I remember the distress I felt with a college girlfriend. She was attractive, bright, and creative. Things were great between us most of the time.
However, during particularly stressful times when she felt unable to control situations, she would threaten to kill herself. While I cared for her, I also felt manipulated by her. Her suicide threats certainly did not strengthen our relationship.
Not all people claiming to be suicidal truly intend to end their lives or even harm themselves. Sometimes, people threaten suicide or other self-destructive behaviors simply to manipulate others.
Recently, our staff cared for a homeless gentleman in our inpatient psychiatric unit. When he was admitted, he told us he felt very depressed and didn't care whether he lived or died. However, he quickly brightened up in the hospital and became lively and interactive with the other patients and staff.
When he was ready to be discharged from the hospital, we felt fortunate to have arranged a temporary placement in a rehabilitation facility. To our surprise, he then announced that if he was not given a private room, he would be suicidal again. Clearly, this patient was not persistently depressed and intent on killing himself. Rather, he was attempting to manipulate the situation.
In our emergency room we often hear similar suicide threats by people insisting on being admitted to the hospital. Many are dissatisfied with their living situations or are trying to get access to medications.
It's sometimes challenging to know if a person is truly depressed and at risk for suicide or simply using verbal threats of suicide to achieve some other goal. Naturally, we are conservative and do our best to provide the most appropriate treatment for our patients. We certainly don't want to disregard true suffering. But we also don't want to be manipulated by patients who have other problems.
People claiming to be suicidal for manipulative reasons may have their short-term demands met, but this type of behavior is not helpful over the long-term. Manipulative behavior is especially destructive in personal relationships.
People who truly are depressed and tell others they are thinking about harming themselves should seek professional mental heath treatment. If they won't go on their own, then family and friends should make sure they are properly evaluated and treated.
Those who threaten suicide for manipulative motivations can also benefit from mental health therapy. Even if they have no intention of harming themselves, they may do so accidentally in their sad efforts to manage their lives.
