After a loved one died by suicide, I hear many people report feeling guilty because someone failed to notice?

A. Guilt is often pronounced when loss results from suicide. Loved ones erroneously feel they could have done something to prevent the tragedy, and they feel powerless. I believe human beings often find it easier to accept that they could have done something and failed, rather than admit helplessness.

Suicide is difficult to predict, sometimes even with professional mental health training. Many people are depressed or isolated, but despite those traits often being referred to as potential “signs” of suicide, those conditions in and of themselves will not necessarily lead to suicide. In addition to depression and isolation, suicidal people also have feelings of pervasive and persistent hopelessness. They believe life will not get better, nor do they have the emotional endurance to tolerate what may seem like insurmountable obstacles to recovery.

Additionally, suicidal people often lack emotional intimacy with others and feel disconnected, either because proper support is unavailable, or they cannot access support. Suicidal people also often feel self-loathing, failure, or lack of purpose, as well as the belief that others will somehow be better off without them.

Combine these risk factors with thoughts of suicide as a real option, a plan, intent, means, and opportunity, and it can be a recipe for disaster.

Suicidal people often don’t tell because they fear (or actually experience) any combination of ridicule, shame, judgment, denial, pity, platitudes, or a minimizing of their concerns. They may feel they will not be met with calm understanding, acceptance, and compassion.

In the saddest, most dire circumstances, people who feel suicidal don’t tell because they are intent on following through with the suicide, and others may interrupt their plans. Those who are adamant about taking their own lives will usually succeed, if not after one attempt, then a subsequent attempt. And those who have made up their minds to end it all may also be misleadingly cheerful in their last days, because they see their suffering as finite.

Other major risk factors include impulsivity, mental illness, family history of mental illness, chronic physical illness, substance abuse, or having loved ones who’ve attempted suicide. At times certain people who are not serious engage in suicidal gestures “for attention,” but the obvious concern is that they may succeed in taking their lives accidentally.

Unfortunately, those who would be most objective and likely able to spot the true signs of suicidal risk are often not close enough to see it. Those who are closer don’t want to believe such a horrific thing is a possibility, and often will not see the signs except through hindsight.

Keeping a candid, open dialogue between yourself and those you love sets the best stage for them to reach out if they need support.

Mary Petersen, L.M.S.W., A.C.S.W., is a Psychotherapist in private practice and is a member of The Family Center’s Association of Professionals. For more information, please visit her website www.marypetersen.com.