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.
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?