"A broad range of warning signs for suicide has been identified in school-based suicide prevention programs, with little consistency across programs and many simply incorporating signs and symptoms of depression," say the authors of a 2006 study, Warning Signs for Suicide: Theory, Research, and Clinical Applications (PDF), in the journal Suicide and Life-Threatening Behavior, 36(3) June 2006. Indeed, "building awareness" of the warning signs of suicide is often the focus of anti-suicide efforts.
What are those all-important signs of suicide - those signs that, if you're careful and vigilant, can help you stop the suicide of a friend or relative? It depends on who you ask. San Francisco Suicide Prevention provides a set of warning signs, including talking about death, a recent loss (such as death, the end of a relationship, or loss of religious faith), a change in behavior (trouble concentrating on school or work), and menstrual abnormalities. Do you know anyone who exhibits any of those signs? Suicide.org has a different set of warning signs, largely made up of the symptoms of depression, including gaining or losing weight. Neglecting personal appearance, irritability, or lacking a sense of humor could also indicate your loved one is on the brink of suicide, according to suicide.org.
The Substance Abuse and Mental Health Services Administration warns about withdrawal from friends and family, a drop in academic performance, or suspicious cheerfulness. The National Suicide Prevention Lifeline (PDF) is a bit more literal - seeking a way to kill oneself is a warning sign of suicide, as is threatening to kill oneself. WebMD lists calling people to say goodbye and putting one's affairs in order as possible signs of suicide.
All these disparate signs and symptoms could be indicative of a suicide. Whatever the warning signs and however vague and ambiguous they may be, the American Foundation for Suicide Prevention tells us, it's important to take them seriously and act on them. "Seventy-five percent of all suicides give some warning of their intentions to a friend or family member," they assure us, without bothering to cite a source for that statistic. "In an acute crisis, take your friend or loved one to an emergency room or walk-in clinic at a psychiatric hospital." Got that? Also, "[r]emove from the vicinity any firearms, drugs or sharp objects that could be used in a suicide attempt."
My problems with such lists of "warning signs of suicide" are several. First, these lists of "warning signs" are vague and confusing, and leave friends and relatives of a suicide with the feeling that they somehow should have foreseen and prevented the suicide, adding to the survivors' guilt.
Second, these lists of "warning signs" are as likely to be read by people seriously contemplating suicide as by those who would prevent suicides. Given the suicide prohibition and the potential consequences for those caught being suicidal, suicides have every incentive to mask any potential "warning signs," forcing them to live even more inauthentically if they are serious about suicide. Saying goodbye is a warning sign of suicide - so we musn't say goodbye. Putting our affairs in order is a warning sign - so we mustn't do that, either. Most importantly, having serious conversations about suicide, which could help a potential suicide figure out his true desires and, at the same time, help friends and relatives understand the suicide's experiences and motivations, become extremely risky and, therefore, much less likely to occur when placed on the list of warning signs.
Finally, of course, a "list of the signs of suicide," published so that people may forcibly intervene in the lives and decisions of others, assumes that preventing suicide is, in all cases, a worthwhile policy goal.
To sum up, the messages conveyed by these lists of "warning signs of suicide" are three:
1. If someone you know commits suicide, you could have, and should have, prevented it. It's your fault.
2. If you are considering suicide, be careful to avoid exhibiting any of the warning signs - specifically, don't talk to anyone about your potential suicide. Hide your intentions.
3. Suicide is wrong and should be stopped in all cases, by force if necessary. We must all be junior spies in enforcing the suicide prohibition.