On Suicide

I have no idea how many times I’ve heard this:

“Suicide is a permanent solution to a temporary problem.”

Is it really? I think it’s more common that it’s a solution to a persistent problem. Or an overwhelming problem. There are people who kill themselves due to a single event or circumstance. But this quote can be more for the speaker to comfort them self by giving the feeling of offering help than a sign of understanding what is a complex issue. And in that context, it reflects an attitude of persons who don’t want to face the problem because that would require serious effort. It transfers all responsibility to a person who is suffering to get help by essentially saying, “Buck up. Life isn’t that bad.” It’s not a quote that engenders comfort or wisdom or insight. It’s a pithy little dismissive sound bite.

Here is a quote from an author named David Foster Wallace who struggled with major depressive disorder his whole life until he ended it in 2008:

The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom Its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who leap from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’, can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling.

Wallace offers actual insight and a powerful metaphor. No one wants to die but in the face of certain problems it becomes an attractive option. And those problems are often the problems associated with major mental illness. Suicide is the leading cause of deaths due to mental illnesses such as major depression, bipolar disorder and schizophrenia. Many people battle for years against these illnesses and if they lose the battle in the same sense that a cancer patient loses theirs, the result is suicide.

They can’t handle the symptoms. The treatment is expensive. If you’re a lower income individual, it’s difficult or impossible to get that treatment for that reason. The side effects of the medicines can be hard to cope with. Diabetes is a side effect of a lot of these medications, for example. Sometimes the medicines don’t work or stop working. There’s no magic bullet psych med and finding even one or a cocktail that works can be a long process. Talk therapy is more effective than medication alone and it is even harder and more expensive to get. Even if you can afford a therapist, many are not taking new patients. If you have to go through your insurance company to find a therapist in network then the problem of finding one who is accepting new clients is made worse by a smaller pool to draw from. The wait after making an appointment is often a month or more.  Acute care along the lines of a talk therapy solution is a crisis hospital where you can expect to be locked in for 72 hours and you will receive some group therapy sessions, visits to a psychiatrist for medicine adjustment. And these places vary wildly in quality of accommodation and treatment.Getting into one in the first place can involve a wait in a general hospital that can stretch out for days itself. The road to suicide is not short for many of us who have been actively seeking treatment.

And that’s speaking for people seeking treatment. Some people don’t seek treatment. There’s a stigma surrounding mental illness. Think about how many words in English can be used as insults that question a person’s state of mind. Crazy. Insane. Nuts. Those are a few mild ones that are useful in other contexts without me even going into specific attacks of one’s mental faculties. People may not seek treatment because they don’t want to labeled in this way should someone find out, whether it’s at work due to the specific demands of a field, the work environment and employees there or they have an unsympathetic partner they’d rather not give more evidence to the assertion that they are crazy and can’t be trusted or listened to. So they may feel the need to be stoic and hide their pain.

There are deep societal problems on display when someone kills them self and also in the reaction by segments of the population. They recoil at the idea saying, “I don’t understand why someone would do that.” Is it that you don’t understand or don’t want to understand? Understanding involves facing difficult problems with no easy solution such as access to mental health treatment and its current state of effectiveness. But it also means that anyone who truly wants to understand may have to face their own problems and failures such as admitting that they may not be as sensitive as they’d like to believe, that for some, yes, life really is that bad and perhaps the failure to understand by swaths of the public as well as friends and family members is part of the problem.

Mental illness is no longer a secret problem dealt with by locking people away but it’s also not a medical problem met with universal support in the way that physical diseases such as cancer are. There’s no CT scan showing the depression in an easy-to-understand picture. The closest equivalent would be empathy which requires effort to listen to people and how they feel and imagine what it would be like to want to end your own life. I don’t know that everyone is capable of that level of compassion or is willing to go to that extent in order to appreciate a problem that can be completely out of the scope of their personal experience. But we’re in the midst of a suicide epidemic and it would be better for people who currently offer surface-level support or outright dismissiveness to attempt to understand the mindset before it becomes part of the scope of their experience in a very personal way.

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