Saturday, August 29, 2009

Still Alive

The miserable have no other medicine
But only hope:
I've hope to live, and am prepared to die.
-- William Shakespeare, Measure For Measure (Act III, scene I)

Life and death have blended into an indistinguishable whole, just as night and day lose their dichotomy after several sleepless nights. The unrelentingly recurring, unnerving systemic assault on the brain—coupled with the absence of faith in the alleviation of the pain—has inevitably left me entertaining the thought of suicide. I want to reflect on what keeps me alive in those darkest of times. I believe it is the thread of hope—the desire to be well and happy, and the desire to return to that state of enjoyment of life.

Another reason is because I see an abundance of corruption, ignorance, and suffering in the world. And it is this feeling of responsibility to this world, which stems from my awareness of these sources of misery—the ability to understand and address them—that motivates me to stay alive so that I may improve the quality of the lives of those who suffer in vain.

It is difficult not to consider the rationality of suicide in my situation. It is curious that death does not relieve pain, because relief can only be felt while remaining alive. So dying to relieve suffering seems oxymoronic. I am concerned about the potential negative implications that my abrupt death will bring. I don't want to cause pain to those close to me.

"All this I realized was more than I could ever abandon, even as what I had set out so deliberately to do was more than I could inflict on those memories, and upon those, so close to me, with whom the memories were bound."
-- William Styron, Darkness Visible

People who have survived great difficulties and went on to accomplish great feats are a significant source of inspiration to me. I hope that once I overcome depression, I will have a more complete understanding of life, which would help me with my pursuit of a better world.

It is this knowledge—the hope for the better—that gives me the strength to go on.

Oh, I must hold on
Oh, I won't be gone
Oh, I won't stop now
Oh, I don't know how
-- Korn, Here It Comes Again

Stigma and Suicide Prevention

"A lot of people don't realize that depression is an illness. I don't wish it on anyone, but if they would know how it feels, I swear they would think twice before they just shrug it..."
-- Jonathan Davis, the lead singer of Korn

The Stigma of Suicide

Suicide has traditionally been a taboo topic in western society, which has led to further alienation and only made the problem worse. Even after their deaths, suicide victims have often been alienated by not being buried near other people in the cemetery, as though they had committed some utterly unforgivable sin.

We could go a long way to reducing our suicide rate by accepting people as they are, removing the social taboo on talking about feeling suicidal, and telling people that it is OK to feel so bad that you'd think about suicide. A person simply talking about how they feel greatly reduces their distress; they also begin to see other options, and are much less likely to attempt suicide.

You flirt with suicide
Sometimes, that's OK
-- Korn, Falling Away From Me

Everybody feels down sometimes, but some people have these feelings for a very long time and feel them very intensely. It is horrible to suffer so much, and it is not anybody's fault to feel depressed or suicidal. Mental illness such as depression is a real illness that can be treated, and if someone experiences suffering and suicidal thoughts, it is a good idea to seek some help, such as to see a psychotherapist or talk to a supporting friend or family member.

One also has to be prepared that not everyone is going to be understanding or know how to help. Even those closest to us--our family and friends--might not understand or be able to help. And it is not because they wish harm, but because the feelings that one feels during a depressive episode are truly inaccessible to someone who has never experienced them. There is a stigma of suicide and mental illness in our society that is very hurtful to those who suffer from such illness, contemplate suicide, or have survived a suicide attempt. The lack of awareness and stigma of suicide has to be taken into consideration when someone is saying something hurtful. People have good intentions, but most people are not trained to help someone in serious situations. Regardless of this, it is always better to seek help, because no one should suffer so much alone.


http://upload.wikimedia.org/wikipedia/commons/4/46/The_way_out.jpg 
The Way Out, or Suicidal Ideation: George Grie, 2007

Suicidal ideation is a frequent medical term for suicidal thoughts, which may be as complete as a formulated plan, without the suicidal act itself. Those who attempt to harm themselves are, as a group, quite different from those who actually die from suicide; females attempt suicide much more frequently than males do, but males are four times more likely to die from suicide.

46% of Americans see suicide as a personal or emotional weakness rather than a health problem, and 22% believe this about depression. This shows that many Americans do not realize that depression is a disease that can be treated. The failure to recognize depression as a disease is most troubling and encourages the misconception that people should blame themselves, family members and friends for this illness. It is already very difficult for people to accept that they have depression and to stop torturing themselves over the "why" they experience the feelings of inadequacy that are associated with depression. The stigma also prevents people from seeking needed assistance. Ignorance and stigma of mental illness, perpetuated by suicide's taboo status, contribute to the difficulty of acceptance of the illness by the victims and their loved ones.

Americans' Understanding of Mental Health:


Americans are more likely to view mental illnesses and other behavioral health problems as personal or emotional weaknesses - rather than real health problems - more often than they do other illnesses.
  • Alcohol or drug problems (57%) and suicide attempts (46%) are mostly often seen as weaknesses.
  • Among mental illnesses, nearly a quarter of Americans (22%) see depression as a weakness, followed by bipolar disorder and schizophrenia (7%).
  • Nearly all Americans see cancer (97%) and diabetes (96%) as health problems - not weaknesses.
Suicide is grossly under-reported in the American news media. The underreporting of suicide leads people to seek help less, and perpetuates a lack of awareness about the subject in society. Suicide awareness is crucial in learning to recognize the symptoms or signs and to learn some avenues of help.

Reasons for the under-reporting of suicide by doctors as the official cause of death:
  • In cases of denial of family members that the death was a suicide rather than an accident, to spare the survivors from having to confront the truth.
  • To avoid causing the families of suicide victims the added stigma, grief, and shame.
  • There is no way of classifying certain instances as suicides, such as some traffic "accidents".
Reasons for lack of reporting of suicide in the media:
  • Public safety--to discourage suicide contagion (copy cat behavior).
  • To prevent stigma of the families of suicide victims.
  • Court order, such as the case when 60 Minutes tried to air a story on the issue but was forced to back down when it was served with an injunction.
Ways colleges under-report student suicide:
  • Suicides committed off-campus are not accounted.
  • Suicides on holidays, breaks, and during summer are not accounted.
  • Suicides by students not registered for classes are not accounted.
    Statistics:
    • In 2006, there were reported 33,300 (approximately 11 per 100,000) deaths by suicide in the U.S. Suicide deaths consistently outnumber deaths attributable to homicide (18,000) by a ratio of three to two--with most suicides attributable to untreated depression. Yet, most Americans greatly underestimate the occurrence of suicide (63% of Americans believe homicides vastly outnumber suicides). A person dies by suicide about every 16 minutes in the United States.
    • The real number of suicides may be three to five times the official number (99,900-166,500) because most suicides go unreported.
    • An estimated 12 to 25 nonfatal suicide attempts occur per every suicide death. For young people there are an estimated two hundred attempts for every successful (completed) suicide. There were over 800,000 suicide attempts in 2005. An attempt is estimated to be made once every minute.
    • While females attempt suicide more often than males, at a rate of 4:1, males "succeed" more often, at the same rate.
    Despite the fact that suicide has been a leading cause of death, the public and the medical profession are largely apathetic. It is sickening that college officials do not talk about the problem.
    • 3.4% of those who are clinically depressed die by suicide.
    • More than 90% of all people who die by suicide have a diagnosable mental disorder at the time of their death, most commonly a depressive disorder or a substance abuse disorder.
    • Major depressive disorder affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year.
    • The lifetime prevalence of depression in the US is 17%. The probability of having a major depressive episode within a year-long period is 3–5% for males and 8–10% for females.
    Youth suicide:
    • In 2006, suicide was the third leading cause of death for young people ages 15 to 24. (1st = accidents, 2nd = homicide).
    • Suicide is the second leading cause of death among college students and for 25-34 year olds.
    Data from the 2006 National College Health Assessment (NCHA) survey of 94,806 U.S. college students, conducted by the American College Health Association (ACHA), revealed the following data regarding students' mental health:
    • 14.8% of students reported having been diagnosed with depression sometime in their lifetimes. Of that percentage, 34.4% reported that they were diagnosed in the past school year, 26.4% reported that they are currently in therapy for depression, and 36.6% reported that they were currently taking medication for depression.
    • 1.3% of students reported attempting suicide at least 1 time during the past school year, and 9.3% of students reported seriously considering attempting suicide at least once.
    • 43.8% of students felt so depressed within the last year that it was difficult to function.
    Prevention:

    "They also serve who stand and wait."
    -- John Milton, Paradise Lost

    The first step in preventing suicide is to educate yourself. Education and awareness can help deter needless deaths and the years of suffering that precedes them. Prevention should focus on addressing the underlying cause (proper treatment and prevention of depression--the biggest cause of suicide), rather that preventing the act of suicide itself. It is our responsibility as human beings to not allow others to suffer the terrible distress that precedes suicidal ideation and attempts in the first place.

    Mental illnesses are very serious--every bit as serious as other illnesses, such as diabetes and cancer, and our nation needs to treat them as such--through better mental health promotion, increased research and health insurance equity that would enable Americans to get mental health services when and if they need them. The discomfort Americans continue to feel towards people with mental illnesses is disconcerting. Societal acceptance and support is instrumental in helping individuals and families facing mental health issues recover and enjoy healthy, fulfilling lives in their community.

    People who live with mental health conditions, such as depression, bipolar disorder or substance abuse, are less optimistic than the general population, in part, because of America's climate of misunderstanding of mental illnesses and the barriers that exist to accessing treatment and supports in the community. With continued understanding, Americans can ensure positive futures for all those who face health conditions of all types.

    Depression is the leading cause of suicide. But addressing depression because of this fact alone is missing the point. Suicide is only the most dramatic denouement a depressed individual may experience. It’s important to recognize that the majority of depressed people, even though they may not kill themselves, are nonetheless profoundly unhappy and find it a struggle to function at home and at work. It is our moral responsibility to each other to actively do everything in our means to help those who suffer from mental illness, like educating ourselves about the topic, openly discussing the topics of suicide and mental illness with those around us, and helping those with the signs of mental illness to cope with the illness and to get additional help. Because, as Milton says, when we remain silent we become the enablers of the terrible hurt.

    "In virtually any other serious sickness, a patient who felt similar devastation would by lying flat in bed, possibly sedated and hooked up to the tubes and wires of life-support systems, but at the very least in a posture of repose and in an isolated setting. His invalidism would be necessary, unquestioned and honorably attained. However, the sufferer from depression has no such option..."
    — William Styron, Darkness Visible: A Memoir of Madness

    Emotional pain can be no less hurtful--and often more distressful--than physical pain. Nevertheless, it is largely ignored by most people, including those in the medical field. This is largely due to the fact that emotional pain is nearly impossible to quantify; emotional pain is so much harder to understand and empathize than physical pain. Emotional pain is invisible to the senses--we can only learn about it by the sufferer's self-reported testimony; the very intense pain experienced during depression is ineffable and incomprehensible to those who did not experience depression firsthand, which is over 80% of people. We can empathize with a burn victim, a woman whose body was burned in a house fire, because the burns are readily visible, and we all have first-hand experience of being burned. And so this woman receives immediate emergency care and the support of her friends, family and other caring people. Whereas the same woman, during a depressive episode might experience no less intense and debilitating pain, but left to tolerate it on her own. This apparent dichotomy fuels the focus of the society on preventing suicide instead of on alleviating the suffering. This is abominable. People who came to the decision to commit suicide might as well be dead due to the emotional and psychological turmoil that is no less than physical in intensity; trying to prevent the sufferers from doing what seems like their only option at the moment, instead of caring for them and working to alleviate their distress, is an insult to human dignity and undermines all sensible moral standards of any individual. If people experienced this pain firsthand, and if they did not care so much about themselves and their money, then people would be much more compassionate, depression would not be so stigmatized in our society, and the medical treatment of depression would be much more advanced. Our inability to understand the pain of depression, coupled with the apathy and my and your selfishness, are what perpetuate the unnecessary, terrible suffering of our fellow human beings.

    Resources:
    • http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml#Suicide
    • http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml
    • http://www.suicide.org/suicide-statistics.html#2005
    • http://www.afsp.org/index.cfm?fuseaction=home.viewpage&page_id=050fea9f-b064-4092-b1135c3a70de1fda
    • http://www.acha-ncha.org/reports_ACHA-NCHAII.html
    • Major depressive disorder (Wikipedia) http://en.wikipedia.org/wiki/Major_depressive_disorder%29 -- this is a great article to inform anyone about the facts of depression
    Articles:
    • "The stigma of suicide within us" http://www.metanoia.org/suicide/stigma.htm
    • "Lost On the Campus" http://www.time.com/time/nation/article/0,8599,93991,00.html
    • "10-year Retrospective Study Shows Progress in American Attitudes About Depression and Other Mental Health Issues" http://www.healthyplace.com/general-news/news/10-year-retrospective-study-shows-progress-in-american-attitudes-about-depression-and-other-mental-health-issues/
    • "Suicide Increase Highlights Mental Health of Students" http://www.dailycal.org/article/8917/suicide_increase_highlights_mental_health_of_stude
    • "UC Berkeley depression statistics high" http://findarticles.com/p/articles/mi_qn4176/is_20070419/ai_n19015766/
    • "College students struggle with stress, poll reveals Many show symptoms of depression but don't seek help, survey finds." http://www.allbusiness.com/medicine-health/diseases-disorders-mental/12474599-1.html
    Books:
    • An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison
    • Darkness Visible: A Memoir of Madness by William Styron
    • Girl, Interrupted by Susanna Kaysen
    • Why Suicide by Eric Marcus

    Most Inspirational Advice

    First off, I agree with Robert Half that "Free advice is worth the price." So, I strive to evaluate "free advice" on the merit of its validity.

    “Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness, that frightens us most. We ask ourselves, 'Who am I to be brilliant, gorgeous, talented, and famous?' Actually, who are you not to be? You are a child of God. Your playing small does not serve the world. There is nothing enlightened about shrinking so that people won't feel insecure around you. We were born to make manifest the glory of God that is within us. It's not just in some of us; it's in all of us. And when we let our own light shine, we unconsciously give other people permission to do the same. As we are liberated from our own fear, our presence automatically liberates others.”
    Maryanne Williamson

    "Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it is the only thing that ever has."
    — Margaret Mead

    "The only way to deal with an unfree world is to become so absolutely free that your very existence is an act of rebellion."
    — Albert Camus, author, philosopher, and journalist who was awarded the Nobel Prize in Literature.

    I see this as the only means of life. Any other means is mere existence. What still had meaning for Camus is that despite humans being subjects in an indifferent and "absurd" universe--in which meaning is challenged by the fact that we all die--meaning can be created, however provisionally and unstably, by our own decisions and interpretations.

    "If you ever find yourself on the side of the majority, it is time to pause, and reflect."
    — Mark Twain

    Mark Twain was a great man who critiqued the status quo and refused to be swayed by the strings of society. He was very much a revolutionary and a visionary--a man who was intellectually ahead of his time. There are a few other examples of such people in history, one of whom is Bertrand Russell.

    "For my part, I think the important virtues are kindness and intelligence. Intelligence is impeded by any creed, no matter what; and kindness is inhibited by the belief in sin and punishment."
    — Bertrand Russell, philosopher, logician, mathematician, historian, religious skeptic, social reformer, socialist and pacifist who was awarded the Nobel Prize in Literature.