Perhaps because it’s the biggest killer of men under 50 talking about suicide has become less taboo but there’s still a lot of stigma and fear when it comes to actually talking about suicidal feelings. People fear that talking about these feelings will result in panic and chaos, that a counsellor will call the police or prevent them from leaving the room until an ambulance arrives with a mental health team and a straight jacket. Some suicidal people want something like that to happen, for someone to relieve them of all responsibility, to take control and let them rest but anxiety about how that may happen prevents them from taking a first step.
My contract has four clauses that limit confidentiality and one of them is if the client is seriously suicidal, but what does ‘seriously’ actually mean?
If a client tells me that within the last few hours they’ve taken an overdose then I’ll call an ambulance whether the client says they want me to or not – the fact that they’ve told me at all suggests that some part of them wants my intervention. So far that’s never happened to me. What has happened is that a client has told me enough to make me concerned that they may actively try to kill themselves within the next few days. I’ve asked their permission to contact their GP to get them involved. I’ve done this twice, both times with the client and me in the same room and with the speakerphone on. It’s important for the client to know precisely what is happening. Both times the client saw the GP within 4 hours. They weren’t sectioned or coerced into anything and continued to come to therapy.
Huge numbers of people feel more or less suicidal every day. When things seem too overwhelming, when you’re too tired and worn down, when there are too many demands and nowhere near enough resources suicide can seem to be a rational choice. The vast majority of people who feel this way don’t want to die, they dearly want to live, but to live differently from the life that they are trapped in. Poverty, pain, violence, shame, discrimination, fear, exhaustion and a long list of other circumstances can make life anguished and hopeless, compounded by the wretched fashion of positivity that boils down to ‘You are always failing.’
Suicidal feelings can be comforting, they offer a semblance of control when everything else seems frighteningly out of control. If the pain or other struggles become too much then suicide simplifies everything. It’s why prisoners are kept on suicide watch: to stop them having any control whatsoever over their own life. To remove that final aspect of control from a person who sees suicide as their last resort is a form of torture.
Feelings of despair and suicidality are more than worthy of being heard, they are the heart of the matter. Sometimes they are a howl from the past when events took over and swept you away. Sometimes the present is unbearable. You know that no one ever gets over the death of a child or another dearly loved person and the idea of living with this pain seems impossible at the same time as beginning to come to terms with it can seem like a betrayal. Moving into the liminal space between life and death can be caused by cumulative smaller events: being subjected to ‘regeneration’ or being made redundant; the end of another relationship or many long years of a violent one; workplace insults and misery can wear a person down to nothing. Living with suicidal feelings can become habitual, the neurological pathways between anxiety, a sad thought, a difficult event and the solution of death become well worn and more swiftly travelled without us even realising it.
Whatever the case examining these feelings and thoughts is the work of therapy. Bringing a light into these places can make them less mysterious, less alarming. Looking at them squarely can diminish their power and witnessing them honours what may have been longing to be seen for many years.
No counsellor can stop a person who is determined to kill themselves. For some people life is genuinely too complex and painful to endure and no amount of care, trust, relationship, medication, voluntary or involuntary hospitalisation or anything else will ultimately prevent it. Yes, suicide often bequeathes more pain and misery, no one denies that, and there are often ways out of present agony other than death.
If you can choose to die at any time, take the time to share your truth with someone who can bear it.
Maytree - 020 7263 7070
Samaritans 116 123
A fair number of clients describe very similar problems. They’re constantly tired, or very edgy and unable to rest; teary, stressed and not coping. What used to be small problems have become insurmountable. They’re irritable, panicky and can sometimes behave in ways that seem beyond their control leaving them feeling ashamed, stupid, defensive and angry.
As well as taking these symptoms seriously in a psychological sense I’ll also ask them to visit their GP to request some blood tests.
Full Blood Count (FBC)
This measures your general health, including how much iron you have in your blood. Anaemia – a lack of iron – can make you feel exhausted, short of breath and cause palpitations. Shortness of breath and palpitations are also symptoms of panic attacks.
Low levels of magnesium and calcium can cause panic attacks.
An FBC will show if you have any underlying infections which will make you feel tired and less able to get through the day.
Thyroid Function Test
The symptoms of an over- or under-active thyroid are very close to the symptoms of anxiety or depression. An overactive thyroid can also result in mood swings, insomnia, persistent tiredness and weakness, and the classic symptoms of a panic attack, palpitations, nervousness and irritability.
A Blood Glucose Test
GP’s generally offer 2 types of blood glucose (sugar) test for people who are not showing overt signs of diabetes: the fasting glucose which shows what is happening to your glucose levels after 8 hours of not eating, and the HbA1C which shows what your average glucose levels have been over the past three months.
Type 2 diabetes is increasingly common and can lurk for years before it’s diagnosed. Some of the symptoms of it are tiredness, depression, and the classic symptoms of a panic attack: anxiety, sweating, palpitations, trembling. If your blood sugar suddenly drops, as it can do in diabetes, you can also feel irritable and bad tempered.
These tests are performed at the same time with just one needle and take about 20ml of blood in total.
Once you and your doctor get the results you will both have a much better idea of what may be causing you to feel psychologically unwell. Even if you have a clinical diagnosis of depression, anxiety or panic disorder, get these tests done. Physical causes of symptoms are notoriously ignored in people with a mental health diagnosis. And as with any medical issue if your GP is unhelpful get a new GP.
There’s an intimate link between the body and the mind and just by attending to what the body needs, whether that’s more or less thyroxin, iron or just water, we can improve and sometimes even cure what seem to be emotional problems. If you have an underlying physical problem that you don’t know about therapy can help you be more motivated to attend to your health so that you eat better food, exercise and drink water more regularly, but this will not address a problem thyroid gland, low iron or diabetes.
You never know, you may be able to avoid therapy altogether!
Tomorrow is the big day and I’ve yet to meet anyone waiting for their results who isn’t anxious. For young people this is an especially critical time because so much depends on it. Whether or not you get into the university that you want to. Whether or not you leave home. How you’ll compare to your peers.
The hours up to 8am tomorrow can feel unbearable but there are a few simple things you can do to manage your stress.
Most importantly, move around. It doesn’t matter if the movement is housework, going to the gym, taking the dog for a walk whatever it takes to get the air moving in your lungs and to build up a bit of a sweat. Stress releases adrenaline and the purpose of adrenaline is to make your muscles more efficient for escaping or fighting. If adrenaline just hangs around in your body you will become irritable and restless. If it comes to it, just jump up and down on the spot until you get breathless. If any of that breathlessness is because you’re laughing at yourself jumping up and down on the spot, so much the better.
From now on any time you feel anxious, use the adrenaline that is produced by your anxiety.
The next most useful thing you can do is have a drink of water. Just water. Not juice or coke or alcohol. There’s a link between even very slight levels of dehydration and anxiety, so rule that out. And have a glass of water every hour or so.
Now, spend 30 seconds breathing properly.
Stand up. Plant your feet firmly on the floor. Imagine a thread pulling you gently upright from the crown of your head.
Breathe in through your nose and imagine that you’re filling your lungs from your belly button upwards. Your tummy should move, then your chest, but not your shoulders.
Let the air move into your body and then gently let it flow out again. Again, your tummy should move then your chest, and your shoulders shouldn’t move. The in and the out breath should take about 12 to 15 seconds.
That breath is how you should be aiming to breathe all the time. From your belly button up as your breathe in. From the belly button up as you breathe out. Simply breathing like that will ensure that you’re not breathing shallowly and too quickly, in a way that can actually bring on a panic attack. If you’re breathing effectively your voice should become a little deeper. If you hear your voice getting high pitched you know that you’re not breathing effectively.
Slow down. Plant your feet flat on the floor. Breathe.
This kind of breathing will slow your thoughts down and help you get things in perspective.
The only admin you can do between now and then is to get the email address and phone numbers of the universities you want to go to, and those of your insurance choices
The UKAS Track website will freeze from 6pm today. For what it’s worth, I’d leave it alone now. You’ve already changed everything you need to. It doesn’t update at midnight and won’t be open until 8am tomorrow.
UCAS’ social media team will be around from 6am and the contact centre opens at 7.30am for enquiries. There’s no point in spending any more time with the website until then.
So get some things in place from now until you pick up your results.
Try not to make alcohol one of them.
Timetable in a couple of exercise sessions – yes, a couple! - and if you can do them with a friend so much the better. Go swimming, go for a run or a long walk. Do some sit ups, press-ups or planks. Do the washing up, cook dinner, clean the windows, walk the dog, try to make the expenditure of energy meaningful. If you can’t find anyone to do exercise with just do it by yourself. Exercise will help you sleep better tonight, so put your heart into it.
Plan a good evening meal, something that has a decent amount of protein in it. Tryptophan is an amino acid, one of the building blocks of protein, that aids sleep and combats anxiety. You’ll find good levels of tryptophan in nuts, tofu, meat – especially turkey – eggs, cheese, beans, lentils and oats. Plan your breakfast around this list too.
Set an alarm, right now, to remind you to breathe properly for 1 minute every waking hour. That’s a total of about 12 minutes. About 50 good breaths.
Find a good distraction and immerse yourself in it. If it’s an outdoor distraction that’s great. If it’s outdoors with friends, even better. If it’s gaming, well so be it, just don’t turn into a slob. Drink water. Get away from the screen to eat a good meal. Run up and down some stairs once in a while. And stop around 10pm at the latest.
Be kind to yourself.
There may be some very critical voices in your head telling you that your life will come to an end if you don’t get the results you need, that you didn’t work hard enough, that you’re a disappointment to your family and to yourself.
Perhaps you didn’t work hard enough. There’s nothing you can do about that now. You can determine to work harder from now on. That’s all anyone can do.
When I did my A levels a friends mother wouldn’t talk to him for 3 days because he didn’t get the results she wanted him to get. We all thought she was cruel and wrong. 30+ years on, knowing all about the causes of punishing behaviours I still think she was cruel and wrong.
If your family or anyone else punishes you for not getting the grades you need they too are cruel and wrong. There’s no point in punishing you. Punishment – including passive aggressive sighing “It’s OK. I know you did your best,” ie "I know you're not very clever," – is not going to alter your grades.
Some families look to their children to lift them out of poverty. In countries where that is a matter of survival pressures are different but in the UK getting good grades is not a matter of life and death. Your parents may well have made sacrifices to get you through education. That’s what parents are meant to do.
What people who take A levels are supposed to do is to work hard enough to get the best grades they can without driving themselves mad. Anorexia, bulimia, depression and anxiety have exploded in young people. That’s a price that’s just not worth paying for A grades. For anything at all.
Breathe in and out properly twice RIGHT NOW!
Then go and get a drink of water.
There comes a point when you have to take stock and say, “Things are bad.”
The beginning of the economic downturn saw a tedious increase in ‘experts’ telling us that positivity would make everything better. Thinking about what is good rather than bad and focusing on the good stuff really can build new neural pathways and change your attitude for the better. But it won't help if you want to walk across the road with your eyes shut.
Very quickly the suggestion that positivity can be helpful has turned into a demand. We live in a country where therapists are working with the DWP to make unemployed people go back to paid employment and where paid employment is suddenly perceived as a ‘positive health outcome.’ If you think that’s wonderful then you don’t care about evidence.
It is unethical, counterproductive and has no basis in fact. It speaks volumes about the desperation that many therapists are feeling.
Because you’re reading this it’s probable that you’re all too aware that things have been falling apart for some time. Many businesses can’t afford the materials and staff they need and so existing staff are working at the edges of their ability and capacity. Public services - the services we all use when we travel, get ill, expect an educated population or want our elderly relatives to have some kind of dignity – have been amputated. Things are falling apart. The most vulnerable amongst us have been telling us this for years. And now ordinary people who are not vulnerable are feeling it.
Cognitive dissonance is
“the mental stress experienced by a person who simultaneously holds two or more contradictory beliefs, ideas, or values; when performing an action that contradicts existing beliefs, ideas, or values; or when confronted with new information that contradicts existing beliefs, ideas, and values.”
We all experience it from time to time but many of us are finding a home in this unbearable environment.
Demands for positivity have become authoritarian, insisting that we cut a smile into our face and do little dances of joy to demonstrate team spirit or something. Anyone saying, “My life is hard” is a shirker. Anyone suggesting that motivational speeches don’t put food on the table is dismissed as unenthusiastic. People who want to care for a sick child are told that they must ‘arrange alternative childcare.’
How do you discern whether positivity indicates confidence or stupidity? Intelligence, good business strategy and the ability to avoid danger involves knowing when to cut our losses. The alternative is to continue staring at the sun, borrow unsustainable amounts of money, time and good will and crash disastrously.
Things are bad for most of us right now and, as adults, we need to look at facts rather than allow our prejudices and desires to rule us. Sterling is falling and the trend is downward. A 60-hour week is no longer unusual. (If you don’t work a 60 hour week that’s a good thing not an indication that you’re lazy.) Anxiety is twice as prevalent as depression. Our children are becoming more and more distressed.
If you’ve read my blog for a while you know I don’t like inspirational quotes and the pretence that everything will improve if we all just pull together and think happy thoughts. Now I’m saying that if you’re an ordinary person and you’re not feeling a bit crap that it’s likely that you’re ignoring something.
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