“I just
can’t go on,” the female voice on the other end of the line said.
“Okay. I got it.
You feel like crap. Are you
willing to talk?”
“Yes.”
I then
began the coaching call I have done for other clients to help them get through
this darkest time. She could only see
and feel the endless pain of her depression and felt hopeless to get through
another night feeling there was a no possibility of things ever changing.
Because
many of my clients live with severe depression, we have shared a look at that
place that feels so interminable. In
going through this experience, they have gained some willingness to take steps
to keep themselves alive long enough to call and have that conversation in
which we make choices about staying alive through this night.
Among the
issues we discuss are the chemistry of the brain that makes this pain so
excruciating while seeming to be endless.
I explain that the blinding intensity of the urge to kill herself lasts
approximately 20 minutes. During that
time the impulse is strong, and it is important that together we find something
she (he) can do to prevent acting on the impulse for self-harm. I suggest an abrupt change of temperature,
intense exercise, or even paced breathing.
Those simple acts can take about 20 minutes, long enough to allow clients
a deep breath and think about not hurting themselves.
Why do my
clients think of suicide when they feel living is an impossible burden? What makes any individual feel that staying
alive is more painful than killing him or herself? Often the urge to take her or his life has
been a recurrent thought. When sadness
or hopelessness get very strong the depressed individual often finds the
thought of suicide reassuring because it is an option which takes her out of
that pain.
My work is
to both recognize and accept that my client is suffering and to offer short-
and long-term solutions. Together we
explore the steps needed at the moment of the call and with her or his ideas
and editing, we find action she (he) can take in order to stay alive through
the intensity after we end our call. Our
work is to keep her (him) alive by finding action they can take that is
tolerable and works in that moment. We also
prepare for the next day in which the emotions that were driving her (him) to
consider these steps may now include feelings of shame for having considered
such intense self-harm.
When I look
at my clients who are or have experienced thoughts of killing themselves I
recognize the enormity of their pain. The question I consider as I aim to support
them is: what can I do to give them the
skills needed to tolerate this pain? Why
do individuals who seem to “have it all” think about or even attempt to kill
themselves? Today, on the one hand, we
have better tools to support individuals in pain. We
have medication and therapy both individual and group treatment and we
have support groups in many different settings.
There are spiritual counselors from various religious denominations and
we are applying mindfulness tools in almost every area of a daily lives.
And we are
still experiencing increasing numbers of people whose feelings of hopelessness
and helplessness lead them to attempt suicide.
One of the answers to why is existential. We are living in a world of constant change
which, for many people is also a world of uncertainty and fear. These new ideas and new policies as well as
the seeming limited ability for each of us to find safety are the starting
point for many individual’s pain. How do
we reach out for those personal connections that were so easy to make before our
communication was impersonal electronic media?
Why are the
highest number of people who complete a suicidal action in the age group of
individuals who are supposedly at the peak of their professional growth and
family satisfaction? Do we, as a culture,
put more pressure on women and men when they reach a certain age or a specific
level of professional growth, or do we expect people to never feel
vulnerable?
What is
missing in our culture that we are unable to connect to our friends, our
neighbors, and even those people we see every day walking our dogs? What made the fear that prevents us from
making these contacts grow? More
importantly, what do we need to know in order to diminish this fear and take
the risk of expressing empathy (a very important and healthy quality)?
Understanding
that we are living in a universe of change that impacts all aspects of our
daily living is an essential and fundamental tool if we are to become a
healthier culture. Empathy is both a
rich and a key skill for surviving in these stressful times and it is an action
we are afraid to demonstrate.
Demonstrating this quality requires both courage and a willingness to remove
the mask behind which most of us hide.
Offering
the homeless person in front of the drugstore a smile or a greeting is the
first step in recognizing that we are all - all of us - experiencing
some level of fear and loneliness. This
willingness to take a chance and offer contact to another person is the
beginning. How do we attack this
epidemic of depression and of suicidal feelings? By recognizing that we are all human, and we
can all start our healing, with the willingness to take responsibility for our
own good health. This healing also
includes recognizing that we are part of a bigger world.
Those
phrases we hear so often, “we are all one,” “we are all connected,” are true
and much too easy to forget. As we work
to lower our own pain, we can also remain aware that we do have an impact on
the people around us. It is so important
to keep in mind that everyone has issues with which he or she is
struggling. Why is the number of suicides
among individuals ages forty-five to sixty so high? What happens to us as we reach those
years? Mid-life is supposed to be the
most fulfilling and is the age of the largest numbers of suicides.
Some of the
answer is seen in the question: these
are the years that are identified as “the richest,” or “the most
satisfying.” We are now living the rich
relationship that we have created through the years of being together, without
the stress of children. The pressure to demonstrate the achievements
of our 40 or so years often feels empty.
These are the years just prior to retirement when, so the media tells
us, we have reached our goals and are celebrating our lives. And, yet, this idea is another urban myth.
The
economic and social changes over the past fifty years have left many
individuals struggling to maintain an image of success. Many individuals have ended relationships and
cut ties with family and are thus isolated in a world that does not provide the
social connections enjoyed at an earlier age.
Women go through hormonal changes at this time that may exacerbate a
pain of isolation created by changes in relationship status. Men are experiencing changes that impact
their professional identity. These physiological
changes can produce a vulnerability to emotional pain for which he or she is
not prepared.
Culturally,
we have not prepared individuals to grow into a rich and satisfying older
age. As we stand on the brink of becoming
an elder statesperson, a status that many cultures celebrate, we find that we
no longer have the purpose of parenting, of career growth, and have not created
another area in which to find joy or satisfaction.
We are
finally talking about the impact of this isolation that becomes more profound
in these shifting times. We are facing
changes in the community and the economy that impact our capacity to process those
predictable daily slings and arrows.
Additionally, there is the demand for tolerance of the unknown for which
we are not prepared. Willingness to
accept our limited capacity to understand living with these changes is an
important step in caring for ourselves.
We cannot
know how to live with every new concept occurring in our environment and we
certainly don’t know how to resolve the challenges presented. What we can do is let go of the need to
control those changes. For many, dread of the unfamiliar leads to thoughts of
suicide. The intensity of the emotions
rising out of our loss of skillfulness leads to the urge to take some stand. We must act in a way helps us regain the authority
we feel we have lost.
Understanding
the limitations of our power to adapt to change in our lives is fundamental to
accepting. With acceptance comes the capacity
to tolerate, and even adapt, to the constant change within our world. Change is inevitable. Growth is optional.
Bethany
decided to take a walk. The sun was
beginning to set and, if she went down to the Palisades, just above the beach
at Santa Monica, she could watch the gold and red and magenta colors slipping
into the ocean. “Will you be okay
walking on that path?” I asked.
Bethany was quiet for a moment.
“Yes. I’m going to be okay.”
“You must
call me in the morning to tell me how you’re doing,” I instructed her. “Okay.”
“And if you
don’t call by 10, I’ll call you.”
Bethany was
silent for a moment and then replied, “I didn’t want to go to the hospital.”
“You are
very brave to ask for help. Call me in
the morning.”
“Thanks. I will.”
“I’m here. I want you alive.”
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