From my inbox... about suicide

Many of you regularly write to me personally and I really value the stories you share, so much so that often I wish they were more available to everyone who drops by Coming Out Crazy. 

The other day, Dorothyanne Brown, a nurse from Ottawa sent an extremely poignant and provocative note. Not only did she give me permission to publish it here, she said I could "bounce people to her blog" – which focuses on living with multiple sclerosis.

Here's what Dorothyanne said on Sunday, September 20, in response to my Friday post On Denial...

"I, like you, have been an advocate for those living silently with depression since I was diagnosed some years ago. I've since been diagnosed with MS and am working with the mood swings thought to be caused by the electrical warfare between the shredded neurons in my brain. Of course, as with depression, MS symptoms remain largely unexplained. Would that we could understand the brain just a wee bit better!

"I'm a nurse and former primary health care manager who had to quit work because of my cognitive lapses and moods – despite medication, everything remains uneven.

"But enough about me. What I wanted to mention to you was the denial other health care professionals show with regard to suicide. At several points in my first year with MS, I've felt suicidal. I made a plan, I gathered the necessaries, I plotted the time of day. Then I called in my helpers.

"No one listened to me. No one took me seriously. Even now, since I moved to a new community, when I reach out for help with these mood things, nothing helps.

"My MS doc listened to my plan and said, 'Well, yes, that'd work.'

"Fortunately, I stepped back from the brink, or have until now. But it does make me wonder how others, less articulate, less well-supported, might manage. It seems to me that unless you show up at the office with a gun or rope, people are not likely to take claims of suicidality seriously. No one seems interested in discussing it, even those at the MS society – despite the high rate of suicide in MS patients.

"What's your experience with this? Depression and depression medications and suicide are closely linked... and yet it still seems to be a hidden subject. Discussing it might help those with these feelings step back, reconsider. The feeling of aloneness in depression is such a high risk factor.

"Good on you to come out and be counted. I've always felt that is the best way to proceed.

"Best wishes – Dorothyanne."

When I responded, I had to confess that I have no personal experience with major depression or suicidal intent. Mania is my madness and I have lived with its psychotic features since my mid-teens. Since I found the right medication – for me – in 1988 at the age of 40, I've been reasonably fine, thanks to my twice-daily doses of Tegretol and especially the support, psychotherapy and constant emotional processing I've been doing with my psychiatrist Dr. Bob for close to 20 years and still counting.

Dorothyanne, you touched a real chord, however, when you stressed how medical professionals are reluctant and uncomfortable discussing suicide with suicidal people. 

Everyone is uncomfortable talking about suicide. It is a taboo subject for many complex reasons. I don't think this is because it is often thought to be caused by depression and too many people are uncomfortable talking about mental illnesses. It goes much deeper than that and I am no expert. I don't know if there really can be real expertise on suicide.

Last year, a neighbour of mine died by hanging himself in his garage on the Monday morning of the Victoria Day weekend. After a phalanx of police cars, fire trucks and paramedic vans pulled away from our dear little dead-end street in the suburbs, after his sheathed body was removed in a red van (not black or bearing any resemblance to a hearse) my neighbours quietly clustered together, whispering. 

Would they have whispered if this kind, gentle man who was suffering with the terminal side-effects of brain cancer treatments had died of his illness, rather than by his own hand? He was depressed because he couldn't envision life – he was divorced and living alone – in constant pain, a close friend of his told me. 

His funeral was in no way "traditional" and he was buried against a fence in the cemetery, separated, removed from other plots, alone in death as he no doubt felt in life. People still say "commit" suicide, though it is no longer considered a crime. So much mystery and mythology still cloaks suicide.

A month later, the New York Times published a cover story in its Sunday Magazine titled The Urge To End It – Understanding Suicide. Two survivors of highly lethal suicide attempts – one by firearms and another by jumping – were interviewed. They were happy to be alive, despite permanent injury and disfigurement. The article was one of the most compelling I've ever read and it certainly furthers the discourse on the impulsivity of suicide. But what of those who are less impulsive and suffer suicidal intent and thoughts, without this impulsivity to act? 

This story didn't really address that. 

It wouldn't really be helpful for you, Dorothyanne, if you want to talk about your suicidal feelings.

Nor would it empower health professionals in their ability to help you, I suspect.

For some personal perspectives on feeling suicidal, you can go through the short engaging videos on the excellent new and undeniably easy to navigate website Working Through It where several people talk candidly about their suicidal feelings. And how happy they are they got help and don't feel suicidal anymore.

That might help you to seek help, but what if you cannot find the help your really need? The right fit for you? Then what? 

A hug and an ear from one of your helpers perhaps can prove better. You were cogent enough to be able to reach out. Feeling loved and wanted and cared about and valued by other people is decidedly more useful. But what if you don't feel that love, even if it's there. Then, what?

In her extraordinary book, Night Falls Fast – Understanding Suicide, (Vintage Books, 1999) one of the only serious studies of the subject, clinical psychologist and Johns Hopkins Hospital psychiatry professor Kay Jamison writes eloquently, perceptively and passionately about suicide. She knows her subject. She was diagnosed with manic depression/bipolar disorder as a university student and years ago, in graduate school, struggling with an episode of depression, she overdosed on her Lithium and almost did kill herself. 

Yet, she, too, is frustrated. 

In her epilogue, Jamison writes: "Like many of my colleagues who study suicide, I have seen time and again the limitations of our science, been privileged to see how good some doctors are and appalled by the callousness and incompetence of others. Mostly, I have been impressed by how little value our society puts on saving the lives of those who are in such despair as to want to end them. It is a societal illusion that suicide is rare. It is not. Certainly the mental illnesses most closely tied to suicide are not rare. They are common conditions, and, unlike cancer and heart disease, they disproportionately affect and kill the young."

But if you're suicidal, reading that book would be impossible. You probably wouldn't be able to focus. 

Dorothyanne, I don't know why some doctors and health care professionals don't take their suicidal patients seriously. Or cannot. Lack the ability. Maybe it's that old and perhaps mythic rubric – "if someone talks about killing themselves, they'll never do it"?

More likely, part of the reason, as Jamison states in her book, is that doctors, themselves, are twice as likely to kill themselves than other people, especially psychiatrists and psychologists – women more than men. And doctors tend to carry their emotional burdens along with the burdens of their patients, working independently and not seeking help or even recognizing that they need it.

Pills are perceived as an easier solution.

Last week, psychologist John M. Grohol on his PsychCentral blog World of Psychology mused about suicide rates in 2006 remaining virtually the same as in 2004 and 2005 – despite antidepressant use on the rise and a dramatic decline in talking therapies. Check it out. 

He also points out a new American National Drug Use and Health report on "Suicidal Thoughts and Behaviours among Adults". For the first time, all adults in this survey of 46,190 Americans 18 year of age and older were asked about suicidal thoughts. In the past, they were only asked about clinical depression. Check it out, too. 

Philip Dawdy at Furious Seasons posted about this, too, and his take is well-worth reading. 

Check out the World Health Organization's global picture.

There's an important clue in all of this, I think. It's found in an August 2009 post by Grohol about the fact that pill use is up (antidepressants) and psychotherapy use is down. People are demanding quick-fix – pills as their primary avenue to mental health and well-being. Maybe because they just can't connect with the right psychotherapist for them. Or the waiting list is too long. Or it's too expensive.

But, as I've said again and again, the answer is not in pills alone. 

My friend, Dr. Ron Pies, Tufts University professor and clinical psychiatrist addressed the issue of medication use in effectively helping people with mental health issues recently, when I asked him about it. He wasn't referring specifically to suicide or even depression, but talking more generally. His remarks, however, are important:

"I think so much depends on what the 'issues' are; how serious and impairing the problems are; and how skilled the clinician is who prescribes the medication – and how closely he or she monitors the patient's response... medication alone is virtually never 'the answer' for those who experience serious emotional or behavioral problems. I continue to believe that, in carefully selected instances, it is often a part of the answer." 

That's vital. I wasn't kidding when I suggested a hug might be better. If not a hug, at least some kind of human engagement. Part of the answer lies outside the realm of strict medical science and in human and humane interaction and communication. 

Yesterday, I discovered this right here at Healthzone in a Toronto Star story recently written by Health Reporter Joseph Hall.

In this story, Hall quotes Karen Letofsky, the executive director of Toronto's Distress Centres, who says: "If you are concerned an individual is at risk (of suicide) then the first thing you would do ... is approach that individual...." and this approach "should be couched as an invitation for this person to share their feelings, while asking directly about thoughts of suicide."

Maybe you don't need a health care professional, Dorothyanne. This is such a crucial question.

Maybe you need a human being who knows how to listen to you. Who can feel with you and for you. Even a stranger on the other end of a Distress Centre phone line.

Or one of us, here, in this online community at Coming Out Crazy. Maybe we can harness the power of the internet to help out. Reach out to you. To each other. We've done it before. Why not with suicide?

I'm throwing this out to everyone reading this post. 

What are your thoughts? If you can talk about suicidal thinking, share your feelings about suicide here, where it's safe, then perhaps it won't seem so difficult, so frightening to face. Perhaps you'll be able to reach out when and if you need support – to the right people for you.

What do you think?

Comments

[susan]

Thank you.... thank you thank you.
btw, imho, 'The Savage God' by A. Alverez is far better than Kay Jamieson's book. Shame it was written in the 70s.

[Karla Forgaard-Pullen]

I have lived with depression and suicidal thoughts since I was in grade school. (Two attempts in early adulthood) I have been through the gamut of treatment and been undermined by professionals. But I have also been helped by professionals and treatments. Part of it is finding the right person and the least problematic medications...but part of it is timing. Sandy referred to that when she mentioned that maybe reading the greatest book wouldn't be possible if depression or anxiety or whatever is clouding your ability to concentrate or think. I have achieved peace with my recurrent waves of suicidal thinking through a combination of re-focus on my positive values (thank you positive psychology) re-balancing my internal conflicts (Thank you Dialectical Behavioural Therapy) and accepting that my particular brain/body have a pattern that erupts when I am confronted by painful realities...(a combination of science and Mindfulness philosophy). Who doesn't have a few things in life that make them sad, or angry or despairing even? For me the trick is to accept that these feelings are true to my experience and that the suicidal compenent is a measure of the depth of my feeling - but it is no more a command performance than my absurd vision of a Wile. E. Coyote rock-off-a-cliff falling on the jerk who just cut me off on the 401...I do not have to act on the thought - I do have to acknowledge the depth and meaning of my feelings.
This has been my route to safety during suicidality. It is mine. Maybe some version of it may assist others.

[Sandy Naiman]

Thank you, Susan. I will add "The Savage God" to my ever-lengthening reading list.

And thank you Karla, for your thoughtful and insightful reflection on your experiences with depression, suicidality and for sharing how you have lived with them and learned from them.

Finding "the right professionals" is the key to healing, no matter what ails you, in my experience. My husband has just returned from the hospital where a very astute doctor has prescribed medication for high blood pressure and high cholesterol. My concerns about his eating habits and disregard for exercise went in one of his ears and out the other. He listened as this physician "spoke" to him, where I was a "nag," and now together, we're committed to making the all-important lifestyle changes we need to make.

You have worked very diligently for a very long time, it seems, to "achieve peace" and it shows. Particularly accepting that your feelings are true to your experience and that suicidal thinking is a "measure of the depth of your feelings."

Self-acceptance is ultimately what we all grapple with in life, no matter what label or set of feelings cling to us or haunt us. Self-acceptance is never a constant state. It nips at my heels, dogs me all the time, every day. I just keep putting one foot in front of the other, eyes straight ahead, smiling if I can. And reaching out to others helps me a lot, too.

Your "route to safety during suicidality" clearly does not appear to include anti-depressants.

I think, Karla, that's crucial. It pleases me no end, if my suspicions are accurate.

In too many cases, depending on drugs is not the only route to safety, or the best route to safety – or peace of mind. It's a route to mental numbness too often, especially if medication is the only tool and it's not properly monitored. It can appear to be an easier route – but it is beneficial?

You would never find your insights in a pill bottle, alone.

You've a chosen a more courageous path – a harder, longer road to self awareness through the various therapies you mention above, plus mindfulness, and acknowledging the depth and meaning of your feelings. Time consuming, but worthwhile, I think.

You're clearly committed to understanding, to insight, to self-perception, to acceptance, to expanding your knowledge – a life long pursuit.

I'm thrilled that you shared your experiences and your perceptions with us and contributing so eloquently to this dialogue.

Thank you for your candour, wisdom and generosity of spirit.

Please drop by again.

sln

[Werner]

Why do you assume that suicide is always wrong? When an elderly pensioner in Germany is assisted in her death because she does not want to live in a retirement prison ... opps a "home" is that woman sick? A masters degree student in Chicago kills himself because he has 65000 dollars in debts and is being constantly harassed by a loan company is that person "ill". People can only stand so much in this life.

[Sandy Naiman]

Hello Werner,

I try very hard not to judge people. Especially anyone who either attempts or completes a suicide.

How can I? That's why I do not use the term "commits" which wrongly implies that suicide is a crime. It may have been considered so once legally, but that law is no longer on the books.

How can anyone really understand why a person ends his or her life? How can anyone sit in judgment in such an instance? I try not ever to sit in judgment. Who am I to judge?

I don't. A soul is lost. A life is gone. People are left behind to live with this monumental and often confounding loss and the eternal question – why? A suicide may always be a mystery to those left behind.

Nevertheless, is it right? Or wrong? Who can answer that? It's irrelevant. It's a question I can neither answer nor even ask. It remains a puzzling and haunting mystery. I try not to sit in judgment of anyone for almost any reason. But I'm not perfect and I do slip from time to time. Not here, though.

I do believe, however, that suicide can be prevented, especially if it is an impulsive decision. Does that mean I think it right or wrong? Not at all. I think it’s sad, terribly sad for the person who has decided to end his or her life and for those he/she has left behind.

Life is a gift, Werner. The greatest gift of all. There are always ways to find solutions to one's problems, I think. If one is given help to see that there is perhaps a way out of what may seem insurmountable problems. Or another point of view to consider. I don’t take life for granted. I’ve almost died, so my perspective is very clear on this.

I cannot imagine ending my life because of debt. Assisted suicide is a very different issue. Completely different, especially if one has a terminal illness and lives in constant pain. Even then, when given this option, people often do not go through with it, knowing that it is available to them should they decide they want it. This has been proven in the U.S. state of Oregon, where there is a "Death with Dignity Act".

I hope this clarifies what seems to be a misinterpretation of what I have said here.

Take care.

sln

[Gardener]

What many people do not really understand about depression is it's potential to become terminal. Like many diseases it is complicated beyond our understanding. But unlike other dieseases we can not physically see it on a MRI or xray. It is not like a broken arm where people go "ouch" when the details of how it happened are explained. We do not understand fully how the brain works and so we tend to fear what we don't understand. How can anyone who has not felt suicidal understand that it's not "You" who wants to take your life, but the diesease. That is how the thinking about suicide has to change. Depression if left untreated, and often when treated, can become terminal.

[Shosh]

I've sat with the comment window open for awhile trying to figure out exactly what it is that I wanted to say, knowing that this really touched something within me. Finally I figured out exactly what it was.

" But what of those who are less impulsive and suffer suicidal intent and thoughts, without this impulsivity to act? "

That has always been my struggle, and one that I've found has been impossible to talk about. I've had a lot of people around me affected by suicide, be it feeling suicidal themselves and needing someone to talk to, and be there for them, or knowing people who have actually acted on their impulses. I've always had suicidal thoughts, but with them also a very strong desire to not act upon them. It has always made me feel like because I know I won't follow through it isn't worth talking about. I feel like if I reach out for support then I won't be taken seriously, or the fact that I have no intention on following through on my thoughts won't be heard. No one seems willing to address how distressful and upsetting it can be to have those thoughts even when you have firmly decided that you would much rather stay alive.

I think I agree that maybe if we all start talking about it a bit more, then maybe it won't be so hard to either ask for or give the help that is needed. Also to know that if we are asking for help, not only will it be available, but also that it will be appropriate to the individuals that we are and our own unique situations.

Here's hoping right?

[Gardener]

To follow up on my thoughts from the 14th. Society needs to stop shaking their heads and saying "tsk, tsk, how could that person be so selfish and take their own life?" Society needs to start realizing that this person lost their battle with depression and feel the same sorrow for that person as if they had passed from any other disease.
It is really very frightening to be alone with ones self when in a suicidal state. Being afraid that maybe this time you won't have the strength to beat "It" down into submission. Depression is very strong and very determined, once it gets a good hold of your brain, to convince you that the world would be better off without you in it. It is a lonely, quiet fight that requires every ounce of strength you have just to say "NO" to "It". It becomes a battle of will, a duel to the end and who is going to come out victorious? You, or "It". I decided a long time ago that I would never let "It" win. And silently I fought my battles and with a lot of hard work, self awareness and the Grace of God, I am still here and I have been able to keep from a major episode for 6 years which has been the longest stretch for me since this all began for me 16 years ago. So, to anyone else reading this who is feeling suicidal, just hold onto the preverbial rope with all your strength until the depression fever breaks - and please, please, reach out for help, it's not a sign of weakness but a sign of strength and the world will be a better place with you still being in it.