We Need To Talk About Suicide

Have you seen bumper stickers that say ‘Touched by the road toll’?

Probably.

Have you seen ones that say ‘Touched by suicide’?

Probably not.

And yet, death by suicide is more common than road accidents and the most common form for 15 to 34 year-olds (click here). This situation is unlikely to correct itself, and if governments persist in creating socioeconomic conditions that breed despair, it falls to community to work for change.

The first step is breaking the silence.

Dr Philip Nitschke, euthanasia campaigner, says we need more words for suicide, and he could be right from his end-of-life point of view (click here). After all, we have several words for killing another person – murder, manslaughter, negligence, accident – so why not for killing oneself?

Mainly, however, I think we need more words about suicide. Fears that talking about it will trigger ripple effects are now seen as misplaced (click here) and in this post I raise five questions for discussion and comment.

1. What do people say about their own suicidality?

Not enough, says David Webb, who completed the world’s first PhD on suicidality by someone with first-hand experience (click here).

Dr Webb has made a huge contribution to bringing lived experience into broader awareness. His website provides excellent resources (click here) and his view of the importance of first-person accounts is now more broadly recognised (click here). He describes his own experience as a crisis of the self, and vehemently opposes reducing diverse personal stories to a single story of mental illness.

What might we learn, he invites us to consider, by asking people about their own experiences?

2. And when family and friends are affected?

Many of us (perhaps most) are likely to be touched by suicide at some stage in our lives through family, friends, and colleagues, and hence to come to know the devastating grief, silence, and stigma (click here).

Last year, a young man in my brother’s extended family killed himself. When I asked my brother how he and his family were doing, he told me the date of the funeral, and then changed the subject.

Some years prior, my sister died an extremely uncomfortable death. She had a PEG feeding tube and when I asked if she would rather it was removed she said she wished she had not survived an earlier coma, and that she had her parish priest to talk to.

My brother did not want to talk, and my sister was politely telling me to mind my own (non-religious) business. Neither of these felt like helpful conversations, and I was perhaps overly reticent to avoid coming across as the ‘expert psychologist sister’.

But I wonder what other people would do in similar circumstances?

3. What about indirect contributors?

Suicide can also touch lives in ways that are less direct than family, friends, and colleagues. Jill Stark, for example, writes of the role the media can play, referring to a suicide that followed a story she wrote, and a more recent example involving a prank call by two radio announcers (click hereand here).

Another group who can be indirectly involved are train drivers (click hereand here). I had not thought about this until I met my first counselling client who was a train driver, and got a glimpse of how it would be sitting in that driver’s seat, horrified, aware of what was about to happen but powerless to stop it.

This person’s experience was many years ago, at a time when drivers were sent back to work the next day. We have made progress, but not enough. We are more aware, but not sufficiently. There are still blind spots and silences.

Who else is ‘touched by suicide’ that we should be more aware of?

4. What if death seems preferable?

Choosing one’s own death has some currency in relation to terminal illness, but what about cases in which the unbearable pain is primarily sociopsychospiritual?

A woman I worked with in counselling died by suicide nearly twenty years ago. It was excruciating – for many people, including me. For her, though, I am as sure as it is possible to be that bringing about her own death was about reclaiming power. This knowledge did not, however, short-circuit my questioning, sense of responsibility, self-doubt, and deep sadness.

Over the journey, particularly working with asylum seekers who have been threatened with deportation, I have known some who have experienced equivalent levels of despair, but were fortunately granted permanent visas and the possibility of rebuilding their lives. This is not always the case, and I would fully understand someone taking their own life rather than facing torture and death in the country from which they fled.

I think we need conversations within counselling professions (and the community more generally) about unbearable psychic pain. Medical professionals are more progressive in their domain, and some practitioners risk prosecution to stimulate law reform (click here, and here).

There are, of course, conflicting positions about collusion in suicide (click here and here) but shouldn’t we at least be having the conversations?

5. How can helping be helpful?

Some of the ‘help’ David Webb describes over his own suicidal journey – blaming, judging, panicking, diagnosing, prescribing, and institutionalizing – was, he notes, not helpful, and sometimes harmful. One response he did find helpful involved bearing witness – without judgement, false empathy, or trying to ‘fix’ him (click here).

In my own work as a psychologist I have aimed for a process that allows exploration of the space between suppressing and indulging suicidal feelings that Dr Webb describes. The challenge has been to do so without breaching professional requirements for risk assessment and duty of care.

This is not a simple navigational process and the line can be blurred and unpredictable. It is hardly surprising that practitioners err on the side of caution, but a process designed for clients should not easily backflip into one that protects the backs of counsellors.

In other words, how can we make sure that helping is helpful for those it is meant to help?

My thoughts in this post – about the lived experience of suicidality, how to help professionally and personally, how to start having conversations about unbearable psychic pain, and how to become more nuanced in our thinking about suicide – are no doubt the tip of the iceberg.

I am interested in responses to the issues I have raised, and additional ideas, insights and comments are also warmly invited, including sources of hope.