Note: this piece is not intended for, or directed at, those who are mourning the loss of someone to suicide. For resources for suicide loss survivors, visit the American Association of Suicidology’s site here.
This piece is also not intended to shame folks for how they’ve reacted to, thought about, or spoken of suicide. I myself am guilty. Most of us are. Let’s move forward together.
“Oh, that’s so great. We need more people like you.”
This sentiment is one of the most common I hear when I tell people I am pursuing my licensure in mental health counseling. They tilt their heads and nod with a smile as if to signify a compassionate understanding of the need in this world for a more powerful force behind mental health care.
They aren’t wrong; we need more people in this field. We always will. I feel honored and often overwhelmed by my evolving role as a mental health provider in this day and age. As with many who work in the healthcare industry, caseloads are often unreasonably high, resources are slim, and access to services are often unattainable by those who need it most.
As a field of practice that grew upward from of the long arm of Freud’s psychodynamic theory–where psychic woes and hysteria were attributed to little more than sexual urges and ego–mental health has become yet another often under-resourced component of the fractured healthcare system in the United States. Insurance options for care have been historically slim, and insurers dictate the treatment process by establishing an “acceptable” list of reimbursable conditions and services. Clients get shuffled between providers and clinics and are often lost in the very system that is trying to help them. Treatment plans are boiled down to a simple reduction in troublesome symptoms, with the goal being to return clients to their previous state of psychological functioning.
I’m getting off track here, though–there could be volumes dedicated to the investigation of the mental health care system as it is stands, and the harm the current system inflicts on those who can’t afford an independent therapist. It’s a mess. It’s not good. We all know that.
What I’m really here to write about, though, is this perception of mental health care workers as the main driving force behind individual and community mental wellness. Indeed, the field as a whole and all the individuals contained within play an integral role in pushing forward the narrative of mental wellness and healing. Our sole purpose as professionals is, and always has been, to guide people back to their lives and promote wellness and healing.
But we’re not everything–we can’t be everything. Just as the oncologist can’t discover cancer in its earlier stages without direct action from individual patients and the community around them, neither can we discover someone who is suffering from severe mental illness without that person–and, more importantly, the people around them–initiating that first therapy session or visit to the hospital. What makes this difficult is that in our society, people are openly and emphatically encouraged to go to the doctor when they find a strange lump in their breast or a scary looking mole, but the same isn’t always true for those who find themselves feeling hopeless, mentally numb, or unusually agitated. They’re called crazy. They’re told to stop their problematic behaviors–get over it, cheer up, calm down. Too easily, they internalize these messages and turn on themselves. They feel like an outsider. They feel scared to open up and ask for help.
All too often, mental illness is cast aside, belittled, stigmatized, and hidden. Those who suffer tend to do so in silence until they simply can’t anymore. Sadly, when they reach out, some are miscategorized, misdiagnosed, or even treated as criminals, especially those who suffer with more severe or misunderstood conditions. Our understanding of mental health as a society is still lacking, and we’re not taught in school or in our professional settings to identify the signs that someone is struggling.
On top of all this, as they’re directly and indirectly stigmatized, we then tell folks who are suffering that they need to be the ones to reach out. They need to say something. They need to end the stigma by talking about it. While it’s true to say that their struggles aren’t their fault but they are their problem, this misses a crucial aspect of breaking the vicious cycle we’ve found ourselves in.
Yes, they are ultimately responsible for taking control of their mental wellness, even when the cause is not their fault. Yes, they should be encouraged to speak out. Yes, self-advocacy is crucial.
And yes, the world needs more people who want to become helpers. Yes, the world needs more therapists and psychologists and psychiatrists and psychological researchers. Yes, the world needs more licensed professionals who are able and willing to use their status to speak out on behalf of those suffering.
But the world also needs more people like you. Average folks who want to help but don’t know where to start, who share sentiments of “we are here for you” and “please reach out” on social media without actually knowing how to be there, or what to say–not for lack of interest or compassion, but because it hasn’t been part of the collective lexicon until just recently.
That can change. You can be part of the cure for stigma. You can take the onus off of the suffering by reaching out first. We can all push the ball forward, but only if we do it together.
On Mental Health, Suicide Prevention & Stigma
Often, when someone takes their own life, survivors are drowned in a sea of confusion, fear, unimaginable sadness, and even anger. Even if they knew their loved one was struggling, it can be difficult to comprehend the desperation and pain of a person driven to suicide as a means to end that suffering. Unless you’ve lived that reality or been close to someone who has opened up about their experience with it, it can seem unfathomable. To those who haven’t been there, it just doesn’t make any sense.
In the wake of the recent celebrity suicides–Scott Hutchison, Kate Spade, and Anthony Bourdain, to name the most recent few–there’s a call from our collective mouth to those who are suffering: reach out, talk to someone, you’re not alone. Please don’t leave. Just tell someone. Their deaths are a higher-profile representation of the suicide crisis we face in this country every day. And so, we often send our messages out to the world in the form of begging those who are in a dark place to take the first step and ask for help.
This is an important message, no doubt. Self-advocacy is a vital component for anyone who is facing a health crisis, whether it’s a mental health condition or a physical condition. It’s important that folks know that their voice matters and that there is someone available and willing to listen. We should never stop telling people that this is a real and open option to them when they are in a dark place.
But that’s only part of the story. What we’ve been missing from our national narrative is an honest look at the complex nature of clinical depression, mental illness, and the intricate web they weave around suicidal ideation. For someone who has never experienced these things, it can seem unfathomable to think that someone would prefer to end their life rather than speak up and seek help. The story is much harder to tell than the story of lung cancer or a stroke or prostate cancer or even breast cancer.
“How could they do that? It doesn’t make any sense. Why didn’t they just reach out?”
It’s understandable that someone might ask these things following a suicide. It’s easy to understand why someone might not be able to comprehend the decision process taken to come to such finality, or the intensity of psychic pain experienced by the afflicted. The grief of those mourning works to compound the pain, confusion, and sadness that envelops suicide loss survivors.
How is it possible, we on the outside ask, to see no other way out of pain? Nothing can be so bad that suicide is the answer, right?
Similar questions are asked of folks with addictions: how could they let their addiction take over their life like that? It doesn’t make any sense. Why can’t they just stop using?
And of people with obsessive-compulsive disorder: how could they spend hours a day washing their hands? How can they let it take over their life like that? Can’t they just stop doing that?
And of people with post-traumatic stress disorder: why do they get so freaked out when someone taps them on the shoulder? How can they be so scared of everything? Don’t they know not everyone is out to hurt them?
And of people with chronic illnesses invisible to the eye: they don’t look sick. How can they possibly be in that much pain? Haven’t they tried eating better/going to another doctor/getting some exercise?
On and on and on.
Unfortunately, these sentiments precede the very attitudes that lead people to stay hidden and ashamed. With clinical depression, where a byproduct of the suffering is often isolation and withdrawal, being told to simply “speak up” can seem an impossible task. Like a broken leg that makes walking incredibly difficult, clinical depression can make a person’s voice feel fragile, vulnerable and raw. It can keep them from speaking out. People who are facing severe depression and suicidal ideation may feel isolated to the point of total withdrawal (emotional and/or physical). Severe depression can take on several forms, including but not limited to:
- excessive anger or irritability that seems out of proportion to the stress or incidents involved;
- lethargy and fatigue which may look like an actual slowing down of the body or mobility. For some people, this may mean the inability to leave the house, take care of themselves, or even get out of bed;
- physical pain that is hard to pinpoint and has no obvious cause;
- expressions of hopelessness, worthlessness, or negative evaluations of themselves or the world.
Furthermore, despite what is commonly believed about depression and suicide, an often-missed warning sign for suicide is a sudden lift in mood or demeanor after someone has been suffering with severe depression for extended periods of time. This is especially true if they have had suicide attempts in the past.
Fortunately, we are (slowly) coming to a point in society where people are starting to question their beliefs about mental health and mental illness. More and more, people are speaking up and fighting back against the very actions and language that serve no other purpose than to place full blame on sufferers and increase the stigma that prevents them from saying something in the first place. More and more, we’re realizing that it’s not as simple as cheering up, reaching out, or “just stopping” whatever it is that’s causing them distress. We’re coming to understand that mental illness is not a byproduct of a moral or character failing.
We’re getting there. Slowly, so slowly. But we are. We need more help, though, and that’s where you–the “neurotypical” folks–can step in.
Right, so: How?
Here are a few easy ways to get your feet wet, starting now:
Empower people who are struggling & encourage self-advocacy
For people with mental health issues, it can sometimes feel like they’ve got no power over what’s happening inside their minds. Especially because we’re still on the very precipice of understanding mental health and the endlessly intricate workings of the brain, not knowing the exact mechanisms behind why you’re clinically depressed or having suicidal thoughts can be terrifying and defeating.
The thing is that even in the most severe cases of depression, anxiety or other mental illness, where so much of it seems out of our control, the individual holds the ultimate power. Encouraging individual choice among those with mental illness is exceptionally powerful; empowering them to build or regain their internal locus of control is even more so. Despite the fact that their brain chemicals may be beyond their control, there are still things that they can control: the decision to seek help or not, the decision on to take medication or not, the decision to speak or not speak, the decision to share their story or not.
For what it’s worth, people should always be encouraged to speak up and use their voices when they can. Self-advocacy is important. Very important. But, it should never be required as a prerequisite for our caring and support. Ever.
So, for those of you who want to do well, here’s the biggest piece of advice I have: be a compassionate, encouraging, nonjudgmental, non-demanding support for the people around you. Period. Make sure they know that how they choose to approach their mental health is their choice, and that seeking help is never (repeat: NEVER) a sign of weakness. This doesn’t mean telling them they should just go see a therapist and leaving it at that; encouraging them to seek help is one part of the puzzle, but so is creating an atmosphere on nonjudgmental acceptance and openness to listen when someone reaches out.
Here are some tips on what you might say to encourage and empower someone who is struggling:
- I’m really glad you reached out to me about this. Thank you for telling me. Is there anything I can do to help?
- I appreciate that you came to me. What can I do to help you get what you need?
- Thanks for talking to me about this. I’m here to listen to you.
- What are you struggling with, and is there anything you need from me to make it through this?
- Would you like for me or someone else to join you for moral support at your first doctor/therapist/psychiatrist appointment?
Be the connection.
If someone you know seems to be suffering, reach out to them, rather than waiting for them to say something. This can feel a little intimidating at first, especially if mental health is a touchy subject for you or you’re not sure how they’ll react. There are a few things you can say to check in with people–and this applies to everyone in your life, not just someone you fear might be suicidal.
Try these on for size:
- I noticed that I haven’t really seen or heard from you in a while and I wanted to check in to see how you’re doing.
- I’ve noticed that you’ve seemed down lately and just want to let you know I am here to listen when you need or want me to.
- I feel concerned about some of the things that you’ve been saying lately and felt the need to ask you how you are doing.
If you’re more comfortable or close with the person and they’ve reached out about their struggles in the past, a few ways to keep in touch might be:
- How have your depression/anxiety levels been lately?
- Is there anything I can do to help you out to make things a bit more manageable?
If you’re in a situation where you have reason to believe that someone may be actively planning to hurt themselves/take their own life, don’t shy away from asking them about it directly. Despite the fear that can surround this type of confrontation, asking someone if they’re considering hurting themselves or taking their own life isn’t going to make it more likely that they will.
Again, the key is to be compassionate and nonjudgmental about how you approach them. Rather than demanding they tell you anything, or threatening to bring them to the hospital, let them know that you care and that you want to listen. Share with them your concerns and encourage them to seek help. If they’re in immediate danger of hurting themselves or taking their own life, this is the point where emergency intervention is warranted.
Educate yourself – don’t expect others to do it for you
Many people who are facing severe depression and suicidal ideation may not be willing or even able to reach out and talk about what their experience is like. They may feel isolated, which can present as withdrawal (emotional and/or physical). This is the result of that complex web of social stigma, self-stigma, and the symptoms of the condition itself.
So, if you’re not familiar with the ways in which depression and suicidal ideation manifest, take the initiative to educate yourself. Depression isn’t just being down in the dumps, and feeling suicidal isn’t just peering over some literal or metaphorical ledge. The more we can understand and learn to identify the ways in which these conditions manifest, the easier it will be to notice it–both in others, and even in ourselves.
Start the conversation.
Not sure how? Feeling uncertain? Check out Make It OK. They’ve got some good tips on how to start the conversation about mental illness without introducing stigma or judgment into the conversation.
You can find more information about talking about mental health here:
Call out stigma. Learn to catch yourself.
Stigma is tough to beat, but it’s not impossible. Rather than putting the pressure on those with mental illness to break the stigma, take it upon yourself to stop it wherever it shows up–including within yourself.
Not sure what stigma looks like? Want to see if you’re affected by stigma? Check out the resources below:
- 9 Ways to Fight Mental Health Stigma
- Time to Change (UK)
- Shaming the Sick: Drug Abuse and Stigma
- Ending the Stigma of Addiction – SMART Recovery
We owe it to each other
Have you noticed how things feel a little out of control these days? Our nation is facing an opioid crisis of epic and lethal proportions, there’s been a sharp rise in alcohol use and abuse among all groups (but especially women), the emergence of #MeToo victims speaking out against sexual assault and harassment, and senseless gun violence in schools perpetrated largely by young white males.
When it comes to suicide, the statistics are staggering:
- suicide is the 10th leading cause of death in the US (nearly 45k adults annually)
- for every completed suicide, there are 25 others who attempt
- white middle-aged men have the highest rate of completed suicide in the nation, with men overall completing suicide over 3 times more frequently than women
- firearms account for 51% of all suicide deaths
This is not ok. Suicide is on the top-ten list of causes of death in this country and yet many of us feel resigned to platitudes. If we’re really trying to end this crisis and show people who are suffering that we want them here with us–that there is, in fact, a place here in this world that is beyond their current suffering–then we have to do more. We owe it to each other to be better than that.
As always, if you are struggling and feel the need or desire to talk to someone about it, the National Suicide Prevention Lifeline is here for you: