Talking About Suicide – A Revelation

“Asking about suicidal feelings cannot ‘put the idea into a caller’s head.'” If you’ve ever worked in a listening organisation that will openly talk about suicidal feelings, like a branch of Samaritans or a university Nightline, you’re likely to have heard this said. In virtually every training group to which talking about suicide is first mentioned, a trainee will ask “But if they’re not actively suicidal, might mentioning it give them it as an idea?” And the answer is no.

This is an important part of the work of these – and similar – organisations. While their manifesto may already state that they are there to talk about whatever feelings are on the mind of their caller, it’s still seen as necessary, sometimes, to remind the caller that yes, it’s really okay to talk about anything at all… even about ending their own life. Showing that it’s okay can open the door to really exploring the caller’s feelings and can make all the difference to somebody in a state of suicidal despair.

What I’d like to share with you is the evolution of a certain subset thoughts about suicide.

Talking About Suicide – A Revelation
(or How I Proved Myself Wrong Twice But Still Got The Right Answer)

Up to as recently as five or six years ago I was of the opinion that certain anti-suicide measures were pointless. I’m talking about building anti-suicide fences on bridges (like the Memorial Bridge in Maine), the installation of platform-edge doors on London’s Jubilee Line (mentioned in this article and shown in this video), and the restriction of the number of analgesics like paracetamol and aspirin that can be bought in one transaction, since 1998. I could not understand that this could possibly work. Suicide is almost invariably a pre-meditated act, and so access is removed to one means of doing away with oneself, you’ll simply use another – and there’s no shortage of ways to take your life.

Then, one day, I discovered that it doesn’t necessarily work like that.

Anti-suicide fences can be statistically proven to reduce not only the frequency of suicides at the site at which they are installed, but throughout the region – if suicide were, as I had believed, unaffected by availability of any one particular means of committing the act – then I would anticipate that a comparable, perhaps only slightly fewer, number of suicides would take place. Switching coal gas to natural gas in Britain in the 1960s was linked to a reduction in suicides on the whole (Kreitman, 1976), and only a smaller increase in suicide rates by other means. Similar studies in the US have shown that reducing the availability of firearms reduces suicide rates more than would be expected if the “saved” would simply switch to a different method.

So it turned out I was wrong. Reducing the availability of means of suicide really can have an impact on suicide rates, as if suicide really were a spontaneous thing (“I’m feeling so low… I could just – hey, look, a rope just hanging there; that’s convenient – well, go on then…”). But those who commit suicide often seem to have planned the act for some time before. Some have been known to have repeatedly visited what would eventually become the site of their death for months or even years before eventually taking their lives. Those who throw themselves under trains sometimes keep visiting their station of choice – unnoticed by staff as they mingle in with the commuter crowd – in order to determine where trains travel the fastest and which trains don’t stop at all. This fact has since been used to provide training to station staff in spotting these people in advance – another suicide prevention strategy.

What does this mean for talking to callers about suicide? When I learnt about these kinds of studies, I started to question what I “knew.” After all, if it’s true that passing a particularly high bridge can be sufficient to push a suicidally depressed person over the edge, so to speak, how could I possibly argue that it wasn’t the case that encouraging that same person to talk about their suicidal feelings would have the same effect. After all, aren’t both the same thing: making suicide seem like an acceptable option by making it more approachable – physically, in the case of the bridge, and more mentally paletable in the case of a caring ear who does not disapprove of your right to terminate your own life. This caused me a significant amount of cognitive dissonance (thanks, Changing Minds!) and I had to put a hold on my volunteer work in this area while I resolved it. As I put it at the time, I had “lost my faith” in the process I promoted.

And that could have been the end of the story. But I’m not a fan of unanswered questions in my mind, and I put a great deal of thought into suicide prevention and into talking about suicide.

Eventually I was able to resolve it. For a while, this resolution was simply based on “what felt right”: I came to the conclusion that seeing a bridge and talking about suicidal thoughts and feeling are actually quite distinct: the former is about the means to perform the action, whereas the latter is about the space to express the feeling. This was enough to put me back on track and, ultimately, make me far more comfortable. Later, I came across psychological studies that backed up that belief, like those referenced by the impressively-titled Scientific Foundations of Cognitive Theory and Therapy of Depression, by David A. Clak, Aaron Beck, and Brad A. Alford.

But for a while there, I wondered.

Further Reading

If I haven’t made you do so already, take a look at chapter 4 of Influence: Science and Practice, by Robert B. Cialdini, which I reviewed some time ago. I’m currently reading The Tipping Point: How Little Things Can Make a Big Difference, by Malcolm Gladwell. Both of these books go into great deal about social proof and contagion and how what happens around us can have a huge effect on how we behave as a society, even leading to streaks of suicide or violent crime. For serious psychology in an easy-to-read and enjoyable format, I thoroughly recommend the Changing Minds website. And if you’re still interested, follow some of my links, above – many of them, combined with a little Google-fu or Wikipedia-surfing, are great starting points for further research.