Saturday, September 26, 2020

Suicide Prevention and Awareness about Mental Health

September is National Suicide Prevention and Awareness Month.

And, inevitably, it's not until the end of September that I can bring myself to write anything about it. I know how horribly real, devastating, and incomprehensible it is when a family member or friend dies by suicide.

I think that when this happens, it is rarely the result of a fully rational and free choice by the person to kill his or her self. Generally, these tragedies involve people with severe psychiatric afflictions that may or may not be evident to those around them. The behavior that results in their death is set in motion by a pathologically distorted perception of themselves and/or their environment.

What I might be able to contribute along the lines of "awareness" is to emphasize some important factors regarding mental health.

Please note: I am not a medical doctor nor do I have any training in the mental health or counseling professions. I am an experienced patient, as well as a university professor in humanities, an active scholar and author, and an incurable thinker who has had a lot of time (and a lot of personal motivation) to think about these things.

The psychological dimension of our humanity remains mysterious in many ways, but we continue to learn about what helps and what harms its delicate balance, how it shapes our attitudes and actions, and how psychological disorders can hinder and even cripple a human being. Psychological health is affected by our own actions, but it is to a significant degree woven from predispositions, events, and experiences that impact us in ways outside our control. Obviously, there are ways to respond to and reintegrate the damage inflicted by bad experiences on our psychological "inner fabric" (and important ways to be helped in doing this). But often we can't "fix" all the complex features of inner brokenness, and therefore we must endure the pain that remains. Psychological suffering is real, and none of us can presume to measure how great is the burden borne by another person.

There is another important and particular point that continually needs to be emphasized: what we categorize as psychological or mental problems are often connected to empirically accessible "physical" diseases, imbalances, and afflictions. Overall physical health and the hormonal and central nervous systems have a significant impact on how well we "think and feel." Then there is the health of the brain itself. In my lifetime, much has been discovered about the complexity of brain functioning and the wide variety of ways it can be damaged or diseased. Neurobiological research still holds much potential, but medications have already been developed that help treat brain disorders in a more "fine-tuned" manner. There are no miracle drugs, but psychiatric medications - responsibly used under proper supervision - can contribute to a therapeutic regimen that makes a big difference in people's lives.

I can vouch for this. Psychiatric medications have been a great help to me in my own 47-year-long battle with depression and OCD. (Ten years ago, I published a book about my experiences which is still available HERE.) I'm old enough to remember what it used to be like struggling with mental illness. Things have gotten a lot better, and the stigma surrounding it has generally decreased.

At the same time, it is often said that we have more mental illness in today's technologically advanced societies than ever before. In part, this might be explained by the fact that we have more awareness and more openness about mental health. But it may also be true that the stressful environments we live in today may be harder on brain health, especially for people who have a (possibly hereditary) predisposition to develop neurochemical imbalances.

There are many reasons why life today has a higher tension, requires more mental energy, and passes through more phases of stress and abrupt change than in the past. I have written about this elsewhere on the blog, with regard to issues related to the enormous growth of technological power. I think it's important to be aware that depression (which is often a factor in the tragedy of suicide) can be a condition "managed" over a lifetime, and subject to different phases of intensity. And while most people learn to navigate the hard stresses of modern life, there are some (perhaps more now than in the past) for whom modern tensions are experienced as overwhelming and "tramatic" events, and who face more personal disruption as a result.

People who are already "managing" (formally or informally) with depression or some related disorder based on a neurobiological-dysfunction/chemical-imbalance in the brain are subject to experiencing a "flare-up" (i.e. their disorder may become symptomatically acute) because of a triggering event - and in our society these may involve disruptions in physical or emotional life, employment, or any number of intense transitions or problems similar to what many people experience in one way or another as stressful and difficult, but manage to recover from and move on. Whereas for people with depression these circumstances and events can have a traumatic effect. They can crack the very fragile edifice of coping mechanisms, the network of convictions, and perhaps even the neurological "rerouting" that the brain has developed to compensate for its chemical or functional weakness. The result is that the whole edifice is destroyed, and the person loses their handle on their "normal" perception and judgment of life, interests, relationships, etc. Recovery will depend on the person's success in reconstructing another "cognitive edifice" with the help of a positive environment and support, psychotherapy, short-term or long-term assistance from medication, and other kinds of therapeutic care. The healing that is achieved will always be tenuous and susceptible to re-injury.

There are many ways you can help someone suffering from depression, but it does not help to tell them to make themselves better by their own willpower or some kind of self-initiated activity. The depressed person cannot "get over it" or "pull themselves up by their own bootstraps." This helplessness is one of the distinguishing characteristics of depression.

Nevertheless, depressed people often don't recognize their own helplessness, which means that they are already adding frustration and self-blame to the depression itself. What you may be able to do is to help them realize their need for specifically psychiatric help, or at least to encourage them and help them to accept that there is no shame in seeking care for mental health. Be gentle, be supportive, be available, and - depending on your relationship with the person - try to help them be accountable for keeping up their healing work, keeping concrete goals in focus, communicating with doctors and therapists, taking their medication, and assessing progress. Be a human being, and treat them as human beings, with all the dignity and love they deserve. Don't dismiss the human person with prepackaged demands or ideas for what they must do to "fix themselves" so that they might become "worthy" of being loved and respected as human beings. This is actually more difficult than you might think. We tend to disrespect one another all the time, even in "normal" situations. You will not always succeed, but be humble and keep trying. Be a friend. Become better informed about mental health, and get advice from relevant mental health professionals and resources (see e.g. HERE) on specific conditions and other factors that bear on the concrete circumstances of the situation the person is facing, and that help you to discern the best ways that you can be helpful in this particular person's life. Be a part of their "team" along with caregivers and other friends and family. Know the role you play and work together with everyone else.

It is very important for other people not to add fuel to the fire of emotional abuse that a depressed person is already afflicting themselves with. That person has already run through the list of "healthy lifestyle choices" they've failed to make, "positive attitudes" they haven't cultivated, prayers they've failed to say, and many other reasons why they think that they ought to blame themselves for their various incapacities. This spiral of self blame and deeper incapacitation can become a whirlwind of interior violence that spins entirely out of the bounds of rationality. A level of delusion emerges which can lead to external self-inflicted violence.

We can imagine how something like suicide may be waiting at the bottom of this descending spiral, like a black hole. But this hardly even begins to grasp even one facet of the destructive catastrophe that is suicide. I know something of the incapacitating strangeness of depression, the suffering it causes, the disconnection from one's sense of one's own value such that one longs to shrink into a little ball and disappear. None of these afflicted states are necessarily aiming at suicide. That doesn't mean we shouldn't care about people who are suffering in this way. It's terrible suffering. We need to help people who are suffering in these ways.

Of course, even in these general and limited considerations, I cannot forget that I am a Christian. Faith, prayer, the sacraments, and spiritual guidance matter very much here. They can reach aspects of suffering (physical or mental) that are inaccessible by other efforts. Jesus brings light to every kind of darkness. Jesus wants our healing. But he wants us to follow him, to do the will of the Father. The things of faith are not meant to replace our humanity. Faith is not a cheap substitute for the human care we owe to ourselves and to one another, or for the application of what medical science and the arts of the healing professions can provide. "Miracles" are possible, but they certainly won't happen for us if we neglect our responsibilities to receive God's help through the natural and human gifts he has already placed on our path. We can rely confidently on God's grace to give us the courage to follow him by seeking all the appropriate resources for help, and by enduring the sufferings that cannot be helped because they exceed the possibilities for human healing available to us and because God permits them (for a time) because he has encompassed them within his plan, through Jesus Christ, to unite us more fully to himself.

It is our task to bring comfort to the afflicted and mercy to those in need. We can't judge with condemnation the ultimate destiny of anyone who dies by their own hand. On the contrary we have reasons to hope in God's mercy, including the perspective that an awareness of mental illness gives us, that suggests full culpability is so often lacking in these tragedies. Why God permits this kind of awful thing is a question that remains mysterious and painful for the living. Still, we must continue to trust in God, no matter what. Before suicide happens, however, we must also do everything we can to help the afflicted person step away from the edge. We must accompany them, love them, and beg them to stay with us. Life is always a gift. As long as it is given, we don't have the right to choose to give up on it, or to neglect other lives entrusted to our care.

I don't have "internal experience" of what leads to a suicide attempt. I have been at the bottom of some of depression's awful holes, but I'm not suicidal. Not everyone with serious depression thinks about or makes a plan or tries to do something to end their own life. There are differences between "feeling like you want to die," "feeling like you are somehow 'dead'," "feeling like you have no value" and "feeling like you should take steps to end your own life." They are all destructive and dangerous states of disordered perception that require personal attention, and medical and therapeutic care.

I know something of what it feels like to "want to die," such that I have had to work on "wanting to live." I still work on it, although in these days - as difficult as they are - I find that I very much want to live. I have never "felt like ending my own life," which is not anything I can take credit for. It's not one of the sufferings that afflicts me. I have wailed in desperate sorrow for the incomprehensible loss of someone else. Why him and not me? I don't know. There are different kinds of depression and different levels, and different ways that it combines with a wide spectrum of other mental disorders. Prevention experts have useful information for helping us identify signs of specific danger (this LINK is an accessible and wide ranging resource from the National Institute of Mental Health).

We can only do our best. Most of the suicides I know or have heard about are very complicated. They still seem like a bunch of knots that I cannot even begin to untie.

There's an element in suicide that is quite obscure to me, that I can't analyse. It's inexplicable to me how I lost my friend 15 years ago on a bright beautiful Fall day, or how we lost some kids in our area over the past decade. Nothing I think or say will ever be anywhere near enough to explain what happened.

To loved ones who remain behind, it stays like an open wound. It always hurts, but it's a pain that cries out to the infinite mercy of God. It stays open as a space where the seeds of ultimate hope mysteriously grow for those we have lost.