How to navigate suicidal ideation with son

[InTheWilderness]

My 20 yr old son is newly diagnosed. Members on this site have been helpful as I learn how best to support him. He is currently stable after 3 hospitalizations this year for suicide attempts. BPD diagnosis has been helpful in his recovery.

Here’s the problem: he won’t go to counseling and is therefore not developing skills to manage intrusive thoughts of suicide when he is in despair. He will take meds, is exercising routinely and is prioritizing sleep, so he is trying. He’s working and likes his job.

To be fair, most 20 yr old men don’t seek counseling (stigma). I want him to stay alive until he’s mature enough to commit to therapy/recovery. When he calls us (lives in another state, won’t come home) and out of the blue tells us he’s been thinking a lot about a plan to buy a gun when he’s 21 (8 months down the road) so he can finally end the suicidal thoughts which are unbearable, my husband and I don’t know how to respond. In the moment, we know what to say/do. The moment passes and in the same day he can seem perfectly okay. How do we manage this? Do I move to his city (which I can do, have been doing off and on), do we continue to advocate for the thing he needs (counseling) from a distance since that’s where he wants us anyway, do we refrain from rushing in when he says these things? What works?

How can a parent significantly affect a child’s desire to end his life when he refuses the help he needs to get better? This roller coaster, the terror, is wearing my husband and me down. I need to get my head on straight about how to parent this child. I’m seeing a therapist about this but also hope for feedback from other parents.

Thanks for reading.

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[Sancho]

Hi InTheWilderness
You must be exhausted from being in a state of 'high alert' yourself. There is no absolute formula that works to prevent someone from ending their own life, whether planned or on the spur of the moment. There are a lot of positive signs in what you have said though: taking meds, enjoying work - contacting you.

Is there a time of day when your ds most often has these awful thoughts? Morning is often a time when depression can be very deep - as the day goes on things improve. I have a friend who had this pattern for years.

I understand counselling is very helpful for many people. For others though, talking about their issues increases their emotions very much and it is not really beneficial.

It seems perhaps that he is connecting with you as a counsellor? He clearly feels comfortable telling you what is in his mind, and he subsequently seems fine. It does place an awful load on you both though. You said that you seem to know how to respond in the moment - so I am thinking what you say is what eases him and allows him to move beyond those thoughts for the time.

Do you think his meds need adjusting?

Re moving: it depends on whether you think this would be helpful or not. Sometimes things work better from a distance, but you know your child and what would be beneficial. Would you live with your ds or separately?

Would frequent visits be an option?

Try to take care of yourselves in this moment because you seem to be a vital link for your child. I know that is easy to say - not so easy to do in this situation.

[InTheWilderness]

Thank you, Sancho. You raise some good points.

Regarding counseling, I was thinking  DBT, which as you know can be helpful for anyone, especially those with BPD. But I believe younger people are less likely to engage in this therapy or counseling. Requires a huge commitment to be effective.

We do have a sense of what triggers him. He struggles to make sense of people and rules of socialization and so when he interprets interactions with a negative bias, which is common for those with BPD, he loses his sense of self and a sense of being loved. His response to that emotion is to entertain suicide and tell us about it, which in our reaction gives him the info he needs to feel loved. There is a logic to it.

He keeps us at a distance until he is triggered. Even then, he doesn’t want physical closeness, so I have lived separately. I realize no one has the answer here. He is only 20 and adulting is hard, especially with BPD. I’m guessing that being in his life so he can offload some of this stuff on me would likely help him. But it comes at a big personal cost, the expense and loneliness of living far from family/friends plus being in the orbit of my child’s dysfunction, which I don’t need to describe to you folks.

I guess this is just hard, will be hard for a long while. And I’m still coming to terms with it.

Thanks for processing with me.

[InTheWilderness]

I'm posting the below with permission from a private message regarding useful firearm + mental disorder info. As an aside, I am very reluctant to call police when my son is in crisis. It can go badly when officers without mental health crisis training get involved. If that call is made, request only officers with training need respond. Otherwise I wouldn't allow them in the home. An unstable person might strike an aggressive police officer and that is a felony.

Gun Laws in the United States for those with Mental Illness can be found here:  https://www.ncsl.org/civil-and-criminal-justice/possession-of-firearms-by-people-with-mental-illness

Since your son is an adult, you cannot 'significantly affect a child's desire to end his life'.  However, you can make it more difficult for him to do so.

Short term solution(s):

+Read the law that pertains to the state where your son is residing, and the states that border it.  Since he has been hospitalized the hospital is required to report your son's stay with a BPD diagnosis to that state's data base.

+Make sure your son is on the list that bans him from purchasing a fire-arm for the state of his residence and those surrounding that state within a 100 mile radius or greater.  This won't prohibit a private person to person sale; however, it will prevent him from making a purchase at a gun show or a gun store.

+If you pay for your son's hospital stay, see if they might be able answer this information for you in an indirect way (e.g. Did you comply with state law to make sure he cannot buy a gun?), but HIPAA ties their hands on what they can respond to; however, it doesn't restrict you from writing a letter, which they will be required to keep and add to his file should an incident happen.  Inquire as to any and all programs from the hospital available to the parents, and do them.

+If you pay for your son's cell phone plan, and you bought his phone, and you are 'loaning' it to him, place a GPS tracker software on it if you can since it is your property; however, if it is his property then you would be violating the law.  This is useful information for the next item...

+Learn the local 10-digit phone number for the 911-dispatch (emergency call center) for where your son lives (usually reserved for interagency communications, so this might be difficult to obtain).  The next time he calls you threatening suicide, call this number and have them do a wellness check on him, explaining he is threatening suicide.  Give them the coordinates or address from the GPS tracking software, and/or have them ping his phone number to determine his location.

+If you are stonewalled by local authorities, use your US senator's and/or congressman's office, to verify this information for you.

[livednlearned]

InTheWilderness,

I echo Sancho, that you must be feeling the exhaustion from being on high alert.

If you're in the US, have you heard about NEA-BPD Family Connections? I attended a session (8 weeks with a support group that met after) and a majority of the people there were people with adult BPD children. My stepdaughter (now 26) was chronically suicidal and living with us off and on. The whole family really struggled with her during those years. I can't pinpoint any one piece of advice as more helpful than another but for some reason being with people who were struggling with the same thing was a godsend.

I understand the instinct to be closer to your son. I wonder, though, if doing so would feel invalidating to him? It's complicated, but he's trying to adult and he's making positive changes, as you say. Would moving closer make him feel he can't do this on his own? If he has not asked I would hit the pause button and channel energies into what Sancho suggested.

There is also a chapter on suicidal ideation in Shari Manning's book Loving Someone with BPD that is quite detailed.

Something else I'm learning with my son (21) who has level 1 autism (what used to be Asperger's) is that me practicing the skills I want him to use is surprisingly helpful. I wasn't expecting this approach to deepen my empathy but that has been a side effect. I would even go so far as to say it has changed me and how I see the world. My son has debilitating social anxiety and while he isn't suicidal, he has pathologic demand avoidance (PDA) which is quite painful for him. Like SI he seems to be learning the ways in which his own brain tricks him and that is no small thing to discover.

[InTheWilderness]

Hi, livednlearned, thanks for replying. I signed up for the NEA-BPD course. The wait is around six months. I'm looking forward to it for both the education and connection. I checked out Shari Mannings book from the library. Thanks for the suggestion. The suicidal ideation is what I'm mostly struggling with. As a parent, these threats raise complicated and strong emotions that I haven't yet come to terms with.

You also raise a good point about invalidation. He has always told us not to visit, but when we do, he is grateful. I can't trust his words because I don't think he understands himself either. However, I do need to be careful, and I think you are right that moving out there might be invalidating. He regresses when I'm involved in his daily life out of necessity (hospitalization). Seems like everything about BPD is tricky. You think you're offering support when in fact you're invalidating.

How great that your son is on a path of self-discovery. And that wouldn't have happened without your support. I hope to get there with my son too. I can tell he's already learning so much about himself. The SI has a real grip on him for now. That's the big one we can't seem to impact.

Thanks everyone for all this good feedback. I so appreciate it.

[Turkish]

ITW,

I'd be concerned about this also even if I weren't a parent, especially the talk of buying a gun. We have SI protocol here for members in distress, but most of this is applicable for anybody. Tell me if you can't follow the link:

Emergency Protocol

I also found this which may help frame your discussions (long, but applicable):

Care and sensitivity are important. A person in crisis can easily feel shamed. Do not say "call 911" (unless they have already done something - like take pills). We want to talk and generally speak in the moment - what happened today. We want to access, at a basic level, the degree of the threat - have they thought of a method for killing themselves - do they have the means (e.g., a gun, rope, a car). We want to gently encourage them to use the text line (741741) or call a hotline.

We want to keep them talking. We want to speak in terms of today ("what happened today). We want to assess the risk.

Assess risk
  (so that you know where to take the conversation)

         Ask the person, "Are you feeling so bad that you are thinking about suicide?"
  If the answer is yes, ask, "Have you thought about how you would do it?"
  If the answer is yes, ask, "Do you have what you need to do it?"
  If the answer is yes, ask, "Have you thought about when you would do it?"

Talk about things (lightly probe and listen)

Overwhelming Pain: pain that threatens to exceed the person's pain coping capacities. Suicidal feelings are often the result of longstanding problems that have been exacerbated by recent precipitating events. The precipitating factors may be new pain or the loss of pain coping resources.

Hopelessness: the feeling that the pain will continue or get worse; things will never get better.

Powerlessness: the feeling that one's resources for reducing pain are exhausted.

Feelings of worthlessness, shame, guilt, self-hatred, “no one cares”. Fears of losing control, harming self or others.

Personality becomes sad, withdrawn, tired, apathetic, anxious, irritable, or prone to angry outbursts.

Declining performance in school, work, or other activities. (Occasionally the reverse: someone who volunteers for extra duties because they need to fill up their time.)

Social isolation; or association with a group that has different moral standards than those of the family.

Declining interest in sex, friends, or activities previously enjoyed.

Neglect of personal welfare, deteriorating physical appearance.

Alterations in either direction in sleeping or eating habits. (Particularly in the elderly) Self-starvation, dietary mismanagement, disobeying medical instructions.

Difficult times: holidays, anniversaries, and the first week after discharge from a hospital; just before and after diagnosis of major illness, just before and during disciplinary proceedings. Undocumented status adds to the stress of a crisis.

[livednlearned]

He has always told us not to visit, but when we do, he is grateful.

ITW, I was thinking about you and your son.

One thing I notice even about my husband is that sometimes he says the opposite of what he wants. I often take his words at face value, which is not unusual. Only later does he tell me he wanted x or y or z. We're getting better at this translation.

Your son seems to do this too. You know your son is grateful when you visit even though he says don't come.

And in terms of suicidality, he's high risk.

If he were my son (who is 21) I would probably get a place in his town. He's not BPD so it's not quite the same but these boys, in this generation, they seem to be so much younger than their years. And like you say, adulting is hard.

If you think your son would feel invalidated, this might be a time when a white lie is preferable. "I like the town so much I'm thinking of investment properties. I'm going to stay a bit and get a feel for the place." Or if you think straight up is a better approach, "I'm going to want to see you and visit a lot and this makes a lot of sense, we're renting a place."

When my BPD stepdaughter was struggling (she's still chronically suicidal but seems to be doing ok atm) we also did research on different facilities in her area, including a multi-level DBT outpatient clinic. It felt comforting to know what was nearby and available and how things worked there just in case the situation took a turn for the worse.

We do have a sense of what triggers him. He struggles to make sense of people and rules of socialization

I have a hunch that my stepdaughter might have a combination of autistic traits and BPD. She struggles to make sense of people and rules of socialization, too.

It might not matter one way or the other but with SD26 it helped me put some things in context and make accommodations for her.

[InTheWilderness]

Thank you, Turkish for the emergency protocol. I wasn't aware of 741741, though my son knows the peer-to-peer crisis line in his state (which he has called) and also 988. One difference, I don't think my son feels shame when he's in crisis. His language and behaviors give no indication of that. Maybe it's different with BPD.

And thank you, livednlearned. Yes, there is a way to show up without invalidating him. Thanks for the suggestions and encouragement. I think it's the right thing to do. Living on his own and supporting himself at 20, in this era of heightened teen and young adult anxiety, is harder I think than living at home with comforts. I've told him this many times, and I think it resonates.

My therapist says I'll get the best help by talking with parents of cwBPD. I'm finding this to be true! I'm so grateful for your feedback. This site is a godsend.