There was nothing Sarah Liljedahl feared more than herself.

When her mind ventured to dark places, the icy roots of suicidal ideation burrowed through her brainstem, embedded beneath her skull and took Sarah captive.

When the darkness lifted, so did the ideation and Sarah knew she did not want to die. But, the thoughts always returned and, with it, the urge to kill herself. It was a deadly cycle Sarah could not escape.

“At the end of it, when I would get out of that bad depression, I realized I hated myself so much there was nobody I feared more than myself,” she said.

Cindy Baker of Touchstone Counseling has dealt with cases like Sarah’s for about 20 years. However, now more than ever, Baker is witnessing spikes in suicidal ideation and death by suicide that trickles down to those as young as 10 years old.

“I believe the stereotypical face of suicide is rapidly changing. I think it is an ever-growing problem now and we are seeing the numbers increase drastically,” she said. “It almost seems to be in vogue to speak the words, ‘Well, I’ll just kill myself then’ ... It almost seems to be part of the language that is spoken.”

This increased dialogue influences suicidal contagion — suicidal attempts which mimic others. Baker’s practice saw this following the 2014 suicide of actor Robin Williams.

“I had to deal with a couple of clients who tried to copycat what Robin Williams did with the asphyxiation,” she said. “So today, when we have teens swallowing bottles of pills or drinking bleach or using razors on their flesh, their classmates hear about this and it plants seeds in their heads as an idea of how to deal with pain. If we look at learning theory, humans learn from imitation and modeling. So, if their peers are demonstrating ways to end pain that are not healthy, those who are also in pain add those steps, those options, to their own mental list of ways they can possibly alleviate their feelings of hopelessness and pain.”

A more recent influence is Netflix’s “13 Reasons Why,” which outlines reasons a young woman kills herself. Baker isn’t the only professional who views the series as dangerous. An internet search for “therapists respond to ‘13 Reasons Why’” returns numerous cautionary responses.

In the week following the series’ release, Baker said she saw in increase in suicidal clients.

“I was up at 4:30 this morning and had an emergency at 7 p.m. I started my day with a suicidal client and ended my day with a suicidal client,” she said. “And one thing behind all that is a new series on TV called ‘13 Reasons Why.’”

Nixa’s Century Elementary Counselor Tina Russell said she did not allow her 14-year-old to watch the series before vetting it. Her biggest concern is that the show provides a misconstrued view of the impact of suicide.

“It’s almost as if she continues to live in the world after she’s gone,” Russell said. “And so, for children, I feel like they don’t have a clear view of what this means. You’re gone forever.”

Suicidal contagion also influences methods of killing oneself. In the past, Baker said most men killed themselves with a gun and women with pills. However, these days, drinking bleach is the trend.

“When I say, ‘Why bleach?’ They say, ‘I don’t know, I heard a friend say it in the hallway.’ So the idea of drinking bleach is spreading like wildfire because they’re hearing each other talk about it as a way to kill themselves,” Baker said.

Regardless of the individual’s unique circumstances, a heavy burden is nearly always the root of suicidal ideation, Baker said — and that burden comes in many shapes and sizes.

For youth, suicidal ideation often comes as the result of being put in an adult situation they are not mature enough to handle — like a romantic relationship breakup or bullying.

For veterans, it is often Post Traumatic Stress Disorder or Traumatic Brain Injury. While enlisted, Baker said military personnel know their identity in a world of structure. When they return to civilian life, especially following a medical discharge, their entire world is altered — and this may lead to depression and suicidal ideation.

“They can’t cope with that. They tell me they’ve lost their identity,” Baker said. “Some say they don’t even know what to do with the world today. This isn’t what they fought for.”

Similar instances happen to the elderly and those battling chronic pain illnesses, Baker said. As their world changes, these individuals may lose hope in situations and resort to desperate measures.

Sarah’s pain surfaced in the face of mental illness and the subsequent shame projected on herself.

“There were arguments in my head of all the horrible things I could do to myself. It started when I was little and I didn’t know what it was. I thought I had bad choices, bad demons in my head that told me to do horrible things to myself,” she said. “Finally getting brave enough to admit that to myself was hard because you feel weak for it, and you don’t want to tell people that you’re bipolar or schizophrenic. There’s an instant stigma that you’re crazy. You’re more likely to snap on yourself, unfortunately.”

With so little control in many areas of her life, Sarah said the suicidal ideation almost became a safe place.

“At the very last moment, it’s a comfort which sounds really weird. But when you’re in a low moment, it’s a comfort knowing that there is something in your control, something you can grasp a hold of even if it’s so horrible,” she said.

Yet, despite everything, Sarah said she did not want to die. So, she did the only thing she knew to stop herself — she called a suicide hotline.

“It was honestly not a surprise at that point because we’d been dealing with it for a few years,” Sarah’s mom, Michelle, said. “We’d sit and I’d talk to her and it just got to the point where it was like, this is not enough. Something’s got to be done.”

Proactively picking up on clues and initiating a conversation with someone suspected of considering suicide is vital, Baker said. Despite popular belief, vocalizing their thoughts will not reinforce suicidal ideation — in fact, it may be the difference in life or death.

“Start with warning signs. Start with asking questions, getting them to talk about it, because I’d say the majority of those with suicidal ideation have asked for help at one point or another,” Baker said. “They don’t just wake up one day and go and kill themselves. It’s been a process. They’ve thought about it. And, again, it’s a decision they don’t want to make. But, they make it in a moment out of desperation ... So if we can talk them through that time frame, the desire to end their life subsides.”

The listener’s response, however, is also extremely critical.

“(They should tell them) that they love them, that they are always there to listen and if they ever want to talk to someone about this, that they are happy to take them to a professional that works with (people) who are struggling in life,” Baker said. “They should not lecture them, remind them how lucky they are, they should not quote Bible scripture or faith tenants at that point and time because the message heard by the (person) is that, once again, they have fallen short, they are worthless, they disappointed someone. And it actually adds to their feelings of depression, hopelessness and self loathing.”

Also, do not underestimate a cry for help.

“Every case should be taken seriously. One thing to never say is, ‘Oh, he or she just wants attention.’ He or she does really mean it,” Baker said. “If they say, ‘I’m going to go home and kill myself,’ you need to take that seriously each and every time.”

Instead, encourage the individual to share their feelings and thoughts, allowing judgement-free honesty. Find out if there is a suicide plan and what the plan is. And then assist in seeking professional help — which should be the conversation’s ultimate goal.

“If we don’t handle traumas properly, they will relive the little things the rest of their lives,” Baker said. “The celebration is trauma and PTSD are 100 percent curable. But we can’t try to fix something that horrific without being trained.”

The bottom line, Baker said, is that viewing suicide as an option for pain must be replaced with information on accurate and restorative coping skills and resources.

“Pain outweighs coping skills and they feel they are out of options,” Baker said. “People do not know that there are resources in our community that are free and readily available to help them when they are in need.”

The darkness has lifted in Sarah’s world. Uprooting suicidal ideation was a critical dissection, and it’s one she is grateful she endured. The 22-year-old feels happy, confident and enjoys her life in the light. Fighting for life, she said, is worth it.   

“You’re worth it, no matter what you think and there is always hope, no matter what you believe and who you are,” she said. “And reaching out doesn’t make you weak and admitting it doesn’t make you weak. It makes you a stronger person.”

Follow Hanna on Twitter @hannasCCHN

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