Safe U Corner of Healing
Hi there, congratulations : ) It seems that you have found your way to our secret hiding place. We created this corner so that you can take your time to heal from your pain and suffering and interact with us through our writings.
It is not easy to talk about your scars. So let us share our musings to get you started on the help-seeking journey.
These copyrighted resources have been painstakingly created by us at Safe U. We ask that you do not copy and paste without permission as it is plagiarism.
Please feel free to choose whatever you feel comfortable with. You don't have to agree with our methods to benefit. You direct your own path : )
Disclaimer:
The resources offer guidance and are not a substitute for professional help. At Safe U, we only act in good faith. We highly encourage you to exercise judgement and use these resources judiciously. You are welcome to contact us for advice.
Safe U will not be held responsible for all consequences, including any inappropriate usage and/or plaigarism resulting in harm.
If you find someone in danger of harming oneself or others, call ambulance 995 or convey person to IMH emergency or any A&E department.
If you are in a mental health crisis, please call IMH Mental Health Hotline at 6389 2222.
The Philosophy Of Our Services
The graceful and resilient butterfly is our totem and forms an integral part of our logo. It symbolises the arduous metamorphosis from a common catepillar to an exquisite and beautiful winged creature. Through our programmes, we facilitate a similar transformation where individuals in suicidal or mental distress are able to overcome adversity and fulfil their potential.
We hope our acts of kindness will be a light in the darkness and instill in them the courage and optimism to give life a second chance.
The Prequel
Before we proceed, please take time to read through our initiative's distinctive methods to improve help-seeking behaviour, alleviate psychological pain and enhance suicide prevention. These are meant to complement our services and provide a useful personal toolkit in times of need. We can assure you that they are different from what you have experienced anywhere in Singapore. If nothing has worked for you thus far, do give these methods a try.
Disclaimer: Please note that these methods are ONLY allowed for personal use. Commercial use or plaigarism of these materials will result in legal action.
The Tomato Emoji ๐
On 27 April 2024, The SAFE U Initiative officially adopted the tomato emoji ๐ as our universal help-seeking communication tool for persons in need and their family/friends. This is the first in Singapore and Asia!
What is it and why is it significant?
It is often a struggle for someone with mental health and/or suicidal issues to reach out and ask for help. This is because in addition to the fear of being judged, most people are not taught what to ask and how to say. The tomato emoji was first recommended as a signaling tool for help by Janina Scarlet, P.h.D, a clinical psychologist at the Center for Stress and Anxiety Management in San Diego, California.
Initiating and Receiving Help-Seeking Behaviour
The tomato emoji ๐ offers a simplified representation of mental health and/or suicidal problems while its red colour signifies urgency and an immediate call for help. It can not only be used by a distressed person to ask for help but it can also be helpful for family members and friends to reach out and intervene in a difficult time of one's life without being too intrusive (see reel for examples). Therefore, the tomato also symbolises love for others and stepping into a new phase of life.
While the tomato emoji ๐
is simple, it has the important function of initiating early help-seeking behaviour. This is the most difficult stage to achieve but it is also the most crucial step because initiation often results in a distressed person starting to access support networks and professional mental health care which leads to improved outcomes. Help-seeking doesn't have to be difficult if all one needs is a willingness to express oneself in a way which is comfortable and universal.
Self-Monitoring Tool & Precautionary Measure
If you still doubt whether it is useful, know that the tomato emoji ๐
offers a way for you to be develop awareness and monitor your emotional state. This allows you to take precautionary measures to regulate your emotions before things get worse and also provides a means for others to support you early before police intervention is necessary.
Everyone can play a part in preventing the loss of lives through spreading awareness of the tomato emoji ๐ as a life saving tool.
Start sharing and reposting our instagram reel and use it with any friends or family members who might need help. You might be surprised by how willing they will open up once they get the hang of it.
Be a lifesaver, embrace the tomato emoji ๐ and make help-seeking easy for all.
How do you react to someone offering help?
Simply use the tomato emoji ๐ as a reply to indicate that you need help now. You won't need to hesitate about how to reply and what to say. That's why there is a common saying that a picture is worth a thousand words. Unlike emotion-related emojis which explicitly display a sad, crying or frustrated face, there is no need to worry about how others will judge your emotions or unknowingly intrude into your personal space since the meaning is discreet and intentionally unobstructive. You get to communicate in a comfortable manner based on gentleness and consensual understanding.
How do you reach out to someone in need?
You can use the tomato emoji ๐
to ask if someone is feeling down, distressed or even suicidal. This removes the need to ask sensitive questions which may trigger a negative response. Similar to receiving help, it helps to mutually agree on the use of the tomato emoji ๐
between both parties before the start of everything. Your help doesn't need to be a serious talk or a particular intervening act. It can be as simple as meeting for food and using it as an opportunity to informally offer help.
* The use of the tomato emoji ๐ is based on mutual trust so please use it ONLY when you really need help.
Safe U Approach to Emotional Regulation & Maintenance ยฉ
We have made it easy for you. Just follow our approach to get started on your journey on attaining self-control over your emotions. We have divided our approach into 2 sections:
1. How to handle emotional discomfort & pain with grace? Use our ABC and 123 methods. The latter includes our Safe U 3-Step Acupressure Emotional First Aid for Psychache.
2. How do you deal with โreboundโ effects? Use the DEF and Standardised Finger-Grip methods.
*A gentle minder that these materials are copyrighted and only available for personal use. Plaigarism results in severe consequences for violators.*
How to Handle Emotional Discomfort & Pain With Grace?
You can begin the healing process with steps as simple as ABC and 123.
A : Affirmations --> Challenging negative thoughts and beliefs and replacing them with positive ones. Our Safe U Affirmation is an example to help you get started.
B: Breathing & Beats --> Physical self-comfort by focusing on how you feel as you breathe in and out while slowing your cardiac beating rate by placing both hands on your heart (The Hands on Heart Technique)
C: Cycling back and forth & Closure at any level--> Oscillating your attention between two self-identified areas of your body. One being an area of emotional pain and the other, an area of relative calmness or relaxation. The aim is to shift your focus back and forth between these areas as if cycling in a loop or pendulating. The aim is to find a balance between emotional comfort and discomfort. (Pendulation)
To break the cycle of emotional pain, it can be important to achieve closure so that it does not become a constant point of trigger. In this context, closure doesn't mean that you get an answer that solves everything. It pertains more to making peace with yourself and the situation you are in. We advocate having some form of closure to help you cope better and using that as an impetus and starting point to heal and move forward in life. (Closure at any level)
Not ready to face your emotions yet?
Fret not, our Safe U 3-Step Acupressure for Emotional First Aid for Psychache ยฉ can help manage your pain in acute situations without requiring re-exposure to discomfort and potentially overwhelming sensations.
This can be achieved through acupressure on the following 3 body points.
1. Head: Between your eye brows (Yintang ๅฐๅ ๏ผ
2. Chest: Between your nipples (Danzhong ่ปไธญ)
3. Wrist: Three fingers down from middle of wrist crease (Neiguan ๅ
ๅ
ณ๏ผ
It is as simple as following 1, 2 and 3 to calm your mind, heart and gut. These regions are often where physical symptoms of emotional discomfort manifest such as headaches and sensitivity to stimuli, palpitations and chest tightness, stomachache and diarrhoea.
Once you are ready, move back to ABC. You can also try both sets of exercises at the same time. The more you practise, the more you achieve self-control over your emotions.
The Safe U Affirmation
โThe More I Feel,
The More I Healโ
Step1: Try the above affirmation when you are experiencing anixety or distress. Sit or lie down in a comfortable position. Close your eyes and focus on your breathing.
Step 2: As you breathe in, say the affirmation silently in your mind and visualise it filling and healing your body.
Step 3: When you breathe out, say it aloud and visualise your negative thoughts and feelings leaving your body with each breath.
Step 4: Repeat the above steps for 5 minutes or until you feel better, whichever comes first.
Why should you try it?
An affirmation is a brief statement used to enforce positive thinking through repetition. This helps to challenge negative thoughts and beliefs and replace them with a more positive inner voice. There are some studies which suggest that affirmations can help improve mood, relieve stress and promote positive behavioural change. However, they work better with good self-esteem so it is essential to work on your confidence too.
Affirmations are usually positively framed and goal-specific. For example, our recommended affirmation 'The More I Feel, The More I Heal' focuses on the goal of healing from emotional pain and is phrased positively (e.g., instead of โThe More I Feel, The More I Feel Less Pain'). You can start off by practising with our affirmation to familiarise with the breathing steps required. Once you are ready, feel free to personalise your affirmation according to a goal you have in mind.
In our affirmation, we relate feeling to healing because experiencing the emotion pain is necessary for us to release it. Repressing it often intensifies our fight or flight response. On the other hand, healing doesn't mean we need to confront our emotional pain full on. It can be very uncomfortable. Using methods such as affirmations help us to process the emotional pain just as it swells up and before it turns into full on distress and anxiety. Such a subtle and gentle approach can gradually reduce the pain and help us heal with regular practice. It is also a good introductory method to a more advanced techniques which we will introduce next.
The Hands on Heart Technique
After trying our affirmation of 'The More I Feel, The More I Heal', you can move on to the Hands on Heart Technique. This technique simulates holding the hand on a loved one and helps to reduce cortisol, which is our body's main stress hormone. It it thus meant to combat the sensations of stress and also help develop the habit of physically comforting oneself during times of need.
There are a few variations to the technique but the easiest to remember is to put two hands on your heart and enjoy the comforting feeling as you breathe in and out. Other variations you can try out include putting one hand on your heart and the other hand on your belly or cheek. It is not compulsory to incorporate rubbing or circular motions on your heart but some people report feeling even better doing so.
It is ok to enjoy the feeling as long as you want or to do the technique a few times a day. It is important to use affirmations and/or the Hands on Heart Technique as part of your daily routine so that you will not forget when you need them.
One may not always receive comfort from others but comfort can also come from self compassion through supportive touch.
The steps are as follows:
1. During stressful situations, take three deep breaths first
2. Place two hands on your heart. Feel the warmth and delicate pressure.
3. Feel the rise and fall of your chest as you breathe in and out.
4. You may move your hand in a rubbing or circular motion if it makes you feel better.
5. Keep the feeling as long as you want. Repeat as required throughout the day.
Pendulation
Seeking a balance between emotional comfort and discomfort can be helpful after first trying out positive affirmations and physical self-comfort. Pendulation simply refers to moving back and forth between two areas or states. In this technique, we are interested in developing an awareness that emotions are transient and move between comfortable and uncomfortable states. We are acknowledging and noticing how our feelings change in a non-judgmental way and doing so in a gentle and gradual manner which promotes healing and avoids overwhelming pain or anxiety. Follow the steps below.
Step 1: Identifying the area of distress
Locate the area in your body where your distress or emotional pain is. Focus on the experience and if it gets overwhelming, move on to the edges of the sensation where the intensity is lesser.
Step 2: Locating a body area which feels totally different
This area should be different from Step 1 and allows you to feel relatively calmer and grounded. Dwell on this experience for some time and inmerse yourself with the pleasant sensations you may encounter.
Step 3: Create a mental imagery for pendulation
Close your eyes and form a mental image of these 2 areas. They could be circles with different colours. Put your hand on the 'pain' area, dwell on it for a few moments before slowly moving your hand to the 'calm' area. Follow back and forth until you feel better.
Step 4: Titration while pendulating
Always start off slow and work with small 'amounts' of pain which you can handle then work up to greater 'amounts' as you slowly find balance between 'comfort' and 'discomfort'. Titration means taking things slowly to prevent one from being overwhelmed.
Step 5: Expand resourced states
The 'calm' area is an example of a resourced state. You can create more states for pendulation by incorporating body sensations such as the grounded feeling of your feet on the floor or happy feelings associated with pleasant memories. More resources allow you to cope flexibly.
Closure at Any Level
One reason why our emotions keep coming up is because we are triggered by a lack of closure. There is no finality to a situation which affected us deeply. Seeking closure doesn't mean we get the answers we want. It just means we focus on overcoming the feelings of anger, sadness, confusion, guilt, and hurt that have been holding us back from moving forward. Closure is a starting point.
Closure may not always be possible when the experience is highly traumatic or if the other person is no longer around. The key to healing and progress is closure for yourself and at any level:
1) Accept the situation as it is: It is often not possible to reverse a situation because the impact is permanent or people have moved on. We may even have flashbacks or intrusive thoughts because the outcome is unacceptable to us and we subconsciously wished to go back and change it. Acceptance frees us from being trapped in a time loop. We make the conscious effort to compartmentalise the past as separate from our present and future. This is an achievable and rational approach which most people can do. Take your time to accept a situation on your own terms, no one is rushing you.
2) Forgive yourself for being hurt, sad or anger: Closure is almost always for yourself rather than for other prople. Even if you are the one being hurt and you feel that the person hurting you should be seeking your forgiveness, understand that the process of forgiveness still starts with yourself. When you forgive yourself, you are less likely to internalise these negative emotions. We sometimes hurt others even though it is not our intention. How do we deal with the guilt without engaging your ego defensive mechanisms? You don't punish yourself or attribute blame to others, neither of which are healthy. You forgive yourself so you don't become a version of yourself that you cannot reconcile with. Closure here means reconciling with who you wish to be.
3) Write a letter to the person you need closure from, even if you wouldn't send it: You may feel strong emotions when asked to confront the person causing you emotional pain. Writing your thoughts down helps you to rationalise and make sense of what is causing your pain. If you can send a letter or meet the person, do so because it can be a form of cathartic release. If you can't, reading the letter yourself can make you feel better too. The aim is not to write a letter of abuse to vent your frustration or anger but a letter focused on kindness and empathy, for example, understanding why your ex chose to leave or why things happened unexpectedly despite everyone's best intentions. The letter can be seen as a farewell letter to the person who suffered and written as the person who is reviewing the situation retrospectively and comforting oneself with the kindest of intentions.
4) Imptly, take your time to process your emotions rather than suppressing them: The emotions we feel only get stronger the more we suppress them ('The Rebound Effect'). As you may have learnt from the other techniques shown above, it takes practice and time to manage our emotions with grace. However, it is also not as hard as you imagine it to be. Be patient with yourself as you process your emotions and understand that closure isn't a magic cure for everything. The key is processing emotions in line with achieving whatever level of closure is possible in your situation.
In most cases, partial closure is better than no closure or obsession with complete closure. Most closures ain't possible due to a multitude of reasons beyond our control. Time can be the best healer when you are able to see closure as a self-process independent of how others respond. Letting go and relinquishing our need to control over how negativity affects our lives are often understated factors that help in closure. The more we focus on our internal locus of control, the lesser things seem unpredictable and out of control. It is ok to cry and release your emotions if you have a moment of weakness.
โWe are only human and that's why we have scars. โ
The Safe U 3-Step Acupressure Emotional First Aid for Psychache ยฉ
What is it?
While distress tolerance skills can take time to learn and are usually reserved only for emotional crises, it is important to acquire emotional regulatory skills which can be used in everyday situations and crisis episodes. The Safe U 3-step Acupressure Emotional First aid for Psychache ยฉ is based on the principles of Traditional Chinese Medicine (TCM). It can be used as a form of self-help or administered to someone who needs emotional assistance. While it does not replace psychological interventions such as distress tolerance skills, it is meant to be complementary and has a low threshold for usage to facilitate easy adoption.
Step 1: Yintang (ๅฐๅ ๏ผ
Our acupressure first aid focuses on the mind, chest and gut. The first acupoint is the Yintang (ๅฐๅ ) or the Hall of Impression which is located between the brows. Gently massaging the Yintang with your thumb can relax the sympathetic nervous system or 'fight or flight response'. You will feel a sense of calmness, relief of headache and sleepiness after 2-3 minutes of repetition. Repeat as required. Yintang is thus also commonly known as a point of mental clarity and often culturally associated with higher consciousness.
Step 2: Danzhong (่ปไธญ)
The second acupoint is the Danzhong (่ปไธญ) which is located at the midpoint between the two nipples. Use the palm of your hand to apply firm pressure and rub downwards towards the belly button. Repeat for 20 times or until you feel better. You should experience decreased chest palpitations and alleviation of chest discomfort. Chest discomfort is suggestive of emotional imbalance and stimulating the Danzhong facilitates the restoration of balance through release of unhealthy emotions. It is thus also given the name of 'happy acupoint'. Spiritually, it promotes self love and awareness of self-harm.
Step 3: Neiguan (ๅ ๅ ณ๏ผ
The third acupoint is the Neiguan (ๅ ๅ ณ) which is located three fingers below the midpoint of the wrist crease between the two tendons. Use your thumb to press down firmly on the Neiguan and rotate in circles for 2-3 minutes. Repeat as required. It relieves anxiety-related gut discomfort such as nausea and vomiting. Neiguan or Inner Gate regulates connection between the heart and the external world. Together with Danzhong, it steadies the heart and relieves symptoms of anxiety, depression and irritability. Neiguan is also especially useful for treating people with PTSD by modulating specific brain regions involved in trauma processing.
How to perform acupressure accurately
Position yourself comfortably, relax your muscles and take a few deep breaths. Start from the Yintang, followed by the Danzhong and then the Neiguan. It is necessary to press firmly regardless if you are using your thumb or rubbing. Do not press so hard until it causes pain and discomfort. There will be tenderness and aching but it should not be painful. Stop immediately if you experience pain.
Be careful not to remove your thumb (or the palm of your hand) from the skin while massaging the point. Focus on massaging. It may help to close your eyes and take deep breaths while focusing.
Precautions
If you have any open wounds, inflamed and swollen areas, bruises or varicose veins, it is fine to omit that specific acupoint and proceed with the other points.
If you have an ongoing mental health condition, it is essential to keep taking your pills as acupressure is meant to be a complementary treatment. It is also recommended that you learn distress tolerance skills which could help you through a crisis episode.
In any case, it is always helpful to have friends and family members around during episodes of distress. They can listen to your troubles and practise different emotional first aid and distress tolerance skills together with you. The more you practise, the easier it is for you handle these situations with finesse and composure.
Why is our 3-Step Acupressure Emotional First Aid useful?
The Safe U 3-step Acupressure Emotional First aid for Psychache ยฉ functions as an emergency 'band-aid' when you experience moments of mental tension and works even better when used with distress tolerance skills during emotional crises. Importantly, it works even if you have distress intolerant beliefs such as 'I can't cope with this' and 'This feeling will never go away'. These beliefs can lead to escape behaviours such as self-harm. Interestingly, the Danzhong acupoint promotes self-care and awareness of self-harm, thereby averting the use of self-injurious behaviour as a maladaptive coping behaviour.
One of the effective methods used in distress tolerance skills involve tipping a person's face into cold water and holding one's breath briefly. The rationale is that this will trigger the mammalian diving reflex which causes the heart rate to decrease and the parasympathetic nervous system activated to induce relaxation. However, this method can be very initimdating and has a short-lived effect which needs to be followed up by distraction or problem-solving techniques. Additionally, this skill is unsuitable for individuals with a heart condition. The Danzhong and Neiguan acupoints can work together to calm the heart while Yintang can promote mental clarity and calmness. The latter helps with problem-solving and also reduces the need for distraction which when used too frequently, can inhibit our capacity to understand and grow from our feelings.
โไฝ ็็่ฆ๏ผไธไผๆฏไฝ ็ๅ
จ้จ๏ผไฝ ไธ็จๅชๆฏๅฟซไน๏ผไธ็จๅชๆฏ้พ่ฟใโ
โYour pain does not define you. You don't have to be only happy, you don't have to be only sad.โ
How do you deal with โreboundโ effects?
Try the DEF and Standardised Finger-Grip Methods
- Deliteralisation
- Emotional integrity
- Focused distraction
- Standardised Finger-Grip Method: Alleviates sadness, fear, anger, worry and nervousness while promoting calmness.
๐ * ๐ง * ๐ * ๐ฅบ * ๐ฐ => ๐ง๐ป
Deliteralisation
When we try to address our negative thoughts and emotions, the distressing symptoms we experience may seem to get worse at times before it eventually gets better. This is where other techniques can come in handy to ameliorate the situation. Deliteralisation refers to the process of reducing the literal quality of thoughts so that a person is seeing thoughts as just thoughts, and not the absolute truth and reality. There are a number of ways deliteralisation can be achieved but we will focus on 3 simple exercises here.
1) Milk, milk, milk exercise
This is a word repetition exercise which was first used by British Psychologist Edward Titchener in 1916 to remove the emotional discomfort and believability of certain words or thoughts that cause that discomfort. We often believe and give personal meaning to our words and thoughts, thus detaching from their symbolic meaning or โcontentโ can provide relief.
Start by thinking of all the characteristics you can conjure when you think about milk such as white, creamy, frothy etc etc. Then verbalise the word โmilk' for 1 minute. At the end of that exercise, you may realise that you have lost all the associations with โmilk' and the word has become a meaningless series of sounds.
Next, bring up the thought that is causing you discomfort, rate it from 0-10 with 0 being no discomfort and 10 being the worst discomfort you experienced. Give the thought a word to represent it. Characterise it in your mind before verbalising it for 1 minute. If the content is still there, repeat again for another 1 minute. By now, the rating of discomfort will have gone down compared to the beginning of the exercise. Repeat as and when required.
2) โIm having the thought...' exercise
This is an exercise that focuses on distancing onself from negative thoughts and feelings and is particularly useful when you are overwhelmed by a distressing thought. First start by bringing the thought to mind and repeat it loudly a few times. For example, โI am uselessโ for 3 times. Secondly, add the phrase โI'm having the thought' such that it become โI'm having the thought that I am useless' and repeat it for another 5 times. Thirdly, repeat the phrase โI notice that I'm having the thought that I am useless' for 7 times. As you work on the exercise, you will realise that you are steadily distancing yourself from your thoughts and you are not โfused' to the discomfort that the thoughts are causing. You will also start to see things more positively with practice.
3) The pop-up mind technique
For this technique, close your eyes and imagine your negative or unwanted thoughts as an internet pop-up ad. You have the option to disengage and close the ad. Thinking is seen as an automatic process which delivers information to your awareness but you do not have to engage with the content of the thought. Simulate the process of closing the ad with a mouse click. Open your eyes and move your attention to something else in the room or to something that you needed to do before the thought distracted you. The purpose of the technique is to show that you have control over your thoughts as you can disengage as you and when required. Always remember that you are not your thoughts.
We are always observing our thoughts rather than being entangled by them
Emotional integrity
When we try to regulate our emotions, one of the main challenges is maintaining a state of inner balance regardless of the situation and whoever we meet. Emotional integrity can be defined simply as a state of emotional completeness or maintaining an authentic self. This requires acknowledging one's feelings, wants and desires without judgement and the need for societal validation. These attributes may seem difficult given that we don't exist alone but it is mostly a matter of perception.
We don't matter as much to others as we believe it to be.
We are only responsible for ourselves and nothing more. Consider these points to maintain your own emotional integrity:
1) Emotions are our full responsibility. Whether you feel sad, angry or jealous is a product of your response to a situation which will not change for you or anyone for that matter. Is it wrong to experience these negative emotions then? No, it is natural to have them. It is only a problem when we hold on to them too long. The key is to observe them and let them float away. If you don't have a bottle of bubble water, just imagine yourself blowing bubbles and the discomfort floating away, bursting and disappearing. This is also a philosophy: Impermanence is a fact of life. Nothing, even emotional suffering, lasts forever.
2. Maintaining honesty with yourself. If you constantly find yourself in situations which bring you emotional discomfort or pain, the environment probably played a major part in perpetuating your negative emotions. Escaping from such an environmeny may not always be possible but this is always something you can do to protect your emotional integrity. A powerful tool is saying โno' to harmful situations instead of compromising your own values and beliefs. Suffering on your own just makes things intolerable. It is not as hard as it seems to reject anything or anyone who infringes on your emotional integrity. Often, the effect of saying โno' can be so catharthic that your distress subsides drastically.
Similarly, expressive suppression should be avoided. It is defined as the deliberate hiding and inhibition of ongoing emotion-expressive behaviour. Since it works late after a emotional response has been elicited, there is a greater requirement on one's cognitive resources to effortfully manage negative emotions as they occur repeatedly.
The constant need to maintain a โfacadeโ creates a widening gap between one's inner experience and outer expression, thus compromising emotional integrity. When we feel inauthentic, we are less able to build meaningful relationships which can help provide a valuable source of social support. With prolonged expressive suppression, we might even feel a disconnect or dissociation from ourselves and the world around us.
If you need to express your emotions privately, excuse yourself for a few minutes and go to a place you feel comfortable to compose yourself. If you are unable to excuse yourself, you can try the fist clenching technique. Clench your left fist while taking slow deep breaths helps to calm your mind and reduce anxiety. Clench your right fist and breathe in the same manner as above to boost feelings of happiness and confidence. Release your fist as you feel better or continue as long as you need.
3) Self-compassion and empathy for others. When we experience negative thoughts and feelings, it is not uncommon to feel guilty for having a dark side. However, most people often oscillate between light and darkness. That you are even thinking that you have a dark side already shows that you have more light in you than darkness. When bad things happen to us, these events are usually out of our control and unpreventable. It is not our fault and therefore self-compassion helps us to put our thoughts and feelings into perspective.
Self-compassion facilitates empathy for others, even for those who hurt us badly. Yes, you may not be able to forgive them fully but empathy lessens the pain with time. Importantly, maintaining a good self identity and better relationships help with our emotional integrity and mental wellness. Forgiveness, for example, is one of the most effective ways to lessen the burden of emotional pain. This is because forgiveness is deeper than acceptance on an emotional level since it requires being vulnerable but still practising magnanimity and extending kindness to others. However, please know that you are not condoning the hurtful act(s). Instead, you are not letting bitterness become a part of your emotional structure and this allows you to move forward and become the person you want to be. This is the greatest gift you can give yourself.
โHonesty is grounded in humility and indeed in humiliation, and in admitting exactly where we are powerless.โ
Focused distraction
Distraction refers to the process of diverting one's attention from the affective aspects of a situation. It belongs to a group of antecedent-focused strategies which occur before the initiation of an emotional response as opposed to response-focused strategies which occur after the emotional response. Antecedent-focused strategies have so far been found to be effective in emotional regulation than response-focused strategies. Importantly, distraction regulates low- and high-intensity negative emotions more effectively and at an earlier regulatory phase compared to other methods.
How does focused distraction help?
1) The key is in the word โfocusedโ. It requires focus on a specific and usually meaningful activity to divert one's attention from the distressing stimulus. This is different from letting our mind wander aimlessly and shutting down our emotions as a form of avoidance mechanism. Avoidance is unhealthy in the long-term since we never learnt to cope with our emotions. Examples of โfocusedโ activities include reading a book, listening to music or engaging in physicial exercise and sports. It is not advisable to scroll on social media as a distraction as there may be unregulated content which may further exacerbate your negative emotions.
2) Creating breathing and thinking space by allowing you to move away from distressing stimuli temporarily and adjust yourself emotionally so that you won't get overwhelmed. Once the emotional intensity goes down, you are in a better state to think and appraise the situation which evoked your emotions. Additionally, we stop the chain of negative thoughts which tend to emerge together with the feelings. When our feelings and thoughts get congested, we usually do not react well to the situation. We engage in behaviour or actions which may further worsen our emotions, for example, drinking alcohol or saying things we will regret later.
3) Temporary and judicious use. Focused distractions can be highly effective in acute situations which is why they are suitable for maintenance and rebound prevention. However, it is still a temporary solution and offers more of a strategic tool. We may have important responsibilities which need to be carried out immediately so engaging in distraction can be counterproductive. One way you can use focused distractions judiciously is to reserve them for high-intensity emotional regulation while another antecedent-focused strategy such as cognitive reappraisal can be used for low-intensity emotional regulation.
Cognitive reappraisal relates to the re-intepretation of an emotionally stimulating event so that our response is altered. For example, a relationship breakup can elicit feelings of sadness and anger which can sometimes be very distressing. We can re-interpret the relationship breakup as an opportunity to assess whether there had been incompatibility issues from the start. It is often painful to lose someone but not so much when we realise it is not anyone's fault but the dynamics of the relationship itself.
By using different antecedent-focused strateges in combination with focused distraction, we are more likely to achieve increasingly higher levels of emotional regulation. It is important to keep practising different regulatory skills on a daily basis so that your mind and body can get used to the effects. It will eventually become more like a reflex which automatically comes out whenever your emotions flucutate.
โAll profound distraction opens certain doors. You have to allow yourself to be distracted when you are unable to concentrate."
- Julio Cortรกzar
The Standardised Finger-Grip Method
๐ * ๐ง * ๐ * ๐ฅบ * ๐ฐ => ๐ง๐ป
What is it?
A common stress relief and healing technique which is used to remove blockage in โenergy flowโ in the body caused by intensified negative emotions. It has strong cultural roots to Indonesia and Japan and is commonly used as a low-cost mental health tool when access to psychological help is difficult. There are a few variations of the method and we have unified them into a general approach. We are not concerned with the arguments for and against energy healing. Instead, we focus here on the subjective experiences of the individual and self-rated changes in emotional intensity
Step 1: Grasp your fingers
One finger at a time, starting from the thumb to the little finger. Take your time and ensure that you form a firm grasp. Finger grasps work particularly well for young children and teens to provide a sense of control during times of uncertainty.
Step 2: Hold on for 2 minutes
Hold on firmly with a light pressure until you feel a pulsation in your finger. Keep holding for 2 minutes or if you are in a rush, at least a minimum of 1 minute. The pulsation is an indication that the โenergyโ is flowing again and negative emotions are being released. The finger-grip method also functions as a form of acupressure, so the alleviation of symptoms could be interpreted as good โenergyโ flow rather than an actual observable phenomenon
The release of negative emotions does not mean that there is total elimination but rather, a balance is achieved between positive and negative emotional states. This is consistent with the Eastern medical philosophy of Yin-Yang.
Continued . . .
Step 3: Power of your palm
Think of your palm as a master reset button which you press after restoring balance to your emotions. By putting your thumb in the palm of your hand and pressing lightly, you go back to a state of calmness. Does it matter which hand you use when you hold your fingers and press your palm? No, it doesn't matter but we can make a suggestion that you allow your left hand to be manipulated as it links directly to your heart.
Step 4: Mix and match
If you don't have time to complete the exercise with all your fingers, simply choose the finger that represents the emotion you are experiencing right now. However, we do recommend that you trying out the method in full to achieve the full benefits. Another reason for doing the full method is that the fingers representing worry and sadness are swapped in the Indonesian and Japanese versions of this method. By doing all, you don't have to remember which is which and you also target mixed emotions more efficiently. If you are confused, just grasp the thumb and ring fingers when you are worried and/or sad.
Step 5: Breathe deeply
The finger-grip method is not typically complete without incorporating deep breathing exercises. Why is deep breathing so important? Well, it activates the parasympathetic system which lowers your blood pressure and heart rate. It can also alleviate depression, anxiety and stress symptoms. By adding the finger-grip to deep breathing, you set the intention of releasing the emotion(s) you have identified.
โEmotion can be the enemy, if you give into your emotion, you lose yourself. You must be at one with your emotions, because the body always follows the mind.โ
- Bruce Lee
The Safe U Barrier-Focused Suicide Prevention Procedure ยฉ
Disclaimer:
The suicide prevention procedure does not substitute for professional help. The information is provided here with the best of intentions and does not constitute any form of treatment or service agreement with the initiative. The SAFE U Initiative will not be held responsible for all consequences, including that caused by misuse and/or plaigarism by other parties. We highly encourage individuals to seek help early regardless of their degree of suicidality.
If you are already planning, rehearsing and/or attempting suicide imminently, please seek help immediately.
Please note that suicidality can have a number of underlying reasons which need to be addressed in a professional context. The procedure is only meant to help you cope as effectively as humanely possible so that you have a second chance at re-evaluating life and death decisions.
Introduction
Early suicide prevention for the individual can be achieved by putting a distance between oneself and suicidal behaviour. The term โsuicide barrier' was initially used to describe a physical structure used to deter people from attempting suicide by jumping from height. However, it can also be conceptualised as a series of thoughts, actions and behaviours which may prevent suicide ideation or mitigate suicide advancement from ideation to attempt. Using the interpersonal theory of suicide and selected psychodynamic principles as our theoretical basis, we were able to identify specific โbarriers' which may increase physical and psychological distance to suicide. This allows more time for an individual to seek help and receive professional support.
This section is more detailed and lengthy as it is meant to be a mixture of psychoeducation, bibliotherapy and aversive conditioning. You may also find it as a useful focused distraction when you have suicidal thoughts.
1st Barrier: Buffering Suicidal Ideation
It is important to acknowledge and accept your suicidal thoughts rather than controlling them. When we try to control these thoughts, a rebound effect usually occurs which increases their intensity and frequency. For example, thought control using punishment by shouting, getting angry or slapping oneself often results in shame and feelings of guilt while worrying about other negative thoughts instead of suicidal thoughts can worsen anxiety symptoms. Both punishment and worrying can increase suicide ideation by denying active coping. A healthier strategy is focused distraction which involves temporarily redirecting your attention to a pleasant thought or activity (e.g., a happy childhood memory or upcoming overseas trip). This is different from unfocused distraction which is unhealthy due to experiential avoidance.
In psychodynamic theory, individuals may experience a form of suicidal thought known as suicidal fantasy or suicidal daydreaming. This can involve thinking about suicide as an act of courage and hoping for relief from emotional or physical pain. It can also be as vivid and intense as mentally rehearsing how to go through a suicide attempt. For example, imagining jumping off a building or overdosing on sleeping pills may actually account for many aborted suicide attempts. Such daydreaming may extend to previous suicide attempts with each attempt providing vivid imagery and thoughts which become easily triggered even in the absence of negative events. It is also common to daydream about the aftermath of suicide. For example, seeking revenge by dreaming about how people who hurt them deeply will react to their suicide and imagining them bursting into tears and saying that they wish they had treated the suicidal person better. Or longing for love by thinking about how their funeral will be like and how their loved ones will start to remember him/her life.
As the boundary between fantasy and reality becomes blurred, psychodynamics suggest that these unacceptable ideas and feelings must be expelled from consciousness by primitive physical defences. The easiest way is by physical action such as through the act of suicide, thus making previous suicide attempts one of the highest risk factors for a future suicide atempt. At the core of these suicidal fantasies, however, is a genuine need for change in one's life. There is no need to feel shame for harbouring these fantasies as it is more common than you think. Work on the underlying issues behind these suicidal fantasies. For example, choosing forgiveness over revenge when it comes to people who hurt you badly. Forgiveness does not mean you forget the hurt you have felt. Instead, it is about practising self-compassion and forgiving yourself for getting hurt and sparing yourself the emotional pain. You can practise a detailed 10-step exercise on forgiveness here.
Although you may experience temporary relief from negative mood after suicidal thoughts, it is nothing more than a poisoned chalice. According to one study, almost 75% of suicidal individuals report feeling a sense of comfort. However, the shift from negative from positive mood can be reinforcing and lead to persistent suicidal thinking. In suicidal fantasies, there is an increase in short-term positive affect at the expense of longer term increase in suicidality and ability to enage in suicidal behaviour. It is crucial to avoid using suicidal ideation as a coping mechanism as it is likely to lead to deep harm and death. You are also denying yourself the opportunity to learn about your emotions, which for some people are lacking due to childhood emotional neglect. You can understand more about emotions and how to manage them at MindSG by HealthHub.
If you are still having difficulty with your suicidal thoughts, consider grounding techniques such as the five senses exercise, mental math and stress ball. The five senses exercise brings you back to the here and now by asking you to identify five things you can see, four things you can physically feel, three things you can hear, two things you can smell, and one thing you can taste. Mental health can be as simple as counting back from 100 in intervals of 3 while squeezing a stress ball can relieve anxiety and keep you in the present.
Remember that you don't always have to be alone. Connect with a loved one using the tomato emoji ๐
or phrases such as โIโm having some dark thoughts and I donโt want to be alone right now. Can you keep me company?'. Even if you are alone and have limited support, a change in environment such as going to a library, park or cafe can provide a welcome distraction and increase feelings of connectiness even if you are not talking to anyone in particular.
2nd Barrier: Comfort Expressing Emotions
If your suicidal ideation persists after the 1st barrier, developing comfort expressing emotions is an important next step. Comfort expressing emotions is defined as the extent to which individuals are comfortable with the external display and verbal expression of their emotions to others. The healthy externalisation of emotions inhibits the avoidance and internalisation of emotions which can lead to social withdrawal as well as depressive and anxiety symptoms. According to Sigmund Freud, suicide results from internalised anger which was originally directed at someone close to the person. The internalisation causes the hated object to be incorporated within the self, causing suicide and other acts of self-destruction since the self is attacked as if it was the object. Therefore, healthy externalisation or โemotional catharsis' by promoting comfort expressing emotions in a situationally acceptable manner is crucial.
In particular, comfort expressing sadness and happiness is associated with reduced suicide ideation through a decrease in thwarted belonginess (perceived disconnection with others) and perceived burdensomeness (belief that one is a burden and that one's death is worth more than one's life). Thwarted belonginess may be mitigated by comfort expressing emotions through increased feelings of connectedness and reciprocal care to others while perceived burdensomeness can be decreased when there are more opportunities to feel valued and needed in their relationships when individuals open up to their loved ones. These positive changes may in turn address hopelessness (โthis will never change') which is characteristic of a desire to suicide.
In Asian cultures, outward expression of emotions can be challenging. Thus, use a graduated approach by using journaling, drawing, singing or even crying and screaming in a safe place to facilitate emotional processing. When you are more comfortable, move on to a non-verbal method such as the tomato emoji. This often opens up opportunities for others to connect and engage with you. If you don't have someone to confide in, consider our Vent Buddies programme as a healthy and non-judgemental way of expressing suicidal thoughts and feelings.
When you are ready to express your emotions, start by challenging some misconceptions. Firstly, it is common for an individual to assume that others do not understand how one feels. Such an assumption is unhelpful as it hinders one from opening up. Note that while experiences can differ between people, the basic emotions of happiness, sadness, disgust, fear, surprise, and anger are universally experienced. They may not fully understand your experience but they can still empathise with how you feel. Secondly, challenge the myth that expressing your emotions makes you weaker and vulnerable. More often than not, you will find it more comfortable to people you can trust the most (best friend, a parent or sibling). You also get to select your own therapist or counselor nowadays. You have a choice and that empowers you. What weakens you is a fear to access your emotions. It might feel uncomfortable momentarily but you will feel liberated once you can identify and label the emotion.
Practising emotional labeling can attenuate the intensity of the emotion and is also the first step in re-attaching your emotions. Emotional detachment is often used as a coping mechanism to avoid or numb our feelings when experiencing stressful events. It can be thought of as a subconscious way of protecting ourselves but it can also lead to worry and anxiety as the reaction is contrary to social expectations (e.g., inability to feel sad after the death of a loved one). A life without emotions is a life of emptiness devoid of meaning and purpose. If you are looking forward to suicide as a solution, you are essentially living it already. It is not a blessed final anaesthesia either, as you will read later.
The key is to choose the kind of life you want for yourself rather than letting your emotions choose the life you will get. Whichever life you end up with, understand that both positive and negative emotions contribute to a well-rounded emotional experience. Happiness alone can lead to unrealistic expectations and diminishing positive returns. Conversely, expressing sadness is essential to promoting resilience and post-traumatic growth.
Learning how to respond to questions of โhow are you?' using indirect but succint expressions such as โI feel blue' and โI feel kinda off' can prevent resistance due to perceived vulnerability. The faster you open up, the less likely negative emotions will accumulate. However, remember that the aim is to promote the comfort of expressing emotions. Express when comfortable, express when ready. There is no time limit or pressure on you to talk, you can start by listening to what others have to share with you.
If you are the friend or family member of a suicidal individual, however, a more direct form of questioning such as โHow have things been for you recently?โ would be preferable. It is also advised to start off by sharing your thoughts and feelings first to encourage the individual to talk through mirroring. If there is still difficulty, don't force things. Try again at a later time and end the conversation using โIโm here to listen whenever you need me. No matter when or why. '
3rd Barrier: Overarousal and Constructive Aversion in Suicide Capability
Suicide capability consists of increased pain tolerance and fearlessness about death. While fearlessness about death is essential to enact lethal self-harm, studies have shown that there is no difference in fearlessness about death between ideators, planners and attempters. It is more accurate to consider fearlessness about death by suicide rather than death, the latter dealing more with the manner of death or what happens after death while the former deals with the process and the outcome (i.e., death).
Many individuals can possess a desire for suicide but ultimately do not attempt suicide because of its aversive nature. It is often an extremely painful process despite myths of painless methods. As you engage in suicidal behaviour, you might have realised that you become less fearful with more exposure to suicide. You might also have experimented with self-harm as a coping mechanism and developed a tolerance for pain. However, it still requires a considerable amount of energy and resolve to keep engaging in a potentially lethal behaviour. Overarousal states such as agitation (feeling restless and unease), insomnia and nightmares may provide the energy to complete these suicidal behaviours in individuals who already possess high levels of suicide capability (high fearlessness and high pain tolerance). Conversely, overarousal may have a protective function for those with low levels of suicide capability (low fearlessness and low pain tolerance).
If you identify with the high suicide capability group, you can manage these overarousal states to reduce precipitation of suicidal behaviours. For example, agitation can be managed by preventing overstimulation of your senses by moving to a quieter and dimmed place. Take a sit or lie down. Practise breathing deeply in through your nose and breathing out through your mouth x3 before reverting to your normal breathing rhythmn. If you still feel agitated, cool yourside down by putting your face in a bowl of cold water and hold your breath for 30 seconds. You can also choose to deplete the excess energy by doing intense exercises such as sprinting or jumping jacks until you feel tired. For insomnia, you can consider these 5 remedies from WebMD . For nightmares, take about 30 minutes before you sleep to journal and problem-solve your worries so that you won't take your worries to bed. It also helps to avoid alcohol and caffeinated beverages before sleep.
While we can modify the effects of fearlessness about suicide and pain tolerance on suicidal behaviour, directly managing these two constructs requires some ingenuity by creating constructive aversion towards suicide methods. We are not here to โscareโ people since loss framing doesn't always work well. More often than not, people are provided with incomplete or misguided information on the topic of suicide and such situations can lead to fatal outcomes. We are here to counter information asymmetry. It is our aim to do so by balancing the general reasons for living with specific reasons for not committing suicide.
The truth is, most people are afraid of suicide even if they have the desire and capability to carry out an attempt. It is estimated that more than 60% of suicidal individuals engage in some form of protective action once they commence a suicidal act. This is suggestive that suicide is a painful experience which gradually turns into fear. At the point of death, a suicidal individual is often filled with extreme agony and terror.
Unlike what you might have read elsewhere, there is no suicide that is painless. The most common suicide methods in Singapore are jumping, hanging and poisoning. All of them are excruciatingly painful. An individual jumping from height will first experience an unsettling sense of weightlessness which results in fear. You will start to regret but it is too late and the fear amplifies all the way until you hit the ground. Your organs and bones break instantaneously and blood splatters everywhere. You are not dead yet. You still have seconds to experience the worst pain of your life as your brain is still perceiving pain from your nerves. You die in extreme pain and horror or if you manage to survive, you will be disabled for life.
Hanging is also not simply death by passing out and dying immediately. Instead, you first experience an inability to breathe followed by the rope cutting into your neck. You will then feel the blood rushing to the head as if it is going to explode. Your neck begins to break under your weight . You are still conscious but you can no longer move. You die slowly and painfully by asphyxiation. Additionally, poisoning by overdosing on medication such as sleeping pills are absolutely NOT painless even though they are meant to help you sleep. When you overdose on sleeping pills, you start to feel dizzy while your stomach starts to develop a deep burning sensation. You dose off but wake up intermittently due to pain and vomiting. This continues for minutes until the pills take full effect. You lose consciousness and die because of vomitus causing asphyxiation. Other so called painless methods such as gassing also have terrible consequences. Gassing causes asphyxiation but this is often a protracted process similar to drowning but many times more painful. You may even experience convulsions as your body shakes uncontrollably. When you eventually pass on, your body turns black because your cells die of hypoxia. You won't die beautifully and painlessly.
Quite simply, suicide is not painless, beautiful or dignified. It is even worse than the suffering you are enduring now. You often see information about painless suicide methods on the internet but it's not hard to tell that almost all are simply copying and pasting hearsay. The truth is that they won't be alive if they knew what the experience is like. Their most likely intention is to encourage people to try and make a mockery of their attempts. What we do know is based on forensic reports of suicide deaths and there is no information more accurate than that.
If you see suicide as playing dices with death and that the chance you might benefit from sending a cry of help to a sympathetic observer outweighs the chance of death, you might accidentally end your life regardless of your level of aversion. You don't have to gamble with life to receive help. Help is always within yourself and available to those who are willing to reach out, no matter how small your attempt might be.
If you are insistent on suicide after much delibration, try asking yourself these 5 questions and consider the following responses before you consider making a plan or attempt:
1. Is my life more painful than the worst pain I can imagine?
- The pain we experience during suicide is often the worst other than the pain we experienced when we were born. You probably won't remember the pain when you were born which means suicide will likely inflict the most overwhelming pain on you even if you are prepared to endure.
- At least in life, know that there is always help available to help you alleviate or manage your emotional pain. We often think there is no help in sight because we are affected by catastrophic thinking (that is, thinking a situation is worse than it really is) and tunnel vision (tendency to focus on a single goal or point of view). These can usually be addressed with psychological help. Thus, your efforts at building up fearlessness and pain tolerance to attempt suicide are often misguided and based on fallacy.
- Fear amplifies pain and fear is a feature you cannot eliminate at the brink of death no matter how fearless you were before the suicide attempt. Just remember the dreadful feeling when you are about to jump off a diving board or that moment when you suddenly get serious muscle cramps while swimming alone. You won't be able to control your fear response even after mentally rehearsing these situations. The only difference is that the fear gets worse once you start the suicide process and you can only watch on helplessly as you fall to your death, asphyxiate slowly or see blood gushing out. And there is no rewind button for you.
- Finally, if you are afraid of pain, then suicide isn't for you because painless methods of suicide are fictitious. Why fictitious? It is common for the traditional media, social media and the internet to romanticise suicide as it increases viewership. A person who died from suicide cannot return alive to describe the experience to you. Suicide attempters can briefly describe incomplete experiences but these are often distorted by altered consciousness and importantly, leave out the most excruciatingly painful and fearful final part of the process.
2. Will you regret ending your life prematurely?
- If you are suffering now, you are probably more inclined to answer no. But even in times of suffering, there were good days. What made you hang on so long?
- Let's move to a time before all this suffering started. It could be a favourite childhood memory you have with your family or a time before you were diagnosed with a mental health condition. If that person could meet the suicidal you, what would the person say to comfort you? Is this person and you are one and the same, are you really alone and helpless in this suffering?
- You don't actually cease to exist when you end your life. You exist in the hearts of those who care for you but what you represent is often sorrow and remorse, which often cause grief and suicidal behaviour in your loved ones. Suicide lives on and โinfects' everyone you care about.
3. Do you want to die or just want the pain to end?
- Most people would say that they want the pain to end and see suicide as the only option. They do not want to die because everything ends, not just pain but also happiness and everything you ever cared about. If you just want the pain to end, you don't have to end yourself. You are not defined by your pain.
- Interestingly, when you express your wish for the pain to end, you are also harbouring hopes of a better future.
- The emotional pain subsides as you recover from the mental health condition or personal situation which triggered your pain
- Just as you painstakingly attempt to build pain tolerance during the suicide process, it is actually more realistic and easier to build emotional tolerance, which is feeling all your emotions without overwhelm and resistance. Do not resist feeling the pain, accept it for what it is without attempting to over-rationalise and blaming it on yourself, try not to hold on but release it as soon as possible. It take practice but your pain will go down the more you accept it as part of your routine.
4. Do you really have mastery over life and death?
- Suicide gives the illusion that you have control over life and death. It is not uncommon for people to end up with permanent disabilities despite their best attempts to end their lives. You end up in a state between life and death. When you use suicide as a tool to take revenge or regain control over what you have lost in life, you are actually ceding control to those who made your life miserable. They won't feel guilty over your death, only those who loved you will and they often suffer after you leave.
5. Have you tried being authentic to yourself?
- If you have been masking your suicidality behind a smile, it's time to reassess whether you are living for yourself or for other people. If the answer is the latter, it is probably the reason why your suicidality is getting worse. It's time to live for yourself and stay true to what you want in life.
- Suppose that you feel that you have been authentic, your emotional states, awareness and behaviours should be aligned. When you are suicidal, chances are that you are still a work in progress. Being yourself can just be as liberating as the possibility of suicide, sans the pain and fear of death. When there is nothing to lose, you have everything to gain by embracing the inner self.
4th Barrier: Threshold of Unacceptable Loss, Threshold of Suspicion and Means Restriction
Individuals who contemplate suicide often set a threshold of loss beyond which a suicide attempt may occur in a suicide ready individual. For example, a person might set a threshold in which a divorce or termination of employment might be enough to kill him/herself. However, suicide often happens when the threshold is violated and the person has both the desire and capability (i.e., suicide readiness) to carry out the act.
In the context of suicide crises, the risk levels often follow an inverted U shape where the danger of acting out the suicide feelings increase and reach a peak before decreasing. However, the time elapsed between the plan and the attempt can be as fast as less than 5 minutes (25% of people) to less than one hour (71% of people). Therefore it is important to act swiftly before a lethal attempt occurs. .
The threshold of unacceptable loss is unique to every person. This explains why events which are seemingly trivial or that friends and family are not aware of can trigger suicide. The main problem is that the negative effect of a loss is doubled. That is, there is loss of a protective factor (e.g. relationship loss) and increase in a risk factor (e.g., loneliness). The fortunate thing is that every suicidal person is aware of this threshold and majority of people (79.1%) are likely to tell their doctor or therapist when asked. The figure is likely even higher when we consider trusted friends and family members. It is also less intrusive than being asked if one is having thoughts of suicide. As long as you are willing to share the negative life event which constitutes the threshold, steps can be taken to avoid or lessen the impact of the event. For example, undergoing marriage counseling to prevent a divorce or getting a new job to replace a lost one. Even if nothing can be done immediately to alleviate the situation, you can be kept safe by someone you trust or precautions taken to prevent access to lethal means. Since the suicide impulse often lasts only a few minutes to a few hours, any delay can effectively prevent a suicide attempt by affecting ambivalence about dying. Suppose if you have initiated and survived, know that approximately 85% of people who survive a suicide attempt will not go on and die by suicide in the future. The risk of a person attemping suicide after a previous attempt is 5-11% as most people heal with time and professional help. To them, life is still worth living after all.
The most effective way to prevent suicide is to restrict access to means. This refers to limiting how suicidal individuals can use certain methods to enact a lethal attempt. Studies have shown that people do not generally substitute to another method if their preferred method is unavailable. Thus means restriction is especially effective. Physical restriction works best when supported by the family and friends of a suicidal individual. These include actions such as keeping painkillers and sleeping pills in the care of a trusted family member, locking up poisons and sharp objects, locking windows and installing window grills, limiting access to the top of buildings and keeping a lookout for suspicious gas cannisters and tubings.
If you are alone and can't stop yourself from researching on suicide methods, do also read up on how suicide methods can impact others. For example, bystanders who witnessed someone jumping off a building or family members coming home to a loved one hanging off the ceiling are often severely traumatised which translate into flashbacks and even suicidal thoughts. There are those who choose isolated places to avoid inconveniencing other people but the person who discovers you is often confronted with a heavily decomposed and maggot infested corpse because it could be days before you are discovered. Keep that picture in your mind, because that is what the person will keep seeing in the mind for the rest of his/her life.
Although restricting access to means is highly effective, it can be further enhanced by having a low threshold of suspicion by observers. For example, a sudden mood change from sadness to cheerfulness without any plausible explanation is a red flag for suicide. Other warning signs and red flags can be found at this University of Texas Medical Branch webpage.
Combining a low threshold of suspicion by others with an awareness of one's threshold of unacceptable threshold allows us to pinpoint when, where and how a suicide attempt might occur. Anticipation can thus be seen a form of means restriction through psychological intervention.
5th Barrier: Giving Yourself a Fighting Chance at Life
Your suicidality should have gone down by time you complete the earlier steps However, if you still feel extremely suicidal and helpless, it is not time to give up. There are still things you can do to give yourself a fighting chance even if they should only be used when nothing else works for you. Please always use them with caution and certainly not as long-term solution. Seek help early if possible, and at the very least get someone to safeguard you till the suicidal impulse dissipates.
Studies show that a number of suicidal individuals turn to self-harm as a coping mechanism to prevent suicide. This is not advisable as it is unhealthy and can accidentally lead to suicide (e.g., cutting your wrist). If you have already started self-harm, there are ways to minimise harm. Instead of cutting, burning or pinching yourself, wear a rubber band around your wrist and snap it when you feel the urge to self harm. You can also try drawing a fake wound on the place that you wish to hurt yourself. The aim is to dissipate the wave or urge to self harm before it becomes a tsunami. Now, these methods may not work for everyone. Do note that there is mixed evidence for substitution methods.
However, anything less drastic than self-harm can still potentially provide temporary relief till you are able to get further help. If you are in a state of panic, try the multi ice cube method as a grounding method. Drink a large cold glass of ice water, chew the ice slowly and let the ice cubes touch the roof of your mouth. Hold a few ice cubes and move them around your hands. Persist with the ice cubes as long as you can. If you can wrap ice cubes in a towel or have ice packs, place them on your chest and the back of your neck for 15 minutes to activate your vagus nerve, which can improve mood and reduce stress response. This multi ice cube method will also work for less severe episodes of distress and people who do not self-harm.
In addition, Safe U's 3 rubber band method ยฉ complements what has been mentioned above. When you first experience a suicidal impulse, put on the first rubber band. Instead of using it as a substitution, this is a visible reminder and personal agreement with yourself to put off the urge for the next 24 hours while practising compassionate self-protective behaviours such as acts of self-care.
Use the multi ice cube method and/or distress tolerance skills (refer to this website for instructions) as preferred to cope with the urge. You don't have to suffer alone as this is the time for you to seek help from crisis hotlines and text services too. If you have a trusted friend or family member, let them know you need a listening ear so that you have an outlet to vent your emotions. For 5 simple acts of self-care for every area of your life, please read this website as a starter.
After 24 hours, take off the first rubber band if there is a noticeable improvement. If the symptoms persist, put on the second rubber band. Again this is a reminder and agreement with yourself to keep safe for the next 24 hours and expand your acts of self-care. Proceed as per the first 24 hours, however, always keep yourself in a safe environment where there is minimal to zero access to any lethal means which could be used for an attempt. Have a trusted friend or family member keep you safe by accompanying you in your activities. If you are alone, go to a library where there are other people around you but quiet enough to calm your senses. If you have a religion, you may also consider going to a temple, mosque or church to pray as religosity can be an effective deterrent to suicide.
If your urge to kill yourself worsens, put on the third rubber band. Do as per the 2nd rubber band, but this is the time to consider if you want to be admit yourself for treatment or wait till things get out of hand and the police has to intervene. You might not be able to think very clearly when you are inflicted with suicidal impulses, but you can still make a relatively straightforward decision. When the police intervenes, it will be involuntary referral to IMH and possible admission. If you admit yourself voluntarily, you save yourself the unnecessary drama and trauma from being apprhended.
Once you abort a suicide attempt, it is quite likely that you would not attempt again in the future. You may feel uncomfortable about being admitted to IMH but at least it will save your life. Admit yourself at your own terms and not at the mercy of others who do not have any idea what you went through.
The 3 rubber band method ยฉ functions like a traffic light and helps you promote self care and develop self awareness of your suicidal impulses so that you have increased perceived control. It also has a hidden function of subtly letting your loved ones know which level of risk you are at now. The rubber bands can โseek helpโ on your behalf and let others know how to support you once they understand what you are doing. Nobody else would know what those rubber bands mean.
Important advice for everyone
The five barriers are not suicide prevention methods that are meant to resolve your underlying issues. The reason why we create so many barriers is to delay the time from suicide ideation to suicide attempt and for the impulses to slowly dissipate. You will realise by now that there is alot of time created as a result for you to reflect and seek professional help as soon as possible.
We always highly encourage suicidal individuals to seek professional help early because there may be medical and psychological reasons behind the behaviour. This is not the same as equating suicidal behaviour to mental illness. Instead, appropriate help will ensure that you will no longer suffer as much as you have till now. If you do have a mental health condition, medication can also drastically reduce the negative thoughts and emotions you are having.
We provide the distance away from suicide so that you can stay alive. However, you only start living when you address what's causing you pain and create a new life path for the future.
To sum things up, here are two story for you to ponder.
The Story of Qu Yuan (ๅฑๅ) and the Fisherman
Every year during late May to June, we celebrate the life of patriotic Chinese poet Qu Yuan (ๅฑๅ) with the Dragon Boat Festival. We all know the story of how Qu Yuan was sent into exile by King Huai of the Chu State because the latter listened to the false accusations of Qu Yuan's political rivals and banished him from court. When Qu Yuan learnt that the Chu State had been defeated by the Qin State, he was filled with sadness and despair and ended his life by jumping into the Miluo River in Hunan Province. This is probably the most well-known altruistic suicide in ancient China.
What you may not know is that there is another story which talks about Qu Yuan's conversation with a fisherman. One day, Qu Yuan was walking along the Miluo River looking forlorn and emaciated when he met a fisherman who asked what is a esteemed minister like him doing here. Qu Yuan replied that he had been banished because he was the only โclean and sober' person in this โfilthy and drunk' world. The fisherman tried to convince Qu Yuan that a wise person would not be disturbed by the behaviour of others but take the world as it comes . He continued by persuading Qu Yuan that since the world is โfilthy and drunk', why hold on your self righteousness and end up in such a pitiful state?
Qu Yuan replied that a person who washed his hair would brush his hat before putting it on his head. Similarly, a person who has bathed would shake his clothing before wearing it. How can he allow his body to be made unclean by filth? Qu Yuan was adamant that he would rather jump into the river and end up in the bellies of fishes than let his purity be tainted by the filth of this world.
The fisherman smiled and rowed away, leaving Qu Yuan with a metaphor: โWhen the river is clean, it is fit to clean my hat tassels. When the river is muddy, it is still sufficient to wash my feet'.
This story offers us two opposing viewpoints. An idealistic one represented by Qu Yuan and a pragmatic one represented by the fisherman. You may find yourself aligned with either side depending on your values. However, there is no right or wrong answer. It is not what the world does to us that decides how we think. It is how we think that decides what the world is to us. When we try to be perfect in an imperfect world or โclean and sober' in this โfilthy and drunk' world, one often encounters feelings of resistance because we hold on to our perception of reality. The reality isn't what Qu Yuan made of it since it was probably biased by his negative experiences in the court of Chu State. It is actually closer to what the fisherman alludes to at the end of the story. Specifically, it is more about adapting to your circumstances. In bad or good times, you make the most of it.
Is it Qu Yuan's fault to commit suicide then? He was probably in alot of emotional pain and ruminating about the past. We can tell he was quite rigid in his thinking. He had tunnel vision and couldn't see other solutions other than taking his own life. He also had black and white thinking since the real world is probably somewhere in the grey area between clean and filthy, sober and drunk. However, if Qu Yuan was willing to be receptive and listen to what the fisherman had to say, he might actually notice these cognitive distortions. The lack of receptiveness often applies to us as well. You might wonder โWhy do I want to listen to a bullshit story and what can you possibly know about what I have gone through? Well, we can't help you unless you are receptive to change. And yes, we will never know your exact experiences but if we are genuine and have never treated your story as bullshit, perhaps there is something you can learn from listening even if we are not you.
You may also have noticed something about the fisherman's metaphor at the end of the story. It is very pragmatic as with what other people often tell suicidal individuals. Things like โIt's all in your head' and โYou need to stop feeling depressed'. They are often well-meaning in nature but you don't feel better because there is a lack of empathy. Suppose the fisherman tells Qu Yuan that he can relate to the indignation and righteous anger that Qu Yuan have been feeling. The fisherman offers a listening ear over a cup of tea. Perhaps Qu Yuan would have calmed down and live to fight another day. It is a misconception that you have to totally agree with someone in order to express empathy. Just being able to see things from another person's viewpoint for a brief moment or two is enough for you to be sensitive to one's needs and emotions. If you are helping someone with suicidal behaviour, this is a lesson not to make comments which may be deemed insensitive. If you are the suicidal individual, know that the intention often comes from a place of love. Please help them understand you bit by bit because suicide can be very confusing for most people.
So why is life so unfair? Why do bad things happen to good people like you and Qu Yuan?
Well, it is only through hardship and adversity that we can appreciate the kindness of time. What kindness you may ask? Time is kind because it is compassionate. It allows us to forget painful experiences in a sure and steady manner as we move forward in time. We start to appreciate happiness better with time as it often comes from overcoming suffering. Additionally, there can be healing and growth when we choose to live and give ourselves the opportunity to experience the warmth and kindness around us.
That is why time is also known as the best healer. It is immortalised in this poignant quote by Japanese writer Osamu Dazai (photo shown above) :
โๆถ้ด็ๆต้ๆฏๅนณ็ญ่ตไบๆฏไธชไบบ็็ๆ๏ผๆ่ฎธไนๆฏๆ่ตใโ
โThe passage of time is the healing that is equally bestowed upon everyone, and perhaps also redemption.โ
The quote speaks of time as a universal healer which does not discriminate against one's circumstances. It is a gift of healing and redemption, alluding to it's ability to heal painful memories from the past, provide a sense of closure and find a path to forgiveness.
If you still feel helpless, know that time is on your side. You may feel better and experience clear mindedness on some days. You may also feel the interval of suicidal thoughts getting longer and this is a sign that you are making progress. You don't have to feel guilty for having bad days either, everyone has that. Time is fair and kind to everyone no matter how bad your life may seem at this moment. And most people do heal with social support and professional treatment.
We only ask you to give life a second chance, because time will do the rest. We are all stories in the end, so why not make it a good one?
The Story of Ernest Hemingway and the Hemingway Family Curse
Ernest Hemingway was one of the most celebrated American writers of the 20th Century. He was awarded the 1953 Pulitzer Prize for his most famous work โThe Old Man and the Sea' followed by the 1954 Nobel Prize in Literature. However, he died of suicide by gunshot wound in 1961. Ernest Hemingway was only 61 years old at the time of his death having endured alcoholism, traumatic brain injury and several psychiatric ailments (including undiagnosed bipolar disorder). However, the Hemingway family curse started much earlier. His grandfather had attempted suicide by firearm before he was stopped by Hemingway's father, who later in life also shot himself to death in 1928.
After Hemingway died in 1961, his two siblings Ursula and Leicester also died by suicide in 1966 and 1982 respectively. His grand daughter, Margaux, passed away due to a drug overdose in 1996. It is quite apparent that the Hemingway family had a very strong family history of suicide but his decision to die by suicide was not sudden.
Since a young age, Ernest Hemingway developed anger against his parents to the extent that he used to have fantasies about shooting them to death. His father was a strict disciplinarian who would beat him up viciously at times while his mother forced him to dress as a girl. Hemingway could have easily felt a sense of guilt which haunted him for the rest of his life since his father did actually die of a gunshot wound while his disdain for femininity contributed to his image of hypermusculinity which prevented him from expressing his emotions freely.
Hemingway also had an obsession with death and suicide at a very young age and this continued throughout his life as evident in his writings. He had likely used alcohol as a coping mechanism to numb his suicidal impulses which only worsened his mood disorder. Interestingly, Hemingway had 9 major concussions in his life with his first concussion happening during his service in World War I when a mortar exploded next to him. He likely had what is now known as chronic traumatic encephalopathy (CTE) which often results in behavioral problems, mood problems, problems with thinking and dementia.
Shortly before Hemingway took his life, he received his final electroconvulsive therapy (ECT) at Mayo Clinic. ECT was supposed to improve his depressive and psychotic symptoms by 90% but because he likely had CTE, ECT probably aggravated his decline. On the morning of 2 July 1961, Ernest Hemingway woke up before his wife, went downstairs and took his life with a shotgun. We would never know what he felt at that moment. Was he incapacitated by his worsening symptoms, inability to write and felt helpless? Was he still driven by powerful feelings of guilt towards his father that he followed the latter's old path?
Despite what Hemingway has experienced throughout his life, he was a hugely resilient individual. His life philosophy of Stoicism was embodied in Santiago, the protagonist of โThe Old Man and the Sea'. Santiago remained calm and dignified in the face of insurmountable challenges. These characteristics reflect the Stoic ideals of facing adversity with courage and gracefulness.
It is evident that Ernest Hemingway had a number of risk factors which made suicide a likely outcome for him. However, he also lived life unapologetically and thrived on adventure. He was a war correspondent, went on safaris and passionately engaged in bullfighting, deep sea fishing and big game hunting. Hemingway used these hobbies to deal with his suicide impulses as he believed that those who live in proximity to death lived life to the fullest. A month before his death, Hemingway wrote:
โThe real reason for not committing suicide is because you always know how swell life gets again after the hell is over.'
Hemingway was never giving up even though he had experienced deteroriation in his mood and writing ability. He was still actively seeking treatment and even became friends with his physician Dr. Hugh Butt at the Mayo Clinic. If the diagnosis standards and treatment methods then were as good as now, it is likely Hemingway would have improved significantly.
Many years later, the Hemingway family curse finally stopped with his grand daugher, Mariel. She suffers from depression but considered herself healed through lifestyle changes such as mindfulness, dietary modifications as well as avoiding substance abuse and alcoholism. Due to the suicides, Mariel's parents seldom tell her about the family's troubled history due to fear and avoidance. When Mariel had her own kids, she broke this bad habit and said: โ When you share the depths of everything and where you come from, you help them not be afraid of whatโs unknown.'
This is the same when we talk about suicide in the community. The more we are able to communicate about different aspects of suicide in a healthy manner, the lesser suicide becomes something we fear so much that we are unable to seek help. You are never too broken and hurt to seek help. If you feel shattered, Ernest Hemingway has this to say:
โThe world breaks everyone and afterward many are strong at the broken places.'
It is ok to let yourself break down and be vulnerable for once. We will catch you as you fall. Take your time to process everything and heal on your own terms. To escape suffering is to experience and understand suffering for what it really is. To embrace a new life is to give up all the fixations that caused you pain now.
ๆ็ฅ็่ฆ๏ผๆน่ฝ็ฆป่ฆใๆพไธๆงๅฟต๏ผๆน่ฝ้็ใ
Copyright ยฉ 2024-2025 The SAFE U Initiative. All Rights Reserved.