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A Friend In Need

Question:

Hi I’m worried about one of my friends. Last year she changed a lot, she seemed sadder and angry often. I was really worried about her so I tried to be there for her as much as possible and get her to tell me what was going on, but she generally doesn’t confide in people. There were a couple times when she just seemed so far gone that I asked her if she was suicidal, she always denied and said that she was fine. Was it wrong to ask her that? Anyway a couple months ago she confessed to me that she was cutting herself. When I asked her about it she said that she would sometimes get so mad at herself whenever she didn’t live up to her expectations that she couldn’t help it. One time she went to far and her parents caught her. Only they didn’t really get her any help they just made her stop with threats. She doesn’t cut anymore that I can tell. But the main reason why I’m writing is because two days ago when we were talking online I asked her if she could tell me this secret that she hinted about a couple months ago. She said that she thought she would if I promised to never tell anyone no matter what and I agreed. She then told me that last year "she came pretty damn close to killing herself like on purpose," she said that shes never told anyone about that before. She said that she doesn’t want to anymore but for all of may/june thats all she would think about, that life was just so bad that plans of doing it just never stopped going through her head. When she told me all this I just didn’t know what to say. I told her how sorry I was and asked why she didn’t tell someone sooner. And she said that she would have rather died than accept someones help. She claims that shes over it now that she doesn’t plan to do it anymore, that she feels better now. But I’m not sure I believe her. I can’t tell anyone because she would just deny everything and people would believe her because shes a good lier and is good at hiding her feelings and if I tried to tell someone she knows things about me that she would reveal to get me in trouble. And shes one of my closest friends and if I betray her she would never speak to me again. I don’t think shes planning anything but I can still tell shes hurting. What can I do to help her?

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Answer:

We’ve got a whole topic center addressing the complex issue of suicide. One of the chapters is specifically addressed to addressing what friends and family members can do when they are confronted by a suicidal loved one . I’ll start by recommending that you read this material.

That suicidal impulses are selfish by nature is probably not news to anyone, but if any one ever doubted this truth they’d only have to look at your present situation for verification. Here you are caring about your friend and now suddenly are the bearer of rather weighty news that she is chronically suicidal. The natural impulse is to want to help, but since she’s sworn you to secrecy and since you are taking that oath seriously, your impulse to help is blocked. You can talk to her about her suicidal feelings, but you can’t easily engage any outside professional help for your friend without her feeling that you’ve betrayed her. The issue is rather serious and lethal, too. This is not a game, but actually the fair chance that someone you care about might literally kill themselves. So, you’re left with weighty worries that you don’t know how to handle or what to do about. I’ve been in a similar situation, and I’ve found myself angry about it. I guess I’m still angry about it. I could be snarky and make sarcastic comment to the effect of "what a good friend she has been to you!", but that would not be quite fair. It is very likely that your friend has a serious mental illness (one or more of them), and her selfish behavior is a reaction to those conditions. If she were to be treated for these issues, it is likely that some of the selfishness (and suicidal impulses) would dissipate.

People who are actively suicidal are often (but not always) clinically depressed. Their condition may be cyclic (as in the case of Bipolar Disorder), or simply depressive (as in the case of Major Depression), but in any case, a mood disorder is probable. Your friend has been cutting herself in addition to being suicidal, or as an expression of the pain she feels. Believe it or not, most cutting is not an expression of a desire to kill one’s self but rather is an expression of another condition known as Borderline Personality Disorder (or BPD). People with borderline personality disorder may also be depressed at the same time; in fact this is rather common. Borderline Personality Disorder is part of a cluster of personality disorders that are collectively thought of as being "dramatic" and "erratic". Thus, the secrecy and the melodrama surrounding your friend’s pain are also a reasonable fit.

Good quality professional help is available for mood disorders like depression, and for borderline personality disorder. Depression symptoms, including suicidality, typically yield to antidepressant medication, to psychotherapy (Cognitive Behavioral Therapy (CBT) or Interpersonal psychotherapy (IPT) are the two forms of therapy to recommend here), or to a combination of these approaches. Borderline personality problems typically are helped by a therapy approach known as Dialectical Behavior Therapy (or DBT) which is now rather widely available (as is CBT for depression). Any family doctor can prescribe antidepressants (although it is typically a better idea to be treated for depression by a psychiatrist). So, help for your friend is widely available today, and all she has to do is ask for it. I recognize that it may be more complicated then that. If she is a minor (e.g., less than 18 years old), she may have to deal with the fact that her parents don’t want to acknowledge her difficulties (or actively contribute to them). And there is the issue of paying for therapy, which isn’t cheap. Even so, if she pushes for therapy, she is likely to get it, I think.

The problem is that she doesn’t want therapy right now, and that puts you in a difficult situation. Professional therapists have it a little easier than you do, because they are ethically and legally bound to report acute suicidal risk to the authorities (usually to the police) so that an intervention can take place and hospitalization can occur if it becomes necessary to do that. A good, competent therapist knows up front that he or she will narc if it becomes necessary and makes it clear to patients that this is what will happen if they talk about being acutely suicidal. Often, this expectation of narcing if the situation warrants it is even written into the informed consent that patients sign when therapy starts.

You are not a therapist, however, but instead, a friend. As a friend, there are a few things you can do to help, I think. You can help educate your friend about the conditions she may actually have (e.g., depression, borderline personality, etc.) and the availability of help for these conditions should she desire it. You can talk with her about why she feels the need to keep her secrets so close to her chest and see if you can’t help break down the shame and (likely) inflated sense of freakiness she may feel which leaves her embarrassed to seek help. There are literally millions of people out there who are suicidal right now and who have either borderline personality or depression; there is no reason for her to feel she is alone in feeling the way she does. You can tell her that you care for her. You can work on her over time to get professional help. If you become aware that she is really on the verge of harming herself, you can drive her to the nearest psychiatric emergency room (which you can look up now so that you know where it is should you need it later) and stay with her until she is admitted.

The final thing you can do is to realize that in the end, you don’t have control over what she does. If your friend wants to die and is determined, she will find a way. You can only do so much, and after that, it is her responsibility to help herself. As the saying goes, "You can lead a horse to water, but you can’t make him drink", and so it is the case with your suicidal, self-mutilating friend. If you are having trouble sleeping at night, you might consider seeking out a few short term counseling sessions yourself, but otherwise, just cut yourself some slack, be the best friend you know how to be, and take care of yourself.

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