Jennie Z. Rose
Sep 5, 2018 · 6 min read

September brings the end of summer vacation and the equally sobering National Suicide Prevention Awareness Month. I wanted to write a suicide myth-buster, but from a mental health standpoint, it’s a tough subject. Social stigma doesn’t make it any easier.

Huge gaps in our knowledge exist, thanks to underfunding of research and the challenges inherent in creating lab studies (inducing subjects to suicidal thoughts is a bit of an ethical bugaboo).

My father, Douglas, was 36 when he was found — dead from Hemlock poisoning — in a car parked on the side of a country road. Proof of his intention and planning was confirmed when the coroner found a botanical card he had used to help identify the poisonous plant; he knew what he was looking for when he picked a few stalks from the parsley family.

In the first few years after he was gone, my questions tended toward the tragic romantic. Did he choose Hemlock because of some symbolic affinity with Socrates? If he left a note, is there someone out there who read it? If I was a worthy person, then why did he abandon me? I even went through a phase of thinking about honor suicide in Japanese culture, and half-hoped his dying had a poetic gesture to it.

I imagine anyone left behind by a suicide has to grapple with unanswerable questions like these. One thing I never figured out was how to separate myself from my dad’s decision to bail out. I’ve had decades to recover, and I still don’t know what advice I can give for healing the harm to self-acceptance that comes with being the survivor.

What is Essential is Invisible to the Eye

Much of human suffering is out there in plain sight, but it is possible that even more of it is hidden. “Be kind, for everyone you meet is fighting a hard battle,” is an often-used phrase that comes into much sharper focus every time we lose people — Anthony Bourdain, Kate Spade, Robin Williams, David Foster Wallace— who seem like they are at the top of their game

It’s confounding. This kind of brain disorder produces complex and contradictory behavior. Two-thirds of people who die by suicide told someone in advance that they were considering it. At the same time, 80% of people who attempted to end it explicitly deny they had been thinking about doing so. In any case, though, if someone ever tells you she is thinking about taking her own life, take that seriously.

Of the few things we are certain, one is that mental and emotional pain can have a tipping point of no return. People think differently when they’re suicidal. There is a feeling that there is no way out. The thinking is described as “cognitively constricted,” says Matthew Nock, a professor of Psychology and director of the Nock Lab in the Department of Psychology at Harvard.

The Nock Lab is developing tests to predict suicidal behaviors and outcomes that will help with tools for suicide prevention. Psychologists there are approaching 80 percent accuracy when predicting today whether a subject is going to think about suicide tomorrow.

Among the lab’s findings, data show that patients who are seen for self-harming or suicidal behavior get less care and are less well-liked by clinicians. “The perception is that they’re creating their own problems,” Nock says.

With such a deeply misunderstood motivation, it’s no wonder that more than half of people diagnosed with depression in the U.S. don’t get treatment for it. It is my opinion that a suicide attempt speaks more to unmanageable pain than a desire to create drama or problems. Since a suicide attempt is made in the hell realm of invisible pain, it calls on the bystander to imagine that what cannot be seen is still very real.

A Terror Way Beyond Falling

David Foster Wallace, author of Infinite Jest who hanged himself in 2008, wrote the most eloquent description of suicidality that I have found so far:

The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who leap from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’, can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling.

The First Rule of Suicide is Don’t Talk about Suicide

Even as suicide has become the 10th leading cause of death in the US and the second leading cause of death among young people, more funding is available for research on baldness and migraines, says Dr. Nock. “Given the scope of the problem, that seems nuts,” he says.

During the last decade in the county where my father died, the highest number of reported deaths by suicide was 49 in 2016, a gradual trend upward from 34 in 2008. Most of these are recorded as gunshot wounds. No other cases of hemlock poisoning were found during this period, according to the county health department.

Although we can see an increase in this one county, suicide rates overall have been flat over the last 100 years. The Centers for Disease Control reports show the rate of suicide is the same as it was around the year 1900. Stagnant probably because we tend to ignore and underreport suicide attempts, which in turn is probably because we think of suicidality as contagious.

An uptick in Google searches on the topic after the Netflix program 13 Reasons Why demonstrates this social contagion. The trouble is, fear of talking about suicide is one of the obstacles to helping people who feel they have more than 13 reasons why.

Contrary to common wisdom, “We know experimentally that asking someone if they are thinking about it is a safe thing to do,” says Dr. Nock, who also works with the suicide workgroup for the World Health Organization’s World Mental Health Survey. The survey is the first large-scale, cross-national study of suicidal behavior, and includes data from 28 countries, many of which never gathered such statistics before.

“Hello? Have you been alright through all these Lonely, Lonely, Lonely, Lonely nights?”

About 20 years ago, The National Suicide Prevention Lifeline (800–273–TALK/8255) built a North American network of more than 150 crisis centers in 49 states in the hopes of setting up more intervention. Callers can expect to be asked several personal and medical questions so that the responder can assess your risk level. You will get questions about your history, circumstances, support network of family and friends, and whether you are seeing a therapist or another medical practitioner of some kind. Other answers about the hotline experience can be found in this FAQ written by a responder.

It’s undeterminable now whether or not suicide hotlines work, because how do you follow up with someone who called in anonymously, right? Still, if you ever find the walls are closing in for you, reach out to a hotline. Really. I know.

Many Sticks Together Are Difficult to Break

While we have problems with research and treatment trials here, low-cost solutions are proving to be effective outside the US. For example, in Uganda, StrongMinds, a US-based nonprofit, trains mental health facilitators to establish peer-group therapy.

Since its 2014 pilot program, more than 25,110 women have successfully gone through treatment. By sharing their own stories, the women in groups affirm that they aren’t alone. As one facilitator said, “One stick is easy to break. But many sticks together are difficult to break.”

To anyone who has not experienced severe brain disorder, please consider yourself lucky. It is well not to pass character judgement on those who have. And to those who have managed to survive for many years with this kind of monkey on your back, I salute you. Let us imagine ourselves as “many sticks together” while we go through our days.

Jennie Z. Rose

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Writes about people working on climate adaptations, plays bad guitar, and needs a dog that will sing along.

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