Ending the silence on suicide
Melinda was tired. For more than a year, she had watched her personality recede. Felt its outlines become fuzzy, like her soul was bleached. Depression was a form of self-erasure. Things that once brought pleasure – food, conversation, painting – were insipid now. She felt slothful and self-absorbed, a cheap counterfeit of her former self. The pain was insensible, insufferable, but she surprised herself with how well she could conceal it from others. Despite the collapse of energy, there was often a sufficient amount left to maintain appearances. When she socialised – which was much less these days – she could nod and smile in the suitable places. She was simulating an inner life. She sought counselling, but robbed of motivation to improve – a diabolical symptom of severe depression – she wasn’t properly committed.
And then she decided: she would end it. She made plans and began re-engaging with friends, who noted a lift in her mood. She was generous with her money, and gifted her belongings. Perversely, in preparing for death she had rediscovered purpose. She felt she would no longer be a burden to others, blind to the fact that her death would be the greatest burden of all. Melinda was experiencing a common misconception of suicidal ideation – that her death would not only be a blessing to her, but others. It is, of course, the opposite: a profoundly devastating act.
Melinda used pills. Fortunately, she was discovered before she died. For this, she is grateful. “The common cognitive state of suicide is ambivalence,” Edwin Shneidman, a leading expert on suicide, has written. “I believe that people who are actually committing suicide are ambivalent about life and death at the very moment they are committing it. They wish to die and they simultaneously wish to be rescued.”
Melinda was happy to be rescued. And it proved to be the pivot point she needed to seek full, rehabilitative counsel. Melinda’s attempt was an example of a plotted, premeditated attempt. There are others.
Alan was a lawyer. Successful and abrasively assured, he was also working within a profession with alarmingly high rates of depression and anxiety. Not that it touched him. He thought of himself as unusually resilient, one virtue of many that comprised his armour. Alan didn’t realise it, but his fierce self-conception – of unyielding talents and inevitable success – was dangerously fixed. There was little that was compromising or flexible about him. And when the bottom suddenly fell out – the result of a drunken scandal – there was a catastrophic dissolution of his identity. Everything he knew about himself, everything that others thought about him, washed away.
Alan’s suicide attempt was unlike Melinda’s. It was impetuous, a sudden response to something that appeared insuperable. What he did share with Melinda was a crisis of identity. Reputations don’t recover, he told himself. He was wrong.
Alan tried to hang himself. He was discovered, cut down. What followed was a painful reckoning. Alan was humbled, but enfolded this humility into a softer, more stable personality. His reputation recovered; he recovered. Like Melinda, he is glad he survived.
Suicide is everywhere in my life, as it probably is in yours. I have seen attempts, made late-night interventions, pulled a woman off train tracks. I have friends traumatised by the deaths of loved ones. I remember the story of a woman whose father snuck into the garage one night and tried to gas himself, before changing his mind and creeping, nauseous, back to bed. As his wife slept beside him, undisturbed, he placed a photo of his two daughters beneath his pillow in tender penance.
Rarely talked about
There were 2273 suicides in Australia in 2011. The road toll that year was 1291. In both, men comprised three-quarters of deaths. While for non-Indigenous Australians 1.6 per cent of deaths are by suicide, the number is far greater for Indigenous Australians – the figure jumps to 4.6 per cent. In Australia, 150 people will attempt suicide each day.
Internationally, more than 800,000 people will kill themselves each year – but given cultural sensitivities, or the fact that suicide is illegal in some countries, that number is likely to be the result of under-reporting. In wealthier countries, men commit suicide at three times the rate of women – but in developing countries the ratio is 1.5 men for each woman.
And yet “suicide is an issue that is rarely talked about or understood”, says the Insight guidebook on suicide prevention. It “can evoke strong reactions in people which curtails or prevents supportive and non-emotive discussions. For the person at risk of suicide, the fear of stigma and the lack of empathy and validation for what they are experiencing often prevent them from seeking help.”
One reason we have rarely spoken about it is that, until recently, suicide was effectively banished from newsrooms unless it involved a celebrity. The inhibiting force was the contagiousness of suicide – the threat of copycat suicides. No reporter wanted blood on their hands. The contagion of suicide is not a recent phenomenon. In 1774, Johann Goethe’s novel The Sorrows of Young Werther was published and rapturously received by Europe’s youth. Its titular character is a young romantic aesthete, bubbling with passion, but it is this very passion that engineers his self-destruction. The book ends with his suicide. European countries began banning the work after a spate of imitative suicides.
In Kay Redfield Jamison’s book on suicide, Night Falls Fast, the author and psychiatrist describes a bizarre suicide epidemic in Japan. In 1933, two young women climbed to the top of Mount Mihara, an active volcano but almost “entirely unknown”. Once there, one woman told her friend she intended to leap in and cremate herself, before drifting to heaven in a column of smoke. And so she did. Distraught, the surviving friend broke her vow of silence and told friends – only for another to emulate the death. “Soon the story was a major force in the cultural life of Japan,” Jamison writes. “People swarmed to Mihara … On a Sunday not long after the two deaths, six people leapt into the volcano; twenty-five others had to physically restrained from doing so. Tourists lined up to watch the suicides, which were now occurring several times a week.” Three years after the first suicide, in 1936, 600 people took their lives by jumping inside the crater.
Plenty of institutions – including the World Health Organisation – accept our suggestibility and have offered media reporting guidelines. But today the prevailing view is that media must strike a balance between circumspection and the power of reporting to educate and console. Not all media reporting correlates to increased suicide – there’s evidence it can decrease it. But newsrooms have erred on the side of caution. So much so, the Australian Press Council revised its guidelines in August 2011. It marked a shift away from cautious silence. “The new standards emphasise that general reporting and comment on issues relating to suicide can be of substantial public benefit,” the council’s statement read. “It can help to improve public understanding of causes and warning signs, have a deterrent effect on people contemplating suicide, bring comfort to affected relatives or friends, or promote further public or private action to prevent suicide. There should not be a taboo on reporting of this kind.”
The Age newspaper editorialised: “The taboo against reporting suicide has been lifted in extensive new guidelines released to the print media today by the Australian Press Council. The journalistic euphemism for suicide – ‘police said there were no suspicious circumstances’ – may fade away now that the new guidelines acknowledge that reporting suicide can be of public benefit.”
Until then, the prospect of contagion meant suicide was rarely reported. The advice was too stark, the responsibility too great. “Totally accurate,” Professor Patrick McGorry tells me. McGorry was the 2010 Australian of the Year, an honour received for his mental health advocacy. “I have campaigned against this [silence]. I think the balance is shifting well now. It doesn’t help to sweep things like domestic violence or abuse under the carpet. The mental health field has, in my view, overstated the risks associated with prominent reporting. Most of the evidence is circumstantial. Reporting of method in my view merely affects the actual method used. It has not been shown to increase the numbers attempting it. It is not as though someone not already at this point is suddenly going to realise that jumping off a building or in front of a train is going to be lethal.
“I don’t think it is at all good to report celebrity suicide but they are the ones that are inevitably reported because they are real news. I do think the ordinary person’s suicide should be reported, though, and a count kept because then the extent of the problem – like the road toll – becomes clear. But no suicide should be reported in a glamorous way or as a reasonable or inevitable solution.”
McGorry is not alone in supporting a national suicide toll. Last month, psychiatrist Professor Philip Morris told ABC’s 7.30: “People are aware of [the road toll] and so that if it goes up, we start to think, ‘What’s happening?’ The politicians then get the pressure and then the services that are provided through the various state agencies and the government agencies start to do things in response.”
We can’t say how the public would respond to such a stark recording of suicide’s prevalence. The road toll is a reminder of human frailty – and awful randomness – but in its long decline also tells a story of improved laws, roads, and car safety. A suicide toll reminds us of something much more personal and confronting. A national toll would be a powerful notation of our capacity for self-annihilation – a broad index of our private anguish, suffering, and illness. For some, the toll would jarringly upset our comforting platitudes about the miracle of life – about its exquisite value. But a national toll would ask us to confront things many of us have evaded. For McGorry and Morris, it would inspire a national reckoning – manifest in candid conversations and the liberation that follows destigmatisation.
It is hoped that those conversations – both public and private – might become more enlightened. Because often, when the topic arises we drop our voices, furrow our brow, look furtively around. The topic can invoke an awkward blend of embarrassment and shame. It is taboo and, as such, misunderstood. A former police officer told me it was “very common” for families of suicide victims to contest the coroner’s finding of death. The fact of the suicide cannot be integrated with their pre-existing concept of their loved one, who seemed so happy, so normal. Incredulity twists itself into a solemn rejection of the coroner’s competency.
If the deceased is a parent, suicide might invoke thorny questions of responsibility – better to banish those with alternative theories. For this and other reasons, suicide can invoke shame and caustic bewilderment. Suicide invites those left behind to feel complicit – to wonder what they might have done differently, to excoriate themselves for their lack of perception. Suicide scorches the earth around you.
There is no neat way of explaining what causes suicide. Contributing factors vary and fluctuate between individuals. Often a suicide is the culmination of myriad factors, both internal and external. A previous suicide attempt is the strongest predictor of a completed one, while a person’s chances of suicide are higher if suicide has claimed someone close to them. Emotional problems figure heavily. By some estimates, 70 per cent of suicide victims are suffering depression or some other emotional suffering. “Mental ill health is the proximal cause,” McGorry tells me. “The vast majority of people who die are not in a mentally healthy state and need some kind of immediate and often longer-term help. It is hard to access in a timely way with sufficient expertise.
“Other contributory causes are life stressors which cause overwhelming emotional pain which create the mentally unhealthy state and suicidal thinking. Substance abuse is an accelerant. Broad social factors as peacetime, economic downturns creating financial and other stress obviously play their macro or tectonic parts, but in the end they are channelled through the mind and mental state of the individual. This mental state is mercurial, which makes assessment and prediction hard as the level of risk changes quickly.”
Myths have a chilling effect upon our response to suicide. Arguably the most damaging myth is that directly asking someone about suicide might actually induce it. As a result, friends and family might inquire obliquely or bashfully. “It’s important not to treat suicide as a taboo subject,” warns the prevention guidebook, Insight. “Raising the issue sensitively and asking directly about suicide gives the person at risk permission to speak about his or her distress, and demonstrates to the person that you care. Rather than feeling worse, the person at risk could feel relieved if the issue of suicide is raised in a caring and non-judgemental manner.”
Insight – as well as the WHO – are eager to banish another myth: that most suicides occur without warning. “The majority of suicides have been preceded by warning signs, whether verbal or behavioural,” the WHO states. “Of course there are some suicides that occur without warning. But it is important to understand what the warning signs are and look for them.”
To start, we begin by thawing our reluctance to think about the issue of suicide.
Labor party pledge
Last month, the Labor party pledged to halve the suicide rate should it win the next election. The aspiration would take a decade, and reflects the Mental Health Commission’s target. “The [target] should be zero,” McGorry tells me. “[Labor’s plan] will take a lot of new funding. It should not be cost neutral as both parties suggest. But I strongly support the national Mental Health Commission’s recommendations, and the 12 regional trials in particular.”
The announcement was further proof that we’ve turned a corner on speaking about suicide. There are many more like Melinda and Alan – men and women who through cataclysm or disease chose to kill themselves, only to discover gratitude and recovery after their survival. Unfortunately, there are many more still who never woke up – who erroneously believed there was no other way out. We owe them – at the very least – a conversation.
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This article was first published in the print edition of The Saturday Paper on Dec 5, 2015 as "Ending the silence". Subscribe here.