Ask A Therapist: Reflecting on Suicide and Missed Opportunities

Counselors Roy Fisher and Liz Covey answer questions for South Seattle Emerald's "Ask A Therapist." Have a question about a relationship? Wondering about the struggles of being a parent? Others likely have the same questions and Covey and Fisher bring years of professional experience to provide their insights.

In this article, Covey answers a reader's question about suicide, and whether they missed an opportunity to help.

If you have a question, please click here and let us know.* We will select two questions each month to answer. The form requires no email address or identification and is completely anonymous. If you are in crisis or in immediate need of care, please contact Crisis Connections at 1-866-427-4747.

Someone I know (knew) casually died by suicide recently. I can't help wondering if I missed an opportunity to extend a helping hand. Does it make sense for me to feel any responsibility?

Thank you, Reader, for bringing the topic of suicide into the light. Therapists intimately know how common and frequent suicidality is, and now you are feeling it too. So let's explore it a little further.

When therapists sit with patients who are experiencing pain due to the loss of a loved one, we call that "grief." Grief is as varied as people are, owing most to the complexities of our intimate relationships, but nonetheless, it is rooted in love and meaning-making. This gets flipped, however, in the case of suicide. In light of the grand finality of death (to cancer, say, or a tragic car accident), one has awe. As life ends, loved ones mourn at the precipice of the great unknown, peering over the lip of the here-and-now into the eternal. But when that death is at the will of the loved one, the survivors tend to turn around 180 degrees, and instead of peering into the eternal, they comb through the details of the loved one's life for signs that were missed of "cries for help" or ways that they could have intervened and prevented this from happening altogether.

This is the process called "survivor's guilt" and suicide practically precludes that this will happen to the loved ones left behind. It is often a brutal and hypervigilant self-study, and it mostly has the effect of delaying the ability to naturally grieve, which is akin to a digestive post-death process: natural (if messy), healthy and necessary. To allay grief is to be experiencing a type of traumatic response.

We must acknowledge that nearly all people who suicide (we don't recommend saying "commit" anymore, as that word is linked with a criminal act, and suicide is not that) have a severe and prolonged mental illness. The vast majority of suicides — about 90 percent' are due to people suffering from major mental health issues, and who come to a point where they need to end the pain, and in a desperate moment, one way to do that is to end their life. A small number of suicides are the result of having the means to do it at a critical moment of suffering. With these deaths, they are more like an accident, such as a teen with the heartbreak of a first breakup, and with ready access to a loaded gun. But these are much more rare.

Alas, we all know that empathetic support can help lessen the grip of the more serious symptoms of mental health, but any professional will tell you that that alone often isn't enough for serious sufferers to reroute their advanced networks of pain. Such sufferers often need a much more concentrated course of treatment through rest, sustained and adequate care, therapy, sometimes medications, and more, depending on their needs and unique circumstances. Sometimes loved ones are instrumental in getting that person help. But it can't be expected that we will always know how and when to act on the behalf of everyone in our lives. There are bills to pay, and we have our own problems as well. It's just not possible to be there for everyone, all of the time. Especially since so much mental health suffering happens in silence, away from friends and in the dark night of the soul, so to speak.

Therefore, my answer to you, Reader, is that you are not responsible. The factors that caused your friend to end their life are probably many, and likely are due to mental health needs that were long-unaddressed, under-treated or in any case, unbearable. I wish we would re-term suicide "death by mental illness" and have loving care such as we have for illnesses of other common and terminal diseases. It is death, by one illness or another, that we sit with. Please take solace in knowing that you can still be a witness that honors their life, no matter what caused their death.

There is more to say about suicide prevention. But this piece is designed simply to address the reader's question about guilt. What can you do when you or someone you know is suicidal? Empathize, and help them get good help in the form of supports in their life, as well as with mental health professionals.

Here are some resources: The National Suicide Prevention Hotline 800-273-8255; the King County Crisis Line 866-427-4747; and The texting Suicide Help Line- text "START" to 741741

— Liz Covey

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Liz Covey, LMHC, LMT, is a counselor and parent coach with a private practice in South Seattle working in the specialty area of attachment, adoption, and trauma, with children, families and individual adults. She is also a trainer, presenter, and writer on topics related to the changing face of mental healthcare, disseminating ideas and practices aimed at improving mainline therapeutics so that they are more inclusive, holistic, and effective. Liz is a Rainier Beach resident, and the extremely proud parent of two incredible school-aged kids.

Roy Fisher has a BA in psychology from the University of California, Berkeley, and a MA from Pacific Lutheran in Marriage and Family Therapy. With over 10 years of experience in various roles as a clinician, consultant, supervisor, and teacher, Roy has seen the positive impact of engaging others in thoughtful dialogue.

*South Seattle Emerald's Ask A Therapist advice comes from professionals and are provided for informational purposes only and do not constitute medical advice and are not a substitute for professional mental health care. By submitting your question, you are agreeing to let South Seattle Emerald use it, in part or in full, and it may be edited for length and/or clarity.

📸 Featured Image: "Walking The Ledge Part IV" by StarMama is licensed under CC BY 2.0. To view a copy of this license, visit: https://creativecommons.org/licenses/by/2.0.