TW: Mention of suicidality and self-harm
My friend had been struggling with their mental health for some time. Things had escalated, leading to some pretty hazardous situations. I wondered if their prescription had changed or if the dosage needed adjusting. “It sounds like maybe your meds aren’t helping like they usually do,” I ventured. After no more than a moment’s hesitation, they told me they’d not taken one particular medication for a while. I wasn’t altogether surprised. “Do you think you might start taking it again any time soon?”
“I’m probably not planning to do that.”
I thought about that conversation on my walk to work the next morning. I wondered how my friend felt, knowing their decisions were putting their health, maybe even their life, at risk? Our friendship was strong enough for me to ask my questions but there was little I could do on a practical level. How did that feel? How was that supposed to feel? It wasn’t the first time I’d asked myself such questions. Suicidality, self-harm in various guises, and risky behaviour of different kinds are a lived reality for several of my friends. In the fifteen years we’ve been friends Fran has always been diligent about taking her meds, but there are other ways to be unsafe. She kept a stash of tablets for a long time. As I wrote when she eventually relinquished them, “It wasn’t easy to accept that my new and frequently suicidal friend kept a quantity of potentially fatal medication, but I came to understand it was important to Fran, and paradoxically protective.”
I stopped on the path outside my office building and jotted a few notes on my phone. I’ve learned to capture thoughts in the moment or risk losing them forever.
What’s it like to do something like that, when you know it’s dangerous?
Not taking meds. Fran’s stash. Self-sabotage. Self-harm.
I took a few steps towards the entrance. A sudden insight. Other people live with danger.
Dangerous jobs. Police. Firefighters. Armed Forces. Reporters in war zones.
They live on the edge. Extreme sports. Mountaineering. Everest.
These people have friends and family too. People who care. People who wait at home or base camp, trusting and supporting, never quite sure what news the next phone call or message might bring. I’ve written elsewhere that I wish my friendship could keep my friends safe but I know it can’t. These living-on-the-edge people and those who care about them would understand.
Those notes were on my mind a lot through the coming days. I knew I needed to write them up. Explore them further, likely in a blog post. I’m a big fan of analogies. I shared a few of my favourites in The Power of Analogy When Talking About Mental Health. This mountaineering one resonated strongly. I’ve always been fascinated by exploration. A few years ago I sat inside a tent that had previously been erected at Everest Base Camp. Pinned to the inner wall below an array of Tibetan prayer flags was a banner bearing words by Sir Edmund Hillary. With Tenzing Norgay, Hillary was the first to reach the summit of Everest, in 1953. “It is not the mountain we conquer, but ourselves.” The analogy isn’t perfect, of course, but there are parallels with how it feels to be there for my friends.
Anyone who’s seen the 2015 movie Everest will remember the character of Helen Wilton, played by Emily Watson. As coordinator of operations for Rob Hall’s Adventure Consultants expedition, she relayed distress calls and coordinated with safety teams as the tragedy unfolded on the mountain above. Most memorably, she connected Rob Hall by radio with his wife Jan Arnold, played in the film by Keira Knightley. Helen Wilton described that call in David Breashears’ documentary film Storm Over Everest.
And I guess nobody wanted to admit it to themselves that it was going to be their last call. It was something that was just never said. And as I put the call through and held the microphone of the radio against the satellite phone, I was almost doubled up, holding my hands up with the phone, because I was crying so much. And I felt that in some ways, you know, it was a terrible thing, as well as a really good thing. It nearly broke my heart, but I was glad that I could do that for them. And every time he spoke to Jan, he lifted. And so that’s the most important thing I think I’ve ever done.
I’ve never been on a call with someone so close to death, but I have been with friends in moments of crisis and distress. I spent two hours on the phone with an ex-friend five weeks after our friendship ended because she was alone and scared and knew I’d pick up. I called an ambulance for a friend after they took an overdose, and stayed online with them until the paramedics arrived. I’ve accompanied friends whose beloved animal companions were critically ill or at the end of their lives. I’ve supported Fran on many occasions. One such experience occurred three months after we first met. The following is from the chapter of our book on being there when your friend is suicidal.
I was online with Fran for hours last night. When I called, her first words were that she wanted to die. I know they are not just words; I understand to some degree how real and ever-present a choice it is for her. She should terrify me. I wonder how it can be that she does not. She says it is because I trust her. I guess that is true.
It is not that I trust Fran never to try to harm herself, or imagine our friendship guarantees her safety. She has never attempted suicide, but she knows what to do, and I take very seriously any hint she is thinking about hurting herself or ending her life. But I trust her to not hide her suicidal feelings from me, and to be honest with me about them. Ultimately, I trust Fran to allow me to help her stay alive.
At the time, I questioned whether my ability to remain calm in the midst of crisis made me the right person to support her and help keep her safe. My thoughts crystallised around something Fran said to me in those early days. “Don’t worry about me. Care about me.” As we explore in our book, “I worry about you” and “I care about you” are often used interchangeably, but there are important differences. The first and most fundamental of these differences concerns trust and fear.
When we care about a friend we are expressing our trust in their abilities, strengths, and resilience. We trust ourselves to support them as best we can, and others to contribute as they are able. We don’t feel we have to do it on our own, fix everything, or find all the answers. When we worry about a friend we express fear that they lack the resources to meet whatever challenges they are facing. We fear we don’t know what we are doing, that we will be found lacking, or not up to the task. We fear others won’t be around to contribute, and we will be left doing everything ourselves.
I feel Helen Wilton would agree. There’s an echo too in the words of Suchi Purja in the 2021 Netflix film 14 Peaks: Nothing Is Impossible which documents her husband Nirmal’s quest to summit all fourteen of the world’s 8,000-metre peaks.
My friends ask, “How do you do all of this?” My answer is always, “If I am constantly worrying about him, then it’s not going to do any good to me. I would break down. You have to be strong.”
Nirmal Purja was successful in his fourteen peak quest. He died in an avalanche on Broad Peak in Pakistan on July 30, 2026.
I mentioned that base camp isn’t a perfect analogy for supporting a friend or loved one whose actions, behaviour, or decisions place them at greater risk than they might otherwise be. The most obvious difference is that Nirmal Purja, Rob Hall and the other seven climbers who lost their lives on Everest that day, and those who die every year attempting to reach the highest places on the planet chose to be there. Add to their number those who return but suffer permanent injury and harm including loss of extremities to frostbite. The danger in which they all find themselves is the result of conscious decisions.
It’s debatable how conscious and deliberate are the “risky decisions” taken by people living with mental illness. Fran has always maintained that she’s not responsible for her three chronic illnesses: bipolar disorder, chronic fatigue syndrome (CFS/ME), and fibromyalgia. She is, however, responsible for staying as healthy and as well as possible. This includes taking her various medications as prescribed, attending appointments, and generally working to maintain as stable a state of health as she can. This isn’t always easy, and illness gets in the way at times. The lines distinguishing the areas of Fran’s life for which she is responsible and those over which she has little or no agency are neither clear nor precise.
The boundaries of responsibility are similarly blurred for those on Everest and in other extreme situations. Rob Hall remained on the mountain rather than descending to safety. Climbers continued their attempts to summit beyond agreed deadlines. (Everest’s 2 p.m. rule demands that climbers turn around and head back if they haven’t reached the summit by 2 p.m. local time.) There can be many reasons for such “dumb” actions. These include physical and mental exhaustion, and the effects of hypoxia brought on by extended periods at high altitude. No climber ends up in the “Death Zone” above 8,000 meters (26,247 feet) accidentally, but in such circumstances people may not always be fully in command of their faculties. A mental capacity assessment is unlikely — though not altogether inappropriate — on the highest slopes of the tallest mountain on earth. It’s sufficient to suggest that those at base camp may have had legitimate concerns for their friends’ ability to make healthy decisions.
The interplay between mental health and mountaineering is described in more positive terms by Beck Weathers, who survived the 1996 disaster after being twice left for dead. In Storm Over Everest he explains his reasons for being on the mountain in the first place. “I’d spent most of my adult life in profound depression, and I John Wayned it, so that I never let anybody know about it. And I discovered that if you drove your body hard, when you did that, you couldn’t think. And that lack of thinking, as you punished your body and drove yourself, was amazingly pleasant.”
People who deliberately put themselves at risk are often accused of acting selfishly, especially those who abandon partners and children to pursue their adventures. There’s a parallel here with people who have harmed or injured themselves, attempted suicide, or lost their lives at their own hand. I’ve never subscribed to the view that self-harm or suicide are selfish acts. I remember telling Fran that I would do everything in my power to protect her, but if she ever chose to leave I would not hate her for it. As I recall in our book, “That might seem at best naive, and at worst dangerously close to condoning her suicide, but my promise was instinctive and heart-felt. I also believe it to be protective. Fran later told me how important my words were to her. Paradoxically, they gave her strength to go on. Most people, she said, ‘try to lay guilt on you about how bad they’d feel if you killed yourself.’ That argument would never persuade her, but dealing with it drained her of the energy she needed to fight to stay alive.”
The base camp analogy highlights the agony of separation between the person at risk and those who support and care about them. Helen Wilton and Rob Hall were separated vertically by some 3,350 meters (11,000 feet) but distance isn’t only measured in feet and meters. As the tragedy unfolded, Helen and the rest of the support team at base camp lost contact with Rob for twelve hours. I can only imagine how hard that must have been.
When Rob called in the morning, I scrambled out of my sleeping bag and I just remember climbing over bodies to get to the radio. I just had to get there. And I picked up the radio and I said, “Rob, where are you?” I was really hoping he was going to say South Col. And he said, “I’m at the South Summit.” And my heart just hit the floor. Rob once said that if you’re stuck up there, you might as well be on the moon.
Fran and I live three thousand miles and five time zones apart on opposite sides of the Atlantic. Mostly, this is irrelevant. There have been times, however, when the distance — or more specifically, a break in communication — has severely affected my ability to support Fran or even know what’s going on. One such occasion occurred in 2013 during Fran’s three month trip around Europe with her parents. Fran’s mental health came under increasing pressure as time went by. At the end of a particularly hard day, we shared a thirty minute phone call, the longest we’d managed in several days. As I recorded in my diary that evening, “Fran was pretty drunk, and I got on her case about that without listening to her side of things. Towards the end of the call she suddenly became very weepy about how much she loves her Mom. I stayed with her until she was cried out, and then we parted so she could walk back to the hotel. I haven’t heard from her since. Given how tipsy and tearful she was, I could do with knowing she got back OK. I’ve texted her and left messages, but no reply yet.” I didn’t seriously believe Fran intended to kill herself, but it was a horrible feeling which only deepened as the hours passed. I went to bed but kept checking my phone for messages.
I finally heard from her around five thirty in the morning. She’d reached the hotel without incident, but had then been sick and still felt poorly. She’d tried to contact me, but the hotel’s Internet was down and she had only a poor phone signal. She scarcely remembered our phone conversation, but assured me she hadn’t felt suicidal. It was a salutary experience. It taught me to stay focused on what is happening whenever I’m with Fran, and to bring any hint of dark or suicidal thinking into the open, rather than ignoring or dismissing it.
Difficult questions are a vital part of being there for someone in crisis. It’s the first thing you learn in any suicide prevention training. Asking if someone is suicidal or thinking of hurting themself won’t put the idea into their head. On the contrary, it gives them permission to share thoughts they may otherwise keep to themselves. I’m reminded of Guy Cotter who asked Rob Hall to descend from his precarious position on Everest, knowing that this meant abandoning his friend Doug Hansen to die. Rob stayed on the mountain and lost his life as a result, but Guy’s intervention was important and I commend him for it. It can’t have been easy. “At the time,” he recalls, “I was effectively being the devil’s advocate. I was trying to give him the option to decide that what I was saying was a good idea. And he might have been thinking it in his own head but yet not being able to come up with that decision himself.”
It was in such a spirit that I asked my friend about their medication. I couldn’t — and can’t — physically keep them safe but bringing things into the open might allow them to reconsider their decision and its implications. My friend is doing their very best to stay as well and healthy as possible. Their very best to stay alive. Talking from experience, another friend expressed it well. “We have to accept that these are their decisions to make, don’t we? And trust that they’ve learnt the skills to bring themselves back when they recognise it. But it’s hard to not want to rush in.”
I’ll close with a final quote by Helen Wilton from her Foreword to Margo Chisholm’s book To The Summit: A Woman’s Journey Into the Mountains to Find Her Soul. Of that 1996 season on Everest, Helen writes, “My job, although set in a harsh environment and with few of the amenities of civilization, was a joy to me. I cared very deeply about the well-being of my team and did what I could to make base camp a home-away-from-home for when they needed it most.”
That’s the space I endeavour to hold for my friends. A space of safety in which their agency, boundaries, and decisions are respected, but in which I’m able to challenge and question when necessary. A friend once told me, “You truly are someone I can rely on in an emergency and at all other times. That means a lot.” It meant a lot to me too, and still does.
Photo by Jean Woloszczyk at Unsplash.
The image shows Mount Everest viewed from Kala Patthar, a ridge across the valley from Everest Base Camp which offers superb and relatively accessible views of the mountain itself.
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