Q&A With Nelly Karrar: Suicide Prevention and Loved Ones’ Intervention

Today marks Suicide Prevention day. This remains a matter that many in the Arab world refuse to believe is due to depression. According to WHO, a person dies of suicide every 40 seconds.

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In an attempt to spread suicide awareness and help others intervene if their loved ones are suffering, we talked to existential psychotherapist & Counsellor and founder of The Wellness Hub, Nelly Karrar.

With a Master’s Degree in existential psychotherapy & counseling from NSPC in London, and a diploma in Practitioner Skills in Eating Disorders from NCFED in London, Karrar’s goal is to fight the stigma surrounding mental illness and to spread awareness about mental health care in Egypt.

What are the suicide warning signs we should be aware of?

​There are obvious signs that we cannot miss as someone explicitly stating that he wants to end his life, writing a lot about death and dying, planning out how they will take their own lives and obtaining a tool to execute their plan.

It can also be a repetitive statement about their loss of hope and that there is no point of staying alive. Hopelessness is very common, yet subtle. It is definitely more alarming if these persons already have attempts history, or if suffering from mood disorders or drug and alcohol dependency. 

There are other behaviour that may indicate that the person is at serious risk, especially if it’s not their habit to express themselves as feeling like a burden to others, isolation, rage, revenge and extreme mood swings, oversleeping or insomnia.

Other worrying behaviours include self-loathing, selfharm, chronic sense of hopelessness and entrapment in their inner pain paired with poor coping skills and the person’s unwillingness to share or seek help. Saying goodbyes to loved ones and giving away one’s belongings as a transitory step to death and writing a will. 

If you suspect someone has suicidal tendencies, what is the best intervention approach?

Bring it to the table. Talk to them gently about it without judgment. You can start by saying, ” I have been concerned about you lately. I noticed some differences and want to check on you.” It is okay to be straight-forward about it. You are probably right and this is what the person has been hinting at. Talking about it can save their lives.

Acknowledging their feelings and giving them the space to talk about their struggle is much better than avoiding the topic, fearing that you will be putting thoughts into their head. If you noticed it, they probably have thought about it many times but cannot say it out loud for many reasons.  

It might be uncomfortable to initiate the talk, but once you do, things flow and the person realizes how much you care about them even if they do not have the capacity to show it.  

Tell your friend that you are worried about him/her. Get them something that they like, make them feel “genuinely” loved and needed. Also give them some space to be, don’t overdo it. Reassure them that these feelings will not last forever and that there is hope.

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What is the most common and worst mistake people make while trying to save loved ones?

It is important NOT to give the suicidal person advise, argue with them or blame them by saying things like “stay strong, you should not feel this way, look at the positive side, praying will make it better, get closer to God.” 

It does not work this way, this is a disorder and unless the person gets the right help, it will continue to be difficult for them. It has nothing to do with how religious or not they are. It is like telling a person with diabetes “If you pray more, your disease will fade away”.

If it was easy to stop a feeling or a thought from occurring, they would have done so. It’s easier said than done. Be gentle, kind and compassionate when you’re talking to a person who’s suffering. We are not machines.

It is also important not to ignore the person if he/she reaches out to you or make a joke about it. Don’t promise that things will remain confidential if you cannot keep your word, since you may need to seek professional help or talk to their parents/loved ones about it.

How do you explain to family members that depression is more than a ploy to get attention?

Depression is not a way to get attention. Depression is a mental health disorder and the person is constantly suffering. Sometimes what is perceived as attention seeking is an indirect expression of wanting help, telling others ” Look at me, I am not okay. I am doing this 0 thing because I want you to notice my pain.”

Depression is much more than a ploy to get attention. It is not sadness and it is not like having a bad mood or a bad day. It is more than a low mood, it is an illness characterized by a general sense of hopelessness and loss of interest in all activities that a person once enjoyed. 

It is coupled with increased fatigue, feelings of worthlessness and lack of concentration. It also interferes with regular eating and sleeping patterns. It can affect a person’s physical and mental health. So obviously no one gets depressed to seek attention.

How does social media affect teens’ self-perception and does it leads to depression?

We need to educate adolescents and teens about the reality of social media. As naturally during those years, teens go through emotionally stressful times. Social media can be a positive or a negative tool, depending on how it’s used. 

For many teens, there is a need to fit in, to be popular, gather more likes or more followers. They see picture-perfect photoshopped models who become their reference of what a perfect body looks like. Once this culture of comparison is born, their mental health suffers. 

In return, all this social media craziness becomes the criteria of their self-worth and an indication of their self-esteem. Their self-image is a reflection of their social media presence which leads to a lot of disappointment, alienation, cyberbullying and many other issues which end in anxiety, depression or eating disorders. 

Parents need to be aware of the impact of social media on their kids and keep talking to them about how real experiences are different from the Internet.

On the other hand, there is the good side of social media, some researchers are proving that when social media is used right, it can actually foster social skills and encourage teens who suffer from social anxiety or have problems with face to face socializations

How should we react if someone sounds suicidal on social media?​

It is important to reach out. It could be a cry for help. It could be their only way to communicate that something isn’t right.

Do not ignore the issue or make fun of the person. Respond and offer help. Tell them you are here to listen.

There is definitely a reason he/she has decided to share their thoughts or feelings on a public platform instead of keeping it to themselves and going through with the act. Take this as an opportunity to save a life! 

How can we help during someone’s journey?

​Listen to their story, acknowledge their feeling, let them know you’re not judging and that you are going to be there until they get better. 

It is important for the person to seek professional help. They need professional guidance on this journey, you can help the person find a psychiatrist to prescribe the necessary medication, get them to find a psychotherapist/counseling-clinical psychologist to oversee their treatment plan and work with them to process their thoughts and feelings. You can encourage the person to find support groups. 

When the person is so involved in their dark perception of life and absorbed in their negative thoughts, it becomes really hard to remember if there is anything positive in life, they may forget their goals and dreams they once had, or that some people love them enough to remain alive.

It is the role of a friend, family member or someone close to remind them of the reason or reasons to live. Remind them how they are needed, the role they play in the lives of their parents, kids, remind them of their pet that can’t live without them or the project they wanted to finish or this certificate they’re about to receive.

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