Ministering to Those in the Shadow of Death

by Torben Bergland

In the time it will take you to read this article, about ten people around the world will take their own life. In the few minutes it will take you to read this, many more will attempt to end their life. And, right now, millions around the world are thinking about suicide.

The French Algerian philosopher and author Albert Camus wrote, “There is but one truly serious philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy. . . . I therefore conclude that the meaning of life is the most urgent of questions. How to answer it?”1

The philosophers have wrestled with these questions and come up with different answers. They do not agree on whether life has meaning, much less what meaning it might have. They do not agree on whether suicide is justifiable or morally acceptable. It is safe to say that there is no worldly agreement on how to answer these questions.

For many of my patients, the questions of suicide and life’s meaning are not merely philosophical questions. They are questions of life and death—literally. And many do not know how to answer them. When life is smooth and things go well, these questions usually do not bother anyone. Blessed and privileged are those who “seldom reflect on the days of their life” (Eccl 5:20, NIV). But when the pains of living in a sin-broken world wash over us, we may ask, “Why all this suffering? Is it worth it? Is there any way out?” Suicide is a way out. Death is an end to suffering. But it’s not a solution to the problems.

As a psychiatrist, when I have asked my patients about thoughts of death and suicide, the majority either struggle with them now or have in the past. Such thoughts are so common that I’ve been surprised in the few cases where patients have told me that they’ve never had such thoughts. Still, I have yet to meet a patient I thought really wanted to die.

Questions about the meaning of life, death, and suicide are not only for philosophers and patients. Most of us, sooner or later in life, touch on these questions. They are responses to suffering. President Abraham Lincoln, considered by many to be the greatest American president, suffered from episodes of depression. Going through one of these episodes, the thirty-one-year-old Lincoln wrote to a friend, “I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would not be one cheerful face on the earth. Whether I shall ever be better I can not tell; I awfully forebode I shall not. To remain as I am is impossible; I must die or be better, it appears to me.”2

What Lincoln felt is what many may feel in the depth of suffering. None of us want to suffer. Yet suffering comes to all of us. When it does, it may feel like it’s unbearable. When suffering dispels all sense of joy and purpose, we desperately seek solutions to the problems, to put an end to the suffering, and find a way out. Suicide is an escape option more than a genuine desire for death. Every cell in the body has the “breath of life” (Gen 2:7, NIV) and fights against death. The better way out of suffering is not suicide, but to alleviate the suffering and find ways to manage and cope with it.

Suicide is when people harm themselves with the goal of ending their life, and they die as a result. Every year, about 800,000 people globally end their lives in suicide. That amounts to, on average, one suicide every forty seconds or more than two thousand suicides per day. Second only to accidents, suicide is the leading cause of death for teenagers and young adults around the world. In principle, no one has to die from suicide. Every suicide is therefore a tragic loss of life.

A suicide attempt is when people harm themselves with the goal of ending their life, but they do not die. Estimates are that for every suicide, there are about twenty to forty suicide attempts. This means that someone, somewhere in the world, attempts suicide about every other second. Females are more likely than males to attempt suicide, while males are more likely to die from suicide as they often resort to more lethal methods.

A word of caution on how we talk about suicide: avoid using terms such as “commit suicide,” “successful suicide,” or “failed suicide attempt” when referring to suicide and suicide attempts, as these terms often carry negative connotations and may come across as insensitive. “Commit suicide” may be linked to ideas of suicide being a crime. It’s recommended to rather use terms such as “death by suicide,” “died by suicide,” or simply “suicide,” when possible.

Suicide does not discriminate. Anyone may become suicidal. People of all genders, ages, ethnicities, and religions can be at risk. Suicidal behavior is complex, and there is no single cause. The most common risk factors for suicide are:

  • depression, other mental disorders, or substance use disorder
  • chronic pain
  • a history of suicide attempts
  • family history of a mental disorder or substance use
  • family history of suicide
  • exposure to family violence, including physical or sexual abuse
  • presence of guns or other firearms in the home
  • having recently been released from prison or jail
  • exposure, either directly or indirectly, to others’ suicidal behavior, such as that of family members, peers, or celebrities

Fortunately, most people who have risk factors will not attempt suicide. It is difficult to tell who will act on suicidal thoughts. Although risk factors for suicide are important to keep in mind, someone who is showing warning signs of suicide may be at higher risk for danger and need immediate attention.

Some important warning signs are:

  • talking about wanting to die or wanting to kill themselves
  • talking about feeling empty or hopeless or having no reason to live
  • talking about feeling trapped or feeling that there are no solutions
  • feeling unbearable emotional or physical pain
  • talking about being a burden to others
  • withdrawing from family and friends
  • giving away important possessions
  • saying goodbye to friends and family
  • putting affairs in order, such as making a will
  • taking great risks that could lead to death, such as driving recklessly
  • talking or thinking about death often

Other serious warning signs that someone may be at risk for attempting suicide include:

  • displaying extreme mood swings, suddenly changing from very sad to very calm or happy
  • planning or looking for ways to kill themselves, such as searching for lethal methods online, stockpiling pills, or buying a gun
  • talking about feeling great guilt or shame
  • using alcohol or drugs more often
  • acting anxious or agitated
  • changing eating or sleeping habits
  • showing rage or talking about seeking revenge

Stressful life events such as the loss of a loved one, legal troubles, or financial difficulties, and interpersonal stressors such as shame, harassment, bullying, discrimination, or relationship troubles, may contribute to suicide risk, especially when they occur along with other suicide risk factors.

It is important to note that suicide is not a normal response to stress. Suicidal thoughts or actions are a sign of extreme distress and should not be ignored or dismissed. If these warning signs are evident, get help as soon as possible, particularly if the behavior is new or has increased recently.3

Whenever you have a suspicion that someone might be suicidal, and you are not aware that someone else is taking care of the person, you should seriously consider engaging with the person about it. You might help save a life. I have found that the best way to address such concerns is a straightforward approach, being direct, respectful, empathetic, and caring. Here are some recommendations on what to do:

1. Ask: “Are you thinking about killing yourself?” or something similar. It’s not an easy question, but studies show that asking at-risk individuals if they are suicidal does not increase suicides or suicidal thoughts. The more comfortable and direct you are able to be talking about it, the easier it may be for the person to be open and honest in return.

2. Be there: Listen carefully and learn what the individual is thinking and feeling. Research suggests acknowledging and talking about suicide may reduce rather than increase suicidal thoughts.

3. Keep them safe: A person who is suicidal should never be left alone. Stay with them until someone else can take over. Ask them how they would kill themselves and eliminate, if possible, a suicidal person’s access to highly lethal items or places. If in doubt about what you should do, reach out to a suicide hotline and ask for advice.

4. Help them connect: If someone is having suicidal thoughts and plans, they require social and professional support. Depending on what they want, what is available, and what seems appropriate, help them make a connection with a suicide hotline, a trusted individual like a family member, friend, pastor, or mental health professional.

5. Stay connected: Staying in touch after a crisis or after being discharged from care can make a difference. Studies have shown the number of suicide deaths goes down when someone follows up with the at-risk person.4

Losing someone to suicide is emotionally painful and complicated. The bereaved often struggle with guilt, a sense of responsibility, and questions that may never be answered. Help them with practical aspects surrounding the death.

Allow them space and time to express all their emotions, and to tell their story, and the story of the one who died. Processing loss is a process. Dealing with grief takes time. Most likely, they will never fully “get over it.” It may be beneficial for them to connect with others who have gone through similar experiences in a support group, and to have professional support from a counselor or therapist.

As philosophers have struggled with what to think about suicide, so has the Christian church. A traditional view has been that suicide is a mortal sin, and such thinking has led to excessive pain for those left behind. My conviction is that whenever someone despairs and gives up on life because of unbearable suffering, God’s heart breaks. Every time.
The apostle Paul says, “For I am sure that neither death nor life, nor angels nor rulers, nor things present nor things to come, nor powers, nor height nor depth, nor anything else in all creation, will be able to separate us from the love of God in Christ Jesus our Lord” (Rom 8:28–29, ESV).

I trust in God’s love and saving grace. He is the compassionate Judge and Saviour who knows all our struggles—also the struggles of those who contemplate suicide and those who take their own lives.
Whether someone chooses to live or to die, they may still be in God’s love. I believe that whenever someone walks in the shadow of death, God is right there with them, ready to guide, to comfort, and lead them to greener pastures and calmer waters (Ps 23). His desire for us is life, but with sin, death entered our world. In the end, whether in life or in death, our hope is only in Him.

1 Albert Camus, The Myth of Sisyphus, trans. Justin O’Brien (New York: Vintage International, 2018), 3–4.
2 Letter to John Stuart, Jan. 23, 1841.
3 “Suicide Prevention,” National Institute of Mental Health, accessed July 28, 2022,
4 Ibid.

Torben Bergland, MD, is a psychiatrist and an associate director of Adventist Health Ministries at the General Conference of Seventh-day Adventists, Silver Spring, MD, USA.

The original version of this article was published in the ELDER’S DIGEST, JANUARY|MARCH 2022 issue, which can be found here.