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Unsure how to help a suicidal friend

I have a question on behalf of a friend of mine. For context, she is in her early twenties and so am I. She’s been suffering with a range of mental problems for as long as she can remember. The most prominent are depression, cptss and borderline. For as long as I’ve known her (about 8 years now), she’s been suicidal as well.

We have become rather close and I know she trusts me as much as she can allow herself to trust anyone. I try to be there for her whenever she needs me and I do think I’ve been an important factor in her aborting a couple suicide attempts.

However, over the past few years I have gotten to know what lies at the heart of her problems, and I’ve learnt just how much she is hurting every single day. (I know that as someone who is not in her situation I cannot possibly fathom what she is going through, but I mean that I understand it as much as anyone in my situation could.) Furthermore, I know that her therapists say that it will take a very long time before she will start to feel good again, if it happens at all.
She is a great person and I want her to live. I want her to be happy and safe and succesfull in life.
But I’m doubting whether I’m doing the right thing when I convince her to hold on. I’m not sure anymore whether I’m doing it for her or for me.

For her therapy she has been given a set of rules to abide that should make the healing process more effective (things like no alcohol, take your meds and don’t hoard them, no self-harm) and she’s not been following these rules lately. Today her therapists told her (very explicitly, which I found both weird and a bit scary) that she had to make a choice: Either follow the rules and live, or die.

Like I said, I want her to be okay and so I’m very tempted to steer her towards following the rules and living, but I don’t know if that would be the right thing for her. Can I justify convincing her to hold on? And if so, does anyone have suggestions for things that I can do that may help her?

Thanks

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Hey @Walther,

Thank you so much for being here. AND for being such a supportive friend. It sounds like there’s a lot of trust between you two, which is definitely precious and needed while battling with suicidal ideation and struggles such as traumas and depression.

Like I said, I want her to be okay and so I’m very tempted to steer her towards following the rules and living, but I don’t know if that would be the right thing for her. Can I justify convincing her to hold on? And if so, does anyone have suggestions for things that I can do that may help her?

First off, I think you’re already doing a lot by listening to her, discussing about those things and caring about her. The things she’s struggling with can be very isolating. From a personal perspective, I can tell that when I’m at my worst and feel very hopeless, I don’t really need advices or practical tips. I just need someone I trust to hear what I have to say, to acknowledge it so I could feel less alone with the pain I’m feeling. It sounds that, as a trusted friend, you’ve been doing this for a long time, and that’s truly awesome.

With that being said, I also can’t help but finding quite harsh the methods that her therapist is using. I’m not a mental health professional, and I can “understand” the point of making someone face their responsability and the choices they are facing, but this approach can also create a lot of guilt that’s not needed and make someone feel worse. In my opinion, this kind of approach need a lot of trust, and a professional is not always that person (even though I don’t know the circumstances around your friend’s therapy - if it was their choice at first, etc.). If i’m fully honest about it, I even find her therapists words quite judgmental - which shouldn’t happen in a therapist office. They may have a psychological degree or whatever, but they’re not Nostradamus. They don’t know how long it’s going to take for your friend to be better (“or if it happens at all”: did they say that? - if yes I wonder why she’s even a therapist, and can only recommend you to encourage your friend to see someone else). No one recovers the same way, regardless of what this person learned in some books. Same with the “rules”. On the paper, it sounds good (?), but it depends on how it’s been approached, and who decided of it. If it’s only to point out what she can’t stop yet - things that objectively take TIME - and say things that are obvious but also without any subtelty… well, maybe it might be good to see another therapist. [rant:off, sorry! Can’t help feeling a bit concerned when I read this, and it hits home in some way]

If I was in your situation, and again it’s a personal opinion, I would actually ask my friend how they’re feeling about this therapy, and about what has been said to her. I would ask if it helps. If it does I’d keep encouraging her as I did before, and if doesn’t I’d encourage and support her to find another therapist.

Maybe you can also ask her: how can I help/encourage you? It might sound very basic, but really, we can easily forget about those simple yet important questions. It gives power to your friend, a possibility to reflect on herself, to decide, to make you part of her own journey and collaborate towards the same goal. Depression, cptsd, and more generally mental health struggles due to difficult events tend to make someone feel like they lost their voice, or like it’s not heard. Yet it sounds like you already have this trust and safety that is needed for this kind of interaction. Again, it’s a precious thing that you have together, and as much as I hear your desire to do more or maybe differently, I really want to acknowledge the importance of the trust between you too, hoping that you don’t underestimate it. Because you’ve been actively contributing on building it with your friend.

I’m not sure anymore whether I’m doing it for her or for me.

There’s truly nothing wrong with doing both at the same time. You want the best for her because you care about her. But you also want her to keep being alive and part of your life… because you care about her. It makes sense, really. It’s just the beauty of any loving relationship. Of true love and care. It’s both about giving and receiving.

Through all of this, I hope you take care of yourself as well. Those kind of discussions can be heavy sometimes. You’re a good friend, Walther. You really are. :hrtlegolove:

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I ask her if there’s something I can do for her quite often, but usually she doesn’t know of anything that might help. But maybe I’ll try to sit down with her and really think about something that might help.

As for the therapist, she’s actually really happy to have found this therapist, because they had some experiences similar to hers and she’s actually dared to open up to this therapist more than she does to me. The therapist is leaving and she’s really bummed about it. But I agree that the therapists methods are somewhere between weird and dubious sometimes. I just hope they know what they’re doing and especially that it won’t be a problem if a different therapist takes over.

Thanks a lot for your message, I hope you’re doing well.

First off, welcome to the community!

Second off, like @Micro said, those therapists are playing a dangerous game by giving someone unstable an ultimatum like that. It might be different if her life was in danger because she wasn’t following her diabetes care plan, but when they say “comply with psychiatric/psychological regimen or die,” they’re referring to her directly taking her life, not her organ systems shutting down. At the very least they’re unprofessional, and that might be wandering into medical malpractice territory.

Third, you are doing an amazing job being there for her. That’s a heavy burden to shoulder. You are doing everything just right, being there for her and calmly recommending that she follow her doctor’s orders. You can’t make her comply, but you can encourage her and celebrate little victories with her.

This is an ethically tricky question. On the one hand, keeping her alive “for you” can be seen as selfish and codependent. On the other hand, “letting her go” by suicide isn’t the right thing to do. We in this community like to say that mental illness is similar to physical illness, but death by suicide isn’t the same thing as succumbing to a heart attack. Depression, PTSD, and borderline may be chronic, but they aren’t inherently terminal. However, you can’t make her want to live–all you can do is be there for her and be a beacon of light, and continue to talk her down when she wants to make attempts. Someone with more knowledge may want to weigh in here, but you might try writing her an open letter talking about all the good things and positive influences she brings to the world. Don’t mention that those would all be gone if she took her life, keep it positive and uplifting. It may not cure her, but it will brighten her life for a bit.

Lastly, make sure you’re taking care of yourself too. You’re taking on some serious emotional weight, and you have your own feelings on the matter too. You’ve been really strong so far, just make sure you don’t burn out, or you won’t be able to help either her or yourself.

Hold strong and keep us posted friend.

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