Suicide and Overdose Reference¶
Historical Context and Suicide Prevention Evolution¶
Ancient Attitudes: Sin, Crime, and Condemnation¶
For most of recorded history, suicide was understood through moral and religious frameworks rather than medical ones. Almost all major religions condemned suicide, with elaborate descriptions of punishments awaiting those who died by self-inflicted means. Civil laws followed religious attitudes: until the early 19th century, most countries had legislation punishing those who attempted suicide—survivors faced criminal prosecution, property confiscation, and social disgrace.
In medieval Europe, suicide victims were often denied Christian burial, with their bodies subjected to ritualized desecration. Families lost inheritance rights and faced social ostracism. This punitive framework assumed suicide was a rational, sinful choice rather than a manifestation of mental anguish—an attitude that created centuries of stigma whose echoes persist today.
Decriminalization: A Gradual Shift (1751-Present)¶
Germany became the first country to decriminalize attempted suicide in 1751, reflecting Enlightenment ideas about individual rights and emerging recognition that punishment failed to prevent suicide. Following the French Revolution, other European countries followed: Sweden (1864), Finland (1910), England and Wales (1961), Ireland (1993). The United States never had federal criminalization, though some states maintained laws against attempted suicide into the late 20th century.
This shift was driven by new psychological theories—including Freud's framework of mental disorders as medical conditions—the recognition that criminalization hindered help-seeking, and changing legal philosophy emphasizing individual rights. However, decriminalization alone didn't destigmatize suicide; it merely removed legal consequences while leaving social and institutional barriers intact.
Birth of Suicide Prevention (1950s-1960s)¶
The modern suicide prevention movement began in the 1950s when VA psychologists Edwin Shneidman and Norman Farberow conducted pioneering research arguing that suicide was preventable and that self-destructive impulses could be forestalled through timely detection, intervention, and treatment. Their work challenged the prevailing assumption that suicidal individuals were beyond help.
In 1958, Shneidman and Farberow established the Los Angeles Suicide Prevention Center—the first dedicated suicide prevention facility in the United States. The center added a 24-hour crisis hotline in 1963 and pioneered the practice of training non-professionals to take crisis calls. This model—accessible, immediate telephone intervention staffed by trained volunteers—revolutionized crisis response. Within fifteen years, over 150 similar centers had been established across the country.
In 1966, the Center for Studies of Suicide Prevention was established at the National Institute of Mental Health, signaling federal recognition of suicide as a public health issue requiring systematic research and intervention.
DBT Revolution: Evidence-Based Treatment (1980s-1990s)¶
Until the late 1980s, no psychotherapy had demonstrated effectiveness for chronically suicidal individuals. Many clinicians believed these patients were untreatable—a nihilism that led to abandonment disguised as clinical judgment.
Marsha Linehan, drawing from cognitive-behavioral therapy, dialectical philosophy, and Buddhist psychology, developed Dialectical Behavior Therapy (DBT) through years of trial-and-error work with highly suicidal patients. In 1991, she published the first randomized controlled trial demonstrating that DBT significantly reduced suicide attempts, self-harm, and hospitalization rates while increasing treatment retention.
DBT's core innovations included: - Skills training: Mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness - Dialectical balance: Accepting patients exactly as they are while pushing for change - Hierarchy of treatment targets: Addressing life-threatening behaviors first - Therapist consultation teams: Supporting clinicians working with high-risk patients
The concept of "building a life worth living"—not just preventing death but creating meaning—transformed how clinicians approached suicidal patients. DBT demonstrated that with appropriate treatment, many chronically suicidal individuals could achieve stable recovery.
Modern Infrastructure (2000s-Present)¶
In 2001, SAMHSA established the National Suicide Prevention Lifeline as a central switchboard connecting callers to crisis centers nationwide. In July 2022, the United States transitioned to the three-digit 988 Suicide and Crisis Lifeline, dramatically improving accessibility.
Federal mental health policy evolved toward person-centered, recovery-oriented, and trauma-informed care—recognizing that suicidality often emerges from treatable conditions and that recovery is possible. However, significant gaps remain: access to mental health services remains unequal, crisis services are underfunded, and stigma continues to prevent help-seeking.
Overdose Evolution: From Moral Failure to Medical Emergency¶
Medical understanding of overdose evolved alongside broader changes in addiction medicine. The discovery of naloxone (Narcan) in 1961 and its approval for opioid overdose reversal in 1971 transformed emergency response—for the first time, a specific antidote could reverse an otherwise fatal opioid overdose within minutes. The opioid epidemic beginning in the 1990s brought overdose into public health focus, leading to expanded naloxone access and harm reduction approaches.
The distinction between intentional (suicidal) and unintentional (accidental) overdose became clinically important: both require emergency medical intervention, but the underlying causes and appropriate follow-up differ significantly.
SSRI Safety: A 1990s Context¶
When selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac) were introduced in the late 1980s, they were celebrated as safer alternatives to tricyclic antidepressants, which had narrow therapeutic windows and high overdose lethality. Early research suggested SSRI overdoses were "minimally toxic" in most cases.
However, clinical experience revealed that large SSRI overdoses could cause seizures, cardiac conduction abnormalities, serotonin syndrome, and—rarely—fatal outcomes, particularly when combined with other substances or in individuals with pre-existing vulnerabilities. The 1990s represented a period of evolving understanding about SSRI toxicity profiles.
Era-Specific Character Implications¶
Cody Matsuda (suicide attempt spring 1995) experienced his crisis during the early SSRI era. Prozac (fluoxetine) had been FDA-approved only since 1987; it was widely prescribed for depression but understanding of overdose toxicity was still developing. Cody was prescribed fluoxetine because doctors attributed his chronic fatigue to depression—a common pattern of psychological misattribution of physical illness. The medication that was supposed to help became the means of his suicide attempt.
Cody's 1995 attempt occurred before DBT became widely available outside research settings—the first DBT trial was published in 1991, and widespread dissemination took years. His treatment options were limited by the era: psychiatric hospitalization, medication management, and traditional psychotherapy that lacked evidence for reducing suicidality. The crisis hotline infrastructure existed but wasn't the integrated system that would develop later. His survival, but with permanent anoxic brain injury resulting in motor apraxia of speech, represents a common but rarely discussed outcome: people who survive suicide attempts but live with lasting disability from the attempt itself.
Jeremy Wallace (mental health crisis June 1998) demonstrates how undiagnosed ADHD can create catastrophic vulnerability. In 1998, ADHD remained primarily diagnosed in "disruptive kids"—not charismatic wealthy teenagers whose symptoms were masked by privilege. Jeremy's rejection sensitive dysphoria, emotional flooding, and executive dysfunction spiraled into a crisis so rapid that his body shut down from malnutrition and dehydration before anyone recognized the severity. His cardiac arrest from malnutrition—not overdose—resulted in post-anoxic brain injury and acquired epilepsy.
The 1998 treatment landscape was better than earlier decades but still limited. Crisis intervention existed, but the connection between undiagnosed neurodevelopmental conditions and suicide risk was poorly understood. Jeremy's case illustrates how missing one diagnosis can create cascading vulnerability.
Charlie Rivera (gabapentin overdose, approximately age 15) attempted suicide in the mid-2020s, benefiting from improved crisis infrastructure and more sophisticated understanding of chronic illness and mental health. His survival and subsequent treatment reflect modern trauma-informed approaches that recognize medical trauma as a contributor to suicidality.
Ezra Cruz (accidental fentanyl overdose, Berlin 2035) and Rafael Cruz (accidental fentanyl overdose death, 2022) represent the ongoing opioid crisis—where overdoses increasingly involve illicitly manufactured fentanyl, potency is unpredictable, and even experienced users face elevated mortality risk. Rafael's death in 2022 came despite decades of harm reduction knowledge; Ezra's near-fatal 2035 overdose—nearly dying the exact way his father had—demonstrates addiction's generational patterns and the ongoing need for accessible treatment.
Overview¶
Suicide: The act of intentionally ending one's own life. Suicide is a complex public health issue with multiple contributing factors including mental illness, trauma, substance abuse, social isolation, and life stressors.
Suicide Attempt: Self-inflicted potentially injurious behavior with evidence that the person intended to die. May or may not result in injury or death.
Overdose: Taking excessive amounts of a substance (medication, drug, alcohol). Can be intentional (suicide attempt) or unintentional (accidental).
Important Distinction: - Suicidal Overdose: Intentional ingestion with intent to die - Accidental Overdose: Unintentional, usually in context of substance use disorder - Both can be fatal or cause serious injury
SUICIDE STATISTICS AND RISK FACTORS¶
Prevalence¶
United States (Annual): - ~48,000 deaths by suicide (2021 data) - 12.3 million adults have serious thoughts of suicide - 3.5 million make a suicide plan - 1.7 million attempt suicide - 10th leading cause of death overall - 2nd leading cause of death for ages 10-34
Adolescents: - Suicide is 2nd leading cause of death ages 10-24 - Rates increasing in recent years, especially among girls - LGBTQ+ youth at significantly higher risk
Risk Factors¶
Mental Health Conditions: - Depression: Single biggest risk factor - Bipolar disorder - Anxiety disorders - PTSD - Eating disorders - Psychotic disorders (schizophrenia) - Personality disorders (especially borderline personality disorder)
Substance Use: - Alcohol use disorder - Drug use/addiction - Substances reduce inhibition, impair judgment - Often co-occurs with mental illness
Previous Attempts: - History of suicide attempts increases risk significantly - 30-40% of those who die by suicide had previous attempt
Trauma and Adverse Experiences: - Physical, sexual, or emotional abuse - Neglect - Witnessing violence - Loss of parent or loved one - Bullying
Social Factors: - Isolation, loneliness - Lack of support system - Relationship problems or breakups - Bullying or social rejection - LGBTQ+ identity (due to stigma, rejection, discrimination)
Access to Means: - Firearms in home (most lethal method) - Medications - Other lethal means
Stressors: - Academic pressure - Financial problems - Legal troubles - Chronic illness or pain - Recent loss or major life change
Demographics: - Male (more likely to die by suicide; use more lethal means) - Female (more attempts but lower completion rate) - Native American/Alaska Native (highest rates) - White individuals (higher than Black, Hispanic) - Middle-aged and older adults (rates increase with age)
Protective Factors¶
- Access to mental health treatment
- Strong social support and connections
- Coping skills and problem-solving abilities
- Reasons for living (children, pets, relationships, spirituality)
- Cultural or religious beliefs against suicide
- Limited access to lethal means
- Help-seeking behavior
WARNING SIGNS¶
Immediate Warning Signs (Crisis)¶
Seek help immediately if someone: - Talks about wanting to die or kill themselves - Talks about feeling hopeless or having no reason to live - Talks about being a burden to others - Talks about feeling trapped or in unbearable pain - Increases use of alcohol or drugs - Acts anxious or agitated - Withdraws from family and friends - Changes eating or sleeping patterns - Shows rage or talks about seeking revenge - Takes extreme risks (reckless behavior) - Talks about specific plan
Particularly concerning: - Giving away possessions - Saying goodbye to people - Putting affairs in order (will, letters) - Sudden improvement in mood (may indicate decision made) - Searching for ways to die (online searches, acquiring means)
Longer-Term Warning Signs¶
- Persistent sadness, hopelessness
- Withdrawal from activities once enjoyed
- Social isolation
- Declining school or work performance
- Increased irritability or anger
- Self-harm (cutting, burning) without suicidal intent (but risk factor for suicide)
- Preoccupation with death or dying (art, writing, conversations)
- Dramatic mood changes
- Changes in appearance or hygiene
- Giving away possessions
METHODS OF SUICIDE AND OVERDOSE¶
Common Methods¶
Overdose/Poisoning: - Medications (prescription or over-the-counter) - Illicit drugs - Alcohol (alone or combined with other substances) - Household chemicals or toxins
Other Methods: - Firearms (most lethal) - Hanging - Jumping from heights - Carbon monoxide - Cutting/bleeding - Drowning
Lethality Varies: - Some methods have high fatality rate (firearms 90%, hanging 70%) - Overdose fatality rate varies widely depending on substance - Many attempts are survived and become opportunities for intervention
Overdose Specifics¶
Medications Commonly Used in Overdose:
Antidepressants: - SSRIs (fluoxetine/Prozac, sertraline/Zoloft, etc.) - Relatively safe in overdose compared to older antidepressants - Can cause serotonin syndrome, seizures, cardiac effects - Large doses needed for fatality usually - Tricyclic antidepressants (amitriptyline, nortriptyline) - Much more dangerous in overdose - Cardiac toxicity (arrhythmias) - Can be fatal in small amounts - MAOIs (older antidepressants) - Dangerous in overdose - Rarely prescribed now
Opioids: - Prescription pain medications (oxycodone, hydrocodone, morphine) - Heroin - Fentanyl (extremely potent and dangerous) - Cause respiratory depression (breathing slows/stops) - Highly lethal - Naloxone (Narcan) can reverse if given quickly
Benzodiazepines: - Alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan) - Cause sedation, respiratory depression (especially with alcohol) - Relatively safer alone but very dangerous combined with other depressants - Flumazenil can reverse (but rarely used due to seizure risk)
Acetaminophen (Tylenol): - Extremely dangerous - Causes liver failure over days - May not seem serious initially - Antidote (N-acetylcysteine) effective if given early - Delayed fatality (days to weeks)
Stimulants: - Cardiac toxicity - Seizures - Hyperthermia - Psychosis
Other: - Lithium (mood stabilizer) - very dangerous - Anticonvulsants - Blood pressure medications - Insulin or diabetes medications
Polysubstance Overdose: - Combining substances dramatically increases danger - Alcohol + pills common and very dangerous - Synergistic effects (combined effect greater than sum)
CODY MATSUDA'S CASE¶
The Suicide Attempt (1995)¶
Background: - Age 16 - Struggling with mental health - On fluoxetine (Prozac) for depression
The Overdose: - Ingested 28 capsules of fluoxetine (20mg capsules = 560mg total) - Intentional suicide attempt
Immediate Effects: - Cardiac arrest - Seizure - Loss of consciousness
Emergency Response: - Found and 911 called - Paramedics, emergency transport - Hospital emergency treatment - Resuscitation - ICU admission
Outcome: - Survived but with anoxic brain injury - Brain deprived of oxygen during cardiac arrest - Lost ability to speak (motor apraxia) - Permanent disability - Long-term rehabilitation
Why This Overdose Caused Brain Injury¶
Mechanism: - Fluoxetine overdose caused cardiac arrest - During cardiac arrest, heart stops pumping blood - Brain completely deprived of oxygen - Even a few minutes without oxygen causes brain cell death - The longer without oxygen, the worse the damage - Anoxic brain injury resulted from the cardiac arrest
Not Typical Outcome: - Many SSRI overdoses do not result in cardiac arrest - Cody's case represents serious complication - May have had additional factors (underlying cardiac vulnerability, seizure, other substances) - Seizure can also deprive brain of oxygen
The Paradox: - Survived the overdose (medical intervention successful) - But permanent disability from the complications - Common outcome of serious suicide attempts - Person lives but with significant lasting effects
MEDICAL EMERGENCY RESPONSE TO OVERDOSE¶
Recognizing Overdose¶
Signs: - Unresponsive or difficult to wake - Slow or no breathing - Gurgling, gasping sounds - Lips or fingernails blue/gray - Very small pupils (opioids) or very large pupils (stimulants) - Seizures - Chest pain - Vomiting - Confusion or delirium
Immediate Actions¶
Call 911 Immediately: - Tell dispatcher: - Person unresponsive or overdosing - What substance if known - Whether breathing - Location/address
While Waiting for EMS: - Stay with person - If opioid suspected and naloxone (Narcan) available, administer - If not breathing, begin rescue breathing/CPR if trained - Position on side if breathing (recovery position) to prevent choking on vomit - Do NOT induce vomiting - Do NOT put person in cold shower - Do NOT try to make them walk around - Keep calm, reassure if conscious
Bring to Hospital: - Pill bottles or substance containers - Any note or information about what was taken
Emergency Department Treatment¶
Initial Assessment: - ABCs (Airway, Breathing, Circulation) - Vital signs - Level of consciousness - Physical exam
Stabilization: - Airway management (intubation if needed) - Oxygen - IV access - Cardiac monitoring - Medications to support blood pressure, heart rate
Specific Treatments:
Antidotes (if available): - Naloxone (Narcan) - opioids - N-acetylcysteine - acetaminophen - Flumazenil - benzodiazepines (rarely used) - Specific antidotes for other toxins
Decontamination: - Activated charcoal (if recent ingestion, patient awake) - Binds drugs in stomach/intestines - Reduces absorption - Only effective within 1-2 hours usually - Gastric lavage (stomach pumping) rarely done now - Whole bowel irrigation (for some substances)
Supportive Care: - IV fluids - Medications to control seizures - Treat arrhythmias - Manage complications (kidney failure, liver failure, etc.)
Monitoring: - Continuous cardiac monitoring - Serial labs (drug levels, organ function) - Neurological checks
ICU Care¶
Serious overdoses require intensive care: - Ventilator support - Hemodynamic monitoring - Organ support (dialysis if kidney failure) - Induced hypothermia (if cardiac arrest occurred) - Seizure monitoring and management - Prevention of complications
PSYCHIATRIC EVALUATION AND TREATMENT¶
Medical Clearance First¶
Before psychiatric evaluation, patient must be medically stable: - Alert and oriented - No longer acutely intoxicated - Medically stable - Can participate in assessment
Suicide Risk Assessment¶
Comprehensive Evaluation: - Mental status exam - Psychiatric history - Intent and lethality of attempt - Current suicidal ideation - Access to means - Support system - Safety planning
Questions Asked: - "Do you still want to die?" - "Do you have a plan?" - "What led to the attempt?" - "What stopped you or how were you found?" - "Do you regret surviving?" - "Do you have reasons for living?"
Disposition Options¶
Psychiatric Hospitalization (Voluntary or Involuntary): - High risk of repeat attempt - Active suicidal ideation - No safe discharge plan - Unable to contract for safety
Partial Hospitalization or Intensive Outpatient: - Lower risk but need support - Strong outpatient plan in place
Outpatient Treatment: - Low risk - Good support system - Engaged in treatment - Follow-up arranged before discharge
Involuntary Commitment¶
Criteria (varies by state): - Danger to self - Unable to care for self - Lacks judgment due to mental illness
Process: - Emergency hold (typically 72 hours) - Evaluation by psychiatrist - Court hearing if need to extend hold - Rights of patient (legal representation, appeal)
Controversy: - Balances safety with autonomy - Can be traumatic experience - Sometimes necessary to save life
TREATMENT AND RECOVERY AFTER SUICIDE ATTEMPT¶
Immediate Aftermath¶
Emotional Responses: - Relief (survived) - Shame, guilt, embarrassment - Anger (at self, others, system) - Continued hopelessness - Fear of judgment - Confusion - Ambivalence (part wants to live, part doesn't)
Common Questions: - "Why did I survive?" - "What's wrong with me?" - "What will people think?" - "Will I try again?"
Comprehensive Treatment¶
Psychotherapy:
Dialectical Behavior Therapy (DBT): - Evidence-based for suicide prevention - Skills for emotion regulation - Distress tolerance - Interpersonal effectiveness - Mindfulness - Specifically developed for suicidal individuals
Cognitive Behavioral Therapy (CBT): - Identify and change negative thought patterns - Develop coping skills - Problem-solving
Safety Planning Intervention: - Written plan for crisis - Warning signs - Internal coping strategies - People/places for distraction - People to ask for help - Making environment safe - Reasons for living
Family Therapy: - Address family dynamics - Improve communication - Family as support system
Group Therapy: - Reduce isolation - Peer support - Shared experiences
Medications: - Antidepressants (with careful monitoring) - Mood stabilizers - Anti-anxiety medications - Treat underlying mental illness
Hospitalization: - Inpatient psychiatric unit - Safety, stabilization - Medication adjustment - Intensive therapy - Discharge planning
Means Restriction¶
Critical Component: - Remove or limit access to lethal means - Lock up medications - Remove firearms from home - No stockpiling pills - Safe storage of household chemicals - Supervision if high risk
Evidence: - Reducing access saves lives - People often use available means impulsively - Suicide attempts often impulsive (within minutes of decision) - Brief delay can prevent death
LONG-TERM LIVING AFTER SUICIDE ATTEMPT¶
Recovery is Possible¶
- Many people who survive suicide attempts do not go on to die by suicide
- Treatment works
- Life can improve
- Reasons for living can be rediscovered
Challenges¶
Stigma: - Self-stigma ("I'm broken, weak") - Social stigma (others' reactions) - Fear of disclosure - Discrimination
Medical Records: - Hospitalization becomes part of record - May affect insurance, employment - Privacy concerns
Relationships: - Family guilt, fear, hypervigilance - Friends may withdraw or not know how to help - Trust may be affected - Changed dynamics
Identity: - "Suicide survivor" as identity - Processing the attempt - Integrating the experience - Moving forward
Ongoing Mental Health: - Underlying conditions don't disappear - Need ongoing treatment - Relapse prevention - Developing skills
Risk of Recurrence: - First year after attempt highest risk - Anniversaries difficult - Need for ongoing monitoring and support
Building Life Worth Living¶
Concept from DBT: - Not just preventing suicide - Creating life worth living - Finding meaning and purpose - Developing relationships - Pursuing values - Experiencing positive emotions
IMPACT ON FAMILY AND LOVED ONES¶
Immediate Impact¶
Shock and Trauma: - Finding person after attempt - Emergency room experience - Fear of death - Uncertainty about outcome - Feeling helpless
Emotions: - Fear, terror - Guilt ("I should have known/done something") - Anger ("How could they do this?") - Confusion ("Why?") - Relief (if survived) - Grief
Long-Term Impact¶
For Parents: - Profound guilt - Hypervigilance - Fear of recurrence - Changed parenting (walking on eggshells) - Questioning everything - Relationship strain - Other children affected
For Siblings: - Fear for sibling's safety - Own emotional distress - Feeling forgotten (attention on sibling) - Guilt (survivor guilt, sibling rivalry guilt) - Changed family dynamics - Worry about own mental health
For Partners: - Caregiver role - Hypervigilance - Fear - Relationship changes - Intimacy affected
For Friends: - Not knowing what to say - Fear of triggering - Withdrawing or hovering - Own emotional needs
Family Healing¶
Family Therapy: - Process trauma - Improve communication - Address guilt - Learn warning signs - Create safety plan together - Heal relationships
Education: - Understanding mental illness - Understanding suicide - Reducing blame
Support: - Family support groups - Individual therapy for family members - Taking care of own mental health
Finding Balance: - Supporting without enabling - Monitoring without smothering - Healthy boundaries - Trust rebuilding
CODY MATSUDA'S FAMILY IMPACT¶
Immediate Aftermath (1995)¶
Pattie (Age 13): - Trauma of learning about Cody's attempt - Fear of losing brother - Guilt (siblings sometimes have complicated relationships) - Hospital visits - Witnessing parents' distress - Own emotional needs possibly neglected
Joey (Young Child): - Confusion about what happened - Disrupted family life - Parents distracted and upset - Possible fear
Susie (College): - Away when it happened - Guilt about not being there - Rushing home - Interruption of college life - Long-distance worry
Ellen and Greg (Parents): - Devastating - Finding Cody or getting the call - Hospital vigil - Uncertainty about survival - When he survived: relief but also facing permanent disability - Guilt (could we have prevented this?) - Grief over Cody's suffering and changed future
Long-Term Adaptation¶
Family Rallying: - Learning ASL together - Supporting Cody's rehabilitation - Accommodating communication needs - Therapy (individual and family) - Processing trauma
Changed Family Identity: - "The family that survived" - Resilience - Closer in some ways - Ongoing grief and adaptation
Siblings' Individual Journeys: - Pattie carrying guilt, trauma - Understanding mental illness - Advocacy or caregiving roles - Own mental health vigilance
FOR CHARACTER DEVELOPMENT¶
Writing About Suicide and Overdose¶
Responsible Portrayal: - Avoid glorification or romanticization - Avoid detailed description of method - Show complexity (not simple or rational) - Include consequences (physical, emotional, social) - Show impact on others - Include treatment and recovery - Show hope is possible
Avoid: - "Successful" or "failed" attempt (use "died by suicide" or "survived attempt") - Suicide as romantic or noble - Suicide solving problems - Contagion effect (detailed methods can trigger others) - Simplistic explanations ("because of X event")
Include: - Warning signs leading up - Multiple contributing factors - Ambivalence (most suicidal people have mixed feelings) - Impulsivity - Medical realities - Treatment - Family impact - Long-term recovery process - Resources for help
Cody Matsuda Character Arc¶
Before Attempt: - Depression, struggles (what were warning signs?) - Isolation, hopelessness - Access to means (prescribed medication)
The Attempt: - Crisis point - Impulsive or planned? - What were the hours before like?
Immediate Aftermath: - Medical emergency - Family trauma - Uncertainty - ICU, rehabilitation
Living with Consequences: - Permanent disability (apraxia, anoxic brain injury) - Processing "I tried to die, but I'm still here, and now I can't speak" - Identity reconstruction - Ongoing mental health treatment - Reasons for living found - Relationships with family changed - Communication barriers adding to frustration
Long-Term: - Building life worth living despite disability - Ongoing mental health management - Relationships (family, romantic, friendships) - Purpose and meaning - Resilience - Possible advocacy
Narrative Considerations: - How does Cody communicate about suicidal thoughts now? - ASL, typing, AAC device - Does he regret surviving? - How has his perspective changed? - Relationship with mental health treatment - How does family talk about it?
RESOURCES¶
Crisis Hotlines: - 988 Suicide and Crisis Lifeline (call or text) - Crisis Text Line: Text HOME to 741741 - Trevor Project (LGBTQ+ youth): 1-866-488-7386
Organizations: - American Foundation for Suicide Prevention (AFSP) - National Alliance on Mental Illness (NAMI) - The Jed Foundation (teen/young adult mental health) - Society for the Prevention of Teen Suicide
Resources for Attempt Survivors: - Attempt survivor support groups - Therapy specializing in suicidality (DBT, CBT) - Lived experience networks
For Families: - Family support groups - Books and educational materials - Therapy
This reference document compiled from suicide prevention literature, clinical practice, and survivor narratives. Suicide and suicide attempts are complex, multifaceted tragedies affecting individuals, families, and communities. Accurate, responsible representation is essential. If writing about suicide, consult additional resources and consider impact on readers.
Content Warning Note: These topics can be triggering. Readers struggling with suicidal thoughts should seek help immediately.
Last Updated: October 2025
Living Document: Medical Reference