The way the media talks about suicide matters

cartoon face shushing surrounded by the word suicide

The way the media reports on suicides can affect the likelihood of the suicide contagion (or “copycat”) phenomenon.  There are a number of organizations that have put together media guidelines for reporting on suicides, and this is a summary of some of their recommendations.

Do’s:

  • include local crisis line information and other community resources
  • include warning signs and information about what to do
  • report on suicide as a public health issue
  • get information from suicide prevention experts
  • use the terms “died by suicide”, “completed suicide” or “killed him/herself”
  • look for links to broader social issues
  • if possible provider education the links between suicide and other issues such as mental illness and substance misuse
  • avoid the use of language that normalizes suicide or presents it as a solution to problems
  • word headlines carefully, and avoid using the word “suicide”
  • be particularly careful when reporting celebrity suicides
  • avoid printing a photo of the person who completed suicide, and if one is used it should not be displayed prominently

 

Don’ts:

  • don’t use sensationalist headlines
  • don’t use prominent placement (e.g. front page) or undue repetition
  • don’t use photos of the location/method of death, grieving friends/family
  • don’t describe a suicide as inexplicable or without warning
  • don’t quote/interview first responders about cause of suicide
  • don’t describe suicide as “successful” or “unsuccessful”/”failed”
  • don’t report specific details of the method
  • don’t offer over-simplified reasons for the suicide
  • don’t romanticize the suicide
  • don’t present a melodramatic depiction of suicide or its after-effects on others
  • don’t label certain locations as “hot spots” for suicide
  • don’t use hyperbolic descriptions like “suicide epidemic”
  • don’t publish suicide notes

 

Sources:

reportingonsuicide.org

Canadian Association for Suicide Prevention

Samaritans

World Health Organization

 

Image credit: geralt on Pixabay

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Book review: After Suicide

AfterSuicide

In After Suicide, author Charlotte Underwood describes her journey following her father’s suicide.  The book also serves as a how to guide to picking up the pieces after the suicide of a loved one, both practically and emotionally.  She shares the lessons she learned along the way, and speaks openly about some of the destructive coping strategies she turned to.  There were significant negative consequences in her own life as a result of her father’s suicide, and this serves as a good reminder that suicide never just affects the person who dies.

This book is very moving and has quite an intimate feel to it.  In the conclusion, Charlotte writes that the book is her way of reaching out a hand to support her readers, and this is very much what it felt like.  This short ebook is available as a free download and is well worth a read for anyone whose life has been touched by suicide in some way.

 

You can find Charlotte on her blog Charlotte Underwood.

 

You can find my other book reviews in my blog index.

Image credit: Smashwords Books

Suicide and barriers to help-seeking

brick castle walls

There’s lots of information out there about crisis resources for people thinking about suicide, but resources accomplish very little if we don’t reach out to access them.  There are many reasons people don’t seek help, and I wanted to talk about a few of them here based on my own experience with major depressive disorder and suicide attempts.

Fear of being a burden

No matter how much anyone might say “you’re not a burden”, I wouldn’t believe them.  The suicidal thoughts were such a heavy burden for me to carry, so why would I want to place some of that burden on anyone else?  And it doesn’t feel like it is with pack animals where I can shift my rocks to someone else’s donkey and make it lighter for my donkey.  It feels more like extra rocks would be getting dumped on both donkeys, so I’ve got extra weight weight that I have to carry as well.

Fear of others’ responses

There’s a lot of stigma out there in the world, about mental illness in general and suicide in particular.  When the word “selfish” gets tossed around in relation to suicide, that’s certainly not going to make it more likely that people will speak up.  Being judged is the last thing someone needs when they’re feeling desperate.

For those of us who have been open with others about our illness, even if we’re not necessarily worried about stigma there’s still uncertainty about how others might respond.  People say well-meaning but just plain stupid things about depression all the time, so what kind of supportive idiocy is likely to come out of their mouths when faced with the topic of suicide?  That I should be grateful for what I have, even though none of it matters?  Or maybe something along the lines of oh, you should go out for a walk in nature?  #SickNotWeak #FuckTheWalk

Hopelessness

My illness makes me feel like there is no hope for the future, and it’s when that hopelessness gets particularly intense that I want to end my life.  I’m not thinking oh, if only I could get help things would be so much better.  At that point, I have given up and don’t want anyone trying and failing to help and in the end just making things more difficult.

Over the entire course of my illness it has proven to be very hard to treat.  In the past I was able to achieve full remission eventually, but now it seems like that may be a thing of the past.  Because of my professional background I know what my options are, and I know there aren’t a lot of them, which tends to really reinforce those feelings of hopelessness.

Worthlessness

When mental illness steals away your whole sense of worth as a human being, it can start to feel like people would barely notice, much less care, if you weren’t around any more.

Crisis lines/services

The only time I’ve ever used a crisis line myself was in the first few weeks after my first hospitalization.  I had discharged myself against medical advice after they decided not to renew my involuntary committal.  I’d been in hospital for 2 months, and out I went, with no discharge plan in place.  I was cutting as a strategy to cope with suicidal thoughts, and mostly when I called the crisis line I talked about the cutting rather than what was underlying it.  I guess it was nice to have someone to talk to, but I remember feeling like their responses were kind of formulaic, as if they’d been told these are the things you should say in these situations.

A lot of crisis lines have volunteers providing support.  I’m sure they’re great, they care, they want to listen, but they don’t have the level of expertise of mental health professionals.  Part of that is that they don’t have training in assessing mental status, which makes me inclined to think they have a lower threshold of concern to call the police.  I may be overestimating the risk of this, but if I’m thinking about ending my life the last thing I want is the police banging on my door.

In some ways it works against me that I’m a mental health professional, because it means I know a lot of people working in local emergency and non-emergency mental health services.  I have no desire to call the emergency mental health service or go into the hospital emergency department and have to deal with some asshole that I’ve worked with before and know is useless at their job.

Fear of hospitalization

This is the single biggest reason I keep my mouth shut when I’m thinking about suicide.  I’ve been hospitalized four times, and these experiences were extremely difficult.  When I’m at my lowest, given the choice between death and hospitalization, realistically death is going to win out.  This reflects fundamental flaws in a system that disempowers and traumatizes patients, but there’s also a sense of personal failure that I connect with hospitalization.  This isn’t a judgment I pass on others, but probably part of why I apply it to myself is that three out of four of my hospitalizations were involuntary, so it’s kind of a failure to maintain the ability to make choices for myself.  This fear of hospitalization is deeply ingrained in me, and over the years it has made me tell lies and keep secrets.  I realize that this is something that puts me at risk, but I don’t see that just spontaneously changing.

 

I know that reaching out for help dealing with thoughts of suicide is the right thing to do, and it’s certainly what I would urge to anyone reading.  But realistically it’s just not alwawys that simple, and I think it deserves some thought when we’re not in the midst of our deepest lows.

What has been your experience of accessing help in crisis?

Click here for info on crisis support resources.

 

Image credit: pcdazero on Pixabay

Crisis resources for suicide prevention

cartoon face shushing surrounded by the word suicide

Sadly, we hear all too often of people who have lost their lives to suicide.  Many among us in the mental health blogging community have either attempted suicide or had thoughts of doing so.  There are resources available to support us; it’s just a matter of knowing what they are and being willing to reach out (I must admit that’s something I’ve been reluctant to do in the past, and I’ll talk more about this in tomorrow’s post).  Here are some of the many resources that are out there.

International:

  • The International Association for Suicide Prevention has listings of crisis centres organized by continent and other resources worldwide.
  • Unsuicide has listings of IM, chat, and text services in Australia, Canada, the USA, and the UK
  • Wikipedia has a list of suicide crisis lines for 48 different countries
  • Suicide.org has a list of local crisis lines for multiple different countries

 

Australia

 

Canada

 

India

 

UK:

  • Samaritans crisis line 116 123
  • CALM webchat for men
  • Papyrus HopeLineUK for adults under 35, call 0800 068 41 41 or text 07786209697

 

USA:

 

Safety planning apps

 

 

 

Image credit: geralt on Pixabay

My relationship with death

mourning candle

Content warning: This post talks about suicide, but not in the present tense.


I’ve always thought my reaction to death was a bit weird, in that I’ve never had a strong reaction to death.  Part of it is that I view death less as a loss and more as a natural transition, and part of it is probably how I think about people who are aren’t physically present.  I’ve always tended to have an out of sight out of mind sort of view of people I don’t have regular physical contact with.  This has popped up in various ways, and is probably a big part of why I’ve never been good at maintaining long-distance friendships.  In a way death feels like the same thing taken to an extreme, a twisted form of object impermanence.

My dispassionate view of death has become even more firmly entrenched since my first episode of depression.  Sometimes when my depression has really bad I’ve had thoughts of suicide.  I’ve attempted suicide four times outside of hospital plus several times in hospital.  It seems unrealistic to me that I would live until a natural death (which, given my genes, probably would happen until well over 90).  I just can’t imagine living another 50+ years, and I’m ok with the idea that my life might end prematurely due to suicide.  It’s not necessarily an outcome I actively desire, but it seems the most likely.  While I do reach out for help with my depression, I don’t disclose to health care providers when I have active thoughts of suicide.  It’s not an issue right now, but most likely it will come into play at some nebulous point in the future.

As my depressive illness has progressed, the future seems very indistinct.  I have a hard time imagining what my life might be like at 50, 60, or beyond.  I’ve got no partner, no kids, a small family, and only one friend.  Life is something I just keep doing out of momentum, not because there’s anything to look forward to.  I sort of feel like that should disturb me, but I’m pretty indifferent.

My grandma, who I’ve always been very close to, is 101 years old, so clearly she doesn’t have long to live.  And I wonder sometimes how I’ll react when she dies.  Will I grieve?  Or will I just shrug and move on, all the while hating myself for feeling that way?  I don’t know, but I’m inclined to think the latter.

Death and I have a weird relationship.  Please don’t worry about me; I’m fine, this is just something I think about sometimes.

What is your relationship with death like?

 

Image credit: geralt on Pixabay

TED Talks on depression and suicide

TED Talks logo

Somehow, the folks at TED manage to gather amazing individuals with powerful voices to speak up about difficult topics.  Here are some talks related to depression that grabbed me.

 

Nikki Webber Allen: Don’t Suffer Your Depression in Silence

When  Nikki Webber Allen was first diagnosed with depression, she didn’t tell anyone, because “I didn’t think I had the right to be depressed.”  She attempted to self-medicate through high achievement.  It wasn’t until her nephew, who she hadn’t known was depressed, died by suicide that she decided to share her story.

 

Andrew Solomon: Depression, The Secret We Share

Andrew Solomon described depression as something “braided so deep into us there was no separating it from our character or personality”.  He observed that depression makes it seem like a veil of happiness has been removed from the world so that the depressing truth is made visible.  He described the current state of treatment as “appalling”.

 

Kevin Breel: Confessions of a Depressed Comic

Kevin Breel points out that depression often happens to people who don’t seem like they should be depressed.  He spoke passionately about the silencing effect of stigma, and the need to shatter that silence.  He described depression as society’s deep cut that we simply slap a bandaid on.

 

Sherwin Nuland: How Electroshock Therapy Changed My Life

Sherwin Nuland shared how his life was saved by ECT in the 1970’s.  At that time, most of his doctors had identified a lobotomy as the only option, and it was a medical resident that actually pushed for ECT.  After 20 treatments he’d experienced a significant response and finally was able to feel hope.  He came up with safe words to manage obsessive thoughts, and I think they’re just perfect: “Ah, fuck it”.

 

Kevin Briggs: The Bridge Between Suicide and Life

Kevin Briggs worked for many years for California Highway Patrol, and was often called to suicide attempters on the Golden Gate Bridge.  He was struck by how well people responded to being listened to.  He sends a strong message that there is hope, and suicide is preventable.

 

JD Schramm: Break the Silence For Suicide Attempt Survivors

In this short talk, JD Schramm addresses the taboos around suicide that silence and isolate people.  He brings up some disturbing statistics, and issues a call to speak up about suicide and provide resources to those who have survived suicide attempts.

 

Have you seen any TED Talks that you would consider must-see?

In times of life or death

shadow_face

As some of you are likely already aware. one of our fellow members of the mental health blogging community attempted suicide earlier today, and posted a suicide note on her blog.  I choose not to link to her blog here because for those of you who aren’t already familiar with her amazing work, I don’t want to introduce you to her at her most desperate moment.

I saw it about an hour after it was posted, and my heart started pounding as I wondered what the hell I was going to do.  I flailed around feeling powerless for a bit before realizing that her Twitter page stated where she lived.  I called the police there, and they said they’d already made contact with her.  I then saw that I’d gotten a message from one of her Twitter followers, who had made the initial contact with police that resulted to them getting to her in time (thankfully; who knows, this may not have been the case if mine had been the first contact).  The police were able to get to her and get her much needed help because there was sufficient identifying information in her online accounts for them to figure out who and where she was.

That got me thinking.  Many of us value our anonymity, and very deliberately choose not to put identifying details about ourselves online  And at the same time, many of us do experience thoughts of suicide at times due to our illnesses.  If we, in moments of desperation and hopelessness, were to publish our intentions or actions with respect to suicide, would fellow bloggers who wanted to help us be able to figure out how?

WordPress doesn’t have a lot to say about the matter.  In their page on “Self-harm and online safety“, they suggest calling the authorities if you know the person, and posting suicide resource information for them if you don’t.  You can “report content“, but it doesn’t sound like this is likely to accomplish much, if anything.

Thinking about myself, the city where I live is displayed on my Twitter account.  I don’t use my full name, but I’ve done some guest posts under my full name, and that probably wouldn’t be too hard to find.  They would mean my first, middle, and last names woild be available, , plus I’m already in the local police system as an “emotionally disturbed person” (police jargon for contacts they have with someone with mental health problems), so they’d probably track me down fairly quickly.  I’m not sure how comfortable I feel with that, to be honest.

Being on the other end, as a fellow blogger wanting to help, the feeling of powerlessness is terrifying.  The desperate desire to help crashes headfirst into having no idea where to even start.  In this particular instance, enough pieces were there, but what if that wasn’t the case?

I’m not sure what the answer is, or if there even is an answer.  We can hope this is an issue that won’t come up very often, but I think the reality is that it’s inevitable that sometimes it will arise.  It’s probably better that we start to think about it when we’re not trapped in the darkest depths, and consider how many crumbs of information we’/re prepared to dole out, and much power we are willing to offer to our fellow bloggers to help us if things get really bad.

 

Image credit: Ian Espinosa on Unsplash

You always remember where you were when…

Sandy Hook elementary never forget sidewalk

There are certain moments in time that become etched in our memories, and we remember exactly where we were and what we were doing when an event happened.  Sometimes that’s because of the significance of the event itself.  For my parents’ generation, that might have been the assassination of John F Kennedy or the moon landing.  I remember that on the morning of September 11, 2001, I was in university but for some reason didn’t have classes that morning.  When I got up my roommates had the tv on, and we watched in stunned, horrified silence as the 2nd tower collapsed.

Then there are the moments we remember not so much because of the event itself but because of our own circumstances at the time.  For me, the Sandy Hook elementary school shooting was one of those moments in time.  Don’t get me wrong, it was a terrible event, but sadly these types of events occur with disturbing regularity.  I remember Sandy Hook, though, because it is burned in my mind what was going on for me at the time.  I was in the small psychiatric emergency ward in a suburban hospital near the city where I lived.  It was a single large room with curtained off beds and a small seating area with a tv.  There was nothing else to do, so I watched tv and picked at the rats nest that my hair had become during the delirious days prior to my admission.  The tv was tuned to CBC Newsworld, the 24 hour news channel of Canada’s public broadcaster.  As I watched the story unfold, I felt a curious sense of indifference.  The only thing that really struck me was that I wished Adam Lanza could have shot me rather than those innocent kids.  Why did they get to escape this world while I was stuck rotting on the psych ward? Aside from that thought, I just kept mindlessly picking away at my hair.

I don’t like the heartlessness that depression brings about in me.  I previously blogged about my own non-reaction to the Las Vegas mass shooting; I was disturbed more by my lack of reaction than by the event itself.  Indifference was not a “normal” way to look at such a horrific tragedy.

I find it interesting that my life’s chronology has come to be defined very little by external significant events and much more by illness events.  Hospitalizations and relapses form the major milestones as I look back at my life over the past 10 years.  Everything else is situated in relation to those milestones; either that, or it just blurs into a fog of meaninglessness.  I regularly watch the news and so am aware of major world events, but unless things somehow relate to my depression journey my brain relegates them to the discard bin.

Mental illness changes how we interact with the world around us, and that can be distressing and even frightening.  It can be hard to separate how much of our reactions are truly our own and how much are the illness.  Why are both 9/11 and Sandy Hook burned in my mind when so many other events have gone into the dusty filing cabinet of my brain?  Why did 9/11 trigger stunned horror while Sandy Hook triggered nothing?  It’s not something I try to beat myself up over, but I do find it curious.  As in so many other situations, I’m not really sure where I end and the illness begins.  On this journey of self-discovery I don’t think I’ll ever find concrete answers, and maybe there will always just be more questions.  Still, it’s important to keep asking those questions – and maybe that’s what I really need to take away from all of this.

 

Rising from the ashes of depression

tattoo.jpg

Those of us waging a battle against mental illness need to find strength wherever we can.  I decided a few years back to display mine on my body.

I got my first tattoo when I was 19, a dolphin on my right hip because I admired those beautiful, intelligent creatures.  I didn’t give much thought to any further body art until 2012.  I’d had my first relapse of depression in 2011 and spent two months in hospital, and I was finally starting to feel better and had returned to work.  I decided it was time for my second tattoo, and decided to go with Chinese characters on my left hip.  I asked a Chinese colleague what characters he thought best represented resilience, and the ones he selected literally mean “return to spring”, in the sense of regeneration and renewal.  The tattooing process was quick and easy, and I was happy with the result.

Not long after I got the tattoo, things began to take a downturn, and kept spiralling downwards until I made a suicide attempt in late 2012.  Once I got established on the road to recovery I decided I needed a more significant depiction of my ability to recover, and the myth of the phoenix rising from the ashes seemed intensely appropriate.  I looked at it as sick me dying with the suicide attempt, and well me being reborn.

I found a tattoo artist I connected with and she turned my vague idea into an amazing drawing.  Then we began the long, painful process of tattooing.  It took probably around 10 hours to do, with regular breaks when I started shaking because it hurt so much.  I just tried to remind myself, though, that the only reason I was here experiencing this physical pain was that I had the strength to endure so much mental pain.  I was thrilled with the result, which covers my left side from hip to armpit.  When I am feeling weak, it’s an amazing reminder of what I can endure.

Celtic oak tree symbolI’ve been unwell for the last year and a half or so, and I think it’s time for another visual representation.  I’m thinking about a Celtic oak tree design, which symbolizes strength and endurance.  I would like to move forward a little more in my recovery journey before I get the tattoo done, but that gives me something to look forward to.  And even when depression makes my mind play tricks on me, my body can always remind me of the truth.

 

Living in fear: The tsunami of depression

crying woman inside a rainy window

While fear may not be a symptom of depression, it is certainly something that has become tightly woven into the fabric of my illness.  When I am well, I am fearful of when the next relapse might be, when the ground might disappear beneath my feet.  When that relapse happens, I am terrified – here we go again with yet another tidal wave to wash my life away.  And as a depressive episode stretches out, I am scared that I won’t get better, that I will drown in this mental pain.

What is probably the most frightening is the lack of control.  I can be doing what would appear to be all the right things, and I will still get sick.  As the years have passed it has become harder and harder to control my illness, so the fear only escalates.  This current episode has lasted for almost a year and a half, and I am utterly terrified that I will never get my well self back again.  I miss her so much, but she is either gone, washed away in the tsunami of my depression, or drowning in a dark basement somewhere.  If only there was a “find my iPhone” for the real me, to give me a life preserver to hold on to.

A few years ago I was making my case before a review board about why I should not remain committed to the psychiatric ward.  As a mental health nurse, I’m a bit of a research geek, so I was talking about the STAR*D research study, which essentially showed that the more treatment failures a patient has the worse the prognosis.  I argued that my suicide attempt stemmed from “evidence-based hopelessness” (although looking back, I’m not sure why I thought that would help my case).  Perhaps a better way to put it, though, would be evidence-based fear – fear based in the evidence of my personal experience and reinforced by the research evidence I was reading.  If I am already fearful that I won’t get better, it becomes very hard to challenge that kind of thinking.

woman drowningI’ve been learning recently about acceptance and commitment therapy (Russ Harris’s ACT Mindfully site is a great resource if you’re interested in reading more), and contemplating how fear fits in with this idea of acceptance rather than resistance.  Is this fear a form of resistance?  And if so, maybe it’s resistance in a good way – a reason to keep fighting for recovery.  Or maybe acceptance lies in making space for this fear, acknowledging it as a neighbour that’s not going to be moving away any time soon.

As I struggle to tread water in the sea of my depression, perhaps I have to both accept and resist.  Resist the urge to stop struggling and just drown already, and accept that another wave might come at any time and push me under.  In the end, whether I feel fear or not, que sera sera.

 

Photo credits:

Milada Vigerova on Unsplash

Christopher Campbell on Unsplash

The lies we tell and the secrets we don’t

person making shush gestureAs a mental health nurse, I always hope that my clients will feel comfortable and safe enough to be open and honest with me.

As a person with depression, though, being open and honest is likely to go straight out the window if it appears to conflict with whatever goal feels most pressing to me at the time.  While this may sound manipulative, it is something I do for the purpose of self-protection and self-preservation.  It is part of the armor that I put on when my illness leaves me feeling weak and defenseless.

The topic I lie the most about is suicidal thinking.  Based on past experiences, I never want to be hospitalized again.  Disclosing thoughts of suicide is probably one of the quickest ways to get committed to hospital, so I keep my mouth shut.  Is that a safe, healthy way to approach the issue?  Of course not.  But in the balance of pros and cons that goes on in my head, there is little that would win out against my desire to avoid hospitalization.  I try to consider this in my professional life and be very mindful of how I’m reacting when clients disclose suicidal thoughts to me.

I also omit symptoms that I either do not want or do not feel ready to talk about.  At one point I had gone off meds for a while after a 3-strikes-you’re-out series of negative experiences with doctors.  After a couple of sleepless months I realized that I really needed to find someone to order some drugs for me.  I didn’t want to talk about my depression for fear of getting a similar reaction to the last few doctors I’d seen, so I only admitted to being unable to sleep.  In doing so I could get my mirtazapine and quetiapine back on board, and after a while I felt safe enough to disclose the rest of what was going on.

girl and face mask juxtaposed on blue eyeIn the end, I can only conclude that we just try to do the best we can with the situation we’re faced with.  And I think the more that health care providers understand that, the easier it might be  for us to start to remove some of that armor.  It’s not realistic to think that we will never feel the need to resort to lies and secrets, but it’s worth reflecting on what underlies them so they don’t end up coming back to bite us in the butt.

 

Image credits:

Kristina Flour on Unsplash

Kellepics on Pixabay