This month, counsellor and psychotherapist Douglas Holwerda deals with the issue of suicide.

 

Dear Douglas,

 

Last week I accidentally walked in on my older sister as she was getting out of the shower. We were both surprised and I left quickly, but not before noticing several cuts on her upper legs and some scars that looked like previous cuts. I haven’t said anything to her about it, but I feel worried that she is hurting herself. Then today, I heard her say that she is “tired of living” to someone on the phone. I am worried about her, but do not know if I should bring it up with her or wait for her to come to me when she needs me.

 

Worried Sister


 

Dear Worried Sister,

 

Thank you for seeking out support when you have felt uncertain about what to do. Clearly, your sister is in emotional pain, as indicated by her cutting herself and the comment about being tired of living. Both of those things are red flags, which means they are alarming to the point that they cannot be ignored.

 

I recommend that you approach her and tell her what you have seen and heard, and ask her to talk to you about how she is doing. I can imagine that you are afraid of what you will hear and wonder if you will know what to say to her.

 

Often people believe that by bringing up the topic of suicide a person might get the idea, so it is better not to talk about it. But the opposite is what is true. If we suspect a person is thinking about killing or hurting themselves and we ask them directly, they will feel a sense of relief that someone else knows and cares enough to ask.

 

The vast majority of the time people can have thoughts about wanting to die without ever having any intention to kill themselves. When people are in emotional pain for a length of time their minds are looking for a way out, and thoughts of “escape” become part of that. We can assume that your sister has been in emotional pain because self-harm is an indication that she has tried to cope with it through cutting herself. Cutting is not an attempt at suicide, but rather a way that people find emotional release from intense emotions that have been numbed or repressed.

 

So, let me give you some guidelines to help you assess what is going on for your sister. You will need to learn from her whether she is likely to commit suicide. There are three things to find out — we could say stages of severity.

 

Stage one is called suicidal ideation. It is when someone has the thought about killing themselves or escaping the world or wishing that others would be better off without them, but when pressed on the question of killing themselves, they say they would never do it. When asked if they have reasons to live, they name a few significant things that keep them from wanting to die, despite their problems and emotional pain.

 

Stage two is when someone is more discouraged and depressed and is feeling more hopeless and helpless to feel better or solve their problems. The reasons for staying alive are fewer and weaker — sometimes it is only for the love of one person, not wanting to hurt them, so that they fight to find a way to stay alive. They have often thought about how they might kill themselves, but have no real plan… a time or place.

 

Stage three is when someone feels they are out of options and that they cannot bear the emotional pain much longer. They will either appear to be in great despair or might even be surprisingly happy and at ease. Let me explain the latter.

 

Sometimes when people who have considered suicide for a while, get to the point where they are ready to die, they feel a big relief and will often visit friends and family, give things away and seems almost euphoric because they can see a way to end the pain they have been living with. It is a different kind of red flag. This stage means they have a plan, meaning, a method, and a time and place, all decided.

 

So, to find out what is true for you sister, you have to ask. You have to ask if she is sure she will not end her life. If she cannot say yes, you have to find out if she has a plan (a method, the means, a time and place). It is important to know what you will do, if her answers lead you to believe that her life is in danger.

 

If she is in stage three, do not leave her until she is in the hands of adults or professionals who can keep her safe and help her find a different way through the crisis. In any event, it sounds like your sister could benefit from meeting with a psychotherapist who can help her understand her emotions and how to regulate them to feel better.

 

Do your homework. Finding names of psychotherapists or support people in your area. Then go and talk to your sister and let her know that you care.

 

I wish you well,

 

Douglas

 

Do you have a question you would like Douglas’s help with? You can email him at This email address is being protected from spambots. You need JavaScript enabled to view it.. Personal details will not be printed

Douglas Holwerda

Douglas is an American trained psychotherapist, writer of the Dear Abby-esque monthly column in the Word, "Dear Douglas". He holds to the notion that the living of life is a creative endeavour... an eternal adventure without promises. And that we are both shaped by the journey and the shapers of what is possible. Our greatest hope is to find love and connection along the way. Live it all.

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