February is American Heart Month. This awareness month, initiated by the Centers for Disease Control and Prevention (CDC), is to help educate people about heart disease and stroke. I wholeheartedly agree that caring for our physical heart is critical for a healthy life. But so is the other definition of heart which is “the place in a person where the feelings and emotions are thought to be” (Oxford). 

So if I ask you “how is your heart?” and you respond: “my blood pressure is in the healthy range now!” or “my cholesterol labs are much better” I promise I will still celebrate with you.  

But full transparency, despite my medical training including as a nurse practitioner in primary care, when I ask

“how is your heart?”

these days I am most interested in hearing how you are feeling and doing psychologically. 

Granted, how we feel changes over time – in the course of a day, week, month and beyond. But knowing how we feel is an important part of staying aware of the clues of what we need to do to ensure our hearts are healthy and encouraged.  

In the last month, a friend has begun turning my favorite question around on me. They have playfully asked “how is your heart?, and after laughing, I get serious, because I think this is an important question and I am committed to answering it authentically. 

My response to them has varied. One day I responded

“deeply inspired. The work I am doing is fueling me and encouraging me.”

Another day, I simply said:

“Weary. So weary”. 

You can imagine if a person feels weary for days on end - and even longer as with depression or other mental health conditions - they can begin to feel hopeless. 

Rarely a week goes by that I do not have someone email me, private message me, or talk with me about suicide in some form or fashion personally and professionally. This is what prompted me to write Suicide Part - 1. And I called it that because I knew this was too big and too important of a topic to do a one and done post about. So if you have not read Suicide - Part 1, I encourage you do so here.  

The response I got to this blog post helped me realize in a new ways how many people are struggling and needing to know how to handle these thoughts whether they or someone they know and care about are experiencing them.

Suicide and thoughts of suicide (suicidal ideation) are hard to process and understand. So I have three thoughts I want to share with you today: 

• All Suicidal Ideation Communicates Suffering

• Don’t Go Through It Alone

• Practice Presence and Don’t Turn Away

All Suicidal Ideation Communicates Suffering

More times than I can count I have had people ask - “But are they seriously wanting to kill themselves?” “How will I know if they are serious?” 

My response: They are suffering. If a person is even thinking or talking about suicide or having thoughts of not wanting to live any longer – it is serious. 

To the question:  “why if they are only saying it for attention?” 

My response: They are suffering. That they are saying what they are saying communicates they are suffering. It is important to listen and support. 

To the question: but what if they don’t really mean it? What if they are not really going to do it? 

My response: They are suffering. Make sure they know you hear them, that you see that they are suffering, and ask how you can support them. This should include their talking with a mental health professional.

Don’t Go Through It Alone

If you are having thoughts of feeling “weary” and you can’t remember the last time this feeling lifted, don’t go through it alone. Talk to those you love about it as well as a mental health expert. 

Those we love and that love us want to know how we are. We can remind one another of brighter days, the best parts of us, and help fan the flames of hope in ways that a health professional can not. 

But it is also critical that mental health experts be included. For example, if you are a mother of a teenager who is struggling, including a mental health professional means that you can remain their mom. You cannot be their mom and therapist. Including this mental health expert signals that mental health treatment is important, that mental health concerns are nothing to be ashamed of, that mental health concerns are just as valid as any other physical condition, and it means the suffering can be recognized and treated more quickly. 

Practice Presence and Don’t Turn Away

Suicidal thoughts often don’t go away immediately even when therapy and medications are started. Thoughts do not mean action and it is important to recognize that having thoughts for a time does not mean the person is not trying or does not want to get better. 

I long to see the day that suicide is no longer a leading cause of death. 

This is not our current reality but through investments in mental health at the individual-, family-, community-, state-, and federal level, we can have more interventions that treat mental health needs that will address the causes of suicidal ideation and suicide. I am honored to work with my Duke and UNC colleagues on the North Carolina Psychiatry Access Line (NC-PAL) consultation and education program that supports primary care providers across North Carolina in responding to mental health needs of pediatric patients in their home communities. That gives me hope that we can get more services and support for people when and how they need it. 

And your response in your circle of influence matters. As individuals, we can see and acknowledge suffering, be present, and ensure they noone has to go through dark times alone.

And we can be extra thoughtful in seasons where there are more triggers, like when there is

• loss (examples: death, divorce) 

• seasons that celebrate love and belonging (examples: Christmas, Valentines) that can make someone struggling feel even more alone and their expectations unmet. 

These triggers are why I wrote Suicide - Part 1 in December and this one in February. 

In my clinical practice and personal life, I have seen both of these seasons be particularly difficult time for people.

And certain age groups are particularly at risk. Valentines can be a big trigger for teenagers making them feel alone, hopeless, or rejected. As we age we have more insight into how we all suffer and suffering comes and goes and hard times ebb and flow. Children and teenagers have had less time to experience this truth, so look for opportunities to create safe places to talk with them about what they or their friends may be going through. 

And as you go through the remainder of this month, I encourage you to think about your physical heart and your figurative heart. They are both vital to a healthy, happy, and hope filled life. And don’t turn away from suffering or the hard conversations. Those around you need you and your ability to see suffering and share hope and encouragement.