The language of suicide

One thing I've learned that I didn't want to know in the last month is that there is a lot of terminology related to suicide, most of which I didn't know.  I know "suicidal ideation" (thinking about it); "plan" (a step that means it's really serious); "intent" (willingness/ability to carry out that plan".  I was taught before this that there are active suicidal thoughts "I want to take every pill in my house" and passive thoughts "I wish my lithium toxicity had killed me".  In the hospital they replaced the passive with the term death wishes which I hate and refuse to use unless forced.  Yesterday I learned a new one. Dr. Mind about about "suicidal gestures" and I had to ask what that was.  It means doing things in prepartion to a plan to die, like getting bills paid, setting up the scenario which is chosen, making a will, writing a note, etc.  And then he said or something like putting a gun to your head like a trial run.  I think I looked at him like "yeah right" which is when he pointedly added "or keeping pills where you can stare at them and plan".  Um, yeah.  No longer feeling smug that this wasn't me and point taken; what I was doing was plenty dangerous.  I suppose the time will come when we have to talk about that even more.  I do not want to go through life at an even higher risk than I was before, although my risk moved up because of this.

When I was in OT school I remember being taught in general how to react if a patient said they wanted to die.  You were to ask if they had a plan, if they had access to whatever danger they were discussing, and you were to get as many details as possible from them, and then you got them help, immediately.  You documented in as much detail as humanely possible.

When I worked in psych I had to do this several times.  The worst then would be that people would ask you to keep what they were telling you a secret before they'd say anything and I'd have to explain that while I would keep anything confidential that I could if they told me they were suicidal or wanted to hurt someone else or if they told me that another human was in danger I could not keep the secret.  I don't remember most of them being too reluctant; I do remember there being a lot of paperwork and in general not a lot happened because for the most part our patients were in a pretty safe environment.  They just were on increased monitoring and the psychiatrist would be notified along with the patient's doctor.  Sometimes meds were given, sometimes not.

A few years ago I had a patient who was very depressed, cognitively intact, and who had been a very successful community member and suddenly found himself to be old and sick.  He struggled hugely with this. This happened to be someone that I got to be close to.  One day he laid out a detailed plan to kill himself upon leaving the nursing home.  He was very serious about it.  I got the usual information and told the nurse. Who actually laughed and told me he certainly wouldn't be doing that in the nursing home.  Ok, but what about home?  It took me several days to get them to listen and get a psychiatrist involved.  By all rights he should have been sent to gero-psych the day he told me that.  After that day I had to argue because the family had gotten rid of the guns in the home so he was safe.  I had to point out to someone you can't make a house totally safe unless you are an expert, what with meds, cleaners, drain openers, razor blades (even after scouring my own home for those 3.5 weeks ago I found more yesterday), etc.  They kept insisting he'd be fine until the psychiatrist saw him in a few weeks.  I don't think anyone ever thought about what it feels like to be suicidal.  Having recently been quite suicidal yet being kept from harmful things in the hospital I can say for certain that while it is good to know you are safe because you are being protected it is also frustrating because you know that a few lies and you're home and able to do whatever you want.  Even if you decide in the hospital it isn't what you want as I did it is frustrating and scary to go home and suddenly have to be responsible for yourself again.  As Dr. Mind told me on the first day home he can hold on to every dangerous thing I own and that doesn't mean that I am really safe.  People who are suicidal need to be helped with coping skills rather than just given false security than only lasts while in some facility.

I don't think it is possible to understand the desire to die that is so strong you are willing to make it happen yourself.  Even though I've had suicidal periods off and on over the years I didn't completely understand that until the last month.  I think that's why I find all the terminology to be weird.  Terminology just helps keep in distant and at least in my experience it is vital to look closely at the feelings, the causes, and the solutions.  Even when the solution is very basic, as mine currently is:  lots of therapy, lots of monitoring, limited access to unsafe items, increased meds.  Big words do not change any of this.  In fact, for me, the most vital thing in staying safe is being held accountable for telling through frequently repeated questions.  I can't say that would have helped much 6 weeks ago as I may have at least tried to lie if asked directly, but I also probably would not get away with my lies.  The lying I did get away with was not so direct.

One of the sessions of my class is on suicide.  I am hoping to read that chapter ahead quickly and I may ask to be excused from it.  I am not sure I'm ready for that.  We'll see.  If nothing else I know lots of phrases now that should help!