This week’s post is by Sarah Gordon, a research fellow in psychological medicine in New Zealand. She also founded the International Association of Service User Academia. This is a speech she delivered at a memorial service for families bereaved by suicide:
Approximately six years ago, a 34-year old woman killed herself. But the paramedics managed to revive her. Waking up from a coma two days later and being assessed as having no long-term mental or physical injury as a result of the suicide attempt, the woman was discharged from the intensive care unit to a psychiatric unit. After two months with this service, the woman asked to be discharged. She felt that this request was quite reasonable: Her immediate acute mental illness symptoms had been addressed.
The psychiatrist refused to entertain any notion of discharge at this time, her reason being that the woman was not in relationship with anyone or anything. You see, she argued, being in relationship with people is absolutely fundamental to living well. So that is what the woman spent the remainder of her time with the unit, a further five months, doing: working on re-learning and practicing being in relationship with herself, her family, her friends and her community.
And what is she doing now? Actively engaging in her roles as a mother and wife, working, dancing, writing, holidaying and shopping _ something which I particularly enjoy.
I often talk about my experience from the third-person perspective. Why is that? Because now, being well, I have no empathy for that woman. Working in mental health, I am well aware of the trauma that results from people taking their own lives. How could I have possibly done that to myself, my family and my two boys? I don’t think there is any easy answer to that question, but please let me share some of my ponderings.
I often hear people talking about suicide in terms of someone having acted selfishly. In fact, that is a very strong view held by many people in our community. Selfishness was not a driving force behind my own attempt, and in fact, the data does not support that being a motivation more generally. I think it is a big problem and very dangerous when, as people in rational states of mind, we start judging the motivations behind the actions of people who, for whatever reason, are thinking and feeling very irrationally. In fact, I believe this is one of the main reasons for the stigma that surrounds suicide.
There are a number of guidelines we are provided with when presenting about suicide in the public or the media. Many of these make perfect sense. For example, we must avoid presenting suicide as a desired outcome or glamorising a suicide attempt. We must avoid the association between between suicide and “crime” or “sin.” I was first made aware of how we can do this with our language when someone relayed to me the words of a grandmother: “Why do you people continue to use the word ‘commit’? My grandson didn’t commit adultery; he didn’t commit a crime; he died by suicide.”
Another guideline is to avoid being alarmist. This is the one I struggle with. Let’s be real about the subject of suicide and put some context around it. Suicide is one of the leading causes of death in the world, especially among young people from high-income countries. Nearly 1 million people die by suicide each year. This corresponds to one death by suicide every 40 seconds. New Zealand significantly factors into these statistics. Each year, approximately 500 people in NZ take their own lives. That is about 200 more than deaths due to homicide, road deaths and war combined. And yet, just think for a minute, about the amount of airtime that deaths due to those other causes get, for example, through our news. As a result, people just aren’t aware of how significant suicide is. When asked, most people report thinking that traffic accidents are the major cause of death for people in their 20s.
Recently when I was at a conference, I saw a piece of art in the distance and these words stood out to me: “When I tell you I can’t cope anymore please believe me. I am desperate. I need your help.” These words resonated with the way I feel when I am unwell, so I decided to check it out more closely. This is what the art conveyed in detail:
“When I tell you I can’t cope anymore I mean it. I am struggling. It is hard to admit that you have reached your limit. It feels like a failure. But there is only so much a human being can take. And I am very human. I am exhausted and frightened. I feel like I am about to disintegrate. I need help. Please believe me. I am sinking. Please don’t be fooled by the way I look. I am trying to hold it together long enough to get the person I care for to hospital. But inside I am terrified by what is happening. I am shaking with fear and dread. I need a break from being responsible for another life. I can’t sleep. I can’t rest. I can’t even work. I am desperate. I am drowning. I am begging for help. I don’t know how else to ask. If I break down in front of you, you might end up with two patients instead of one. I’m trying so hard not to cry, so that I can explain what is happening. I know that if I let one tear go, it will become a flood I won’t be able to stop. I am trying to stay calm but I need your help.”
This may come as a surprise to you, but this piece of art was something of a revelation to me. It is no wonder family and friends find it difficult to continue supporting us when they get to places as despairing as where we are at. It takes a village to raise a child. It also takes a village to prevent suicide. However, our communities are currently not operating as villages. I believe one of the problems is our pace of life. The other, I think, can best be communicated by way of example.
Having two young children, you would think that the school environment would be an ideal place for me to meet and form relationships with other parents. Yet often through my interactions at school, I come away just feeling like a big loser. You see, on asking another parent what they have been up to for the day, I often get a response like, “Well, today I have done three loads of washing, cooked and frozen the meals for the next five nights, been for a 10k run and, in my downtime, written a book. And I can’t wait to take the kids home and spend some quality time playing in the yard and reading books. How about you?”
“Well,” I respond, “I have just been sitting around watching soaps and fagging. What’s more, I am not looking forward to spending the next five hours with my kids. They have been little shits all week and will probably spend most of the afternoon in time out.”
The interesting thing, though, is the response I usually get. Rather than ostracising me, it seems that by being honest and sharing my failings and vulnerabilities, people then feel safe to expose and share their own. Often, I believe, with a great sense of relief. The things I now know about the mothers, fathers, children and extended family of my school community would make for a brilliant novel.
The fact is that every one of us has struggles and challenges in life. The support we need to face those requires us being in relationship with each other. But those relationships will never develop while we are all full of pretense. In “The Age of Innocence,” Edith Wharton coined the phrase, “The real loneliness is living among all these kind people who only ask one to pretend!”
Responding to suicidal ideation simply in terms of physical capability, and restricting that, will always just be a stop-gap measure. It is not the actions that we need to be focused on; it is the thoughts and feelings that are fueling those actions. Self-harm generally isn’t something that a person just suddenly chooses to adopt. It is generally something that has been anguished over for some time, and by the time we are seeing actions, the suicidal ideation is often fairly established and prominent in the mind. To change that, similarly, requires time and the constant repetition and reinforcement of different messages that will challenge those ingrained thoughts and feelings and ultimately change them.
There have been occasions in my life when my family and I have required the support of a village, and we have been lucky enough to access that in the form of what is known as a therapeutic community. One of the key things that they do within a therapeutic community is called reality confrontation. In my own case, this involved the community continually confronting me with how my suicide would impact on my family, friends and the community generally. Over time, this confrontation caused my thoughts about suicide to change until I accepted that it wasn’t an option that I could take to relieve my distress. It was only then that I could fully commit to and pursue alternative options.
We come together today as people with lived experience of suicide – whether that be through having experienced suicidal thoughts, having survived a suicide attempt, having cared for someone who has attempted suicide, having been bereaved by suicide or having been touched by suicide in some way.
It is my firm belief that the most powerful tool we have at our disposal to prevent suicide is our stories.
By sharing these sacred narratives, we confront others with the impact that suicide has and prompt individuals, services and communities to respond differently to the distress that people seek to alleviate through suicide. In so doing, we also create positive legacies for our loved ones who have already died.
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