It happens to a lot of us.  You tell someone you’ll have something done by a certain day, but you’re not able to do it.  Your friend e-mails to remind you, and although you mean to get back to them, you think it’s better to respond after you’ve finished what they asked for, which in your mind will surely be tomorrow.  But tomorrow comes, and the next day, and you just don’t have the time to get to it. And then comes the texts. As you read them you get irritated and more anxious. You wish you never agreed to do the favor in the first place, and resent your friend for harassing you.

Sound familiar?  This is the avoidance trap, and while people rely on it as a coping strategy, it really isn’t coping at all.  In fact, avoidance usually makes things worse and takes a toll on relationships. While it may provide relief in the short term, it’s really just  an illusion and a way of denying what’s really going on – feelings of embarrassment or fears of negative judgments, or even a fear of conflict. And these feelings tend to snowball quickly.  The more you avoid something, the bigger the feelings get around it, both for you not wanting to talk to your friend, and your friend being hurt or annoyed at you for ignoring them. And when avoiding becomes a habit, it tends to erode your self esteem.  You feel embarrassed and often get trapped in all the little lies that often accompany avoidance, such as making excuses, or promises you know you can’t keep. Research shows that avoidance actually magnifies stress as well as increases anxiety.

So when you feel the urge to avoid a phone call or a text, a request or a conversation, take this as a sign.  Ask yourself what you are really avoiding. Is it the fear that you made someone angry or disappointed? Is the project too challenging and you are afraid to ask for help or more time?  If you can identify the source of what is actually troubling you, it helps to sort out how

to approach a more active solution. Once you do, then the next step is to communicate. Often the reaction you get will be far better than you fear. People are usually much more understanding than your own critical voice inside your head and can help be a part of problem solving a solution. And besides, people prefer to know the truth of what is happening, even if it is bad news, than to be ignored!  Quite often, once you share what is going on, you both feel a sense of relief. So the next time you notice yourself hiding out, take it as a sign you need to reach out.

Some changes are tragically permanent.  This past Monday I was asked by my clinic staff to see a patient in crisis.  She had found her teenager, the morning after her high school graduation party, non-responsive in her bed.  She had died by suicide, a lethal dose of pills and alcohol. It was truly one of the most difficult sessions of my life as I tried to offer something to this mother whose life had just instantly come crashing down.  “Why,” she kept asking, or “If only I had…” she kept repeating, hoping to find some way to make sense of her horrific tragedy.  And later in the week, the entire nation is asking similar questions as we read quotes of family and friends “shocked” to learn of the deaths by suicide of Kate Spade and Anthony Bourdain. While I certainly don’t have clear answers about why people kill themselves, I talk with people almost every day at work who think about it, either as a vague thought or a well informed plan.  So I thought I would give myself a little time to reflect on this and share some of my thoughts with you.

For most people, no one thing causes them to want to die.  It’s usually an accumulation of a number of factors that wear down their coping and resiliency.  Suicide is seen as a solution, a way of having control over what seems like an impossible situation. People with depression, especially, have very little hope and see the world as it is, and as it always will be, in a negative light.  They usually feel they’ve been a burden to the people that care about them, and that rather than understanding the pain they will cause loved ones, they truly believe that by ending their lives they are doing them a favor. For some, life has been on the edge for a while, putting them at risk for an impulsive act when something further goes wrong, like a drug or alcohol relapse, or the loss of a job or relationship. They may have what feels like unresolveable anger at themselves or the world. Most people who die by suicide don’t tell people about their pain. They are afraid to burden people, or the stigma for reaching out and asking for help is insurmountable in their opinion.  They are afraid of being met with judgment or being seen as fragile or crazy.  This leads to untreated conditions and a growing sense of isolation and despair.

As many of the articles printed this week point out, the rates of suicide are rising in our country.  Every state in our nation saw a rise in suicide rates, according to the CDC, from 1999 to 2016, with as many as 25 states as much as 30%.  In 2016, 45,000 Americans died by suicide, making it the 10th leading cause of death.

Just as there is no one cause of a person’s decision to die by suicide, there is no one answer to how to prevent or address the problem.  Research clearly shows a few possible steps, such as limiting gun access (countries that have done so have seen decreases in suicide rates) and increasing support for housing and medical treatment for pain and substance abuse.  But for each of us, personally, we need to make sure we are reaching out to one another. If we are having thoughts of harming ourselves, we need to let someone know and get help. If we know someone else is hurting, we need to let them know they are important to us and that we will support them in getting treatment and that they are not alone.  When someone is ill, financially stressed, or going through some other difficult time, we can challenge their beliefs about being a burden. While we are not responsible for other people’s choices regarding suicide, and we cannot solve their problems, we can offer perspective and comfort simply by letting them know how important they are to us, and be supportive in the process of getting treatment.  

In my line of work we address suicidal ideation with therapy that addresses risk factors, such as support for losses, financial stress, isolation, and substance abuse, and possible medication for depression.  In addition, we seek to increase what we call the protective factors, such as feeling connected to other people or interests, a sense of purpose, and plans for the future. Most often, the reasons for wanting to die can be ameliorated when a person can talk about what they are feeling and get help in finding potential solutions to what seems like insurmountable problems.  

Talking about suicide does not cause suicide, in fact, research shows the opposite.  When people at risk are able to share their thoughts, the thoughts become less powerful. If someone says something or posts something that makes you concerned, it is best to reach out and ask them directly about it.  I have never heard anyone report that they regretted asking or being asked about suicide. Quite the opposite. Both parties feel a sense of relief. And if you know someone who suffers from the pain of such a personal loss by suicide, it also helps them to reach out.  Even if you don’t know what to say, the simple act of acknowledgment is important in reducing stigma and isolation. While their pain may be overwhelming to both of you, if given the time and support, healing can occur. I can attest from personal experience that while the pain never goes away, you can learn to live with it.  While I cannot bring back the daughter of my patient, as much as I would like to, I can be a source of support and walk beside in her unexpected journey through darkness.

Here are a few resources to make you feel more prepared when reaching out.

In the US:

Crisis Text Line: Text START to 741741 from anywhere in the USA, at any time, about any type of crisis

The National Suicide Prevention Lifeline: 1-800-273-8255

The Trevor Project: 1-866-488-7386

Outside the US:The International Association for Suicide Prevention lists a number of suicide hotlines by country.

For survivors of suicide loss:  survivingsuicideloss@afsp.org 

The Compassionate Friends at 877-969-0010.