What if we REALLY got rid of shame about suicide?

by Thomas Ellis, PsyD, ABPP on March 1, 2014 · 7 comments

in suicide

De-stigmatization seems like such a no-brainer.

Stigma, whether associated with an affliction like AIDS, or (in our case) mental illness, is a bad thing. It brings suffering to victims above and beyond that inflicted by their illness. At its worst, it brings with it such shame that people often don’t obtain the care they need.

Ironically, this sword has another edge that’s not immediately apparent, for when true de-stigmatization starts to take hold, some of us start to feel, well, a little uncomfortable. Some of us remember the edginess we felt when we first heard Betty Ford talk about her breast cancer. Or Magic Johnson talk about AIDS. Or Robert Downey, Jr. talk about his chemical dependency.

Surviving suicide attempts

suicide attempt survivorsA less well-known, present-day example is the emergence “from the shadows” of people who have made suicide attempts and survived. The field of suicide prevention has seen a lot of change over the past few decades, as we have sought to make suicide okay to talk about. The last thing most of us would want would be shaming around this topic.

But we mental health professionals also place high value on the individual’s right to privacy, and we can even get a little (or a lot) protective of our patients’ privacy (such as not even acknowledging we know a patient, much less divulging information).

By extension, we can even become a little paternalistic about even the patient’s own right (or the advisability) of disclosing information. To wit: Is it really OK for a current or former patient to disclose on Menninger’s Facebook page or blog site, or perhaps at a conference we sponsor, that he or she made a suicide attempt (and perhaps continues to have suicidal episodes?). Not that he or she doesn’t have a right to disclose whatever he or she wants on his or her own, but can we ethically be a party to this disclosure?

You might think, “obviously not,” but consider this: The American Association of Suicidology (AAS) recently began sponsoring an interest group devoted to bringing suicide attempts “out of the closet.” This group of “attempt survivors” now has space on the AAS website where individuals can post messages about their own experiences with suicidal episodes.

Now these are not clients of AAS, nor is AAS a clinical organization; so no confidentiality is being breached here. Nevertheless, these are arguably vulnerable people putting highly sensitive information “out there,” where it cannot be controlled by the AAS or anyone else. Or are these perhaps paternalistic sensitivities of an overprotective clinician, viewing these individuals as less resilient than they actually are?

Here’s a recent post, a remarkable video of a young man, Misha Kessler (his real name). He nearly killed himself, and here he shares his story:

 

Questions to consider

Misha is remarkably articulate and apparently unabashed about this self-disclosure. Is this OK? Is he harming himself, now or potentially in the future, with a video that he can never take back? Or does the good done by this courageous act trump any adverse future consequences? Does the empowerment and de-stigmatization (there’s that word again) bring more benefit to his psychological health than the cost of any judgment that he might experience from others (including prospective mates or employers) who don’t “get it?”

From a distance, I am cheering Misha on. De-stigmatization of suicide, like de-stigmatization of alcoholism or homosexuality, can’t come too soon. Then, putting it to the ultimate test, I ask myself: What if he were my son?

Can I get back to you on that one?

Take a look at the video. Let us know what you think. No right or wrong answers here.

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{ 5 comments… read them below or add one }

Debi Strong March 3, 2014 at 8:39 pm

After looking at some of the other comments, I feel the need to add this: no matter how many credentials or degrees one has in the fields of psychology , neurobiology, etc., one can never know the pain of major depression and the hopelessness that results in a suicide (successful or not) until one has actually been there.
There are lots of professionals writing about the subject of suicide, and they have been studying the issue for many years. The fact that more and more people are suffering from depression and killing themselves at an increasing rate around the world suggests that these professionals, along with shame and stigma, are not the appropriate roads to making progress. I feel very strongly that we who have been there need to be part of the solution, and we need to be treated with respect and not coddled as fragile beings if we are truly in recovery.
We have a lot to offer to others who are still in that deep, dark hole surrounded by monsters. I think there have to be ways for peers to work along side professionals to create a synergy that could truly make a difference…

Deanna Cross March 3, 2014 at 7:08 pm

As an attempt-survivor who went on to degrees in psychology and counseling/therapy, I feel the insight I gained became a valuable tool for life. The difficulty I had was in explaining and gaining understanding from others about the horrendous pain mental ill-health can have.
I do not regret my decision to quit living (Freud said that we cannot conceive our own death), it was a way to be rid of the pain. Some of that pain still persists, as I must now deal with a debilitating, incurable disease.
And you are right, others do become uncomforable hearing about one’s experience with mental illness, and/or talk of suicide.
I decided, therefore, to put my experience in a book (no one wanted written) and still receive very little feedback–as though it is something that should be kept secret.

Jenn G March 3, 2014 at 8:02 am

As someone who has written multiple times for the AAS Attempt Survivors blog, I felt it was important to point out something that Dr. Ellis has apparently overlooked – how incredibly cathartic it is to write about these feelings and experiences that are so far outside the realm of normal human life and the community of attempt survivors that it has helped create. And yes, we are resilient. The fact that we are still here is proof of that.

I “came out” last May on the blog and was justifiably terrified of what people might think of me. Luckily, the clinicians who treat me were proud of my courage and praised my honesty and have even referred other patients to the blog for support and to help them appreciate that they are not alone in their struggles. My friends and family have been beyond supportive. My father, who found out about my suicide attempt from reading the blog, regularly prints out my blogs and gives them to others who work in suicide prevention with him in another state. I have received numerous emails from individuals who received the blogs from my father with the words, “she is my hero.” I would hope Dr. Ellis would feel that way about Misha.

Sue Martin March 2, 2014 at 3:52 pm

I bridled at this post when I first read it. In particular my hackles went up over this, “Nevertheless, these are arguably vulnerable people putting highly sensitive information “out there,” where it cannot be controlled by the AAS or anyone else.”
My suicide attempt was in the early 1980s. I remember, quite clearly, being so ashamed of wanting to kill myself. I thought I was the only person who had ever felt so terrible. I don’t remember if people were speaking openly about suicidal depression in the 80’s. I expect not.
I’m really glad you wrote this post because that means you, and I am hopeful, other clinicians are paying attention to those of us who are speaking up about having tried to kill ourselves. There’s just a whiff of paternalism in your post but at least you recognize that there might be. Those of us who are speaking up and standing up are probably a lot more resilient than you think. Otherwise we wouldn’t be speaking up.
And if Misha was your son? I think you’d be very proud of him.

Debi Strong March 2, 2014 at 2:58 pm

As a former patient at Menninger, who has been “coming out” in a big way (most recently in a Menninger fundraising publication), I absolutely applaud Misha and his accomplishments.

As a mother, and because of all I’ve learned during recovery, my views are somewhat skewed. I cannot imagine myself, for instance, not using every possible resource available to help one of my children if they came to me with the story Misha described. It would be hard, especially if they were attending a prestigious college and appearing to be doing so “well.”
But I know better than most that appearances are not always to be trusted when it comes to “success” in our society. I know too many other people who, like myself, appear to be intelligent, resourceful, successful people in their fields, and yet suffer from crippling bouts of depression, feelings of worthlessness, and suicidal ideation. And some of these people I have known have successfully committed suicide.

Ultimately, the question of, “Suppose he were my son,” or something similar comes down to this: am I a compassionate human being who believes that we all have talents and strengths, as well as demons and vulnerabilities? Or do I believe that there are people who have absolutely no “soft” spots (and are not psychotic homicidal serial killers)? It certainly seems like a no-brainer question to me, but it’s not so cut-and-dry to most.

I believe that there are going to have to be some major changes in how employers in fields other than mental/behavioral health are going to view these issues, because hiring someone who can hide their vulnerabilities well, as opposed to someone who is open and honest and dealing with their problems, is not always the wisest choice. I believe full-disclosure benefits all parties involved and makes for a healthier workplace.

A big discussion needs to be started in the world outside of mental health, and the sooner the better. We cannot discriminate against people in their employment because of mental health issues. People need to be helped if they are suffering, and others need support to stay in recovery. Can they do the job? Do they have the skills and education, or whatever specifics are needed? These are the most important questions for employers.

But I see the reality of this mental health stigma daily as I talk to people about the depression support group I lead. There are two big reasons people give me for not being able to attend: 1)they are professionals who don’t want to be labeled as depressed, and/or 2) they don’t want to be seen going into the facility where I lead the group (an acute psychiatric treatment center). These same people don’t deny that they need help. They admit they are suffering. But they refuse to seek assistance because it might change other peoples’ perceptions of them or cause them trouble where they work. Bottom line: this belief is not going to make the world a better place for any of us.

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