Every night I fight myself to stay alive.

"Do you remember that scene in Avengers: Endgame? When Captain America is fighting himself?"

"I do."

"That's how I feel every night," Bethany confessed as she tucked her blonde hair back behind her ears. "It feels like I am fighting myself to stay alive."

Bethany was smart, pretty, a talented musician, and had a streak of sarcasm that made her funny as hell. And she couldn't stop thinking about killing herself. She fought herself to stay alive every day, a dichotomy so beautifully explained in her Captain America reference.

(Fortunately, I was a Marvel fan myself, which provided a platform to relate back to during the course of treatment.)

During the two years I treated Bethany, it often seemed as if the only things that allowed her to stay alive and put one foot in front of the other were small, time-limited goals. Little things that she could look forward to, such as the release of a new movie or a musical performance she had spent months preparing for.

Bethany ended up in the hospital once during the course of treatment. Her psychiatrist was frustrated that her medication wasn't working and sent her to the hospital for a psychiatric consult. She spent six hours in the emergency room, all the while worrying that she was going to fail her French test the next day because she wasn't studying.

This should have been a sign that Bethany was not in immediate danger.

But no one wants to be wrong in this situation. So, how can you help a suicidal friend?

Encourage them to seek professional help.

This should be the first action you take if you are concerned about someone's well-being. But, in reality, you can't force someone to seek help, and so this seemingly easy, obvious solution is only the tip of the iceberg.

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End the cycle of guilt and shame.

Time and again, I have heard well-meaning, loving parents advise their depressive, suicidal teenager to remain silent.

"Don't tell Grandma," Mom says, rubbing her daughter's back encouragingly.

"I'm not sure you need to tell your friends," Dad says. "After all, you wouldn't want them to get the wrong idea."

"We have decided not to tell the school," a mother informs me—a stance that often precedes the termination of therapy. "We don't want this to affect her ability to get into college."

These well-meaning parents have just implied that this depression, these thoughts of suicide, are something to be ashamed of.

And when that secret is broken—as it will inevitably be since teenagers depend on their friendships as a part of their burgeoning self-identity—then guilt will follow.

The need for secrecy adds shame and guilt to the already overwhelming burden of a depressed teenager who is waging a daily war with herself as to whether she can stay alive for one more day. Many people also have the mistaken belief that talking about suicide encourages suicide. This is not true.

When we speak only in whispers about mental health, we're implying that there's something "less than" about those who seek treatment to effect change.

Cultivate emotional health.

Emotional intelligence is:

• Awareness, understanding, and the ability to manage your own emotions
• Awareness, understanding, and the ability to manage and/or navigate the emotions of others

Our expectations of ourselves, and the expectations that we perceive others have for us, take a tremendous toll on our mental health. "I'm not thin enough." "I'm not smart enough." "I have to get into a good college." "My wife doesn't appreciate me." "My husband left me." "I don't make enough money." "No one will ever love me." "I hate myself." "I'm going to be depressed forever." "Things will never get better." We focus on what we feel we lack rather than focusing on our emotional responses and how we handle these emotions.

How can you improve your emotional intelligence? Think before you act. Consider the consequences of your actions from the other person's point of view. Take an honest, non-judgmental look in the mirror. How can you be a better person, and are you willing to do the work to get yourself there? Take responsibility for your actions. Apologize if you make a mistake, and make attempts to remedy the situation.

Remember, a person who attempts suicide has given up hope that things will get better. They might not mention suicide to their close friends or even to their therapists, even if they have it in mind. I can count on one hand the number of patients who have reported wanting to end their own life as their primary reason for seeking help because mentioning suicide to your therapist or even a friend is scary. If you don't ask about this issue, your distressed friend might not bring it up at all.

In an emergency, call for help.

If a friend or loved one tells you that she is thinking about killing herself, you should encourage her to seek help, but in order to know what kind of help is needed in the moment, you need to know how immediate the danger is. Is this something your friend is thinking about doing today? Tonight? Immediately?

If the threat is not immediate, encourage your loved one to make an appointment with a mental health professional or primary care physician as soon as possible instead of going to the hospital, where admission to an emergency room or psychiatric ward might just end in referral to an out-patient treating psychiatrist anyway—sometimes delaying the help a suicidal person needs. If you have a small window of time, offer to help with the details of arranging an appointment, which can be overwhelming in and of itself.

You never know when helping someone with the small details of an overwhelming situation can be all they need to put one foot in front of another for another day or two—which might be long enough to convince them that life is worth living.