Let’s talk about suicide

There’s been much discussion of suicide this week after Stephen Fry’s courageous decision to discuss a recent attempt on his life. It’s a terrifying subject to discuss with anyone without lived experience of suicidal thoughts. The whole concept of suicide so offends our logic that it’s far easier to dismiss it as self-indulgence or cowardice than to face up to the truth that none of us are immune to it. Mental illness does not discriminate and it can strike out of nowhere; as Stephen Fry says in his interview ‘if there were a reason for it you could reason someone out of it’. It is much more comforting to imagine that it only happens to the weak-willed than to acknowledge that it could strike anyone without rhyme or reason.

Equally it isn’t easy discussing suicide with those who do have lived experience. Anyone who has ever felt suicidal has a cipher with which decode a suicide attempt. They understand the grubby, sordid reality of the experience.  Just knowing you have that experience in common with someone exposes a very intimate part of your past.

It’s little wonder that suicide is considered a shameful secret that’s often discussed in hushed innuendo. A suicide mitigation expert recently told me that when she was working in a area with a particularly high suicide rate that residents were keen to tell her ‘we don’t have suicide round here’. She said the biggest barrier to engaging with the people at risk was the unwillingness of people to acknowledge the fact that it could affect them. Local residents spoke as if the existence of suicide would bring sully the area, as if it was some local scandal that would send house prices tumbling rather than a serious health issue. Trying to engage people in discussion yielded the same disapproving tone and uncomfortable shifting as discussing unmarried mothers in the 1950s. No one was prepared to acknowledge the problem. Presumably if their daughters ever have suicidal thoughts they’ll be sent to the country to have them at a relatives house until the gossip dies down.

I don’t wish to sound flippant because I’m not saying it’s easy. Discussing suicide is just a profoundly unpleasant experience.  But so’s discussing cancer and diabetes and heart disease. It’s not nice, but we have to grow up and start talking about it because, like every health issue, it gets  significantly worse when we ignore it and hope it will go away.

So for those who want to understand the experience I’m ging to briefly discuss my experience. I’m obviously not going to presume to know everyone’s experience, but for me I can say that there are two distinct stages to a serious bout of depression. For me an episode starts with working too hard and sleeping too little sparking crippling anxiety. Anxiety can be truly dreadful, but even at its worst it not so much a desire to die as a fear of life. Then there’s the tipping point where suffering collides with a kind of existential crisis. It’s often said that sea-sickness has two stages ‘first you worry you might die, then you’re afraid that you wont’; this describes an episode of depression perfectly. The pain is unbearable but you’re not even sure if you’ve got the mental agility to end it all.

Suicide seems like an almost inhuman impulse; one of the defining features of humanity is that we stay alive. One of the greatest comforts to us as a species is the fact that the human spirit can survive in the face of overwhelming suffering. The stubborn persistence that is essentially and fundmetally human is shaken by depression. The things around us no longer seem imbued with any meaning, they are just brute facts. Without a lively consciousness the world is just a collection of disparate objects, just arrangements of matter. Nietzsche said that ‘he who has a why to live can bare almost any how’ and it’s this ‘why’ that depression clouds. It’s not simply suffering, it’s suffering without meaning.  You can try and reason this away –  you don’t always feel like this, you have friends and family who love you, there are things in your life that make you happy, your life usually has a purpose. But when you’re depressed you can’t imagine having that hunger for life anymore than amid a nasty bout of food poisoning you can imagine hunger for a large cod and chips.

As with physical illness your symptoms ease slowly and gradually. I remember coming out of a period of depression thinking that it was as if someone had coloured in the outside. Not well and not vibrantly. Not even with felt tips. Just shaded eveything in with a coloured pencil. As after a bout of flu and you feel the colour slowly returning to your face and the faint sensation of a hunger pang.  As with post-viral hunger you start tentatively with scraps of bland interest. A bit of tidying, a walk round the block. Tea and toast for the soul.

The reason we need excellent crisis care everywhere is to get people through these dark moments; just keep them going until the fever breaks. When people emerge from a crisis they need to know that there’ll be a service to pull them through should they ever be in that position again. While suicide remains a tabboo we lose people who are too scared to say these things out loud or who feel that their thoughts are too alien to demand that there are crisis services are available for them. Ordinary people having conversations have the power to crush stigma and break tabboos; just talking can be the start of a quiet revolution in mental health. Celebrities can lead the way, but it is up to the rest of us to do the leg work, so, let’s get cracking; let’s talk about suicide!