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by Ashley Smith, PhD

As a clinical psychologist, I probably think about suicide more often and in different ways than most. I’ve read the research. I’ve been trained to ask the hard questions. I am all too familiar with the frustrating gaps in our knowledge base: what causes it, who is at risk, how do we prevent it? I understand the stigma and misconceptions surrounding it, and I know, firsthand, the collateral damage that stems from it.

May 27, 2011 was the worst day of my life. I lost one of my favorite people on this planet to suicide. This week, sadly, my world was yet again touched by this tragedy, and I feel compelled to write these letters.

To the Grievers,

I feel your pain. I, too, have lost a loved one. I know the initial shock as your mind strives to process the news that seems so unfathomable, so impossible. We know that it happens, but we just didn’t see it coming.

I know the heartbreak that sets in as the shock wears off and you realize that your person is gone. This is not a bad dream. You’re awake, and it sucks. I know the deeper layer of heartbreak that comes with the realization of just how much pain your person must have been in. The weight is crushing.

You’ll want to go down the If Only path, but don’t. That will only result in endless loops of anguish and no real clarity. Know that it is not your fault.

You may be struggling with wanting to understand WHY this happened. Know that you may never fully understand your person’s state of mind or the factors that led to their death. You may never have a satisfactory explanation.

Know that it’s ok if you feel angry, but understand what happened. In the mind of someone who dies by suicide, they are a burden to others and do not belong. You and I know that’s not true, but in their mind, riddled with the insidious lies of Depression, they did not. They believed, TRULY believed that that their existence caused pain and that the world would be better off without them. From their perspective, their last act was a selfless one or one of mercy to end suffering. That’s the tragedy of suicide.

You feel lost and stuck as the rest of the world continues on like nothing has changed…but things will never be the same. The waves of grief that crash over you now, buckling your knees and taking your breath away, will gradually slow down. They will begin to come less often and with less intensity.You’ll find yourself feeling (almost) normal for increasing periods. You’ll stop feeling like you’re drowning, but it will never completely stop hurting.

Know that you WILL be ok. It’s going to hurt…a lot and for a long time. There’s no way around it and no way to avoid it. But know that you CAN get through this loss.

Be in Peace,

Ashley

To the Contemplators,

I feel your pain…at least I want to. I want to listen, to wrap my arms around you, to tell you that you are NOT alone, that people care, that this will pass, that life CAN get better, that there IS hope, that NOTHING is unforgiveable or irreversible.

Know that brains lie, and yours is no exception! Question it. Challenge it. Fight back! You DO have worth! Things CAN get better! It will not always feel like this. These thoughts and feelings will pass if you can hang on. You are strong. The fact that you’re still here is a testament to that. Even the strongest need a hand sometime, though, so share your burden (and know that YOU as a person are NOT a burden). It will be easier to carry, possible to endure, with help.

There is always someone there. If not a family member or friend, call the confidential National Suicide Prevention Lifeline anytime, 24/7, at 1-800-273-TALK (8255).

Please find some tiny ray of hope and cling to it like the life raft that is. Things can get so much better!

Be in Peace,

Ashley

To the Rest of the World

I feel your pain…even though you do not…yet. You may feel a mixture of judgment or disbelief when you think about suicide. “That’s only for the mentally ill/attention seekers/weak of heart. It will never happen to me.” Or “My loved one would never do that.” Or you don’t think about suicide at all. You’ve been lucky. It hasn’t touched your world yet, but it will.

Someone dies by suicide every 12 minutes in the US—every 40 seconds worldwide—and for every completed suicide, 20+ more attempt. Suicide is the 17thleading cause of death worldwide, 10thin the US, and 2ndfor teens and young adults. Rates are on the rise, with a startling 24% increase over the past 15 years, and 1 in 5 teens seriously considers suicide. That’s 20% of our youth!

Yet, there is so much stigma, so many misconceptions and unhelpful attitudes around suicide.  What if we likened it to cancer? Like cancer, suicide does not discriminate on the basis of gender, race, or socioeconomic status. There is no stereotypical face of it and no one single path that leads to it. For some, it is a sudden, intense phenomenon that takes life rapidly and with little warning. For others, it is a war waged internally for years. And, like with cancer, what if we did not blame the sufferers, even if their actions seemingly contributed in part to the outcome, and instead understood that they, tragically, lost their battle?

Suicide is not a selfish or cowardly act. It is not due to a lack of discipline or religion or to a weakness of character. It is caused by a number of factors, a perfect storm of biological vulnerabilities and environmental elements that results in circumstances that are beyond someone’s ability to cope. In that final moment, there is no alternative, no way out. Like when a heart no longer has the capacity to keep beating during a heart attack, they die of a brain attack.

“Suicide is just a cry for attention or a cry for help,” you may say. Maybe it is sometimes. That brave soul is fighting for their life! LISTEN TO THAT CRY! Help if you can.

I urge you to be kind to others. You can not tell by looking at someone if they are struggling with suicidal thoughts or who they’ve lost to suicide. Arm yourself with education and compassion. Suicide is a public health issue and affects us all.

Know that it’s ok to ask someone about suicide. There’s a common misconception that asking someone if they have suicidal thoughts will implant the idea. That’s a myth. If someone is not suicidal, asking about it will NOT cause them to be. And, if they are, asking about it may just save their life. By asking and listening without judgment and without anger, you’ll let them know that the door is open to talk about it, that you are a safe place for them, and that you will help them take the first steps toward preventing it.

Be in Peace,

Ashley

To Z and the Others Who Lost Their Battles,

I can’t feel your pain…it’s too overwhelming and unbearable. My heart breaks that you suffered alone. Seven years later it’s still hard to imagine—and live in—a world in which you don’t exist. Know that I love you and that my life is better because you were in it. Be in peace.

Ashley


About the Author:

Ashley Smith, PhD, began studying and treating anxiety disorders in graduate school. She earned her PhD in clinical psychology from the University of Nebraska-Lincoln in 2007. As part of that training process, she completed an APA-approved predoctoral internship at Children’s Mercy Hospital and Clinics before joining the staff at Omaha Children’s Hospital to help develop their dedicated anxiety services. In 2009, she relocated to Kansas City to serve as a senior staff psychologist at the Kansas City Center for Anxiety Treatment before starting a private practice in 2017.

In addition to direct clinical work, Dr. Smith is actively involved in other scholarly activities. She has been an adjunct assistant professor in the Department of Psychology at the University of Missouri-Kansas City and has provided supervision, trainings, and consultation for students and other professionals. She has several publications (see below) and maintains active involvement in professional organizations like the Anxiety and Depression Association of America. She regularly presents workshops and trainings on a local and national level and has been involved in planning and producing local and national conferences.

Dr. Smith strives to provide top-notch care in a collaborative and supportive manner. You will find her to be direct and knowledgeable, open and honest, and enthusiastic about guiding you through your journey.

Visit Dr. Smith's website here. 

My mind can't cope with how people are valued and I can't seem to get past my perception of lacking in it. I keep trying but to no solution past these dark thoughts. I hope others are having better luck/results past these unreasonable mental blocks.

Really good article, great in fact, but I agree with Kyle. There are things in life that are simply unforgiveable and irreversible. An example that immediately came to mind, a drunk driving accident that caused the demise of someone (or severe unrecoverable injuries). Aside from that, excellent piece.

Dear Ashley,
I can tell you've never experienced the pain yourself. You don't 'get' it. Too many people out there with initials and titles before and after their names, such as yourself. You've studied and researched and probably written interesting papers on this subject. Plus, the loss of someone you knew gives you an interesting perspective....But, you don't get to the heart of the matter because you've never been there. I'm 68. Three months ago there was a murder/suicide in my family. There's a 7 month old orphan left behind. Until you really get down into it, you don't know how it feels to grieve the loss of a child. It never ends. You wish morning wouldn't come. You don't know what day it is, and you don't care. The depth of the pain is unfathomable. Friends and family think you should be over it already, they don't come around. Don't assume everyone has caring relatives and friends. You really need to learn more about this. Your knowledge is superficial and your writing is condescending and full of platitudes. I'm sorry to come across as being rude, but you need more than institutional learning. I was a help-line/crisis interventionist. Nothing prepared me for this level of pain....and for the very limited resources for real understanding.

My hope in writing these letters was that by sharing how I made sense out of and came to terms with the death of my person, I could help others do the same. I am so very sorry for your loss and for your pain, and I am sorry that my words could not offer any comfort.

Your comments, you accuse Ashley of being rude? You are the one that rude. You are transferring your pain & suffering onto someone that is ONLY trying to help. Give her credit for that instead of bashing her. You don't know exactly how she or anyone else truly feels. You're not that powerful. No one is. She is showing compassion. You'd be better to do the same.

My son, my only child, I lost to suicide in Oct. 2017

There is much to say about suicide and depression. No one mental health professional can cover all perspectives. "Never been there", Sterling says. But Ashley has been there, and she admits it. "Never experienced the pain yourself", he says. Yes, she has, and she says so. "Your writing is condescending," he complains. I didn't feel I was being talked down to.

I lost my brother to suicide many years ago, so I recognize the pain you're in, and I empathize. But your criticisms are of Ashley are unduly harsh and unfair.

As a guy who is writing a play about a suicidal teenager, I have read dozens of books and online articles about depression and suicide among teens. One thing Ashley emphasizes that many others don't: the convictions of worthlessness that people who want to die feel and express are essentially lies, not just (as cognitive-behavioral psychologists would have it) "cognitive errors". When we feel that low, we say things to ourselves like, "the world would be better off without me," "I'll *never* recover from this rejection, " "No one will care if I take my life," "I *can't* ever feel any better than I do now," and so on. When we hear someone talking this way, we should know it's time to intervene and help in some way. Because truly, it's never hopeless until you're dead.

My brain runs constantly make it hard to focus and just be able to breathe. I have lived like this for as long as I can remember in and out of therapy ( currently in) I get stuck with the voice telling me that I am a burden know mater what I do or say if something goes wrong my brain tells me it’s my fault. I have tried 6 times to commit suicide and I can’t even do that right. Six times I’ve ended up in the hospital with doctors rushing around to save my life when all I wanted was the pain to stop and my brain to stop screaming at me all the time. I have been in and out of rehab and hospitals over 12 times. I’m 24 years old and should want to live life but I don’t. Out of those 12 times maybe more I have seen the pain I have caused my mother and grandmother everytime. The hope they have when I’d get out and the disappoint and pain on their face when I start to go back down hill. I know that they would live with the pain of losing me but my mind tells me that if I just do it then they will learn to move forward not saying they would be in less pain but they wouldn’t have to be afraid when their phone rings because they don’t know if I’m alive or dead. I cause them pain every single time I end up not being okay and it shows on there face I know it’s because they care and love me but if I would just end it it would be the last time they would ever have to worry. So in my mind I am the burden and even though I truly don’t mean to or want to I cause them pain constantly. I just want the pain inside of me to end.

If yoire going to kill yourself, and not try and keep riding the merry go round, try leaving. There's no reason to not radically change whatever you can. If you can afford a ticket than do it, who cares about rent or hotels or plans. Just go.

After 30 years of clinical depression and suicidal thinking, all I get is no one cares and it doesn't get better. Every time I've tried to seek help, I become a liability and people get away from me as fast as possible. Therapists, teachers, counselors that say they will help. Until the fear of a potential lawsuit after I kill myself. Just like 13 reasons why. All talk, but not real.

I’m not going to go into detail but I’ve battled this illness for a very long time and this past year has been the loneliness that I have ever had in my life I lost my best friend of 30 years suddenly ,my husband doesn’t communicate with me and doesn’t try to understand or engage in any type of intimacy from holding hands & so forth I have no friends anymore/ my only child is 20 and she’s pretty much erased me from her life & response to me as her Narcissis father does she shows traits of following in his footsteps she will not go to therapy
..all of my family know that i’m lonely and what I battle with but for 11 months now -not one person has came knocking at my door or calling my phone I have escaped death 6 times- I see a psychiatrist but it’s really what’s the point & I hv seen a therapist really what’s the point . The three loved ones that truly knew me & showed interest in spending time w/me & thought I was funny have all passed away in the last four years / my husband doesn’t even sleep with me.. re-married eight years the only thing I’ve ever asked from him is his time ... and I’ve been waiting for that for four years the darkness is getting stronger and stronger I don’t know what to do

My best friends husband committed suicide two summers ago and now I see why. It was sudden and nobody was prepared.... I was confused, sad, and mad all at the same time. But the more I'm here I understand why! I walk around every day and I try to smile, I pray, I even listen to gospel 80 percent of the time.... The only reason why I'm here is Because I have one child and I know that if I leave he would be miserable. I've set in bathrooms for hours trying to talk myself into ending this life because you dont know how it is to be alone until you really realize your actually alone. I use to think that people that do that are selfish but now that I'm in the same boat I understand it a little more. Selfish is waking up every morning going to work and barely having a check left after you've paid all the Bill's, and not being able to do anything differently because you dont have help! People always make it seem like it wasnt that bad for someone to take there life.. but you dont know what they were dealing with. I have quote on quote friends who are always to wrapped up in there own lives to even talk to me. I text and they may respond 2 days later. Sometimes the signs be right in your face but most people dont open there eyes to see. I do believe in God I just believe the devil is riding my back and apparently has installed a seat! I'm working two jobs in school trying to better myself but it's just to much at times. Most of my problems have came from helping others and letting my guard down for people who didnt care about me just used me. So now I'm here ...... what's ironic is I wasnt going to keep my don but my faith wouldn't let me go through with it..... hes my knight in armour and he doesn't even know it. He saves me every week!