Take suicidal comments seriously and get help – experts

Three people committed suicide in the Johannesburg Jewish community in November, and four others since January, leaving families and friends questioning how to spot the signs and help anyone thinking of taking their own life.

This is especially important as the pandemic drags on and the festive season arrives – a time when many are more emotionally vulnerable.

For Sarah*, the loss of her friend to suicide, “was the greatest shock of my life. She was gorgeous, extrovert, smart, successful, financially secure, and well-loved. Lockdown isolation put a nail in her coffin. We believe that if COVID-19 hadn’t happened, she would still be with us. I had to identify her at the mortuary. No-one should ever have to do that. It has been traumatic.

“I don’t think that people considering suicide – and presumably they are among us – have any idea of the impact of their actions,” she says. “They do it believing that the world would be better off without them. They are so wrong. It leaves everyone reeling,” says Sarah.

“We are all obsessing about the signs we missed. It’s hard to hear a person ‘deeply’ at the moment when they say they feel anxious or depressed, because we all feel that way. It doesn’t stand out. How do you know when you need to worry? When do you need to intervene? I don’t have the answers.”

According to Chevrah Kadisha Funeral Director Philip Kalmanowitz, there have been five suicides in the Johannesburg Jewish community since lockdown began, and one unnatural death that may or may not have been a suicide. “No person who is a victim of suicide is treated differently to anyone else in death. We see it as an illness. They are buried in the same way and the same place as others,” he says.

“With COVID-19 being so prolonged and so much financial strain, people don’t see an end in sight, which could lead to depression or thoughts of suicide,” says Johannesburg clinical psychologist Leanne Stillerman Zabow. “The risk over the holiday period is that there aren’t as many distractions; it’s a time of taking stock, and may be a reminder of everything we feel we may be lacking in life, which can bring up depressive feelings.”

“Suicide feels so counter-intuitive,” she says, “because in many ways, people strive for life. So, this idea of taking one’s own life – how one predicts that – is jarring. Often a person who commits suicide has so much going on internally that’s hidden from others. There’s often a sense of pain and anger turned against the self, rather than being expressed outwards.

“It can also be ‘masked’. Someone can be a very high achiever, but have an enormous internal sense of worthlessness. Often someone will act out as a ‘cry for help’, especially teens. It could be subtle, so we really need to take heed. People have a fantasy that there is relief in suicide, and it can lure or tempt them, but the truth is, you’re not going to get another chance to resolve things. People may think ‘my family will be better off without me’, but in reality, suicide causes massive waves of trauma.”

Johannesburg psychiatrist Dr Shana Saffer says, “The person almost has a drumbeat in their head saying ‘you are of no value, your family will be better off without you, you don’t belong, get it over with’. The problem is others don’t regard that person in the same way – we may see a funny, talented, delightful person, and we would be shocked to know what their inner ‘voice’ is repetitively saying.”

She refers to suicide expert Dr Lisa Firestone, who says that people who talk about suicide often do go on to kill themselves. “We should take their communication seriously. They may allude to ‘not being around anymore’, yet when someone shows concern, they may quickly deny that they are in distress.

“This back-and-forth behaviour speaks to ambivalence in suicidal people; a part of them wants to die, but the other part wants to live up until the last moment. So it’s worthwhile for us to make an effort because many people are just waiting to be helped.”

Warning signs include having trouble sleeping, isolation, withdrawal from friends, family or social activities, loss of interest in hobbies, work, school, and in one’s personal appearance, giving away possessions, making out a will, having experienced a recent personal loss, taking unnecessary risks, and talking about suicide.

“Another risk is when we have admitted a patient to hospital for severe depression, around the time of discharge, the person may finally have the energy and planning ability to carry out a long-contemplated attempt. A person who had been very low but suddenly has a brighter mood could indicate a decision to carry out a suicide plan,” says Saffer.

Johannesburg clinical psychologist Yael O’Reilly says she sees two kinds of “suicidality” in her practice. “The one is a sense of life being so hard that ‘I wish I wasn’t around anymore’, but there’s no intent to actually hurt themselves. It isn’t so much about suicide as this person needing help to manage everyday life. If supportive elements are put in place, that person isn’t necessarily at risk for suicide.

“The other element is when they are actually suicidal, and it’s not just their representation of how hopeless, depressed, or lonely they feel. The questions we want to ask [to differentiate] are ‘do you have a plan’ or ‘is there intent to hurt yourself?’

“In the first category, they’ll say no, definitely not, I can’t do that to my family, or it’s against my values, or I can’t imagine leaving my child etcetera. But if you ask the second category of person, they will often cry, and say ‘yes I have thought about how I would do it’.” If someone falls into this category then “it’s considered a medical emergency, and that person needs to be admitted to hospital for suicide observation”, says O’Reilly.

The biggest way to help someone in these moments is by offering emotional support. “I can’t stress this enough. The more supported a person feels, the less likely they are to go through with it,” she says. “Support comes in so many different forms – psychotherapy, medication, a support system, or organisations. This is really what can pull a person through, especially in critical moments. If there are interventions, the person has a really good chance of coming out of that depressive episode and suicidal ideation.

“While there have been massive strides in the realm of mental health and the availability of resources, there is still a stigma,” says O’Reilly. “It’s so important to realise that mental illness doesn’t discriminate. In this day and age, it should be second nature to know where and how we can access help. There needs to be an ongoing narrative, and everyone should know the warning signs. We still have a long way to go in normalising and acknowledging that this exists, particularly in our more insulated community.”

*Not her real name