[we’re all mad here] but suicides have a special language

(Before reading this, please be informed that I am not a doctor or a psychiatric professional of any kind. I speak from my own experience of many years of mental illness only. Nothing you read on the internet should take the place of a doctor’s advice.)

World Suicide Prevention Day.

There’s something nearly comical about seeing campaigns to raise awareness of suicide, when you’re living in the land of the chronically mentally ill. I would very much like not to be aware of suicide. I would very much like if several of my close friends had not felt – do not feel – they should have a go at ending their lives. I would very much like if I didn’t feel that way myself on more occasions than can be any way healthy.

The World Health Organisation says that 3000 people end their lives every day. From this viewpoint, all you can think is please don’t let my loved ones be among them. Please don’t let me be.

I feel selfish writing this, but I don’t have any other way to consider it. I think the goals of WSPD are laudable. I think there’s a lot to be done to improve mental health services everywhere – and I’m in an EU country, a developed country, so I can only imagine how much work there’s to be done elsewhere in the world. I think measures to reduce suicide by pesticides in still-developing countries are a good step forward. I think that opening a dialogue about mental illness with young people in schools is utterly vital in reducing the stigma that still surrounds having mental health issues.

But ultimately, I come back to how Anne Sexton described suicidality:

But suicides have a special language.
Like carpenters they want to know which tools.
They never ask why build.
Wanting to die is a lonely walk out on to a dark promontory. All the goodwill and best wishes in the world cannot stop the relentless drive in your unbalanced brain. In the end it’s a fight that takes place entirely in your mind, that ends up written on your body in scars or vomit or bruises. It’s a place that, once visited, haunts the back of your mind for a long time.
Kay Redfield Jamison, the celebrated mental health author who herself attempted suicide due to bipolar disorder, wrote, “When people are suicidal, their thinking is paralyzed, their options appear spare or nonexistent, their mood is despairing, and hopelessness permeates their entire mental domain. The future cannot be separated from the present, and the present is painful beyond solace. ‘This is my last experiment,’ wrote a young chemist in his suicide note. ‘If there is any eternal torment worse than mine I’ll have to be shown.'”
Awareness is good. Don’t get me wrong, awareness is good, but only if it’s accompanied by active work on mental health infrastructure. Blithely chirping that one should stay strong! and tell me all about it! may make the speaker feel better, but is unlikely to do a huge amount for someone already in the dreadful grip of hopeless despair.
I compare it to cancer awareness, often: everybody knows cancer exists, but not everybody has access to a doctor, or knowledge of how to check their body for odd lumps. Those are the things that need work.
At the very basic level, there’s no point passing on a Facebook status or joining To Write Love On Her Arms (and don’t even get me started on that rubbish) unless you know what to do if a friend does turn to you and say ‘I want to hurt myself, I’m scared, please help’. So, with a certain amount of experience behind it, here’s what I’ve found helpful:
  • if your friend is in immediate danger (has taken an overdose, opened a wrist, etc), you need to get them to medical help. Call 999 if necessary.
  • if it sounds like your friend is about to be in immediate danger, ditto. Get them to an emergency room. If they already have a doctor, especially a psychiatrist, call that doctor’s office and alert them.
  • if you’re far away, for example, an internet friend: try to reach anyone you know to be near your friend. A partner, a local friend, a family member, their doctor. Someone who’ll be able to get them to a hospital or sit with them until they feel less in danger of hurting themselves.
  • if you’re with the person and they’re not in immediate physical danger, follow their lead when it comes to interaction. Get them sitting somewhere safe, remove dangerous things from the vicinity, make them a cup of tea, and just be with them. Let them talk if they need to, but don’t push it. Sometimes the best company is someone who knows you well enough not to make you talk.
  • if you’re far away, but the person isn’t in immediate physical danger, do the same as best you can. Keep them on the phone or on IM/email, don’t force them to talk, but let them know they’re not alone. If you think they’ll respond well, encourage them to call a local friend or family member to come over.
  • your main objective here is harm reduction. It’s very hard to make a suicidal mind un-suicidal through conversation alone, but it’s possible to help someone calm down enough to stay out of immediate danger until they can reach professional help. If they’ve already hurt themselves, your objective is to get them to medical help ASAP. Harm reduction. You might not be able to achieve complete harm prevention, but you can stop things getting a whole lot worse.

Dear suicidal friends, brothers, and sisters: there’s lots of us. More than any of us know. There’s help available, even if you’re scared. If it comes to it – show this blog to the person to whom you’re relating your woes, and it might help them to understand. And as Bob Dylan said, keep on keeping on.

Once you’ve reached the lowest point, it’s got to get better.
For the simple reason that it couldn’t very well get worse.
Recommended reading:
Kay Redfield Jamison – Night Falls Fast: Understanding Suicide (seminal and unparalleled work on suicide and the suicidal mind)
Susan Rose Blauner – How I Stayed Alive When My Brain Was Trying To Kill Me (slightly fluffy for my taste, but worth the look)
Andrew Solomon – The Noonday Demon (excellent work on depression, including suicidality as a result of MDD)
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