Suicide and Pastoral Care
Last week I mentioned our discussion of suicidality in my introduction to pastoral care course. A curious commenter, Joe Stewart to be exact, asked for some specifics. Borrowing heavily from a class handout, here they are:
Overall Notes and Helps:
- Main take away: If you suspect that someone is thinking of suicide, ASK. Don’t be afraid that your question will give the person the idea. Usually they are relieved to be asked.
- Don’t panic.
- Don’t promise anything that you do not want or cannot deliver.
- Prevent isolation.
- Follow-up is important. Call them back the next day, continue to helpthem workout some of the problems presented.
- Listen, listen, listen.
Clues to Suicidal Intention:
Verbal: “I just wanted to say goodbye.” “I’ve had it, I can’t stand it any more.” “I won’t be around much longer for you…”
Behavioral: The clearest behavioral clue is a “practice run” – a prior attempt of whatever seriousness. Putting affairs in order. Giving away prized possessions.
Situational: Just learned about a terminal diagnosis. Recent traumatic loss. Extreme pressure.
Syndromatic: Depressed. Disoriented. Defiant. Dependent-dissatisfied.
Role Play we did in class:
We then broke up into small groups and carried out a role play using a script about like this…
Helpee: Express pain and despair
Pastor: Mirror and probe
It sounds like you’re feeing very ___ lately
Does it every get so bad that you feel like hurting yourself?
Helpee: Acknowledge such feelings
Pastor: Validate and explore risk
I’m glad you feel you can share that with me.
Can you tell me more about those feelings/thoughts….Do you have a particular way in mind that you would do it?
P: Have you felt this way before?
P: How close are you, do you think, to carrying out a plan? Do you have the pills/gun/knife, etc?
P: Concern + we need to get support + contract
I’m very concerned about the pain you are in, and that you have a pretty firm idea about how you might end your life. It sounds like we need to get some support for you. I would like us to work together to find you the help that you need. I would really like you to make a promise/commitment to me that you won’t act on your plan to hurt yourself until we can get you connected with a good counselor today. Are you willing to do that?
P: I would like you to put that in writing for me. Here, would you write a promise on paper that you will not hurt yourself, and sign it, so we know this is a solemn promise?
So, Joe, that was our main takeaway and practice. Your original question wondered to what extend our response might be theological or biblical. Well, honestly, we discussed that very little. Basically, going down that road might be very dangerous and it sort of gets away from the issue at hand. That’s not to say there aren’t biblical/theological ideas that help with suicide considerers, but as lowly pastors with very basic pastoral care training, there’s definitely people more qualified to delve into such questions. We’re about connecting, and seeing the signals, and having that initial conversation with the contract.
Thoughts?
If you or someone you know is considering suicide, seek help now: SAVE or the National Suicide Prevention Hotline.
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Tackling it from a counseling standpoint is good, and these are all very useful and constructive suggestions. We’re just frontline counselors, and should be sure to work with/refer to professional psychologists and psychiatrists when folks surface those issues. We’re kinda just EMTs on that front..stabilizing and reassuring those in need and getting them more sustained care. This is particularly true if individuals are suffering from clinical depression or other forms of mental illness.
The theological approach is more…delicate. As pastors, I’d contend that our primary task is putting things into a theological and spiritual framework. Going down that road is only dangerous if we use it as an excuse to preclude other professional care. Understanding the spiritual dynamics of providing support is an essential component of a wholistic approach to suicide prevention. Personally, I tend to approach the issue this way:
http://weblog.xanga.com/Beloved_Spear/682643266/christianity-and-suicide.html
Very thought provoking!
Thanks, David. And for the link. Good stuff (well, difficult stuff too).
Adam,
I am beyond flattered to have my question featured in its own post! Additionally, I am pleased that such a topic is being addressed in seminary, as the issue of pastoral counseling and severe mental illness are certainly relevant. A few thoughts:
As pastors, you have a uniquely important relationship with those seeking your assistance. Your spiritual-ness creates a special level of trust and connection for which your parishioners will come to seek counsel. There are those out there who would much rather talk with their pastor versus taking the time (and money) to set up an appointment with a psychologist. Chances are, you are much better at counseling than you think you are; just because you don’t have PhD or MFT behind your name does not mean your ill suited to handle such a thing. In fact, I would much rather send a person in deep emotional need to you than some of the aspiring therapists I’ve come across in my graduate studies thus far. In the end, you are a well-rounded human being who exudes a warm, welcoming, and empathic demeanor. This is your (and a therapists) greatest tool, not some high fallutin’ cognitive behavioral technique.
Your specific points about how to approach the issue are right on, especially your point on not being afraid to talk about it. Persons with suicidal intent are often feeling so “emotionally isolated”, lonely, and in despair that their feelings move in a vicious downward spiral. To have someone genuinely ask about how they are feeling, and to show interest and care through active listening/gentle inquiry of feelings is an amazing thing. This allows them greater awareness of their own feelings, as well as builds a bridge to another person who may be able to help them.
You are right in that suicidality is an emergency issue, which makes it difficult to bring up the issues of spirituality with which it is affiliated. In the case that a member of your church approached you with strong suicidal intent, you would definitely want to do some good troubleshooting/assessing/contracting in hopes of getting them the proper help as soon as possible.
More commonly, you will also come across members of the church who have lingering feelings of hopelessness, vague sentiments about ending their life, and may not be immediately suicidal. With these folks, that ongoing spiritual dialogue and its relevance to their feelings are of the utmost importance. Many notable psychotherapist see spiritual growth as part and parcel to positive mental health. In the Alcoholics Anonymous community, for example, there is a strong element of spirituality. During my work at the psychiatric facility, I came across many severely mentally ill patients who leaned heavily on their religion to guide them through their dark times. Despite all the turmoil that life throws at them, many find it deeply comforting to know that a force greater than those terrestrial factors are guiding them and that it will all be ok.
Anyway, just a few thoughts out there. I greatly appreciate your addressing this issue Mr. Copeland, and wish you the best. Until next time,
-Joe
I had moments in my life when I thought my life really sucked. Thanks to my strong will I was able to cope with living. Laughing helped me and I created an oath to to live to at least 100 years old. Sad thing is I’m always reminded of my past.
Suicide Prevention in Your Life