The circumstances surrounding the demise of Hollywood actor Robin Williams early this month has put the spotlight on mental illnesses. He was reported to be suffering from the early stages of Parkinson’s disease along with severe depression at the time of his death, sparking new talks about the co-relation between the conditions. Parkinson’s experts have noted how the incurable and debilitating nervous system disorder also affects people emotionally. In this article, first published in October 2010, a former SPD social worker, Stella Quek, shared her thoughts on managing people with acquired physical disabilities who have suicidal thoughts.
Even in modern day society, suicide is often a taboo subject, shrouded in secrecy, denial and avoidance. It is not uncommon for people to feel uncomfortable in handling those who express suicidal thoughts. As a result, persons who present such thoughts are often avoided, dismissed or misunderstood.
The reasons contributing to a person harbouring suicide ideation or attempting suicide are often varied and complex. An example of a risk factor which is particularly relevant in the context of SPD is the experience of traumatic and often drastic changes in the person’s well-being affecting his health, mobility or functioning. It may contribute to a person being more susceptible to suicidal thoughts when prospects for the future do not seem to have any possibility of improving and there is a pervasive sense of hopelessness.
In the case of a person with newly acquired physical disabilities, such as a stroke survivor with paralysis on one side of his body, or an accident victim with traumatic brain injuries that affect his movements, there are often adjustments to be made in the physical, psychological and social aspects.
For example, the person who faces altered mobility experiences grief and loss issues and these changes will have an impact on family members and interactions with his social circle. When a person has great difficulties in coping, there may be increased risk of contemplating suicide. Grollman (1988) wrote that “suicide occurs when there appears to be no available path that will lead to a tolerable experience.”
While some may have the misconception that suicides take place without forewarning, more commonly, most would indicate their intentions in a subtle or direct manner. Suicidal persons tend to have ambivalent feelings. They may feel a deep sense of hopelessness, yet long to be rescued. The balance between the reasons for and against suicide is frequently so delicate that if those around them respond in concern, the scales may tilt more in support of living.
Some helpers (family members or close friends) are rather averse or hesitant to ask about suicide because they feel that it may cause the person to contemplate suicide if they have no prior thoughts or to ponder about it more seriously if they do harbour such notions. However, persons at risk often appreciate and feel relieved that another person is willing to talk and allow them to explore conflicting and troubling feelings.
Thus, the social support system around a person can play an important role. Following are some strategies for assisting a suicidal person, as adapted from Kok, Tsoi, & Fung (1993):
1) Listening and attending to feelings – Sometimes, a helper may unwittingly try to dismiss the importance of the problem by saying, “things are not that serious” or “you should not feel this way”. This may cause the person to feel more isolated. Remember, it is important to lend a listening ear to a suicidal person in a non-judgemental manner as he expresses and vents his pent-up emotions and thoughts.
To a person who feels neglected or worthless, being shown care and concern are significant forms of encouragement. When thoughts kept within a person are shared, troubles may appear less complex and more manageable.
2) Strengths and motivations for living – While thoughts of suicide can appear strong and frequently in a person, the fact that he is at this point alive shows there is some internal struggle about dying. The helper can highlight this and involve others in supporting him. Emphasising his strengths, resources and motivations for staying alive can be helpful since outlook on life is bleak.
3) Exploring alternatives to suicide – One way of carrying out the above is to have the suicidal person imagine the worst case scenario. For example, a person who experiences loss of mobility could be asked about the possible impact on his relationship with the people around him, if that is an issue he experiences anxiety about. It is uncertainty that adds to apprehension and expressing the exact fear can help to remove some of the feelings of being out of control. After that, alternative solutions to the concern can be explored.
Another method is to help the person see the problem in a different paradigm. A person may experience loss in mobility but he may still have other good qualities and skills that exist despite his disability. For example, while he may no longer be able to take on the role of breadwinner of the family, he has other important roles like that of a husband and father.
4) Tension-relieving activities – The suicidal person may also feel trapped and tensed. Tension reducing activities like reading, praying and even punching pillows can help him deflect his urge to harm himself.
5) Establishing a contract – Involving the suicidal person to agree upon a plan not to harm himself may help to avert the immediate risk of suicide. A no-suicide contract should encompass the following components – i) a voluntary consent from the person to adhere to the contract, ii) a specified and limited time period during which he will not make any suicide attempts and iii) an agreement that he will make contact with the helper again when the contract ends. It would be helpful to ask the person to agree to get in touch with loved ones or professional help, such as the Samaritans of Singapore (SOS), before executing any suicidal intent.
If a helper can stay around to provide support to the person, the crisis will most usually pass with time and the problem managed. However, it can be emotionally and mentally draining to provide long term support. While the above list provides some suggestions on handling a suicidal person, do note that it is not exhaustive. If the helper is unable to cope with the issues surfaced, perhaps it can be timely to consider the assistance of professional help.
1 Grollman, E.A. (1988). Suicide: prevention, intervention, postvention. United States of America: Beacon Press.
2 Kok, L.P., Tsoi, W.F, & Fung, M. (1993). The wish to die: suicidal behaviour in Singapore. Singapore: Samaritans of Singapore.
3 Appleby, M., & Condonis, M. (1990). Hearing the cry: suicide prevention; what to look for; what to do; where to go. Narellan, N.S.W.: R.O.S.E. Education Training & Consultancy.
4 Ramsay, R.F, Taney, B.L., Lang, W.A., Kinzel, T. (2004). Suicide intervention handbook. Canada: LivingWorks Education Inc.