Depression has been under the spotlight this week after Robin Williams’ suicide. It’s great that despair – lets call it what it is rather than a medicalised euphemism - and mental ill-health are finally coming out of the dingy little spare room closet for an airing and wonderful that people who are suffering depression are having their voices heard. Talking about how mental ill-health can feel shameful, that there is little parity of esteem (a nice, tight, catchphrase) between the care offered to people with physical illness and people with mental illness is temporarily refreshing. Politicians and policy makers are saying worthy things about how dreadful this and that are and how they’ll make things better.

They're being economical with the truth.

People with chronic illnesses, physical and emotional, are being driven to suicide by the same ministers now saying how awful depression is, something that was recognised by the DWP back in 2012. It's only going to get worse.

It’s not just people at the end of their financial tether that are killing themselves. Successful men, you are killing yourselves at a catastrophic rate.

“We have a series of assumptions about suicide that are explicit and implicit, and they make a toxic mix,” Powell says. “One is that suicide is undertaken by failures: people who have no friends, who spend all their time in their room, who have something wrong with them. Are you going to talk about people close to you who might have taken their own lives if that is what others are thinking? If you say your son has taken his own life, then that means saying he’s a failure too. But when you look at the people who do this it’s quite the reverse - it’s often true that they are admired, well-loved and talented - though they might push themselves extremely hard.”

Take a look at this article:

"The most deadly criticism one could make of modern civilization is that apart from its man-made crises and catastrophes, is not humanly interesting. . . . In the end, such a civilization can produce only a mass man: incapable of spontaneous, self-directed activities: at best patient, docile, disciplined to monotonous work to an almost pathetic degree." Lewis Mumford, 1951

Unhappy women generally medicate and endure, unhappy men kill themselves.

I’m no fan of the Good Old Days when we all lived in each others pockets and did our socialising at the communal launderette or men-only club, but when as a nation we took the decision to vote for personal prosperity people began getting more sad. Now we're reaping that whirlwind. People who bought their council houses find their adult children have nowhere to live. When we all demanded cheap washing machines it was inevitable that manufacturing was going to go abroad. When we decided to treat each other as economic units it can’t come as too much of a surprise when we are also treated not as individual people but as things that make other things function. Like a widget. 

Counselling falls into this trap too. Far too many counsellors join in the scroungers and strivers nonsense. Too many believe that success is a client returning to work, even in the face of a foundational belief that our job is to support the client in discovering their own meaning for their own life.

For a great many people depression is a sign that your life has lost any meaning. A lot of people believe that having a high status job title, two posh cars, a big house and garden owned by the bank, and some nice clothes will mean their life is complete, but if they ever attain all that life remains just as hollow and meaningless as ever.

Look to the US which is 5 or so years ahead of us. If you want that life then do nothing, it’s on its way. You may be interested to learn that the American Dream has been totally debunked: if it were true then immigrant women would be sipping champagne in a swimming pool on a Learjet.

If you’re depressed take yourself seriously. As well as going to the GP and doing all the stuff you already know helps depression, think about what you want to do with your life. It may be that you want to spend more or less time with your children. You might want to spend more time awake, relaxed and communicating with your partner or you might want to get far away from them. You might regret having got on your bike like you were told to at 18, to move far away from your family, who are getting old. You may have to sell your house and move somewhere smaller (If you move out of London this won't be a problem.) you may have to take a significant wage cut. But you really are more than your job title and bank balance.

You don’t need to come to counselling to discover this – though it can be helpful to get some support as you explore your fears, desires and options. But you do need to recognise that something is wrong, understand that you don’t have to do what’s expected of you – even if it’s just you who’s putting you under pressure – and then dare to think of what you genuinely want to do with the rest of your life.

Campaign Against Living Miserably is a charity specifically for men under pressure.

The media is buzzing with commentary and opinion on Robin Williams’ suicide some of it fairly shocking. “Williams was selfish,” “What a stupid thing to do,” “Didn’t he know how much people loved him?”

People who haven’t experienced clinical depression can have no idea what depression is like. When it’s bad it’s a life sentence in an underground cell with no door or window. When depression is just ticking over you know that life is a sea of endless pain and loss and sorrow and that whilst there are little shallow islands of not-misery you know that continuing to live means having to continue swimming through pain and loss and sorrow.

Williams suffered bipolar disorder and had a long relationship with addiction. Other people have suffered bereavements, traumas, illnesses and disappointments that they just can’t recover from. Some people go through the world with one less layer of protective psychological skin than other people, that’s just the way they’re made. Anti-depressants can definitely help some people and other people are not helped by them. The same can be said for therapy: drugs and therapy can work well to begin with and then their efficacy wears off.

Imagine having an illness that isn’t visible, that can’t be seen on an x-ray or CAT scan or be identified in a blood sample. You can understand feeling miserable if you’re made redundant or a relationship ends or someone close to you dies but when those feelings spiral downward into depression that’s less easy to understand. You’ve read about exercise and diet being really good for depression, so why can’t they come out for a run or even a walk for goodness sake? Why can’t they just eat better?

Being around someone who is depressed can be tough. It’s difficult to understand why a depressed person just can’t clear their head, take a deep breath and see that life isn’t so awful – there is sunlight and beauty, joy and pleasure in the world there for the taking. What makes it particularly difficult is that to a great extent this is true, it’s just that for someone who is depressed it’s not. People who don’t have depression can aim to leave this painful place they’ve found themselves in, people with depression can do all the exercise and healthy eating and find god and all the rest of it, and some of it may help but for a significant number it won’t make much of a difference.

You might be surprised to know how many people seem completely fine but think about death every day.

Therapists have a duty to break confidentiality when someone discloses that they are acutely suicidal. That means that if someone says, “Thanks Clare, it’s been great but this is our last session. I’ll be killing myself later today,” or “I’ve taken an overdose,” I am obliged to call the clients GP and possibly an ambulance. That seems sensible to me. And there are some people who have become exhausted from trying to keep their head above the sea of misery. They’ve taken the drugs, had all the therapy, made the lifestyle changes, love their family and friends, feel guilty about the trauma they know they’ll leave behind them and the sheer weight of having to bear life is greater than everything else.

That’s what happens to a lot of people who get cancer, MS, Motor Neurone Disease, osteo- or rheumatoid arthritis or any other chronic condition. Many of us can understand why some of those people make their way to Dignitas because we can see how their illness has reduced their enjoyment of life to nil. That’s what many people with chronic depression feel and not all the love, care or sense of duty can make a difference.



RIP Robin Williams



A link to helpful resources for people who are suicidal is on my homepage, including the Maytree Sanctuary for the Suicidal. If you want to commemorate Williams, consider donating to them.

4 senior bankers have killed themselves in the last week. 

As a Bloomberg article says,



Though the reasons are not clear in either case, the coincident deaths will feed the discussion of excessive stress levels in the financial industry, not just for the young interns working 100-hour weeks but also for accomplished executives. Stress-related resignations, heart attacks and suicides may be par for the course in a high-octane, risky businesses, but the public does not really want finance to be one of these: Its money is at stake.

That sounds callous but it’s what all employers, including yours, are ultimately concerned about. If you are self-employed then you are likely to be even less caring about your own wellbeing than the average money-focused, gimlet-eyed employer.

Enough now. These men were amongst the most high-status, intelligent and wealthy people in society and they killed themselves. If they can find themselves locked into a despairing panic state then any of us can.

I don’t think it’s possible to say these 6 things too often:

• You want something to change as long as everything stays the same? Can you see why that’s not going to work?
• Your employer is not going to change. It’s going to have to be you.
• It’s very likely that to make your life better you’ll have to work fewer hours.
• If working to your contract and no more isn't possible then you may have to reduce your income.
• Even in a recession – and there is no recession in London – this is possible.
• You need to decide what’s more important to you: your status, your income or your health.
  

There are a great many techniques that will help you manage your time and your attitude towards work but working a consistent 50 hour week is just not sustainable. Don’t swallow the rhetoric about Hard Working Taxpayers. With unemployment down, why is productivity also down? Economists are baffled but for a small fee I'll tell them why this is: Everyone is outrageously hacked off, largely for excellent reasons. Don’t wait until you want to jump out of a window before you address it.

When ones career involves immersion into everyday distress and reactions, both positive and negative, to that distress it’s paradoxically easy to become distanced from it. 

Counsellors get used to hearing parts of peoples lives that are filled with anguish, melancholy, fury and sorrow and respond to suffering with care and interest. We discuss it, debate it, research it and attempt to make sense of it with clients and peers and thus the awful stigma of suffering rapidly diminishes.

So in a way it’s enlightening that so many parts of the media are calling today International Suicide Day, as if we’re all going to join hands and jump off bridges together sometime this afternoon, perhaps raising some sponsorship for a worthy cause at the same time. If this is the level of engagement that the Fourth Estate has for this most serious subject then there remains a massive amount of work to be done.

Suicide accounts for the death of one person worldwide every 40 seconds. In England it’s one person every 2 hours. One person every two hours.

If you are feeling suicidal you are not alone. That sense of isolation, of being utterly unable to make contact with someone who will listen to you and help you, is central to many people’s decision to kill themselves. In fact there are networks of people who will do precisely that: listen to you and help you avoid suicide.

The Samaritans is perhaps the best known and they’ve become more accessible. As well as speaking with someone on the phone you can write to or email them as well as dropping in to one of their branches.

NHS mental health services, from GP's to residential inpatient wards are everywhere. While some are good, many mental health wards are holding areas staffed by disinterested people and they will remain like that until we approach mental health with as much concern as we do the care of small children.

If you’re feeling suicidal and are not totally, utterly committed to killing yourself, if there’s the smallest doubt that you might not want to die then go to one of these centers. They will keep you alive, give you 3 meals a day, provide warmth, light and a bed and, taking all responsibility from you, give you time. You may meet a member of staff or another patient who will listen in a way that you find helpful. They can help connect you with other services that you didn’t know about. At the very least they can show you what route you may be heading down and offer a sobering view to the future. Any number of people have been so shocked by what they’ve experienced on psychiatric wards that they change their lives for the better to ensure they never return.

There are a small number of places run by people who have a genuine interest in and compassion for other people in crisis offering heartfelt care rather than statutory support. The Maytree, based in London is an enlightened, excellent place that offers “a short stay in a safe residential setting where you can talk, reflect and rest - and restore hope. Maytree is a place where you will be heard, respected and accepted, without judgement and in confidence.”

The Government has published a report today on reducing suicide which makes interesting reading. But unless we’re willing to ask for help, to offer help and to be able to point each other to meaningful help and support when we become suicidal, all the reports in the world are going to be meaningless. Reach out. You do not have to die today.