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Feeling like there’s no way forward? ‘Please press pause, and consider the options for getting support and help’

Psychologist Dr Eoin Galavan, in conversation with Liadan Hynes, has sound advice on understanding the suicidal mindset, the importance of empathy, and the impact of loss to suicide on a family

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Suicide prevention

Suicide prevention

Suicide prevention

‘I think one of the things that’s useful in general, when we’re thinking about the topic of suicide, is to have some understanding of what it is that’s going on in people’s minds,” says senior psychologist Dr Eoin Galavan.

He outlines some of the conclusions around suicide that psychologists have agreed on over the past decades.

“There are some ideas that can help us shine light on the mind of a suicidal person. One is when people feel they’re a burden on others, that others would be better off without them.

“A sense of disconnectedness, isolation or loneliness is another. A feeling that you don’t matter to people. The idea that there’s no connection, or value in your presence. And that other people wouldn’t miss you if you were gone.”

Then there is the issue of fearlessness.

“This is idea that sometimes people
get to a point where they’re no longer frightened of self-injury.

“The pathway to that can be varied. But it can include things like self-harm, excessive drug or alcohol misuse, and other practising or rehearsing suicidal behaviours.

“When a crisis occurs, the suicidal behaviour itself doesn’t seem as fearsome as it might otherwise have – because they’ve gone on a journey where they have become in some way accustomed to the idea of death by suicide.”

Having a basic understanding of what might be going on in a person’s mind can help to inform conversations.

“One of the first things is thinking about practical safety. Does the person have an active plan? Do they have access to lethal means?

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“It can be a fearful ask – but it’s a really important question. Because it opens up the possibility of negotiating, reducing or removing access to lethal means.”

There isn’t one version of the suicidal struggle, Dr Galavan explains.

“It is true to say that, for some people, suicidal crises come and go. But for others, this is something that lingers with them for prolonged periods of time.”

Just because a person is thinking about suicide does not mean they will act on it.

“A person who feels overwhelmed might think something like ‘I wish I wasn’t here’ or ‘I don’t think I can cope with this any more, maybe I’d be better off dead.’ But it never goes beyond that.

“For another person, they might start imagining a method they might use and start planning it. And yet another person might actually behaviourally engage in the process of leading up to an attempt.

“As you move along that spectrum, the numbers of people gets smaller and smaller. In other words, the vast majority of people who think about ending their lives, don’t go on to think about a method, and don’t go on to have an attempt.”

How possible is it to reach someone and make a difference?

“I would say again there’s huge
variation. The degree of conviction is something that varies considerably.

“The typical characteristic of the suicidal struggle is ‘part of me wants to live, part of me wants to die’. So we can become fearful that the desire for death is so overwhelming that there’s nothing that we can do to alter that person’s trajectory.

“But if a person is still alive, then the wish to live has so far been more powerful than the wish to die.”

It is really important to keep this in mind. That even if a person is feeling very bleak, and very convinced that death by suicide is the answer, “whatever part of them that has decided otherwise has so far been more powerful”.

“That struggle is a flexible thing. It’s
fluid, and rarely static.”

So how do we know if there is a risk? A large number of people who attempt suicide will have talked about it in the weeks and days up to their attempt, Dr
Galavan says.

“That’s important to know. If someone has said they’re thinking of killing themselves, then regardless of how they’ve said it, that needs to be thought about more.”

This won’t always be the case though.

“One of the real dilemmas with suicide is that it’s often a very private struggle, and is extremely difficult to predict. So we can’t say with any degree of certainty who will or won’t kill themselves. But we can identify the things that make it more likely.

“People who are engaging in self-injury are more likely to die by suicide, but the vast majority of people who engage in self-injury don’t die by suicide. People who are talking about killing themselves are more likely to have an attempt, but the vast majority of people who talk about killing themselves don’t go on to have an attempt.”

It creates what he describes as a kind of perpetual dilemma with suicidality.

“Everyone is terrified of this awful outcome, but it’s very unpredictable and there isn’t an absolute thing that we can do to predict who will and who won’t.”

Given this, he says the rule of thumb is to take all suicidality seriously, and open up the dialogue.

“Until that conversation is happening, you never know where the other person is at. It wouldn’t be unusual, for example, for someone to be suicidal – but also to be very ashamed about that.

“They may find it extremely difficult to tell someone where they’re at. That’s where it might come out in some oblique way.”

If you do open up the conversation, and the person says they’re not thinking about suicide and would never do that – then, as Dr Galavan points out, there’s nothing lost. But the important thing is that by opening up the conversation, you are demonstrating your willingness to go there.

“Saying that it’s OK to talk about this can be a really important message for someone who is deep in despair, who’s finding it very difficult to see things improving, who’s thinking about suicide. The message that it’s OK to talk about this, and there might be a way forward, can be important.

“So the rules of thumb are: we can’t predict it; we should take all suicidalities seriously; and we should always be willing to open up the conversation.”

To counterbalance the stigma around suicide, maintaining an empathic mindset is key.

“If we think about the things that really help people, it’s for them to feel they are connected and cared about. Everyone can relate to the idea of feeling unloved, to feeling overwhelmed, hopeless and in despair – because those are parts of the human condition.”

This kind of empathetic thinking helps to diffuse the stigma around suicide, that it is bad, shameful, othered.

“I think the point is to find the human struggle. And to find ways to identify with that. Because we’re all humans, we all suffer, we can all identify with those things to some degree.”

In terms of the emotions specific to a loss from suicide that the bereaved will feel, Dr Galavan explains that while there isn’t a typical version of this, there is a layer of complexity to a loss by suicide.

“Part of that complexity comes from the idea that they did this to themselves. Which might lead a person to feeling angry, confused, struggling with the question of why they did it. People often feel guilty that they should have or could have done something differently. They almost feel kind of punished by a tyranny of ‘what if?’ It can be torturous.”

It is important to remember that death by suicide is not predictable. There probably isn’t something you could have done differently that would have guaranteed a person would choose life.

“Sometimes people die by suicide, and everyone around them knew they were suicidal, and they were all doing their best and the person still died by suicide. There’s real suffering and torture in that loss and it can be extremely hard to come to terms with.”

The other important thing to know is that people do find a way to continue
after such a loss.

“Albeit painful and tragic, people find a way to live with the loss over time.”

In general, if anyone has a family member who has died by suicide, they’re at increased risk compared to the general population. Broadly speaking, there are two types of reaction to the death of a family member by suicide – those who become more averse to the idea, and those who become more vulnerable.

“If you can identify with a person who’s done this thing, that makes it potentially more likely you can do it. We don’t know an awful lot about what divides people into those two reactions.”

To someone experiencing suicidal feelings, he says “the first thing would be, ‘Well done for sticking with it so far. Please press pause, and consider what the options for getting support and help might be.

“If you’re near anything that’s likely to hurt you, put some distance between you and whatever that might be, and then start thinking about – maybe even write down – a list of the people you can call to talk about accessing help​​​​​​.”

If you have been affected by any of the
issues here, the Samaritans Ireland can be contacted 24 hours a day on 116 123. Further details and support can be found at samaritans.org


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