Responding to Suicidal Ideation (2/3)

This is the second (2/3) posting concerning what to do about the question of suicide after brain injury.  The previous post presented an introduction to these thoughts.  If you have not read it, please do so now.  This posting has my suggestions to caregivers and the reasoning behind them.  Thank you for reading, and please leave your thoughts.

To Caregivers

To begin bluntly, know that a caregiver — especially a nonprofessional caregiver — cannot be the “hero” that “saves” a person from the thought or the act of suicide.  Get rid of any idea like this — it puts an unfair burden on both the caregiver and the survivor.  Suicide is a choice made by the person who commits the act.  A caregiver can, and should, seek to positively influence the survivor, but should not take on responsibility for a suicidal decision.  Taking on such responsibility can not only cause extended emotional trauma for a caregiver, but can also lay further stress upon the survivor — the survivor is no longer responsible for only personal wellbeing, but also the wellbeing of the caregiver.  In my experience, feeling “pressure to live” and not kill myself for the sake of other people became another stress — I was not encouraged to live but felt further defeated.  My thought process was, “Well, I’m getting pretty good at screwing everything else up, why not die and just add one more thing to an already long list.  At least that way the list of my screwups won’t get any longer.” 

Similarly, the caregiver should not seek credit for helping the survivor — the survivor is the only person who makes the choice to live or not live.  Furthermore, this decision to live should not be a glorified.  It is an important choice, but also — very simply — necessary.  Any person who wants to continue in this life constantly makes the decision to live, though often it is done unconsciously — death is always possible, but most times we ignore this choice.  For a caregiver to take credit for encouraging a survivor to decide to live takes away the power of that decision from the survivor.

With all those caveats, This puts the caregiver in the unenviable position of being a person who works a thankless task and never receives credit for the work done — what’s more, a caregiver can never know if any work done has affected a survivor in anyway.  It is always a survivors decision.

But what is this work?  What can a caregiver do to encourage a survivor to make the choice to continue living?

This work is — to Be there.

In the purest sense, simply be there — let the survivor know you are available and would like to listen, if there is anything to hear.

This is not asking ‘Are you okay’.  This is not suggesting behaviors.  This is not offering guidance.

Just listen — without judgement.

“But how?” A caregiver may ask, “How do I Do this?”

It’s not a thing to do, it’s a way to be. 

At this point, I run the risk of falling into the realm of spiritual mysticism — “Just Be, man” — and that might shake some people, so let me cut that thought off — this is NOT about being mystic or meditating or the spiritual.  It’s also not about “fixing” a thing.  This is about trusting in the person for which you care to come to you when they are ready to express a need.

Now, that said, I do suggest a caregiver try to keep a light line of communication open — don’t go out of your way to ignore the survivor, but when you talk, keep things emotionally light — “Hey, how you doing?”  “You wanna get some coffee this afternoon?  No? Okay, let me know if you change your mind.”  “Anytime you want to do something, just let me know and I’ll see what’s up.”  Don’t try to force your way in — that will only push the survivor away — but just be there as someone who cares.

As a survivor, I remember needing to cry, to complain, to scream without the fear of having some other rehabilitation or therapy or life-affirming habit thrust into my life.  Recovery sucks — things may be slowly getting better, but let a survivor recognize the pain and confusion and hate and all the negative feelings and emotions by talking about them — being able to express the negative is the beginning of moving onto positive thinking.  As a caregiver, it is not your job to fix everything that is wrong — it is your job to CARE for the survivor, and sometimes that care is best shown by simply being there and letting the survivor dump all the shit out of his or her mind — and as a caregiver, its gotta be okay to wipe off this shit, smile at the survivor, give a hug, and brace yourself for the next load.

That is the first, and I believe the most important step — care — with no expectation or desire for recognition — care.  Be there.

I recognize this cannot be easy.  Giving care is often thought of as an active event, and the act of simply being may seem aggravatingly passive.  Don’t worry, as a caregiver there is still a lot you will need to do — transportation to doctors’ appointments, preparing meals, helping the loved one navigate a new set of physical limitations — we could continue as the list of necessary things to do for a caregiver is rather extensive, but I do not want to become distracted.  This is about the question of suicide — and this is one thing a caregiver cannot actively do.  From my experience, a caregiver can best help by actively being there — available, ready, but not insistent.

In tandem with this, a caregiver can — and should — have information about suicide prevention services, encourage participation in social activities, demonstrate positive thinking, and be knowledgable of suicide dissuasion methods — these sort of actions are important for a survivor to have in his or her life, but first there must be trust.  A survivor will have difficulty hearing a caregiver offer positive information if this information feels forced upon the survivor.  I remember knowing that there was self-help information when I was in the intense part of my early recovery, but often felt I was being pushed toward it — and it made me uncomfortable to make the decision to access such help and extra curricular services when I did not feel autonomy over the decision to do so.

This raises the question — Would I have had less suicidal ideation if I felt more autonomy in the decision to reach out for rehabilitative resources?

I don’t know. 

Maybe I did have a person or persons who provided a sort of unobtrusive care, but it was done in a way that I wasn’t even aware of the care, and this care helped to keep me from making the wrong decision — in which case these caregivers did a damn fine job and I am eternally grateful.  Or maybe I didn’t have these people and I was fortunate to navigate the precipice of suicidal ideation on my own.

I cannot  know.

A frustrating answer, but the only one I can honestly give.

What I can say is that living with my new and continuously changing set of skills provided a series of pressures, and at times these pressures squeezed out thoughts of suicide.  How much it was my caregivers — those recognized and those I was never aware of — that inspired me to temper these thoughts, and how much it was my personal tenacity that kept me alive is unknown.  It’s a damnable unknown, but one I’m thankful for and one I can Live with.

Returning to the role of a caregiver in curbing suicidal ideation, the primary job is both the simplest and the most difficult.  Be there.  Allow a survivor to cry to you, to complain, to consider all choices — all paths — all results.  Have information at the ready and answer any questions asked of you, but do not insist that you know the “correct” thing to do.  By being there with unobtrusive consistency, a survivor can find comfort in knowing there is support as he or she continues into a new stage of life.

I hope this makes sense.  Please share with friends if you think they might find this entry interesting or helpful.