There were 3,318 suicides in Australia in 2019, the most recent year for which data was published (source ABS). Typically three times as many men kill themselves as women. Mens’ Health Week passed recently – I saw nothing of substance written.
Barely a week goes by without obituaries referring to being “taken suddenly”, generally festooned with anecdotes bearing amazing appreciation for the person. Despite claiming three times as many lives as our roads, it seems that suicide is not something to be openly discussed. I agree that we don’t need to be detailing the methods people use to end their own lives. I don’t agree that we shouldn’t be openly discussing suicide itself. In fact, as Treasurer of Doctors’ Health Queensland, and with my own experiences in dealing with depression and mental health, suicide has become a topic I’m vitally interested in.
If you attend a course on suicide prevention one of the first things you will learn is that from the point of view of the person concerned, a decision to suicide is entirely rational. Rarely is it done on a whim, which is why people often seem calm in the days prior. It seems to me that the driver is often in pain. Normally we consider pain through a narrow and physical lens but if you have experienced real loss in your life (loss of a loved one, significant financial loss, standing in the community or myriad of other things), you will know that emotional pain can be as real as physical pain. People suffering from schizophrenia and other chronic mental illnesses report the pain associated with the dreadful confusion of not knowing who they are from one day to the next. Pain can be chronic, as with arthritis, or acute like that of a stab wound. It tells us something is wrong. Constant rumination on the causes, and self-medication via alcohol and drugs, and even overachievement or humour (think Robin Williams) can wear us down. With our energy depleted and without a circuit breaker, the idea that death offers a solution becomes very real. There is perhaps no better insight into this than country singer Rod Dowsett’s song “Rhyme or Reason”.
Interestingly though, it seems that even when we are in the darkest of places, a shard of light can pierce through. That shard might be a brief inkling as to the consequences of your intended actions on your family, or a realisation that life insurance might not payout. It has to directly challenge a rationally held belief that suicide is the answer. It has to do that on a very personal level and that’s one reason why the training courses tell you to be very direct with the person you are concerned about. “Are you considering suicide?” is a highly confronting question that takes guts to deliver. “Yes” or “No”, it’s also very difficult to escape from.
Professional help is widely available and comes in many forms, but moving beyond the crisis, there is something that does not seem to be so well understood. It’s a limbo that might be termed “losing the ability to experience joy”. Joy is what keeps us going and it is innate. A smile from our spouse, pride in our work, the warm aroma of a cup of coffee, as today in walking under the bluest of skies, the holiday with the kids, completing the university degree. None of these things count for anything if our state of mind prevents internalising the worth of our day to day lives. And without joy, there is nothingness. That’s why “limbo” is so dangerous.
Creating the conditions to re-experience joy involves making space in your mind so it can pick up the signals that message that life is worth living. Medication, exercise and learning how to manage your thoughts are powerful tools in making room for joy, but for many people, the underlying key is in beginning to understand what “look after yourself” actually means. It might be that for many people depression and suicide is at least in part based on an inappropriate empathy with our own feelings. That needs active management. We also have to be careful that “doing more” is not just covering the pain of our feelings and wearing us down further. You really have to be alert to the spiral nature of the trap.
Of course, I am no psychologist, psychiatrist or counsellor and I’m not pretending this is a panacea, but I think it is very wrong to limit difficult discussion to “oh no”, and “isn’t that terrible”. The research is littered with a vast array of numbers quantifying the problem, but little accessible material as regards causes and prevention. Helplines provide a great service, but perhaps it would be better for all of us to become very aware of the brittle nature of mental health, and to learn early on what is required to maintain it.