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9 risk factors for suicide and 1 important question you can ask to hopefully know for sure.

There's something you should know about people with severe depression.

Many of us feel inept when it comes to acknowledging suicide.

"It's so tragic."

"What a waste of a beautiful life."


"Why didn't he just talk to us about it?"

We are often at a loss for how to deal with the profoundly devastating topic of suicide. We can talk about it in a removed, social-ill, this-world-is-so-messed-up, throw-our-hands-up-in-helplessness kind of way when it comes up in passing — like when people are talking about how much they miss Robin Williams.

But we are poorly equipped to discuss it in any substantial way. Which is understandable. Most of us aren't trained in psychiatric services and are doing our best to muddle through our own difficulties in life. Figuring out how to solve America's suicide problem seems above our pay grade.

It's important for each of us to commit to getting better at talking about it.

When you have that one friend you can just sit and talk with about anything. Image by Garry Knight/Flickr.

The truth is that each of us could have a friend who's suicidal right now — today — and isn't telling us about it. They're not telling us about it because they know very well that they live in a world ill-equipped to help them without judging them.

The main thing that kept me from speaking up long ago when I toyed with the thought of ending my own life was: "If I admit I'm barely able to take each next breath right now, will I always be labeled as fragile or troubled forever for the rest of time?" Saying something is a decision to commit to someone else's memory that this messed-up mental stumble is happening. It takes bravery to talk about it, especially when you're in the thick of it.

Everyone and anyone could be at risk for suicide. Suicide doesn't have a "look." Moms, dads, 11-year-olds, pastors — the thought of ending it all can take root in anybody's mind. But there are some groups who are more prone to suicide than others. According to the CDC, lesbian, gay, and bisexual youth are four times more likely to attempt suicide than straight peers. And 25% of transgender young people surveyed report having made an attempt to take their own life. The thing that some well-meaning people don't know is that snapping out of it or learning how to enjoy life isn't an option for those who are truly depressed — it's not a mind-over-matter thing. At that particular moment in their lives, the afflicted person just can't.

The little things that can spark our spirit during normal times don't do the same thing for someone who's depressed. Image by Rick/Flickr.

Why does suicide start looking like a viable option?

John Gibson, a pastor whose name was recently released as part of the Ashley Madison hack (where people were outed for starting accounts with the intent to cheat on their spouses), committed suicide in August.

"He talked about depression. He talked about having his name on there, and he said he was just very, very sorry. What we know about him is that he poured his life into other people, and he offered grace and mercy and forgiveness to everyone else, but somehow he couldn't extend that to himself."
Christi Gibson, on her husband John's suicide letter

Jody Nelson, a clinical social worker in Lansing, Michigan, explains part of why a person can be drawn to suicide in the first place:

"A suicidal person will often see suicide as a neat, tidy, and self-contained solution to their emotional state of desperation. Suicide is never neat. Never tidy. And never truly self-contained. Suicidal people are not capable of seeing or predicting the ripples and waves their act will cause in lives around them. Yet their suicide will impact lives they aren't even aware they are touching via connections their own illness makes impossible for them to see."

He advises us to know the risk factors:

"Not all of these are going to mean impending suicide attempts, but the risk increases as they pile on each other."

1. Depression. Isolation. Losses.

2. Big life changes (and sometimes, just some small ones like going on or off certain meds).

3. Prior attempts. Substance abuse.

4. Irrational or erratic behaviors.

5. Financial difficulties.

6. Access to means.

7. Suicidal intention.

8. A family history of suicide.

9. Connections to others who have died by suicide.

Nelson says that if we see those signs, we should ask straight-up something like this question:

"Hey I've noticed you've been particularly down lately. Are you thinking about hurting yourself?"

It won't make someone who's not suicidal suddenly consider it. And it won't make someone who is thinking suicidal thoughts go through with it. What it will do, if they have been thinking about it, is break through a wall that's keeping the person isolated and suddenly alleviate some of that buildup they've been sitting alone with. A person struggling with depression and suicidal thoughts is often very grateful to find someone they can talk frankly with about their thoughts.

And if they say yes, listen and talk, but also get them to an emergency room. Go with them. Get them there. They will be connected to the right resources once they get there. Then follow up and keep an eye. Keep talking with them. But don't let them put it off — they will try to downplay it as not that serious. Who wouldn't?

Here's why it's important for us to talk about this right now, and publicly.

There's no shame in needing your friends. These guys know. Image by SmellyAvocado.

When we learn how to talk about suicide more productively and demonstrate publicly that we're trying to understand it a little better than we used to, we open doors in case someone in our circle is thinking about opening up.

We signal that we aren't going to judge our friends and loved ones — just love them. Sharing an article like this is one way to start sending that signal.

And when more people get the message that there's someone around they can talk to, maybe we'll see the suicide numbers drop significantly.

In the big picture, that would be amazing. But as anyone who's lost a loved one to suicide can tell you,saving one person and stopping those devastating ripple effects from starting is immeasurably valuable.

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Three women, three MS journeys: How multiple sclerosis looks different for everyone

Gina, Nathalie and Helga share their reactions to being diagnosed with MS and how they stay informed and positive in the face of ever-changing symptoms.

Courtesy of Sanofi

Helga, Nathalie and Gina all have MS, and their experiences show how differently the disease can manifest.

True

It’s been 155 years since neurologist Jean-Martin Charcot gave the first lecture on a mysterious progressive illness he called “multiple sclerosis.” Since then, we’ve learned a lot. We know MS causes the immune system to attack healthy tissue, including damaging the brain and spinal cord. Resulting symptoms can be debilitating and include fatigue, blurred vision, memory problems and weakness. Huge advancements in our understanding of MS and its underlying causes, as well as treatment advances, have been made in the past few decades, but MS remains a complex and unpredictable reality for the 2.8 million+ people diagnosed around the world.

Ironically, the only real constant for people living with MS is change. There’s no set pattern or standard progression of the disease, so each person’s experience is unique. Some people with MS have mild symptoms that worsen slowly but sometimes improve, while others can have severe symptoms that drastically alter their daily lives.

All people with MS share some things in common, however, such as the need to stay informed on the ever-evolving research, find various lines of support and try to remain hopeful as they continue living with the disease.

To better understand what navigating life with MS really looks like, three women shared their MS stories with us. Their journeys demonstrate how MS can look different for different people and interestingly, how the language used to talk about the disease can greatly impact how people understand their realities.

woman with horse, woman riding horseGina loves riding her horse, Benita.Courtesy of Sanofi

Gina—Hamburg, Germany (diagnosed with relapsing multiple sclerosis in 2017)

When her youngest son was 4 months old, Gina started having problems with her eye. She’d soon learn she was experiencing optic neuritis—her first symptom of MS.

“Immediately after the diagnosis, I looked up facts on MS because I didn’t know anything about it,” Gina says. “And as soon as I knew what could really happen with this disease, I actually got scared.”

As her family’s primary income provider, she worried about how MS would impact her ability to work as a writer and editor. Her family was afraid she was going to end up in a wheelchair. However, for now, Gina’s MS is managed well enough that she still works full-time and is able to be active.

“When I tell somebody that I have MS, they often don't believe me the first time because I don't fulfill any stereotypes,” she says.

Overwhelmed by negative perspectives on living with MS, Gina sought support in the online MS community, which she found to be much more positive.

“I think it’s important to use as many positive words as you can when talking about MS.” It’s important to be realistic while also conveying hope, she says. “MS is an insidious disease that can cause many bad symptoms…that can be frightening, and you can't gloss over it, either.”

To give back to the online community that helped her so much, Gina started a blog to share her story and help others trying to learn about their diagnosis.

Though she deals with fatigue and cognitive dysfunction sometimes, Gina stays active swimming, biking, riding horses and playing with her sons, who are now 11 and 6.

Cognitive dysfunction is common in MS, with over half of people affected. It can impact memory, attention, planning, and word-finding. As with many aspects of MS, some people experience mild changes, while others face more challenges.

Gina says that while there’s still a lot of education about MS needed, she feels positive about the future of MS because there’s so much research being done.

woman in wheelchair holding medal, woman rowingNathalie is an award-winning rower with multiple international titles.Courtesy of Sanofi

Nathalie — Pennes Mirabeau, France (diagnosed with relapsing-remitting multiple sclerosis in 2002)

Nathalie was a teenager and a competitive athlete when she noticed her first symptoms of MS, but it would take four years of “limbo” before she was diagnosed.

“Ultimately, the diagnosis was more of a relief, than a shock,” she says. “Because when you have signs and you don’t know why, it’s worse than knowing, in the end, what you have.”

However, learning more about the disease—and the realities of disease progression—scared her.

“That glimpse of the future was direct and traumatic,” she says. Her neurologist explained that the disease evolves differently for everyone, and her situation might end up being serious or very mild. So, she decided to stop comparing herself to others with MS.

She said to herself, “We’ll see what happens, and you’ll manage it bit by bit.”

By 2005, Nathalie’s MS had progressed to the point of needing a wheelchair. However, that has not dampened her competitive spirit.

Nathalie began her international rowing career in 2009 and has won multiple world titles, including two Paralympic medals—silver in London and bronze in Tokyo. Now, at 42, she still trains 11 times a week. Fatigue can be a problem, and sometimes hard workouts leave her with muscle stiffness and shaking, but she credits her ongoing sports career for helping her feel in tune with her body’s signals.

“Over the years, I’ve learned to listen to my body, letting my body guide when I need to stop and take breaks,” she says.

Nathalie explains that she used to only look backwards because of the initial shock of her diagnosis. In time, she stopped thinking about what she couldn’t do anymore and focused on her future. She now lives in the following mindset: “Even when doors close, don’t miss out on those that open.” Instead of focusing on what she can’t do, she focuses on the opportunities she still has. Right now, this includes her training for the 2024 Paralympic Games in Paris, where she will compete for another rowing medal.

“I only go forward,” she says. “Well, I try, anyway…It’s easy to say, it’s not always easy to do. But that’s what I try to do.”

woman exiting water after swimming, woman with great daneHelga's Great Dane has become a helpful and beloved companion.Courtesy of Sanofi

Helga—Johannesburg, South Africa (diagnosed with relapsing multiple sclerosis in 2010)

When Helga first started having balance issues and numbness in her feet, she chalked it up to her training as a runner. But when the numbness moved to her face, she knew something was wrong. She never guessed it was MS.

“When I was diagnosed, I felt completely overwhelmed and clueless,” Helga says. “I felt that I had nowhere near enough information. I did not know anything about the disease…I had no idea that it was going to be a process of continually monitoring and adjusting your lifestyle.”

In the beginning, Helga’s symptoms developed slowly, and she didn’t appear ill to others. She was even able to run for a few years after her diagnosis, but she couldn’t do marathons anymore, and she began to fall frequently due to balance issues and right-foot dragging. Then her cognition issues became more problematic, especially in her job as a trainer in a printing company.

“My executive function, decision-making and short-term memory were affected to the point that I was eventually medically unfit for work,” she says. She stopped working in 2017.

However, she didn’t stop living life. Even though she could no longer run, she continued to swim competitively. She got a Great Dane puppy and trained him as a service dog to help her walk. She also serves as vice chair of the patient support organization Multiple Sclerosis South Africa, and she advises others who have been diagnosed to join a patient advocacy group as soon as possible to get reliable information and meet others with MS.

Helga says she is “hopeful” about the future of MS. “I must say that I am so grateful that we have all the new medications available, because my life would not be the same if it wasn't for that,” she adds.

Part of how she manages her MS is by looking at the positives.

“If I could tell the world one thing about MS, it would be that MS is an incurable disease of the nervous system, but it's also the greatest teacher of valuing your health, family, friends, and managing change in your life,” she says. “My life is diversified in a way that I never, ever thought it would, and MS has been honestly the greatest teacher.”

Each MS journey is unique – with each person impacted experiencing different struggles, successes, and feelings as they manage this unpredictable disease. But the common thread is clear – there is a critical need for information, support, and hope. We are proud to participate in World MS Day and share these incredible stories of living life while living with MS. To learn more about MS, go to https://www.sanofi.com/why-words-really-matter-when-it-comes-to-multiple-sclerosis.

MAT-GLB-2301642-v1.0-05/2023

This article was sponsored by Sanofi. Participants were compensated when applicable.

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