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How working for a suicide prevention hotline made me rethink pain and empathy

It was a Thursday night around 11, and I was making coffee in the office kitchen. I was just about to start my shift. But before I could finish stirring, my supervisor came in. She looked more worried than usual.

"Are you ready?" she asked me. "This guy's really going through it."

"I can take it," I said.

A month earlier, I'd decided to volunteer overnight at the Didi Hirsch Suicide Prevention Hotline. This was the time of night that drew the most hopeless of callers. Walking into my glass-walled cubicle, I set down my coffee, opened my notebook, took a deep breath, and picked up the phone.

"Hi, my name is Nick. I see your name is Johnny." I didn't wait for a response. "What's going on tonight?"

A voice erupted on the line. Johnny was panicked, talking fast. There was so much intensity in his voice it was as if he were strapped to a detonating bomb. From his rolling R's and extended "o," I guessed he was Hispanic, young, but I never truly knew who was on the line. That was the point: strangers speaking with strangers.

When people call a suicide prevention hotline, they often don't know how to start the conversation. How do you tell someone you want to kill yourself? Johnny was no different. When I asked him what was wrong, he launched straight into a litany of terrible experiences, the worst of which was the end of a recent relationship. He was distraught. He felt helpless and unable to change his situation, and he was ready to end his life.

"Are you thinking of suicide?" I asked.

"Yeah," he replied timidly. I could sense he had never said the words aloud.

"And how are you thinking of killing yourself?"

"I'm going to jump in front of a train."

I took a deep breath. I was shocked. Usually the answer to that question isn't so specific.

"And where are you now?" I asked.

"I'm lying down on the train tracks."

My stomach churned. My throat tightened. My foot began shaking, and I closed my eyes. I felt a bead of sweat run down the side of my face. I needed to support Johnny quickly, and that meant meeting him on his terms. I imagined his each and every move. I focused on each sound I heard in the background. I tuned in to the tone of his voice, his cadence. I listened to his breathing, the sense of anxiety and dread building. The absence of sound or talking could be just as important. But I had to find something I could use to connect with this man, to join him in his suffering. That was the priority.

"What's that noise? It sounds like people." I asked.

"Just some drunk teens being assholes."

I could hear them in the background taunting Johnny: "Look at that idiot, what is he doing?"

"The world's against you tonight, eh, Johnny?"

"Yeah, nothing new."

"So it's not just tonight. You've been hurting for quite some time," I said.

"Yeah, no one cares. I've been doing this on my own for too long. I'm done."

"Have you shared how you've been feeling with anyone other than me?"

"Yeah, plenty of people. They just tell me to ‘suck it up,' ‘don't be such a downer,' or offer me a beer. I'm tired of feeling like a burden."

"You sound exhausted, hopeless even. You've been trying to connect with someone about what you're going through and encouraged to face it alone, until tonight."

Johnny was silent.

In the distance, I thought I heard the burgeoning sound of a train whistle. My heart rate quickened.

We all suffer. That's not just some Buddhist dogma — in my job as a mental health therapist in Los Angeles, I'm reminded that it's true every day. We may differ in the impetus of our suffering, the intensity of that suffering, and our response to it, but we share the universal burden. I've found accepting our own helplessness can be a transformational experience; so can joining another in their experience of pain. Unfortunately, many of us suffer alone.

After years in entertainment marketing, I decided to examine my life — I wasn't particularly happy, and I wasn't sure that my career was right for me. I sought out a therapist, and in treatment was asked a clarifying question: What times in my life did I feel most alive? I discovered it was when I felt connected to another person, not necessarily in space, but in conversation.

I reoriented my life around this revelation, allowing myself to explore a lifelong fascination with mental health. I joined the suicide prevention hotline, but quickly learned that a keen interest is not the same as aptitude or experience. I was surprised by the exhaustive volunteer training regimen for the hotline: It lasted months, each session opening with an in-depth lecture on a mental health topic followed by a series of group role-plays focusing on that day's topic. Until I began training, I hadn't realized how unprepared I was for my new career. I considered myself an empathetic person, a supportive friend, somebody who was caring to strangers — but I was severely mistaken.

It was during one of these training sessions — a Saturday afternoon role-play with a mentor — when I was confronted with the extent of my incompetence. My mentor had a history of bipolar disorder. He struggled with suicidal ideation in his own life and had made serious attempts to end his own life. But his suffering made him especially adept at connecting with high-risk callers. He had an innate ability to join callers in their experience of suffering. In joining them, he created a shared experience, often the key to bringing a caller back from the brink. We began the role­-play:

"All right, so in this scenario, I'm a 42-year-old man, I have no friends, I'm at high (suicidal) risk. I lost my job; my family has been dead for years. I have no attachments, a history of mental health issues, I'm not taking my medications, and I've pretty much given up," my mentor said. "You ready to start?"

"Sure, I said. I laughed nervously. I began the protocol for a call: "What's going on?"

My mentor started in as the caller. Using the details we'd agreed on for the scenario, he told a story so powerful and so rich that it seemed we were moving from a fictional story into his real life.

Suicide prevention training provides you with a basic format for each call: First, connect with the caller and assess the level of imminent suicide risk. Monitor level of suicide risk throughout the conversation. Second, determine underlying reasons for the call and explore those reasons with the caller. Third, brainstorm potential resources to assist the caller in improving his situation. Fourth, encourage the caller to call back as needed for further assistance or support. The hotline provided me with hundreds of pages of tips, perspectives, and stories of successful calls. But like becoming a new parent or climbing Mount Everest, no one can prepare you for the real thing. Only practice makes better.

"Are ... are you thinking of suicide?" I asked my mentor, stumbling over my words.

"Damn right! I've been thinking of suicide since I was 13. I've planned it out. I've attempted. I've felt the burn of the rope as it slid across my neck." There was no hesitation in his voice.

"And how might you take your life?"

"I dunno. There are so many ways, I haven't really thought about that."

My mentor's comfort in chatting about killing himself shook me. I didn't know how to enter this man's world. I couldn't join him in his aloneness. I didn't want to. I stopped the role-play.

"I have no clue what to say next." I said.

"Okay, then let's talk about what happened." My mentor said, breaking character. "You lost me. I didn't feel connected to you."

"Really?" I replied, still processing the role­-play.

"Definitely. You felt distant. What was going on for you in that role­-play?"

"It was hard to hear everything you were going through. I didn't really want to hear it."

"Absolutely. Makes sense why this guy is so alone, right? It's been hard for him to trust anyone to connect with his pain, his suffering. Most people don't want to be around that. They don't really want to hear it. They're scared or don't have the time. So he remains alone."

People join suicide prevention hotlines for myriad reasons. Some wish to give back, some have their own histories with suicide, some wish to experience a kind of pseudo-therapy environment prior to entering graduate school.

When I first joined the hotline, I did it for my ego. I believed my mere presence on the phone would be enough, that my knowledge would be enough, that I could change a caller's world in a word. But conceptual knowledge isn't enough. A voice on the other end of the line telling you it isn't worth it won't save anyone. My mentor during that session taught me the most important thing I've learned about suffering: People call suicide hotlines looking for a connection, for somebody who can join them in their anguish. Sharing our pain with others, just being seen in our experience of pain, can create tremendous momentum toward alleviating our suffering. Empathy is what saves people.

"We've been talking a lot tonight about the part of you that wants to kill yourself. But you called a suicide prevention line and are talking to me now. I wonder, is there a part of you that may want to live?" I asked Johnny.

"I guess. I mean, I'm pretty scared of this thing hitting me. I'm not sure I want to die."

"That's a powerful statement, and one to consider," I said. "In fact, I'm really glad you called tonight. It takes a lot of courage to pick up the phone, especially when a person gets to a place like where you are tonight. Placing your trust in a stranger, hoping they'll understand. That's hard."

I began to notice a shift in our conversation. Johnny's breathing had slowed. Some of his tension seemed diffused. But now I was sure I could hear a train whistle.

"That train sounds like it's getting closer." I stated, tempering my panic.

"Yep, it's coming right at me," he said definitively.

"Are you going to let it hit you?"

I couldn't believe I'd said something so directly. There was a chance my question would backfire, would cause Johnny to prove he was serious by letting the train hit him. I was terrified. This man wanted to die tonight, and I'd just reinforced his decision. I expected him to start yelling, to tell me his pain was real and if I didn't believe him, just wait.

But Johnny was silent. The pause gave me hope. It meant he was considering his options.

The train whistle grew louder.

Suddenly, Johnny took a deep breath and exhaled quickly.

"I think I want to live tonight," he said.

As soon as that last "t" came out, I heard the cacophony of a train passing by, the whoosh of air in the receiver of the phone. The train had passed by in what could only be inches.

My body shook with relief.

Nick Holt, LCSW, is a mental health therapist in Los Angeles serving the communities of Brentwood, Santa Monica, West LA, and Sawtelle. His expertise includes veterans, suicide prevention, and men's mental health.

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