Why do we have suicide prevention? I haven’t investigated but I’m wondering if many of the measures and practices in place were created by someone left behind or like a clinician? How much have these measures been informed by someone who deals with chronic suicidal ideation? I’m thinking about those autism organizations that are founded by/on the woes of parents with autistic children and have little input from those that are actually living with and experiencing the diagnosis.
Suicide prevention seems preoccupied with those who contemplate and decide to take action in the next 48 hours. They certainly need intervention, let’s not take anything away from that. It just doesn’t seem to have developed an approach for those suffering long term. I guess that’s the difference between being suicidal and having suicidal ideations. The mental health industry, as I have experienced it over the last decade, only wants to prevent the action and doesn’t care much about your motivations.
The threat of involuntary detention, institutionalization and resulting long term trauma is sufficient reason to be dishonest about it with your providers. Death would literally be better than the exacerbated suffering those systems can cause. Preoccupation with keeping you from doing anything, robbing you of the agency to deal with your problems (as best as you can determine at the moment), without concern and action towards your causal factors is not sufficient. The solution cannot just be to detain and increase the dosage. Inpatient or outpatient care is also not a solid solution. That all costs a lot of money, money some people don’t have and can’t scrounge together. You may ask about insurance and my response to you is that I’m an American. That word means nothing here.
Maybe this isn’t an issue for those with the means to cover extensive treatments and intensive care. For those without, it seems really cruel to suggest. Effective psychological care is not only hard to find, sometimes there’s a waitlist, and then it’s cost prohibitive. So again I say, it’s cruel.
Catch, traumatize, release is sloppy and can’t possibly be clinically proven to be effective.
This leads me to believe that maybe the government and healthcare system actually does want poor disabled people to kill themselves. Have you ever gone through the process of applying for disability? I really do think they’re hoping you just drop dead. Am I saying the quiet part out loud? Maybe they don’t mean death in a physical sense but more ontologically? Like 13th amendment stuff. Become so poor and so lacking in community support that you will inevitably offend some legal code and be welcomed into the bulky arms of an involuntary labor facility.
I recently learned and realized something about a therapist's duty of care. There are certain things they are obligated to do if a client mentions suicide or self harm in order to minimize their own liability if their client actually does something. There are certain questions they must have asked and actions they must take and it must be on record. This is so they 1) can keep their insurance and 2) have evidence to defend themselves should a left-behind loved one want to pursue legal action for negligence of something. So now, these clinicians can’t provide you with the real nuanced help you might need because they have to pivot their focus to make sure they’re legally protected first. Med adjustment, involuntary holds, sign a contract, etc. It’s not client centered at all. Here’s a great write up from a psych pointing out some of the issues in suicide risk assessment. For the purpose of fully understanding what I’m trying to communicate, consider it required reading.
But to be fair, if your darkness and malfunction is caused or facilitated by serious complex social issues and negative circumstances in life, then the best they can probably do is give you a pill to suppress your very reasonable and rational feelings of despair. Neither they nor you can change these problems simply or maybe not at all. So like, learned helplessness? When all else fails, I suppose all these clinicians can do is help you cope or numb you through the hell. You can die quickly or slowly but better it be slow and at a high daily rate. Someone should profit off of your demise, right?
I guess my point is, there are limits to what therapy can do and I think I’ve found them.
Dr. Kanojia a.k.a Dr. K of HealthyGamerGG (who I listen to often) recently did an interview over at Diary of A CEO. He had a great take… no, that’s actually not accurate. It isn’t a take. It’s his experience and observations as a practicing clinician. He shared some stuff about male suicide that apparently some people out there really didn’t like. Funny thing is, it was the first time I’ve actually heard my particular relationship to suicide and mental health validated and well represented in public discourse.
There are indeed some people for whom the conclusion of “I’m going to end my life for x,y,z reasons” is irrational and more a product of their cognitive distortions and maybe chemical imbalance theories* manifesting. (I don’t have the time right now to dig into chemical imbalance theory) Those are people for whom one can point to relevant, real life examples that are contrary to their beliefs. This is the sort of person who believes nobody loves them or cares, that people would be better off without them. But in actuality their partner/sibling/friends regularly display love towards them. Their neighbor/coworker/church members regularly display true and specific care and compassion for them. Their child/dog/internet scam vulnerable elders would absolutely be worse off without them.
AND there are some people who are being perfectly logical. Their feelings of big Depression make perfect sense and are completely justifiable because they really do live in isolation and disconnected from community. Their daily life is unenjoyable or outright sucks ass (no offense to those who enjoy sucking ass. i don’t mean to kink shame). They have nothing happening in the next week/month/year that they’re looking forward to. They aren’t on the pathway to a better life and they fail continuously despite trying to make improvements. After a while of that, you get disinterested in continuing or become less able to put in the effort to go on. AND THAT IS FAIR! It makes sense. I liken it to being at a party or event that you haven’t enjoyed for the last hour but waited around for 20 minutes to see if things turn around, where the parking is charging you by the minute, and you have no obligation to stay. Wouldn’t you leave the fucking party?
Having passive ideations sucks in a very special way. Simple nonexistence is so alluring but you don’t have the specific plan or will to take action (yet). And it seems no one takes you serious (enough) until you make a threat (with a plan) or already have an attempt on your record. All the interventions are just to keep you from doing it. No one with a license, certification, degree, or on the hotlines seems to be trying to help with the causal factors. I’ve also encountered far too often those that incorporate guilt, shame, and invalidation in their mental health & suicide prevention talks and guest panelist commentary. Maybe I’m the fool though. Maybe they don’t provide the type of help I’m wanting and looking for. So I guess I’ll just be here quietly suffering, smiling, laughing, keeping up the routine, putting in some effort, and enduring patronizing affirmations and platitudes until there’s an imminent threat. Then I’ll send you a postcard.
Epilogue
In Canada, there’s a big ongoing discussion around medically assisted death, mental health, and poverty. I learned about it while doing some background research to help with writing my own version of Jonathan Swift’s “A Modest Proposal”.