Introduction to this blog
I’m publishing this late I know. I wrote most of it then chickened out of sharing it on the day. But I have become known for being ‘brave’ enough to share my own experiences (which I am told is helpful to others) and talking about ‘taboo’ subjects and therefore I am going to do that again – exposing the most difficult situation I have ever had and a tough one to talk about….Suicidal Ideation. I have learnt more about this area through my work and through my own personal experiences and therefore I hope that I can help others learn more, and use it positively, through sharing this.
This is the most personal thing I have ever shared to date and I am a sensitive soul so please bear this in mind as you read and if you choose to comment or feed back.
I am trained in Mental Health through my job and have plenty of experience through that in assessing and managing Mental Health conditions. However, I am not claiming to be an ‘expert;’ I am just sharing my views and experiences.
The content will not be an easy read in places so please be prepared for that or maybe don’t proceed if you may find it upsetting.
Introduction to ‘Suicide Prevention’
It sounds so easy doesn’t it?
‘Suicide Prevention.’
But it isn’t easy, of course. For those suffering or for those around them who desperately want to help but often don’t know how. That is, if anything was even noticeable to others in the first place; and that’s certainly a major factor obstructing suicide prevention.
After someone has successfully taken their own life, there is often some puzzlement and guilt as well as deep sadness. Was it really that bad? Why couldn’t they see any hope? ‘If only I’d noticed.’ ‘If only I could have done something.’ Why didn’t they say something?
But it isn’t that simple. The unfortunate truth, in my view, is that those that are that far into the depths of despair often suffer in silence and go unnoticed; they may be so desperate that they can’t see how anyone or anything can help. The people that express their depressive feelings and discuss their suicidal thoughts are usually relatively ‘safe;’ it’s the quiet ones we often need to worry about. Of course this is a generalisation, but it is a pattern that I have observed anecdotally. Some of the people I am aware of who lost their lives this way had not previously sought help. Outside appearances can be highly deceptive and this can be evident in the comments made about someone; ‘But they were always smiling.’ ‘They seemed to have the perfect life.’
No-one else can know what is going on inside someone else’s mind – or necessarily why. If and when it is expressed, it may not make sense from the outside; it can seem totally illogical. But you don’t need to understand or make sense of it. You just need to accept that they feel the way they do and support them the best way you can.
As doctors, we are taught to question our patients about ‘suicidal ideation.’ Suicidal feelings, thoughts, plans, intent of suicide etc. But, I think this slightly oversimplifies the risk assessment, albeit these are important points to explore.
Why does someone get to this point?
I would say, in basic terms, the psychological distress simply becomes overwhelming. The root can be from a mental illness such as depression or anxiety. It can be following psychological trauma. It can be stress-induced. It can relate to a loss of control; your world is crashing down around you and you can’t stop it.
At the time, you may not be fully ‘yourself’ and will not be able to see the bigger picture properly; there is a loss of perspective. All that is visible to your mind is the crisis of the current time; the future and potential hope for that future may not even be on the radar. They may not be able to recognise that they are envisaging a tragic permanent outcome for what is usually a temporary problem or psychological state.
It can be from a relatively small trigger; the balance can quite suddenly tip, especially if there is already a background of some of the above i.e. the effect can be cumulative so that a relatively small issue, on the background of other difficulties over time, can trigger a catastrophic reaction.
For many people, the reason they don’t take steps to follow through on suicidal thoughts is because there is something that helps them to prevent it such as knowing that it would upset their children. But, even this can not be relied upon to keep someone safe; you can reach the position of thinking ‘I am just a burden to everybody’ or ‘They are better off without me’ all too easily. Everybody in this world has a value and their loss would be mourned, but that may not feel evident to the person at the time. For some, the impact on others may not even enter their thoughts as they are so deeply consumed by their distress.
Another circumstance that I believe can occur is that somebody can feel so detached from their true and rational being that they can then act on their underlying suicidal thoughts without really intending to do so i.e. during a time of ‘depersonalisation.’
My Own Experience
I would say I am naturally an optimist. As my ‘motto’ says, I will find positives in pretty much any situation. I love life. It is beautiful in so many ways; though I do confess to finding beauty and enjoyment in very simple things! There is so much to experience. And I am all too aware life is short and you only get one chance to live it; most of the time I am horrified at how quickly my own life is passing, partly as it sometimes feels like I will never reach any of my goals before it is all too late. Therefore, in the past, I confess I have previously failed to fully understand why some people find themselves feeling suicidal – surely there’s always something to live for, even if the current time is tough?
Yet I have felt suicidal; sometimes quite vaguely but, at worst, extremely close to taking definitive action. (I am fine now, I hasten to add, before anyone worries!)
Two years ago, when I had the ‘depression’ that started this blog, that primarily came from burnout and the unhappy parts of my life dominated over those positive feelings that would normally have kept some balance to my psychological status. I was ‘loosely’ suicidal then in that I was so exhausted that I couldn’t face having to function at all. I just wanted to be able to rest my mind, body and soul for a very long time without any responsibilities and without even having to think because life just never stopped and gave me a break. I did imagine ending it all to ‘solve’ this desire to sleep and never wake up and I couldn’t trust myself to go out alone for a while in case I found myself wandering in front of a lorry or something similar – that ‘depersonalisation’ and detachment that I mentioned in the previous section. What I actually ended up doing was staying at home and pretty much staying bed for a few weeks. And writing – writing those first few blogs was my therapy at that point. Discovered completely by accident whilst I sat in bed on my own.
Just over a year ago, I was seriously violently assaulted by my now ex-husband then ended up on a highly traumatic path of separation and divorce with ongoing abuse – I then had times of much more significant suicidal feelings. There were no plans. But there was an overwhelming desire to not have to face the traumas that were incessantly present day after day going on and on and on. Every time I woke up, I was filled with an immense surge of anxiety and almost disappointment – ‘I’m still here and I’ve got to face another tough day yet again. Every day is a battle. I can’t keep doing this.’ I had intrusive thoughts that popped into my mind and, quite frankly, freaked me out – because I had enough insight to realise that wasn’t the right thing to do. I had various visions that would just pop into my head and I had to fight them away. The main one was a recurrent draw to the balcony at work; almost fantasising about jumping off – I even stood there one day working out where to put my feet to climb over. And the idea felt exciting and liberating; I wouldn’t have to suffer everyday anymore….it would all be over. There was a sense of anticipation which made my soul feel light and care-free; the opposite of the trials of real life at that point. I couldn’t see a future. I couldn’t see hope. I’d been make to feel, by various sources, that I was a bad doctor and a bad mother – if I wasn’t even of any value to my own children, then there really was no point carrying on and nothing to stop me…
What stopped me in the end? There was just enough of those tiny protective thoughts popping in to my mind… I had enough insight to realise that my children DID need me despite what others were making me feel. I didn’t want my children to be brought up only by my ex-husband, who I despise and don’t trust with my children – and I didn’t want him to ‘win’ (a narcissist gains satisfaction from successfully inflicting distress on others). I knew my parents’ hearts would break. I knew that my work as a doctor IS appreciated by some. But I still found it a massive fight to prevent myself from acting on extremely compulsive thoughts and I took steps to keep myself as safe as I could; particularly by sharing what I was feeling with various people around me.
How close I got to going through with it is terrifying; it still makes me shudder when I remember how I felt then. It is scary and you can feel incredibly alone, even with many people around you.
Would anyone have noticed anything was wrong from the outside (if I hadn’t said anything)? No, not obviously.
What can you do to help somebody else?
- Notice the little signs. More info on this on my previous blog: Mental Health Awareness Week 2019: What we can do
- Just ask. Directly. Don’t fluff about with how you say things. It may just need ‘Are you OK?’ or ‘You don’t seem yourself – do you want to talk about it?’
- Somebody might be trying to tell you something but it may be cryptic; look for the cues and follow them through. (See blog link above.)
- Listen, listen, listen. This is more important than any response you might make and can be therapeutic in itself. This is a huge part of what we do as GPs; the ‘therapeutic relationship’ can be just as important as any medication we might prescribe.
- Be completely non-judgemental in your responses. This sounds obvious but instinctive reactions can show – just being aware of this means you can modify your response accordingly. Communication skills are particularly important in this context.
- Remember that mental health difficulties and suicidal ideation doesn’t discriminate; it can happen to anybody so don’t make assumptions about somebody because you think it wouldn’t happen to them. Just ask – there is nothing to lose and you might ‘save’ somebody.
- You don’t need to find ‘solutions’ for them; just being there, giving them a hug, making them a cup of tea etc – can mean the world. It shows that somebody cares. This brought to mind the two Winnie the Pooh quotes I have shared below.
More information about Mental Health Support and Resources here – and I will continue to build up information on my website over time.
My key message for this blog: You don’t need to understand; just be there and listen.
GP and Human - Dr. Kathryn Hayman 