Stephen Fry is frank

Stephen Fry is a well known actor author and comedian. In an interview this week he revealed his fears that he might kill himself one day.

I remember reading of research about typical responses in the workplace to someone admitting they were depressed or suicidal. It was depressing research, with ‘get over it’ and ‘buck up’ being the regarded as most helpful by colleagues of someone with depression. Those same responses were probably regraded as least helpful by those affected by the condition.

A person with depression can’t just get over it or snap out of it. Rather than being helpful, those types responses highlight a lack of understanding about mental health conditions. Lack of understanding and misconceptions about depression contribute to the stigma associated with it, and to the isolation of those afflicted.

Reading the responses from readers posted against the Stephen Fry article I am dismayed. The research was many years ago and I thought, I hoped, we had made some progress. Maybe not. Reading those comments I can see the stigma around mental health is as pervasive as ever.

Stephen Fry was asked about his bi-polar condition in an interview and he was frank, realistic, in his responses. Empathy, it seems,from we the readers, is still too much to ask for.

*I have written about what you can do if a friend is suicidal. There are links to information about what to say, what not to say and how to support a friend in need.

Crisis counselling is available around the world. In Australia Life Line 13 11 14.

A selfish, cowardly act? I don’t think so…

Recently I heard someone say that suicide is “…a selfish act” they said it was “…the most narcissistic act a person could do”, they thought it “cowardly”. The sentiment and the words upset me.

I have written a lot about crippling effects of a deep depression, the crushing lows and isolation. I have read a lot and there isn’t any source where there is a hint of selfishness. In his journal Mottsu wrote of struggling with something “ terrifyingly unfathomable” a “debilitating life in my head” that prevented him from feeling “normal”. They’re not the words of a cowardly man but a strong man balancing on the the cliff edge of life and facing death.

Scientific American described suicide as “an attempt to escape from oneself”. The suicidal mind is described as “unbearable”, burdened with a “crushing intolerable weight”. The same article says “Feelings of worthlessness, shame, guilt, inadequacy, or feeling exposed, humiliated and rejected leads suicidal people to dislike themselves in a manner that, essentially, cleaves them off from an idealized humanity. The self is seen as being enduringly undesirable; there is no hope for change and the core self is perceived as being rotten.” That’s not the mind of a narcissist. Is it?

In anger at losing someone to suicide you might feel abandoned, you might wonder how they could leave so abruptly, you might think lots of things about the person who has died, and I hope you remember them well, and not think less of them for their decision and actions. Compassion and understanding make the world an easier place to live in, not anger, blame and stigma. Don’t let the way someone dies change how you remember them living. Please don’t think badly of someone who dies by suicide.

This conversation and a debate we should have more often, so that the negative emotional urgency that motivates (many instances of) suicide is not confused with a selfish desire for death.

“There is but one true serious philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy.”

Albert Camus, “An Absurd Reasoning” quoted in Oates, J. C. (2011). A Widows story:A Memoir. New York NY:Harper Collins

Crisis counselling is available around the world. In Australia Life Line 13 11 14.

Concession

From time to time it is necessary to concede that the advice of a Professional is necessary. There are many reasons one might consult a Professional; health, money, job seeking are a couple of areas where advice can be helpful. Unfortunately said Professional is prone to labelling conditions after a diagnosis. You may find yourself regarded as depressed, in debt, or unemployed. Labels that stick.

The naming, or labelling, of an ailment can provide relief, instructing us about courses of action. For family and friends a diagnosis can bring information, understanding. A diagnosis can also come loaded with fear, dread, misinformation and pre-determined treatments.

Why is seeking care a concession?

For me asking for help requires a concession that I am unable to look after myself and that’s a position of vulnerability. It’s hard to do and exacerbated, in part, by the attitude of some medical practitioners, not to mention the resource constrained system in which they operate. The readiness with which a prescription is dispensed scares me, I worry that my natural immunity may be compromised by medication. I have no patience for being an obedient patient whose treatment is dictated to her. I expect my health advisors, doctors and specialists, to consider me a client,and one who wants to be informed about treatment options and active in decisions affecting her well being..

Mottsu did not wish to give up, or concede, his powers of self determination to any helping authority who might have forcibly held him and drugged him. He knew better than to disclose his darkest thoughts and be detained in treatment. He held onto himself and used his strength for his own self determination. The church, the law, and society in general condemn his suicide as wrong. I mourn for my loss but I think it is the medical system and not the man who needed to concede to the wishes of the other.

Better ways of caring are required.

Fact and fiction

Depression can be fatal. I now know that a condition barely visible to an observer can be deadly. I know the fabulous wonder of the mind and its creative imaginings and only a little of its destructive power when in the grip of a dark absence of feeling.

You can recover from depression. With support, treatment and care, it is possible to recover. Recovery is an option. “To remain as I am is impossible. I must die or be better.” said Abraham Lincoln.

Suicide is preventable. I hope so, that is not my experience so I can’t say for sure. Reading the story in the Australian, I caught the part, about guilt. There is a guilt shared by people touched by a death by suicide. Prevention efforts and campaigns have high visibility and lend support to the premise that suicide is preventable. Is the burden for prevention to be shouldered by those with the closest relationships? The wife, mother, sister, daughter, the best friend?

It might be more truthful to say that suicide in not inevitable. I don’t know if that is closer to the truth. To believe suicide is preventable belies the numbed, detached state of the suicidal. If suicide is preventable there are many, like me, who failed in that task. The shadow of guilt, cast by not having prevented a death, is a big part of the stigma that holds back conversations about suicide.

I feel implicated by various reactions of disbelief and horror, and the lack of discussion and the reluctance to engage on the topic. It is funny how upsetting others can be when they don’t want to upset me.

I may not be guilty for Mottsu’s suicide, the super pillow incident notwithstanding, certainly not to blame. Blameless? That’s a whole other conversation for another blog post. I am guilty of not having prevented his suicide, for not knowing it was even a possibility. I am guilty for underestimating the possible outcomes of his depression.

It might be time to talk but not with a psychiatrist…

An article in the New York Times caught my attention. It states that:
“Recent studies suggest that talk therapy may be as good as or better than drugs in the treatment of depression, but fewer than half of depressed patients now get such therapy compared with the vast majority 20 years ago.’

The story describes how brief consultations are required by insurers who reimburse patients and set the rates schedules. In a 15 minute consultation a psychiatrist can do little more than provide a prescription. I understand it is only psychiatrists can prescribe psychiatric medication, and other types of therapists can not, and previously psychiatrists could also provide talk therapy, with more patient time (and more patient insurers), there was more opportunity to tailor the treatment.

I find that alarming and worthy of talking about, because medication is not for everyone. Mottsu,for example did not feel psychiatric medication would be helpful and he sought psychological support. The treatment is not condemned by the outcome, Mottsu’s situation and process were complex.

The treatment of depression requires healing in the guise of both medical science and healing arts, there’s no panacea. Anybody’s situation and process are complex, what works for one may not work for another. I like talk therapy.

Returning to the article, linked above, “Dr. Levin expressed some astonishment that his patients admire him as much as they do. ‘The sad thing is that I’m very important to them, but I barely know them,’ he said. ‘I feel shame about that, but that’s probably because I was trained in a different era’.”

That’s a good reminder: my therapist is, in all likelihood, more important to me than I am to them.

There are many helping professions offering healing interventions, psychiatrists, psychologists, psychotherapists, counsellors, and then doctors too. Standards are established and maintained by professional authorising bodies. Qualifications and requirements differ in different states and countries, so I won’t attempt to describe them and risk getting it wrong. Each offers different forms of treatment and there are some overlaps, and there are different schools of thought and approaches within a profession.

A doctor would be a good person to advise on what each can do. Recommendations are helpful and listen to your inclinations and leanings, follow your them. Trust your cynicism and seek treatments that fit best. Talk about it.

Facing down fear

I learned a little while back that Electroconvulsive Therapy – ECT is still used in the treatment of deep depression. I was shocked, but that sounds wrong so let’s say I was aghast. ECT was something I only knew of from movies, and the my memory of the movie images was fairly frightening.

I mention it because I have been thinking about fear. I have a friend who is going to face down her fear of heights. She is challenging herself scaling great heights freezing up, coming through and then setting another challenge. She terrifies herself while learning she can be safe even at uncomfortable heights. It is working she is proud and victorious. I hope her efforts prove the antidote to fear. I admire her tenacity but it’s not for me. I have my own mantra “No pain – no pain”.

Another friend was offered ECT as treatment. Scary and no pain – no pain didn’t hold true this time. The treatment and its side effects were explained to her, the fear didn’t disippate but she was determined to be better, whatever it took. Her bravery was different to my heights-fearing friend, both are amazing women.

The friend considering ECT as a path to wellness listened to her doctors, she asked questions, talked to her family and expressed fears. She went into her treatment with eyes open and scared. ECT might not be what I would do in the same situation, I can’t say. My dear friend however is proud and victorious just like the first friend.

Fear can be stared down, you don’t have to. In any situation seek qualified advice find out what you need to know and make your own choices. Fear can be respected, and it can be overcome, both are valid choices.

So how does it feel if one simply can’t get a grip?

As a counter-point to The Daily Mail article I wrote about yesterday is this truly fabulous blog Who Stole My Smile? subtitled as A Blog of One Man’s Fight Against Depression and its Stigma. It’s written by Adam Glenn, someone who is really making a difference.

On January 5th he posted an entry called What I’m Feeling and said….

But I’m tired. I’m tired of the low self-esteem. I’m tired of the feelings of worthlessness and hopelessness. I’m tired of simple tasks feeling like monumental undertakings. I’m tired of finding no joy in things I used to love to do.

I’m trying to get better, but these feelings hit me every day. This dark fog envelopes me and makes it so hard to see the way. How can I hope to get out? How can I hope to be the person I was before all this depression?”

This is one eloquent person with depression who doesn’t need to get a grip, he has a firm grip already. I nearly wrote ‘depressed person’ in the previous sentence, but I think ‘person with depression’ is a better phrase, it makes a difference.

Talking, blogging, sharing all make a difference, helps others to talk about the same. Talking helps us appreciate how depression feels and to start understand what can be done to support people with depression, real people, normal people with their real and normal mental states.

Adam Glenn is doing exactly what Professor Damasio advocates “Perhaps the most indispensable thing we can do as human beings, everyday of our lives, is remind ourselves and others of our complexity, fragility, finiteness, and uniqueness.” Damasio, A. (1994) Descartes’ Error : Emotion, Reason, and the Human Brain, London: Vintage.

Crisis counselling is available around the world. In Australia Life Line 13 11 14.

A Friend Indeed

What can you do for a friend with severe depression? It is an important question, I am sometimes asked what should be done, what might help? Depression is a serious condition that people can die from, it needs treatment. I would just say that if a problem is shared with you don’t wait, start listening and understanding. There is a lot you can do as a friend:

• Be a friend to your friend.

• Hold your friend’s hand in any way that is comfortable. If a substantive physical clasp isn’t your style (or perhaps their style) hold on metaphorically.

• Talk to them and listen to them. Stay in touch, be around. Answer the phone if your friend calls, and ring them just to check-in and say hello. Here is a great practical list of things to say and not to say to a friend with depression.

• Seek support, encourage them to see a doctor. Support your friend to get to appointments, sit in the waiting room and drive them home, be supportive of their treatment. Help them feel safe.

• Look after yourself, make sure you have a soft place to land and seek support for your own well-being.

Here is another practical list of things, there’s some overlap with the list above (as you would hope), it is useful information. Being a friend to someone with depression can be demanding, and you can make a difference.

Crisis counselling is available around the world. In Australia Life Line 13 11 14.

A sad soul can kill you…

I came across a quote today “A sad soul can kill you quicker, far quicker, than a germ.”

John Steinbeck wrote that in Travels With Charley, his book about a journey across America (and back) with his dog. It sounds like he is issuing a warning not to underestimate depression as an affliction.

A sad soul can kill you, and quickly too.

Last August I wrote about Elizabeth Wurtzel who said it happens gradually and then suddenly . In my experience the gradual part is hardly noticed by anyone.

Wurtzel wrote: “Depression is a lot like that: Slowly, over the years, the data will accumulate in your heart and mind, a computer program for total negativity will build into your system, making life feel more and more unbearable. But you won’t even notice it coming on, thinking that it is somehow normal…and then one day you realize that your entire life is just awful, not worth living, a horror and a black blot on the white terrain of human existence. One morning you wake up afraid you are going to live.” Wurtzel, E. Prozac Nation: Young and Depressed in America (1994) NY:The Berkley Publishing Group

I could take Steinbeck’s quote to mean that sadness of the soul is more lethal than germs. That thought is more evident in the full passage of Steinbeck: “I remember an old Arab in North Africa, a man whose hands had never felt water. He gave me mint tea in a glass so coated with use that it was opaque, but he handed me companionship and the tea was wonderful because of it. And without any protection my teeth didn’t fall out, nor did running sores develop. I began to formulate a new law describing the relationship of protection to despondency. A sad soul can kill you quicker, far quicker, than a germ” Steinbeck, J. (1962) Travels with Charley in Search of America. USA:Viking Press

I know I get so easily wounded by the words and action of others, I could think those who harm are the sad souls who will quickly kill you. That might be a part of the message, but reading this again and again I think the sad soul is the one who can’t accept the (imperfect) companionship of another. Friends.

Crisis counselling is available around the world. In Australia Life Line 13 11 14.

What it feels like to kill yourself

*This post could be tough to read, it wasn’t easy to write and this insight is helpful for someone left behind after a death by suicide (I mean me). If you or someone you know needs emotional support, in Australia call Lifeline on 13 11 14. Crisis Counselling is available around the world.

I came across an incredible article published in Scientific American last month. Incredible because it gave me insight to what I had witnessed from the outside. The article affirmed what I have been thinking that I can not judge the thinking of a suicidal mind by the standards of a non-suicidal one, and to do so is flawed.

The article draws on the work of Florida State University psychologist Roy Baumeister and his 1990 Psychological Review article , “Suicide as Escape from the Self.” In that article he described six steps that, culminate in a probable suicide if all of the criteria are met. He noted that if any of the steps are avoided the outcome is unlikely to be a suicide:

* 1. Falling short, of standards. Almost paradoxically the better things are; the higher the living standards, the better the weather, the smarter the student the greater the risk of suicide. As high achievers know, high expectations can lead to bitter, even if only perceived, disappointments. Evidence supports the premise that preceding suicide is failure to attain expectations and standards.

* 2. Internal attributions. People who die by suicide blame themselves,for outcomes. Self loathing and self condemnation take hold. On Mottsu’s last day he commented on my goodness for buying Wally, our dog, a Birthday present. It was obvious to me that his own badness was at the fore. I tried to reassure him, Wally didn’t know it was his birthday or that he had a gift. I had only bought a present, a drizabone raincoat, hoping to make Mottsu smile. Mottsu beyond smiling was, at that late stage, convinced he was no good.

* 3. Uncompassionate and high self-awareness. At this stage there is a heightened and relentlessly unforgiving self awareness. In comparison to others the suicidally depressed person assess themselves as chronically deficient of the expectations of others.

* 4. Negative Affect. Feeling marginalised because there is something wrong with you is the next step. The emotional distress and anxiety of depression can bring on feelings of shame and other acute negative emotions, a downward spiral. Mottsu’s journal entries confirm a negative affect.

* 5. Cognitive deconstruction.When preparing for suicide, one can finally cease to worry about the future, for one has effectively decided that there will be no future. The past, too, has ceased to matter, for it is nearly ended and will no longer cause grief, worry, or anxiety. And the imminence of death may help focus the mind on the immediate present.” I have heard anecdotal evidence that in the immediate lead to suicide people seem less depressed than previously, relief that’s apparent with the decision can be mistaken for a start of recovery.

* 6. Disinhibition. Any inhibition about killing oneself is gone. In this final stage, there is no optimism left, no sense of living. “Alternating between being numb and feeling very bad is not a good thing,” Dr. Baumeister said. It is perhaps unsurprising that the oblivion of suicide is sought to make it all stop. Living has become intolerable and disinhibition is what allows

It’s all information and I find it helpful in trying to comprehend what is most difficult to understand I’ve written a lot and plan to keep writing on difficult topics. I am learning.

Some related posts:
Hope can be learned
The hardest thing in the world to do is live
Depression can huddle like a sick ape in the back of your mind
Depression is nearly incomprehensible to those who haven’t experienced it
Someone will hold your hand
You can recover from depression
There are things you can do if a friend is in crisis
This is a topic we should talk about more and report more

Tough topic.