On "getting help."
Yes, you may link to this entry. I'm fine with that.
A good while back, I did a couple of entries about suicide. They're right here:
My personal history. In that entry I establish that I have never attempted suicide, but that suicidal ideation is very familiar to me.
On suicide being a "selfish" act. In that entry I attempt to take down the idea that suicide is a selfish, cowardly act.
After I posted those, one commenter remarked: "But not everyone who commits suicide is mentally ill. And the ones who are could get medicine. Most don't bother to try."
I promised that person I would respond to their comment when I was through wishing I could bite them in the face. I hope they are reading, because this is that response. It's long, it's difficult, it's not pretty, but something another person of my acquaintance said today made me think it might be a good time to link to those old entries again and finish up that little bit of unfinished business by dragging out this entry, written a while ago, cleaning it up, and posting it.
Disclaimers:
I am screening comments for at least the first couple of days, here, because I'm stating the obvious and that always pisses people off. If you don't want your comment unscreened, say so, and I will not unscreen it. I don't plan on approving inflammatory remarks or responding to them, nor will I necessarily debate anything. If you're looking for that kind of attention or feedback, you can write about it in your own journal and probably get better results.
As I said in one of the other entries, my intent is to clear up some basic misunderstandings about depression and suicide, with the hope that if people have a greater understanding of this truth, they will be better able to offer support to people who need it, or maybe be willing to offer it, you know, at all.
If someone you love has committed suicide, you have my utmost sympathy. If that kind of thing didn't break my heart, I would not write entries like this. That said, I am centering the experiences of mentally ill people for this conversation, and unfortunately that means I cannot also center the experiences of those who have lost a loved one to suicide. This is not meant as an invalidation of others' feelings and experiences, but I personally cannot talk about the two together like that, and think it would be a bad idea for me to try. I have no desire to judge individual instances of suicide because I'm not qualified. If you are hurting a lot in that regard, it might be best if you skipped this entirely.
Moving on.
"But not everyone who commits suicide is mentally ill. And the ones who are could get medicine. Most don't bother to try."
That one utterance, that single comment, is a distillation of almost everything that is wrong with how people view mental illness and suicide.
So that everyone reading might be enlightened, and so that anyone inclined to do so might link to it, I would like to dismantle a few of those myths by dismantling that comment, point by painful point. It's a bit like taking a hammer after a fruit fly, but sometimes it needs to be done.
First.
People who deliberately kill themselves are mentally ill. With the arguable exception of terminally ill individuals who are making that decision to spare themselves and their families terrible suffering, mentally sound people don't generally kill themselves. They were not in their right minds, even if it was only for the single moment it took to take that step.
If exceptions to this exist, and I concede that they may, they are so rare as to have no bearing on how we as a culture should view suicide. Those cases should not define the issue.
Most people who commit suicide are not psychotic or delusional, this is true, and so the person often seems sane because unless a person's mental illness manifests in a particularly disastrous way, it is often invisible. Mental illness is not confined to psychosis or delusional disorders. It encompasses a lot of things that just don't show.
Most people who commit suicide are depressed. Whether it is a passing, single episode of depression, or one of a cycle of depressions, or an unremitting, persistent state, depression is a disabling condition that fundamentally alters the way a person reacts to their surroundings.
Sure, depressed people often seem normal, and suicide can therefore come as a shock, but a normal outward appearance is not an indicator of mental health.
Second.
"Medicine," and the less specific "help," are not magic vending machine buttons you can push to dispense a "cure."
"Getting help" is easier for some people than for others; it is not psychologically forbidding for them to reach out, and when they do reach out they find help quickly. Others find it quite difficult to reach out, either because they have been conditioned not to, because they feel guilty for doing so, or because there is no-one to reach out to. Some people have no problem asking for help, but help is hard to come by, leaving them essentially helpless.
For someone reluctant to seek help that is hard to find the path is often riddled with false starts, dead ends, and roadblocks. I experienced this firsthand when it took me a year to admit I needed help, and another four months to even start getting it. I won't try to calculate how long it took after "getting help" to actually feel any improvement. Months. A year. It is, in retrospect, surprising I survived that. Had I been watching someone else ride through that hell, I would not have expected them to stay on the horse.
Third.
It is important to understand why depressed people may not seek treatment.
Sometimes they do not know how to ask for help. They may not know who to go to, or they may be uncertain of what to say. If they believe others think of them as strong and perfect, or if they occupy a position of authority or power, they may feel at a loss to express their suffering without a loss of face. They may be so invested in the image of themselves as strong and perfect that they don't think such feelings are "really them," and will deny them until those feelings have done irrevocable harm. Some may fear that they will not be believed if they admit to having these feelings. They may fear that they will be seen as weak, and they may fear the repurcussions of being labeled weak or ill. They may fear that by asking for help, they will be letting their family and friends down.
They may simply not be experienced at talking about their feelings, and such things may be difficult for them to articulate. Some people -- like me -- don't like talking about difficult issues unless they have figured out exactly the exact right way to say what they need to say. Some people do not want to ask for help unless they know for sure what they should be asking for, what sort of help they want or need. Some are afraid of placing a burden on their loved ones, or on a system that they believe is there to help other people, people with "real" illnesses, or people who might be more ill than they are.
Sometimes they have asked for help before and have not gotten it. Sometimes they have been actively rebuffed, perhaps more than once, and each successive rejection makes it harder to reach out. Some people don't ask for help because they don't feel like anyone will help them - and given how society as a whole views (and therefore treats) suicidal or depressed people, they may very well be right about that. Something as simple as hearing a friend dismiss suicide as selfish is often enough to ensure that friend is never, ever trusted with any important emotional cargo. I know that's true of me; why would you open yourself up to someone you knew viewed your pain as an emotional crime against others?
Sometimes they are too ashamed to seek help. Depressed people are often very strong people, and they feel foolish or weak for being unable to fight it off. They are embarrassed by emotions that seem to have no real source, emotions that may be difficult to articulate or define. Many people have been taught to that depression is a sign of a weak character, a lack of emotional strength, and that suicide is something that only weaklings and quitters consider. Others have been taught that talking about depression is manipulative, a grab for attention - and that this especially applies to people who are suicidal, because suicide is so widely regarded as "selfish" and failed attempts are seen as "manipulative."
Some people feel that they deserve their depression as a punishment for past mistakes, or for perceived shortcomings. These people are, rather unsurprisingly, unlikely to seek help for a problem they regard as nothing less than they deserve. There are folks out there who will tell you that depression - a chemical imbalance - is a sin, and they are all too willing to judge people accordingly. Not all of these people are motivated by religion. Society is downright eager to add to the burden of shame suffered by those who are depressed and suicidal by telling them that they brought it on themselves.
Sometimes suicidal people do not feel like they deserve help at all. This is perhaps the most disturbing of all the reasons a person refuses to seek help. Of course they do deserve help, but feelings of unworthiness - hellish all on their own - prevent them from doing what they must do to care for themselves. It sounds ridiculous, but this absolutely happens, and it happens to incredibly intelligent, strong, willful people. Given how nightmarishly difficult it can be to find someone to treat you, find the right drug, force insurance to cough up or find another way of paying, and so on, it's not surprising that certain people have a problem demanding what they need. When depression combines with self-esteem issues, the result is a lethal cocktail.
Fourth.
Those who seek treatment often find that it does not provide an immediate end to their suffering.
Sometimes the treatment doesn't work at all. The wrong drug can very easily make an unstable mental state worse; that happened to me. The wrong therapist will do no good, and a bad one may do harm. A wrong diagnosis can mean the difference between a treatment approach that works, and one that might kill you by not working when you need it to: to wit, if you treat bipolar depression with the same SSRIs commonly used to treat major depressive disorder, you stand a good chance of making your patient worse. Yet bipolar depression is often wrongly diagnosed by doctors who don't yet understand what Type II is all about. Sometimes a treatment seems to be working, but reveals itself, too late, as insufficient. Sometimes the patient feels guilty that the treatment isn't working, and may be slow to admit this to doctors or caretakers because of it. They are taught that most of the problem is theirs, and so they keep "trying," thinking they are the part of the equation that's broken, when it's really the drugs.
Sometimes the treatment takes too long to work. It can take weeks for drugs to take effect, not counting the months it often takes to find the right one to begin with. Therapy is hardly any better. It can take months for someone who is suicidal to stabilize - or a year, two years, or never. It is a disgusting myth that you can pick up the phone to get help and start feeling better the very next day. Many people who commit suicide are on antidepressants or mood-stabilizing drugs, seeing therapists, in support groups, the whole nine yards. They are doing everything "right," and yet they are still suffering. Why? Is it because drugs and therapy and support don't work? No. It's because the people who need these things are ill, and there is more to becoming well than just taking a drug and talking to a shrink. It's not like an ear infection, where, after a course of antibiotics, the problem is gone. This is an ongoing condition, and for many people, it is something they will have to deal with forever in one form or another.
Sometimes the treatment stops working. Even if an effective drug can be found, certain drugs are prone to give up the ghost after months or years, leaving the patient vulnerable until she can find a suitable replacement. Therapists go into retirement or change clinics or are removed from insurance plans. One of mine moved to Egypt. Egypt. When this happens, it can add to the burden of pain as the patient must begin the process of "getting help" or finding a new drug all over again. Sometimes the emotional resources to do this just aren't there. Going over the whole painful backstory with a new therapist for the third time in a year is a hideously demoralizing and agonizing process that does nothing but slow down advancement.
Sometimes the treatment is unavailable. It was three months before I could get in to see a therapist after my bad break. Three months, and I was at the brink of suicide when I sought help. I couldn't put my pain on pause during that time, and unfortunately the idea that help was coming didn't make it any easier to live with that pain. Yes, I could have hospitalized myself in order to get immediate care, but guess what? Institutionalization is not the best option for a lot of people. For some people it's a godsend, but it can be extremely damaging for others, especially given the opportunities for abuse that abound in such a setting.
Sometimes the site of treatment itself is inaccessible. A poor person with no car may not be able to cross town to get to the low-cost clinic, especially if they live in a town, like mine, like many midwestern towns and small towns, with no affordable, reliable public transportation system. A disabled person may find that the clinic is not accessible to them at all. This is not as unlikely as it sounds. My first therapist was located on the third floor of a building with no elevators. Until it moved, the most suitable low-cost option was located on the second floor of a building with no elevators and a very narrow, steep stairwell with a jog in the middle. When it moved, it moved to a building that had four steps down to the curb and no wheelchair ramp. If a person has panic attacks triggered by getting in a car, or suffers from agoraphobia, or any of the other things that can make leaving the house a living hell, "getting help" becomes a nightmarish prospect.
Sometimes the cost of treatment is prohibitive. Not every community has a low-cost mental health clinic, and existing clinics do not always have openings for new patients. Sometimes the only low-cost option may be unacceptably bad, or provided through an inappropriate venue; a good example of this would be a gay man seeking grief counseling for the death of his partner and finding the only "widower's" workshops are conducted by a local evangelical ministry. This is not at all unlikely. The best mental health hospital in my area, the one I take outpatient therapy from, says right up front on all its literature that it is a Jesus-based organization. I lucked out, my therapist is a bitchy old atheist, but I would be lying if I didn't feel uncomfortable about the crucifixes in every hall.
So good help can be hard to find, and affordable, appropriate help still harder, especially if you live in a smaller city with reduced options to begin with. Not every person knows how to ferret out resources or has a doctor, friend, or spouse who is willing and able to go out of their way to help. If the in-network caregivers are all booked up, a person with insurance might have to see a provider who is not in their insurance network if they want to be seen in a timely fashion, and that might mean paying more of the costs themselves, perhaps all. A person without insurance might have to pay $120 a session or more to see a therapist - sessions that may be needed weekly, or twice weekly, until the person has stabilized. Someone who needs lifesaving medication may not be able to pay for it - generic drugs and older drugs are often cheap, but they don't work for everyone. Some people require expensive, specialized drugs, very new drugs, or combinations of drugs, to get effective relief without unbearable side effects. I have insurance, and I still had to pay half the cost for one of the mood-stabilizers I took. It was about $90 a month. If I had entered this latest episode poor and with no insurance, I would have had no way of getting help at all. Would I still be alive? I don't know. Thank god for my privilege, which I never deserved, but which saved my sorry ass.
Sometimes the treatment stops being covered by insurance. Many insurance plans have a yearly or even lifetime cap on how much they will pay for mental health services. Sometimes an insurance plan deletes drugs from their approved formulary or reclassifies them, causing them to skyrocket in price. Patients must then scramble to switch to a different drug - a switch that can cause severe side effects. And, again, the drug they switch to might not work. If a person experiences a lapse in coverage, they might find that their mental illness is now classified as a preexisting condition. This can not only lead to them not getting further care, it can contribute to people not seeking help in the first place as they wait for their job situation or their spouse's job situation to become stable.
Fifth
When depressed people don't seek help, it is often because of feelings of shame, fear, guilt, hopelessness, or helplessness.
Sometimes, as incredible as it is to say, people don't know they are depressed. They blame their pain on circumstances: a crappy job, a difficult family situation, an illness, stress at school, a death, the lack of friends, their poverty, their body, and so on. They believe that if the circumstances changed, they would not be depressed and life would be wonderful again. They keep waiting for whatever they are blaming to go away, assuming that they will feel better when it does. Improving one's circumstances might bring relief to people whose depression genuinely was situational, and will probably bring relief to someone who is clinically depressed, but it is not a cure of any kind. A hallmark of depression is having a good life, and being miserable anyway. That doesn't stop people from blaming circumstances for their depression - no surprise when you consider the cultural messages about depression that most of these people have been bombarded with since birth. If I had nothing but the way other people talk about mentally ill individuals, I'd rather blame my shitty job for my misery than think that something was wrong with me, too.
Sometimes they are in denial. Because of the stigma attached to mental illness and suicide, and also because of how genuinely awful mental illness can be, many people are unwilling or unable to admit how terrible their situation is. They cling to the belief that they will, as people tell them to, "snap out of it." They tell themselves that their problems are not worth getting worked up over, that their fate is no worse than anyone else's - others have it worse! They tell themselves that they are not "like that," not one of "those people," not a "drama queen," not "high maintenance," or they tell themselves that they could not possibly be depressed because there are good things about their life. They tell themselves that if they just keep pushing, it will pass and things will get better. Sometimes they do this because the prospect of actually being mentally ill is too awful for them to contemplate.
Sometimes they simply feel hopeless. A person suffering deeply from depression or suicidal feelings may not feel that there is any hope. I certainly have days where I don't feel like there's any hope for me. A hopeless person contemplating suicide may feel that their life is meaningless, that they contribute nothing, or that what they contribute is insignificant in comparison to what they take. They feel that they cannot change and that nothing they can do will make up for the burden they place on their friends and loved ones. They may believe that their self-inflicted death is inevitable and they may as well hasten it along. For me, there are days when the knowledge that many, many bipolar people commit suicide feels like a terminal diagnosis - and that leads to the dreadful thought that it's foolish to fight the inevitable end. Whether I commit suicide or not, I'm now a statistic on one side or other, and that's sobering.
Sometimes they feel helpless because they don't believe that drugs and therapy will help them; sometimes they've tried it in the past and it hasn't worked. Sometimes it is simply the complexity of the tasks necessary to get help that foils them and makes them hopeless; to a person deep in the pits of despair, making a single phone call can be unbearably daunting. Navigating the alligator-infested, pitfall-ridden swamp of the medical industry can weaken even the stoutest heart. The slightest resistance can exhaust already depleted emotional resources. The ridiculous things the mental health care system routinely demands of mentally ill people are too often things that the people most in need of help have no resources to devote to doing.
Sometimes they are afraid of treatment. An aversion to taking drugs is common; stories of terrible side effects are frightening, after all, and not hard to find, not to mention the value our culture places on not needing drugs to "get by," the value ascribed to "toughing it out." Physical side effects are bad enough; psychological side effects can be terrifying. I know I had many second thoughts about trying drugs. "What if it steals my creativity? What if it turns me into an automaton? What if it takes away my ability to feel anything, not just pain?" It took a great deal of courage to risk that, and even more to persevere and keep trying new drugs when everything that I feared and worse came to pass.
Some people may be afraid because they know that drugs and therapy take time to work; they may also be aware that getting help itself can be difficult - and in both these cases the wait and the fight can be destructively demoralizing.
They may fear that if they ask for help, or if they are honest about their feelings, they will be labeled as dangerous to others or to themselves, that their treatment will be taken out of their hands and they will be forced to take drugs or enter an institution against their will. The fear of being "sectioned" is very real and completely valid.
People may fear the label of "mentally ill" itself, either because they buy into the stigma associated with it, or because they know all too well the stigma others would apply to them. There is even the fear of not suffering any more. "What will happen once I am being treated and begin to feel better? What will I do with myself? How will I make up for all that wasted, lost time? How can I possibly go forward, having lost so much ground? Who will I be if the treatment works? Now what?" These questions can seem foolish to someone who has never had to ask them, but they are all quite understandable, and I have agonized over them all at one time or another. Living the answers to these questions is so often a healing experience, far easier to navigate than the suffering one is trying to alleviate, but it's impossible to viscerally believe that from the other side of the divide. We fear what is unknown. Our suffering is at least something we are familiar with.
Sixth
Saying that "most people don't even try" to get help is an insulting dismissal of the very real obstacles that face mentally ill people trying to do exactly that.
We have just gone over many of those obstacles and seen that they are not trivial things.
That "most people" don't try to get help is not something we can know. Our figures for mental illness fucking suck, because the diagnosis rate fucking sucks. I personally believe that "most people" who have a mental illness of any severity do try to get help in some form at some point. I just also believe that this doesn't always, or even usually, lead to the kind of help that is actually helpful, the kind of help that they deserve.
"Don't even" implies that wow, these suicidal people must just be a bunch of lazy dumbasses or something, because how hard can it be to just get help? It's a phrase with a lot of hidden blame. Blame for those who suffer from depression or other mental illnesses does not ever belong in any compassionate discussion of suicide. It is a human life we are talking about. Not abstract human life in general but real, individual human life. A specific living person. Their life. Someone you could shake hands with, someone who laughs at in-jokes with their friends and mulls over their unfulfilled dreams and has a guilty fondness for a certain awful TV show and who has probably been the only living witness to more than a few beautiful, incredible things. That truth, the reality that pain affects human beings, should command the greatest respect.
The whole statement stinks of someone trying to minimize the suffering of others because it is just too scary for them to contemplate the ugly idea that we live in a world where mentally ill people routinely seek help and either don't get it or get help and then commit suicide anyway because mental illness can be just that horrible, and some help is just that unhelpful.
It's more reassuring to believe in a just world, where everyone who kills themselves is someone who deserved it on some level, someone who had every chance and threw it away, someone who had access to exactly the right therapy at the right time and chose not to take advantage of it, someone selfish and thoughtless and stupid, someone we are better off without.
If you genuinely believe that shit, I wouldn't go pointing fingers at people without whom the world would be a better place. Pot. Kettle. Look into it.
So, in short:
"But not everyone who commits suicide is mentally ill. And the ones who are could get medicine. Most don't bother to try."
Bull. Fucking. Shit.
Thank you and good night.
A good while back, I did a couple of entries about suicide. They're right here:
My personal history. In that entry I establish that I have never attempted suicide, but that suicidal ideation is very familiar to me.
On suicide being a "selfish" act. In that entry I attempt to take down the idea that suicide is a selfish, cowardly act.
After I posted those, one commenter remarked: "But not everyone who commits suicide is mentally ill. And the ones who are could get medicine. Most don't bother to try."
I promised that person I would respond to their comment when I was through wishing I could bite them in the face. I hope they are reading, because this is that response. It's long, it's difficult, it's not pretty, but something another person of my acquaintance said today made me think it might be a good time to link to those old entries again and finish up that little bit of unfinished business by dragging out this entry, written a while ago, cleaning it up, and posting it.
Disclaimers:
I am screening comments for at least the first couple of days, here, because I'm stating the obvious and that always pisses people off. If you don't want your comment unscreened, say so, and I will not unscreen it. I don't plan on approving inflammatory remarks or responding to them, nor will I necessarily debate anything. If you're looking for that kind of attention or feedback, you can write about it in your own journal and probably get better results.
As I said in one of the other entries, my intent is to clear up some basic misunderstandings about depression and suicide, with the hope that if people have a greater understanding of this truth, they will be better able to offer support to people who need it, or maybe be willing to offer it, you know, at all.
If someone you love has committed suicide, you have my utmost sympathy. If that kind of thing didn't break my heart, I would not write entries like this. That said, I am centering the experiences of mentally ill people for this conversation, and unfortunately that means I cannot also center the experiences of those who have lost a loved one to suicide. This is not meant as an invalidation of others' feelings and experiences, but I personally cannot talk about the two together like that, and think it would be a bad idea for me to try. I have no desire to judge individual instances of suicide because I'm not qualified. If you are hurting a lot in that regard, it might be best if you skipped this entirely.
Moving on.
"But not everyone who commits suicide is mentally ill. And the ones who are could get medicine. Most don't bother to try."
That one utterance, that single comment, is a distillation of almost everything that is wrong with how people view mental illness and suicide.
So that everyone reading might be enlightened, and so that anyone inclined to do so might link to it, I would like to dismantle a few of those myths by dismantling that comment, point by painful point. It's a bit like taking a hammer after a fruit fly, but sometimes it needs to be done.
First.
People who deliberately kill themselves are mentally ill. With the arguable exception of terminally ill individuals who are making that decision to spare themselves and their families terrible suffering, mentally sound people don't generally kill themselves. They were not in their right minds, even if it was only for the single moment it took to take that step.
If exceptions to this exist, and I concede that they may, they are so rare as to have no bearing on how we as a culture should view suicide. Those cases should not define the issue.
Most people who commit suicide are not psychotic or delusional, this is true, and so the person often seems sane because unless a person's mental illness manifests in a particularly disastrous way, it is often invisible. Mental illness is not confined to psychosis or delusional disorders. It encompasses a lot of things that just don't show.
Most people who commit suicide are depressed. Whether it is a passing, single episode of depression, or one of a cycle of depressions, or an unremitting, persistent state, depression is a disabling condition that fundamentally alters the way a person reacts to their surroundings.
Sure, depressed people often seem normal, and suicide can therefore come as a shock, but a normal outward appearance is not an indicator of mental health.
Second.
"Medicine," and the less specific "help," are not magic vending machine buttons you can push to dispense a "cure."
"Getting help" is easier for some people than for others; it is not psychologically forbidding for them to reach out, and when they do reach out they find help quickly. Others find it quite difficult to reach out, either because they have been conditioned not to, because they feel guilty for doing so, or because there is no-one to reach out to. Some people have no problem asking for help, but help is hard to come by, leaving them essentially helpless.
For someone reluctant to seek help that is hard to find the path is often riddled with false starts, dead ends, and roadblocks. I experienced this firsthand when it took me a year to admit I needed help, and another four months to even start getting it. I won't try to calculate how long it took after "getting help" to actually feel any improvement. Months. A year. It is, in retrospect, surprising I survived that. Had I been watching someone else ride through that hell, I would not have expected them to stay on the horse.
Third.
It is important to understand why depressed people may not seek treatment.
Sometimes they do not know how to ask for help. They may not know who to go to, or they may be uncertain of what to say. If they believe others think of them as strong and perfect, or if they occupy a position of authority or power, they may feel at a loss to express their suffering without a loss of face. They may be so invested in the image of themselves as strong and perfect that they don't think such feelings are "really them," and will deny them until those feelings have done irrevocable harm. Some may fear that they will not be believed if they admit to having these feelings. They may fear that they will be seen as weak, and they may fear the repurcussions of being labeled weak or ill. They may fear that by asking for help, they will be letting their family and friends down.
They may simply not be experienced at talking about their feelings, and such things may be difficult for them to articulate. Some people -- like me -- don't like talking about difficult issues unless they have figured out exactly the exact right way to say what they need to say. Some people do not want to ask for help unless they know for sure what they should be asking for, what sort of help they want or need. Some are afraid of placing a burden on their loved ones, or on a system that they believe is there to help other people, people with "real" illnesses, or people who might be more ill than they are.
Sometimes they have asked for help before and have not gotten it. Sometimes they have been actively rebuffed, perhaps more than once, and each successive rejection makes it harder to reach out. Some people don't ask for help because they don't feel like anyone will help them - and given how society as a whole views (and therefore treats) suicidal or depressed people, they may very well be right about that. Something as simple as hearing a friend dismiss suicide as selfish is often enough to ensure that friend is never, ever trusted with any important emotional cargo. I know that's true of me; why would you open yourself up to someone you knew viewed your pain as an emotional crime against others?
Sometimes they are too ashamed to seek help. Depressed people are often very strong people, and they feel foolish or weak for being unable to fight it off. They are embarrassed by emotions that seem to have no real source, emotions that may be difficult to articulate or define. Many people have been taught to that depression is a sign of a weak character, a lack of emotional strength, and that suicide is something that only weaklings and quitters consider. Others have been taught that talking about depression is manipulative, a grab for attention - and that this especially applies to people who are suicidal, because suicide is so widely regarded as "selfish" and failed attempts are seen as "manipulative."
Some people feel that they deserve their depression as a punishment for past mistakes, or for perceived shortcomings. These people are, rather unsurprisingly, unlikely to seek help for a problem they regard as nothing less than they deserve. There are folks out there who will tell you that depression - a chemical imbalance - is a sin, and they are all too willing to judge people accordingly. Not all of these people are motivated by religion. Society is downright eager to add to the burden of shame suffered by those who are depressed and suicidal by telling them that they brought it on themselves.
Sometimes suicidal people do not feel like they deserve help at all. This is perhaps the most disturbing of all the reasons a person refuses to seek help. Of course they do deserve help, but feelings of unworthiness - hellish all on their own - prevent them from doing what they must do to care for themselves. It sounds ridiculous, but this absolutely happens, and it happens to incredibly intelligent, strong, willful people. Given how nightmarishly difficult it can be to find someone to treat you, find the right drug, force insurance to cough up or find another way of paying, and so on, it's not surprising that certain people have a problem demanding what they need. When depression combines with self-esteem issues, the result is a lethal cocktail.
Fourth.
Those who seek treatment often find that it does not provide an immediate end to their suffering.
Sometimes the treatment doesn't work at all. The wrong drug can very easily make an unstable mental state worse; that happened to me. The wrong therapist will do no good, and a bad one may do harm. A wrong diagnosis can mean the difference between a treatment approach that works, and one that might kill you by not working when you need it to: to wit, if you treat bipolar depression with the same SSRIs commonly used to treat major depressive disorder, you stand a good chance of making your patient worse. Yet bipolar depression is often wrongly diagnosed by doctors who don't yet understand what Type II is all about. Sometimes a treatment seems to be working, but reveals itself, too late, as insufficient. Sometimes the patient feels guilty that the treatment isn't working, and may be slow to admit this to doctors or caretakers because of it. They are taught that most of the problem is theirs, and so they keep "trying," thinking they are the part of the equation that's broken, when it's really the drugs.
Sometimes the treatment takes too long to work. It can take weeks for drugs to take effect, not counting the months it often takes to find the right one to begin with. Therapy is hardly any better. It can take months for someone who is suicidal to stabilize - or a year, two years, or never. It is a disgusting myth that you can pick up the phone to get help and start feeling better the very next day. Many people who commit suicide are on antidepressants or mood-stabilizing drugs, seeing therapists, in support groups, the whole nine yards. They are doing everything "right," and yet they are still suffering. Why? Is it because drugs and therapy and support don't work? No. It's because the people who need these things are ill, and there is more to becoming well than just taking a drug and talking to a shrink. It's not like an ear infection, where, after a course of antibiotics, the problem is gone. This is an ongoing condition, and for many people, it is something they will have to deal with forever in one form or another.
Sometimes the treatment stops working. Even if an effective drug can be found, certain drugs are prone to give up the ghost after months or years, leaving the patient vulnerable until she can find a suitable replacement. Therapists go into retirement or change clinics or are removed from insurance plans. One of mine moved to Egypt. Egypt. When this happens, it can add to the burden of pain as the patient must begin the process of "getting help" or finding a new drug all over again. Sometimes the emotional resources to do this just aren't there. Going over the whole painful backstory with a new therapist for the third time in a year is a hideously demoralizing and agonizing process that does nothing but slow down advancement.
Sometimes the treatment is unavailable. It was three months before I could get in to see a therapist after my bad break. Three months, and I was at the brink of suicide when I sought help. I couldn't put my pain on pause during that time, and unfortunately the idea that help was coming didn't make it any easier to live with that pain. Yes, I could have hospitalized myself in order to get immediate care, but guess what? Institutionalization is not the best option for a lot of people. For some people it's a godsend, but it can be extremely damaging for others, especially given the opportunities for abuse that abound in such a setting.
Sometimes the site of treatment itself is inaccessible. A poor person with no car may not be able to cross town to get to the low-cost clinic, especially if they live in a town, like mine, like many midwestern towns and small towns, with no affordable, reliable public transportation system. A disabled person may find that the clinic is not accessible to them at all. This is not as unlikely as it sounds. My first therapist was located on the third floor of a building with no elevators. Until it moved, the most suitable low-cost option was located on the second floor of a building with no elevators and a very narrow, steep stairwell with a jog in the middle. When it moved, it moved to a building that had four steps down to the curb and no wheelchair ramp. If a person has panic attacks triggered by getting in a car, or suffers from agoraphobia, or any of the other things that can make leaving the house a living hell, "getting help" becomes a nightmarish prospect.
Sometimes the cost of treatment is prohibitive. Not every community has a low-cost mental health clinic, and existing clinics do not always have openings for new patients. Sometimes the only low-cost option may be unacceptably bad, or provided through an inappropriate venue; a good example of this would be a gay man seeking grief counseling for the death of his partner and finding the only "widower's" workshops are conducted by a local evangelical ministry. This is not at all unlikely. The best mental health hospital in my area, the one I take outpatient therapy from, says right up front on all its literature that it is a Jesus-based organization. I lucked out, my therapist is a bitchy old atheist, but I would be lying if I didn't feel uncomfortable about the crucifixes in every hall.
So good help can be hard to find, and affordable, appropriate help still harder, especially if you live in a smaller city with reduced options to begin with. Not every person knows how to ferret out resources or has a doctor, friend, or spouse who is willing and able to go out of their way to help. If the in-network caregivers are all booked up, a person with insurance might have to see a provider who is not in their insurance network if they want to be seen in a timely fashion, and that might mean paying more of the costs themselves, perhaps all. A person without insurance might have to pay $120 a session or more to see a therapist - sessions that may be needed weekly, or twice weekly, until the person has stabilized. Someone who needs lifesaving medication may not be able to pay for it - generic drugs and older drugs are often cheap, but they don't work for everyone. Some people require expensive, specialized drugs, very new drugs, or combinations of drugs, to get effective relief without unbearable side effects. I have insurance, and I still had to pay half the cost for one of the mood-stabilizers I took. It was about $90 a month. If I had entered this latest episode poor and with no insurance, I would have had no way of getting help at all. Would I still be alive? I don't know. Thank god for my privilege, which I never deserved, but which saved my sorry ass.
Sometimes the treatment stops being covered by insurance. Many insurance plans have a yearly or even lifetime cap on how much they will pay for mental health services. Sometimes an insurance plan deletes drugs from their approved formulary or reclassifies them, causing them to skyrocket in price. Patients must then scramble to switch to a different drug - a switch that can cause severe side effects. And, again, the drug they switch to might not work. If a person experiences a lapse in coverage, they might find that their mental illness is now classified as a preexisting condition. This can not only lead to them not getting further care, it can contribute to people not seeking help in the first place as they wait for their job situation or their spouse's job situation to become stable.
Fifth
When depressed people don't seek help, it is often because of feelings of shame, fear, guilt, hopelessness, or helplessness.
Sometimes, as incredible as it is to say, people don't know they are depressed. They blame their pain on circumstances: a crappy job, a difficult family situation, an illness, stress at school, a death, the lack of friends, their poverty, their body, and so on. They believe that if the circumstances changed, they would not be depressed and life would be wonderful again. They keep waiting for whatever they are blaming to go away, assuming that they will feel better when it does. Improving one's circumstances might bring relief to people whose depression genuinely was situational, and will probably bring relief to someone who is clinically depressed, but it is not a cure of any kind. A hallmark of depression is having a good life, and being miserable anyway. That doesn't stop people from blaming circumstances for their depression - no surprise when you consider the cultural messages about depression that most of these people have been bombarded with since birth. If I had nothing but the way other people talk about mentally ill individuals, I'd rather blame my shitty job for my misery than think that something was wrong with me, too.
Sometimes they are in denial. Because of the stigma attached to mental illness and suicide, and also because of how genuinely awful mental illness can be, many people are unwilling or unable to admit how terrible their situation is. They cling to the belief that they will, as people tell them to, "snap out of it." They tell themselves that their problems are not worth getting worked up over, that their fate is no worse than anyone else's - others have it worse! They tell themselves that they are not "like that," not one of "those people," not a "drama queen," not "high maintenance," or they tell themselves that they could not possibly be depressed because there are good things about their life. They tell themselves that if they just keep pushing, it will pass and things will get better. Sometimes they do this because the prospect of actually being mentally ill is too awful for them to contemplate.
Sometimes they simply feel hopeless. A person suffering deeply from depression or suicidal feelings may not feel that there is any hope. I certainly have days where I don't feel like there's any hope for me. A hopeless person contemplating suicide may feel that their life is meaningless, that they contribute nothing, or that what they contribute is insignificant in comparison to what they take. They feel that they cannot change and that nothing they can do will make up for the burden they place on their friends and loved ones. They may believe that their self-inflicted death is inevitable and they may as well hasten it along. For me, there are days when the knowledge that many, many bipolar people commit suicide feels like a terminal diagnosis - and that leads to the dreadful thought that it's foolish to fight the inevitable end. Whether I commit suicide or not, I'm now a statistic on one side or other, and that's sobering.
Sometimes they feel helpless because they don't believe that drugs and therapy will help them; sometimes they've tried it in the past and it hasn't worked. Sometimes it is simply the complexity of the tasks necessary to get help that foils them and makes them hopeless; to a person deep in the pits of despair, making a single phone call can be unbearably daunting. Navigating the alligator-infested, pitfall-ridden swamp of the medical industry can weaken even the stoutest heart. The slightest resistance can exhaust already depleted emotional resources. The ridiculous things the mental health care system routinely demands of mentally ill people are too often things that the people most in need of help have no resources to devote to doing.
Sometimes they are afraid of treatment. An aversion to taking drugs is common; stories of terrible side effects are frightening, after all, and not hard to find, not to mention the value our culture places on not needing drugs to "get by," the value ascribed to "toughing it out." Physical side effects are bad enough; psychological side effects can be terrifying. I know I had many second thoughts about trying drugs. "What if it steals my creativity? What if it turns me into an automaton? What if it takes away my ability to feel anything, not just pain?" It took a great deal of courage to risk that, and even more to persevere and keep trying new drugs when everything that I feared and worse came to pass.
Some people may be afraid because they know that drugs and therapy take time to work; they may also be aware that getting help itself can be difficult - and in both these cases the wait and the fight can be destructively demoralizing.
They may fear that if they ask for help, or if they are honest about their feelings, they will be labeled as dangerous to others or to themselves, that their treatment will be taken out of their hands and they will be forced to take drugs or enter an institution against their will. The fear of being "sectioned" is very real and completely valid.
People may fear the label of "mentally ill" itself, either because they buy into the stigma associated with it, or because they know all too well the stigma others would apply to them. There is even the fear of not suffering any more. "What will happen once I am being treated and begin to feel better? What will I do with myself? How will I make up for all that wasted, lost time? How can I possibly go forward, having lost so much ground? Who will I be if the treatment works? Now what?" These questions can seem foolish to someone who has never had to ask them, but they are all quite understandable, and I have agonized over them all at one time or another. Living the answers to these questions is so often a healing experience, far easier to navigate than the suffering one is trying to alleviate, but it's impossible to viscerally believe that from the other side of the divide. We fear what is unknown. Our suffering is at least something we are familiar with.
Sixth
Saying that "most people don't even try" to get help is an insulting dismissal of the very real obstacles that face mentally ill people trying to do exactly that.
We have just gone over many of those obstacles and seen that they are not trivial things.
That "most people" don't try to get help is not something we can know. Our figures for mental illness fucking suck, because the diagnosis rate fucking sucks. I personally believe that "most people" who have a mental illness of any severity do try to get help in some form at some point. I just also believe that this doesn't always, or even usually, lead to the kind of help that is actually helpful, the kind of help that they deserve.
"Don't even" implies that wow, these suicidal people must just be a bunch of lazy dumbasses or something, because how hard can it be to just get help? It's a phrase with a lot of hidden blame. Blame for those who suffer from depression or other mental illnesses does not ever belong in any compassionate discussion of suicide. It is a human life we are talking about. Not abstract human life in general but real, individual human life. A specific living person. Their life. Someone you could shake hands with, someone who laughs at in-jokes with their friends and mulls over their unfulfilled dreams and has a guilty fondness for a certain awful TV show and who has probably been the only living witness to more than a few beautiful, incredible things. That truth, the reality that pain affects human beings, should command the greatest respect.
The whole statement stinks of someone trying to minimize the suffering of others because it is just too scary for them to contemplate the ugly idea that we live in a world where mentally ill people routinely seek help and either don't get it or get help and then commit suicide anyway because mental illness can be just that horrible, and some help is just that unhelpful.
It's more reassuring to believe in a just world, where everyone who kills themselves is someone who deserved it on some level, someone who had every chance and threw it away, someone who had access to exactly the right therapy at the right time and chose not to take advantage of it, someone selfish and thoughtless and stupid, someone we are better off without.
If you genuinely believe that shit, I wouldn't go pointing fingers at people without whom the world would be a better place. Pot. Kettle. Look into it.
So, in short:
"But not everyone who commits suicide is mentally ill. And the ones who are could get medicine. Most don't bother to try."
Bull. Fucking. Shit.
Thank you and good night.