Suicidal Feelings – Still a Taboo Subject?

If you’re feeling suicidal right now, this is a good guide for avoiding acting on  those feelings. Above all please talk to a friend or family member, or call a crisis line in your area – here’s a list.

In an attempt to reduce the shocking suicide statistics, we’re encouraged to talk about suicide, especially during Mental Health Week. There are 24-hour suicide lines and guidelines for reporting of suicide, especially the sudden deaths of the uber famous like Robin Williams. There are support groups for survivors – those who lose loved ones to suicide.

But suicidal feelings? Not so much. They are buried in the mush of the word ‘depression’, which is so vague it refers to any kind of low mood. Suicide is caused by depression, apparently, and therefore depression is Bad, and so is mental illness. At least these assumptions signal the community struggling to acknowledge that mental suffering can be as tortuous as physical suffering. But how can we expect the public to have the first understanding of mental illness when the sector itself is in crisis, by lack of funding on the one hand and the clash of competing paradigms on the other?

There may be support groups of survivors but there are no bricks-and-mortar self-help groups (that I’m aware of) for those afflicted with suicidal thoughts (if anyone knows of one, please let me know and I’ll mention it. There is an online forum for people who feel suicidal, Suicide Forum). There are plenty of other self-help groups, of course, for the kind of problems that can lead to suicidal thoughts. As soon as you voice a suicidal thought in such a group, a protocol comes into play. This is a good thing – it is evidenced based and its one aim is to stop the person in question suiciding, to keep them safe during the crisis. Suicidal feelings can result in death so must always be taken seriously. But it speaks to the problem of suicide – that it’s difficult for the person afflicted with the thoughts to speak about them. Once you do, the direction of the discussion must change immediately, if not come to a halt. There’s still a taboo.

Part of the problem is that suicidal feelings can actually mean many different things and arise for many different reasons. Lumping them all together could be as harmful as not dealing with their disparate causes.  I’d suggest the following categories of suicidal thoughts arising from mental suffering (I’m not an expert – feel free to offer opposing opinions or some additional categories).

Also, these categories are fluid – some may suffer from a combination of these things.

― Fleeting thoughts that everyone has. The only problem with these thoughts is that the person who has them might decide they were abnormal. I guess the internet makes that fear obsolete. 

Fleeting thoughts of self-harm during a low period are pretty normal as far as I can tell.

― OCD thoughts. The sufferer here doesn’t actually have the desire to commit suicide at all but  afflicted with persistent, disturbing thoughts and images of self-harm – a form of pure OCD known as suicidal OCD. The sufferer is not in danger of committing suicide, but needs treatment for the OCD.

― Suicidal thoughts during periods of an acute mental illness. This would include particular kinds of depression, including bipolar, that push sufferers into extremely desperate states. It might also include a psychotic episode for someone with schizophrenia. Such people might actually realise they are a danger to themselves and ring up a suicide line or admit themselves to hospital. That is, they may know that as a life choice suicide is not what they want – but they fear the illness will take over and make a terrible decision. Anyone suffering from an untreated mental illness could be at risk simply because their mental suffering is severe and they  don’t know how to reduce it.

― Suicidal thoughts provoked by unbearable grief. This can afflict all genders but males are particularly vulnerable because society teaches males to cover up and repress their feelings when they experience loss, for example the loss of the family farm or the breakup of a relationship. Some may find the feelings of grief unbearable or fear that the feelings will never change.

What these people desperately need is help to process their feelings. Often these feelings may be accompanied by unhelpful, unrealistic ideas about gender expectations, so these people may also need help in being compassionate with themselves and letting go of outdated ideas. The latest DSM has been criticised for pathologising grief, but this is perhaps because the idea of a drug for grief is so counterproductive. Perhaps it’s not that the grief itself is pathological, but that sufferers of pathological grief don’t have the tools they need to process and get through it. Help with doing that – if the therapist is willing to ‘suffer with’ the patient – can only be a good thing.

―The suicidal thoughts of someone with mental illness when they have insight. These thoughts are based on the overall quality of life, and the reality of continuing mental suffering. These thoughts could be equally applicable to someone with chronic physical illness or disability, and also their carers.

In particular this reason may merge with the previous one because any kind of illness or disability involves an element of ongoing grief as to the limitations that the illness places on the sufferer (even if some of those limitations are caused by social attitudes). So feelings of quality of life must be dealt with separately from the grief-work that is part of having a chronic condition or caring for someone who has.

What this shows is that there is not just one remedy for suicidal thoughts and impulses. However, if someone feels acutely suicidal then there are urgent things that need to be done regardless of the causes. The appropriate treatment comes later.

The Grow Program and Me

In my last entry I looked at Grow, a peer support program for mental health and life skills that I’m part of. This week I’m giving a personal perspective of my involvement with Grow.

My history with Grow is instructive for anyone navigating self-help in the mental health area for the first time. I went to my first meeting way back in around 1990, and scurried away because it didn’t seem ‘suitable’ – in fact, the people seemed ‘sicker’ than me. I was sharing a house with someone whose partner was a psychologist; she told him I’d been to Grow, and he confirmed my impression, relaying through her that Grow was for the really ‘sick’ people, and definitely not right for me. (At the time I’d never been diagnosed, so who knew how ‘sick’ or otherwise I was?)

So I left it at that until 17 years later, in a particularly difficult period of my forties. I had moved out of the inner city and left my previous 12-step program, and my freelance work was drying up. I was unmoored and uncertain, and lacking in any real hope for the future.

In the middle of this Dante-esque period, in around 2007, I went to a Grow meeting in St Kilda, and came away with the same impression: I just wasn’t ‘sick’ enough for Grow. In fact, I thought, I didn’t fit in anywhere; no-one understood how hard it was for me to sit through a meeting, but I considered the problems of most of those at the St Kilda Grow group, some of whom seemed to be on very strong medication, to be remote from mine. (I was wrong in retrospect: it was my fear of medication that was the barrier, not whether I had anything in common with the other members.)

Finally, late last year, I hit rock bottom. This was when my OCD got so bad that I felt I had no choice but to go back on antidepressants. I thought I’d try Grow again, and that the meetings might be manageable, given I was on drugs. Grow was my last resort.

I remember being led into a cramped room with yellowish light, where a group of about 10 people sat in a close circle. There was one vacant chair in the circle, and everyone pointed me to it. In my desperate state, the chair seemed symbolic – there was a place for me here.

The cohort was completely different from the St Kilda one; the majority were reasonably prosperous retired people aged sixty and over. There were a few younger people, mainly dealing with life after addiction or learning difficulties. The problems people aired seemed work-a-day, those I was familiar with from other groups I’d attended. Predictably I constructed myself as the sickest puppy in the meeting, but I also felt I a sense of acceptance and lack of judgement that, while it couldn’t douse my fear, did subdue it a bit.

Grow was medicine for me when I first arrived, but for a while I was in danger of sliding away from it because I didn’t take my need for medication seriously enough. When things got bad again, Grow was a bridge to some version of normality. When I was ready to take my medication regularly, I got support from the meeting to get back on my bike. Not that I really believed that I could feel better; but I pretended that I believed, and kept going to meetings, and now I do feel better. I’m still up and down, but the acute suffering is gone.

Group dynamics at Grow meetings

One aspect of Grow meetings does pose a problem for me. For about two years a decade or so ago, I attended an intensive, twice-a-week therapy group led by a psychiatrist; as well as providing objective feedback to the problems aired by participants, the main point of the group was to voice and explore the emotional responses that other people evoked, both positive and negative.

The dynamics of the Grow meetings have brought out all my personality traits and then some, but there’s no real avenue in Grow for processing the feelings that come up towards others, and as a response to interacting with the group. Occasionally people whom I’m very fond of will nevertheless irritate the hell out of me – but there is no real forum to explore where those feelings come from and what they might reveal. On the other hand, this gives me the opportunity to simply practise patience. Seeing a therapist one-on-one would help with this.

What I do love about Grow is that it gets me out of my own head. During the sharing part of the meeting I can listen to other people’s problems and along with other members offer objective advice. It’s such a relief to get the attention away from myself for a change, and to realise that I can bring an objectivity that is often completely lacking when I try to deal with my own issues; and the other members do the same for me.

I would recommend Grow for anyone. It really does provide a strong level of support once the initial settling-in period is overcome. I feel more optimistic about the future now, but not in a fake way; I know I will always have difficulties, and I still get very resentful about the circumstances of my life.

And I still find meetings very difficult; I’m convinced that soon, perhaps next time, they’ll get too hard and I’ll never come back. Yet as long as I follow my gut, I’m mostly okay. It’s hard but it does seem as if there is a group bond that helps me, even if it can’t save me completely. One of the older members, who is a plain speaker and who knows how difficult I find it, once said to me something like ‘keep coming to Grow because we love you’. Oh well, if you put it like that ...

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