You know, I got the real acid test in asking for help a year ago.  I think the Universe had this planned for me especially because my husband, (Johnny), and I had been so ill that our housework and maintenance work was suffering badly. My back and hip had progressed to the point that I couldn’t walk even with my canes or my walker. The doctor would not operate until I lost a significant amount of weight. And even though I was doing the best I could to get there, I still could not move to help increase my metabolism. I couldn’t move without severe pain so I knew any weight loss would not happen quickly –it would be awhile. I needed a new hip and it was a catch 22 that I had to have a new hip in order to exercise to lose the weight to qualify for a new hip. To get any of the needed home maintenance and errands done, I asked a few people if they could give us some help and mostly I heard reasons why they wanted to help but they just did not have the “exact” time to do “exactly’ what we needed done. Some asked if we needed help and when I accepted their offer to help, I heard only variations on the previous theme! So I thought I’d take a new tack. I asked others if they knew anyone needing some extra money. We were looking for someone who would be willing to do some cleaning and maintenance work around the house and yard for a good wage of $20/hr. We were not able to find even one person who either had the time or the inclination…Amazing. Then one day, a neighbor who happened to know I was incapacitated dropped by and asked if there was anything we needed. I answered, “yes” and revealed we needed some groceries and a pick-up of meds for John and I. She cheerfully went and obtained what we needed. We were so grateful. I was also thankful that when she asked she was prepared to accept the request and actually fulfill the task. What truly amazes me is that when people ask if they can help and you say, “Yes, we could use some help”, you then get to listen to the myriad of sidestepping reasons why they cannot do that one thing. The next time someone asks if they can do anything for us, I’m going to say the same thing Jimmy Stewart says in the movie “Harvey”.  The bystander asks Stewart, “Can I help you?”, Stewart answers, “Sure, what have you got in mind?” There is a serious lesson here. We all say we are willing to help others – but are we really? We wait until they say, “I need help.” My whole last talk was on being the “caller” (freely offering help) not being the “callee” (who sits waiting to be asked to help). But there is a powerful edge to this coin…in being willing to do the thing needed to be done when called to do it. Man, we all hate having to ask for help and if we’re lucky we’re usually on the side providing the help. But more than that, when you actually get up the guts to ask for the help you need or to answer, “Yes, we could use some help”…it’s even harder to listen to the variations of “Oops, I didn’t actually expect you to say you needed help, so, no, sorry, I really can’t help you even though I asked if you needed some.” So, be prepared. If you ask me if I need help, I’m going to answer, “What have you got in mind?”

More and more forensic research is being done in the name of suicide prevention and I am absolutely nonplussed at the conclusions that are reached by talking to the suicide victim’s PCP, their family, friends and by researching whatever writings or videos the suicidal victim left. First off, individuals in relationship to the person who died by suicide have a distinct and obvious reason for not delving into the situation. It has been found that many coroners are asked by family members to obscure the reason for death or just list it as accidental if no absolute evidence to the contrary is presented. Some person told me years ago that depression was caused by being suicidal. I shook my head and laughed, treating the comment with scornful condescension. How could you be suicidal before you became depressed? Specializing in treating suicidality for decades as a licensed mental health therapist and a certified chemical dependency counselor, I now know that comment was closer to correct than I ever suspected. I have been doing research involving those who are suicidal and who have recounted the circumstances around their numerous suicidal attempts. From that direct data I formulated the “psychobiology of suicide”. I discovered that the majority of my suicidal patients did not qualify for a DSM diagnosis. When I delved into the naissance of their suicidality, I discovered something else extremely significant – they all could identify a period in their childhood when they felt helpless to change their situation or to improve an untenable problematic atmosphere. At this point the child began thinking about “not being here” in order to cope with the untenable situation. Thinking about “not being here” brings on a rush of “well-being” and somehow they know they have hit on the answer – the one thing that makes everything bearable. It is this thought pattern of “not being here” that makes the situation liveable. That is about all a child can do. The brain will always look for ways to relieve pain, whether the pain is emotional or physical. No one knows about that except the enlightened suicidal person. Certainly no onlooker would ever pick up on it. No way. Most people think that suicide starts in adolescence or adulthood because that is when others find out about attempts. There are usually an average of six attempts for every suicide. So you think you are hearing about the one time. But guess what?!  It has happened many, many times before that. I assure you. I must have tried at least that many times before I ever even told anyone I was suicidal. But when I think about it I used a lot of metaphors for suicide before I actually used that exact term. I noticed that was true for most of my patients also. I’d use the words, “not long for this world, leaving this place for good, buying the farm”. Now that I think of it there were quite a few and said in a flippant, kind of haggard way, no one would really stop and think I might mean just that. When a kid decides that not being here is the only answer to overwhelming problems, he or she is reinforced by the endorphins that accompany finding an answer that works – if only temporarily. Still over time that relief is sufficient only if the thought generating it is sufficient to resolve the level of problems presented. Sooner or later just thinking is not good enough and planning must take over. That’s when the pain and agony really begins. The emotional toll that takes on one’s mind is unbelievable. The constant onslaught of emotional pain results in thoughts of suicide to relieve it. That’s why I believe the person who told me that suicide causes depression was right. Suicidal thought can cause depression, not the other way around. And as far as discoveries concerning any aspect of suicide, the investigators are asking the wrong people. It still amazes me that anyone who reports suicidal thoughts is dismissed from most studies on suicide or most any study really. That leaves only second hand information about the experience of suicidality and that information is often based on biased and stigmatized report. To understand suicidal thought investigators need to ask the right questions but they also must ask the right people. There needs to be more listening to those of us who have been suicidal and note taken on the methods we have employed successfully to deal with it.

The latest statistic for the suicides in the U.S. Army National Guard so far in 2013 is 71. Some popular reasons rolled out for military suicide are multiple deployments, financial difficulties, or disruption in personal relationships.  However, most of those who died by suicide had not been deployed to any war-involved theater and most were employed and had significant relationships. Still, seventy-one of our citizen soldiers have killed themselves in the last seven months. Devastatingly true but if the current rate continues the projected number of suicides will exceed more than any number of suicides in the Army National Guard so far in any previous year.  What does that tell us? That simply means what the military has been doing is not working. That would not seem so horrendous or terribly militarily different – I mean, some program not working. But this failure is costing valuable lives. Valuable, talented, important and essential people are dying while the military doles out apps, and produces PowerPoints, and funds millions for anti-suicide nasal sprays. The lives of fathers, mothers, sisters and brothers, daughters and sons are irreparably altered, changed forever because of the loss of their loved one and nothing is happening to change that. All the military programs to reduce stigma, to encourage seeking help, to promote positive psychology are not working. All the millions thrown towards developing the perfect pill for trauma-related depression, the ideal method for referral to mental health care, or the elusive resiliency classes have created the opposite effect. Why is that? These are “things” the military throws at the troops. External “things” are projects, devices, gadgets, all exogenous mechanisms that generally don’t work when the problem is endogenous, internally oriented. Isolation is one of the major hallmarks of suicidality and “things” create further isolation between people. “Things”, devices, gadgets and projects all create separation. They don’t bring people together. They don’t convince someone that anyone cares. “Things” can’t do that. “Things” and projects expand the suicidal emptiness and sense of disconnect instead of making the bond that only human interaction can create. Unit cohesion is what the military touts as human connection. Battle buddies are the only real connection that the military encourages. But when it comes to battle buddies doing anything beyond escorting someone to the chaplain or medical for suicidal ideation, that is not considered as effective action. Perhaps that is thought of as interference with unit cohesion. I really do not know why the military does not take advantage of the one true benefit that is the  human connection. The answer to resolving suicidality not only in the military, but in the world is human connection – human support, not “things”.  The answer to suicide in the military is the same as the answer for the entire world and it is right in front of their eyes. How do we open their eyes? More information can be found in the book, “Just Because You’re Suicidal Doesn’t Mean You’re Crazy: The Psychobiology of Suicide”, 2012. Or you can go to the website, http://www.jsp3.org, where there is a downloadable booklet that explains how trusted friends and family can actively support someone who

When I tell people that suicidal thoughts begin as a way to save your life, they recoil in disbelief. How could thinking about suicide preserve your life? The real truth is no one starts off thinking about actually killing themselves. Even though it might seem so even to the suicidal person, when asked, the patients I have surveyed reveal similar histories. When finding themselves in a no-win, non-alterable situation usually early in life, they have to find a way to withstand it in order to live through it. Bearing adverse situations requires mind over matter and one begins to think of “not being here” in order to survive untenable life conditions. My suicidal patients over the last 14 years have described the first time they remember wanting “not to be here”. Each one also described having to endure a long-term abusive or neglectful environment in which they had no control. If they could not remove the problem adversely affecting their lives, then it is ingenious to devise a way in their mind to live through it by symbolically removing themselves from the danger. When a mind can eliminate anguish, a feeling of control is established. Thus, imagining “not being here” equals the only means of control over the situation at that time. Interestingly, when I realized this I could not put my own self into this scenario, even though I knew I could trace my suicidality from 8 years old. Yet after I wrote my book about my childhood and my 24 years of suicidal ideation and attempts, my readers were the ones to inform me they directly related to similar childhoods also insufficiently nurturing (and in most cases, much worse than mine). I realized that my patients and I shared a daunting suicidality that protruded into our dreams and invaded our desperately few quiet moments. But I had been delivered from active suicidal ideation. At age 32, I finally told my best friend what I was dealing with and she took it upon herself to form an intimate and confidential coalition of my friends who became dedicated to keeping me alive until I could learn to keep myself alive. Between my own strides in mental health therapy and their specifically planned efforts, we all succeeded. At that point in my life I knew I had to change courses. Prompted by a new career devoted to mental health and chemical dependency counseling and in research for my Masters in Counseling, I looked further into the identified thought progression of wanting “not to be here”. Continuing to work with suicidal patients, I learned that the initial thoughts of wanting “not to be here” were endorphinergic. That is to say, as long as the thoughts of freedom from pain and despair could be generated, they produced pain-killing, mood-elevating neurochemicals and hope-filled feelings. But it wasn’t long before those thoughts alone were not sufficient to bring the relief that they did originally. The need to create more permanent feelings of relief innocently and subconsciously started and perpetuated the ever-heightening suicidal ideation which then led to attempts of increasing lethality. Each of my patients noted the same progression beginning with adverse childhood experiences. No one started off thinking about killing themselves.  All felt better when initially thinking about “not being here”. All learned early in life about suicide’s ability to end someone’s troubles. Usually suicide had been explained simplistically as a way to be free of pain or to be “happy and in peace with Jesus”. Each patient was nonplussed by the entire process which had inexplicably morphed into anguish. Each felt they must be mentally ill because they could not understand where the thoughts came from or how to get rid of them. I realized that our suicidal thoughts were not our fault. They were deeply and unconsciously engrained neural pathways that had innocently developed over time and had become default thought patterns engaging full force whenever we were presented with difficult situations. All of this happened totally without any volition on our part. Unfortunately, when you have an efficient unconscious go-to thought process available, there is no need to develop problem-solving skills. This explained why all of my patients stated they felt like they were helpless, hopeless and…crazy. I wondered if the kind of focused, problem-solving peer support that initiated my recovery could help my patients. I dissected and analyzed what my team of friends did for me and replicated that in a protocol for suicide prevention. I poured over neuroscience research and found evidence that my psychobiology of suicide theory could be viable. I explain the origins of suicidality with neuroplasticity research underpinning it and present it in my book, “Just Because You’re Suicidal Doesn’t Mean You’re Crazy: The Psychobiology of Suicide” (2012). Particular cognitive behavioral and neuroscientific principles are part of the support members’ education. With the knowledge of exactly how to help the suicidal person they become goal-directed and confidently move forward. Shortly after publication, a reader called me to let me know that the JSP3© (Jensen Suicide Prevention Peer Protocol©) has saved her life. She had been inexplicably tortured for decades with suicidal thoughts and attempts. For the first time in her life she felt like she was in the driver’s seat, no longer a pawn to her out of control and heretofore overwhelming suicidal thoughts. I continue to work pro bono forming individual suicide prevention support teams for anyone who wants to start leading their life free from active suicidality. Discovering that this enduring neural pathway does not go away on its own, I learned it can, however, be atrophied through lack of use. I’ve realized that any thought now that resembles a suicidal thought is a message that I have to solve a problem currently undermining my peace. In my ongoing research, I discovered that most of my patients had been discharged from one or more psychiatric hospital wards without any outpatient support (as I was also). They were commonly dismissed with only a tenuous referral for a follow-up counseling appointment. Research reveals that the likelihood of suicide is at its greatest in the first few weeks following discharge from the hospital. It seemed no one was doing anything to prevent that from becoming the possible eventuality. I’ve been working to inform psychiatric nurses, hospital social workers and emergency room social workers about a way to build protection into the discharge plan of suicidal inpatients. I’ve described my three hour session orienting, educating and coordinating the JSP3© members with the suicidal person as the one in the driver’s seat of the team. The JSP3© team provides the daily support while a licensed therapist resolves the underlying trauma that initiated the helplessness, hopelessness and the need “not to be here”. There is ample evidence that peer support for most populations is very successful in suicide prevention. Unfortunately, in general, hospital management hasn’t been eager to institute a new program which requires significant staff time and effort. In addition, I have addressed many battalions, squadrons and commanding officers at Joint Base Lewis McChord where there have been an unprecedented number of military personnel suicides. It saddens and frustrates me to have been unsuccessful in convincing either the Veterans Administration or the Department of Defense hospitals to institute a peer support safety net before they discharge the individuals treated for suicidality. In the meantime I hope that continuing to teach professional education classes in Treatment of Suicidality will bring some pressure to bear on both civilian and military hospital administrations. The therapists who receive training in the JSP3© protocol have been excited about its success and have begun the process for their suicidal clients. Hopefully the hospitals will follow suit and realize that if nothing else they can reduce their liability by providing this safety net for their patients. The Jensen Suicide Prevention Peer Protocol© is a structured way to keep the suicidal person alive until they can retrain their brain and establish new meaning in life. It’s simple and it’s saving lives every day. However, when I was fighting to stay alive every day for 24 years, I never dreamt that it would be my friends who would give me the platform to transform my life. I spent decades in stigma, silence, and shame dogged by self-destructive thoughts I could not understand. I did not know how to live. Eventually I told the right people and they began a cascade of new beginnings – a new way of helping a suicidal person and a new way for the suicidal person to help themselves. I’m still in touch with my entire support team. We talk and have lunch regularly, still solving problems for each other. We’ve shared births, deaths, cancer, disaster, plane crashes, weddings, divorces, and continuous triumph. What we began together became an enduring reciprocal coalition. I would never believe at any time during those troublesome and desperately confusing suicidal years that I would be telling this story today – or that the same wonderful people who supported me then still support me now.

This morning I awoke thinking about retirement and how my “retirement” has been the very opposite of what I originally imagined. Here I am now retiring from another position in my life, the directorship of The Soldiers Project WA, only to embark on another mission which I believe has been providentially bestowed on me, the directorship of The Jensen Suicide Prevention Peer Protocol, The JSP3©. As I move forward I want to thank you for believing in me and not judging me when I admitted suicidal thoughts.  In “Just Because You’re Suicidal Doesn’t Mean You’re Crazy”, I reveal suicidality is a coping mechanism that began as a way to deal with untenable, seemingly unsolvable problems early in life. That helplessness early on leads eventually to hopelessness as life continues, as life inevitably does, to present a procession of difficult challenges. When feeling desperate and in pain, I have made the mistake of revealing suicidal thoughts to a number of my doctors. Not knowing that suicidal thoughts are merely cautionary road signs indicating a mounting problem in need of identification and resolution, those doctors have deserted me with a curt conclusion and a quick fix prescription. The last doctor got up, opened the exam room door, quickly handed me a prescription for an antidepressant and said, “I’m sorry you are having such a hard time. Good luck”. I imagine he leaped to the judgment that I was trying to manipulate him somehow. Perhaps he noticed I’m in recovery from alcohol and drug addiction since 1985, he suspected I was trolling for pain meds.  Many reasons run through my brain as I sit in the exam room chair after a doctor has “escaped” from my revelation. Doctors seem less afraid of virulent contagion than of a patient revealing suicidality. Each time this happens I ask myself, “Why did I let that slip out?” Docs never stick around long enough for me to explain what suicidal thoughts mean. I’ve come to understand that suicidal thoughts are simply caution signs that I need help identifying a problem and finding a solution. I’m usually in the doctor’s office consulting them to solve that problem. Reminding myself out loud of that urgency involves acknowledging my re-emerging suicidal thoughts. But I am no longer afraid of those thoughts. I know what they mean, how they got started and why that unconscious automatic neural pathway that is suicidality is still not fully extinguished and probably never will be. As yet, I may be the only one that understands the suicidal neural pathway. I am trying to disseminate the information to the world. But not understanding the psychobiology of suicide as described in my book, is the reason most are terrified of suicidal thoughts and panic at the mention of them. Consequently the many suicidal millions keep quiet. We carefully shelter our thoughts protecting doctors from our inner landscape, not generally for their benefit but more pointedly for our own. We have had our fill of judgment. Doctors are not unlike the general public in that what they don’t know about suicidality can fill volumes. Unfortunately no voluminous instructions exist for these situations, so they, like the general public, cannot truly be blamed. Filling those critically needed volumes is one of my tasks as a patient, a suicidologist, and a person with a long history of both active and nonactive suicidality. It is from individuals like me that you and your colleagues can learn about suicidality and how to deal with it. I encourage you to let your colleagues know that there is a nonpharmaceutical method of recovery using specific support from trusted educated peers. It is outlined in my book and on my website (http://www.jsp3.org) and will be feathered out in more detail in future publications. In my current book, “Just Because You’re Suicidal Doesn’t Mean You’re Crazy: The Psychobiology of Suicide”, the explanation for undulating long term suicidal thoughts and plans frees readers from the panic that is engendered by ignorance of the psychobiology of suicide. Studies conducted by intrigued researchers, books written by survivors, stories told by individuals with schizophrenia or bipolar disorder, and websites published by suicide prevention alliances conclude that suicidal individuals are each and every one mentally ill and emotionally unstable. The truth is most suicidal individuals are successfully employed with deep familial and community involvement. That is why many docs, friends and even closest loved ones refuse to believe that someone who usually acts happy and well-adjusted could possibly reveal alarming thoughts of self-destruction. The more successful and accomplished the suicidal person is the harder it is to believe they could be harboring suicidal thoughts. Therefore dismissal comes easy. Rationalization provides the more palatable belief that this person could not possibly be contrary to what they seem. This is the conspiracy of denial. Unlike other doctors I have seen, you abide by the enlightened adage…You can’t judge a book by its cover. You are a most remarkable healer and I have been so very fortunate to be under your compassionate care for almost three decades. I depend on being able to be honest with you and not have you panic or dismiss me. I know someday you also will retire. It will be one of the saddest days of my life. If you could do me one favor…start telling your colleagues what you’ve learned from me about suicidality so they won’t panic when their patients are honest about their suicidal thoughts. Tell them they are on the front lines of not only physical healing but they have the venue to provide inroads to psychological healing as well. If you can impart to them the importance of not panicking at suicidality – but instead to be the purveyors of hope in explaining the psychobiology involved in it. In so doing, maybe someday they will approach your understanding and compassion. Gratefully, RJ