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Things had been getting on top of me for a while. Therapy is tough, memories are awful, life is confusing and so very painful. How do you live, when the essence of who you are was destroyed as a child. So for the past couple of months each day has involved suicide thoughts and the subsequent stay alive thoughts; “This is too painful”, ‘Its o.k, you can survive this pain’, “I can’t fight another second”‘, ‘Yes you can, the good times are worth the fight’, etc etc etc.
Then one day, I dont know why, there were no more thoughts. Everything was calm and peaceful. I knew what I had to do. There was no more stream of endless thoughts in my head. Just the realization that I was going to die, eternal rest, endless sleep, blissful death. I forgot I had kids, a husband, a mortgage, a reason to fight. All I knew was that it was all going to end.
I was stopped though. By my case manager. Sent to hospital. Sent back home. Sent back to the same place I was at before my death. And I was angry. Very angry. How dare anyone presume they know what I want. How could anyone stop my my death and force me to live in pain. Who gave him the right to control what happened to me.
And then, this morning, just before the alarm went off, my kids came into bed with me. They squirmed and giggled and kicked the sheets off and as they got up to get breakfast they said “I love you mummy”.
Wow. While I cant yet say that I am pleased to be alive, I can definitely say I am pleased I’m not dead. I am grateful for a second chance, a chance to be the person my kids think I am. I am grateful that my case manager stopped me, and then sat there while I told him how angry I was at him, and now is ready to help me with my second chance.
I dont know how many mental health professionals deal with suicide, or the rather uncomfortable after effects. But I just wanted to say, thanks for being there, thanks for trying, thanks for believing, thanks for not giving up, thanks for being everything I couldn’t be when I lost my way.
Torah.
Wow. Powerful post Torah.
Lola x
Thanks Lola. It is great to have somewhere to post, and it is nice (not great yet) to be alive to post
Speaking more closely than you might imagine from your kids` perspective, I`m glad you`re still with us. Splendid and brave post.
Thank you. It is almost creepy how your brain lets you forget about your children, it is almost like your brain is allowing you to die. I guess that is what they mean by lack of insight.
Torah, that was beautiful.
And I don’t mean to rain on parades or anything, so I apologize in advance. But Torah’s is the story everyone expects to come out of suicide prevention. It is the story people want to hear. What about those of us who never come around to being glad we are alive and deciding all the awfulness is worth it? Are our stories less valid than Torah’s? People have told me this, told me I would come around someday, that I am still too young to understand. But, of course, no one would accuse me of being too young to understand if I had come around to deciding not committing suicide was worth it. (Right now, “too young to understand” means being 25 and often told that I am “wise beyond my years,” sometimes by the same people. )
I am very very glad that Torah is alive and that she is glad to be alive. I don’t discount that at all. But not everyone has the same experience.
Thank you for your post torah, you articulate why many professionals are reluctant, or at least, ambivalent, about fully endorsing assisted suicide/euthanasia or simply the withdrawing of treatment.
We know all outcomes are not as positive as your own and some people remain angry and still wish to die.
The problem is we cannot know the difference.
I’m for ambivalence and reluctance. I understand that this is very difficult ground to tread. I’m against “solving” the problem by discounting a significant portion of the population (either those who ultimately want to live or those who ultimately don’t), which is what absolutist suicide prevention does (and refusing to intervene in suicide at all would do the same thing, which is why I don’t advocate that either). I am for trying to achieve the delicate balance. I know that will be incredibly hard, but I see no compassionate alternative.
Jessa, I wasn’t particularly referring to you, you actually posted at the same time as I sent my post and before I had seen yours.
That’s okay.
Wonderful post.
Thank you. Torah.
quote: I dont know how many mental health professionals deal with suicide, or the rather uncomfortable after effects.
my friend & colleague committed suicide. he was processing enormous loss in the last few months before he died. i visited him and tried to help where i could, but i got bound up in my own bullshit and told myself he had other friends, plus he was hospitalised so i figured the professionals could handle it. who was i fucking kidding? i knew he was ‘on the list’, i knew he was high risk… *sigh*
i felt so null. nothingness. just a vague guilt that i hadn’t been a better friend that i rationalised over for a few weeks. then all that ugliness and guilt came raging up at the funeral, where i held it together until the end and then wept silently as they brought him past, feeling like a fraud piece of shit because i had no right to be conspicuously upset like that – not at a family funeral.
mine (and his) previous contact with suicide was in prison. prison suicide is like a bomb going off, there’s a blast radius – the impact rips through the hive mind top to bottom. pad mates, first responders, next door neighbours, managers, some bloke on the yard – doesn’t matter how negligible the contact is or was with the topee, people get very angry – very hurt. they look for signs of callousness in the other tribes and where they look, they find it. William Blake wrote ‘Excess of Joy Weeps, Excess of Sorrow Laughs’. that’s how people manage something so dismal, so awful – they front it.
i’m just blurbing here. it’s a bit off topic sorry. in my current job we lost a client to suicide. the caseworker sort of laughed it off nervously when they told me… 3 days later they were signed off work indefinitely. it can really throw people sideways – at a subconscious level, like ‘what did i miss?’ ‘could i have done anything that would have made a difference to this outcome?’.
i suppose from a worker’s perspective, if someone is angry with me i can handle that – i do all the time, but they can’t die on my watch if i have a chance to intervene. i say that for totally selfish reasons ie. i have to be able to put my head on my pillow at night and SLEEP>.
ambivalent about posting this – i’m trying to be honest i’m NOT judging anyone or anything.
ps thanks for your great post torah
Hi Jessa, I am genuinely sorry you still feel like suicide. I am not glad to be alive, but I am glad I am not dead. Strange huh. There is a huge void between the two, and I think alot of people are living there. I dont know how to move forward, but I have a second chance. That has to mean something. I hope you can find your way out of the void. Best wishes. Torah.
Oh! Thank you, but I’m not actually suicidal at the moment. I have been suicidal and I have been forcibly “saved”. I do quite enjoy life at the moment. However, even knowing what I know now, that I could eventually have the life I currently have, I still wouldn’t have wanted to stay alive through my depression. To me, this life, wonderful as it is, is not worth what I went through.
Hi jbarber, thank you for posting. I am also very sorry you feel this way. It is an awful state to be in. I am still incredibly angry. Angry I was saved, angry I allowed myself to be saved, angry I am sick, angry I need help, angry for my childhood, angry for my adulthood. I dont know how to live, I dont know how to not be angry, I dont know how to be happy, I dont know how to be me, but I am going to to try and learn. Torah.
Hi Radio rental. Your post was great to read. I asked my case manager if he cared if I lived or died or if he just didnt want a dead client on his books. His response was similar to yours, and it was nice to hear. It is nice to hear that people care, and that he thought highly enough of me to intervene. Thank you for posting so honestly, it is great to see that the other side (mental health workers), have feelings and thoughts and faults and fears. It is great to know that you guys are human too. I am so very sorry for your loss, just truly deeply sorry. Torah.
Nice to know we occasionally get it right. (I wonder what Ted would have to say?)
Suicide; permanent solution to a temporary problem.
I hate that phrase, “Suicide is a permanent solution to a temporary problem.” The stakes are too high and the situations too nuanced for a trite phrase to do it justice or even be appropriate.
1. We cannot know in advance whether a problem is permanent or temporary.
2. Even if suicide is solving what turns out to be a temporary problem, any solution may be better than none at all.
Is that what you would say to a suicidal patient/ friend?
“Suicide is a permanent solution to a temporary problem” may well be trite but a trite phrase may be what is needed to give someone something to hang onto while you search for a more nuanced argument for putting up with this veil of tears we call life.
Yes, I would absolutely say that to a suicidal friend. I don’t think it is useful to lie to people, even in the interest of getting some extra time to come up with something better. I have learned to fear hope because I was given so many hopeful lies like this when I was in mental health care. I’m sure no one meant to cause me to fear hope, but that is what happened. I probably would have been more willing to stay alive if I were told “Hey, we simply aren’t allowed to let you die, even though suicide might actually make sense. Here are some true things….” Because most of what I was being told was instead facetious hope and lies, I had no reason to trust the professionals about anything good they said about living.
“I have learned to fear hope”
Thats a very pessimistic point of view and I am glad that I have not reached that level of cynacism, sometimes it is better to travel in hope than to arrive.
As a mental health professional I could never give someone the plain unvarnished truth as you suggest for professional reasons but given the uncertainty of any outcome in mental health I would personally be vary wary of “legitimising” suicide as an option.
Not an attack, but a sincere question: what is wrong with telling the patient the truth? From my perspective as a patient, the truth would have served me far better than the lies I was told. I would not fear hope because I would not have been told hopeful things over and over again that never came to fruition. I might have learned more from professionals if they helped me realistically assess myself, my strengths and weaknesses, instead of lying and telling me that I am super awesome in every possible way. I knew they were lying to me and I refused to go along with it, which meant I had to figure out how to realistically assess myself without their help. I didn’t learn social skills from them because they refused to acknowledge that, in the real world, sometimes people are jerks and those social skills they tried to teach me weren’t going to stop that. If they couldn’t acknowledge that aspect of reality, how can I trust that they know anything about social skills and how can they teach me to interact with those jerks? I didn’t learn how to mediate my negative “cognitive distortions” because they refused to acknowledge that those same patterns can be used (must be used, perhaps) as “cognitive shortcuts,” so they couldn’t help me untangle the unhelpful negative distortions from the neutral or helpful or necessary shortcuts.
Especially if I am locked up at the moment anyway, what is wrong with telling the truth? I think it is better for me to hear the truth while I am locked up and physically safe so that I can learn how to handle reality when I bump up against it in the outside world, than for me to be shielded from reality while I am locked up, then sent out in to the world to encounter reality without having any strategies for handling reality, which is what happened to me.
I have learned to fear hope because I was given so many hopeful lies like this when I was in mental health care. I’m sure no one meant to cause me to fear hope, but that is what happened.
I can understand that. I’m sick of people dangling false hope. It’s cruel. “Okay, this is probably what’s gonna happen – it’ll suck, but this is how we can try and alleviate that” – I can deal with that. “But of course CBT will work! Why are you so negative? Don’t you want to get better?” – that’s just fucking setting me up for disappointment, and I’ve got enough of that already, thanks.
They say neurotics build castles in the sky, and psychotics live in them. Except when it comes to unrealistic expectations from treatment, in which case it’s suddenly proof you’re nice and co-operative. Listen up, shrinks: it’s not that I don’t want to get better. It’s that I’m far too sensible to pin all my hopes on a miracle.
Actually, the best thing a doctor ever said to me was “okay, it’s gonna feel like nothing’s happening, and it might even get worse before it gets better*, but you need to keep going. That acknowledgement and validation meant a lot.
* People don’t kill themselves when they’re too depressed to move. They kill themselves when the meds are starting to work and their energy comes back. For me, the first few weeks on meds, even meds that work with few side-effects, are awful.
Lorna! I love you!
I hate that you had to experience mental health care in a similar way as the way I experienced it, but it is EXTREMELY validating to hear you articulate some of the same things I’ve articulated about my experience, independently of me. These are things where most of the professionals still seem to think I’m just being crazy. Some of them think that I must just be crazy having such a problem with lying to myself in CBT because so many other patients don’t have a problem with it, they even find it helpful.
Like the best thing you were told, the most true thing I was ever told in mental health care was, “recovery is different for everyone.” But they seemed to use that as a cop out for why they couldn’t tell us what recovery would look like, because it was obvious to me that they didn’t really believe it when they insisted that x, y, and z absolutely must be a part of everyone’s recovery.
“what is wrong with telling the patient the truth?”
The problem with telling the patient “the truth” as you put it is who’s truth are we talking about here? Truth is relative and not always the same as fact. The truth as I see it may not be the same as the truth as you see it.
The problem in predicting outcomes in mental health is the degree of uncertainty involved. I had an ethical discussion with my colleagues today, would tell a road traffic accident casualty the “truth” that they would be dead in 15 minutes and allow them to make their peace with the world or reassure them that every thing would be OK and spare them the fear and anguish of knowing they were about to die?
Most of us opted for telling the truth (i.e. you have 15 minutes to live make the most of it) despite the obvious utilitarian argument in favour of not doing so. The problem with translating this to a mental health scenario is that you cannot tell with any certainty how things will turn out. No one is advocating giving obviously false hope or making totally unrealistic predictions but sometimes a more nuanced approach is needed. Sometimes it is better to travel in hope than to arrive.
Also don’t forget the ability of a clinically depressed patient to reason effectively is severely impaired. I can think of one or two chronically ill mental health patients who would not be here now if I had given them the plain unvarnished “truth” as I saw it when we first met. If someone decides to end their life then that has to be their decision I would not want to think that I had in anyway encouraged them down that road.
The “truth” as I speak of it here is that there is no guarantee that any particular patient will get better. Professionals I have interacted with tend to be overly optimistic in this area, and I have seen that carried over to other areas: refusing to acknowledge that there are jerks in the world, that cognitive shortcuts are a valid mode of thought, that I have weaknesses, etc. (hence my other examples of how I have been lied to in mental health care).
No one here may be advocating giving obviously false hope to patients, but many mental health care professionals do just that, Lorna and I have both experienced that and there are shelves full of books promoting obviously false hope in the self-help sections of libraries and bookstores around the world. I agree that one of the difficulties in mental health is that nothing can be predicted with any certainty, but there are so many people who claim to do just that, who tell their patients, “CBT will cure you!” It sounds as though you are treading some middle ground between saying, “you WILL get better,” and acknowledging the uncertainty to your patients, “we will try to help you get better, but there is no guarantee,” since you don’t want to tell patients the unvarnished truth, nor do you want to obviously lie to them. What is that middle ground? Or have I misunderstood?
I’m not advocating just letting people commit suicide whenever they want; there is good reason to pause before letting them make that decision. Nor do I think that acknowledging the uncertainty of the future and that suicide may very well be a logical choice equates to encouraging someone to commit suicide. In treatment I was told to put a pause between the impulse and the action in order to give myself time to think about the action and whether or not I really wanted to do it (self-injure, jump off a cliff, whatever). However, they only ever thought the post-pause decision was valid if I had decided NOT to jump off that cliff. If I still wanted to jump, I still needed to pause, the implication being that no one would still want to commit suicide in a rational frame of mind. Poppycock.
I understand that severely depressed people can have impaired reasoning. I have had that impaired reasoning (case in point: I was absolutely convinced that one’s body size was directly correlated to one’s level of extroversion; I was 100% introvert, therefore I had to be 100% tiny). However, I have also found that professionals have tended to assume that my reasoning was much more impaired than it actually was. I understand the difficulty of discerning a patient’s truly rational reasoning from their mixed-up reasoning, but I would suggest that it is better to admit that you can’t discern which is which than to assume that all of that patient’s reasoning is mixed-up reasoning.
You’ve gotta be plausible, though. Trustworthy and realistic. It is partly a trust thing; if someone’s telling me things I can check later and find out are probably not true, I won’t believe a word they say. If I’m giving someone power over my brain, I need to know their judgement is reliable and they will not lie to me ‘for my own good’. Yeah, control issues. Or just wanting a life like a normal grownup. Plus no-one feels better because they’re made to feel like they’re the only freak in the world who’s not improving, like it’s their fault or something.
Mine were all “let’s not think about the worst-case scenario”. And I said, “No, let’s. Then we can be prepared for it. Or I will steal all your fire extinguishers, because having them around is just silly negative thinking.”
Like KRJ says: “Medications take a painfully long time to take hold, and the recovery period is jagged, discouraging and never easy. A setback after finally feeling better again can be devastating, if not lethal. The frustration and rockiness of this period can be predicted, and the clinician’s doing so can take away some of the sting.”
Yes, Lorna, yes!
And wanting to hear the truth was, for me, not only a trust issue (although that was very much a factor). I believed that I was a terrible person because I lied to myself on purpose. It was a survival thing and it worked, but I didn’t want to lie to myself again to get better. Also, one of the things I value about myself, and one of the only things I was able to acknowledge was good about myself throughout my depression, is my sincerity. Lying to myself to survive violated that already, but lying to (maybe) myself to get better would have violated that again. I could never really start to feel better about myself if I was lying to myself and willfully violating my own standards of integrity.
“cognitive shortcuts are a valid mode of thought”
Would that include pithy aphorisms like “Suicide is a permanent solution to a temporary problem” or “It is always darkest just before the dawn”?
“there are shelves full of books promoting obviously false hope in the self-help sections of libraries and bookstores around the world.”
Most mental health professionals in the UK at least do not have a pecuniary interest in “selling” you anything so I am not sure what your point is here.
“but there are so many people who claim to do just that, who tell their patients, “CBT will cure you!”
No therapist worth their salt would ever make such a ridiculous claim but to make the claim CBT will make you feel better is not such an outrageous claim surely. If I can convince you that standing on your head and spitting two penny pieces out of your mouth will make you feel better then the chances are, owing to the highly subjective nature of mental illness, it will.
What is that middle ground? Or have I misunderstood?”
No I don’t think you have misunderstood. Just because the middle ground is difficult to locate doesn’t mean you should not look for it. The problem I have with your “give it to them straight approach” is that while it might be philosophically coherent it might not be terribly pragmatic. Is telling someone a little white lie such a terrible thing if it gets them through a difficult patch to a place where they can make a more rational choice? You sound a little like the surgeon who tells the relative that the operation was a complete success but unfortunately the patient died.
Cognitive shortcuts are valid modes of thought, yes, I stand by that, even when the shortcut is, “suicide is a permanent solution to a temporary problem.” Cognitive shortcuts are the reason I don’t have to worry every day about getting raped (it is possible but unlikely) or shot at (indeed, if I did NOT use those cognitive shortcuts, I would probably be considered mentally ill). I do not put myself in situations which make those things particularly likely, so I have no reason not to use the shortcut. However, if I was on the front lines of a war, I would be remiss not to be thinking more about getting shot at because of my context. Likewise, “suicide is a permanent solution to a temporary problem,” is an appropriate cognitive shortcut for a context in which suicide does not frequently come up, but it is inappropriate in a context where suicide is a major topic of concern and doubly inappropriate in a context where we are critically examining our thoughts and assumptions about mental health care (which is how I would characterize Mental Nurse).
This thread, and others on Mental Nurse, seem to indicate that I have experienced an extremist form of CBT. I apologize if I mis-characterize CBT on that basis, but that is my only point of reference. (http://files.e2ma.net/10743/as.....ferent.pdf – I have had therapy with this guy. He might be summarizing his book here, but his method really doesn’t have much more nuance than this, just a lot more examples and applications. I was cheeky as hell with him, pointing at him whenever he said “should”, but he never got the hint.)
I mentioned the thousands of self-help books to make the point that, even if no one here is promising they can cure mental illness, there are plenty of people who are making that claim.
I suppose fudging the truth a bit can be helpful for some people. It can also turn out to be unnecessary and get in the way of getting on with some useful therapy. It can also snowball into much bigger lies. I don’t deny that affirmations have been helpful for some people, even false, overly positive ones. I do think it is inappropriate to persist with them, even when they are obviously not working or in the midst of protests from the patient who knows herself better than anyone else ever will. I think there is a danger of making a patient dependent on those lies; what will happen when that bubble is burst? If they are well by then, it will be fine, they will be able to handle it. But are you just hoping that they won’t find out the truth before they are well?
What I needed was to hear the truth because I was unwilling to lie to myself anymore, because building on what I believe is good about myself (sincerity) by lying to myself would have been counterproductive, and because that was the only way to build trust with the professionals. Perhaps the straight up truth is not what everyone needs. Perhaps the straight up truth is not even a good starting point. But somewhere along the way, professionals should be able to recognize that the white lies aren’t working (at the very least, they should recognize this when the patient is directly pointing out the lies and asking for verification of her understanding of the truth). In my experiences, no one was ever willing to tell me the truth until I was already well. If you are able to adjust your truth-tactics according to your patients’ needs, than you are great, keep doing that. But the professionals that I interacted with did not do that, and that is what I have a problem with.
E: Pragmatically speaking, what do you do when the patient relapses (I recently found out most people with capital-D depression do, in the long term), or something goes wrong? How do you get them to believe you again? It’s not a philosophical thing for me; it’s a practical one. I like to be prepared for the worst. I don’t want it to come as a nasty shock. That way, if it happens, it’s more “oh yeah, we can deal with this” and less devastating.
Also, I’d honestly like to believe that the people with power over me are smarter than I am. Seriously. And that’s difficult when they don’t tell me stuff I can find out with a quick Google.
I have a lot of issues with professionals not telling me what they were up to, or not admitting when they were out of their depth, or just plain making shit up. Usually med-related. “Here’s two weeks’ worth of citalopram, and I’ll see you in a month” – right, so I could have two weeks of side-effects and two weeks of cold turkey. Lovely. “Guidelines say you can only have a week’s worth of fluoxetine at a time” – rubbish. “You can’t have buspirone because it’s addictive” – no it’s not, and I sent the guy (consultant psychiatrist!) a bunch of studies to prove it. “This is just something to calm you down, take it whenever you need to” – it was an old-skool antipsychotic with cardiac side effects, and the shit hit the fan about its safety a few months later. But also stuff like them clinging to the “a year of antidepressants and some CBT and you’ll be all better” approach – after nine years? After I’ve already gone through the year-of-meds-then-stop cycle once, and the damn things came back?
And the practical result of all this, for me as a patient, is that I don’t trust them. Probably never will. I go in to all my appointments prepared to fight like hell. How is this gonna help?
(Regarding false promises, my former therapist did actually say “maybe you keep relapsing because you’ve never had therapy.” Imagine how awesome that made me feel when the therapy didn’t help.)
Lorna
Pragmatically speaking when someone with a capital D relapses I do not give them anything like the plain and unvarnished truth. In my opinion what people in that position want to hear is the reassurance that things WILL at some point get better and for most of them it does.
What use is it to anyone in the middle of a depressive episode to hear that there are over 5000 suicides in the UK each year or that 15% of people diagnosed with clinical depression end up killing themselves, or that we don’t really know how antidepressants work and for many people they don’t?
If you were watching a drowning man in the middle of a lake (assuming you could not jump in and rescue him yourself) would you:
• Shout encouragement and hope that he finds the strength to make it to the shore even if you think this unlikely
• Tell the drowning man that 25% of people in his situation do not make it and that it might be easier in the end to accept the inevitable and drown.
There is an assumption, a reasonable one I think, that MH professionals while not necessarily “smarter” do at least know more about the treatment of mental illness than most patients by virtue of our training and experience. While this may not always be the case with particular individuals it is the case in the majority of situations, at least I hope it is if not then why do we go to all the trouble of training Doctors, Nurses and Therapists?
When I take my car to be serviced at the garage I understand how my car drives, it’s various quirks and foibles. I know that it makes an odd clonking noise from the rear when I drive over speed humps at a certain speed or that the engine catches in second if I don’t keep the revs up. But I don’t argue with the mechanic about if the shock absorbers need replacing or what type of oil he should use. He after all is the expert.
E: Thank you so much for engaging with Lorna and I. Thank you so much for not running off and saying we’ll never understand because we’re crazy. Thank you for taking up the challenge of discussing this with us. Also, you have softened my position, I’m now more amenable to the idea that lies can be helpful to some people. Nevertheless, I still vehemently believe that was not the case for me and that professionals need to be able to adjust their tactics for people for whom lies are not helpful.
You said, “In my opinion what people in that position want to hear is the reassurance that things WILL at some point get better and for most of them it does.” I don’t doubt that this is true for some patients; this may even be true for most patients. However, Lorna and I have made it clear that this is not the case for us; we want the truth, we would have benefited more from the truth than from being promised things that no one can guarantee. What about us? We are patients, too.
It sounds like you don’t want to tell the unvarnished truth to someone who needs a nice lie for fear of making things worse for them. That is fine, I am okay with that; I don’t want to hurt those people unnecessarily either. But telling those nice lies to someone (like Lorna or me) who needs the truth can also make things worse. Why is that different? Do professionals not know the truth and instead really believe the lies they tell? Do they not believe that there really are patients who would be better served with the truth than nice lies? Do they not believe us when we say we will better served by the truth?
Like I mentioned before, I don’t think you should necessarily stop telling happy lies to people when that is what they need. I don’t necessarily think you should stop using that as your default starting point with patients. But when you come across a patient who, like Lorna or I, makes it clear that that is not what they need (by saying, “please tell me the truth,” by directly questioning the veracity of what you are saying, or whatever), how are you changing your tactic? (Have you never come across someone like this in your work? Have you just not recognized it?) Do you (would you) start telling the truth? That’s all I’m really requesting of you here: if a patient asks for the truth, tell her the truth.
To me, I don’t generally care if the professionals are smarter than me or not as long as it doesn’t get in the way of things. In terms of telling nice lies, it can get in the way because those nice lies aren’t going to do me very much good if I am smart enough to know I am being lied to (even if I was a person who would be better served by nice lies). When I point out those lies to the staff and they try to “redirect” me or insist that they aren’t lies, it feels like they think I’m an idiot. It’s like they think I’m only calling them out on their actual lies because I’m paranoid and happen to have gotten lucky by identifying an actual lie instead of an imaginary lie.
“That’s all I’m really requesting of you here: if a patient asks for the truth, tell her the truth.”
Truth Lies and Video tape. Again it comes back to who’s version of the “truth” we are talking about here. For me the “truth” is no more than a sincerely held belief which may be correct or false. When Christopher Columbus was told not to sail over the horizon the accepted “truth” was that the earth was flat and that he would fall off the edge. The “truth” in this case was demonstrably false but was it a lie?
Anyhow I hope you have regained some of your capacity to hope. A life without hope strikes me as a very dismal place to be.
Hope was personified in Greek mythology as Elpis. When Pandora opened her box she let out all the evils except one; Hope. Apparently, the Greeks considered Hope to be as dangerous as all the world’s evils put together but without hope to accompany us, humanity is filled with despair. So Pandora later went back to her box and let Hope out as well. It is worth noting that hope is represented as weakly leaving the box but is in effect far more potent than any of the other major evils put together.
Zeus did not want man to throw his life away either no matter how much the other evils might torment him, to that end, he gave man Hope. But in truth, Hope is the most evil of evils because it prolongs man’s torment.
Bit of a bugger really.
Telling me the truth, your sincerely held belief, is the best someone can do. They can’t tell me an objective truth they don’t know (i.e. Columbus couldn’t have told me the Earth was round). Even that would be better than what I have gotten in mental health care.
They have promised me that I would get better as an argument for not committing suicide. Yes, eventually I did get better, but that was never a promise they could really deliver on. Lots of people don’t get better. Lots of people get better for a while and then get sick again. They have to know this. Lots of people die naturally having never gotten better. Lots of people die of suicide having never gotten better. Those people never got better. Yes, lie to the people who need it. But after it has become apparent that the lies aren’t helping and I am still asking you (generally, not you, E, specifically) for the truth on this, if you still promise I will get better, you are either lying or delusional. Even if you believe that it would have been possible for someone to get better if they hadn’t died or committed suicide before they had the chance, that doesn’t make you able to promise that someone will get better. Even if you firmly believe in hope, people still die never having gotten better. I’m not asking anyone to say, “no, you will probably never get better,” when they don’t believe that. I’m asking you to admit that some people don’t get better when I ask for the truth about that.
Eventually, asking these questions becomes a test of trustworthiness more than anything else. I know the answer to “does everyone get better?” The answer is “no.” If someone tells me the answer is “yes” even when I clarify the question, make it clear I want the unvarnished truth, I know that this is not a person who I can trust. It’s maddening to be in a place where they say, “trust us because that is the only way this will work,” but I can’t get a straight answer from anyone about anything. In some of these cases I understand that you want to preserve hope for your patients. But in others of these situations, where there isn’t that sort of reason, or we have already experienced the negative outcome we were told would never ever happen, why do professionals keep telling the happy lies?
I feel the kind of frustration now that I often felt in hospital. Trying to get someone to give the honest answer and not getting it and not understanding why they were lying to me. I am immensely relieved that you admit, E, that sometimes professionals tell happy lies in order to offer hope to their patients. But I’m still not understanding why you would never be willing to tell patients the truth. I’m not seeing any benefits to it, but it does degrade the quality of treatment because it can cause patients to be unable to trust their treatment team. I just don’t understand it.
Maybe someday I will learn how to hope, but for now, I’m still kind of traumatized over the whole thing. People made promises, so I felt like those would be okay to put hope in, that they were good bets, but then everything was shot to hell because people made promises they couldn’t keep.
As a MH nurse who has ‘lost my way’ a few times and come though depression it has enabled me to empathise with people feeling suicidal and having that hope for them, to support them, although I am aware that my life has a lot in it and that if I get though the depression I have a lot of good things to live for and am in good health and appreciate it that some people have nothing in their lives to live for, are in severe physical pain due to terminal illness etc. In these latter cases it is very hard to convince the person they shouldn’t kill themselves as their future alive may be too bleak, but I look for glimmers of hope in the bleakness and try my best to help people see these glimmers and reevaluate their wishes to kill themselves. I have always felt that life isn’t for everyone and it’s hard finding meaning in the world, especially in this age of consumerism, but becasue I have made my own life into something meaningful I can encourage others that this can be done, it takes a bit of a cognitive shift in them to see this too, but if people get through it they can look back at the past and the suicidal phase as a big dark hole and the future as something positive.
It’s the classic problem: when are we allowed to use force for someone’s “own good”? Some people (like Torah) are clearly grateful for others using force against them for their own good. Others, like Jessa and myself, can never forgive it and will always feel that it was wrong, no matter how much we like our lives.
I don’t think we should argue about whether which of us is right. I think we are all essentially correct – all the best judges of our own lives. It seems incoherent to me to discount those in Jessa and my position (“Oh, you’ll get over it and come around eventually” – I’m 31). The best course is to try to differentiate between those who value life more than freedom from force, and those who value freedom from force/dignity/whatever you want to call it more than life. I recognize that’s hard in the heat of the emergency room. But such differentiation could easily be built into our institutions – e.g. with a pre-arranged opt-out from being forced to remain alive, reserved for people with a long-standing desire to die that is not the product of a delusion.
I’m with you, Curator. I am quite obviously fighting for my position on suicide, and mental health care generally, to be taken seriously, for my experience to be acknowledged rather than discounted as wrong. I have no interest, however, in discounting the experience of people who did find mental health care helpful in all the ways it is meant to be. I am thrilled for those people. I wish I was one of them. I wish everyone could find mental health care helpful that way. But they don’t, and the people for whom mental health care is not currently helpful still do need and deserve help. And I will fight for those people.
One thing is though that if you really want to kill yourself you can do so quite quietly at home or away from anyone by a variety of methods. If you have genuinelly failed to do it then you can look into more successful ways. If someone has a long standing desire to die then I don’t see what’s stopping them, if it’s such a strong desire then they would be able to do it, even if they are heavily supported by mental health services if they are away from 24 hour observation then they could do it if they wished, you have that freedom to do it in private, even though it would be classed as ’suicide’ and undignified in the eyes of society as it is. It’s only when your found not dead that people try to talk you out of it, if you go off somewhere and just do it where you wont be found until your actually dead then nobody can stop you can they?
As I understand it, suicide’s more like “painless, effective, accessible: pick two out of three”.
…which is why I feel people should have the right to die if they chose and if still after years of people having input from mental health services and them still feeling that way they should have that choice to do so as adults. I guess though thinking about wanting to die (as have before when depressed) and actually going through with it are 2 seperate things and I wonder how many people who feel suicidal would actually do it if someone offered them the option to do so legally and in a safe, dignified manner. I know some people would go through with it, but I think many may be scared to and it may even shock them into re-evaluating life and death.
Exactly. I think it would force people to think about it maturely, as adults.
I would disagree with the statement that “if you really want to kill yourself you can do so quite quietly at home or away from anyone by a variety of methods,” though. Most methods have low success rates, and the ones with higher success rates (gunshot, jump from heights) carry serious and real risks of harmful sequelae in the event of failure.
These kind of considerations get in the way of suicide being a real option in our current system. People say “suicide is legal, so no problem” – but humane methods of suicide are most certainly not legal. The ONLY method of suicide used in places where physician-assisted suicide is legal is barbiturate overdose. Expecting someone to use a gun or jump from a bridge if they’re “really serious” is a rather extreme position.
Suicide is much more difficult than I think most non-suicidal people realize.
I find suicide a really difficult subject. Not least because I’ve had my long-held views changed, which always throws me.
I used to be pretty strongly of the opinion that suicide was something people thought about fairly carefully, and that you couldn’t make someone more likely to do it. Then I read Night Falls Fast, by Kay Redfield Jamison, and found it very challenging. Particularly since I could recognise a lot of my own behaviour in there – the stuff she said about bad tempers, and impulsivity, and alcohol, all hit pretty close to home. Here are the two posts I made while reading it.
Now I’m much more open to the idea that yeah, actually, it is contagious. It is often impulsive. (The methods that work, like shooting and jumping? Also the methods where you make one decision very quickly and there’s no going back from it.) It is often a decision made with impaired judgement. That’s kind of an uncomfortable and embarrassing realisation for me, and I don’t know how to act on it without denying the mentally ill their (our) autonomy. Hmmph.
I do agree that suicide can be impulsive and contagious and poorly thought out. But, unlike most people and suicide prevention advocates especially, I do not believe that those are the only circumstances for suicide. I am even willing to entertain the idea that most suicides are poorly thought out, but I am so so horrified that people would assume that all suicides fit into this category.
When I state my position on this, emphasizing that suicide can be rational, that forcing certain people to live is unbearably cruel, people think I just want to allow all suicides, or go around killing people myself. It is like the ridiculousness of the health care debate here in America or arguing with a religious Fundamentalist. Some of these people who assume I want to go around killing people, who think I have to be on one extreme or the other, are the very same people who told me I wasn’t allowed to think in “black and white” terms, but must learn to live in the gray. Perhaps by living so totally in the gray, that means I am being an “extremist” for moderation? These people make no sense to me.
Yeah, I don’t mean that’s the case for everyone. Just that it shook me up a bit to realise that it often is, particularly given the things she said about anger and impaired judgement and whatnot hit pretty close to home for me. And I don’t even know what to do with this new information, given I also believe very strongly that crazy does not equal stupid or infantile, and that crazy patients should get their own way as often as possible. *Sigh* Grey areas and confusion are such fun.
[...] today I read this post on mentalnurse.org.uk. It talks of the anger at being saved from suicide. I still feel that [...]
Glad you’re still alive; glad you’re glad about it.
For me, suicide is a basic human right. Using force (and not merely persuasion) to prevent a voluntary death is a particularly cruel and wicked act.
It is not surprising that some people who were forcibly prevented from dying feel violated by the act, while others come to accept it. Drug laws make it hard enough for people to kill themselves peacefully and in private, while psychiatry has the arrogance to presume it knows best. What a sad state of affairs.
E:
What use is it to anyone in the middle of a depressive episode to hear that there are over 5000 suicides in the UK each year or that 15% of people diagnosed with clinical depression end up killing themselves, or that we don’t really know how antidepressants work and for many people they don’t?
They might feel less like a freak and a failure. They might be less likely to be pushed into denial and treatment-avoidance by the stigma and their own ambivalence. And by “they”, I mean “I”. Bear in mind I am one of these people who relapses on a regular basis. All I have asked for from my shrinks is for help honestly addressing what’s gonna happen in the long-term, and learning to live with it. I want help overcoming my terrible ambivalence towards taking my meds.
But I don’t argue with the mechanic about if the shock absorbers need replacing or what type of oil he should use. He after all is the expert.
Your mechanic must’ve been better than my mental health professionals, is all I can say. Arguing like hell is what gets me treatment for my illnesses instead of my sexuality, and what keeps me off major tranqs and benzos. I’ll keep arguing.
Dammit, posted in the wrong place.