I am a psychologist, this is what I advise when a patient says they don't want to live

A clinical psychologist describes how a 22-year-old patient's plea to stop living is heard in the therapy room. The account argues that listening without judgement, challenging myths and spotting distress early can open a path to help.Editor’s Note: In this fortnightly column, top doctors share how they deal with their own health challenges, offering readers expert insight grounded in experience. Read more such stories here.A 22-year-old student comes into the therapy room. His gaze is empty, his hands are shaking, and he speaks in an almost trembling whisper.“I don’t want to live any more.”His voice cracks as he says it, and tears roll down his face. Exhaustion hangs in his voice, as if he has been fighting himself for too long. It is the exhaustion that comes from carrying pain in silence for too long. At that moment, he does not need a quick fix to all his problems. He needs someone to hear him without judgment and without rushing to fix everything. His vulnerability is not a symptom. It is a plea for help. And it is real.His story, like so many others, began long before this moment. Somewhere along the way, pressure, pain and the quiet loss of hope had accumulated, accompanied by multiple prior, often unacknowledged, expressions of distress.I HAVE SEEN THIS ACROSS DIFFERENT SETTINGS I have been practising in the field of clinical psychology for over a decade. During this time, I have seen multiple patients come to me with different problems.I started my career in a smaller town, and since then, I have spent the majority of my career practising in a metropolitan city. Many times, we assume that with advances and modernisation, people in metro cities are more aware of mental health than those living in rural areas. To a certain extent, this may be true because of easier accessibility to care.But when it comes to awareness about mental health, a metro city can be no different from other parts of the country.Lack of awareness and the stigma associated with mental health often prevent people from seeking help. By the time many people reach a mental health professional, they are already exhausted mentally, physically and, in many cases, financially. They may have also lost hope that they will be able to deal with their problems.WE ARE SEEING MORE YOUNG PEOPLE IN DISTRESSWe have also started seeing an increase in cases of suicide attempts and deaths by suicide. As much as it pains me to say this, we are seeing an increasing number of cases among adolescents and young adults.According to global data, young people aged 15 to 29 and older adults aged 75 and above represent populations that are particularly vulnerable to death by suicide. India is not different in this regard.The factors can vary. Among young people, academic stress, relationship difficulties and worries about the future can be some of the factors associated with suicidal distress. Among older adults, loneliness, physical illness, loss of a spouse or the loss of a support system can increase vulnerability.Marginalised and socially vulnerable groups can face additional challenges. Mental health conditions such as depression, anxiety and substance use disorders, particularly alcohol use, are also strongly associated with suicidal behaviour.Rather than looking only at the causes, I would like to adopt a humanistic lens and reflect on our collective role as a society and what we can do to prevent these tragedies.COMMON MISCONCEPTIONS ABOUT SUICIDEThere are several misconceptions about suicide that we need to challenge.People who want to die do not talk about it.In reality, a person who dies by suicide may have given some indication of their unbearable emotional pain, hopelessness or exhaustion before attempting to take their life.When somebody says they are not okay, it can indicate something deeper than a casual statement. We should not simply brush it off as attention-seeking behaviour.I strongly believe that if we can just listen, we may be able to save a life.Talking about suicide will encourage the act.Talking about suicide does not mean encouraging it. Open and compassionate conversations are necessary to reduce stigma, provide relief and encourage people to seek help.Suicide only happens to people with severe mental illness.This is not true. Suicidal thoughts can occur in anyone, regardless of whether they have a diagnosed mental health condition.Successful or educated people are not at risk.External success does not guarantee mental well-being. Someone who appears completely fine on the outside may still be silently suffering.Suicidal distress can affect anyone, including someone successful, educated or who appears to have everything in life.WE NEED TO CHANGE THE CONVERSATIONThe WHO theme for suicide prevention, “Changing the Narrative on Suicide: Start the Conversation”, calls on us to challenge myths, reduce stigma and foster compassionate dialogue.It is time to move away from the hush-hush attitude, silence and misunderstanding surrounding suicide. We need more openness, empathy and support, and we need to create an environment where a person who is suffering feels safe enough to speak without fear of being judged.Most importantly, they should feel that seeking help is possible.WHAT CAN YOU DO IF SOMEONE YOU KNOW IS STRUGGLING?Pay attention when you notice a deviation from someone's usual behaviour.For example, a colleague who was previously engaged, talkative and jovial may suddenly become withdrawn, less vocal in meetings or increasingly isolated. They may also say things such as, “I feel like giving up” or “I feel exhausted.” Changes such as sleep difficulties, low appetite or unexplained weight loss may also indicate that something is wrong.These changes may reflect genuine distress, although they may also have other explanations. But if they do signal suffering, your attention could make a difference.Pay attention to noticeable changes in how someone acts, feels or functions from day to day.Gently ask, “Are you okay?”And then listen. Really listen.Do not judge them or immediately rush to fix their problems.Even if they say, “I’m fine” or “I don’t need help," stay with them. Your presence alone can be powerful. You do not always have to offer advice. Sometimes, simply sitting with someone in silence can make a difference.WHAT SHOULD YOU SAY?Many of us worry about saying the wrong thing. We may panic and immediately start lecturing or advising the person. Sometimes, we may even shame them for having suicidal thoughts.Statements such as “You have everything in your life, why are you having these thoughts?” can make a person feel even more ashamed.We may also unintentionally minimise what they are experiencing by saying things like, “It’s nothing” or “I’ve been through worse.”Even phrases such as “Think positive” can increase shame when someone is struggling to do exactly that.Instead, stay calm and listen to what they have to say without judgement.Ask direct questions clearly and without hesitation. Treat everything they share as important and worthy of attention.Help them access appropriate support.If you believe the person is in immediate danger or there is an immediate possibility that they may harm themselves, do not leave them alone. Reach out to their caregivers or people who can stay with and support them when you cannot be there.SUICIDAL DISTRESS CAN BE TEMPORARYWhat we need to understand is that suicidal thoughts and ideation can represent a crisis. The intensity of what a person is experiencing at that particular moment can be temporary, even though it may feel permanent to the person experiencing it.Helping them understand that the feeling can pass, just like other intense emotions, can be important.Sometimes, helping a person get through that difficult period, showing them that support is available and helping them understand that these thoughts can be managed can be enough to help them find a reason to hold on.It can help them move from hopelessness towards hope.SOMETIMES, ENDING THE SUFFERING IS THE GOALUltimately, we need to see suicidal distress not merely as a disease, but as human suffering.Most of the time, ending life is not the goal. Ending suffering is. A single conversation, our presence and an act of kindness can give someone a ray of hope and can be profoundly healing. That is the impact we can and should create.Let us choose compassion over silence, connection over judgement and kindness over indifference. Because every conversation matters, and every life is worth saving.(Anuna Bordoloi is Lead Clinical Psychologist, Department of Mental Health and Behavioural Sciences, Fortis Healthcare, Noida and Greater Noida)- EndsPublished By: Smarica PantPublished On: Sep 10, 2026 08:00 IST