The Signs Of Suicidal Thinking

The most often overlooked warning sign of suicide is something both doctors and lay people and, for that matter, suicide prevention experts, often overlook: Brain damage. People who suffer traumatic brain injuries, whether in combat or in sports or during common household accidents are significantly more likely to think about committing suicide.

That doesn't mean that someone who's had a knock on the head is automatically likely to commit suicide. A study of US military veterans who suffered traumatic brain injuries found that those who had a single brain injury were at a 3.4% risk of suicidal ideation (thinking about suicide) in the year after the injury. Those who had endured a second brain injury were at a 12.0% risk of suicidal ideation during the next year.

Suicidal thinking is also common among people who have suffered other kinds of brain injury. Heart attacks, for instance, reduce circulation to the brain. Depression and sometimes suicide can occur after heart attacks. Post-traumatic stress causes changes in the brain that raise the risk of suicide. People on antidepressants, anticonvulsants, pain medications, smoking cessation medications, or steroids may suffer subtle changes in the brain that predispose them to suicide. And of course, most forms of mental illness can increase the likelihood of self-harm.

What do you do to help people in these categories? Without needing to be needed, simply be present for them as much as you can. You don't have to become a doormat, hostage to the possibility of suicide. Your friend's respect for you helps your friend find respect for himself or herself.

If someone expresses thoughts of suicide, take them seriously. Avoid minimizing or dismissing their feelings. Let them know you care and are there to support them. Create a safe, non-judgmental space for them to talk about their feelings. Listen actively, without interrupting or offering solutions right away. Sometimes, they just need someone to vent to.

It's important to ask them directly if they are thinking about suicide. This can open up a conversation about their feelings and intentions. Keep in regular contact with them. Isolation can worsen their feelings. Even a simple text or phone call can make a difference.

For people you don't know really well, there are other signs that suicide may be imminent:

• Writing a will.
• Visiting old friends or relatives not seen for a long time.
• Giving away prized possessions.
• Making plans consistent with imminent death.
• Talking about plans for suicide.
• Buying a gun after talking about plans for suicide.
• Regular use of drugs (prescription or otherwise) or alcohol.
• Social isolation, not having friends, not being involved in groups.
• Family history of suicide.
• Hallucinations, especially command hallucinations that give instructions to commit suicide.
• Recent loss of a significant other or close friend.
• Recent release from a psychiatric hospital.
• Anxiety about life events.

Add to this list, your own hunches about suicide.

If someone says, "I am feeling suicidal, and this is how I am going to do it, and here are the tools I'll use to kill myself," don't try to play the role of sympathetic friend. Get emergency professional help. Be aware that suicide is sometimes accompanied by homicide.

But if the talk is just how hard life is, and how little promise life holds, and how difficult it is to carry on, listen without needing to listen. Don't judge. Inspire.

Now for another part of the story of Randy and Bob.

Randy happened to have his major heart attack the same week Bob was going in for exploratory surgery for cancer. When Randy was told by his cardiologist he would probably die without immediate surgery, his first thought was "Finally." But then Randy realized that his recovery might be the one thing he could give to Bob to show him respect, and willingness to be present for the friend who was present for him.

Randy couldn't afford the heart procedure he really needed, but he did get a procedure that kept him alive. Having a friend who was worth staying alive for helped Randy make the right choice.