Suicide - Spectrum of Survival

Following the life transitions of both Stephen tWitch Boss and Jason David Frank, I decided to write my first post about suicide. "During a storm, if you focus your attention on the top of the tree in the backyard, you have the impression that it is very vulnerable. It can be blown away by the wind at any time. But when you focus your attention on the trunk of the tree, you see that the tree is deeply rooted in the earth." - Thích Nhất Hạnh

"There are soldiers in my brain. They are stealthy in their efforts to find tactical and strategic measures to produce rumination in an effort to retrieve my mistakes, weaknesses, and shortcomings. All of this, for a winless and seemingly endless battle". -- Alyson Davis

Cause of death is not the completion of suicide listed on the certificate. The cause of death is anxiety, depression, multi-generational trauma, etc. No one person is responsible.The term suicide does not encompass someones full experience. It does not mean criminalization, selfishness, eternal damnation, cowardice, or weakness. Death is the end of life in the natural sense but not spiritual.

During a Narrative Therapy conference I attended, a concept proposed numerous ways to avoid a threat. The countless ways described a spectrum. On the far end of that spectrum is suicide. The spectrum is vast, but in someone's darkest moments, there is hypervisibility on the end of the spectrum. In the presentation, a speaker described an Indigenious name for those who have completed suicide as a Fallen Warrior. This concept did not remove a person's integrity but instead held them with honor. While the warrior was fighting for their life, they lost the battle. A quote stated, "I didn't get to decide the torture was going to stop, so I got to decide to stop being tortured." An act of resistance is staying alive when battling for your life.

Extending empathy to suffering

Most people in their lifetime will experience suicidal ideation. My first experinece hearing about suicide was the quote "a permanent solution for a temporary problem." However, when navigating hopelessness, the experience does not feel short-term. Suicide attempts often are not during someone's darkest times, but rather, the fear of returning to them. During times of despair, the ideas of death volunteer promises of relief, escape and rest. Many individuals who survive express not wanting to die while also not wanting to continue the way they are living.

Suicide is a taboo subject, that some fear if spoken about will conjure a fatal response. However, being able to talk about thoughts that are perceived as dark openly creates an open dialogue to understand better what's triggering the ideas.

There is a spectrum within avoiding threats. Everyone comes to battle with different tools and resources for their life. Our tools can be both inherited and made. Tools consist of what we have learned or witnessed in our lifetime. Some people battle with the means of self-care, mindfulness, and therapeutic practices to distract, soothe, and learn from a threat. Others utilize self-harm to externally feel the sensation of what their feelings cannot put into words. Addiction is sought to numb pain and provide temporary relief. Ruminations attempt to appease and control intrusive thoughts. Suicide attempts try to both combat or flee from the danger. The spectrum of suicide reveals fight, flight, freeze or fawn survival responses.

The fear of "what happens if I don't complete suicide," becomes more significant than the fear of suicide itself. Individuals do not want to be both trapped by their thoughts and the helpers through involuntary hospitalizations and stigma. Considering the current political climate, inflation, interest rates, student loan debt, systemic injustice/ racism, global conflict, diseases, climate change, and social media comparison culture, sometimes despair is effortless.

Helpful things to remember:

We are in control of nothing. It was once a nerve-wrecking thought in my life, but now I view it as fortunate. Thoughts of suicide are often rooted in feeling out of control with a heightened sense of responsibility. Acknowledging our lack of control can also take the world off of our shoulders.

Maybe the internal voices say:

• You have failed, and there is no room for redemption.

• The world will be better off without you; you have made no significant impact and have no purpose.

• No one cares about you.

• You don't matter.

• You're unlikable

• You don't belong.

• Life is meaningless.

• There are no other options.

• There is no point.

• The situation is too dire.

• My mistake was too big.

• They will be better off without me.

• Nothing will help.

• I'm alone.

Suicide as a part of the story

As a Narrative Therapist, I practice with the concept that the dominant stories and themes we are told about people who are like us, both covertly and overtly dictate our lives. There are societal messages that influence our ideas about who has the right to live, who is worthy, and who is valuable. This is seen through classism, ageism, ableism, racism, homophobia, etc. We know whose stories circulate and whose are ignored. There are stereotypes that if you are wealthy, you have no justification for depression. Or, if you are grateful, you can't also be sad. People face problem-saturated-narratives that dictate their views on the world, whether optimistic or pessimistic. Until we can find discrepancies and plot holes in our problem story, the problem feels like our whole being rather than a part of our experience.

For example, gender bias creates barriers for cisgender men to access mental health services due to stigma about emotions and threats to masculininty. There are risks to speaking up. For specific career fields, professional opportunities are threatened for those taking mental health medication, or have an assessment that indicates past suicidality or hospitalization. This creates a story that encourages suppressing emotions, hiding, or for someone to take matters into their own hands because the world has no room for who they are or what's bothering them.

Suicide tells a story of how someone perceives their role in their story, and also how they understand the world to view their story. We all learned about suicide somewhere- family history, books, movies, music, etc. The way we learned about suicide influenced our beliefs about its power. Aspects of a person's identity influence their relationship to hopelessness. There are many things we cannot see when it comes to how a person's identity and experiences impact their quality of life. When clients decide to work with a Mental Health Professional, they can determine the risk of what would happen if the suicidal ideation was no longer present. This way, clients can understand the utility behind the thoughts. Behind the suicidal ideation is a perceived giant that will need to be faced. Thoughts make sense, suicidal ideation reveals:

1. This feels too big to handle alone

2. I am out of ideas of how this could get better

3. I need something different

4. I'm scared of what I might do if I do not get help

5. The problem's significance feels like it outweighs my ability to fight.

Understanding the origin of intrusive thought patterns weakens their intensity. Individuals can ask these questions:

• How did I know when I was first suicidal?

• What did these thoughts reveal about the relationship I have with myself?

• What has helped me resist these thoughts in the past?

• How are various aspects of identity affected or not by these thoughts: ethnicity, socio-economic status, gender, sex, sexual orientation, national origin, first language, physical/emotional/developmental (Dis)ability, age, race, gender, religious/ spiritual affiliation). For example, if one of our identities is marginalized and threatened, it can fuel the story that our life is meaningless and the world would be better without us.

• How do privilege, power, colonization, and white supremacy impact my relationship to suicide?

• How do I recognize the symptoms and signs of these feelings to know how I want to respond to them?

• What is my preferred Life Story?

Death Language

In the therapeutic space, the feelings of hopelessness are validated. The reality is some life circumstances make people feel like they are going to die. When children are overwhelmed, a common response to a challenge is, "I quit!" Suicidal ideation can feel like wanting to give up when something feels too unmanageable.Television dramas quote teens when they feel embarrassed by saying"I could just die." Some experiences instinctively result in bargaining, "God, if you could just get me out of this one, I promise I will change my life". When the desired miracle doesn't occur, people can feel rejected and abandoned by the universe or their higher power, making the temptation of suicide stronger. Seemingly receiving "no answer" makes suicide feel like THE answer. There is especially the dread of facing an unexpected hardship that stress creates statements like "these bills are killing me." Death-language is common and referenced in response to symptoms of defeat.

Perceived Freedom in Death

Death makes a loud statement. It gets the attention of the severity of the problem.There is a societal romanticized view of death. Due to the fear of the unknown, people contemplate the enticing unknowns of death. There is a notion that people should not speak ill of the dead. Death creates a sense of safety because it is untouchable. Influential leaders are often hated while living and glorified when they die. Mental illness can be viewed with pity and sympathy, while the dead experience empathy. For some, there is a concept that a villainized person will be granted the pardon of humanity in death.

Getting help

So if you are reading this and thinking about your own experience, past or present, with suicidal ideation know that you can borrow courage from providers or community. When I say borrow courage, outside support can lend hope when people fear their future. You have options if you need a battle buddy in the fight for your life. A battle buddy is a partner assigned to a soldier serving in the United States Army. They are a way of reducing stress, teaching teamwork, and a sense of responsibility for our fellow person. When the mind is at war with itself, the top intervention is the support of another human being.

The alleviator of anxiety is knowledge and opportunities; both give back control. The more we know, the more space we have makes a difference. Depression functions to alert us when we are working outside of our capacity. If our emotions didn't slow us down, we would keep moving to depletion. Listen to your internal compass; your intuition is like a check-engine-light. Think of a bad cold or flu; slowly, we lose our five senses to immobilize us to get rest: clogged ears, stuffy nose, watery blurred vision, diminished tastes, and sore muscles. Depression helps to slow us down; it staggers our motivation, makes us tired, and tells us we need more of something we are not getting and cannot continue until we get it. Whether therapy, coaching, group support, a conversation with your PCP or psychiatrist, or reaching out to a trusted person, you don't have to carry the burden of your thoughts alone.

Burdening

Speaking of burden, people assume that their problems will burden their support systems. The thought is friends and family have their own problems and way too much going on to listen. Contrarily the burden is created when people we love discover we are hurting, we need them, and withhold ourselves from accessing their care. The burden comes from people wondering what they missed or could have done differently. Sure, we all have problems, and with the busyness of life to address them openly will feel like an inconvenience. Rather, if we don't make space for how we are feeling, it consumes in detrimental ways.

I disclosed, it went badly...

Alternatively, if you have told someone previously that you felt suicidal and they did not have the words or answers you were looking for, it does not mean you were wrong to disclose. Not everyone can immediately help, and sometimes there is no one right thing to say. It may feel outside of the scope of practice of your community to address suicidal ideation; this is where a trained professional can take over. These conversations are both practice for the one disclosing and the one listening. The ability to tolerate challenging conversations is a relational muscle that strengthens over time. Be patient. Suicidal ideation is overwhelming to both people in the conversation, be open to the reality that a part of love is being able to sit with someone in their hurt. The hope is people learn to listen to understand before jumping to change minds. Understandably, there is a natural sense of urgency people feel when suicide enters the room. If disclosing elicits tears from the person you opened up to, you did nothing wrong, they are just processing.

Being a "good example"

In a technological era, within an individualistic society where we are at a distance, it's not surprising that we are accessing mental health services more due to the lack of community and close relationships. In my clinical experience, those who access a support system regularly find healing inner work more attainable. I've heard criticism that when public figures complete suicide, they are not being "a good example" and will influence youth who look up to them to imitiate behavior. Remember, someone in despair questioning their existence may find themselves removed from the idea that they are a role model. I believe this shows that we are all human and all hurt, and if our favorite celebrities address contemplation of suicide, then it's the acknowledgement that no one is exempt from suffering, it is the one thing we all connect on. Not all of us will know wealth, but we will all know pain. It concerns me when religious groups discourage people from seeking mental health services. Members of all religious groups complete suicide, and to instruct someone to pray away their problems and insinuate that their sadness shows a faith deficit is negligent, cruel, malicious, and blatant malpractice.

Dismantle the "strong-friend trope"

There are criticisms from those who manage depression in their lives. It is from the observation that when a celebrity dies, they see a flooding of "check on your strong friends" on their timelines. There is a feeling that mental health is primarily taken seriously in response to death. Still, society does not acknowledge the seriousness of it before it gets to that point. As a provider, I see both sides, that loss does create advocacy, while also highlighting an ongoing issue. Please check on ALL of your friends- the strong, quiet, shy, timid, outspoken, funny, etc. It has to be more than "checking in."

Mental wellness is not a box to check our due diligence can't be a situational "how are you, thinking about you" message. We are beyond check-ins. It comes down to taking a vested interest in each other's lives, following up consistently, and making the time we feel we don't have.

We also need to manage our expectations; unfortunately, good intentions can't save everyone. How often have we heard "I just saw them, we just talked, I didn't know what they were going through, if they had just talked to me, I feel like this is my fault..."Though we cannot guarantee that our presence and love will help someone in the fight for their life, it doesn't hurt to try. As a therapist, there is always a risk of losing a patient, while there is the possibility of saving a life. I recognize my limitations; all I can do is try.

*This blog is not intended to take the place of mental health services. Please reach out to 9-1-1 or 9-8-8 if you are experiencing a crisis or emergency.*