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
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.
Avatar was on the television again this evening and I was reminded of the phenomenon of Avatar Blues
"One can say my depression was twofold: I was depressed because I really wanted to live in Pandora, which seemed like such a perfect place, but I was also depressed and disgusted with the sight of our world, what we have done to Earth. I so much
wanted to escape reality," Hill said.
We’re living through extraordinary times. As I write this people are being held at American airports and sent to any old country.
In the UK the temptation is to say: “That will never happen here.” Yet we have had a British MP murdered by a member of a legal organisation. Within a day of the Brexit vote hate crimes began and within two weeks had increased by 58%. If you’ve spent any amount of time online you’ll be aware of newly emboldened commentary from people sneering, bullying, spilling over with contempt.
So if you have an ounce of sensitivity a film like Avatar can be very painful. We know that indigenous people have been destroyed whenever they come into contact with our civilisation. We know that animals and people do not connect in the way the film shows us, and that we have made the purpose of the natural world to be industrialised for our use. We know that the untamed world has never risen up against an enemy that is destroying it, and who can bear the destruction of the helplessness and innocent?
It is incredibly rare to be born blunted and callous. We have to close large parts of our hearts and minds because to keep them open and vulnerable is too painful. Sometimes, because we are not exposed to pain happening in front of us, we ignore it.
Fascism doesn’t arrive wearing jackboots. Of course, if any group were forced to wear an identifying badge a great many of us would also wear that badge in solidarity. But would you identify as ‘Unemployed’? Or ‘Poor’?
The UK poor have been dying decades before their more prosperous neighbours for centuries. It’s quite normal for adverts at bus stops to tell us to anonymously inform on anyone we think may be defrauding the benefits system even though benefit fraud is such a minute issue that it’s not counted separately from errors in benefit distribution: combined they account for around 1% of the benefits bill. You know that unemployment benefits are 1% of the total benefits bill. And you know that pensions account for 42% of benefits.
If we can allow one group to suffer, to be identified as worthy of contempt and vilification, then we can allow it to happen to anyone. In our hearts we know that. There are three ways we can respond to it:
Join in with it.
Resistance is painful and exhausting. Acceptance can feel like a relief but it gnaws away at you because you know it’s wrong. Joining in with it can be wonderful. You’re amongst friends. They support you and you gain entrance to a genuine community with a narrative about the world that makes you feel justified and safe. Very often there is no downside to this, people do not wake up and say “I was wrong,” we go to our graves believing in things that are deeply, demonstrably wrong with no regrets.
For people who are unsure about what the hell is happening and what to do about it, it can feel best to keep it simple, to know the enemy and turn a blind eye. If you know the historical futility of resistance life can become unbearable. Low-grade suicidality is not at all unusual, it’s so common that many people don’t recognise it until it’s identified in their behaviours or in the casualness of their language. Pain becomes normal.
How to remain on an even keel in times like this?
Identify the parts of you, without judgement, that hate. We all have them. The part that says, “The Jews have put the house prices up there,” or “Trump’s mad but he’s got a point about Muslims,” or “If the poor worked harder they wouldn’t be poor.”
Non-judgement is absolutely critical. It’s not about being good or bad, it’s about knowing what’s going on. Treat that part of yourself with respect; listen to what it has to say. Listen. Don’t tell it what to do.
When we’re better able to hear ourselves, in all our aspects, we gain a better understanding of the world. When we’re able to be gentle with our own flaws we can accept them more gracefully in others. And at a time when grace is sorely lacking that’s becoming an urgent interpersonal and political need.
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:
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.
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