How about: do you need help?

I don’t know how many times I have read the sentence: “Be direct. Talk openly and matter-of-factly about suicide.” I have always thought that it was ambivalent to the point of uselessness. What does it mean to be direct? In this blogpost I want to explore it.

Normally, I read the sentence on websites with advice to talk to people (I have written a number of posts suggesting that such advice is misguided). This time, however, I have read it in a tweet:

and I thought that the phrase has become so formulaic that it really can’t have any clear reference. When I started investigating, I remembered a tweet by Rose McCabe:

who reported a conference paper in which the speaker seemed to claim that direct talking has protective value. I followed up and was directed to this report (link here). There is little here on the issue, apart from research in which men declare that one needs to be direct, as, for example, in:

You need to be very direct with me, tell me you know what’s going on.

And so, I was disappointed to see implications that direct talk can be seen as protective. In fact, such research offers no evidence of protectiveness of ‘direct talk’. The only evidence it does provide is that (some) people say they would like others to be direct with them in the context of suicidality. Nothing more. Declarations of impact are not evidence of impact.

I briefly looked for some other evidence supporting the claim about directness and, alas, I could not find it (I do stress I didn’t take the time, I assumed that if it was there, I’d find it immediately). However, I did find statements such as:

The evidence proves that open, direct talk about suicide, when helping someone who may be considering suicide can help that person understand they have other options. (…) Evidence shows that open and direct conversation about suicide, is key to suicide prevention. (Here is the link to the full document.)

I must admit that it is very irritating to read references to ‘the evidence’, with no evidence that the evidence exists. In other words, there is no link, no reference, just a claim that ‘direct talk’ is key to prevention. Is it? After looking for evidence that ‘caring conversations save lives’ (the link to my post is here), I actually don’t believe such references at all. Put up or shut up, I am now inclined to say, I’m afraid.

In any case, existence of evidence notwithstanding, I still don’t know what ‘direct talk’ is. I am particularly suspicious of claims of direct talk as, in contrast, I think I can see a concerted effort to euphemise suicide. The removal of ‘commit’, with its negative connotations, insertion of ‘complete’, with its positive connotations, removal of agency by the use of ‘die’ can all be seen as euphemisms. And with suggestions that suicide crisis should be rephrased as ‘transformative struggle’ (link to my post on this here), it seems that even mentioning the word ‘suicide’ is hardly acceptable.

And so, I set off to look for examples of direct talking. Wherever I looked (too many links to offer), I saw

Be direct. Talk openly and matter-of-factly about suicide.

No examples, no explanations. I understand of course, that ‘direct’ means ‘openly’ and ‘matter-of-factly’, but that’s just defining unknown by unknown. I immediately thought that if I am supposed to speak matter-of-factly, then I can’t ask questions, as questions are not statements. But that probably was not what was intended by the statement.

After a few minutes, I did find some explanations:

By listening to what the person in crisis has to say and by asking direct and open questions, we show our willingness to talk about anything with that person, including his/her feelings about suicide.

Start by telling the person you are concerned and give him or her examples. (link here)

So, talking directly and openly means saying that one is concerned. Great, except that’s reference to the topic, not the way of talking. After all, you can say this in many ways, some of which (presumably) are direct and other are not. So, that’s hardly helpful. But next, an actual example comes:

While directly asking about suicide can be scary, the person you’re concerned about needs you to ask, “Do you feel so badly you are thinking about suicide?”

First, let me say that I do object to the representing the question in terms of needs of the person being asked. Yes, in some cases, perhaps the person does need to be asked, but others really don’t. Just because you’re concerned, doesn’t really mean that you’re right. Indeed, I was once asked such a question (I was in the middle of reading a corpus of suicide notes, and I apparently became quite sombre) and I hated it. I thought the person asking was taking liberties and they should f… off.

Let me repeat – just because you suspect something, doesn’t mean you’re right. And I think, any advice to talk should make it clear.

What about the question itself? Is this really the direct way of talking about suicide? Well, probably not. First, the question asks about feelings and not about suicidality. Suicide is relegated to the subordinate clause, and the main focus of the question is feeling, and referring to suicide is done indirectly through the main clause. In other words, you really ask about how the person feels and not whether they’re suicidal. Direct? No, not really.

Moreover, all the person is asking is about is suicide ideation and there is significant literature on the absence of clear correlation (let alone impact) between ideation and suicide. In other words, many people think about suicide and don’t attempt/commit it. So, where exactly is the directness then?

The authors of the advice go further and suggest the following questions:

  • Do you have a plan to take your own life? or Have you thought of how you would do it?
  • Do you have the means or materials available to act out your plan? If so, What and where are they?
  • Have you set a time? or Have you decided when you would do it?

I think they should really decide whether to ask about planning or thinking. These are questions about different mental activities. Also, for one reason or another, the question somehow avoids talking about suicide. Is this on purpose, or just stylistic?

But that’s really not what I want to comment on. I am reading those questions and I am astounded by the assumption that if you ask them, the person you ask will simply tell you. What is it based on? Judging by my own experience, as I indicated, my immediate reaction was to say ‘fuck off’, which I replaced by something like:

Oh, I didn’t realise I had changed, thank you for your concern, I appreciate it

I think the person that took upon himself to ask me the question realised that I had no intention of continuing the conversation.

Similar kind of questions are mentioned on the Yorkshire police website (link here)

  • Are you feeling hopeless about the present or future?
  • If yes, ask: Have you had thoughts about taking your life?
  • If yes, ask: When did you have these thoughts and do you have a plan to take your life? Have you ever had a suicide attempt? 

Is the initial question the direct and open way of talking about suicide? Gosh, who would have known? But the question I really want to ask is: who speaks like this. This is a question taken from a questionnaire. Put in the mouth of a person at work will sound stilted and strange. Moreover, what’s this thing about the timing? Is there really evidence that if someone says ‘yesterday’, they’re safer than the person who says ‘I’m having them now’?

This is like I (a layperson) am asked to do a quasi-clinical interview and, in my view, such questioning is simply inappropriate. Why would anyone countenance this kind interrogation from a person who, bottom line here, has no business asking such questions. Again, such questioning is underpinned by assumptions of a right to ask and duty of answer. Neither obtains, neither is appropriate.

Incidentally, note that the questions continue to avoid the word ‘suicide’. Why? Aren’t we supposed to be open and direct?

The final example I came across I want to quote is the following (link here):

Be direct – Talk to the person you are worried about, and ask about suicide. Tell them you want to know how they really are, and that it is OK to talk about suicide

Once again, what’s the directness here? Is it that ‘it is OK to talk about suicide’?

Incidentally, is it OK to talk about suicide? No, it’s not. It’s just another stupid (sorry!) phrase that I keep coming across, just like ‘It’s OK no to be OK’. Is it? Are we really saying here that all those people who prefer not to talk about suicidality or depression are simply stupid and don’t realise that it’s OK to talk about them? Just another topic, isn’t it? Whenever I read this fatuous “It’s OK to talk”, I want to scream. No, it’s not OK to talk and this fatuous advice should be stopped.

And before (some of) you might protest, let me mention one of the oldest men I interviewed. He was well into his 70s, and in psychiatric care since he was in his 20s. How many people knew about his depression? One. Yes, ONE. It was his sister, who also covered for him when he was in a bad way. No one else. Not even his wife or his children. NO ONE! Why? Because it’s not bloody OK to talk about it. And if you want to change it, stop saying it is.

Time for a conclusion. Have I found what it means to be direct? Not really. The examples are either not there, or they are strangely all over the place, often avoiding the word ‘suicide’. Thinking about suicide hardly points to the act, while plans, even assuming that they are shared, might not be put in action. Have I found any matter-or-factness? Not even if my life depended on it.

But there was one thing that struck me more than others. In all these clearly well-intentioned hypothetical questions, looking like clinical interviews with no authority to do them, no one (like no one!) thought to ask one direct question:

Do you need help?

 

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