How do you talk about suicide?

Content Warning: this article discusses suicide. If you or someone you love is struggling, please call Lifeline on 13 11 14 or follow this link to a variety of alternative resources:

http://www.mentalhealthcommission.gov.au/get-help.aspx

As a literature major and a psychologist, the idea of writing about suicide is full of conflict. There is a burden to dispel the stigma around suicide with as blunt a force as necessary. At the same time while I have repeatedly seen suicide discussed in stories worldwide with sadness it is often coloured with Romanticisms watery pastels. To perfectly illustrate my point, at the time of writing the Wikipedia link to Romanticism in Literature has a photo of a young man dead at 17 years of age from suicide. At the turn of the 19th Century, notable Western intellectual heroes admitted their urge toward self-harm. This triggered a heated debate against the prevailing understanding of suicidality as weakness. In contradiction the Romans for instance considered suicide noble, depending on the circumstances. When Christianity prevailed (and also where most other religions outside the West held power) it was considered a sin. This black and white thinking is clearly still prevalent today.

The current understanding of depression and suicide is that a tendency to dysfunctionally over-think walks with it hand in hand. Analysis is an useful to uncover problems and protect ourselves from threat. In the case of the over-thinking associated with depression it is often due to an interpersonal threat (http://www.scientificamerican.com/article/depressions-evolutionary/). Too much analysis and your bias will be to find threat everywhere. You might fall into a habit of searching for what could possibly go wrong. That is a deep rabbit hole. When someone runs out of energy to dig the claustrophobia can be intolerable. It’s from this position that someone might consider suicide, and possibly write a suicide note. I want to pare back the complexity of the issue and use the blunt force I alluded to earlier. At the same time I want to address the romanticism that worries me. To do this I’d like to look into the phenomenon of the suicide note.

Can words adequately scrape up the relevance to explain such a profound act? My initial professional reaction is that a suicide note is reflective of a perception heavily reliant on an internal state that while may be frequently felt, is transitory. What is that experience though, and what do notes tell us when it comes from the source of an unusually unreliable narrator (we are all unreliable narrators). One of the most strongly carried experiences described through suicide notes is a heightened sense of perceived burden on others (http://www.apa.org/science/about/psa/2009/06/sci-brief.aspx) which reiterates the research that a suicide note is the attempt to address an overwhelming interpersonal issue. From my practice it seems that people come because they do not want to burden their friends. This is often told as a concern of seeming too negative or not wanting to share their struggle at all. This takes us back to the idea of interpersonal threat, feeling like you do not belong. A suicide note is terrifying in the sense that it is the written expression to which someone felt they could not give voice.

Romanticism glorified the sensitivity of the soul of the philosopher or artist, and it created the most extreme narrative to represent that sensitivity. The original Emo Kids. Unfortunately the latter is the kind of negative stereotype that only succeeds in solidifying an identification with persecution and the sense of being alone. Generally, inner torment is not enough to have someone commit suicide but it also requires repeated exposure to the resistance inherent in the survival instinct and a slowly accumulated capacity to override it (http://www.apa.org/science/about/psa/2009/06/sci-brief.aspx). This can be achieved through regular self-harm, or even exposure to mental anguish in a variety of forms.

So, how can we avoid playing into the romanticism that surrounds suicide, the glorifications, but still try to discuss it openly? I have a few ideas about how the idea of the suicide note can be salvaged from what might feel like an impotent representation of the complexity of the impacts of suicide. Perhaps we can use the clues within one to try and ward it off where possible.

A great deal of my work in a one on one session is to directly address suicidal thoughts in a way that reduces the fear of them. There is research around a technique known as defusion, which treats words similarly to objects in so far as that it understands that we can experience the meaning we create in too literal a sense. That we can feel the fear of a snake by thinking of stepping into long grass. A valid fear, a sensible instinct, but not a guaranteed pairing. Yet experiences such as a panic attack exists, completely outside any real exposure to a threat. In an example more related to the topic however, specifically the idea of social connectedness, is the phenomenon of someone becoming overwhelmed when presented with the word “weak”.

Defusion is the process of diluting the power of this association between language and the literalism that leads to our misery (for some great examples of defusion techniques visit: https://contextualscience.org/cognitive_defusion_deliteralization).

An important process that might be paired with defusion includes asking how these thoughts might provide a secondary gain. A benefit that comes aside from finding a solution to the problem at hand. Many of those who experience suicidal thoughts often feel a sense of unusual sense of calm and release when deciding on suicide, researching it feels like finding an answer. My question is how do we help someone achieve this feeling in a sustainable way without having to follow through with the behaviour. We need a replacement act. Part of that alternative could come from the precursor to suicide, the function inherent in a suicide note. If depression has the adaptive function of looking for a solution to socially based problems such as feeling disconnected, how might the suicide note help that person be heard, feel understood?

I want to make it clear that suicide is often not a “cry for help”. Many people are sick of asking for help that does not feel like it’s ever going to come or more tragically, that when it does come it will not make them feel any better. There is a strong argument for medication in some cases. That is not to say that these techniques alongside cannot make a world of difference in self-care.

Firstly let’s extract from the suicide note the expression of desperate hopes. In this case, many people could engage with this exercise. What do you long for but have difficulty articulating? Finding words for painful emotional states is research-proven as a way of reducing the power of those emotions. Writing down why you feel so horrible onto the page then continue writing toward some small step of a solution is also a time honoured saviour (sometimes the solution does not even require inclusion). Your brain is not always in a state to contain all of your options at the front of mind to carefully compare and contrast at once. As a functional description (but a significantly reductionist one) this exercise draws the blood back to your frontal cortex (where long term planning and complex decision making occur) and away from your lower brain regions (such as your amygdala; responsible for emotive states).

It is possible that you could even write down a note to friends instead of considering a face to face discussion. A cry for help isn’t a problem if someone is literally asking for it, rather than acting out in a way that scares people and confuses people. The person overwhelmed by their emotions is often more scared and confused than you are by their actions, particularly after the fact. It is our obligation as decent humans to put aside the judgement as to whether their expression deserves our wild cynicism.

Finally, it is the strangest paradox of the human mind that the constant search for a moment of happiness can be the biggest obstacle to achieving it at all. If you try to stop white knuckling on expectations of how you should feel right now, that if you change your relationship with your emotions, you might be able to achieve relief specifically due to the fact that you aren’t holding on so desperately. Maybe that includes writing a note that forgives yourself for you.