~ Content Warning: Self-harm, Suicide ~
I have been on suicide watch twice in my life — neither time for an attempt, or even because I was suicidal. So, I beg the question — what went wrong? And let’s get one thing straight — something is going wrong. I find a shocking amount of liability overcompensation in the Mental Health system, and subsequently, in treatment. One that is quite possibly carried over from the days of institutionalization (are we really that far gone?). One that is so deeply ingrained in our doctors and clinical teams, that maybe, it is harming us the most.
It’s a strange dichotomy. Nurses and doctors are trained extensively to fix and make better. With mental illness, it doesn’t really work like that. Especially with suicidal patients, or “perceived” suicidal patients. Nothing you say is trusted — you could potentially be lying about anything. Your history, your family, your schooling, your medications, etc. In turn, suicidal patients or perceived suicidal patients are often treated roughly, with anger and hostility, and lacking empathy and genuine concern.
Example 1: Seizure at a Baseball Game
I had my left arm wrapped in layers of protective bandaging. Two days before, I had a self-harm episode, after a few weeks clean. At this point, I was telling other people that my legs were attacked by a dog, so I reverted to using my forearm. When I had a seizure at my high school baseball team’s State Championship game, the EMT’s asked what the bandage was for. My friends tried to protect me, claiming it was a new tattoo that shouldn’t be touched. Quickly, however, the EMT’s asked for my medications. Gabby screamed out, “Uh, she’s on Prozac, and …”. Immediately, the questioning shifted. “Was she on drugs?” “Do you have any drugs on you?” “What was she doing that caused this?”.
When I woke up in the hospital, I was naked under a bed sheet with a woman on my left (Suicide Watcher), and one of my high school teachers. My “self-destructive tendencies” were being laid out for my high school staff to see, and I had babysitter. What they didn’t understand was, I wasn’t trying to kill myself. I was trying to do the opposite. Anything I could to stay alive. This experience led me to vow not to speak of any suicidal thoughts to doctors, for fear of ending up watched like a dog.
Example 2: Seizure at Brown University
My freshman year, I had two vasovagal syncope episodes turned pseudoseizures twice in one month. The first time, though I had not self-harmed in weeks and had no new, apparent wounds — I was unable to leave the hospital and go home until a psychiatrist deemed me “not suicidal”. I cannot accurately describe the pain, shame and fear I felt. My autonomy, my decisions, my brain, was being questioned. I felt like a child. Again, I thought, if I were really suicidal, I would never willingly ask for help. A nurse grabbed my arm and asked ‘What happened here?’. I am well-versed now to give a cool, unemotional response like, “These are old self-harm scars.”. She looked at me, pet my arm, and said, “Honey, you’ve got everything going for you! You’re going to Brown, right? Just be grateful for what you’ve got!”.
How can I protect my autonomy?
- Wellness Recovery Action Plan: These are amazing for planning overall care, avoiding a crisis, and understanding what is happening if a crisis arises. You can include the following information:
- Phone numbers for your loved one’s therapist, psychiatrist and other healthcare providers
- Family members and friends who would be helpful, and local crisis line number
- Phone numbers of family members or friends who would be helpful in a crisis
- Addresses of walk-in crisis centers or emergency rooms
- The National Suicide Prevention Lifeline: 1–800–273-TALK (8255)
- Address and phone number(s)
- Diagnosis and medications
- Previous psychosis or suicide attempts
- History of drug use
- Things that have helped in the past
- Mobile Crisis Unit phone number in the area (if there is one)
- Determine if police officers in the community have Crisis Intervention Training (CIT)
2. Psychiatric Advance Directives: PADs is a legal document that allows “a second party to act on your behalf if you become acutely ill and unable to make decisions about treatment.” The PAD is written by you (yay for autonomy!!!) when you are currently ‘competent.’ It details your preferences for treatment should you become unable to make such decisions due to your mental health condition. Planning ahead can make a huge difference in your treatment experience, and we at Project LETS, Inc. highly recommend this.
So, with so much clinical fear, what can we do to stop suicide?
I’ve experienced suicidal thoughts on and off for years. I do not want to die. But I talk about it. I have go-to’s. Not everyone, realistically, can handle the heavy stuff. But we should all know the resources/options if you’re presented with a friend who is experiencing something like suicidality. I cannot stress this enough: talking about suicidal thoughts and feelings is essential. They are not shameful. They are not a sign of being weak. And until we understand this, we will continue losing individuals. People have experiences and stories, tidbits of wisdom and advice that can change your life. I beg you to, please, let somebody in.
I work with students and young adults every day who are suicidal, but have never admitted it to a doctor. This is a problem. We refer individuals to therapists/psychiatrists, only to have them hide their true thoughts/feelings. When our only form of assessment is through verbal communication, and patients are too scared to tell the truth, how do we address the problem?
At Project LETS, Inc., we strongly believe in creating a climate of open communication + total honesty. Discussing suicide, suicidal thoughts, attempts, tendencies, etc. is one of the only ways to fight the stigma. However, we will continue to be at a blockade until individuals who are suicidal are not treated like criminals, but individuals with autonomy. Individuals with choices.
We need to understand that self-harm and suicidality come along with mental illness — they are not acts of rebellion, for attention, or for sympathy. We need to talk, talk, talk, and understand, truly, that these situations can happen to us. To those we know and love. To our own children. We must learn that self-harm does not equal suicide. Those who self-harm are not (always) trying to die. And even those who are suicidal, are trying to find ways to live.
We cannot let suicides be a “heartbreaking tragedy” of the moment — no more so than any other means of death. . Suicide knows no boundaries, no borders or limitations. So speak up. Speak up loud. Question policies that you don’t agree with. Educate yourself. Push for the education of others. Be a person who promotes and supports recovery. If you are a person struggling with your mental illness, share your story. If you are a person succeeding with your mental illness, share your story. As the wonderfully talented Shira stated in her article for Huffington Post:
“Stigma creates a climate of silence, shame, and death. When I say death I mean death. People suffer alone, until they can’t bear it, and then they break. Stigma perpetuates a cycle of private struggle and risk. When I look out into the cultural landscape and the only time I see the mentally ill represented is when people are in distress, I can’t possibly see a reflection that gives me hope. To not see examples of mentally ill people thriving is essentially to always feel death on the horizon. I know I’ve felt this way.”
Let us strive for a culture where identifying stigma is not the last step. We must work everyday to eradicate it from our daily lives/experiences, and from that of those around us. Let us strive for a culture where suicidal thoughts and tendencies are treated and discussed like diabetes. Let us rid fear and shame from our vocabularies and our hearts. Protect your friends, protect your loved ones. And never stop speaking.
Stëfanie Lyn is a spoken word poet, human rights warrior, Russian enthusiast and the Executive Director/Founder of Project LETS, Inc. — a non-profit organization supporting students and young adults with mental illness. She is a junior at Brown University studying Global Mental Health + Contemplative Studies.
Stëfanie Lyn lives with Major Depressive Disorder, Obsessive Compulsive Disorder, and BPD — even though her doctor told her not to share the last one with anyone else unless it was an emergency. She doesn’t really like hypocrisy, so here it is. The good, bad, and ugly.
Contact Stefanie at: firstname.lastname@example.org