Q-and-A on suicide with award-winning journalist Anna Mehler Paperny

• CONTENT WARNING: This article discusses thoughts and feelings about suicide. 

Author and journalist Anna Mehler Paperny joined the University of Calgary on Jan. 23 for a keynote address and discussion: Living with Suicide: A Community Dialogue. Her book, Hello I Want to Die Please Fix Me, was a national bestseller and shortlisted for the Hilary Weston Writers' Trust Prize for Nonfiction in 2019. The event was presented by UCalgary’s Community Mental Health and Well-Being Strategy, supported by the Provost’s Office of Institutional Commitments.

After her keynote, Mehler Paperny, along with members of the UCalgary community, took questions from the audience. Due to time constraints, not all questions were able to be answered, so we asked Mehler Paperny to address several more in this follow-up Q-and-A. 

Find her keynote speech recording here.
 

What does “support system” mean to you and why do you use this definition? How can community members develop support systems for individuals experiencing depression, especially for those who are a part of marginalized communities? 

I wouldn’t say it’s a definition, but to me a support system is a web of human and societal resources — people you care about and can rely on, first and foremost, but also a range of medical and social interventions including pharmacotherapy, psychotherapy, paid sick leave. Strong support systems are especially crucial for marginalized communities because of the ways those communities can be made vulnerable from the get-go. 

I won’t presume to say what marginalized communities need, but I think a starting point is to ask people what they need and try to provide that, keeping in mind that they are dealing with not only depression and suicidality but systemic discrimination in various forms. Individuals aren’t able to make up for the shortcomings of society but just being there, offering an ear, telling someone they matter and you’re glad they’re alive, can mean the world.

Is passive suicidal ideation still as much of a concern as active suicidal ideation? 

Depends what you’re concerned about. Someone who is actively suicidal is more at risk of dying but being passively suicidal is excruciating and can easily escalate to active suicidality. If you’re experiencing protracted, persistent, low-grade suicidal ideation, know it’s serious and crappy and you deserve help. If you are actively suicidal, I would absolutely reach out.

Call or text the Suicide Crisis Helpline 24/7 at 988 if you’re thinking about suicide. 

How often is suicide impulsive? Or could you discuss the impulsivity of suicide? Understanding there is often a detailed plan — but is the act impulsive when the plan is fulfilled? 

To take a stab at this one I consulted Crystal Walker and Mara Grunau, at the Centre for Suicide Prevention. Here’s what they said:

People consider suicide due to numerous factors. Suicide attempts or deaths can seem impulsive when a person faces something that adds to a pre-existing burden and leads them to act on thoughts of suicide. A suicide attempt may seem impulsive when really a person is experiencing a growing intensity of suicidal thoughts and despair. 

Any significant change in behaviour is a sign someone may be thinking about suicide and could act on their thoughts. If someone you know changes their behaviour (e.g. withdrawing from people or activities, significant mood changes and/or changes in routine, sleep or eating habits, etc.), reach out, have a conversation with them, and connect them to help.

When a person has a suicide plan, suicide is more accessible to them because they already know how they’ll do it. This is why it’s important, if someone tells you they’re thinking of killing themselves, to take it seriously. Ask them if they have a plan and help to dismantle it or connect them with someone who can. Call 988 together. If you find yourself planning your own death, reach out to a loved one, a mental health professional, or 988. 

In those instances when you are experiencing suicidal ideation, how would you like the people around you to provide support? What is beneficial and what should be avoided? 

The biggest thing is just to be there. Listen. Listen actively. Listen compassionately. Validate their mood state without justifying it, if that makes sense: what they are going through is genuinely awful even if it does not, rationally, merit death. If someone is suicidal ask them if they have a plan — and, if they say yes, work with them to minimize the risk of that plan being enacted. 

Work with them to craft a safety plan — write down things that make life worth living, triggers and how to address them, phone numbers to call when the shit hits the fan. Don’t ghost and don’t be didactic. If the suicidality becomes urgent or overpowering, sit with them in the psych emergency room. Visit them in hospital. Bring snacks and a good book. 

Do you have any words for those of us with suicidal ideation and dealing with such thoughts and/or actions? 

First of all, I’m so sorry you’re going through this. It is genuinely awful and should not be minimized. It feels like this is going to last forever. It’s not. And it feels like nothing could possibly alleviate it. But that’s not true. We suck at addressing this but there are things that have been shown to work. 

• Reach out to someone you trust and tell them what you’re going through. If they’re not helpful, that’s not their fault, they’re just scared. Spell out what you need from them. 
• Write down things that make life worth living — doesn’t matter how small or seemingly insignificant. Put that list somewhere you’ll see it often. 
• When you’re feeling up to it put together a safety plan; write down triggers and things you can do to defang them, write down coping mechanisms and things you can do to bring you joy. 
• Write down phone numbers to call in case of emergency. 
• Do those things that bring you joy. 
• Try to find a health practitioner who earns your trust. 
• Try taking meds, if they’re available to you, it’s worth a try. 
• Try psychotherapy even though it feels hokey at first. 
• If you find yourself making a plan to kill yourself, reach out for help — one option is to call or text 988. 

If you’re reading this, some small part of you wants to live. Hang on to that small part. It’s all you need, for now.

I completed my PhD recently, I am a postdoc now and feel emptier than ever in my life and have strong thoughts of suicide. How do I feel less empty? 

First of all, I want to say how sorry I am you're going through this. That kind of empty is awful. But it's not permanent, and it's not inevitable. If you're thinking of killing yourself or your lows go beyond day-to-day crappiness, seek help, through your family doctor if it isn't urgent, through the emergency department if it is. 

It's urgent if your thoughts of killing or hurting yourself are immediate or persistent. It may be worth a visit to a crisis centre if you find you’ve lost your capacity for what my psychiatrist calls the “activities of daily living.” Reach out to someone you trust and care about, both for comfort and to be reminded of the ways in which life is worth living. If you don't have anyone who fits the bill, try calling or texting 988. Write down a list of things that make your life worth living, and consult it often. Expand it as needed.

Do suicide survivors suffer for the rest of their life?

This could refer either to people who attempt suicide and survive, or to people whose loved one kills themselves. Because I have never had a loved one kill themselves (although I know it is excruciating), I’ll address the former: The short answer is “No.” You can survive a suicide attempt and go on to live a long and happy life. Chances are it’s not so simple: While surviving suicide can be a relief because it means you have a second chance, it can also feel like a disappointment. Whatever made you want to kill yourself may still be there. Cling to that promise of a second chance, though. It’s worth pursuing in the face of pain. 

How much would you recommend people share about their mental health with their colleagues? Public messaging encourages sharing, but there are risks that people will see and treat you differently. How can folks go about making decisions on whether to share and how much? 

This is a tough question because it’s very dependent on your situation. You should never feel pressured to disclose, period. If you want to tell someone, if you trust them, if you feel like they’re a friend first and foremost, if you feel like that disclosure won’t make workplace interactions awkward, go for it. If you’re unsure, see how a person responds to mental illness in other contexts, with other people. Also, you can tell as much or as little as you want: “I was off sick” can be all, if that’s all you feel comfortable with. Or you can expand on that, if you want.

If you or someone you know is experiencing suicidal thoughts or behaviours or a mental health crisis, know that you are not alone and there are many supports and caring individuals available to assist you. If your safety or someone else’s is at risk, call 911 for emergency services. If you or someone you know is experiencing thoughts of suicide, call or text 988. Find more supports for your mental health and well-being here.