A Perspective on Suicide

Some days you will be the light for others and some days you will need some light from them. As long as there is light, there is hope and there is a way” Jennifer Gayle

Caring_for_myself

I am not sure what the solution is to the tragedy of suicide. People need to feel that are loved and belong, including working on loving themselves. They also need to feel their life has meaning and a purpose. Viktor Frankl, a holocaust survivor, writes about this in his book Man’s Search for Meaning [1, 2].

There are nearly always reasons for living, no matter how bad things feel. It is important that we give encouragement to others in our family and community [3]. Over the last number of years I’ve met some people who saw themselves as well meaning, giving all sorts of judgements and “insights” into my life. As well as criticism. Without any empathy or understanding about my life journey. This led to feelings of frustration and discouragement. Listening non-judgmentally would have been a lot more helpful.

For over 3 years I was prescribed the anti-depressant Citalopram to help with anxiety and panic (until August 2008). I now suffer from a condition called Tardive Dysphoria. What was a mild or moderate Depression is now a more chronic and severe condition. Medical journalist Robert Whitaker has written about this [4]. I am a lot more prone to suicidal ideation since these drugs than before taking them.

While some people may feel they have benefited from anti-depressants, for others they have caused major problems. In the US these drugs have a black box warning due to the increased risk of suicide in younger people, especially when starting, stopping or changing the dosage [5].

In suicidal mode the idea that all the pain will end might feel good at the time, but whatever emotional pain a person is going through will pass. It is important to reach out to someone, even if they don’t feel like doing that at the time. I once heard a man who has been through suicidal thoughts say that he did not want to pass his pain onto other people. When someone takes their own life it is can be devastating for family, friends and the community.

There is probably something causing their distress. Maybe a multitude of things that seem to be going wrong at the same time. It is easy to get overwhelmed and to go into a state of shock/high anxiety when faced with what seem like unsolvable problems e.g. worrying about a mortgage or debt. If a person feels suicidal they shouldn’t be afraid to discuss how they feel with someone they can trust, a helpline, the Samaritans (116 123) or a private therapist. Problems nearly always have a solution. Sometimes the advice of others is necessary, as the person may feel they are in a fog and cannot think clearly or see any solutions.

As a society and community we need to be more supportive of each other. People may need to look at lifestyle e.g. alcohol, nutrition, stress and the various aspects of their life. If doctors were to take a more Psycho-social approach, as opposed to a biomedical one, I do believe we may see some progress. Or maybe those in distress need an alternative to going to a busy GP surgery that is dealing with such a wide range of medical problems.

A number of years ago, in a documentary that covered suicide, I heard a doctor say that if someone takes an overdose of medication, they can end up alive and brain damaged. Probably worse off that before the overdose. Knowing this may deter a person from taking an overdose. While not being judgemental of a person in a very distressed state, drowning in the sea, lakes, canals or rivers is also a bad idea. A person can end up missing for weeks, causing even more distress to their family, friends and those that care about the person in their community. Not forgetting the huge level of dedication, effort and time that can go into searching for the the body, sometimes in very cold, risky, dangerous and difficult conditions. From listening to a friend who volunteers with sub aqua search and rescue/recovery, the body can end up in a bad state.

ASIST (Applied Suicide Intervention Skills Training)

One of the things that has helped me in dealing with suicidal thoughts, while also giving me the skills to be able to help others, is ASIST. Applied Suicide Intervention Skills Training is a

two-day interactive workshop in suicide first-aid. It is suitable for all kinds of caregivers … people responding to family, friends and co-workers. ASIST trains participants to reduce the immediate risk of suicide and increase the support for a person at risk. It helps them seek a shared understanding of reasons for suicide and reasons for living.

The workshop provides opportunities to learn what a person at risk may need from others in order to keep safe and get more help. It encourages honest, open and direct talk about suicide as part of preparing people to provide suicide first aid. Participants also consider how personal attitudes and experiences might affect their helping role with a person at risk” [6, 7].


Wellness Recovery Action Plan (WRAP)

A few years ago I got to do WRAP training with the charity Suicide or Survive. This training combined with ASIST has helped build up my resilience which I need to face into each new day and week. Having a WRAP plan in place can help a person who is experiencing emotional distress to stay well and to move forward. The 5 key concepts in WRAP are: Hope, Personal Responsibility, Education, Self-advocacy (standing up for yourself) and Support [8, 9].

A WRAP plan has sections on a Wellness Toolbox, Daily Maintenance Plan, Triggers, Early Warning Signs, When things are Breaking down, Crisis Plan and Post Crisis Planning.

WRAP can help the person identify triggers (events and/or reactions to people that can make their symptoms worse) and also to list activities that can help the person feel better. It may also be important for the person to write a crisis plan, so that if the person finds themselves in a crisis it has been outlined what their wishes are.

It is vital to establish who is there to support a person in their recovery and to build on this if necessary e.g. family, friends, connecting to others in recovery or by attending meetings with mental health support groups (e.g. Grow).

WRAP can even be used to help write an advance directive, where the person can specify acceptable and unacceptable treatments, including prescribed psychoactive drugs that have worked in the past and ones that don’t, and whether or not a person sees Electric shock treatment (ECT) as an option for them.

Reasons to Stay Alive

I’ve just re-read Matt Haig’s very good book “Reasons to Stay Alive” [10]. In severe Depression a person may feel there is no hope or future. Matt highlights how it can feel like you are inside a tunnel that is blocked at both ends. “You are walking around with your head on fire and no one can see the flames”. When he went through a major crisis he didn’t want to be dead. He just didn’t want to be alive.

Drinking and smoking too much can be a big factor. As can diet and not getting enough sleep. Matt suffered from Anxiety, Panic attacks and Depression and compared that to being in a swamp with whirlpools in it. He writes “Minds have their own weather systems. You are in a hurricane. Hurricanes run out of energy eventually. Hold on”.

He compares his symptoms of emotional distress to back pain “It doesn’t really help me, when the pain flares up, that millions of other people suffer from back problems”. He lists some of his “Weapons for the war” ~ writing, reading, talking, traveling, yoga, meditation and running. Some of the things that help him with panic include yoga, slower breathing, meditation, acceptance (“Don’t fight things, feel them”), live in the present and Love.

One person tweeted this message to him about suicide “The hole you’d leave is bigger than the pain you suffer by being”. “The key is in accepting your thoughts, all of them, even the bad ones. Accept thoughts but don’t become them”. Writing about things your enjoy can help. And refer back to that when you don’t feel so good.

Suicides Rise Dramatically with Increasing Psychiatric Care

Danish studies has been done on the link between Psychiatric care and suicide. Extract from this article [11] ~ As the amount of involvement that people have with Psychiatric professionals and Psychiatric care increases, the likelihood that they will commit suicide rises steadily and dramatically, according to a study in Social Psychiatry and Psychiatric Epidemiology. Taking Psychiatric medications makes people nearly 6 times more likely to kill themselves, while having spent time in the previous year in a Psychiatric hospital makes them over 44 times more likely to kill themselves … an accompanying editorial suggested the findings more likely showed that “Psychiatric care might, at least in part, cause suicide.”

I am hoping that coroners will keep an accurate record of what prescribed medication that the person may have been on at the time they died. Whether they had recently started to take Psychoactive medication e.g. anti-depressants or stopped taking such medication. It appears that sometimes this information can be overlooked. As many deaths are not recorded as suicide, we do not have an accurate picture of the number of people in this country that take their own lives every year.

Conclusion

There are no easy answers to suicide. But I do feel, based on the number of suicides I’ve heard of recently, our approach doesn’t seem to be working. I think it is time that we get some honesty from those with the power to influence public opinion. Instead of drug pushing, we need to hear that the “chemical imbalance” theory was an elaborate marketing campaign that sadly is not based on fact or Science. Some doctors, in their rush to push the drugs, forget about the significant number of people that these drugs are not suited to. Some of us don’t metabolize the drugs very well. A pill is not going to mend a broken relationship, bring back a job that is lost or help with the bereavement process.

If someone does decide to go down the biomedical route, they deserve full informed consent about these drugs. Something myself and many others didn’t get. People in distress also need crisis houses to go to, as an alternative to Acute Psychiatric units. An example of this in the UK is The Maytree [12]. Such crisis housing is part of the policy document Vision for Change which is now over 10 years old [13]. We need a new plan and a new vision.

At the moment there seems to be a lot of emphasis on celebrity culture and hearing the stories of celebrities. While that can provide short term inspiration, in a crisis the person in distress needs to have their own set of tools and resilience to battle through a rough patch. There is also a danger when mental health is over talked in the media. Family and communities may feel that the issues are been dealt with and may not realise someone in their own circle is in distress and needs support.

Relationship_with_self


{ Note ~ What I discuss in part of this blog is my own experience and is not medical advice. We all have our own unique journey. Do not stop or change prescribed drugs without advice. Change has to be done slowly under the supervision of an expert, due to the dangers of withdrawal.
Samaritans ~ 116 123 }

References

[1] Man’s Search for Meaning, Viktor Frankl ~
https://www.amazon.com/Mans-Search-Meaning-Viktor-Frankl-ebook/dp/B009U9S6FI

[2] Man’s Search for Meaning ~ Meaning as a Cure for Depression and other ills ~
https://www.psychologytoday.com/blog/hide-and-seek/201205/mans-search-meaning

[3] Viktor Frankl ~ Why Believe in Others ~
https://www.ted.com/talks/viktor_frankl_youth_in_search_of_meaning

[4] Tardive Dysphoria: Anti-depressants can turn mild/moderate Depression into a chronic condition ~
http://www.psychologytoday.com/blog/mad-in-america/201106/now-antidepressant-induced-chronic-depression-has-name-tardive-dysphoria

[5] Antidepressant Use in Children, Adolescents, and Adults ~

https://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273

[6] ASIST leaflet (Applied Suicide Intervention Skills Training) ~
http://www.hse.ie/eng/services/list/4/Mental_Health_Services/NOSP/Training/ASISTleaflet.pdf

[7] Information on ASIST training ~ http://www.yourmentalhealth.ie/get-involved/news-events/

[8] WRAP (Wellness Recovery Action Plan) ~ http://mentalhealthrecovery.com/

[9] WRAP App Demo ~ https://www.youtube.com/watch?v=0BK_jLMToeM

[10] Reasons to Stay Alive, Matt Haig (2015) ~

http://www.matthaig.com/reasons-to-stay-alive/

[11] Suicides Rise Dramatically with Increasing Psychiatric Care ~
https://www.madinamerica.com/2014/09/suicides-rise-increasing-psychiatric-involvement/

[12] Suicide sanctuary ~
www.maytree.org.uk/

[13] Vision for Change ~
http://www.hse.ie/eng/services/publications/Mentalhealth/Mental_Health_-_A_Vision_for_Change.pdf

Other links that may be useful

* The dangers of giving anti-depressants to children. Jake McGill (14) ~
https://www.independent.ie/irish-news/courts/mother-of-boy-14-who-died-of-selfinflicted-gunshot-wound-welcomes-open-verdict-inquest-34115868.html

* Community Action on Suicide Prevention Education and Research (CASPER) ~
Maria Bradshaw, mother of Toran Henry (Maria now lives in New Zealand) ~
https://www.independent.ie/regionals/wicklowpeople/lifestyle/maria-leads-suicide-fight-30596376.html

* Cutting jail benzo use reduces violence ~

www.irishexaminer.com/ireland/cutting-jail-benzo-use-reduces-violence-215716.html

“Harry Kennedy, head of the Central Mental Hospital, said that since they stopped prescribing the medication in their prison clinics, the suicide rates there had fallen”.

* Denmark ~ “Antidepressant regulations tightened following suicide”:
www.cphpost.dk/news/antidepressant-regulations-tightened-following-suicide.8243.html

* Kerry coroner makes emotional plea over suicides ~
www.irishtimes.com/news/crime-and-law/kerry-coroner-makes-emotional-plea-over-suicides-1.1365157

* ‘Suicide remains a taboo subject, something few people are prepared to talk about’ ~
www.youtube.com/watch?v=US-oM-wBBxI

* Life After Suicide BBC Documentary 2014 “Documentary. Angela Samata explores why some people take their own lives and how those who love them come to terms with the loss”.
www.youtube.com/watch?v=HdIxzeA1F2k

When suicide comes in clusters ~ What can we do to prevent copycat suicides ?
www.psychologytoday.com/blog/media-spotlight/201208/when-suicides-come-in-clusters

* Alcohol and suicide, Kendall, 1983 ~
www.ncbi.nlm.nih.gov/pubmed/6648755

* Smoking and Suicide: A Meta-Analysis ~

www.ncbi.nlm.nih.gov/pmc/articles/PMC4938402/

* Suicidal Ideation and Suicide Attempts in Treatment-Seeking Pathological Gamblers ~
www.ncbi.nlm.nih.gov/pmc/articles/PMC3397475/

* Stages of Compulsive Gambling ~
http://www.elementsbehavioralhealth.com/addiction/stages-of-compulsive-gambling/

* Caring for patients with suicidal behaviour: An exploratory study ~
https://www.researchgate.net/publication/5821268_Caring_for_patients_with_suicidal_behaviour_An_exploratory_study

* We’ve become too complacent about the mental wellbeing of others’ –
https://www.independent.ie/irish-news/news/weve-become-too-complacent-about-the-mental-wellbeing-of-others-priests-warning-after-high-number-of-suicides-in-town-36830689.html

 

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