When a Rock Meets a Hard Place
By Marla W. Friedman, PhD, Clinical/First Responder Psychologist
*This is an article from the Winter 2022/2023 issue of Combat Stress
Working as a Clinical/First Responder Psychologist, the concept of suicide is sadly a familiar one. This is a subject studied at length by my professional peers and myself. We know that this single act can leave loved ones with questions that will remain unanswered. Suffering and destruction will blast out like a bomb after the death notification is made. My focus though will be to try to answer the question most often asked by patients seeking treatment following the completion of a suicide by their loved one. How could they take their own life knowing it would destroy me?
Over the years, I have developed a metaphor to try to explain and to give part of an answer to this question, though uncertainty always remains.
Ultimately, the person’s pain, physical or psychological, becomes intolerable, unbearable and their mind begins to tell them, “I wish I were dead” or “I wish I would never wake up.” Some are upset and scared by the thought. Other’s feel as if it is coming from someone other than themselves. It can be intermittent or steady and continuous, over years, days, hours or urgently over minutes. This is suicidal desire and ideation. This is what a skilled clinician will ask you about. If this continues, the person will rehearse different plans in their mind as to how they would accomplish it. Most people have thought about suicide at some point in their lives, whether serious or just wondering about it after hearing about someone else taking their life. Of course, most people do not follow through on these ideas. I suspect some people are plagued by the thoughts or see it as an emergency exit if they ever need it. This is never discussed at the dinner table.
First responders including Veterans, firefighters, police officers, dispatchers, telecommunicators, emergency room doctors, nurses, and many more we don’t immediately identify as first responders, find themselves fantasizing for a way out of their jobs, but feel trapped to stay for so many reasons. These high stress jobs can result in addictions, problems with interpersonal relationships, trauma from what they are exposed to on a regular basis, sleep disorders, and more.
So, how do we jump to a place where a person who is so overwhelmed with their lives, that options to continue on no longer seem appealing?
To want the total loss of consciousness, the desire to not exist, to extinguish all ideas and feelings pushes the plan into action. How do the movies inside the mind of our loved ones and the natural instinct to survive become overridden, allowing a person to remove themselves from life? There is no easy answer to that, so we attempt to make sense of it from those who have attempted and did not complete the act. We question and examine the facts we have and listen to the person who has stepped back from this permanent choice. The person may explain, if able, how they arrived at that point in their lives, but it’s still a massively large happening for the person who chooses to stay with us on earth to describe the psychological place they have been enveloped by. Detailing the words, sensations, pressures, and imaginings do not come easily. Even to them.
Here is a metaphor that I constructed to understand the process myself. Imagine that a person is a capsule attached to a rocket. When the rocket launches and leaves our planet’s atmosphere, it is travelling at an incredibly fast rate of speed. It is putting distance between the first responder and the reality on the ground. As the sorrow deepens, the confidence that things can change grows faint. Options are weighed as they move from desire and ideation into a plan. This is dangerous, as we already know that first responders have access to guns, pills, and other means of destruction they have previously ruminated about. As the rocket continues its assent, the concerns, worries and the voices of those they hold dear began to lighten and fade.
Eventually, the rocket releases the capsule, the person is in a new atmosphere where they exist without others. There is still time to return to earth, like an astronaut who completes their assigned mission, or they can choose to push forward into unknown territory. If they choose not to return, they find themselves alone and in an atmosphere where only they exist. The voices of those they love can no longer be heard. They don’t dismiss the sounds and emotions of those who care about them. They are just too far removed to hear or feel any of it. In a sense, they now exist on a different plane where no one else draws breath. They are singular in the universe and their life which existed just a short time ago is a vague memory if that. They survive only as that capsule, not the person who was admired, and loved by others and they will eventually disappear. If they do not decide to return, to separate themselves psychologically from the capsule, then they are lost to us. Those who reclaim themselves by turning back, know that life will be very hard for awhile until they seek and complete treatment. It is possible to turn back. I did. There is nothing easy about it. Either decision puts you in hell for a while, at the very least. The act of suicide is very rarely undertaken to hurt another person, but only just to stop crippling pain that interferes with every sphere of life. It’s relentless and overwhelming. Hopefully those in agony will choose life. We are researching and learning as much as we can as quickly as possible to stem this horrific tide.
The next section is not about eliciting guilt in survivors but explaining that the destruction of that capsule is similar to the anguish and destruction experienced by those left with confusion, regret, anger, heartbreak, and the alteration of who they were before and who they are now. They are never the persons they were before the suicide. Looking at common responses to the suicide of someone close to you may include some of the following:
- Insisting there is a misidentification. “That is not my husband,” though they are looking at his body. Passively or angrily, “You’ve made a mistake. Check again.”
- “She never wore those clothes, those aren’t hers, that’s not her.” Some see their family members, identify them, and walk out showing no emotion.
- Total denial is not uncommon, because the truth is unbearable. “No, she’s at school right now, I’ll call her,” “Liar!” “I just got a text from him from Afghanistan. It’s not possible,” It’s someone else’s son. I would know if he was gone.”
- In addition to denial, there is complete collapse of the psyche. The person is inconsolable or almost comatose in the psychological sense. They won’t eat or sleep and consider suicide themselves to be near their loved ones. Begging for it not to be true, “Please, please I’ll do anything,” “Bring her back!!” “Trade me, I’ll take his place.”
Everyone expresses grief differently…. enraged, silent, avoidant, sleeping as much as possible. This is a physical pain that is unrelenting. This is psychological destruction. Some have relief that their family member is finally out of pain and/or with GOD…. or they fear that they aren’t. This is a life altering experience and no one is the same afterwards. Their worlds are split between before and after the event.
Unlike other deaths, suicide comes with a stigma. We have been putting books, trainings, and workshops together for years to try to break this stigma.
“What a coward,” “I always knew this would happen,” “No one cares. She was nothing but trouble to us,” “He would never do that, “He was murdered.”
The responses are numerous and touch all corners of human emotion. It’s an equation where both sides suffer terribly.
I will leave you, the readers, with both a list of common risk factors and reasons why we think people take their own lives. Then I’ll add some things I have learned in more intimate discussions that may be helpful.
Most are familiar with the variables below, but some are unaware of what we have learned. I will list some risk factors and reasons why people take their own lives. This is not a complete list, as we don’t know all the variables. Some are fluid.
Suicide Risks and Reasons
- Impaired mental health, depression, anxiety, psychosis
- Interpersonal issues, shattered relationships
- Previous attempts
- Severe trauma or cumulative trauma without cessation of symptoms
- Substance abuse and other addictions and their consequences
- Ongoing inability to have nutritive sleep, in combination with other factors
- Medical issues
- Firearm access
- Legal problems
- Traumatic brain injury
- Family history of suicide
- Revenge, to hurt or punish another
- Financial problem
- Being blackmailed
There are many more reasons for suicide that can be teased out in psychotherapy. We are told that social contact is a key factor in stabilizing mental health and reducing suicide. I have seen that to be true in many cases. However, being a first responder can also bring about a sense and feelings that you are an outlier. You have difficulty reintegrating into society and even your prior personal relationships seem out of reach. A wall separates you from true intimacy. You become unable to trust others. Hyper-vigilance and suspiciousness interfere with relationships. Feeling that you are empty or dead inside stops the natural attachment process from being realized. A wish to isolate yourself, to find ways to fill the emptiness or to dull the pain is an intrusion. Reports of profound and debilitating loneliness exist and further push the person out of normal life activities. There is disdain for others who are described as idiots, assholes, and worthless creatures. Feeling both hopelessness and helplessness in trying to regulate your emotions puts another brick in the wall. Guilt, remorse, fears of being found out as a coward and loss of any confidence previously held are all things that do not evaporate over time. The list above are all treatable conditions now and continued research will continue to find ways to conquer and treat these conditions more quickly and effectively. The research is promising, and we are hopeful for additional highly trained clinicians, more treatment protocols, and more effective medications. We can greatly improve our current management of mental health issues in first responders. This is just the beginning.
- Clark, D.A., & Beck, A. T. (2012). The Anxiety and worry workbook: The cognitive behavioral solution. New York: Guilford Press. ISBN 978-1-6062-918-6
- Foa E. B., Hembree, et al. Prolonged Exposure Therapy for PTSD, First Edition, (2002) Oxford University Press, Oxford England, UK
- Johnson O., Papazoglou K., Violanti J., Pascarella J. (Eds). (2022). Practical Considerations for Preventing Police Suicide. Springer, Cham. https://doi.org/10.1007/978-3-030-83974-1
- Rosenzweig L. Shuman A., Too Good to be True: Accelerated Resolution Therapy Archway Publishing, 2021 Bloomington, IN
- Shapiro, F. Eye Movement Desensitization and Reprocessing-EMDR Therapy Third Edition, The Guilford Press, 2017 New York, NY.