that the chances for recovery are excellent.

Be suspicious of any rapid improvements in the person's condition. The individual may be faking recovery in order that you drop your guard.

A History Lesson

The young man became so preoccupied with suicide that his concerned friends moved in and stayed with him day and night, making sure to remove knives and guns from his presence. As he stayed awake, agitated and delirious, they maintained a vigil for more than a week. Later, after the crisis abated, a friend invited the man to live in his lodging and helped start him on a career in law.

The young man later went on to become sixteenth President of the United States - Abraham Lincoln. Bear in mind: Lincoln had a great support system. How reliable is yours?

Updated Jan 2, 2011, reviewed Dec 5, 2016


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