CW: Suicide, Suicidal Ideation, Self Harm
I saw a raft of posts the other day from Andy’s Man Club, with the devastating news that one of their group facilitators had taken his own life. I don’t know who, or where he was, but my heart reaches out to him, his loved ones, and the whole AMC family who I know will be grieving. I hope they all band together to support each other in this truly horrible time.
It cemented something for me though – thoughts I have had for quite some time.
It is wonderful that we have these groups, self organised peer support to help people (in this case men) to have somewhere to talk and realise that to struggle is to be human, not weak. It is wonderful that we have helplines, and support available via text, email, web chat, or even the good old fashioned snail mail. Support given by volunteers.
But it is not right that this should be the main source of support for suicidal people. And that when many suicidal people reach out for professional medical support they do not get the right kind of help, or even care they need. By care I mean caring. Compassion. Understanding. Trust. Belief.
More and more I get the feeling that there is no clear idea what to do. No clear message as to why we say the things we do.
Suicide is a terrible thing. So many of us (including myself) have lost people we love to it. So many of us have felt its seductive and awful allure. I spent much of my life troubled by suicidal thoughts – “ideation”. I attempted several times when I was young – but came close many many times until turning a corner somewhere in my early thirties. Since then the thoughts come occasionally but are not as attractive or powerful.
4912 deaths by suicide were registered in England in 2020. There’s always a delay in the statistics, so these are not necessarily deaths that happened in 2020 – there is always some lag in terms of waiting for an inquest – but then the pandemic also meant these took even longer, so the figures are an indication rather than being set in stone. This is 404 fewer than the year before. This could be due to the above delay. Or it could be something else. But numbers had been going up for a few years before this. Quite steadily.
And this is the lowest the number could be. Because we know there are lots more that are really suicide that get registered otherwise due to lack of certainty in some way. Accidents, deaths by misadventure, narrative verdicts etc.
But then there are the bigger numbers.
10-25 times that amount of people are estimated to attempt suicide each year. So 49,120 to 122,800 people getting to the point of taking action to potentially end their life. Just in England.
And then there are those who don’t get to that point but maybe get close. Those of us who think about it in one way or another. Which is estimated to be 1 in 5 of the population.
It is not OK that nearly 5000 people died by their own hand – nor is it ok that 1 in 5 of us experience such hopelessness and despair that we contemplate ending it all. Maybe some degree of this is natural and understandable. The passive, fleeting feeling of not being able to go on the way we are, not having it in us to keep going, not knowing what to do about the difficulties we face. Live can be bloody hard sometimes. To acknowledge that, is to acknowledge maybe we can’t do it alone. We are not solitary creatures. If we are trying to get through without support it is maybe our mind’s way of reminding us that if we carry on trying to carry this load alone we are going to break our back.
If you’ve ever played a computer game, and it doesn’t go as you want it to, and it gets difficult and boring, and maybe you don’t know if it’s even possible to meet your objectives any more having found yourself where you are – it’s not uncommon to think – I’ve had enough of this, I’m going to quit and start again. But we lose everything we learnt or accumulated in that life. As far as we know, real life is not a game, we don’t get to reboot. Maybe it is, maybe we do – but it’s a hell of a chance to take, and it does mean we are losing everything about this life, not just the bad stuff. And the other thing we are pretty sure of is that the other characters are conscious too – and our leaving the scene affects them even if we did go on to some new iteration. So while it may be normal sometimes to get to that point of frustration or despair – I hope we can agree we want to find a way for people to be able to click “No”, when the “Are you sure you want to quit” box pops up.
Why do we get to that point? I have a fairly straightforward understanding of how and why mental ill health develops which may be wrong, but it helps me to navigate my experience. It is of course more complex than the following – but for ease of discussion: Life is stress. Stress builds. If there is too much stress, too many problems, we get anxious and feel a desperate need to act to solve or get away from those stressors. If they go on too long, if we can’t solve them, escape them, if they are out of our control, we can become depressed – because maybe the best way to keep safe is to isolate, hunker down, wait it out. But if that goes on too long, or if the problems seem absolutely overwhelming and inescapable – what then is the point?
The important word there is “seem”. Because it’s all about perception. Whether we feel there is a a solution, a way out, hope. While we have hope – we can keep going. When we lose all hope – that is when we become suicidal. But hope is perception, is relative – is chemical. When we become anxious and depressed our brain changes and that changes how we see the world. Threats become more terrifying, problems more impossible, life more painful and cruel. We can no longer see the light at the end of the tunnel. Not because it isn’t there but because our brain has blindfolded us.
The brains of suicidal people are seen to have less endorphins than average. Endorphins – happy dolphins I heard someone call them once – that swim through our blood stream and make us feel good – ease our pain. You injure yourself, your body provides this natural pain relief to help you deal with it. And our brain perceives physical and emotional pain in pretty much the same way. Perhaps this is why so many people turn to self harming behaviours – causing injury to ourselves – in response to emotional distress. If I am depressed and in despair, my mind swirling in torment – and I hurt myself in some way, not only does the shock of the pain break through the noise for me for a moment – but my body sends those endorphins which help both the physical and mental pain just a little bit.
However that is not a solution – or a particularly healthy long term coping mechanism.
Luckily there are other ways to get endorphins. And this is where a lot of the recommendations that we might receive from helplines or medical services come in – which seem patronising and trivial. Take a walk or a bath, exercise, eat something nice – do something you enjoy…. Of course these won’t solve your problems. That’s not their job.
There are different levels of suicidal ideation. I think of it like a storm. Not all suicide is linked to Depression but lets take it as an example. Depression is the gathering of dark clouds. They get darker and darker. Our perspective on life, our ability to see our way through, becomes more and more bleak. At some point it starts to rain. This rain is the emergence of suicidal thoughts – the light drizzle of possibility. It grows heavier, we start to contemplate it more and more. It takes shape as an idea, of what we would do and when, torrential downpours as our plan solidifies – and if we are at the point of thinking of taking action -that’s when the thunder and lightening are happening.
If it’s thundering and lightening we have no hope in that moment. Whatever anyone says to us feels like a nonsense, we don’t believe it – we cast around in despair and cannot see any possibility that the rain will end, the storm will pass and maybe one day the sun will even shine.
We need to get back to a place where that seems possible. We need to get through the raging depths of the storm – and part of that is trying to increase our endorphins. Trying to make this moment less terrible. Trying to distract ourselves from it for a little while – till things subside and we are able to start to even contemplate any support that is offered, or find the ability within us to seek it out or take other action.
Happy Hormones. DOSE – Dopamine, Oxytocin, Serotonin, Endorphins. How can we increase these. Especially Oxytocin and Endorphins in this circumstance. Dopamine can be a little problematic in that it makes us more motivated, so could make us more likely to act impulsively. But Oxytocin comes when we feel safe and connected, Endorphins reward us for doing things that keep us that way, that are beneficial for our survival – hence warmth, food, movement, pleasure.
There are always several sides to suicide prevention. What can the person themselves do – difficult when we are in that state of mind but not impossible – if we can come to recognise when we are feeling a given way that it is not an inescapable state. Recognise our suicidal thoughts as a call to action of a different kind – not to do what they say, but to extinguish them. A fire alarm tells some to evacuate, but others to go and find and put out the fire.
But if someone cannot do that for themselves, how can others help them? How can I as a friend, or volunteer, or colleague, or random person on the street – help them to feel better in that moment, and start to find a way through.
There are courses of course which tackle this- what can we do to help prevent suicide and support people – excellent free basic training online by the Zero Suicide Alliance https://www.zerosuicidealliance.com/training . We cover it in a little more depth in Mental Health First Aid, then there is Suicide First Aid, a one day course, and Applied Suicide Intervention Skills Training (ASIST) – a two day course.
We can learn to look out for warning signs, know risk factors, and most importantly – step in, ask the question, be there for the person, have a conversation. Listen. Be empathetic, not judgemental or angry. Build Connection. Make the person feel safe, help them to find hope. Being with someone, acknowledging their pain, how hard it feels for them, showing we care – helping them to talk, and share what is going on for them, helping them to contemplate the options, or reframe their experiences.
Show them they are not alone. Be with them. Go with them. Do things to change their immediate emotional and physical state if you can. Move to a different place, talk about something else until they are ready to talk about the issue at hand. Find common ground.
It’s vitally important that people in our mental health services get a thorough understanding of these things. I understand the difficulties presented by underfunding – lack of resources and staff etc – the inappropriateness of A&E as a mental health crisis service. But there is a fundamental lack of basic understanding of mental health across many health professionals and support staff, and more troublingly – a seeming lack of the specific knowledge I would expect to see in mental health services themselves.
The number of people who experience mistreatment and cruelty within services is unforgiveable. The punishment of people who present with suicidal ideation or having attempted to end their life – event to the point of criminalisation. It’s a disgrace. If someone is persistently suicidal, or keeps coming back – it is not because they are meaning to be bothersome, manipulative, attention seeking, a waste of time. It is because they are still in pain. Either their current circumstances are overwhelming them and they do not have the resources – physical, emotional or otherwise, to cope – or their life experiences have overloaded their emotional system so that they are unable to regulate to see through the noise to bring perspective into their understanding of what is going on for them.
Surely our job is to help them to find solutions. To provide compassionate support and understanding. To give the support – therapy, tools, medication, coping strategies – to help them to be able to begin to manage those wild emotions. We need to help them feel safe now in this moment, and believe that they will be safe in the future. We need to help them heal from past traumas and leave the echoes of past insecurity where they belong – in the past.
Shouting, judging, being critical, punishing, withdrawing care, – will not do this. It will compound any feelings of insecurity, of being unloved, unwanted, unworthy – it will confirm every bad thought the person’s mental illness has given them about themselves – and it will most of all push hope even further away.
Maybe one day there will be a pill we can take when the clouds gather, like we do when we get a headache, which will instantly clear them and restore hope and perspective. But for now it takes a little more work. And that isn’t necessarily a bad thing. Pain, whether it be physical or emotional is telling us that something is wrong. Sometime our wires get crossed and we feel more pain than the problem warrants. Ghosts in the machine telling us that our leg is dropping off, or that the world is ending. We need to find a way to remind ourselves, and to believe – that just because it’s loud doesn’t mean it’s true. And if the people around us, the people we turn to for help, can help us to see the gaps in the clouds – with kindness, with compassion, with love – with infinite empathy for another creature in such desperate pain – then hopefully we will find the strength to keep going, to find hope, to find solutions or alternatives. The possibilities are endless, as long as we don’t end them.