Talking saves lives.

An expert explains why suicide must be discussed, which myths are dangerous and what support really helps.

Context

Suicide is among the most common causes of death and yet the topic often remains hidden. Many affected people keep their thoughts to themselves out of shame or fear, whilst relatives are uncertain how to respond or offer support. On World Suicide Prevention Day, psychiatrist and psychotherapist Reinhard Lindner explains which societal myths persist, how suicidality can be recognised and what concrete steps in everyday life can help.

About the person

Prof. Dr. med. Reinhard Lindner is a psychiatrist, neurologist and psychosomatic specialist. He has been treating suicidal people in psychoanalytic psychotherapy for many years. In addition to his work in a psychotherapeutic practice in Hamburg, he is Professor of Social Therapy at the Institute for Social Welfare at the University of Kassel, where he trains social workers and psychologists. Together with Barbara Schneider he heads the National Suicide Prevention Programme NaSPro and coordinates nationwide activities for suicide prevention there.

1. Why is it more important than ever today to speak openly about suicide and suicide prevention ?[14] "Suicide is still taboo. Taboo means: people who think about taking their own life are worried about talking about it – and relatives or friends also have fears about bringing up the topic. Right now, openness is particularly important because there is a tendency to see suicide as an option for freedom. Yet this overlooks the fact: most suicidal people are not concerned with freedom, but rather they are in distress. They are stuck in problems and do not know how to move forward."

"Suicide is still taboo. Taboo means: people who think about taking their own lives are worried about talking about it – and relatives or friends also have fears about bringing up the subject. Right now, openness is particularly important because there is a tendency to see suicide as an option for freedom. But this overlooks the fact: most suicidal people are not seeking freedom, they are suffering. They are caught up in problems and do not know how to move forward."

2. Has society's approach to the topic changed in recent years?

"There are things that have not changed at all – we have had to keep bringing these into society for many years. But there are also changes: an increasing acceptance and a notion of freedom, of freedom of choice. Along the lines of: if someone is suicidal, surely it should be good to be able to leave life. This is also reflected in terms like 'willing to die'. This completely ignores the fact that suicidal people are often torn – ambivalent. That is precisely what we want to draw attention to. Self-determination is certainly a very high good in principle, but in suicidal people the possibility of truly free and responsible decisions is often severely restricted, which is why therapy, counselling and support can help to come to a freer decision about how life can improve."

3. What role does World Suicide Prevention Day play?

"World Suicide Prevention Day is an opportunity to make visible in the public sphere a topic that is being pushed out and taboo. Through joint activities on a specific day, it is much easier to draw attention to suicide prevention and help options than if one does it sporadically throughout the year. Moreover, it also strengthens those who work in suicide prevention: you realise you are not doing this work alone and can advance the topic together."

4. What does the term "suicide" mean – and why is precise and sensitive language so important in this context?

"Suicide means self-killing, that is, self-inflicted death. We speak of suicide because we want to use a word that carries neither devaluation nor heroisation. If you say 'Selbstmord' (literally 'self-murder'), for example, the word murder is in it. Murderers are criminals. A person who commits suicide is not a criminal. And if you say 'Freitod' (literally 'free death'), suddenly the word freedom is in it, even though the freedom of suicidal people is very often severely restricted. That is why we are looking for a word that does not offend or hurt anyone, but also does not propagate suicide as a wonderful solution. 'Suicide' fits the bill."

5. What persistent myths and misconceptions do you encounter in your work around the topic of suicide – and why are they dangerous?

"I very often encounter the myth: whoever talks about it will not do it. From many years of psychotherapy experience, this is simply false. We also know from large empirical studies that people who are suicidal communicate with their environment about it, in one way or another. Many seek help from doctors or within their circle of friends and family. But this communication often fails. And unfortunately it is the case: people who talk about it can still commit suicide. A second myth is: you can do nothing. This denies that suicidality is treatable and that help is possible – therapeutically, socially or quite concretely through better living conditions."

6. How can you tell if someone might be suicidal? Are there clear warning signs?

"There are warning signs that are not one hundred per cent reliable, but which you can keep in mind. An important warning sign is when someone withdraws from an otherwise close relationship, that is, a psychosocial withdrawal. You notice: the other person is seeking distance, is no longer so in contact and connection. A second warning sign is when people talk about it. If someone says: I am not doing well, I am thinking about killing myself, it is important to take that seriously and not downplay it or look away. Often certain situations also play a role, for example losses: the death of an important person, separation, but also the loss of one's own health or independence.

Long-term warning signs can be long-lasting mental disorders, but also recurring relationship problems. For example, if someone constantly ends up on the sidelines or constantly has serious conflicts with others. Anger, quarrelling and aggression can also have another side. Many people find it difficult to talk about their inner life. Then they send out signals that can be misunderstood. Some men appear very aggressive in despair. Keeping in mind that a desperate person might be behind this helps to start a conversation."

7. How can I help if I suspect that a person in my circle is suicidal? Are there concrete do's and don'ts?

"If you have the feeling: something is seriously wrong here. My friend, my partner, my colleague is really not doing well, and I have the feeling they want to kill themselves, then the key thing is to talk to that person. This is difficult because you are afraid of hurting them, saying the wrong thing or not knowing what to do next. But speaking directly, for example: 'I have the feeling you are not doing well. What is wrong?', is the first step towards help.

The next step is: make clear that help is possible. You need to make a conscious effort to say: 'I know there is support available, even if I do not immediately know exactly what it is.'"

8. Should you bring up the topic directly, or could that "put ideas into their head"? [35] "We actually know this quite well: people who are suicidal generally find it pleasant when you speak to them directly, in a friendly and non-judgemental way. It is a good experience because someone is turning towards them, is concerned and is thinking about them. 'Putting ideas into someone's head' would mean that you are reinforcing suicide. You do not do that. You think together: what can the next step towards help be? But there is this myth that you first put ideas into people's heads about killing themselves by talking about it. Empirical studies have found no evidence for this whatsoever."

"We actually know very well: people who are suicidal generally find it pleasant when you address them directly, in a friendly and non-judgmental way. It is a good experience because someone is turning towards them, is concerned and is thinking about them. 'Putting someone up to it' would mean reinforcing suicide. You do not do that. You think together: what can the next step towards help be? But there is this myth that you first get people to kill themselves by talking about it. Empirical studies have found no evidence whatsoever for that."

9. How can you offer support without overwhelming yourself?

"Conversations about suicidality can be very burdensome for those around you. That is why it is all the more important to seek help for yourself and to inform yourself. It is good to know that help is possible and that therapy, counselling and support can actually prevent people from killing themselves. Information and knowledge help to manage difficult conversations better. It is also important to free yourself from the feeling that you must immediately know the absolute solution. Rather the attitude: let us think together about what the next step can be. And: point to professionals. Sometimes you have to search several times before you find the right person. Do not give up at the first disappointment."

There are also contact points for relatives – both for relatives of suicidal people and after a suicide. In Germany there are self-help initiatives, organisations such as AGUS as well as psychotherapy, specialised counselling centres and online services, such as Arbeitskreis Leben, the Telefonseelsorge or online counselling such as U25 and MANO. Such help should be made more widely known."

10. Where can you find help if you are affected yourself or are in a suicidal crisis ?

"There are many different ways to find help. It is good to first talk to people who have an overview of help services. These can be GPs, who often know the psychosocial services in the area. For many, this is easier because you already know each other better. Of course, you can also contact psychiatric institutions directly, such as private practice psychiatrists or the outpatient clinics of psychiatric hospitals. It is also important to think about where you have received help before and with whom you can speak well.

There are also many treatment and support options: counselling, social work, psychotherapy or psychiatric treatment. Or also medical treatment, if it is a matter of treating serious physical illnesses in such a way that you can live better with them."

11. The step to see your GP or have a personal conversation often requires great courage. Are there low-threshold services that those affected can use first – for example, anonymous or uncomplicated contact points – in order to gain initial access to help?

"Yes, I think the very first step is to talk to someone close to you about it. So that, for example, your girlfriend says: come on, get help, let us look together at what is available. The first step is not to keep everything to yourself, but to show yourself. And to someone with whom you have already managed to feel understood."

12. What do you wish for from politics, media and society to make suicide prevention more effective in the long term?

"What must continue to be massively promoted in Germany is low-threshold access to help for suicidality, so that it is easy for people to seek help. This has to do with public relations work, with society, but also with the fact that there are professional help services, because some problems cannot be solved through friendship or family. Low-threshold help must be as free of charge as possible, easily accessible and available across the board.

Especially in rural areas, there are still far too few services. Online help can be very effective. It should not fail because you live in a region where few people live. A central wish would also be a well-known emergency number for suicidal people that quickly connects people to someone who can clarify the next step towards help with them."