Suicide Isn’t Painless
September 10, in case you missed it, was World Suicide Prevention Day. Each year 6,000 people in the UK, and 800,000 worldwide, take their lives so there is clearly plenty of prevention to be done. Each suicide has a profound effect on those it leaves behind, with around forty people severely affected, and more following celebrity deaths. A study which examined news reports covering the suicide of Robin Williams identified a 10% increase in people taking their lives in the months following his death. This places a lot of pressure on the media as to how they report suicide.
My father, a wonderful warm and witty academic chemist, took his life when I was seven and my brother was nine. It was not easy or painless. He used a deeply unpleasant and painful method for reasons I can never know. My mother thought he’d had a heart attack and told us that. When the truth emerged at a post-mortem, we were shielded from it for 30 years. As a result, a young ‘MD’ worried a little about his heart but not about his mind. I made it through medical school, the junior doctor years and as far as a witness at the Bristol Heart Inquiry without any significant mood disorder and no self-harm or suicidal ideation. And then I discovered not only had my father taken his life, but my great grandfather and great uncle.
As a ‘truth-seeking’ journalist, my mother worried I would be angry at having these dark family secrets kept from me for so long, but I’m eternally grateful. I have seen so many patients burdened for life by the suicide of someone close that I feel I had 30 years of freedom to sort my own shit out before having to process the propensity of men in my family to kill themselves. And as a long-term supporter of assisted dying, it made me pause to consider how people can safely make rational decisions about their death, particularly when your mind and your mood changes over time.
Suicide is never simple and often happens for multiple complex reasons. It increases at times of austerity across all populations, particularly amongst men. I do not blame any of the men in my family for taking their lives, not do I use the term ‘committed suicide’ as if to suggest it is a sin or a crime. Those who do it may have been suffering extreme mental distress and/or unbearable pain for some while, or more transiently. What is clear from those who manage to survive life whilst coping with recurrent strong suicidal thoughts is that it may be possible to learn that ‘depression is a liar’ and that such negative thoughts are wrong and can be dismissed. Alternatively, it may be possible to distract yourself until the suicidal thoughts pass, as they always do eventually.
The mental health of NHS staff is particularly poor, partly because of the stress and exhaustion the job entails but also because doctors and nurses somehow like to imagine they are immune to such pressures. I recently met Mandy Stevens who, despite 30 years as a registered mental health nurse, didn’t notice depression creeping up on her. ‘It was only when I finally cried at work that I realised something was wrong. At the time I was working as an executive director in a London mental health NHS trust. There wasn’t the obvious feeling of being extremely sad – there had just been a slow downhill trundle and loss of enjoyment in life. My range of symptoms included being overly self-critical and a loss of interest in things I usually enjoy. I was tired but not sleeping. Procrastinating and feeling like I was a failure. I was very surprised by the rapid decline in my mental health and how it affected every area of my life so quickly. I went from fully functioning as a director to being almost mute, constantly crying, unable to care for myself and actively wanting to kill myself in 10 days.’
Stevens was assessed urgently and admitted to hospital for her own safety. ‘The care I received through the NHS was first class. The compassionate nurses, thoughtful and careful doctors, and an impressive array of multi-disciplinary team members were consistent, recovery focused, caring and just amazing.’ Stevens describes a strategy one psychiatric nurse taught her when she had suicidal thoughts after her discharge. ‘I had to make a list of ten things I’d previously enjoyed that I had to force myself to do before listening to the thoughts. This included playing music I liked and which reminded me of happier times, going to my favourite café for a coffee and cake, going on a favourite local walk and so on. No matter how strong the suicidal thoughts were, they never lasted beyond number 7 on my list.’ For others, such diversionary tactics may not work and help is needed more urgently. And the treatment works. Mandy Stevens was fully recovered nine months after admission, and back to full-time work a month later. Suicidal thoughts can and do happen to anyone, but suicide itself is often preventable. Zero Suicide Alliance offers excellent, free suicide prevention training. At 56 and despite my family history, I haven’t had strong suicidal thoughts. But I know to seek help if I do
You can call Samaritans on 116 123 at any time