In the previous issue I wrote an article on suicide and I was privileged to receive a large number of responses from readers who shared very intimate thoughts about contemplating suicide. After carefully reading them all, it occurred to me that for CRPS sufferers, suicide itself is like a chronic disease.
Most people contemplate suicide when they feel their lives have hit rock bottom. For most, that feeling does not occur too often in a lifetime. For people who suffer from CRPS, rock bottom and suicidal thoughts might occur daily.
This article is for the loved ones of those suffering from CRPS and their role in helping prevent suicide. You may actually be both the first and last protection against suicide. While that may sound like an awesome responsibility, it is really not so difficult to handle. According to Samaritans of NYC (a 24-hour a day suicide prevention hotline) there are specific things you can do to help. First, remember that a person with CRPS who is contemplating suicide usually does not want to die- they want their pain to disappear. Also, they want someone to understand how they feel. So they send out both verbal and non-verbal signals. Your job is to pay attention to them; they are really cries for help.
Recognizing the warning signs
The person with CRPS sends different signals those from the general population because much of the behavior displayed by a potential suicide already exists in people who suffer from CRPS. Therefore, you need to look for changes in the degree of these symptoms. Watch for:
1. Changes in personality: For example, a person may become sad or withdrawn, irritable, anxious, tired, indecisive or apathetic.
2. Changes in behavior: This can be manifested in many ways; for example, a person might have difficulty concentrating even on the most routine tasks.
3. Changes in sleep pattern: These may be harder to detect in someone with CRPS because sleep difficulties are often a symptom of the disease itself. However, if someone suddenly begins staying in bed most of the day or begins to have frequent nightmares, it should set off a red flag.
4. Changes in eating habits: Again, CRPS patients may already have problems with eating, but if they change in frequency or degree, it should be considered.
5. Loss of interest in friends, hobbies, or anything else they previously enjoyed.
6. Fear of losing control, going crazy, or harming themselves and others
7. An even lower sense of self esteem than usual and increased feelings of worthlessness and hopelessness.
8. Feelings of self-hatred or shame
9. Overwhelming sense of loss tied to health, economic status, or career
10. Loss of spiritual faith or in other personal beliefs or philosophies
11. Talk and preoccupation with the themes of illness, death, and dying.
12. Giving away of possessions, especially those that are prized
13. Previous suicide attempts.
14. Watch for phrases such as “nobody cares”, “everyone will be better off without me,” and, “I wish I were dead.”
It is important to remember that the risk of suicide may be greatest as
the person’s depression begins to lift.
Become Involved in Active Listening
If the person begins to talk about suicide, listen to what they say.
Show that you respect their feelings and that you take those feelings seriously. Don’t be afraid to ask: “Do you feel so badly you are thinking about suicide?” Sometimes just opening the door to this kind of discussion may be enough to alleviate the crisis.
If the person answers yes, they are thinking about suicide, you must take that response seriously and do a risk assessment by asking the following questions:
1. Do you have a plan to take your own life?
2. Do you have the means or materials available to act on your plan? If so, what and where are they?
3. Have you set a time?
If the person has a definite plan, has the means at their disposal, and has set a time that is soon, then you must consider this person to be at high risk for suicide. Never leave the person alone. Keep them talking. Again, most people do not want to die, but want to find some way to get through the terrible pain. They want someone they can turn to during these terrible moments of fear and desperation.
By being that person, you can often stop the patient from taking the next step.
If you feel that you are not able to help enough and the patient starts taking any action you believe to be life-threatening, call an ambulance or emergency services at once.
In almost every case, just listening and engaging the patient in a conversation about their pain in a non-judgmental, sympathetic way will be enough to avert a crisis. But since suicidal thoughts in CRPS patients can be “chronic” and no one can devote 24 hours a day to help, a long-term goal might be to persuade the patient to seek some kind of therapy so they can learn better ways of coping with their physical and psychological pain. At this point, nothing and no one can completely alleviate all of the pain and depression associated with CRPS. But by following the steps and ideas listed here, you can play a critical role in helping ensure that your loved one can lead a better life, and more importantly that they are here to live that life.