To many people, suicide is unspeakable. Even mental health professionals sometimes do verbal gymnastics to avoid saying the word.
That’s why Meghan Markle’s decision to talk openly about her suicidal thoughts in her interview with Oprah Winfrey has the potential to change the way we all talk about suicide. By speaking about her experiences, Meghan helped chip away at the stigma that constrains people from disclosing their suicidal thoughts. Her disclosure also educates others about the universality of suicide risk. Nobody is immune, whether they live in a palace or in poverty.
But many people keep suicidal thoughts to themselves, while friends, family and even mental health professionals often don’t ask those in distress if they’re considering suicide. In my work as a psychotherapist and suicidologist, I train mental health professionals and students how to interview people to assess suicide risk. Professionals with decades of experience have told me they don’t dare ask a client with depression or other major risk factors if they’re thinking of suicide.
More than one therapist has told me something like, “I don’t want to give them the idea” or, “If they’re thinking of suicide, they’ll tell me.”
It’s a myth that talking about suicide gives somebody the idea. Research consistently shows that asking somebody about suicide, even several times a day, doesn’t cause or increase suicidal thoughts. Even among children, by the third grade most kids already have a clear sense of what suicide is on their own.
It’s also a myth that most people will admit they’re considering suicide if asked directly. Many people don’t answer honestly because of embarrassment, fears of being hospitalized against their will, fears of being judged, fears that they can’t be helped or a desire not to worry others.
At first, Meghan didn’t speak directly about suicide, either. In her interview with Ms. Winfrey, she described how trapped, maligned and miserable she felt in her royal role, one that she said engendered racist attacks in the media based on her heritage. (Her mother is African-American, and her father is white.)
“I just didn’t see a solution,” she told Ms. Winfrey. “But I knew that if I didn’t say it that I would do it — and I just didn’t want to be alive anymore. And that was a very clear and real and frightening constant thought.”
“I would do it.” That’s what she said — not, “I would kill myself” or “I would end my life.” Simply, “it.” Ms. Winfrey had to say outright, “So, were you thinking of harming yourself? Were you having suicidal thoughts?”
“Yes,” Meghan said, “this was very, very clear.”
Later, we learned just how clear it was. She recalled what she told her husband: “It was like, these are the thoughts that I’m having in the middle of the night that are very clear, and I’m scared, because this is very real. This isn’t some abstract idea. This is methodical, and this is not who I am.”
Meghan said she asked a senior member of the royal family about the possibility of being hospitalized for her mental health problems but said that this person refused in order to protect the family’s image. She said she was too scared to be left alone, worried that she might end her life. So she confided in Prince Harry, who supported her emotionally but didn’t share the extent of her troubles with his family.
“I guess I was ashamed of admitting it to them, and I don’t know whether they’ve had the same feelings or thoughts,” he told Ms. Winfrey. “I have no idea. It’s a very trapping environment that a lot of them are stuck in.”
This is why Meghan’s disclosure is a gift to so many strangers. You don’t have to be royalty to be trapped into silence. According to one 2015 study, almost 10 million American adults had seriously considered suicide during the previous year; a 2019 survey found that almost one in five high school students had such thoughts. Despite the relatively high prevalence of suicidal thoughts, fewer than half of people experiencing them tell a friend or family member. Among those who died by suicide between 2000 and 2017, only about one in three had seen a therapist or psychiatrist in the past year.
Some people may be concerned that Meghan’s disclosures could trigger other vulnerable individuals to view suicide as, to use her word, a “solution.” Indeed, research indicates that knowing someone who died by suicide or who attempted suicide is linked to increased risk of suicide. When a celebrity dies by suicide, suicide rates increase slightly in the month following their death.
Yes, contagion can occur after a suicide, but hope is also contagious.
Hearing stories of people resisting suicidal thoughts without acting on them has been linked to decreases in suicide rates. Perhaps tales of recovery can inspire hope and healing.
The tragedy of the silence around suicide isn’t only that people suffer alone. It’s also that they rarely hear the stories of those who have been suicidal and survived. Research indicates that almost half of people say they know someone who died by suicide. Though this hasn’t been studied, far more people likely know someone who has recovered from suicidal thoughts, since roughly 240 times more people consider suicide in a given year than die by it.
Meghan’s story is one of recovery. Near the end of the interview, she credited her husband with saving her life, because of his willingness to step away from the royal family. By sharing her story, she demonstrates that confiding in a loved one, problem-solving with him and making changes in her life took her off the path to suicide.
By encouraging more openness about suicidal thoughts, like Meghan’s, we can send the message to others that they are not alone, that change is possible and that people do make it out alive. I’m one of those people. I attempted suicide twice in my 20s. For two decades, I kept my story secret from all but a few people. Now I share my story openly as an act of defiance against stigma.
Here are some ways to weaken the walls of silence around suicide:
Name it. Ask the question, “Are you having thoughts of suicide?” or “Do you have thoughts of ending your life?” If you are nervous, couch the question: “A lot of people who feel the way you’re describing think of suicide. Do you think of killing yourself?”
Frame suicidal thoughts as the mind’s understandable attempt to stop hurting. This can help alleviate shame or embarrassment. For example, you might say, “It makes sense that that’s where your mind goes. We’re biologically wired to avoid pain. But there are other ways to stop the pain, and let’s brainstorm those.” You can empathize with the suicidal wish without validating suicide as an option.
Don’t panic. Don’t call 911 unless the person is clearly in danger of acting on suicidal thoughts this instant. Don’t respond with clichés, false encouragement or guilt.
Respond with curiosity, not judgment. Ask questions that invite the person to tell their story. “Tell me more.” “What’s happening that’s made you feel so bad?”
Connect. Offer emotional support, and help the person find professional help.
As Meghan said: “I’m still standing. My hope for people in the takeaway from this is to know that there’s another side, to know that life is worth living.”
If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK) or go to SpeakingOfSuicide.com/resources for a list of additional resources.
Stacey Freedenthal is a psychotherapist and an associate professor at the University of Denver Graduate School of Social Work.