A Perspective on Suicide


“I have come to believe that caring for myself is not self-indulgent.
Caring for myself is an act of survival” Audre Lorde

I am not sure what the solution is to the tragedy of suicide. People need to feel they 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].

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. Addictions can increase the risk of suicide, including Alcohol Dependence [2], Smoking [3]and Gambling [4, 5].

For over 3 years I was prescribed the antidepressant 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 [6]. I’m a lot more prone to suicidal ideation since these drugs than before taking them. While some people may feel they have benefited from antidepressants, 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 [7].

Over the last number of years I’ve met some people who saw themselves as well meaning, giving all sorts of judgements and criticism about my life. 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.

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. 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 and high anxiety when faced with what seem like unsolvable problems e.g. worrying about debt. It is important to reach out to someone, even if they don’t feel like doing that at the time. 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 Psychosocial 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 trying that. 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)

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

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).

It is a “two-day skills-building workshop in suicide first-aid … 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” (from the downloadable ASIST leaflet [8]. There is a website to search for where ASIST and other HSE training is taking place [9].

Wellness Recovery Action Plan (WRAP)

A few years ago I got to do WRAP training with the charity Suicide or Survive and more recently with Paul Partnership in Limerick. 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 with their life. As well as help them identify triggers and plan for a crisis. I have written more about WRAP in the chapter Hope of Recovery and Healing.

Reasons to Stay Alive

Matt Haig’s wrote a very good book called “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.

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 the activities that help him through difficult times including writing, reading, talking, travelling, yoga, meditation and running. Slower breathing, acceptance (“Don’t fight things, feel them”), living in the present and Love help with panic.

Someone sent 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 you enjoy can help. And refer back to that when you don’t feel so good.

Suicides Rise Dramatically with Increasing Psychiatric Care

Danish studies have been done on the link between Psychiatric care and suicide. “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” [11].

Coroners need to be aware of prescribed medications the person may have been on at the time they died. High quality testing show the level of these drugs correctly. Whether or not they had recently started to take Psychoactive medication, e.g. antidepressants, or stopped taking such medication is also relevant. Sometimes this information can be overlooked.

There are no easy answers to suicide. But I do believe, based on the number of suicides I’ve heard of recently, our approach doesn’t seem to be working. It is time that we get some honesty from those with the power to influence public opinion. 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, sort out debt 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 [13].

When mental health is talked about a lot 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. More recently 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. In my experience some of those skills can be developed via ASIST and WRAP training. Even some sleep can make all the difference.

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

[3] Smoking and Suicide: A Meta-Analysis ~

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

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

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

[6] 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

[7] Suicidality in Children and Adolescents Being Treated With Antidepressant Medications :
https://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders/ucm161679.htm

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

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

[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 Relevant Information

* 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

* 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’ – priest’s warning after high number of suicides in town ~
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

* 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

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

 

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