Resource "We have to reconceptualize suicide" - Craig Bryan

[Rounded Apathy]

Excerpts from an interesting article I happened upon from someone in the mental health field who actually seems to understand the complex nature of the problem of suicide - in fact, it is a "wicked problem" (meaning here one that is resistant to simple, conventional solutions)! I've just been lucky enough to be able to put a hold on the book at my local library so we'll see how that goes, but for now thought I'd share some kinda vindicating content from the interview.

I left out some of the middle parts that talk about impulsivity and increasing likelihood of surviving attempts/reducing access to firearms, as I feel that without the context of the whole interview (and even with), it's probably not what many people here are interested in. I've seen lots of us talk about how impulsive, transient-cause suicides are a damn shame, and I've selected for a focus on the more deeply-rooted issues.

Author Craig J. Bryan is trying to shake up our limited understanding. His "Rethinking Suicide: Why Prevention Fails, and How We Can Do Better" is a powerful, eye-opening examination of research shows about why suicide happens, and the actions that could prevent many of them. While traditional mental health support has an important place, for example, it's not enough. We need to be looking at circumstances and opportunity. Consider, for example, one of the most astonishing revelations of the book: "Whereas adolescents with a mental illness living in a household with a firearm are 3 times more likely to die by suicide, adolescents without a mental illness are 12 times more likely to die by suicide." Our presumptions about the warning signs are not enough. So what does work?

Salon spoke to Bryan, a clinical psychologist and the Stress, Trauma, and Resilience (STAR) Professor of Psychiatry and Behavioral Health at The Ohio State University Wexner Medical Center, about what we get wrong about suicide, and what we need to know to tackle one of our most pressing "wicked problems."

...

The term "wicked problem" was developed to really capture the notion that there are some types of problems that are highly complex and cannot be readily solved through traditional, solution-focused, linear thinking. A lot of the typical examples of wicked problems are these big societal problems. Right now that might be global warming, or poverty, or homelessness, where there really isn't a clear single solution. You really can't think about wicked problems in terms of solutions, especially in terms of right and wrong strategies. You have to think in terms of better or worse. Some strategies might be better than others, some strategies might be worse, but there's no right answer or single solution.

It's definitely the case with suicide. One of the arguments that I'm making in the book is that we tend to approach it from that solution focused angle, and the predominant solution that has been proposed and that's been adopted, definitely here in the U.S., arguably globally as well, is "mental health problems, mental health treatment." That if we could just get everybody into mental health, if we could identify them earlier, get them into treatment, then we could solve, theoretically, this problem of suicide.

That's not a terrible start, raising awareness of mental health and mental health treatment. But the problem, as you lay out, is that this is not always just a clearcut mental health issue. You talk about confirmation bias and you also talk about survival bias, and the fact that a lot of what we know about suicide comes from people who survive attempts.

On top of that, the people who survive attempts oftentimes are interviewed, they're surveyed, we collect data from them in clinical settings. They survive a suicide attempt so they come to the emergency department, receive medical care. They might be admitted to a psychiatric inpatient unit, they're referred for mental health treatment. So we largely have based our assumptions about suicide from this subgroup that is convenient for mental health researchers to access. The voices that we are missing, of course, are those who don't survive their first suicide attempt, those who don't come in for mental health treatment. They could potentially have a very different pathway towards suicide. Some of what I explore in the book is that the data would seem to suggest that's very probable that they are following a different course and we are largely missing them because their data, their information is totally invisible to us. In essence getting it wrong.

The thing that is extremely important, that is terrifying, but also maybe hopeful because it starts pointing us in the right direction, is how much of suicidality can be down to impulsivity.

What's interesting is over the past, maybe decade, if not less time, that notion of impulsivity has become fairly controversial among suicide researchers. There are many who I think have argued very effectively that suicide is not impulsive. Or maybe a better way of saying it is that impulsive people do not necessarily attempt suicide.

What it reflects on is this notion of what we even mean by impulsivity. Impulsivity is actually a pretty nonspecific term. We use it to refer to lots and lots of different things. There are good data saying that the whole notion of trait impulsivity as a characteristic of who you are as a person doesn't really seem to be strongly correlated with suicidal behaviors. Nonetheless, there is a large subgroup of people who attempt suicide very suddenly.

...

You talk about dialectical behavioral therapy and "the life worth living," which is a huge concept. Tell me what that is, and how that can head off suicidal behavior in a way that other types of treatment and other types of therapy don't necessarily do.

The status quo approach with suicide prevention is to prevent people from dying. So we put them in hospitals, we call the police, things like that. The whole idea is keep them alive. But what that fails to consider is that oftentimes to the suicidal person, life is unlivable. It's very painful, there's a lot of suffering. There may not be a lot of desire to continue living. So to many suicidal individuals, it's like you're just, prolonging my suffering by keeping me alive. I think being able to recognize that and then say, the alternative to dying is living, it's sort of a subtle shift. I like to say living because it really captures that it's a process. It takes lots of little things, not only for the person, but also the community around all of us, to impact the desire to live and to make living worthwhile.

How we treat each other, how we construct our environments and communities, how we think and how we behave, can help us to find purpose, to find meaning, to find even positive outcomes or positive situations even in our darkest moments. What we think is, at the neural level, when a person's making that decision, "Am I going to live, am I going to die?" if they can harness or tap into these positive emotional states, like having that sense of purpose and meaning, it hits as a braking system. It's like, just hang on. Hold on just a second. Don't act now. And it helps to get them through that urge.

My appreciation for this came with all the work that I did with suicidal individuals who said after our treatments, "I still get stressed out, I still have problems, I'm still depressed. But now I realize that there are good things in life. That people care about me." What they were telling us was that in that moment of despair, being able to hit the brakes and say, here are the positive things in my life, that was to them the most impactful and most useful parts of going through treatments like DBT or cognitive behavioral therapy.

It shifted my thinking because initially, myself and I think others, really see treatment as, we get rid of the bad stuff. We get rid of the hopelessness and the depression and the anxiety. But what seems to actually be making a difference is strengthening those positive things. Helping people to remember what is worth living form which for some people is reconnecting with reasons for living that you've lost or that you've forgotten about. But there are others for whom we create new meaning in life that didn't exist before.

I use with my patients a lot the notion of lost keys. Most people have lost their car keys at some point in their lives. I will ask my patient, "How did you find them?" They're like, "I retraced my steps, I went back to where I last had them, I asked other people to help me find them." The lesson that is really important is that when you lose your car keys, it's not that they cease to exist. It's just that you don't know where they're at. And there are these strategies we can employ to find them. Worst case scenario, maybe you never find those car again, but you can always get a locksmith to create a new lock and a new key set. That's in many ways what a part of the meaning-making process is all about, sometimes finding what you've lost, other times creating something new that maybe wasn't there before.

There's a show that I like on Hulu called "This Way Up," and there's a character who has survived a suicide attempt. In one episode, she says, "If I could helicopter back to myself that day that was so bad, I'd have felt like it was going to last 20 years. But actually it was just a day. I'd say to myself that while it might not even be the worst day yet, it's still just one of hundreds of days that might be great, and those are some really good odds. So keep going."

I think there are these expectations, because that whole notion comes up all the time in therapy. I have patients who say, "Every time something good happens in life, then it all falls apart." I'll be like, "Have you also noticed that every time things fall apart, they start to get better afterwards?" We'll draw it out on a board, like this up and down. When you're up there's probably going to be a down. But when you're down, there's probably going to be an up. Being able to take a step back and look at the bigger picture is often what we forget because we get locked into that tunnel vision and that moment of despair. Being able to hit the brakes, and take a step back and say, "It probably won't always be this way, although right now feels like it's never going to end."

To anyone who's going to read this book, what would you say is the biggest thing you really want us to understand about suicide so that we can help each other?

Suicide prevention is about the environments that we create. It's about quality of life. I think we've gone so far down the spectrum of focusing on individual problems. It's like a thing inside of us, or inside of people. We've got to find them and we've got to screen for them, and we've got to get rid of those bad things through treatment. That's hard to do. The reality is that there's a lot that we could be doing to create meaningful lives for all of us on a day-to-day basis. Some of which are related to political action. But some of which is just within our communities and how we treat each other. You know, treating each other with dignity and respect, expressing gratitude and appreciation, creating communities that foster hope and growth and positive emotional states, and surrounding ourselves with other people who model positive emotional states.

Those are the little things that we take for granted. I think sometimes they even seem kind of like cliché or almost pop psychology-esque. But if you really think about it in your own lives, how many times have we had a job that we were miserable at, or that was really stressful, but we loved the people that we worked with? That gives a great sort of example of how we can build community and support one another and create lives that are worth living. That goes beyond all of the traditional mental health approaches that right now I think have a major monopoly on suicide prevention.

 

[Forever Sleep]

I guess it's 'nice' that they care to want to try and make people's lives better.

I know it's just excerpts here but what I feel is missing- that I read over and over in threads is our perceived lack of meaning to everything. I think that's an especially difficult one to tackle- because no one knows the meaning of life and by the time you're depressed, I don't think- even if you felt like your life had purpose before- that it really applies anymore.

Yes, you can still have relatively 'better' days. Some things may even bring you joy but I believe depression tends to make you focus on the negatives- so it feels like everything overall is bad. If there's no point or value to any of it anyway- what does it even matter? The only reason it would matter is if you are committed to carry on living- in which case, it's a bandaid and a crutch to get you through. Sorry to be so negative. I think the other thing about 'negative' people is- many of us are terribly stubborn!

I personally believe that suicide is rarely rash or impulsive. The ACT of it may seem that way if the person showed little or no signs of being depressed. Still, I'm certain most people start off with ideation- sometimes years- even decades before.

 

[Rounded Apathy]

I guess it's 'nice' that they care to want to try and make people's lives better.

I know it's just excerpts here but what I feel is missing- that I read over and over in threads is our perceived lack of meaning to everything. I think that's an especially difficult one to tackle- because no one knows the meaning of life and by the time you're depressed, I don't think- even if you felt like your life had purpose before- that it really applies anymore.

Yes, you can still have relatively 'better' days. Some things may even bring you joy but I believe depression tends to make you focus on the negatives- so it feels like everything overall is bad. If there's no point or value to any of it anyway- what does it even matter? The only reason it would matter is if you are committed to carry on living- in which case, it's a bandaid and a crutch to get you through. Sorry to be so negative. I think the other thing about 'negative' people is- many of us are terribly stubborn!

I personally believe that suicide is rarely rash or impulsive. The ACT of it may seem that way if the person showed little or no signs of being depressed. Still, I'm certain most people start off with ideation- sometimes years- even decades before.

Did you...read the whole excerpt? He literally talks about meaning-making in these situations, especially in the context of community. If nothing else, I think your response pretty clearly indicates the truth of the take that this is indeed a "wicked problem". What seems to you as insufficient might be exactly what someone else needs in order to want to be alive. Or vice versa. Maybe medication is necessary, maybe not at all. Stubbornness/resistance to solutions is part of this picture, but what's the answer to that? IT'S WICKED!

Take a look at the rest of the article. It talks about some of the very things you note to be absent or lacking (rates of impulsive suicides [or at least attempts; very high], "invisible"warning signs, etc.). The whole point is that "suicide" can't be looked at as how we might view a math problem where there is one, or at best a very small number, of understood and structured ways to go about arriving at "the" solution. Consider the following from the Wiki, about the even better or more fitting idea of a "(social) mess":

1. No unique "correct" view of the problem;
2. Different views of the problem and contradictory solutions;
3. Most problems are connected to other problems;
4. Data are often uncertain or missing;
5. Multiple value conflicts;
6. Ideological and cultural constraints;
7. Political constraints;
8. Economic constraints;
9. Often a-logical or illogical or multi-valued thinking;
10. Numerous possible intervention points;
11. Consequences difficult to imagine;
12. Considerable uncertainty, ambiguity;
13. Great resistance to change; and,
14. Problem solver(s) out of contact with the problems and potential solutions.

What led me to this article was another on the same site about psychogenic death, posted by another here, which contained a very interesting bit about how people who have been despondent for a long time (for whatever reason) may begin to have problems with dopamine neurocircuitry. So already you have blow apart the idea of "medication" as a monolithic intervention - many first line depressants work with serotonin, which literally may not be involved at all in complex cases.

 

[akirat9]

I guess it's 'nice' that they care to want to try and make people's lives better.

and how are they doing that. because '
talking and pills are not going to do a anything thing. Especially for a disabled like me.
So what tangible actions are they doing to do so ? I figured none, but the same old same old

 

[Euthanza]

For me it's clear cut and bright that solution to suicide is euthanasia, with legal optional voluntary euthanasia then the problem of suicide can be minimized to lowest level. Suicide shouldn't be a problem at all if we accept it as an insider solution to all problems.

People might still see suicide bombers in the name of religions or school shooters (murder+suicide) but that's not part of euthanasia.

 

[lyles]

Thank you for sharing, definitely interested in more of a read! This is the sort of person I would feel comfortable divulging information of my suicidal tendencies with. I wonder what they would make after talking to the actively suicidal en masse. For as much as people talk about us, I find it rare they talk with us.

 

[Forever Sleep]

Did you...read the whole excerpt? He literally talks about meaning-making in these situations, especially in the context of community. If nothing else, I think your response pretty clearly indicates the truth of the take that this is indeed a "wicked problem". What seems to you as insufficient might be exactly what someone else needs in order to want to be alive. Or vice versa. Maybe medication is necessary, maybe not at all. Stubbornness/resistance to solutions is part of this picture, but what's the answer to that? IT'S WICKED!

Take a look at the rest of the article. It talks about some of the very things you note to be absent or lacking (rates of impulsive suicides [or at least attempts; very high], "invisible"warning signs, etc.). The whole point is that "suicide" can't be looked at as how we might view a math problem where there is one, or at best a very small number, of understood and structured ways to go about arriving at "the" solution. Consider the following from the Wiki, about the even better or more fitting idea of a "(social) mess":

1. No unique "correct" view of the problem;
2. Different views of the problem and contradictory solutions;
3. Most problems are connected to other problems;
4. Data are often uncertain or missing;
5. Multiple value conflicts;
6. Ideological and cultural constraints;
7. Political constraints;
8. Economic constraints;
9. Often a-logical or illogical or multi-valued thinking;
10. Numerous possible intervention points;
11. Consequences difficult to imagine;
12. Considerable uncertainty, ambiguity;
13. Great resistance to change; and,
14. Problem solver(s) out of contact with the problems and potential solutions.

What led me to this article was another on the same site about psychogenic death, posted by another here, which contained a very interesting bit about how people who have been despondent for a long time (for whatever reason) may begin to have problems with dopamine neurocircuitry. So already you have blow apart the idea of "medication" as a monolithic intervention - many first line depressants work with serotonin, which literally may not be involved at all in complex cases.

If I'm honest, I probably only scanned through the article. I'm probably too biased against suicide prevention to give it a real chance in my mind.

I guess I'm just not interested in being 'helped' so I suppose I assume a lot of people would feel the same way. I suppose the brutal truth is I don't see suicide as a 'problem'. I believe it is a choice we should all be entitled to.

While I admire the sentiment in the article- community support etc, I'm not sure how you make everyone start being nice to one another. I'm not convinced that raising awareness will do it. There will always be bullies, narcissists, abusive and neglectful parents that shouldn't have had children to begin with. I can't see businesses and individuals ever stop exploiting the 'weaker.' Plus, there's physical and mental illness.

Personally, I believe there will always be suicidal people and I imagine suicides will only increase. Maybe 'treatments' will get better as people like this make more effort to understand the suicidal mind.

I suppose it's a bit like the charities with the word 'prevention' in. NSPCC, RSPCA. While I'm not criticising the vital work they do, I see their roles as picking up the pieces after the atrocity has occurred. I doubt either organisation gets to 'prevent' a lot of cruelty (although perhaps it prevents future cruelty from that individual).

Similarly, I don't think you can stamp out all suicidal ideation- without turning the world into a paradise where everyone treats one another with love and respect and no one is born with, or develops a physical or mental impairment that seriously impedes enjoying life to begin with. Still, it is the right thing to try I guess- or at least to be more aware of the early warning signs and offer that individual support.

I suppose I just wonder how many people here feel like they can be 'saved' by any of these methods... and whether they want to be in the first place. Many people here have already gone through several rounds of treatment- both therapy and medication, yet they're still at this point. Perhaps it is because our current treatments aren't suitable. Maybe this is the answer.

The honest and selfish truth is- I can't wait to be shot of this world and I'm just glad I haven't brought a life into it to navigate through all this crap. I guess I just don't have enough investment in the future to genuinely care what happens. I know that's selfish but that's the truth. I'm too tired of it all to care myself but I do admire people like this who clearly want to help and make the world a better place.

 

[Rounded Apathy]

Thank you for sharing, definitely interested in more of a read! This is the sort of person I would feel comfortable divulging information of my suicidal tendencies with. I wonder what they would make after talking to the actively suicidal en masse. For as much as people talk about us, I find it rare they talk with us.

Glad it did something for you. Being a clinical psychologist, I'm pretty sure the author has already talked to the suicidal en masse; I don't think that's a passive profession.

If I'm honest, I probably only scanned through the article. I'm probably too biased against suicide prevention to give it a real chance in my mind.

I guess I'm just not interested in being 'helped' so I suppose I assume a lot of people would feel the same way. I suppose the brutal truth is I don't see suicide as a 'problem'. I believe it is a choice we should all be entitled to.

While I admire the sentiment in the article- community support etc, I'm not sure how you make everyone start being nice to one another. I'm not convinced that raising awareness will do it. There will always be bullies, narcissists, abusive and neglectful parents that shouldn't have had children to begin with. I can't see businesses and individuals ever stop exploiting the 'weaker.' Plus, there's physical and mental illness.

Personally, I believe there will always be suicidal people and I imagine suicides will only increase. Maybe 'treatments' will get better as people like this make more effort to understand the suicidal mind.

I suppose it's a bit like the charities with the word 'prevention' in. NSPCC, RSPCA. While I'm not criticising the vital work they do, I see their roles as picking up the pieces after the atrocity has occurred. I doubt either organisation gets to 'prevent' a lot of cruelty (although perhaps it prevents future cruelty from that individual).

Similarly, I don't think you can stamp out all suicidal ideation- without turning the world into a paradise where everyone treats one another with love and respect and no one is born with, or develops a physical or mental impairment that seriously impedes enjoying life to begin with. Still, it is the right thing to try I guess- or at least to be more aware of the early warning signs and offer that individual support.

I suppose I just wonder how many people here feel like they can be 'saved' by any of these methods... and whether they want to be in the first place. Many people here have already gone through several rounds of treatment- both therapy and medication, yet they're still at this point. Perhaps it is because our current treatments aren't suitable. Maybe this is the answer.

The honest and selfish truth is- I can't wait to be shot of this world and I'm just glad I haven't brought a life into it to navigate through all this crap. I guess I just don't have enough investment in the future to genuinely care what happens. I know that's selfish but that's the truth. I'm too tired of it all to care myself but I do admire people like this who clearly want to help and make the world a better place.

I doubt seriously that the article, or the even book most likely (though we'll see when I get my copy), was written for an audience of suicidal people or even people in general. It seems to be for clinicians, and that is relevant. They're the ones people in our boat end up often dealing with as a first line option, in a psych ward after a failed attempts, in media depictions, whatever - and it's evident that the current paradigm doesn't work. This guy seems to be focusing on that and advocating for change on that reasoning, and offering some visions of alternatives. Obviously he isn't going to magically make human society some kind of fantastical utopia even in so doing but just pointing to the fact that suicide is so commonly not an individual's isolated and personal problem is extremely relevant.

Just look at how the medical system is set up - most of the time you go to some building and talk to some person for a while, they may do some tests, procedures, whatever, then send you on your way with some instructions and/or drugs. No one comes to check up on you. No one helps you do things that might become a challenge. The awful individualistic consumer-capitalist societies many of us live in make it hard, but this is abso-fucking-lutely not normal and a fairly recent phenomenon. Not many generations ago would a family/town doctor be someone you could ring up at any hour and would come to you to tend to you. In many unindustrialized parts of the world healthcare is still a very social and community interaction/relationship.

I don't know what you mean exactly when you say that you don't see suicide as a problem - I and a lot of others here certainly do; most of us don't want to die, and we want even less to kill ourselves; what we want is a life that feels worth living, something we have either known before and has been taken, or never have and have given up hope. I sure as shit would like to be helped and I'd venture to say I am not alone; if at the end of the day it turns out I still don't want to be alive cause things are/have gotten/end up being too bad, then yes, I want the freedom to choose a peaceful and supported exit - if that's not possible, I would consider that a problem, but I think people offing themselves before all realistic or theoretically possible but practically inaccessible methods have been exhausted is the problem the author is trying to address.

 

[Forever Sleep]

Yes, I agree- I'm sure the book is aimed at people in that proffession in the hopes of reforming it. I'm sorry to have sounded so cynical about it. It is a good thing that people are looking into the wide spectrum of reasons why people become suicidal.

I guess my frustration comes from the fact that it won't stop people becoming that way in the first place. Like you said- society is unlikely to change. Perhaps a book like this will make therapists more sensitive to a wider range of causes but I'd kind of hope someone in that position would be sensitive to whatever problem you presented them with anyhow.

Not to say the book is useless or pointless by any means. I guess I'm just doubtful as to how revolutionary it CAN be given the financial restraints on the health service (in the UK at least but likely elsewhere too.) I've read that 1 in 4 people develop a mental illness at one point in their lives (including depression). I simpy don't believe there will ever be the resources to monitor and support this amount of people in the hopes they never get to the stage where they want to take their own lives.

So true about the medical proffession at large. Even in my lifetime, I can remember a doctor who seemed to know, check up upon and deeply care about his patients. I'd like to hope that it isn't because doctors today don't care but because their workload is just too much to cope with- so they simply don't have the time for that level of treatment. We've become a very 'processed' society I think.

I honestly admire your interest in this. It shows a deep concern for others and the future of mental health treatment. In truth, my 'problem' is I'm so negative and cynical. This thread has been interesting because it's made me think whether any earlier treatment may have stopped me reaching this point. I really don't know to be honest. I've wanted to kill myself since I was 10.

Can I ask- have you reached out for help? What are your experiences of therapy or medication? Did they help? I am genuinely curious as to what intervention you think may have stopped you on this path.

 

[Rounded Apathy]

Yes, I agree- I'm sure the book is aimed at people in that proffession in the hopes of reforming it. I'm sorry to have sounded so cynical about it. It is a good thing that people are looking into the wide spectrum of reasons why people become suicidal.

I guess my frustration comes from the fact that it won't stop people becoming that way in the first place. Like you said- society is unlikely to change. Perhaps a book like this will make therapists more sensitive to a wider range of causes but I'd kind of hope someone in that position would be sensitive to whatever problem you presented them with anyhow.

Not to say the book is useless or pointless by any means. I guess I'm just doubtful as to how revolutionary it CAN be given the financial restraints on the health service (in the UK at least but likely elsewhere too.) I've read that 1 in 4 people develop a mental illness at one point in their lives (including depression). I simpy don't believe there will ever be the resources to monitor and support this amount of people in the hopes they never get to the stage where they want to take their own lives.

So true about the medical proffession at large. Even in my lifetime, I can remember a doctor who seemed to know, check up upon and deeply care about his patients. I'd like to hope that it isn't because doctors today don't care but because their workload is just too much to cope with- so they simply don't have the time for that level of treatment. We've become a very 'processed' society I think.

I honestly admire your interest in this. It shows a deep concern for others and the future of mental health treatment. In truth, my 'problem' is I'm so negative and cynical. This thread has been interesting because it's made me think whether any earlier treatment may have stopped me reaching this point. I really don't know to be honest. I've wanted to kill myself since I was 10.

Can I ask- have you reached out for help? What are your experiences of therapy or medication? Did they help? I am genuinely curious as to what intervention you think may have stopped you on this path.

I forgot to write this explicitly in my last response, but I agree that the complete annihilation of suicidal ideation is impossible. It's been around far longer than we've had broken systems of addressing it, but as you also indicate, just leaving it be seems ridiculous given that there are any suicides that weren't the process of long-thought-out or deeply rooted problems. Saying we shouldn't try to prevent any suicides because there will still be some that can't be prevented is a pretty poor argument for doing nothing. Someone killing themselves because they've had a nagging feeling to do so for a week is tragic on its face; it's a different story for someone to do so after living an extended period of time with unrelenting, unbearable, and incurable physical or mental anguish.

I haven't tried any medications and have only had a few briefer stints of therapy, each a slightly different experience. But already the multi-faceted nature of this problem appears; I would like to access both at present but for one I don't have the finances/the current model of therapy is, as we've already seen, broken - second, in this country most specialists require a referral which takes an eternally long time. I spoke to my GP about psychiatric support in late spring and am still waiting just to hear from anyone to schedule an appointment, let alone actually have it. Same goes for those in physical medicine, which is actually the major component of why I am where I am mentally. Despite being in a big, cold, stupid city I hate for over a year mainly to have easier access to facilities, help has been excruciating slow to come while things with me continue to degrade. I can't do anything about this.

All of this ties into the fact, we seem to agree on, that the medical institution at large is fucked. If I had all the kind and caring support I needed and it was still the case that nothing could be done, well, at least I'd know as opposed to sitting in lonely silence waiting, with things possibly getting worse, to the point that when/if I finally/ever am seen it'll have to be a way worse course of action by that point. There are indeed far too many cases for too few practitioners, but people now legitimately get into medicine only for money and/or prestige and that is fucked up to the umpteenth level. Human lives are directly in their hands. This isn't some fucking game. Doctors make an obscene amount of money while people like nurses toil away in obscurity for nothing. The more patients a doc goes through, the more cash they come to. Again, disgusting capitalist bullshit.

Not sure I totally responded to the salient points; hard not to ramble about things like this. Hopefully I did

 

[Forever Sleep]

I forgot to write this explicitly in my last response, but I agree that the complete annihilation of suicidal ideation is impossible. It's been around far longer than we've had broken systems of addressing it, but as you also indicate, just leaving it be seems ridiculous given that there are any suicides that weren't the process of long-thought-out or deeply rooted problems. Saying we shouldn't try to prevent any suicides because there will still be some that can't be prevented is a pretty poor argument for doing nothing. Someone killing themselves because they've had a nagging feeling to do so for a week is tragic on its face; it's a different story for someone to do so after living an extended period of time with unrelenting, unbearable, and incurable physical or mental anguish.

I haven't tried any medications and have only had a few briefer stints of therapy, each a slightly different experience. But already the multi-faceted nature of this problem appears; I would like to access both at present but for one I don't have the finances/the current model of therapy is, as we've already seen, broken - second, in this country most specialists require a referral which takes an eternally long time. I spoke to my GP about psychiatric support in late spring and am still waiting just to hear from anyone to schedule an appointment, let alone actually have it. Same goes for those in physical medicine, which is actually the major component of why I am where I am mentally. Despite being in a big, cold, stupid city I hate for over a year mainly to have easier access to facilities, help has been excruciating slow to come while things with me continue to degrade. I can't do anything about this.

All of this ties into the fact, we seem to agree on, that the medical institution at large is fucked. If I had all the kind and caring support I needed and it was still the case that nothing could be done, well, at least I'd know as opposed to sitting in lonely silence waiting, with things possibly getting worse, to the point that when/if I finally/ever am seen it'll have to be a way worse course of action by that point. There are indeed far too many cases for too few practitioners, but people now legitimately get into medicine only for money and/or prestige and that is fucked up to the umpteenth level. Human lives are directly in their hands. This isn't some fucking game. Doctors make an obscene amount of money while people like nurses toil away in obscurity for nothing. The more patients a doc goes through, the more cash they come to. Again, disgusting capitalist bullshit.

Not sure I totally responded to the salient points; hard not to ramble about things like this. Hopefully I did

That's really awful- that you're still waiting for an appointment. Especially when one of the first things people say after a CTB attempt is- 'Why didn't they reach out?' Makes you wonder just how many people DO reach out and are either ignored or put on hold somewhere in the system.

Do you HAVE to be referred by your GP? Are there no independent therapists in your area? I guess they probably charge even more though.

I'm so sorry for your situation. I know I couldn't handle physical pain on top of everything else. I hope you get some assistance soon.

 

[Rounded Apathy]

That's really awful- that you're still waiting for an appointment. Especially when one of the first things people say after a CTB attempt is- 'Why didn't they reach out?' Makes you wonder just how many people DO reach out and are either ignored or put on hold somewhere in the system.

Do you HAVE to be referred by your GP? Are there no independent therapists in your area? I guess they probably charge even more though.

I'm so sorry for your situation. I know I couldn't handle physical pain on top of everything else. I hope you get some assistance soon.

Thanks for the kindness. The worst part is physically there isn't much pain the majority of the time. I've written about it in detail in other posts/on my profile but basically structural/functional shit getting worse over time, having recently ramped up and causing more discomfort - the kinds of things that might theoretically be easier to treat in their early stages, and are just being left to worsen due to the shite medical system. Being in this situation and feeling abandoned (and socially isolated with nothing else to engage me) have been ruining my mind.

I mean I feel fucking worse for all those cancer patients that have just been in limbo during covid, it's all such a joke. The system was never great but we've had a fuckface conservative politician running the province and gutting everything related to public good for a ridiculous number of years now; one such thing being healthcare, literally capping nurses' pay, removing hospital funding, all so their party can try and weasel in a privatized system once the existing one has become "overburdened". I wish the premier would fucking die.

Anyway that was quite the tangent, haha sorry. I live in the nation's biggest city so there are plenty of independent therapists, but yes as you say the costs can be insanely prohibitive. Like well over a hundred dollars for a single hour session, unless you wanna go with a student who may well be too inexperienced to give good help (or maybe they have yet to become fully jaded?). Plus only psychiatrists can prescribe medication (not that I necessarily want any given the horror stories here), and they are referral only.

And on your point about people actually trying to get help and being left out to dry - absolutely. I made two poll posts some time ago and in one, a third of responders felt their issues were theoretically solvable but they lacked the means to bring the change about. In another, over half would have chosen their reasons to ctb being removed from life (as long as physical/natural laws were obeyed) over a death of their complete choosing within a years time (same restrictions). The cruelty and shittiness of society and its constructs definitely contribute to the epidemic of suicide.

 

[LaVieEnRose]

I read a book about chronic suicidality written by a prominent psychiatrist. I wanted to gain some insight into why I felt the way I do (I didn't really learn anything novel). The book's intended audience was clinicians and not patients like me as its purpose was to try to educate them about chronic suicidality, which conventional people are not going to relate to. That was pretty clear when he wrote things like it takes a lot of imagination to understand people in constant emotional distress (not for me it doesn't!). The most noteworthy parts of the book was when he said that some people are just not cut out for adult life in society and that life doesn't always give second chances and some people are condemned to be on welfare their whole lives. He doesn't qualify these statements at all, so the obvious implication that follows is essentially that these people are screwed. I suppose there's no way to have decades of experience and not draw these conclusions. He says at one point that an imperfect life is better than no life. Of course, there are many ways a life can be "imperfect". Not being so rich you can buy whatever you want without a second thought could be considered an imperfection. So is being in daily agony.

Overall, I'm a bit tired of normie doctors teling me how to view life.

 

[Rounded Apathy]

Heads up to @lyles, @Forever Sleep and @LaVieEnRose - picked up the book today and just starting. It's already obvious that it's written for people in the practitioner's world, but we'll see what comes of it, if anything. Some hopeful points made in the intro which will each have chapters devoted to them include: stating and recognizing that suicide is not strictly a symptom of mental illness; the ineptitude of current healthcare models in dealing with suicide; and minimizing detrimental/maximizing beneficial conditions for quality of life in general. If nothing else the book might be good reading to throw at your own therapist if you have one. Cautiously optimistic...

 

[lyles]

Heads up to @lyles, @Forever Sleep and @LaVieEnRose - picked up the book today and just starting. It's already obvious that it's written for people in the practitioner's world, but we'll see what comes of it, if anything. Some hopeful points made in the intro which will each have chapters devoted to them include: stating and recognizing that suicide is not strictly a symptom of mental illness; the ineptitude of current healthcare models in dealing with suicide; and minimizing detrimental/maximizing beneficial conditions for quality of life in general. If nothing else the book might be good reading to throw at your own therapist if you have one. Cautiously optimistic...

Thank you so much for the update!

I like to think that there are more professionals in the mental health field who do conceptualize (perhaps even a few who could agree with) the sentiments many of us share. Even if it is directed towards practitioners, if you find that the concepts and verbalization of them are worthwhile I will definitely pick it up.

 

[Rounded Apathy]

Thank you so much for the update!

I like to think that there are more professionals in the mental health field who do conceptualize (perhaps even a few who could agree with) the sentiments many of us share. Even if it is directed towards practitioners, if you find that the concepts and verbalization of them are worthwhile I will definitely pick it up.

About a quarter way through (just shy of 200pp total). Note the book is written by an American, and most of the data and situation is reflective of that; the rising rate of suicide in the last several decades despite exponential increases and awareness of mental health issues and resources (and why the correlation is/isn't relevant).

Some interesting stuff so far:

• cases of people he'd seen who attempted suicide with absolutely no known history of mental illness, previously or concurrently,
  • his own and the profession's knee-jerk reaction to simply label such cases as mental illness due to the pathologization of suicidality, often diagnosing something called "adjustment disorder" (which apparently isn't supported by about half of practitioners),
• the unfounded "90% statistic" (new to me); something apparently deeply entrenched in the field which states roughly that percentage of suicides are concomitant with, or a result of mental illness
  • how this is bogus due to the diffusion of one single meta-analysis, which most cited studies that used "psychological autopsy" - a process of retroactively diagnosing a mental illness based on investigating evidence and people after someone has died, which is plagued with confirmation bias

And this nice little sentence at the end of chapter 2: "although mental illness probably influences the emergence of suicidal behaviour, this does not mean that it is necessarily causing suicidal behaviour". Let that one sink in, folks...someone in the field actually saying you can be mentally unwell, and suicidal, and they can be unrelated.

 

[Rounded Apathy]

Second update for @lyles, @Forever Sleep, and anyone else potentially following; just finished chapter 3. I do not expect this one to be of much interest to those like us, haha. Quite statistical and research-oriented, mainly discussing topics like why suicide risk screening is only an iota away from being completely useless - important and interesting, but much more so for clinicians and practitioners, and while the tone and language weren't overwhelming, if I didn't have some background with this kind of content I'm not sure how accessible it'd be, especially for any with cognitive issues.

Chapter four looks like it may be more of the same, or similar, sadly. The good shit seems to all be at the end...but I'll scan if necessary. Also taking actual scans of pages every now and again that have good points or passages. Could share these if anyone's interest once done. A kind of selective preview, if you will.

 

[lyles]

Second update for @lyles, @Forever Sleep, and anyone else potentially following; just finished chapter 3. I do not expect this one to be of much interest to those like us, haha. Quite statistical and research-oriented, mainly discussing topics like why suicide risk screening is only an iota away from being completely useless - important and interesting, but much more so for clinicians and practitioners, and while the tone and language weren't overwhelming, if I didn't have some background with this kind of content I'm not sure how accessible it'd be, especially for any with cognitive issues.

Chapter four looks like it may be more of the same, or similar, sadly. The good shit seems to all be at the end...but I'll scan if necessary. Also taking actual scans of pages every now and again that have good points or passages. Could share these if anyone's interest once done. A kind of selective preview, if you will.

Thank you for the update!! Even if it is data-centric, I still find that valuable. As philosophical as suicide and our situations may be, having a more analytical list of evidence to provide has its own merit, as you mention. My mother is a psychologist, so even if I run into roadblocks with it I am certain I can either borrow some of her literature or pick her brain over it. Thank you for putting so much effort into looking into it, if you are able to scan pages it would be much appreciated! Obviously, you are under no obligation.

 

[LastFlowers]

Did you...read the whole excerpt? He literally talks about meaning-making in these situations, especially in the context of community. If nothing else, I think your response pretty clearly indicates the truth of the take that this is indeed a "wicked problem". What seems to you as insufficient might be exactly what someone else needs in order to want to be alive. Or vice versa. Maybe medication is necessary, maybe not at all. Stubbornness/resistance to solutions is part of this picture, but what's the answer to that? IT'S WICKED!

Take a look at the rest of the article. It talks about some of the very things you note to be absent or lacking (rates of impulsive suicides [or at least attempts; very high], "invisible"warning signs, etc.). The whole point is that "suicide" can't be looked at as how we might view a math problem where there is one, or at best a very small number, of understood and structured ways to go about arriving at "the" solution. Consider the following from the Wiki, about the even better or more fitting idea of a "(social) mess":

1. No unique "correct" view of the problem;
2. Different views of the problem and contradictory solutions;
3. Most problems are connected to other problems;
4. Data are often uncertain or missing;
5. Multiple value conflicts;
6. Ideological and cultural constraints;
7. Political constraints;
8. Economic constraints;
9. Often a-logical or illogical or multi-valued thinking;
10. Numerous possible intervention points;
11. Consequences difficult to imagine;
12. Considerable uncertainty, ambiguity;
13. Great resistance to change; and,
14. Problem solver(s) out of contact with the problems and potential solutions.

What led me to this article was another on the same site about psychogenic death, posted by another here, which contained a very interesting bit about how people who have been despondent for a long time (for whatever reason) may begin to have problems with dopamine neurocircuitry. So already you have blow apart the idea of "medication" as a monolithic intervention - many first line depressants work with serotonin, which literally may not be involved at all in complex cases.

(This is only addressing one aspect of the equation but..)
Why would anyone be resistant to actual solutions?
..Unless they weren't actual solutions.

I don't mean this in the context of preventing suicide (not the point that should be paused on imo) but regarding solutions to the reasons as to why we suffer in the first place.

Sometimes people define what solutions are to other peoples' problems, the same way they do with the word "help"…then they blame the sufferer for denying "help" or "solutions" but that's usually because what's being offered is NOT a bona fide fix to the core issue.

I don't understand why so many people want to stop suicide, when suicide is not the problem.
The problem is what leads to it.
Nobody should be wasting effort and resources on preventing an end to suffering unless by way of proposing yet another valid avenue of ending said suffering.

If the reasons why we suffer cannot be prevented then no one has a right to prevent suicide..certainly not beyond suggesting a time period of thoughtfulness in order to prevent pure impulse from taking over in specific cases.

I read a book about chronic suicidality written by a prominent psychiatrist. I wanted to gain some insight into why I felt the way I do (I didn't really learn anything novel). The book's intended audience was clinicians and not patients like me as its purpose was to try to educate them about chronic suicidality, which conventional people are not going to relate to. That was pretty clear when he wrote things like it takes a lot of imagination to understand people in constant emotional distress (not for me it doesn't!). The most noteworthy parts of the book was when he said that some people are just not cut out for adult life in society and that life doesn't always give second chances and some people are condemned to be on welfare their whole lives. He doesn't qualify these statements at all, so the obvious implication that follows is essentially that these people are screwed. I suppose there's no way to have decades of experience and not draw these conclusions. He says at one point that an imperfect life is better than no life. Of course, there are many ways a life can be "imperfect". Not being so rich you can buy whatever you want without a second thought could be considered an imperfection. So is being in daily agony.

Overall, I'm a bit tired of normie doctors teling me how to view life.

That's part of the same problem I mentioned above, people defining things any which way they please..then projecting that onto others, whose lives they do not have to live.
Give those same people authority and power over those who have neither and it's a recipe for disaster.

Even the word "imperfect", as you correctly pointed out, could be defined to different extremes..or no extreme at all.
It's a wide spectrum, so therefore rather insulting of him to suggest any form of imperfection is preferable to no life at all.
I vehemently beg to fucking differ.

Sounds like he's got some contradictory thought processes of his own.

 

[avoid_slow_death]

I actually appreciate the concepts put forth by this particular article. It won't help everyone seeing as how everyone's circumstances are varied and unique, but not only can the concepts help a good number of people, but they actually promote societal concepts that could not only change the view and discussion around suicidality, but other facets of societal interplay as well.

There's just one problem. To realize this concept would ultimately require a radical shift in our ways of thinking and interacting with one another. This will require a great deal of work and sacrifice from ALL of us. That, sadly, is very unlikely to happen, so, instead we have the current system. It's like a curtain to hide away an ugly truth to satisfy a selfish and lazy impulse rather than to treat the symptom and be a communal and enlightened species that made us the apex of currently know evolution. We see examples of how it could be here and there. Glimpses. Fleeting, but present. Maybe one day we can. Maybe. Just not anytime soon that I can see.

 

[LastFlowers]

If I'm honest, I probably only scanned through the article. I'm probably too biased against suicide prevention to give it a real chance in my mind.

I guess I'm just not interested in being 'helped' so I suppose I assume a lot of people would feel the same way. I suppose the brutal truth is I don't see suicide as a 'problem'. I believe it is a choice we should all be entitled to.

While I admire the sentiment in the article- community support etc, I'm not sure how you make everyone start being nice to one another. I'm not convinced that raising awareness will do it. There will always be bullies, narcissists, abusive and neglectful parents that shouldn't have had children to begin with. I can't see businesses and individuals ever stop exploiting the 'weaker.' Plus, there's physical and mental illness.

Personally, I believe there will always be suicidal people and I imagine suicides will only increase. Maybe 'treatments' will get better as people like this make more effort to understand the suicidal mind.

I suppose it's a bit like the charities with the word 'prevention' in. NSPCC, RSPCA. While I'm not criticising the vital work they do, I see their roles as picking up the pieces after the atrocity has occurred. I doubt either organisation gets to 'prevent' a lot of cruelty (although perhaps it prevents future cruelty from that individual).

Similarly, I don't think you can stamp out all suicidal ideation- without turning the world into a paradise where everyone treats one another with love and respect and no one is born with, or develops a physical or mental impairment that seriously impedes enjoying life to begin with. Still, it is the right thing to try I guess- or at least to be more aware of the early warning signs and offer that individual support.

I suppose I just wonder how many people here feel like they can be 'saved' by any of these methods... and whether they want to be in the first place. Many people here have already gone through several rounds of treatment- both therapy and medication, yet they're still at this point. Perhaps it is because our current treatments aren't suitable. Maybe this is the answer.

The honest and selfish truth is- I can't wait to be shot of this world and I'm just glad I haven't brought a life into it to navigate through all this crap. I guess I just don't have enough investment in the future to genuinely care what happens. I know that's selfish but that's the truth. I'm too tired of it all to care myself but I do admire people like this who clearly want to help and make the world a better place.

We're on the same page, I agree with pretty much everything you've had to say.
I just don't think these people who supposedly want to "make the world a better place" are admirable nor really in it to do just that, there is always some egotistical bias or selfish reasoning involved…otherwise they wouldn't continue to produce & sacrifice so many lives in order to reach this prophetic paradise/utopia.
No vision or heaven on earth will ever justify the hell so many people have already been put through..and will continue to be put through, just so others can attempt to "live the dream".

Besides, not unlike what you suggested..there is no one type of world that suits every being.
Though some wants and needs we humans all pretty much indisputably desire to have met..when it comes down to the details, one person's dream is another person's nightmare..one person's heaven is another person's hell.
Always, so long as there's more than one of us in existence.

I'm not saying we shouldn't try to make things better for those who are already here, but that was true during the dawn of mankind..and we just kept the shit going..like playing the lottery, spinning the wheel..torturing so many people just so that a select few could/can live some type of life they consider "worth it".
I find the whole deal to be disgusting, quite frankly.

For example: torturous experiments done on some humans in order to help other humans..
wtf kind of bullshit level logic is that?
Life itself is a testament to this…this gamble, this utilitarian crapshoot…this trampling upon corpses to reach some mirage of an end point.
I am not even of the "sacrifice the few for the many" persuasion, but even that doesn't describe what's going on here.
It's actually the inverse.
And either way, I've had just about enough of it.
It's a fucked up value system where we are supposed to believe that some future generation is more deserving of pleasure and the absence of suffering than we are (or those before us)…and that we should all work ourselves to the bone to create what many of us will never have a chance to take part in.
Absolutely bizarre.
Like being asked to parent a superior race by way of laying down our bodies as stones in the foundation of their everlasting, ethereal tomorrow.

No fucking thank you.
It's delusional wishful thinking anyhow.

 

[Rounded Apathy]

I actually appreciate the concepts put forth by this particular article. It won't help everyone seeing as how everyone's circumstances are varied and unique, but not only can the concepts help a good number of people, but they actually promote societal concepts that could not only change the view and discussion around suicidality, but other facets of societal interplay as well.

There's just one problem. To realize this concept would ultimately require a radical shift in our ways of thinking and interacting with one another. This will require a great deal of work and sacrifice from ALL of us. That, sadly, is very unlikely to happen, so, instead we have the current system. It's like a curtain to hide away an ugly truth to satisfy a selfish and lazy impulse rather than to treat the symptom and be a communal and enlightened species that made us the apex of currently know evolution. We see examples of how it could be here and there. Glimpses. Fleeting, but present. Maybe one day we can. Maybe. Just not anytime soon that I can see.

I agree, and no radical and/or relevant change for the better was ever accomplished in a short time. Thank you for providing this measured and balanced take on the content and topic I've introduced here. More than can be said for the following...

We're on the same page, I agree with pretty much everything you've had to say.
I just don't think these people who supposedly want to "make the world a better place" are admirable nor really in it to do just that, there is always some egotistical bias or selfish reasoning involved…otherwise they wouldn't continue to produce & sacrifice so many lives in order to reach this prophetic paradise/utopia.
No vision or heaven on earth will ever justify the hell so many people have already been put through..and will continue to be put through, just so others can attempt to "live the dream".

Besides, not unlike what you suggested..there is no one type of world that suits every being.
Though some wants and needs we humans all pretty much indisputably desire to have met..when it comes down to the details, one person's dream is another person's nightmare..one person's heaven is another person's hell.
Always, so long as there's more than one of us in existence.

I'm not saying we shouldn't try to make things better for those who are already here, but that was true during the dawn of mankind..and we just kept the shit going..like playing the lottery, spinning the wheel..torturing so many people just so that a select few could/can live some type of life they consider "worth it".
I find the whole deal to be disgusting, quite frankly.

For example: torturous experiments done on some humans in order to help other humans..
wtf kind of bullshit level logic is that?
Life itself is a testament to this…this gamble, this utilitarian crapshoot…this trampling upon corpses to reach some mirage of an end point.
I am not even of the "sacrifice the few for the many" persuasion, but even that doesn't describe what's going on here.
It's actually the inverse.
And either way, I've had just about enough of it.
It's a fucked up value system where we are supposed to believe that some future generation is more deserving of pleasure and the absence of suffering than we are (or those before us)…and that we should all work ourselves to the bone to create what many of us will never have a chance to take part in.
Absolutely bizarre.
Like being asked to parent a superior race by way of laying down our bodies as stones in the foundation of their everlasting, ethereal tomorrow.

No fucking thank you.
It's delusional wishful thinking anyhow.

(This is only addressing one aspect of the equation but..)
Why would anyone be resistant to actual solutions?
..Unless they weren't actual solutions.

I don't mean this in the context of preventing suicide (not the point that should be paused on imo) but regarding solutions to the reasons as to why we suffer in the first place.

Sometimes people define what solutions are to other peoples' problems, the same way they do with the word "help"…then they blame the sufferer for denying "help" or "solutions" but that's usually because what's being offered is NOT a bona fide fix to the core issue.

I don't understand why so many people want to stop suicide, when suicide is not the problem.
The problem is what leads to it.
Nobody should be wasting effort and resources on preventing an end to suffering unless by way of proposing yet another valid avenue of ending said suffering.

If the reasons why we suffer cannot be prevented then no one has a right to prevent suicide..certainly not beyond suggesting a time period of thoughtfulness in order to prevent pure impulse from taking over in specific cases.

That's part of the same problem I mentioned above, people defining things any which way they please..then projecting that onto others, whose lives they do not have to live.
Give those same people authority and power over those who have neither and it's a recipe for disaster.

Even the word "imperfect", as you correctly pointed out, could be defined to different extremes..or no extreme at all.
It's a wide spectrum, so therefore rather insulting of him to suggest any form of imperfection is preferable to no life at all.
I vehemently beg to fucking differ.

Sounds like he's got some contradictory thought processes of his own.

First off, I would appreciate if you didn't derail this thread with the kind of overreaching life-denying proselytizing that has tons of other places for outlets on this forum. Yes I posted this in suicide discussion but there's a rather specific subject, and respectfully request comments stay on it.

The more time I spend on this site, the more I realise so many people here are just as delusional as the so-called "pro-life" camp. I see more and more black-and-white-binary rhetoric like this; shit like "I'm miserable and believe the world is bad, therefore anyone disagreeing must be screwed in the head!", "if you can't eliminate all suffering then it's pointless to try and eliminate any at all", or "suicide is not a problem".

Working backwards: people here should know better than anyone else that suicide is not a uniform issue. A case of someone who successfully kills themselves after a decade of insidious physical and/or mental decline, after thorough deliberation and attempts at recovery, is absolutely not the fucking same as a heartbroken teenager who has never thought about, much less wanted suicide, who just happens to have access to a gun during a moment of intense emotional distress. The fact that suicides like the latter happen, representing those that, given simple, minor, respectful and meaningful intervention wouldn't have, absolutely is a problem and I will die on this fucking hill. Another problem is that just like "normies", tons of people here seem to equate these two kinds of suicide as one and the same. They aren't - deal with it. This, so far, is the kind of situation the book and author are focusing on. We'll see what happens later.

The second point - again, this is extremist thinking. These are human lives we're talking about, for christ's sake. One life cut short, any number of others afflicted by that trauma...despite literally saying "I'm not saying we shouldn't try to make things better for those who are already here", you sure are arguing pretty hard against there being any possible or legitimate way of doing so.

Lastly - same thing. "Pro-lifers want everyone to live their best life but the world is so shit; they should just let people die". Just swap the key terms: "suicidal people want to die even though the world is so wonderful; I want them to live". Both are opinions stemming from human perspectives. As strongly as anyone on either side of this fence feels about their position, it's all just human bullshit. Seemingly shockingly to many here, most people don't want to destroy themselves, or the entirety of existence. Biologically speaking it's us who are fucked up. We can think that life, nature, existence, whatever is cruel, unfair, yadda yadda but that's perspective. What do you think a rock would think about this? It probably doesn't, because it's a god damn rock. Minerals and elements are no less a picture of life than humans, animals, or plants - we literally are all composed of the same elementary shit and needs to straight up eat minerals (ie rocks) otherwise we die.

All this typical, human projection is maybe more nauseating to me than many "pro-life" takes. I am not going to defend the evil that is the modern, industrialized corporate health"care" hydra, bu some people in the world are actually less than total shitheads and do want to help others. Does something as benign as simply feeling good when doing so discount the authenticity of this pursuit? Abso-fucking-lutely not. If humans never felt good about anything then no one would do anything. It's not biologically sound...that said, maybe I should hold my tongue lest the pro-death camp take this too and run with it screaming naked into the windy night.

 

[akirat9]

I agree, and no radical and/or relevant change for the better was ever accomplished in a short time. Thank you for providing this measured and balanced take on the content and topic I've introduced here. More that can be said for the following...



First off, I would appreciate if you didn't derail this thread with the kind of life-denying drivel that has tons of other places for outlets on this forum. Yes I posted this in suicide discussion but there's an actual topic, and respectfully request comments stay on it.

The more time I spend on this site, the more I realise so many people here are just as delusional as the so-called "pro-life" camp. I see more and more black-and-white-binary rhetoric like this; shit like "I'm miserable and believe the world is bad, therefore anyone disagreeing must be screwed in the head!", "if you can't eliminate all suffering then it's pointless to try and eliminate any at all", or "suicide is not a problem".

Working backwards: people here should know better than anyone else that suicide is not a uniform issue. A case of someone who successfully kills themselves after a decade of insidious physical and/or mental decline, after thorough deliberation and attempts at recovery, is absolutely not the fucking same as a heartbroken teenager who has never thought about, much less wanted suicide, who just happens to have access to a gun during a moment of intense emotional distress. The fact that suicides like the latter happen, representing those that, given simple, minor, respectful and meaningful intervention wouldn't have, absolutely is a problem and I will die on this fucking hill. Another problem is that just like "normies", tons of people here seem to equate these two kinds of suicide as one and the same. They aren't - deal with it. This, so far, is the kind of situation the book and author are focusing on. We'll see what happens later.

The second point - again, this is extremist thinking. These are human lives we're talking about, for christ's sake. One life cut short, any number of others afflicted by that trauma...despite literally saying "I'm not saying we shouldn't try to make things better for those who are already here", you sure are arguing pretty hard against there being any possible or legitimate way of doing so.

Lastly - same thing. "Pro-lifers want everyone to live their best life but the world is so shit; they should just let people die". Just swap the key terms: "suicidal people want to die even though the world is so wonderful; I want them to live". Both are opinions stemming from human perspectives. As strongly as anyone on either side of this fence feels about their position, it's all just human bullshit. Seemingly shockingly to many here, most people don't want to destroy themselves, or the entirety of existence. Biologically speaking it's us who are fucked up. We can think that life, nature, existence, whatever is cruel, unfair, yadda yadda but that's perspective. What do you think a rock would think about this? It probably doesn't, because it's a god damn rock. Minerals and elements are no less a picture of life than humans, animals, or plants - we literally are all composed of the same elementary shit and needs to straight up eat minerals (ie rocks) otherwise we die.

All this projection is far more nauseating to me than any pro-life argument, to be honest. I am not going to defend the evil that is the modern, industrialized corporate health"care" hydra, bu some people in the world are actually less than total shitheads and do want to help others. Does something as benign as simply feeling good when doing so discount the authenticity of this pursuit? Abso-fucking-lutely not. If humans never felt good about anything then no one would do anything. It's not biologically sound...that said, maybe I should hold my tongue lest the pro-death camp take this too and run with it screaming naked into the windy night.

if you want to live fine
if someonemewants to die fine

no derailing needed

 

[Rounded Apathy]

Apologies to @lyles if you're already following this thread and my tagging you just piles up notifications; just wrapped chapter 5.

4 was indeed rather dry, mainly focusing on why the traditional linear model of someone's risk of suicide is far inferior to the cusp catastrophe model (if you really wanna nerd out, nabbed that image from this paper by the same author). I forget if it was in this chapter, but he brought attention to the fact that data show a massive association between successful suicides after a recent psychiatric hospitalization, I believe in a five-week window. Didn't go far on that one but I could see what he was intending to say.

5 wasn't my favourite either, but sort of interesting - suicidality as a product of varying environmental factors and decision making traits/abilities, as opposed to "mental illness". Began by discussing how even new models of suicide research are overly-informed by the previous paradigm of "mental health" give the field basically didn't exist until well after the war, and only really took off near the close of the 20th century. Talked about the classic marshmallow experiment as well as two improved modern takes on it, how those were integrated with studies on suicidal people in terms of brain activity in two specific regions dealing with both positive/negative emotional processing, and how all that fits with the "small reward now vs. big reward later" thing.

Some of what he was on about in the middle I was practically rolling my eyes at, but I very much enjoyed and appreciated the following:

"I want to emphasize...: the decision-making process of someone who almost died as a result of their suicide attempt [as opposed to someone who chose a method unlikely to succeed] was no different from someone who had never attempted suicide, was not currently suicidal, and did not have a mental illness. This is an especially important finding because it shows us that some who engage in suicidal behaviors have a decision-making style that is no different from those who do not have a mental illness and have never tried to kill themselves. This finding lines up with the idea that there can be multiple pathways to suicide".​

​

Vindicating.​

Chapter 6 seems as though it'll be on why the healthcare system has continued to suck on this front; its title I expect will be an allusion to Ignaz Semmelweis, a doctor whose claim that washing hands between patients was crucial for health was utterly rejected because, among other reasons, they went against the era's accepted scientific models. Chapter 7 might be a snore, as I think it's going to be almost entirely about decreasing easy access to firearms as a measure to curb United States suicides (almost certainly true, but less of interest to me personally. The final chapter is the one about making a life worth living and all the sunshine and kitties stuff I'm holding out for. Sadly it's barely 19 pages...but at least it's there. I don't expect this guy to fancy himself some kind of messiah, so it's nice that anything like that will even be in an academic work at all.

 

[lyles]

Apologies to @lyles if you're already following this thread and my tagging you just piles up notifications; just wrapped chapter 5.

4 was indeed rather dry, mainly focusing on why the traditional linear model of someone's risk of suicide is far inferior to the cusp catastrophe model (if you really wanna nerd out, nabbed that image from this paper by the same author). I forget if it was in this chapter, but he brought attention to the fact that data show a massive association between successful suicides after a recent psychiatric hospitalization, I believe in a five-week window. Didn't go far on that one but I could see what he was intending to say.

5 wasn't my favourite either, but sort of interesting - suicidality as a product of varying environmental factors and decision making traits/abilities, as opposed to "mental illness". Began by discussing how even new models of suicide research are overly-informed by the previous paradigm of "mental health" give the field basically didn't exist until well after the war, and only really took off near the close of the 20th century. Talked about the classic marshmallow experiment as well as two improved modern takes on it, how those were integrated with studies on suicidal people in terms of brain activity in two specific regions dealing with both positive/negative emotional processing, and how all that fits with the "small reward now vs. big reward later" thing.

Some of what he was on about in the middle I was practically rolling my eyes at, but I very much enjoyed and appreciated the following:

"I want to emphasize...: the decision-making process of someone who almost died as a result of their suicide attempt [as opposed to someone who chose a method unlikely to succeed] was no different from someone who had never attempted suicide, was not currently suicidal, and did not have a mental illness. This is an especially important finding because it shows us that some who engage in suicidal behaviors have a decision-making style that is no different from those who do not have a mental illness and have never tried to kill themselves. This finding lines up with the idea that there can be multiple pathways to suicide".​

​

Vindicating.​

Chapter 6 seems as though it'll be on why the healthcare system has continued to suck on this front; its title I expect will be an allusion to Ignaz Semmelweis, a doctor whose claim that washing hands between patients was crucial for health was utterly rejected because, among other reasons, they went against the era's accepted scientific models. Chapter 7 might be a snore, as I think it's going to be almost entirely about decreasing easy access to firearms as a measure to curb United States suicides (almost certainly true, but less of interest to me personally. The final chapter is the one about making a life worth living and all the sunshine and kitties stuff I'm holding out for. Sadly it's barely 19 pages...but at least it's there. I don't expect this guy to fancy himself some kind of messiah, so it's nice that anything like that will even be in an academic work at all.

No need to apologize! It is honestly a joy to see your notifications!

It is appreciated that you are making your way through the dry parts. I do think there is value in an academic perspective being taken on the issue. The addressing of shit life syndrome, essentially, is also good. When material and social conditions are so poor in so many places, it really should not be such a shock that some people do not care to live. It is the consequence of a serious neglect systemically of these facets of our lives. I am excited to hear about the last chapter there, hopefully it is worth it overall!

 

[Rounded Apathy]

For @lyles, @avoid_slow_death (cause ya seemed sorta interested), and anyone else maybe following or coming late to the party:

Chapter 6 straight up started with the story I predicted, haha. Themes of the chapter include why the medical institution continues to lag behind demonstratedly superior treatment modalities for suicide, and what those are and how they may work. Several deserved jabs made at the institution, comparing it to the slow, egotistical beast it was in the mid 19th century when Semmelweis (and others around the world) advocated for radical changes like proper sanitization and the germ theory.

The primarily discussed modalities were dialectical behaviour therapy (DBT), cognitive behavoural therapy for suicide prevention (CBT-SP), and crisis response plan (CRP). In addition to explaining how they work, Bryan talks about how they may lead to changes in the brain when administered properly, and are sometimes seemingly used in practices but really not. The DBT example was great for me; long ago an acquaintance thought I might benefit from it, but the one person I saw who used it felt underwhelming. But as explained in the book, many practitioners will use merely a "DBT-informed approach", which eliminates central components - a week of true DBT generally involves something like an hour-long session with the clinician, an hour long skills-based group workshop, and another an hour long "in-between" session with the clinician. Very different from just talking for one hour a week with someone who incorporates whatever they think are the core concepts of the approach.

Further fucking things up is the horrendous number of professional programs found to actually include suicide-specific training: less than 1 of 2 psychology, 1 in 4 social work, 1 in 16 family, and 1 in 50 counsellor programs had any at all. While psychiatry seemed to rank best at 9 in 10, only a quarter of those were skills-based - meaning actually learning from more than just textbooks and lectures. Further discussion about the "dilution" issue (which I referenced in the previous paragraph) ensues, as well as condemnation of clinical "best practices" (which are apparently largely administrative, and implemented mostly to avoid being sued), recognizing the change in paradigm must be thorough and multi-pronged, with a focus on the actions and behaviour of individual practitioners.

Despite a couple of places where I felt like he was saying something totally against the rest of what he was arguing (which I have conveniently omitted from my mind), I liked the message behind the chapter and finished feeling a perhaps better of understand why sooo many people here, among other places, feel they have not only been failed by the existing systems, but that it's inherently worthless. Perhaps yet another wicked problem unto itself? My favourite quotations, relevant to this point and from two places in the chapter which I've merged into one:

"We repeatedly implore people to 'get help' because 'treatment works', but when someone follows this advice, there is only a remote chance that they will receive one of the better treatments that are currently available...if the suicide prevention community and society more broadly are going to continue encouraging people to seek out mental health treatment when feeling suicidal, we need to make sure they have easy access to suicide-focused treatments. Status quo practices are simply not enough and need to be replaced with newer methods that yield better results."​

​

Odds are, after thumbing through chapter 7, I'm going to end up skipping most of it. Looks like it'll mainly be about reducing access to and availability of things that can kill you in order to lower rates of suicide...kind of a no brainer. Installing high rails on bridges, reducing total contents of OTC drug products, increasing restrictions on firearms - in the interest of preventing impulsive suicides and leading to less overall harm due to failed attempts and the like, there's no question in my mind that these kinds of controls can only have a beneficial effect. But the main point just isn't of much interest to me, or likely many folk here.

 

[LaVieEnRose]

The mental health system is full of sadistic, ego-trippers who couldn't care less about the suffering patient, who is, at least in American, sacrificed on the altar of the almighty dollar. Sounds like that needs to be improved before any meaningful reduction in the suicide rate is achieved.

 

[Rounded Apathy]

The mental health system is full of sadistic, ego-trippers who couldn't care less about the suffering patient, who is, at least in American, sacrificed on the altar of the almighty dollar. Sounds like that needs to be improved before any meaningful reduction in the suicide rate is achieved.

I'd love to see your evidence for this, as well as hear your theories on how to go about effecting such a change.

 

[LaVieEnRose]

I'd love to see your evidence for this, as well as hear your theories on how to go about effecting such a change.

Evidence? I don't really have any "evidence" except 20+ years of mental health care as well as hearing and learning countless other people's stories, all of which I found credible because of my personal experience?

Solutions? I'm not sure what can be done about the systemic cruelty. People say it's only "a few bad apples" but reality says otherwise. I think for-profit hospitals should be forbidden and I think for clinicians there should be changes to the concept of liability because as it stands fears of liability have them in a stranglehold, to the detriment of all.

 

[Rounded Apathy]

No need to apologize! It is honestly a joy to see your notifications!

Jeez, I totally didn't respond to this very kind sentiment. Thank you very much. @avoid_slow_death I saw ya hearted the last one, so imma tag you again for...chapter 7.

It was what it was. Big explanation in the beginning of how as numbers of drivers (in America) continued to soar into the 20th century, traffic fatalities shot up in a commensurate way up until about the late 70s, when there were several different strategies implemented across various spheres of the...driving world? in order to curb the problem. Changes to road design, intersections, onramps. Seatbelts, airbags, headlights, automobile safety standards. Legislation around speed limits, impaired driving, etc. Large, structural things not really targeted at the individual - including safe driving campaigns, which were apparently specifically designed to be community-minded, as that was seen to be more effective. And boy howdy, have traffic fatalities decreased despite drivers and distrance driven both increasing. Paraphrasing Bryan, it's impossible to know precisely to whom, when, and/or why traffic accidents or fatalities will occur, so the approach was to make them less likely to happen to begin with, and less lethal if they did happen - knowing full well it is impossible to prevent all of them.

Then the big analogy: this is the model that should be used for suicide prevention - but it hasn't been. Almost the entire effort has been focused on the individual and assessing their behaviour, often through the narrow lens of mental health; which, as was talked about earlier, is already flawed. Bryan applies the example of the hierarchy of controls to both efforts, highlighting how the traffic example has used multiple tiers of controls, while suicide prevention effort has basically used only one - the second-to-least useful, at that. The rest went basically as predicted; barriers on bridges, smaller medication packages, removing carbon monoxide from residential gas, and the substitution of highly lethal pesticides with versions far less all have correlated to not only marked reduction in deaths by suicide in a number of countries across the latter half of the 20th century, but interestingly enough, did not lead to an increase in deaths by suicide from other methods.

I was groaning and grumbling about a lot in this chapter - we don't know if those people who didn't die of suicide didn't attempt another method and just survived. We don't know if they eventually did die of suicide beyond the years tracked in the data. In other words: we don't and can't know for sure if these were proper solutions, or simply a bandaid/obstacle for the suicidal. What's worse, Bryan throughout was letting on he's at least to some degree of the position many of us find so detestable: that it's better to survive a non-lethal suicide attempt than die from a lethal one.

The first quotation that really had me convulsing:

"Research suggests that...most people actually do not switch methods when one method has been restricted. Nonetheless, it's a possibility and probably happens in some cases. Under these circumstances, means restriction functions as a substitution control by replacing a more dangerous hazard with a less dangerous hazard, akin to traffic circles, which restrict drivers from..."​

-hold up WHAT?!? You previously talked at length about how post-suicidal hospitalization experiences are so awful that people are far more likely to kill themselves after being discharged, and now you're saying it's somehow better to fail an attempt cause the end result is somehow superior? This was really fuckin' weird to me. I wonder if he wrote these parts at very different points in time and neither he nor the editor gave a shit about synthesizing harmony between the parts in the final iteration. Sigh.

Anyway the chapter closes out focusing on guns. And it was here that it became real obvious that up until now, almost the entire focus of the book has been on that apparently large ratio of suicidal people he talked about way back in the early chapters - those who do act on urges impulsively, some of whom have never had a fully-formed thought of suicide before. This is where the whole "lethality" thing comes full circle:

"Across 90 research studies that have followed suicide-attempt survivors for up to 10 years*, around seven out of 10 people who attempted suicide and survived did not attempt suicide again and nine out of 10 did not go on to die by suicide. If someone survives their first suicide attempt, there's a very good chance they will not die by suicide at all, even many years later. Firearms and other highly lethal methods rob the individual of this second chance."​

*(I don't love that incomplete explanation of those studies, which is pretty uncharacteristic of the book so far...how many people were in the studies? Up to ten years? How many actually followed them that long, and what was the minimum follow-up time? Actually I found the referenced paper in the book's sources and as far as I can tell, the precipitating event was only "self-harm, which is not defined in the analysis...)

There was one illuminating point in this section, however, which I think is beyond the field of perception for most people like us on this forum (again, being an American book about America) - a disturbing number of children (ages 1-17) survive or die of suicide annually; 166 and 693, respectively. How many of those deaths are accidental? How many are impulsive? and even if deliberated, how many so young has both had enough life experience and reached a stage of mental development sufficient to make such an ultimate choice?

This made me realise that I think both sides tend to miss the mark - those of us here who have lived through too much torment for too long believe that not only do we have a right to die, but that those who want to make suicide even harder to accomplish are out to get us because they don't understand our reasoned wish to just have our suffering end. Those who want to quash sites like this and restrict suicide methods think there could never be someone in a position like ours; suicide are tragedies, accidents, if-only's - like a case of a child who played with a parent's gun and ended up dying as a result. I'm glad I didn't totally breeze through this chapter, as I wouldn't have come to this insight if I had.

Jesus Christ I didn't expect this to turn into a freaking book report. I am seriously hoping the short, final chapter addresses the issues that many of us here maybe face more intensely, as opposed to the possibly larger number of accidental, impulsive, likely legitimately preventable suicides that we here never see...those who don't brood, crave connection and understanding, want to be exactly sure of how best to leave this world; those who just try and succeed.