September 9th through 15th was National Suicide Prevention Week. Every year, in the United States 750,000 people try to take their own life. Almost 39,000 succeed. In 1994, I was a part of the former statistic and almost a tick in the latter box. I have learned so much since then about suicide and the mental illnesses that lead to suicidal thinking. As a mental health services consumer and provider, I firmly believe there is a great deal we can do to reduce both of those statistics.
In the summer of 1994, my most recent episode of Major Depression had been in remission for two years. My career was going well. I had been accepted into graduate school to finally obtain the Counseling degree I had had my sights on since I had gotten my undergraduate degree in 1988. The feelings of anger, betrayal, and disappointment that had wracked me since my divorce three years earlier had faded into a soft thudding pain rather than a searing, scorching one. In fact, I had just gotten engaged again.
But in mid-June, everything went from at least a moderate amount of light to a deep black darkness. I didn't see it coming. Unlike the three prior episodes of depression that I'd experienced, this one did not come on gradually. One moment all was fine. Then I felt a rumble under my feet, a shifting of the Earth. I lifted my gaze and there was a wall of water stories high ready to slam into me. I could do nothing to avoid or escape it. The tsunami of a wave hit me, crushed me in its grip and carried me to a pit of depression, leaving me there bruised, battered and in complete despair.
My psychiatrist started me back on anti-depressants but it was too late to stop the building hopelessness and anguish that lead me to believing that taking my own life was the only escape from my pain. Within two weeks, I was hospitalized in the psychiatric ward, for my own safety and to quickly increase my medication (something safely done only in an inpatient setting so side effects can be monitored).
I had been hospitalized during each of my last two episodes of depression, due to suicidal ideation. Those stays had been at a different hospital than this one, and they had been moderately helpful. But this stay was horrible. Not only wasn't it helpful, but it traumatized me even further than my eight years of childhood sexual abuse already had.
The staff was jaded and cynical. They looked at me, and my fellow patients, like we were malingering bottom feeders. I quickly learned to keep my distance from them and they were more than happy to keep that space between us. There was little programming for patients. We spent our days playing board games and watching television. I did get to see a Psychology Intern, but his sole goal was to discuss daily affirmations and positive thinking that I could employ on a daily basis. As if that would cure the deep despair, depression, and hopelessness I felt in every cell of my body.
After eight days I was told I needed to “get better” or be transferred to a State-run locked psychiatric facility. That terrified me. I knew of the facility. It was a place people went to and didn't come back from, for a very long time. I quickly told them I was better. They discharged me the next day. I was feeling just as depressed and suicidal as I did when I was admitted. And now I was frightened to seek help, for fear of being committed against my will to that infamous hospital.
The following day I went to visit my fiancé, carrying my heavy load of depression with me. He wouldn't meet my eye, wouldn't touch me. I felt his disdain for my illness and subsequent hospitalization hanging in the air. He told me he had met someone while I was in the hospital and no longer wanted to see me again.
As quickly as the depression had set upon me I chose to let it claim me. Getting back in my car I slammed the door shut, closing the door on my remaining will to live. I was done. I had experienced way too much pain, abuse and betrayal in my life to feel like things would ever get better. The light at the end of the dark tunnel would never be anything other than another vicious beast coming to claim my happiness and success. This was my day to surrender and die.
Resolute in my decision, I felt an eerie calm settle over me. Along with it came relief. I no longer felt the intense struggle inside myself to keep on top of my urge to die. The fight was over. I didn't have to battle anymore. I actually felt the weight of my depression lift a bit. Those positive feelings were enough to reinforce my thought that I was making the right decision.
As I went through the lengthy process I wasn't upset or anxious. I actually anticipated my death with both calm and gratitude. I had spent so many years of my life depressed, anxious and being abused. I didn't cry a tear of sadness over what my life had been. But I was only a short step away from crying tears of relief that all of that would finally be over.
Lying down on the bed, seeing unconsciousness creeping into view, I felt another shifting under my feet, remarkably similar to the trembling I felt when the depression had hit me several weeks earlier. In the same instantaneous flash my emotions took a 180 degree turn. Suddenly, I wanted to live. I panicked because I knew I was moments from passing out. Thankfully I had a phone in my bedroom (no cell phones back then). I called 911. Help arrived in time to save my life.
I spent the next four days in the hospital, a day in Intensive Care and three days in the Cardiac Care Unit. Hospital staff treated me with disdain. On the second day, I heard two of them talking in the hall outside my room. One asked the other what had happened with me. The second replied, with marked disgust in her voice, “Oh, she had a fight with her boyfriend and decided to kill herself”.
“NO!”, I wanted to scream, “that isn't it!” It was so much more than that, deeper and wider than just a romantic tiff. I was humiliated.
That same day my pastor came to visit me. I was still drifting in and out of my drug and alcohol haze. I woke to see her standing next to my bed, a look of scorn on her face. “Are you finished with this now?” she demanded. “Are you done with these foolish feelings of suicide?” What could I say? I wanted her approval and acceptance. So I was repentant and assured her I was no longer suicidal. She rewarded me with her approval. I felt like a fraud. And I was.
After I had sufficiently recovered, I was transferred to the hospital's psychiatric ward. I wrote about that stay in my blog post The Day Charades Healed Everyone...Except Me. The only good thing that came from that hospitalization, aside from the pretty tea trivet I made in Arts and Crafts, was my realization that I was not going to get better unless I advocated for better care. Being a passive patient had garnered me nothing but disdain and subpar treatment. If I was going to get care that would lead me away from my depression and suicidal ideation I'd have to demand and even fight for it.
I did just that. I found a new therapist, psychiatrist, and hospital inpatient program. I fought with my insurance company to pay for these services and paid for what they wouldn't cover by borrowing money. The next few years were a turning point in my recovery. I worked hard on so many levels. And it paid off. I haven't been in the hospital since 1994. I got my Master's Degree in Marriage and Family Therapy in 1997. I got married again and had the most incredibly precious little boy.
It hasn't been all roses and glitter painted kittens. After my depression went into remission in 1999 I experienced a fifth episode in 2001 that has haunted me since then. If I ever recover from this episode, which I may not, the chances are 99% that I'll have another episode. That is the reality of severe, recurrent Major Depression.
Have I had suicidal thoughts with this episode? Yes, I have. Some of them fierce and frightening. But I have better tools now to cope with them. And I have my team of providers I work with, including my incredible Dr. Wonder, who I worked hard to assemble and who fight hard, in return, to keep me as far on top of my depression as I can.
As a consumer of mental health services, I learned a great deal about suicide, treatment and the world's response to suicidal people from my peers. As a mental health provider I have gained a whole different perspective on those matters. It is from both of these viewpoints that I write, with great conviction, that there is much we can do to prevent the 38,000 plus deaths by suicide every year. While they would by no means prevent every suicide; acceptance, compassion and an easily accessible, high quality mental health care system will drastically reduce the number of deaths by self-inflicted harm.
Before much can change, there must be a greater acceptance of mental illness. Stigma must end. 90% of those who die from suicide have a mental illness. They need treatment, effective treatment. Yet, when the majority of our society believes mental illness is the result of a character weakness, poor self-control or malingering those that need treatment are more likely to hide in shame than seek that which they desperately need.
Mental illness must be treated the same as any other illness. One would not dream of telling someone with diabetes that they just need to suck it up and get over it. We don't tell people with cancer that they need to simply think more positively and count their blessings to be cured. Mental illness is a genetic, biologically based illness. Just because the illness is “invisible” does not make it any less real or lethal.
We must stop making sweeping negative generalizations about mental health. When we stop treating mental illness and those with it as second class citizens the shame surrounding seeking treatment will dramatically decrease. More people getting help means fewer people committing suicide.
Second, we must learn to treat those experiencing suicidal ideation with compassion. I am ferociously tired of hearing harsh judgments like, “She wasn't really serious. She did it just to seek attention.” or “Suicide is a permanent solution to a temporary problem”. In rare times these statements may bear some truth. But again, these are sweeping generalizations that do not apply across the board and are, as a result, harmful when applied to everyone.
For many, many people attempting suicide is a signal that they need help dealing with painful, overwhelming and despair dealing mental illness. Even if it was not a lethal attempt, it is a signal that their thinking is impaired. Shame and scorn will not encourage them to seek help.
And, yes, sometimes people who are otherwise mentally healthy will, in a moment of despair over a particular circumstance, try to or succeed in killing themselves. But these people are in the minority. Most who commit suicide have been struggling with persistent, chronic feelings of despair. They have tried to get treatment, but either the treatment is not of high quality or the illness is so severe it is treatment resistant. Compassion, not judgment, is needed. Before you declare someone's suicidal ideation to be the contemplation of a “permanent solution to a temporary problem” ask them how long they've been ill and what they endure as a result of their illness. When we treat those who are suicidal or have attempted suicide with scorn, rather than compassion, we run the risk of driving them deeper into their despair. We most certainly discourage them from seeking treatment.
Individuals with mental illness also need high quality, effective treatment. Acceptance and compassion will do wonders in bringing people into treatment. But unless we provide them with services that will actually help them, it is a moot point.
Every day I watch television commercials that tout the effective, high quality treatment for cancer and cardiac care here in the Dallas/Fort Worth area. The ads rave about how wonderful the facility's services are and how successful they are at combating the illnesses they treat. But I never see psychiatric hospitals with such commercials. On a whole, the United States does not have hospitals that treat mental illness like the hospitals these commercials feature. Instead, we warehouse or do the Medicate and Discharge Dance with our mentally ill because our society doesn't see a value in investing in psychiatric treatment. Ultimately, this is because we don't see value in those with mental illness.
Another reason we don't see a lot of high quality hospitals that treat mental illness is because there is little profit margin in that field. Many individuals with chronic mental health issues are on Medicare or Medicaid. The profit margin in treating this population is so slim that it does not make a lot of financial sense for facilities to operate in this specialty. Those with “visible” illnesses are more likely to have insurance, which make earning a profit much more likely. Again, we see so little value in treating mental illness that we don't offer those providing mental health services enough of a reimbursement to stay economically viable.
We also don't invest in the research necessary to improve our treatment of mental illness. For example, in 2013 the National Institute of Health is estimated to be providing 808 million dollars in research funding for breast cancer research. Yet, they are providing only 67 million dollars for researchers to study suicide and suicide prevention. Looking at these statistics one would think that breast cancer was a much more lethal disease in our nation. The reality is that breast cancer and suicide claim almost the same number of lives every year, with breast cancer deaths at just over 39,000 and suicide at just under 39,000. Again, it reflects where we have placed our value, and we clearly do not see the life of a suicidal individual as having equal worth as one with breast cancer.
Mental health services need not only be high quality but they must be easily accessible. When they are in crisis, individuals should not have to wait weeks to get an appointment or have to visit emergency rooms because clinic based services aren't available. Parents should not have to wait for their child to commit a crime before their son or daughter can get the residential care they need. Suicidal individuals need to have inpatient beds available to them rather than being medicated and turfed out the door. When we make it hard to get treatment for people who are already have a fragile grasp on life we discourage them from continuing to advocate for the care they need. Entry into the mental health care system should be simple and quick.
As someone who uses and provides mental health services I assure you that acceptance, compassion, and easily accessible, high quality mental health care will reduce the number of unsuccessful and successful suicide attempts our country experiences every year. We can not only save lives but prevent the trauma experienced by those who experience the suicide of a loved one. We simply must decide that those who suffer from mental illness are valuable and worthy. We must stand up and declare that every life is worth acceptance, compassion and care. And we must not sit down until it is a universal truth.