3 ms·

"No."? Jules' thoughtful comment deserved better than that terse derision. And, the attitude of simplifying all of this to "get professional help asap" is not

by pen2l 12y ago

"No."? Jules' thoughtful comment deserved better than that terse derision. And, the attitude of simplifying all of this to "get professional help asap" is not very productive. For one, not everyone can afford or access that kind of help. Two, pronto professional help can sometimes yield to bad choices very quickly. Blowing it up risks violating a depressed individual's privacy, they might see that as an action of offense. When a friend of mine was suicidal some odd years ago, I didn't just dial the phone for some professionals to get him, I tried to make it clear to him how much I valued his friendship and what it would do to me if he were to go away -- the guy is rocking life these days. Of course that's definitely not to say don't call for help, rather that this sort of thing demands a more considered response.

tptacek 12y ago
I'm sorry that I can't say this any more clearly: suicidal depression, or intrusive and/or detailed suicidal planning or impulse, is a life-threatening medical emergency. People experiencing it require medical assistance. Please do not attempt to judge for yourself whether or how much assistance is needed. The national suicide hotline in the US is: 1 (800) 273-8255 Given no other modes of helping someone that will result in them obtaining medical help, and assuming that suicidal thoughts have reached a point where they are intrusive and there is evidence of planning or intent, a 911 call is not unreasonable (you can also drive someone to the hospital).
- throwaway459847 12y ago
  My opinion is that your attitude about this is too categorical. I have been in a position where I called a friend because I was frighteningly close to actually doing it. This is after many years of very aggressively pursuing professional mental help in therapy / outpatient settings (which all my close friends are aware of). If my friend had called 911 after I asked them not to, I would have considered it a betrayal. It would have set in motion a set of events that would cause extreme distress for me, and (I am fairly certain) not provided any greater relief than the years of medications and talk therapy I was already pursuing. And it would have breached the trust I feel in one of my closest friends in a way that I'm not sure could have been recovered. I believe this would have put me on a path towards having distance from my friends, and being more imperiled overall. If I couldn't trust my friend not to call 911, I never would have called them. Unless that national suicide hotline above promises absolute confidentiality and not involving authorities, I guarantee I will never call it. Everyone is different and I'm not giving any advice here. I'm just glad my friend didn't take the hard-line stance on this that you do.
  - tptacek 12y ago
    This too is an issue that medical advice to friends and family regarding suicide covers explicitly: to wit: do not commit yourself to confidences regarding suicidal impulses. You may need to break those confidences to ensure the safety of those you care about, and the commitments may harm your own judgement about your best course of action. There are a variety of things you can do before calling 911; "call an ambulance NOW" is not the message I am trying to send. If you're someone I know well enough to judge the credibility of a plan to kill yourself (which could mean "complete stranger" is the plan is particularly credible), and I become aware of such a plan, I would feel obligated to ensure you saw a doctor, with the word "ensure" chosen carefully. At this point I feel like I'm replying to comments on these threads more out of habit and standard message board compulsions than anything else, and, given that the topic we're discussing is sensitive, I'm going to force myself out of the thread now.
    - throwaway459847 12y ago
      > If you're someone I know well enough to judge the credibility of a plan to kill yourself (which could mean "complete stranger" is the plan is particularly credible), and I become aware of such a plan, I would feel obligated to ensure you saw a doctor, with the word "ensure" chosen carefully. The scenario I am describing to you is one in which I was seeing a doctor, regularly (once a week). I was already getting help. The only assistance I was not getting was inpatient, take-your-rights-away-for-a-while forceable assistance.
  - throwaway158458 12y ago
    I agree. People talk about "professional help" like it's categorically a good thing. Unfortunately, that's not always the case. It is incredibly important to understand that many inpatient facilities are profoundly hostile environments for some patients, despite claims of a "therapeutic milieu" (which is somehow exactly the same for both depressive and manic disorders; sure, of course that's credible /s). Based on my experiences at the only two such facilities in my metro area, I would be very, very, very hesitant to ever admit to suicidal ideation in the future. The idea of going back to such a place is enough to make me consider the risk of "going it alone", even knowing that doing so could be a fatal mistake. Comparisons to imprisonment are not exaggerations: it absolutely did feel like punishment, like I had no rights, like the staff merely treated me as a "problem" rather than as a patient or client. Some of the "professionals" were not worthy of the term, particularly the "clinical social worker" types (some of whom expressed, with complete confidence, deeply weird and absolutist "theories" of mental illness that correspond to no credible theory that I've read about in reputable literature). (punchline: my depression was almost certainly caused by a chronic physiological disorder, one which neither facility screened for; most of the "treatment" I received was probably exacerbating my condition instead of improving it) I guess if I had to make this venting "practical" I would say this: if you ever have a close friend or family member in an inpatient facility, and they tell you that they really, really need to leave because it's a bad place, believe them. No one else will.

by pen2l 12y ago

tptacek 12y ago

I'm sorry that I can't say this any more clearly: suicidal depression, or intrusive and/or detailed suicidal planning or impulse, is a life-threatening medical emergency. People experiencing it require medical assistance. Please do not attempt to judge for yourself whether or how much assistance is needed. The national suicide hotline in the US is: 1 (800) 273-8255 Given no other modes of helping someone that will result in them obtaining medical help, and assuming that suicidal thoughts have reached a point where they are intrusive and there is evidence of planning or intent, a 911 call is not unreasonable (you can also drive someone to the hospital).

throwaway459847 12y ago
My opinion is that your attitude about this is too categorical. I have been in a position where I called a friend because I was frighteningly close to actually doing it. This is after many years of very aggressively pursuing professional mental help in therapy / outpatient settings (which all my close friends are aware of). If my friend had called 911 after I asked them not to, I would have considered it a betrayal. It would have set in motion a set of events that would cause extreme distress for me, and (I am fairly certain) not provided any greater relief than the years of medications and talk therapy I was already pursuing. And it would have breached the trust I feel in one of my closest friends in a way that I'm not sure could have been recovered. I believe this would have put me on a path towards having distance from my friends, and being more imperiled overall. If I couldn't trust my friend not to call 911, I never would have called them. Unless that national suicide hotline above promises absolute confidentiality and not involving authorities, I guarantee I will never call it. Everyone is different and I'm not giving any advice here. I'm just glad my friend didn't take the hard-line stance on this that you do.
- tptacek 12y ago
  This too is an issue that medical advice to friends and family regarding suicide covers explicitly: to wit: do not commit yourself to confidences regarding suicidal impulses. You may need to break those confidences to ensure the safety of those you care about, and the commitments may harm your own judgement about your best course of action. There are a variety of things you can do before calling 911; "call an ambulance NOW" is not the message I am trying to send. If you're someone I know well enough to judge the credibility of a plan to kill yourself (which could mean "complete stranger" is the plan is particularly credible), and I become aware of such a plan, I would feel obligated to ensure you saw a doctor, with the word "ensure" chosen carefully. At this point I feel like I'm replying to comments on these threads more out of habit and standard message board compulsions than anything else, and, given that the topic we're discussing is sensitive, I'm going to force myself out of the thread now.
  - throwaway459847 12y ago
    > If you're someone I know well enough to judge the credibility of a plan to kill yourself (which could mean "complete stranger" is the plan is particularly credible), and I become aware of such a plan, I would feel obligated to ensure you saw a doctor, with the word "ensure" chosen carefully. The scenario I am describing to you is one in which I was seeing a doctor, regularly (once a week). I was already getting help. The only assistance I was not getting was inpatient, take-your-rights-away-for-a-while forceable assistance.
- throwaway158458 12y ago
  I agree. People talk about "professional help" like it's categorically a good thing. Unfortunately, that's not always the case. It is incredibly important to understand that many inpatient facilities are profoundly hostile environments for some patients, despite claims of a "therapeutic milieu" (which is somehow exactly the same for both depressive and manic disorders; sure, of course that's credible /s). Based on my experiences at the only two such facilities in my metro area, I would be very, very, very hesitant to ever admit to suicidal ideation in the future. The idea of going back to such a place is enough to make me consider the risk of "going it alone", even knowing that doing so could be a fatal mistake. Comparisons to imprisonment are not exaggerations: it absolutely did feel like punishment, like I had no rights, like the staff merely treated me as a "problem" rather than as a patient or client. Some of the "professionals" were not worthy of the term, particularly the "clinical social worker" types (some of whom expressed, with complete confidence, deeply weird and absolutist "theories" of mental illness that correspond to no credible theory that I've read about in reputable literature). (punchline: my depression was almost certainly caused by a chronic physiological disorder, one which neither facility screened for; most of the "treatment" I received was probably exacerbating my condition instead of improving it) I guess if I had to make this venting "practical" I would say this: if you ever have a close friend or family member in an inpatient facility, and they tell you that they really, really need to leave because it's a bad place, believe them. No one else will.