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How would you talk a stranger off the ledge?

10 Post author: MoreOn 23 January 2012 02:52PM

Last month, two people far at the periphery of my social circles have threatened suicide. Seems like a sign for me to learn some ledge-fu.

I reviewed the stuff I'd learned back in high school ("Listen." "Be supportive." "Don't argue." "Etc etc etc.") I have trouble believing that this would work outside of movieland, especially on strangers. More so, in person I'm an awkward, fidgeting introvert---the impact of everything I say is thus diminished, and I sound very insincere or clinical, like I'm following a bad movie script, when I say anything like, "You are not alone in this. I’m here for you." or "How can I best support you right now?" I doubt that this would sound any better in writing.

I suppose I could split my question into two related ones: what would you say to a person threatening to commit suicide, 1. in person, and 2. in an email?

I'm looking for out-of-the-box ideas that don't rely on charisma or compassion shining through. Personally, if I ever need to talk myself out of suicidal thoughts, I apply the "bum comparison principle": if my life is so crummy that I'm willing to commit suicide, then I should be willing to just walk out on everything I value and drift off in a random direction, survive by dine-and-dashing out of cheap restaurants and wash dishes if I get caught, maybe take odd jobs or hitchhike or gather roots and berries or blog from public libraries. I don't see this possibility in a negative light, and yet I still haven't done it. To me, it means that however bad my life may seem, I'm still too attached to it to walk out; therefore, suicide isn't on the menu.

People have different reasons to want suicide, and I understand that what works for me with my first world problems probably won't work for a person who is in too much physical pain from an incurable disease. To the best of my knowledge, the two people I mentioned earlier are both unskilled laborers who had lost their jobs, one of them so long ago that he's no longer eligible for unemployment benefits. I don't think I'll meet these particular people again, but I'd appreciate everyone's thoughts on what I could've said if my brain hadn't frozen.

Comments (95)

Comment author: shminux 23 January 2012 05:31:13PM *  -1 points [-]

As you have probably learned, you want to establish a connection first. Given that you had suicidal thoughts yourself, you can start with something like "Yeah, man, some days I want to off myself, too. Life sucks. I swear, if I had a pill handy I might have done it already." You then try to go on by comparing the issues that make you think of ending it all (loss of a job, of a partner, bullying, depression, illness, ...), asking for advice in your circumstances etc.

There is no point trying to convince them of anything until they trust that you understand what they are going through. The lines you quoted ("You are not alone in this. I’m here for you." or "How can I best support you right now?") actually set you apart from them. What they hear is: "I am in a good place, I can even spare some of my happiness to listen to your clearly overblown issues".

Even after you are on the same wavelength, pushing what worked for you on them is probably counter-productive (typical-mind fallacy etc.). Letting them tell you what got them off the brink before and whether it would work this time might work better. Slipping into one of your more depressed moods and letting them give you advice is more likely to get them to apply this advice to themselves, a far more effective approach than rummaging through your own bag of tricks and see what works on them. There is, of course, a chance that their foul mood would push you over the edge, too, and you should be prepared for it.

There are helpful online resources available, such as the video testimonies from the It gets better project. Once you understand your friend's issues, you might offer visiting a relevant site together and talk it over while browsing.

If this seems like too large an investment of time and effort, it's because it is. Whether you find it worthwhile for you is up to you to decide.

Comment author: magfrump 24 January 2012 09:32:16AM 1 point [-]

As someone who has experienced depression, hearing that other people are unhappy doesn't help me at all or make me feel sympathetic. Having someone simply offer to help or care is what I am honestly hoping for when I'm feeling down.

This may not generalize well, but when I'm feeling down, I still have some sense that things could be better, and might be better again, and emphasizing that, and that people are around to pull me up from the bottom until they do, is valuable for me.

Comment author: Eneasz 23 January 2012 10:34:41PM *  2 points [-]

Strange this should come up now. Two days ago my best friend attempted "suicide". (I put it in quotes because it was a fairly obvious cry-for-help, not an actual I-wanted-to-be-dead-but-screwed-up). I've spent the whole weekend with fallout and mitigation (visiting in the hospital, cleaning up his apartment for when he's released, contact his mother & boss, etc).

I'm glad it was only a cry-for-help, because I find it difficult to argue with someone who has decided they are better off dead. I figure they are probably a better judge of that than I am. I was suicidal once myself. I'm glad I didn't follow through, my life is good now. But I have the benefit of hindsight. Back when I was suicidal, I really would have been better off dead, my life experience was one of constant negative utility. Had my life NOT improved and I'd gone the past 12 years continuing to experience that, I'd have endured tons of pain for no good reason. I hate telling people that their life will get better, and the person they'll be 10 years from now will be very happy they didn't kill themselves, because I don't know that will be true.

That being said, it's much harder to kill yourself when your friends/family are around. Don't let them be alone, as much as is feasible. And yes, that means physically present. Internet is no substitute at all, and phone is a VERY weak substitute.

As for a stranger? I don't think it can be done, unless they already WANT to be talked down (in which case it was a cry for help anyway). Grab them and physically keep them away from the ledge until a loved one or paramedic can come collect them.

Comment author: Desrtopa 24 January 2012 01:59:58PM 0 points [-]

I'm glad it was only a cry-for-help, because I find it difficult to argue with someone who has decided they are better off dead. I figure they are probably a better judge of that than I am. I was suicidal once myself. I'm glad I didn't follow through, my life is good now. But I have the benefit of hindsight. Back when I was suicidal, I really would have been better off dead, my life experience was one of constant negative utility. Had my life NOT improved and I'd gone the past 12 years continuing to experience that, I'd have endured tons of pain for no good reason. I hate telling people that their life will get better, and the person they'll be 10 years from now will be very happy they didn't kill themselves, because I don't know that will be true.

Most people who fail in suicide attempts are eventually glad that they didn't succeed. In life, there are no guarantees, only better or worse odds.

Comment author: Hedonic_Treader 13 February 2012 10:38:13PM *  2 points [-]

Most people who fail in suicide attempts are eventually glad that they didn't succeed.

On what empirical information is this claim based? Would you hear honest opinions from those who wind up regretting they didn't die 10 years earlier, as compared to those who can tell you their socially accepted story of rebirth?

Comment author: Desrtopa 13 February 2012 11:51:18PM 1 point [-]

Most people who attempt suicide suffer from severe depression, and depression is, in most cases, treatable. It's unlikely that people who attempted suicide while extremely depressed, who no longer suffer extreme depression, are lying when they claim to be glad to have survived.

Comment author: Hedonic_Treader 14 February 2012 08:49:23AM *  1 point [-]

This doesn't really answer the question on which empirical data the claim is based. Some further points:

Suicidal behavior or ideation are a diagnostic criterion for severe depression. If someone is identified as suicidal, that fact alone is likely to get them diagnosed as depressed. This reduces the usefulness of the depression classification to decide whether a particular suicide is a good or bad idea.

The treatability of depression, as defined by the likelihood that you eventually get these people to claim they're better, doesn't tell me how much they suffered before getting to this point, whether they would voluntarily go through it again to survive, and what their future risks of recidivism are.

There are probably selection effects as to who reports what in a salient manner. Given that suicidal people can be involuntarily hospitalized, honesty under threats of such forced treatment is less likely. As for cases salient in the media, I expect strong selection effects based on society's desire to hear about happy endings, rather than a felicific analysis that may turn out negative. You don't go on TV and say you wish you'd died 10 years ago, leaving your family behind. I expect people both to lie and to be selected for their willingness to lie about this.

Finally, people can simply be wrong about their total distribution of wellbeing. You are miserable for years, then get better, and in hindsight it becomes a blur. This doesn't tell me that the total quality of life beyond the suicidal point is something I would want, or force onto someone, or even recommend to someone.

More arguments or empirical data?

Comment author: Desrtopa 14 February 2012 01:59:36PM 2 points [-]

The treatability of depression, as defined by the likelihood that you eventually get these people to claim they're better, doesn't tell me how much they suffered before getting to this point, whether they would voluntarily go through it again to survive, and what their future risks of recidivism are.

However much they suffered before that point, and whether they would go through it again to survive, are not relevant points to whether they should be glad that they didn't die. They're sunk costs. A person might be tortured, and have a long life of good quality afterwards (data point, John McCain,) and it's possible that they would not be willing to go through torture again to survive, but this doesn't mean that they won't be glad that after they were tortured, they didn't die, even though they might have killed themselves to escape the torture if they could.

There's certainly a possibility of biased reporting among people who report their quality of life and whether they're glad they're alive among people who've formerly attempted suicide, but then, that possibility exists among everyone, since whether you've attempted suicide before or not you're still subject to social stigma if you admit to wanting to die.

As it happens, I know quite a lot of people who've attempted suicide. Of those, all of them currently appear to have qualities of life that are fair to good. In fact, one of the apparently happiest people I know attempted suicide about a decade ago. It's possible that these people are systematically misrepresenting themselves to avoid social stigma, but at this point you'd be starting to get into invisible dragon depression territory.

Comment author: Hedonic_Treader 14 February 2012 05:17:37PM 1 point [-]

However much they suffered before that point, and whether they would go through it again to survive, are not relevant points to whether they should be glad that they didn't die. They're sunk costs.

Subtle distinction: A person's being glad that they are currently alive is not the same thing as their being better off, in total, by not having died at an earlier point X. This is relevant because the central argument for non-consensual suicide intervention is pointing out the former as evidence for the latter - incorrectly, I think. From the perspective of imminent suicide and its possible prevention, the intermittent suffering before eventual (potential) recovery is not a sunk cost yet!

Comment author: Desrtopa 15 February 2012 04:18:57PM 1 point [-]

I never said in the first place that most people who survived suicide are better off than they would be if they had died at an earlier point. This is a different question, but also one that people in suicidally depressive states are particularly unqualified to answer.

That said, I think it's entirely appropriate to regard the former as evidence for the latter. If self reporting that one's life has seemed worth living is not evidence that will sway one in favor of thinking that the person was better off alive than dead, what would be?

Comment author: Hedonic_Treader 16 February 2012 12:02:07PM *  0 points [-]

I agree it's a piece of Bayesian evidence, but I wouldn't treat it as conclusive. I don't see that an observer who happens to come across a suicidal person is better qualified to judge the rationality of their decision than the suicidal person. The depressed states are often identified via the suicidality alone, which makes it worthless for judging the decision in the absense of other evidence. I would certainly talk someone off the ledge if I thought they were harming others, or they're clearly hallucinating, or if I knew them enough to know they're not in a representative emotional state for their general outlook on life. However, I would not override someone's decision in the absence of such information, because that may greatly harm them.

I do think that the self-reported suicidality is at least as much evidence against the value of a life as the general statistical restrospective self-reporting of being glad to be alive of formerly suicidal people is evidence for the value of a life. As an observer without further knowledge, I don't see intervention as justified.

The world doesn't lose much if a comparatively small number of individual people choose to die, but it loses much freedom if everyone is deprived of the right to make this decision. But alas, "every human being is infinitely valuable" is a nice-sounding meme that can trump such rational considerations in public opinion.

Comment author: Desrtopa 16 February 2012 02:56:21PM 0 points [-]

I would certainly talk someone off the ledge if I thought they were harming others, or they're clearly hallucinating, or if I knew them enough to know they're not in a representative emotional state for their general outlook on life.

That they're attempting suicide is strong Bayesian evidence that they're not in a representative emotional state for their general outlook on life. People who attempt to do so without other symptoms of depression are very much in the minority.

Comment author: fubarobfusco 23 January 2012 04:43:27PM 4 points [-]

There are specialists in this field, namely suicide hotlines, suicide crisis centers, etc. who are prepared to help your friends at a moment's notice.

Comment author: MixedNuts 24 January 2012 07:01:31PM 2 points [-]

Hated the hotline I called once. Refusal to judge when explicitly asked for advice and canned lines are barely tolerable when your problem is with getting a cell phone to work, not with remaining alive.

Comment author: MileyCyrus 24 January 2012 08:07:48PM 2 points [-]

I was never suicidal, but losing my religion left me emotionally numb and barely competent. It's basically impossible to explain existential angst to a hotline or a psychiatrist.

Comment author: sixes_and_sevens 25 January 2012 11:32:23AM 1 point [-]

Several years ago I was offered free counselling through my workplace. I only attended one session, and in retrospect I have nothing but sympathy for that poor woman. I don't recall everything we talked about, but I do remember at one point trying to explain Dennett's Benign User Illusion.

"How would you help someone suffering from an existential crisis" seems as much a valid question as the top-level post question, into which you'd think the LW community would have some insight. I'd imagine people suffering from existential crises are great candidates for introducing to rationality, but beyond "so, you've decided there's no God..." I'm not sure they generalise all that usefully.

Comment author: MileyCyrus 25 January 2012 05:27:36PM 3 points [-]

Ok, I'm writing a post about my existential crisis and how I got out of it.

Comment author: Baughn 25 January 2012 01:12:46AM 0 points [-]

Interesting.

I'm sorry if this is a sore point, but have you written more about that anywhere?

Comment author: MileyCyrus 25 January 2012 01:51:54AM 3 points [-]

No, that's pretty much the first time I've brought it up. Maybe we need to start a thread about it.

Comment author: Baughn 25 January 2012 02:27:53PM 0 points [-]

That'd be excellent. Having been brought up an atheist, I'd never seriously considered there might be issues like this.

Comment author: MoreOn 23 January 2012 05:19:59PM 6 points [-]

I'd love to redirect everyone in my blast radius who's ever mentioned suicide to a hotline, but somehow I think that's the first thing just about anyone says when someone mentions suicide... to the point when "get professional help" is synonymous with "I don't want to deal with this personally."

In a similar vein, do suicide hotlines actually work? I'm reading up on them right now, and found this alarming article, that basically says that sometimes the call centers screw up, but overall they work sort of well, and that lapses need to be fixed with better training. I can't find any specifics about what that training entails; I'd love to read about what those hotline volunteers actually say to the strangers who call in.

Comment author: David_Gerard 24 January 2012 09:15:24AM 0 points [-]

They appear (from the experience of friends who have brains such that they have had to frequently resort to them) to be a vast improvement over not having them. The volunteers are imperfect humans, but actually care about what they're doing, which seems to help.

Comment author: CronoDAS 23 January 2012 11:19:45PM *  5 points [-]

I once actually tried calling one of those hotlines to see what they were like; I waited on hold for a while and then gave up.

Comment author: gjm 26 January 2012 02:36:26AM 1 point [-]

If you had to wait on hold, then it's a damn good thing you gave up because otherwise you'd have been taking up the time of their people "to see what they were like" when instead they could have been, y'know, trying to help someone who was suicidal.

(Assuming for the sake of argument that they actually are helpful on balance, which seems likely.)

Comment author: CronoDAS 26 January 2012 06:26:23AM 1 point [-]

Well, I was also feeling pretty down at the time, but sometime between deciding "maybe I should try calling" and getting frustrated with being on hold, I started feeling better.

Comment author: gjm 26 January 2012 12:27:19PM 6 points [-]

This suggests a novel sort of therapy for depression...

Comment author: CronoDAS 23 January 2012 11:58:52PM 11 points [-]

An alternative argument for not killing yourself yet: in the U.S., life insurance is required by law to cover deaths by suicide that occur at least two years after the policy was purchased, and the "return on investment" is ridiculously large; when I looked up insurance quotes a few years ago, an otherwise healthy young man can get a million dollar insurance policy for an annual premium of $600. Of course, money isn't of much use to a dead man... or is it? You can designate a charity as the beneficiary of the policy, or simply make the charity the owner of the policy. And GiveWell gives some relatively low figures for the amount of money it takes to save a life in Africa - somewhere around $1000-$2000. If you kill yourself and didn't buy health insurance first, the people the insurance money could have saved won't be. So if the would-be suicide is also altruistic, you might be able to talk them into deciding to delay. And if you tell them this plan and they actually go and do it, well, at least you've saved more lives than were lost...

Comment author: mwengler 24 January 2012 07:52:32PM 1 point [-]

I love it! Precommitment saving lives! I know with budgeting, putting off spending is quite effective even though you might not think it is. I would be willing to bet in suicide prevention that putting off the suicide is also effective.

Comment author: CronoDAS 26 January 2012 06:22:47AM 0 points [-]

I would be willing to bet in suicide prevention that putting off the suicide is also effective.

That's my impression as well.

Comment author: buybuydandavis 24 January 2012 08:19:37PM 0 points [-]

That's a great way to get someone to temporize.

The trouble is, in a couple of years, they've got a million more reasons to kill themselves. I can hear Mr. Potter now: "Why, George... you're worth more dead than alive."

I don't think I wanted to know this.

Comment author: anandjeyahar 29 February 2012 09:49:59AM *  1 point [-]

The trouble is, in a couple of years, they've got a million more reasons to kill themselves. I can hear Mr. Potter now: >"Why, George... you're worth more dead than alive."

I doubt that's the case. As someone who has been there, it's almost always a biased evaluation. (Rephrasal: The decision of suicide by an agent can be modeled by a Rational AI agent in 99.95 of the cases by adding some strong biased viewpoint. ). And spending two years will give you a very different set of reasons and more importantly perspective on your life. True there still is a chance you might not outgrow your bias, but anecdotal(personal) evidence suggests otherwise.

Or to quote from a movie "Suicide is always a permanent solution to a temporary problem"

Comment author: Nornagest 24 January 2012 08:29:23PM *  1 point [-]

It is a gamble, but I think I'd be fairly sanguine about the odds. None of the suicidal folks I've been close to (and there have been a few) have given me the impression that they were making an unbiased cost-benefit analysis of their futures, or indeed were capable of making such an analysis; extreme depression taints expectations badly, and so do most of the other problems that can lead to suicidal ideation. Get them to commit far enough in the future that their troubles are likely to ease, and I'd say it'd be more than likely that they'd drop the original plan. Especially if you can then get them to commit to therapy, exercise, or another of the common strategies for building emotional stability in the meantime as a palliative measure.

And if they are making that cost-benefit analysis, perhaps the horse will learn to sing.

Comment author: Craig_Heldreth 25 January 2012 12:16:44AM 3 points [-]

This is a series of posts by a fellow who volunteered on a suicide hotline for a number of years which I found informative. It provides the straightest answers I have seen to the question: how do you talk a stranger off the ledge?

This is an aggregation of resources on another website which has discussed the issue in detail.

Comment author: see 24 January 2012 11:44:01AM 15 points [-]

When I was actually suicidal, what kept me from going through with it was:

1) Although my plan had three separate ways by which it could kill me, it was possible that all would fail, such that I would wind up still in all the pain that was driving me to kill myself, plus on life support machines and with people hovering over me annoying me.

2) I would actually have to get up and do it, which was effort.

When I told people about the plan in #1, though, it was because I wanted them to listen to me. I was back off the brink for some reaon, and I wanted to talk about where I'd been. Somebody who tells you they're suicidal isn't asking you to talk him out of it; he's asking you to listen. Which is why the advice you were taught works. Someone who listens is a precious gift, there, where you can still feel the pull of suicide, even someone you suspect is listening just because they're socialized/paid to do it.

On the other hand, when you're out feeling the pull, you've had lots of (people you perceive as) idiots, giving you (seemingly) bad advice and (seemingly) pointless arguments. I, at least, didn't want to hear yet another theory as to why suicide was a bad idea; frustration at such yammerers made suicide look like a better idea the longer they talked.

The advice you were given back in high school was distilled professional expertise. Evaluate carefully before you dismiss it.

Comment author: antigonus 24 January 2012 12:08:20PM 8 points [-]

When I told people about the plan in #1, though, it was because I wanted them to listen to me. I was back off the brink for some reaon, and I wanted to talk about where I'd been. Somebody who tells you they're suicidal isn't asking you to talk him out of it; he's asking you to listen.

Just wanted to say that I relate very strongly to this. When I was heavily mentally ill and suicidal, I was afraid of reaching out to other people precisely because that might mean I only wanted emotional support rather than being serious about killing myself. People who really wanted to end their lives, I reasoned, would avoid deliberately setting off alarm bells in others that might lead to interference. That I eventually chose to open up about my psychological condition at all (and thereby deviate from the "paradigmatic" rational suicidal person) gave me evidence that I didn't want to kill myself and helped me come to terms with recovering. Sorry if this is rambling.

Comment author: see 24 January 2012 11:05:46PM 3 points [-]

Sorry if this is rambling.

Not at all. A concise and relevant comment.

Comment author: wedrifid 24 January 2012 11:53:21AM 1 point [-]

Someone who listens is a precious gift, there, where you can still feel the pull of suicide, even someone you suspect is listening just because they're socialized/paid to do it.

And when you pay them to do it they become a 'valuable commodity'.

Comment author: anandjeyahar 29 February 2012 09:39:40AM 0 points [-]

1) Although my plan had three separate ways by which it could kill me, it was possible that all would fail, such that I would >wind up still in all the pain that was driving me to kill myself, plus on life support machines and with people hovering over >me annoying me

Been there... and have indeed talked about these problems with a friend who once said she was contemplating suicide. But i wouldn' t recommend this to all. I mean for most people the listening and trying to help them in their interest area can help better.

Comment author: David_Gerard 24 January 2012 09:11:38AM -1 points [-]

IME, distracting them until they come down helps. (I've never dealt with a physical ledge, occasionally over the phone.)

It's a good real-world example of "shut up and do the impossible". It's also unspeakably draining and I want not to have to put in such effort ever again. But, of course, will and can if I have to.

Comment author: EStokes 23 January 2012 09:29:24PM -1 points [-]

Do you mean something like that if one has that many problems one could just walk away from them and become a bum...? I think that one could think that they or the world or some interaction of the two is the problem, and there's no escaping from that by becoming a bum.

Comment author: mwengler 24 January 2012 07:57:56PM 2 points [-]

YMMV. Its not about rational proof, but rather what works for you. For YEARS the idea that before I would ever kill myself I would just go live under the boardwalk at Santa Cruz and drink 1/2 gallon bottles of red wine was an extremely comforting thought. In my later life as I have contemplated my own demise, I remember that and think how much harder it is now to take comfort from that, but not impossible.

In my case, I recognize any suicidal thoughts as just frustration, signalling, wanting to call the world's bluff. I NEVER want to kill myself when I am happy, its not a rational thing at all.

Along these lines I would imagine bringing the person to a happier frame of mind. Explore things the person might want to talk about and get him talking about those. When we are intereacting we are connected, when we are connected we don't generally want to be dead.

I am talking through my hat, I don't know anything about these topics from any sort of study.

Comment author: NancyLebovitz 17 February 2012 03:21:43PM 0 points [-]

This reminds me that I've read that for some people, having access to suicide is very comforting even if they never use it.

Comment author: Costanza 23 January 2012 07:44:47PM *  10 points [-]

This actually came up for real on this site a few months ago. Not a literal ledge, but a blog post and comments. It didn't work.

ETA: Sorry, depressing topic. I should have explained more. It came to the attention of LW that a former LW user had mentioned what might have been a suicide plan on his personal site. A lot of LessWrongers attempted to dissuade him. He apparently disclaimed any suicidal intentions and deleted the post, but I'm sorry to say it later became clear that he soon did, in fact, kill himself.

Comment author: Viliam_Bur 24 January 2012 11:07:38AM 3 points [-]

He apparently disclaimed any suicidal intentions and deleted the post, but I'm sorry to say it later became clear that he soon did, in fact, kill himself.

I noticed a similarity with my friend's suicide -- first step: "I am contemplating suicide for unclear reasons", second step: "don't worry, everything is perfectly ok now, honestly", third step: funeral. (As opposed to a cry-for-attention suicide threat of another friend; first step: "I am going to kill myself because this happened to me, and I want everyone to know this"; second step: same as the first step, but the shocking value wears off; third step: "uhm, this was kind of stupid, let's change the topic".)

I don't want to generalize too much from 2 examples, but now it seems to me that the "everything is ok now" part is a huge warning, even if it's followed by some rationalization. Not sure why. Maybe it is a result of thinking: "I am so completely worthless, that I want all people to stop worrying about my coming death". Or maybe it is an overreaction to some last hope, and the suicide is an overreaction to when the last hope fails. Problem is that wishful thinking on our part wants to believe that everything is OK when the suicidal person says so, but rationally any sudden improvement should be treated with high suspicion.

Comment author: NancyLebovitz 17 February 2012 03:19:42PM 1 point [-]

Another angle-- being given advice that doesn't work can be really wearing.

If you're dealing with people who are apparently committed to lifting your mood, and your mood doesn't lift, now what?

What's more, they may well be talking as though if you were a normal person, their methods would work.

Note: I haven't been in this situation, I'm extrapolating from less drastic problems.

Comment author: MixedNuts 24 January 2012 05:36:43PM 2 points [-]

cry-for-attention suicide threat of another friend; first step: "I am going to kill myself because this happened to me, and I want everyone to know this"; second step: same as the first step, but the shocking value wears off; third step: "uhm, this was kind of stupid, let's change the topic"

That's probably an accurate model, but ouch. What is one supposed to do when one is feeling absolutely awful, in need of help, and somewhat suicidal but one is aware one most likely won't go through with it? Even recognizing that's what's going on hurts - "How dare I compare my puny problem I won't even kill myself over to those of actual, important, real suicidal people? I'm just a whiny teenager, this is disgusting, I should kill mys- oh wait". (Obviously, I've been there.) And cries for help less extreme that suicide threats... don't actually get answered with much help, which may explain why such threats are so frequent.

Comment author: Viliam_Bur 24 January 2012 07:35:42PM 1 point [-]

And cries for help less extreme that suicide threats... don't actually get answered with much help, which may explain why such threats are so frequent.

I think it is very useful to have at least one moderately wise person you can freely communicate with. But it can be difficult to find one, because in our society extended families are torn apart and teenagers have to spend most of their time in Matrix (a.k.a. school) among their equally unexperienced peers, with a few overburdened and burned out teachers. There are psychologists, of course, but to visit one is really bad for signalling. Thus a sick environment is created, where it is socially more acceptable to say "I will kill myself" than "I have some problem that I don't know how to solve; may I have your attention for a few minutes, please?" :-(

Comment author: MixedNuts 24 January 2012 07:43:10PM 1 point [-]

I want to take the word "attention" out, shoot it, and hang it with its own bowels. Yes, someone to talk to is usually necessary. But what's really hard to find is people who will actually help. Like, look up psychologists or cook you meals if you're anorexic or take care of you while you're chained to the wall weaning off heroin.

Comment author: TheOtherDave 24 January 2012 07:12:56PM 0 points [-]

What is one supposed to do when one is feeling absolutely awful, in need of help, and somewhat suicidal but one is aware one most likely won't go through with it?

In my experience, there are two pieces to this.

First, find friends who actually give a crap about me, who want me to be happy and fulfilled, who are willing to listen to me talk if I want to talk, who care what happens to me. (Professional therapists can also serve this role, if nobody else is available. That's not to say it's the only role they serve, merely to say that they can serve this role.) This is the most valuable piece; without it not much else works.

Second, simply describe my current state. For example: "I feel awful. I've been thinking about killing myself, and though I don't expect I'll ever actually do it, I suspect that the suicidal ideation is itself a bad sign. I don't seem to enjoy anything, I'm either sad or indifferent most of the time, despite there not really being anything in particular to be sad about, and I can't imagine it ever getting any better than this. I need help and I don't know how to seek it out, and I'm afraid that even admitting to this will cause people to think poorly of me."

Of course, it's all easier said than done.

Comment author: see 24 January 2012 12:07:00PM 4 points [-]

I don't want to generalize too much from 2 examples, but now it seems to me that the "everything is ok now" part is a huge warning, even if it's followed by some rationalization. Not sure why.

Consider: It's much easier to commit suicide if the people around you aren't on guard against you committing suicide.

"I am contemplating suicide for unclear reasons" was a gasp of the part of the person not yet committed to action of suicide; it puts people on guard, it gets them to help (interfere, from the view of the suicidal parts of the mind). If the person then decides to commit suicide, he's got to set the guardians at ease, get them to cease interfering. Telling the lie that "everything is okay now" makes it easier to succeed at suicide.

Comment author: Viliam_Bur 24 January 2012 12:23:48PM 0 points [-]

Makes sense. :-(

But it may be many different causes for different people. For example is someone's depression is biologically caused and they take some prescribed drugs, they may honestly report improvement... and then become overconfident and stop taking the drugs.

Comment author: see 24 January 2012 11:03:33PM 0 points [-]

But it may be many different causes for different people.

Oh, of course. I speak from only my own mix of experience and imagination, not as a trained or experienced psychologist. The powerful emotions of my individual experience definitely bias me to a specific view which I probably overgeneralize, even when I'm conscious that I might be overgeneralizing.

Comment author: wedrifid 24 January 2012 11:44:07AM *  0 points [-]

I don't want to generalize too much from 2 examples, but now it seems to me that the "everything is ok now" part is a huge warning, even if it's followed by some rationalization. Not sure why. Maybe it is a result of thinking: "I am so completely worthless, that I want all people to stop worrying about my coming death". Or maybe it is an overreaction to some last hope, and the suicide is an overreaction to when the last hope fails. Problem is that wishful thinking on our part wants to believe that everything is OK when the suicidal person says so, but rationally any sudden improvement should be treated with high suspicion.

In the case of the suicide risk for people on antidepressants it is said that when improvement begins the 'overwhelming akrasia' component declines, leaving the depressed individual with the ability to actually carry out goals. (Take this with a grain of salt. It's a 'just so' story if ever I heard one. Testable to be sure, but not easily so with our level of technology.)

Comment author: sixes_and_sevens 23 January 2012 06:31:15PM 12 points [-]

A few disclaimers. I am not a mental health professional, as is probably more than apparent. I have some experience dealing with both ostensibly and explicitly suicidal friends. My personal history also includes periods of depression and bouts of suicidal intentions of varying degrees of intensity. In addition, have an intellectual interest in the subject. If anyone with better experience, knowledge or training in this area wants to correct me, I implore you to do so. Dealing with a suicidal friend or loved one is one situation where you definitely do not want wrong information in your head.

With that out of the way...

It is my belief that if someone has a genuine, premeditated and well-thought-out intention to end their life, you won't find out about it until they've already done it. It will be planned in such a way that they won't be disturbed, and won't fail on the basis of conviction. They'll do it 'properly'. As a result, this advice applies to the more melodramatic 'cry for help' expression of suicidal intent.

People don't just suddenly decide that it's a good idea to kill themselves. It usually isn't a very good idea. It's usually the result of a sequence of events which points to threatening suicide as an appropriate outcome of the situation. The old saw of not being able to reason someone out of a position they didn't reason themselves into is quite true in this case. Don't try and engage in rational argument about why they shouldn't kill themselves.

Your goal is to try and steer their mood to a point where they think "gee, wasn't I silly for thinking about killing myself?" I find the most straightforward way of doing this is focussing their attention on near-future events. People they want to see, places they want to go, upcoming social engagements, even something as mundane movies or books they expressed an interest in. Planning for the future and contemplating suicide are fundamentally at odds with each other. In Robin Hanson jargon, suicide is Far, and becomes appealing through a lack of Near consequences for carrying it out. Even something as trivial as missing the next Batman movie can be enough of a Near consequence for someone to feel silly about the whole wanting-to-kill-themselves thing.

Another important element is to try and keep the tone and content of the conversation as normal as possible. There's a fairly well-established cultural narrative for how these sorts of exchanges are supposed to go, and steering away from that narrative will make their actions seem more and more silly in context.

Comment author: EStokes 23 January 2012 10:49:32PM 0 points [-]

I... don't see how making someone feel silly is going to help in the long run? If it really is a problem for them, then wouldn't they have a harder time bouncing back from thinking they've said something silly/stupid, not to mention feel alienated and alone, possibly discouraging them from talking about it again instead of doing the deed? It seems to me that an expression of suicidal intent as a cry for help doesn't necessarily make it insincere. It doesn't sound unlikely to me that someone could say they've the intent to do it, because their view of how things are makes it seem like life's not worth it, but that they'd of course want to think otherwise, and so would still like to hear serious advice on the matter, or at least hear that someone cares. Honestly, it sounds very callous.

Comment author: sixes_and_sevens 24 January 2012 10:21:56AM 2 points [-]

I'm not suggesting that it's beneficial to make suicidal people feel silly. I'm proposing that the sensation of retreating from a position of suicidal intent is often feeling silly about having done it.

I'm starting to regret posting this now. There's way too much room for misinterpretation.

Comment author: TheOtherDave 23 January 2012 06:50:13PM 2 points [-]

I endorse most of this, though I'll note that in cases of profound depression my emotional response to being invited to consider near-future events may well be to assert that no, actually, there's nothing I actually want to do.

Also...

if someone has a genuine, premeditated and well-thought-out intention to end their life, you won't find out about it until they've already done it.

Often, not even then.

Comment author: sixes_and_sevens 23 January 2012 07:37:09PM 0 points [-]

When I started writing this, I found I had a lot more that I wanted to say than could have been squeezed into a moderate length comment, which is why it ends kind of abruptly. There are so many possible caveats and special cases to make it difficult to assemble all-purpose advice on the subject.

Comment author: Desrtopa 23 January 2012 04:23:00PM *  9 points [-]

I reviewed the stuff I'd learned back in high school ("Listen." "Be supportive." "Don't argue." "Etc etc etc.") I have trouble believing that this would work outside of movieland, especially on strangers. More so, in person I'm an awkward, fidgeting introvert---the impact of everything I say is thus diminished, and I sound very insincere or nosy, like I'm following a bad movie script, when I say anything like, "You are not alone in this. I’m here for you." or "How can I best support you right now?" I doubt that this would sound any better in writing.

It might seem to you that this isn't the sort of thing that would work in real life, but in general, yes it does.

If you're worried about sounding insincere, try and think of something genuine and non-trite that you can say. For instance, many suicidal people don't believe that anyone would care or be meaningfully affected by their deaths; try and think of a sincere way that you could tell them that you do care whether they live or die.

Any specific words you might have been taught are unimportant, they're really just a guideline to the sort of structure you ought to assume.

Comment author: scientism 23 January 2012 04:09:16PM 4 points [-]

The argument you give here (the "bum comparison principle") is the exact same one I've used on myself. If I can commit suicide, then I should be able to walk away. Perhaps some variation would work on other people.

Comment author: anonymous259 23 January 2012 09:14:17PM 2 points [-]

I find this a complete non-sequitur. If you stay alive and become a bum, you will consciously experience a (potentially large) loss of status. Whereas if you commit suicide, you won't.

Maybe being dead is low-status too, but at least you're not around to experience it.

Comment author: scientism 23 January 2012 09:32:45PM 3 points [-]

I think the fact that "you're not around to experience it" is the tricky part of reasoning about the utility of suicide. Visualising walking away helps because it puts the more selfish aspects of suicide in stark contrast. If I walked away from my life I'd carry with me a lot of guilt and I'd have to live with the awareness of how my absence has affected others. If I kill myself, the primary advantage is that I don't have to experience that guilt and that, I think, makes suicide easier to contemplate than making a serious commitment to walking away. That's why I say if I'm not ready to walk away from my life (and face all the consequences of my actions), I'm not ready to commit suicide.

Comment author: TheOtherDave 23 January 2012 06:59:48PM 8 points [-]

This worked for me from my mid-teens to some time around my late thirties. What I'm finding now is that depressive episodes much more ideation along the lines of "Nah, it's just too much work, I can't be bothered."

Mostly my response to this was to establish the "other people matter" principle, which implies that if I'm going to kill myself I ought to do so in a way that minimizes the amount of suffering I cause others, which I'm pretty sure means I should make it look like an accident or like natural causes, which takes a fair amount of work. By the time I feel like doing that work, I'm no longer in the mental state where it seems like a good idea.

Comment author: cousin_it 24 January 2012 01:20:02PM *  1 point [-]

It might be a mistake to say things like "if I commit suicide, I'll make it look like an accident" in public where your loved ones can hear it, because you could die in an actual accident (which is more likely than suicide) and they would suspect it to be suicide because of what you said.

Comment author: TheOtherDave 24 January 2012 01:26:59PM 0 points [-]

True. That said, I'm fairly confident this is not such a forum.

Comment author: pedanterrific 23 January 2012 08:18:18PM 0 points [-]

I have a medical condition that makes the Bum Comparison Principle untenable (constant care required), but I have to say the Other People Matter Principle has worked pretty well for me so far. At this point, the idea of coming up with and implementing a foolproof minimal-impact suicide plan seems way more annoying and tiring than just going on with my life.

Though, while it worked pretty well in my case, I'm not sure I would recommend "if you kill yourself I'll never forgive myself" as an actual generalized strategy.

Comment author: TheOtherDave 23 January 2012 09:09:46PM 3 points [-]

Nobody has ever pulled the "I'll never forgive myself" thing on me, but then I don't often have this conversation explicitly with people.

It's more a general sense that there are people who are engaged with my life, who value my presence, who consider what happens to me in some sense their (collective) responsibility, would be hurt by my absence, and doubly hurt if it were self-inflicted.

Admittedly, I had a stroke a few years ago that almost killed me, which made me very aware of how much people care that I'm still alive. I'm not sure if I'd be thinking about this the same way five years ago.

Comment author: TeMPOraL 24 July 2013 08:17:34PM *  0 points [-]

What to do when "bum comparison principle" argument stops working because the internal, emotional pain won't leave you alone no matter where you go and what you do, and you see no way to stop it, and you gradually, over the years, build an immunity to this argument?

Comment author: buybuydandavis 24 January 2012 08:04:04AM 0 points [-]

I at least find the pain of impending loss much worse than actual loss. After an actual loss, I just move on. But I find an impending loss very oppressive. I'd check to see if the loss was impending, or had already occurred. If it has occurred, getting them to really accept that it has already occurred may help. If it hasn't occurred yet, temporize, and tell them that you never know how things will turn out. Wouldn't it be a shame to kill yourself when the Awful Thing ended up not happening? At least stick around to find out.

Along the lines of temporizing, try to convince them that they can always kill themselves tomorrow. Should work like a charm for the procrastinators around here. Surely there must be something they'd like to do before they go. You may as well do it first, before you kill yourself. Too busy killing yourself to go to a movie? Do they have any money they could give to charity? Movies they'd like to see? Places they've wanted to visit. Freaky sex they never got around to? Drugs they never tried? Some fancy restaurant they were always too cheap to go to? No point in dying with a dollar in your jeans.

Comment author: CronoDAS 23 January 2012 11:24:21PM *  0 points [-]