Wednesday, December 11, 2013
Right by You
Dear friends -
It's been a busy fall and I'm finally getting to a place where I'm ready to take the time to write to you again. In the next few weeks I would like to tell you about the Canadian Association for Suicide Prevention conference last October, about Andrew's and my experience hosting a Survivors of Suicide event on November 23, the networking connections we've made, and about the work our Washington friends at Forefront are doing.
In the moment, though, I want to forward you an appeal for action by Partners for Mental Health, a new organization that is taking a very active role in advocating for much-needed strides forward in mental health care and suicide prevention. Please see their president Jeff Moat's email below.
Lynn
From: Partners for Mental Health
Date: December 10, 2013 11:05:54 AM PST
Subject: Your action is needed now
Right By You - Partners for Mental Health
Dear Lynn,
We’ve come to a crucial point in our Right By You campaign in support of greater funding for youth mental health and suicide prevention.
Action is needed now. Every day, we lose 2 young Canadians to suicide. Almost 90% of people who die by suicide have a mental illness, yet the majority of children and youth – 3 out of 4 – who have a mental health problem or illness won’t get the treatment they need. And the average wait time before children with diagnosed mental health issues receive treatment is 12 months. This is unacceptable, and we need to work together to fix this.
In order to drive real change, we must show the government that this is an issue that matters to all Canadians. Local politicians need to hear directly from the people they represent – people like you.
It’s time to raise our voices with government. And we’ve got the tools and resources to easily help you get started.
First, sign the Right By You petition to show your support.
Then, contact your local politician using our toolkit to further amplify your voice and put pressure on our elected officials to act.
Specifically, we are calling on:
Federal government – to create a $100 million national suicide prevention fund.
Provincial and territorial governments – to provide access to mental health services, treatment and support to all children and youth when they need it, no matter their ability to pay.
These changes can happen but we need your help today.
Thank you,
Jeff Moat
President, Partners for Mental Health
Sunday, August 25, 2013
Take Action to Save Someone's Life
Dear friends,
The September 2, 2013 issue of US Weekly, prominently displayed at grocery magazine stands, features a front-page story on the suicide death of Gia Allemand. You may be aware that sensationalized stories of celebrity suicide deaths are frequently followed by a spike in suicide deaths by the same method. The "Bachelor Suicide" story, which describes the cause of death and normalizes suicide as a response to difficult life events, is a classic example of this type of story.
Please join me in taking action to defend people at risk of suicide from this type of destructive media coverage. I have written letters to grocery story managers asking them to remove copies of this magazine from their shelves, and to US Weekly to ask them to revise their editorial practices. Copies of these letters are included below. You are welcome to use these or variants of them to help lobby for these changes.
Please, if at all possible, do not buy this magazine and ask others not to buy it. I would hate for US Weekly to experience a spike in sales as a consequence of publishing this story, and for them to financially benefit from media coverage that could cause a spate of tragedies. You can skim the story on page 46 to confirm the violations in ethical journalistic practice.
Lynn
Letter to Grocery Store Manager
Re: US WeeklyIssue 968, "Bachelor Suicide"
Dear Store Manager;
I am writing to ask you to immediately remove copies of US Weekly Issue 968 featuring the cover story of Gia Allemand's suicide death from your magazine stands.
You may be aware that sensationalized stories of celebrity suicide deaths are frequently followed by a spike in suicide deaths by the same method. The "Bachelor Suicide" story, which describes the cause of death and normalizes suicide as a response to difficult life events, is a classic example of the type of story that results in these deaths.
You, like many others, may be under the mistaken understanding that someone who dies by suicide has made a choice, or that if someone really wants to kill him or herself there is very little that can be done to prevent this. If this were true, we would expect that changes in journalistic practice or restrictions to the means used to cause death would have little effect on the overall number of suicide deaths. Someone who really wants to die would go to whatever lengths were necessary to gain access to lethal means or substances.
The truth is, though, that fewer than 10% of the people who survive a suicide attempt will eventually die by suicide. Over 90% will not. Research also shows that when access to common methods of suicide is restricted, the overall number of suicide deaths declines significantly and often dramatically and remains lower over decades.
For example, when the gas used in U.K. homes was changed from coal gas to less toxic natural gas in the 1960s, suicide deaths suddenly and rapidly declined by 30-40%, and have remained lower through over 40 years. After the Israeli Armed Forces changed protocols to prevent reserve soldiers from taking firearms home on the weekends, suicide deaths dropped by 40%. And after the Sri Lankan government banned a set of highly toxic pesticides commonly used in self-poisonings, suicide deaths overall dropped by 50% and have remained lower over a decade later.
If we can, therefore, increase the likelihood of someone surviving a suicide attempt or provide treatments and interventions to prevent those attempts, we are not just prolonging the inevitable -- we are saving lives.
"My brain is trying to kill me," one woman wrote in her journal a few months before her death. In the crisis of suicidal despair, that brain will use whatever information and means are readily available to try to inflict death. Stories of celebrity suicide deaths that describe the means of death and normalize suicide as a response to difficult life events, such as the one US Weekly has published about Gia Allemand, inadvertantly provide support for the suicidal urges against which someone at risk is desperately battling. These stories are typically followed by a spike in suicide deaths by the same means.
The following changes to a story such as the one published by US Weekly could save lives:
- Not reporting the means of death.
- Emphasizing the likelihood that the victim was suffering from depression or some other life-threatening mood disorder, mental illness or injury, elevating their suicide risk, and that these conditions are treatable.
- Providing crisis line contact information for readers who may be at risk.
- Providing information or links to resources on signs of depression and suicide risk.
The vast majority of people at risk of suicide experience the equivalent of a mental health heart attack, a temporary crisis of despair during which they are at high risk of acting impulsively to cause their own death. People at risk of suicide battle desperately against these urges, fighting against their own brains to try to preserve their own lives. These people deserve whatever support we can provide them.
In the interest of preventing suicide deaths among your customers and their children, please remove this magazine from your shelves. Please let your magazine distributor know what you have done and why. Please help prevent future tragedies.
Sincerely yours,
Letter to US Weekly Editor
Letters to US Weekly1290 Avenue of the Americas
New York, New York
United States of America
10104-0298
New York, New York
United States of America
10104-0298
Re: "Bachelor Suicide", Issue 968
Dear Editor;
I was appalled to read Eric Andersson's story on Gia Allemand's suicide. You and your colleagues may be aware that stories of celebrity suicide deaths are frequently followed by a spike in suicide deaths by the same method.
You, like many others, may be under the mistaken understanding that someone who dies by suicide has made a choice, or that if someone really wants to kill him or herself there is very little that can be done to prevent this. If this were true, we would expect that changes in journalistic practice or restrictions to the means used to cause death would have little effect on the overall number of suicide deaths. Someone who really wants to die would go to whatever lengths were necessary to gain access to lethal means or substances.
The truth is, though, that fewer than 10% of the people who survive a suicide attempt will eventually die by suicide. Over 90% will not. Research also shows that when access to common methods of suicide is restricted, the overall number of suicide deaths declines significantly and often dramatically and remains lower over decades.
For example, when the gas used in U.K. homes was changed from coal gas to less toxic natural gas in the 1960s, suicide deaths suddenly and rapidly declined by 30-40%, and have remained lower through over 40 years. After the Israeli Armed Forces changed protocols to prevent reserve soldiers from taking firearms home on the weekends, suicide deaths dropped by 40%. And after the Sri Lankan government banned a set of highly toxic pesticides commonly used in self-poisonings, suicide deaths overall dropped by 50% and have remained lower over a decade later.
If we can, therefore, increase the likelihood of someone surviving a suicide attempt or provide treatments and interventions to prevent those attempts, we are not just prolonging the inevitable -- we are saving lives.
"My brain is trying to kill me," one woman wrote in her journal a few months before her death. In the crisis of suicidal despair, that brain will use whatever information and means are readily available to try to inflict death. Stories of celebrity suicide deaths that describe the means of death and normalize suicide as a response to difficult life events, such as the one you published about Gia Allemand, inadvertantly provide support for the suicidal urges against which someone at risk is desperately battling. These stories are typically followed by a spike in suicide deaths by the same means.
The following changes to a story such as the one written by Andersson could save lives:
- Do not report the means of death.
- Emphasize the likelihood that the victim was suffering from depression or some other life-threatening mood disorder, mental illness or injury, elevating their suicide risk, and that these conditions are treatable.
- Provide crisis line contact information for readers who may be at risk.
- Provide information or links to resources on signs of depression and suicide risk.
The vast majority of people at risk of suicide experience the equivalent of a mental health heart attack, a temporary crisis of despair during which they are at high risk of acting impulsively to cause their own death. People at risk of suicide battle desperately against these urges, fighting against their own brains to try to preserve their own lives. These people deserve whatever support we can provide them.
Because of the importance of this issue, several U.S. suicide prevention agencies have collaborated to publish guidelines for reporting on suicide: http://reportingonsuicide.org/Recommendations2012.pdf In the interest of preventing suicide deaths among your readers, I encourage you to incorporate these into your editorial practices.
Sincerely yours,
Monday, August 12, 2013
International Connections
Dear friends -
As mentioned in a previous update, early in June Ileah and I attended World Congress on Suicide 2013 in Montreal. It was a very rich international research conference, with researchers, academics, and government representatives from the United Kingdom, the United States, Australia, New Zealand, and Canada -- the vast majority of them leaders in this field, some with decades of experience to share.
I felt very privileged and sometimes overwhelmed to be attending seminars on topics ranging from micro-RNA variations and stem cell research to debates on national strategies and debates on fifth edition Diagnostic and Statistical Manual (DSM V) classifications. Here is a synopsis of the overall meaning I was able to make from that immersion: an overview of some of what has been found to be effective and ineffective in reducing suicide deaths.
I developed this as a presentation and have delivered it a couple times now. If you find the speaking notes leave you with questions or are unclear, please let me know and I'll be happy to clarify.
September 10 is World Suicide Prevention Day. This year that date also marks the launch of FOREFRONT, a University of Washington initiative to advance innovative approaches to suicide prevention through policy change, professional training, school-based interventions, media outreach and research. It is one arm of the work being done by my dear friend Jennifer Stuber, who has also been a driving force behind recent legislative changes in that state.
I'll be in Seattle to attend FOREFRONT's launch, and warmly welcome you to join me. I promise that it will be a moving and inspiring occasion. Please see the invitation for logistics and links to more information. I would be delighted to have you with us.
As mentioned in a previous update, early in June Ileah and I attended World Congress on Suicide 2013 in Montreal. It was a very rich international research conference, with researchers, academics, and government representatives from the United Kingdom, the United States, Australia, New Zealand, and Canada -- the vast majority of them leaders in this field, some with decades of experience to share.
I felt very privileged and sometimes overwhelmed to be attending seminars on topics ranging from micro-RNA variations and stem cell research to debates on national strategies and debates on fifth edition Diagnostic and Statistical Manual (DSM V) classifications. Here is a synopsis of the overall meaning I was able to make from that immersion: an overview of some of what has been found to be effective and ineffective in reducing suicide deaths.
I developed this as a presentation and have delivered it a couple times now. If you find the speaking notes leave you with questions or are unclear, please let me know and I'll be happy to clarify.
Invitation: FOREFRONT Launches September 10 in Seattle
September 10 is World Suicide Prevention Day. This year that date also marks the launch of FOREFRONT, a University of Washington initiative to advance innovative approaches to suicide prevention through policy change, professional training, school-based interventions, media outreach and research. It is one arm of the work being done by my dear friend Jennifer Stuber, who has also been a driving force behind recent legislative changes in that state.
I'll be in Seattle to attend FOREFRONT's launch, and warmly welcome you to join me. I promise that it will be a moving and inspiring occasion. Please see the invitation for logistics and links to more information. I would be delighted to have you with us.
Saturday, July 6, 2013
Correcting Misconceptions about Suicide
Dear friends -
Last weekend I learned that a colleague had died by suicide the Friday before. I only knew him through conversations with others, had never met the man, but the news of his death has been very painful. A lawyer in his mid-50s, someone who had been successful in his career and risen through management levels, he had been struggling with anxiety and depressions for at least a year before he died. In contrast to Cliff, the organization he worked in is very aware of mental health concerns and suicide risk. He received the best support the people working in the organization knew how to provide.
I wrote the following in the wake of his death, an attempt to help others cope and a reflection of how my understanding of suicide has changed over the past 18 months.
Last weekend I learned that a colleague had died by suicide the Friday before. I only knew him through conversations with others, had never met the man, but the news of his death has been very painful. A lawyer in his mid-50s, someone who had been successful in his career and risen through management levels, he had been struggling with anxiety and depressions for at least a year before he died. In contrast to Cliff, the organization he worked in is very aware of mental health concerns and suicide risk. He received the best support the people working in the organization knew how to provide.
I wrote the following in the wake of his death, an attempt to help others cope and a reflection of how my understanding of suicide has changed over the past 18 months.
Suicide Misconceptions
- Suicide is a choice.
Suicide is no more a choice than dying of cancer or cardiovascular disease is a choice. Someone who dies by suicide has been suffering from a severe, life-threatening disorder, and has not been able to receive the treatment or resources needed to survive.
- The person wanted to die.
It is the illness or disorder that puts someone in so much pain or distorts his thinking so that death seems to be the only option. Once people recover from a suicidal crisis, the vast majority are grateful and relieved to be alive, even if they survived a suicide attempt. This feeling may not come until the disease or disorder has been resolved, but when that happens it does come.
- A loved one or colleague found the body. Why would the person who died do that to them?
In trying to make sense of what's happened, we may wonder whether the person who died was trying to get revenge or express anger towards his loved ones, and particularly towards the person who found the body. While that may in some circumstances be a factor, it is more likely that the person who died was driven to act quickly, and wanted somewhere readily accessible where they had the resources to kill themselves and would not be interrupted. The suicidal crisis attacking him prevents him from caring about who will find the body, just as it prevents him from valuing his own life. - Someone who kills him or herself is weak.
Someone at risk of dying by suicide is under attack by her own thoughts and emotions. Everyday, she is fighting a battle to survive. This takes an enormous amount of strength and courage. If someone dies by cancer, that doesn't negate the strength and courage she or he demonstrated while living with the disease. The same is true for someone who dies by suicide.
- Why didn't he just take anti-depressants or talk to somebody?
Someone at risk of suicide has usually tried many types of treatment, therapy, and self-help techniques. Unfortunately, some forms of mood and anxiety disorders may only respond to specific medications, or may not respond to medication at all. Many mental health professionals, who we think of as experts in this area, have received little or no training in the treatment of suicidal crises. Someone in a suicidal crisis may question whether he is beyond or unworthy of help. Receiving ineffective treatment can reinforce those beliefs and worsen the crisis.
- Someone who is suicidal is beyond help.
Effective treatments are available. Dialectical behaviour therapy has been shown in randomized clinical trials to reduce suicidal thoughts and behaviours. Sometimes medication can be very effective in treating or preventing a suicidal crisis. Restricting access to firearms, poisons, medications, and other means of dying has been shown to be very effective in reducing deaths. Even a change in circumstances can relieve the suicidal crisis and enable the person to recover.
People being attacked by a suicidal crisis deserve the best possible treatment and support we can provide for them.
- Someone at risk of suicide should be in the hospital.
While hospitalization may sometimes be necessary, it has not been demonstrated to be the most effective treatment for a suicidal crisis. In fact, people are at very high risk of dying just after being released from hospital. These transition times must be managed very carefully. Highly effective treatment for a suicidal crisis is available outside of a hospital setting.
- Teenager girls are at the greatest risk of suicide.
Sensationalized news coverage of young people's deaths can shape our perceptions of suicide. While suicide is the second leading cause of death for teenagers in Canada (motor vehicle accidents is the first), males are at four times greater risk of dying by suicide than females, and men age 50 and over are the people most at risk. Suicide affects people of all ages and genders.
- There's nothing I can do.
There are many ways to help people at risk of suicide survive and recover.
a) Blame and fight the disease, not the person the disease is attacking.
b) Encourage the person to keep trying treatments until she finds something effective.
c) Take any suicidal crisis seriously. Help the person at risk find the treatment and support he needs to stay alive.
d) Remind the person at risk that you care about her and that you want her to be alive. In randomized clinical trials, non-demanding demonstrations of care by others have been shown to reduce deaths.
e) If you are the person closest to the person at risk of suicide, don't assume medical and mental health professionals have expertise in treating suicidal crises, or will provide you with the information you need to be an effective support. Ask questions; advocate for the person at risk; don't be afraid to get involved.
f) Take a suicide first aid course like ASIST or safeTALK.
g) Take care of your own mental and physical health. If you're not healthy, your capacity to support others will be diminished.
Sunday, June 23, 2013
Saving Lives
Dear friends -
I had the privilege of being in Montreal with Cliff's daughter Ileah June 10-13 for a world congress on suicide research. For three and a half days, researchers, academics, medical professionals, and government representatives presented their work -- everything from micro-RNA studies to national suicide prevention strategies.
Some of the information I've learned:
The conference was an enormous learning experience and an excellent opportunity to meet others with deep interests in this tragic topic. It was sometimes inspiring, sometimes emotionally taxing.
In the midst of seminars on statistics, cutting-edge research, and evidence-based practices, Government of Canada representatives made an emotional presentation on a Manitoba First Nations youth program they're funding, without providing any evidence the program has reduced deaths by suicide or even improved participants' mental health.
On the other end of the spectrum, Dr. Matt Miller from the Harvard Centre for Injury Prevention showed that restricting means can reduce suicide deaths dramatically. For example:
Why is means restriction so effective? Because a suicidal crisis -- the time period in which a person is most at risk of attempting suicide -- is usually short-lived, and the person at risk is usually acting on impulse. The method chosen is therefore usually one that is readily available. If that method is highly lethal, there is less chance of intervention or survival. Of those who do survive a suicide attempt, fewer than 10% eventually die by suicide -- over 90% do not.
After the conference, Ileah and I spent the weekend in Toronto visiting Cliff's family there as well as a childhood friend. Friday, June 21 marked 18 months since his death. The pain I feel on these anniversaries and the pain I see in Cliff's children, family and friends strengthens my resolve to change this for others.
I had the privilege of being in Montreal with Cliff's daughter Ileah June 10-13 for a world congress on suicide research. For three and a half days, researchers, academics, medical professionals, and government representatives presented their work -- everything from micro-RNA studies to national suicide prevention strategies.
Some of the information I've learned:
- In Canada, a person is three times more likely to take their own life than to be killed by someone else. (The ratio in the U.S. is 2:1.)
- Although men and women engage in similar amounts of suicidal behaviour, men are at four times greater risk of dying by suicide.
- Of everyone who attempts suicide, older men are those most likely to die.
- Despite all the statistics and assessment tools, we are very weak at being able to predict who is most at risk of dying by suicide.
- Suicide is preventable: The physiological and psychosocial factors that put people at risk of dying can be changed.
- Effective treatments are available that reduce psychological suffering, increase capacity for problem solving, and prevent deaths.
The conference was an enormous learning experience and an excellent opportunity to meet others with deep interests in this tragic topic. It was sometimes inspiring, sometimes emotionally taxing.
In the midst of seminars on statistics, cutting-edge research, and evidence-based practices, Government of Canada representatives made an emotional presentation on a Manitoba First Nations youth program they're funding, without providing any evidence the program has reduced deaths by suicide or even improved participants' mental health.
On the other end of the spectrum, Dr. Matt Miller from the Harvard Centre for Injury Prevention showed that restricting means can reduce suicide deaths dramatically. For example:
Suicide rates in Great Britain dropped sharply after residential gas service was changed from coal gas to natural gas. Rates dipped again much more recently when the number of paracetamol pills in each package was reduced to a sub-lethal dose.
Having a gun in the house increases the risk of dying by suicide for all members of the household. Storing guns unloaded and locked separately from the ammunition reduces that risk, but not as much as for a household with no guns.
After the import and sale of World Health Organization class 1 toxicity pesticides were restricted in Sri Lanka, suicide rates declined by 50%. Thousands of people's lives have been saved every year. These same pesticides are still responsible for about 1/3 of suicide deaths world wide each year -- deaths that could be prevented if other developing countries had the same bans and restrictions as North America and Europe.
Why is means restriction so effective? Because a suicidal crisis -- the time period in which a person is most at risk of attempting suicide -- is usually short-lived, and the person at risk is usually acting on impulse. The method chosen is therefore usually one that is readily available. If that method is highly lethal, there is less chance of intervention or survival. Of those who do survive a suicide attempt, fewer than 10% eventually die by suicide -- over 90% do not.
After the conference, Ileah and I spent the weekend in Toronto visiting Cliff's family there as well as a childhood friend. Friday, June 21 marked 18 months since his death. The pain I feel on these anniversaries and the pain I see in Cliff's children, family and friends strengthens my resolve to change this for others.
Monday, April 22, 2013
Sitting with Suffering
Dear friends -
I have been thinking often this past week about Rehtaeh Parsons and Audrie Pott, how to respond to those devastating tragedies.
Rehtaeh and Audrie's rapes and deaths pull the curtain to show the sexual exploitation, public shaming, and social ostracization Amanda Todd experienced was by no means an isolated incident. If these three girls have died, there are many other young women and men who have experienced the same horrendous treatment and who are courageously struggling to survive -- people who deserve to be acclaimed for their strength and bravery, but are terrified to tell their stories.
How do we support these anonymous Heroines and Heroes? How do we make it safe for them to speak up? How do we protect others from exploitation, violence, abuse and hatred? How do we respond to the young men and women who have perpetrated those crimes, and prevent others from doing the same?
The day I learned about Rehtaeh and Audrie's deaths was the day of the Boston Marathon bombings, the horror of so many people maimed and dead, and knowing that, too, is not an isolated incident; that similar and worse bombings happen in other countries -- the nightmare of dismemberment, grief, and trauma the Boston Marathon survivors now share.
And finally the news last night of a five-year old being raped in India. I broke down sobbing on my kitchen table. How could someone speak that news without crying? I remembered working in a group home in my early twenties, one of the teenagers confiding in me she had been at an older relative's house party and walked in on a child being raped. What should she do, she asked?
In the past, I have not done well at being with my own or other people's suffering. "Human beings cannot bear much reality," T. S. Elliot said. When our capacity for being with our own discomfort and pain is low, when we have little empathy for ourselves, have been trained to "keep calm and carry on", find a quick fix, or distract ourselves with work or entertainment or addiction (as most of us have been trained in this culture), what do we have to offer others who are in emotional pain? Especially when it's a pain that persists, or that can't be mended?
How do we learn to be with pain and suffering more skillfully so that it neither engulfs us in fear and depression nor cauterizes our hearts and makes us cruel? So that we can better recognize and respond to the suffering of others? How do we help our children do the same?
This morning, I received this quote from Claude AnShin Thomas in my email inbox:
I have been thinking often this past week about Rehtaeh Parsons and Audrie Pott, how to respond to those devastating tragedies.
Rehtaeh and Audrie's rapes and deaths pull the curtain to show the sexual exploitation, public shaming, and social ostracization Amanda Todd experienced was by no means an isolated incident. If these three girls have died, there are many other young women and men who have experienced the same horrendous treatment and who are courageously struggling to survive -- people who deserve to be acclaimed for their strength and bravery, but are terrified to tell their stories.
How do we support these anonymous Heroines and Heroes? How do we make it safe for them to speak up? How do we protect others from exploitation, violence, abuse and hatred? How do we respond to the young men and women who have perpetrated those crimes, and prevent others from doing the same?
The day I learned about Rehtaeh and Audrie's deaths was the day of the Boston Marathon bombings, the horror of so many people maimed and dead, and knowing that, too, is not an isolated incident; that similar and worse bombings happen in other countries -- the nightmare of dismemberment, grief, and trauma the Boston Marathon survivors now share.
And finally the news last night of a five-year old being raped in India. I broke down sobbing on my kitchen table. How could someone speak that news without crying? I remembered working in a group home in my early twenties, one of the teenagers confiding in me she had been at an older relative's house party and walked in on a child being raped. What should she do, she asked?
In the past, I have not done well at being with my own or other people's suffering. "Human beings cannot bear much reality," T. S. Elliot said. When our capacity for being with our own discomfort and pain is low, when we have little empathy for ourselves, have been trained to "keep calm and carry on", find a quick fix, or distract ourselves with work or entertainment or addiction (as most of us have been trained in this culture), what do we have to offer others who are in emotional pain? Especially when it's a pain that persists, or that can't be mended?
How do we learn to be with pain and suffering more skillfully so that it neither engulfs us in fear and depression nor cauterizes our hearts and makes us cruel? So that we can better recognize and respond to the suffering of others? How do we help our children do the same?
This morning, I received this quote from Claude AnShin Thomas in my email inbox:
We are constantly encouraged to reject what is unpleasant, disappointing or difficult. 'What's all this suffering? Let's be happy! Have fun!' But our suffering is not our enemy. It is only through a relationship with my pain, my sadness, that I can truly know and touch the opposite -- my pleasure, my joy, and my happiness.
Sunday, March 24, 2013
Understanding what drives someone to suicide
Dear friends -
After Cliff died, one of the big questions I found his family, friends, and myself asking was why had it happened? What was going on in his life that had pushed him to his death?
In previous posts I've written about four areas of action that I believe could have made a big enough difference to prevent Cliff's death and could prevent other deaths. These don't, however, address the question of what drove Cliff to take his own life.
It hasn't been difficult, in retrospect, for me and others to think of many obvious and potential stresses affecting his life. His work situation presented some obvious ones, which I've discussed in a previous post. Could other situations have been factors in his death, too? A legal matter he'd been dealing with for nine months previous? A knee injury that was still interfering with skiing and hockey? A bump in his relationship with someone dear? Getting older? A car accident we witnessed? Did he have fears about our budding life partnership?
While any and all of these factors can cause stress, frustration, sadness, and fear, we all have similar issues with which we grapple. Even the combination of a number of these situations does not typically lead to a person's death. Why, then, did Cliff die, and which, if any, of these factors were direct contributors?
Thomas Joiner's book Why People Die by Suicide provides insight about the factors found to increase a person's risk of dying by suicide (not just thinking about it or even attempting it). Reading this helped me get clearer in my own mind about which issues in Cliff's life I believe to have have been normal stresses, and which could have forewarned us that he was at high risk.
I want to emphasize that this is my interpretation of events. Others may have different perspectives and insights. If you think I've missed something or am wrong about any of this, please let me know.
The fears and fixations that Cliff expressed while he was in that anxious state were directly related to the threat of job loss: Fears about finding work, money, and physical security. The extreme anxiety reduced his ability to concentrate. He had always been concerned about whether he was a valued and respected employee. This concern escalated to a fear that management didn't value him, didn't want him, no one would give him a good reference, he would be unable to get another job, and he would end up on the street.
If an event triggers an emotional crisis, it is usually an event of some magnitude: Job loss or threat of job loss; a spouse or significant other ending a relationship; the death of someone very close; extreme financial difficulties. For Cliff, the threat of job loss attacked not only his financial stability, but his sense of belonging, his sense of having a place in the world and being a valued contributor. People who identify strongly with their careers -- doctors, lawyers, dentists, police officers, firefighters -- are at higher risk of a crisis when they perceive their career as being threatened.
First, fear triggers physical and psychological processes in preparation for fight or flight. The mind becomes hyper-alert and focused on the perceived threat. The body shuts down any functions unnecessary in the short term so that all energy is in reserve for a physical response. When a quick response is needed, this physiological response may be very helpful or at least manageable. When fear is overwhelmingly intense and unmanageable, or when it persists over weeks and months, the physiological response becomes debilitating.
Some of the primary physical functions to be disrupted are digestion and sleep. Cliff quickly developed insomnia, stomach pain, and other digestive issues for which he sought medical help. Not getting proper nutrition or sleep over an extended period further undermined his ability to recover. Insomnia is particularly detrimental to one's mental health and physical stamina. At times, the anxiety was so extreme that Cliff felt his skin was burning and he would pace the house rubbing his arms and talking.
His hyper-focus on the perceived threat of job loss and associated fears prevented him from being able to either believe that other options and outcomes were possible, or even just put aside his worries for a while and relax or play. The anxiety was so overwhelming that he found it difficult to even imagine successfully competing for another job. Fear undermines confidence -- both one's own and others'. Thus a vicious cycle was created, and the barriers to Cliff being able to respond effectively became greater and greater.
Finally, persistent anxiety can lead to depression, yet the symptoms of anxiety mask that depression, making it more difficult for others to identify or diagnose.
Many experts believe that suicidal ideation is a relatively normal response to overwhelming psychological or physical pain. The unrelenting anxiety created psychological pain and persistent physical discomfort for Cliff. Numerous self-help techniques, medications, and even hospital treatment failed to free him from the fear and pain.
E.g. Childhood abuse raises adult suicide risk
The Relationship of Childhood Abuse to Impulsivity and Suicidal Behavior in Adults With Major Depression
For Cliff, being unable to control the anxiety on his own, having to go on medication, the possibility of being reliant on sources of income other than what he himself had generated, being hospitalized and forced to go on sick leave all undermined his sense of control and competency and further fueled his fears.
When repeated attempts to cope appear to have failed, psychological pain is constant, and things keep spirally downward, suicide may come to seem the only way to re-assert control.
According to Joiner, a person becomes at much greater risk of death by suicide if he or she has acquired the ability to inflict lethal self harm. This happens through repeated or severe injury or trauma, or through suicide rehearsals and attempts. While emotional and perceptual risk factors are more variable and subject to influence, once a person has inured him or herself to suicidal behaviours that person may always be more vulnerable.
Sometimes suicide attempts are seen as a cry for help; we question whether someone was "serious". This attitude can hinder us from responding effectively and compassionately. Any suicide rehearsal or attempt is a confrontation with one's fear of death, one that takes a person closer to being able to overcome that fear.
For Cliff, there were a number of events that contributed to his ability to inflict lethal self harm. The physical abuse he experienced as a child was probably the first of these. Then there was a motorcycle accident when he was 20 that left him with two broken legs and took months in the hospital from which to recover. During a particularly difficult period during his 30s, his sister tells me that he would show up with bruises on his face from bar fights that he may or may not have instigated. And by the time he died, Cliff had made two previous suicide attempts.
From what I've learned, these are the factors that drove Cliff to take his own life. That does not mean his death was inevitable. Effective support, education, and intervention could have helped him ride through the crisis to a place of more stability and possibility. The biggest tragedy for all of us who knew and loved him is that did not happen.
After Cliff died, one of the big questions I found his family, friends, and myself asking was why had it happened? What was going on in his life that had pushed him to his death?
In previous posts I've written about four areas of action that I believe could have made a big enough difference to prevent Cliff's death and could prevent other deaths. These don't, however, address the question of what drove Cliff to take his own life.
It hasn't been difficult, in retrospect, for me and others to think of many obvious and potential stresses affecting his life. His work situation presented some obvious ones, which I've discussed in a previous post. Could other situations have been factors in his death, too? A legal matter he'd been dealing with for nine months previous? A knee injury that was still interfering with skiing and hockey? A bump in his relationship with someone dear? Getting older? A car accident we witnessed? Did he have fears about our budding life partnership?
While any and all of these factors can cause stress, frustration, sadness, and fear, we all have similar issues with which we grapple. Even the combination of a number of these situations does not typically lead to a person's death. Why, then, did Cliff die, and which, if any, of these factors were direct contributors?
Thomas Joiner's book Why People Die by Suicide provides insight about the factors found to increase a person's risk of dying by suicide (not just thinking about it or even attempting it). Reading this helped me get clearer in my own mind about which issues in Cliff's life I believe to have have been normal stresses, and which could have forewarned us that he was at high risk.
I want to emphasize that this is my interpretation of events. Others may have different perspectives and insights. If you think I've missed something or am wrong about any of this, please let me know.
Factors in Cliff's Death
1. Threat of job loss
While there were a number of stressful situations that happened for Cliff in the year or two preceding his death, his reaction to most of these was within a normal range of emotion: Frustration, sometimes anger, probably some fear. Some of these may even have affected his sense of identity. But the one that most closely preceded the unmanageable level of anxiety he experienced that fall was the news that his organization's contract was expiring and his job was at risk.The fears and fixations that Cliff expressed while he was in that anxious state were directly related to the threat of job loss: Fears about finding work, money, and physical security. The extreme anxiety reduced his ability to concentrate. He had always been concerned about whether he was a valued and respected employee. This concern escalated to a fear that management didn't value him, didn't want him, no one would give him a good reference, he would be unable to get another job, and he would end up on the street.
If an event triggers an emotional crisis, it is usually an event of some magnitude: Job loss or threat of job loss; a spouse or significant other ending a relationship; the death of someone very close; extreme financial difficulties. For Cliff, the threat of job loss attacked not only his financial stability, but his sense of belonging, his sense of having a place in the world and being a valued contributor. People who identify strongly with their careers -- doctors, lawyers, dentists, police officers, firefighters -- are at higher risk of a crisis when they perceive their career as being threatened.
2. Anxiety
The news that Cliff's contract was expiring triggered an unshakeable fear or anxiety that quickly became his constant companion. Anxiety, which many of us may think of as the most normal of psychological disorders, actually carries with it a greater risk of suicide than depression when it is severe. This may be for several reasons.First, fear triggers physical and psychological processes in preparation for fight or flight. The mind becomes hyper-alert and focused on the perceived threat. The body shuts down any functions unnecessary in the short term so that all energy is in reserve for a physical response. When a quick response is needed, this physiological response may be very helpful or at least manageable. When fear is overwhelmingly intense and unmanageable, or when it persists over weeks and months, the physiological response becomes debilitating.
Some of the primary physical functions to be disrupted are digestion and sleep. Cliff quickly developed insomnia, stomach pain, and other digestive issues for which he sought medical help. Not getting proper nutrition or sleep over an extended period further undermined his ability to recover. Insomnia is particularly detrimental to one's mental health and physical stamina. At times, the anxiety was so extreme that Cliff felt his skin was burning and he would pace the house rubbing his arms and talking.
His hyper-focus on the perceived threat of job loss and associated fears prevented him from being able to either believe that other options and outcomes were possible, or even just put aside his worries for a while and relax or play. The anxiety was so overwhelming that he found it difficult to even imagine successfully competing for another job. Fear undermines confidence -- both one's own and others'. Thus a vicious cycle was created, and the barriers to Cliff being able to respond effectively became greater and greater.
Finally, persistent anxiety can lead to depression, yet the symptoms of anxiety mask that depression, making it more difficult for others to identify or diagnose.
Many experts believe that suicidal ideation is a relatively normal response to overwhelming psychological or physical pain. The unrelenting anxiety created psychological pain and persistent physical discomfort for Cliff. Numerous self-help techniques, medications, and even hospital treatment failed to free him from the fear and pain.
3. Childhood physical and psychological abuse
This part of the story happened long before I knew Cliff, and is not mine to tell. What I can say is that, very sadly, physical and psychological abuse, including ostracization and neglect, were part of Cliff's and his siblings' childhood experiences. Several studies have shown that these childhood experiences, especially when the abuser is a parent, are associated with increased suicidal ideation and behaviour in adulthood, and an elevated risk of death by suicide. Some of the seeds of Cliff's death were, I believe, planted much, much earlier in his life.E.g. Childhood abuse raises adult suicide risk
The Relationship of Childhood Abuse to Impulsivity and Suicidal Behavior in Adults With Major Depression
4. Fears of being a burden
One of the paradoxes that Cliff was caught in as his situation worsened was the need to experience himself as capable and in control even as the anxiety diminished his ability to think clearly and respond effectively and the situation spiraled out of his control. As fears about competency and control heighten, one may respond by trying to re-assert oneself in those areas. This is a particular danger for highly intelligent people who are used to being in control and to being very good at solving problems and managing difficult situations, e.g. doctors, lawyers, or, like Cliff, computer programming professionals. Attempts to reassert competency and control lead to help negation, the conviction that "I need to do this on my own," at a time when one is most in need of help.For Cliff, being unable to control the anxiety on his own, having to go on medication, the possibility of being reliant on sources of income other than what he himself had generated, being hospitalized and forced to go on sick leave all undermined his sense of control and competency and further fueled his fears.
When repeated attempts to cope appear to have failed, psychological pain is constant, and things keep spirally downward, suicide may come to seem the only way to re-assert control.
5. Acquired ability to inflict lethal self harm
Thomas Joiner asserts that when a person's sense of belonging and sense of capability are threatened, many of us will experience self-destructive or suicidal thoughts. Nonetheless, the instinct for self-preservation and fear of death are incredibly strong. Although one may have a strong emotional and psychological response to feeling isolated and seeing oneself as a burden on others, this does not necessarily lead to suicidal behaviour.According to Joiner, a person becomes at much greater risk of death by suicide if he or she has acquired the ability to inflict lethal self harm. This happens through repeated or severe injury or trauma, or through suicide rehearsals and attempts. While emotional and perceptual risk factors are more variable and subject to influence, once a person has inured him or herself to suicidal behaviours that person may always be more vulnerable.
Sometimes suicide attempts are seen as a cry for help; we question whether someone was "serious". This attitude can hinder us from responding effectively and compassionately. Any suicide rehearsal or attempt is a confrontation with one's fear of death, one that takes a person closer to being able to overcome that fear.
For Cliff, there were a number of events that contributed to his ability to inflict lethal self harm. The physical abuse he experienced as a child was probably the first of these. Then there was a motorcycle accident when he was 20 that left him with two broken legs and took months in the hospital from which to recover. During a particularly difficult period during his 30s, his sister tells me that he would show up with bruises on his face from bar fights that he may or may not have instigated. And by the time he died, Cliff had made two previous suicide attempts.
6. Hospital discharge
People at risk of suicide are very vulnerable at transition points in their care, for example in the first 48 hours after being discharged from hospital. This was the period in which Cliff died. Because there was no crisis plan in place, the discharge process was handled so casually, and no one close to him was informed this could be a vulnerable time, Cliff was alone and at the mercy of his volatile thoughts and moods.From what I've learned, these are the factors that drove Cliff to take his own life. That does not mean his death was inevitable. Effective support, education, and intervention could have helped him ride through the crisis to a place of more stability and possibility. The biggest tragedy for all of us who knew and loved him is that did not happen.
Monday, February 11, 2013
Living with the Full Catastrophe
Dear friends -
In a recent phone conversation, a well-intentioned friend, after inquiring how Christopher, Ileah and I were doing, responded very cheerfully that time heals all wounds. I felt stunned by her comment, unsure how to respond. Does she really believe this? Because I work in an organization that serves many people whose wounds don't get all better, and from some wounds people actually die. One's definition of "healing" has to be pretty broad to include all that.
Cliff's death ripped a hole in the world where he used to be. After the shock of that, I found a part of me had died, too. While some things heal, that part hasn't grown back. It may not be evident to others that anything is missing, but it's very evident to me. It's as if I'm living in a different body, experiencing the world through a different set of senses, having had to re-familiarize myself with everything from a changed perspective.
As well as they are functioning and re-engaging with the world, Christopher and Ileah are also experiencing an irreparable loss. As someone whose own father died at 46 of cancer, I know what a hole that left in my life, particularly during my 20s and 30s. Christopher and Ileah had unique relationships with their very unique Papa. This, their ages and maturity, and the sudden and traumatic circumstances of his death have shaped and will continue to shape their own experiences.
I don't want people to feel sorry for any of us. We are each taking care of ourselves, taking the next steps in our lives. We are each in our own ways very capable people. We have amazing circles of family and friends, and we have the love and support of each other, all of which has been tested and deepened.
Yes, there is healing that happens. Yes, there can be creative, generative, adaptive responses to this kind of loss. Christopher and Ileah, two of the most creative and intelligent people I know, have already demonstrated this. And there are also some wounds that can never completely heal, some parts of us that can't grow back. We live with all of this -- as Jon Kabat Zinn says, the full catastrophe.
In a recent phone conversation, a well-intentioned friend, after inquiring how Christopher, Ileah and I were doing, responded very cheerfully that time heals all wounds. I felt stunned by her comment, unsure how to respond. Does she really believe this? Because I work in an organization that serves many people whose wounds don't get all better, and from some wounds people actually die. One's definition of "healing" has to be pretty broad to include all that.
Cliff's death ripped a hole in the world where he used to be. After the shock of that, I found a part of me had died, too. While some things heal, that part hasn't grown back. It may not be evident to others that anything is missing, but it's very evident to me. It's as if I'm living in a different body, experiencing the world through a different set of senses, having had to re-familiarize myself with everything from a changed perspective.
As well as they are functioning and re-engaging with the world, Christopher and Ileah are also experiencing an irreparable loss. As someone whose own father died at 46 of cancer, I know what a hole that left in my life, particularly during my 20s and 30s. Christopher and Ileah had unique relationships with their very unique Papa. This, their ages and maturity, and the sudden and traumatic circumstances of his death have shaped and will continue to shape their own experiences.
I don't want people to feel sorry for any of us. We are each taking care of ourselves, taking the next steps in our lives. We are each in our own ways very capable people. We have amazing circles of family and friends, and we have the love and support of each other, all of which has been tested and deepened.
Yes, there is healing that happens. Yes, there can be creative, generative, adaptive responses to this kind of loss. Christopher and Ileah, two of the most creative and intelligent people I know, have already demonstrated this. And there are also some wounds that can never completely heal, some parts of us that can't grow back. We live with all of this -- as Jon Kabat Zinn says, the full catastrophe.
Saturday, February 9, 2013
Collaboration with Andrew
Dear friends -
At the end of November as I was contacting different agencies to learn about their services, one of my contacts introduced me to Andrew Curran. Andrew's wife, Jane Storey, died by suicide January 25, 2012 at the age of 33. Since Janey's death, Andrew underwent a formal complaint process through Vancouver General Hospital and has done an impressive amount of research.
Janey's situation was disturbingly similar to Cliff's. She grappled with anxiety and depression for months. Unlike Cliff, she expressed concerns about the suicidal thoughts she was having, which finally led to her admission to Vancouver General Hospital.
The psychiatrist assigned to treat Janey was not a personable man. Their relationship was uncomfortable at best. Because no office was available, sessions with her doctor were conducted at one end of a hall in the ward. There was no privacy from the other patients. Although Andrew and Janey were married, the professionals treating her gave Andrew no more opportunity to be involved in Janey's care than there had been for me to be involved in Cliff's.
At the end of her hospital stay, Janey's discharge was handled very casually. The suicidal ideation was assessed as being "resolved". Consequently, unlike Cliff, she was never connected with community outreach services despite Andrew's daily phone calls. Far from being resolved, the suicidal impulses Janey was experiencing had, in fact, heightened. She died under very similar circumstances as Cliff only two weeks after her discharge.
Even before Andrew and I met in person or shared our stories, I had the sense we knew each other. We talked for two and a half hours when we first had tea. At our second meeting in early January, we were ready to dive into collaborating. Here's the action plan we crafted.
If you have connections, suggestions, or an interest in participating in any of the above, please let me know.
I've learned a great deal from Andrew already, both from the research he's done and from his calm and principled approach. Working together, we've been able to develop a clearer sense of direction and bolster more energy than either of us had been able to maintain on our own.
Cliff and Jane were both remarkable, loving, kind, creative people. Part of their legacy will be positive, enduring, systemic changes that improve survival rates and quality of life for others like them. Meeting Andrew has renewed my optimism that those changes are possible.
At the end of November as I was contacting different agencies to learn about their services, one of my contacts introduced me to Andrew Curran. Andrew's wife, Jane Storey, died by suicide January 25, 2012 at the age of 33. Since Janey's death, Andrew underwent a formal complaint process through Vancouver General Hospital and has done an impressive amount of research.
Janey's situation was disturbingly similar to Cliff's. She grappled with anxiety and depression for months. Unlike Cliff, she expressed concerns about the suicidal thoughts she was having, which finally led to her admission to Vancouver General Hospital.
The psychiatrist assigned to treat Janey was not a personable man. Their relationship was uncomfortable at best. Because no office was available, sessions with her doctor were conducted at one end of a hall in the ward. There was no privacy from the other patients. Although Andrew and Janey were married, the professionals treating her gave Andrew no more opportunity to be involved in Janey's care than there had been for me to be involved in Cliff's.
At the end of her hospital stay, Janey's discharge was handled very casually. The suicidal ideation was assessed as being "resolved". Consequently, unlike Cliff, she was never connected with community outreach services despite Andrew's daily phone calls. Far from being resolved, the suicidal impulses Janey was experiencing had, in fact, heightened. She died under very similar circumstances as Cliff only two weeks after her discharge.
Even before Andrew and I met in person or shared our stories, I had the sense we knew each other. We talked for two and a half hours when we first had tea. At our second meeting in early January, we were ready to dive into collaborating. Here's the action plan we crafted.
Strategy #1: Family Involvement in Patient Care
- Meet February 22 with the manager of Vancouver Community Mental Health Services to learn about their Family Advisory Group
- Access opportunities to tell medical professionals about our experiences via the Patient Voices Network
- Identify potential sponsors in health care administration
Strategy #2: Suicide Assessment and Intervention Training for Mental Health Professionals
- Organize a research project to assess the current state of training requirements in British Columbia
- Consult with Jennifer Stuber, instrumental in getting suicide assessment and intervention training requirements legislated for mental health professionals and other front-line care providers in Washington state.
- Identify potential sponsors and allies in professional associations, public policy, and government
Strategy #3: Psychological Workplace Safety
- Continue to learn about and share work being done in this area
- Promote psychological safety principles, and mental health and suicide intervention training within my own workplace as appropriate
Strategy #4: Support for Companions
- Connect with organizations that run support groups for family and friends of people with mood and anxiety disorders (e.g. Mood Disorders Association, AnxietyBC, SAFER)
- Assess resources currently available to companions and opportunities to augment these
If you have connections, suggestions, or an interest in participating in any of the above, please let me know.
I've learned a great deal from Andrew already, both from the research he's done and from his calm and principled approach. Working together, we've been able to develop a clearer sense of direction and bolster more energy than either of us had been able to maintain on our own.
Cliff and Jane were both remarkable, loving, kind, creative people. Part of their legacy will be positive, enduring, systemic changes that improve survival rates and quality of life for others like them. Meeting Andrew has renewed my optimism that those changes are possible.
Monday, January 21, 2013
Support and Education for Companions
Dear friends -
This update is a long one. When I began writing, it was short, impersonal, and off topic. Finally, I realized I was avoiding writing about what happened for Cliff and I. That was difficult to write and has also ended up being long.
With that caveat...
In the last update, I wrote about the role Cliff's workplace played in his anxiety, depression, and death. Many of you wrote to me to say you appreciated knowing more about what had been going on for him. Some of you who were colleagues could identify with some of what Cliff was going through.
Witnessing the anxiety, depression, and suicidal urges that overtook Cliff was nightmarish, even though it was mild compared to what Cliff was experiencing. When he first learned the contract at work would be ending, I was happy and relieved. I did not have a high opinion of his employer, having worked for them myself for almost seven years. The former colleagues I knew who had left the organization were much happier in their new roles. Cliff was an intelligent, creative, gregarious man with a skill set that was in high demand and a solid resume. I had no doubt he could find better employment.
The anxiety he began experiencing at the end of September surprised me. It began mildly. By Thanksgiving it was strong enough that going to friends' for a big social evening -- something that he normally would have loved -- was a challenge. He was having difficulty sleeping, and started having digestive problems. His doctor diagnosed irritable bowel syndrome, gave him a sleep aid, and also prescribed medication to help manage the anxiety.
From the beginning, Cliff tried numerous strategies to get the anxiety under control and manage the situation. He quit drinking, because he found it made the anxiety worse. He was exercising, meditating, taking vitamins, walking, being more frugal, applying for other jobs, going to yoga class. He downloaded personal growth audio files, listened to relaxation sound tracks, and read books he'd found inspirational in the past. We began doing daily check-ins during which we would each take turns just talking about what we were experiencing that day while the other person listened.
In many ways, even this experience brought us closer together. Any good front that we were still trying to maintain for each other was blown away. We opened our hearts to each other in our daily check-ins. I did my best to support him in doing whatever he needed to do to try to bring the anxiety under control. Although he was obviously suffering, Cliff continued to demonstrate his love for me, do kind things, and offer his help in my own endeavours.
Despite everything Cliff was trying, the anxiety continued to worsen. Whenever he had a better day, we both continued to be hopeful that this was the turning point, that the worst was over, but that never proved to be the case. Eventually the anxiety became so bad that without medication he felt like his skin was burning and would repeatedly jump up and pace the floor, talking over and over about the worries that had engulfed him.
Cliff tried getting professional help, but this proved challenging. Services through his Employee Assistance program were free, but of low quality. Paying for a coach or counsellor was expensive, and much of his anxiety was focused on finances. His doctor referred him to a Mood Disorder Clinic, but the groups there met during the weekday, and the last thing Cliff was going to do at that point was miss work. He became terrified that at any sign of weakness, he would be fired.
As the situation progressed, I became more and more confused and concerned by Cliff's reactions, and felt more and more helpless and uncertain about what to do. He was certain that the world was heading towards an economic collapse; that his financial situation was dire (from my perspective, it was definitely not); that no one would hire him; and that he was now incapable of continuing to do IT work (although he was continuing to do high level work capably even while he was obviously not well).
His suicide attempt at the beginning of December caught me completely off guard. The topic of suicide had arisen twice earlier. The first time was when he shared the results of a counseling assessment with me in which he'd been asked to rate how often he thought of suicide. I was concerned when I saw there was a "1" beside it, but he told me this was a very low rating, that it wasn't an issue. The antidepressant medication he was later prescribed had "suicidal thoughts and feelings" as a side effect, so we talked about how to handle that, agreeing that he would just have to tell me and his doctor if that started happening. I didn't know what else we would do.
The first weekend in December, I went to Seattle to visit friends and attend a workshop. I had repeatedly asked Cliff to come with me, but he was committed to working that weekend. When I arrived home Sunday night, I found him passed out on the bed. I managed to wake him, but he was obviously heavily medicated. Unable to convince him to go with me to the hospital, I called 911. Then I found the suicide note and the packages of pills he'd taken.
We spent three days in emergency and the Acute Medical Unit at Vancouver General. After they stabilized his physical condition, they moved him to the Brief Intervention Unit of the psychiatric ward where he stayed for another 13 days. During this time, I consulted three counselors as I looked for someone to work with, and talked with three psychiatrists within the hospital. None of them talked to me about what signs had shown that Cliff was at risk of suicide; what to watch for in case he became suicidal again; or what to do if that happened. Although I spent hours at the hospital with him every day, none of the professionals there involved me in their meetings with him.
I myself was a weak advocate, not knowing what role to play. The psychiatrists advised me to let Cliff retain as much control over everything as he was able. He didn't want to tell his children or his friends why he had been admitted. I didn't want to violate his trust in me. We weren't married, and I'd only been living with him for nine months. I was unsure to what extent I could or should question what was happening or ask to be more involved. I was also relieved that he was finally getting dedicated professional help, and hopeful that this would finally be the turning point; that they would be able to do what Cliff and I had been unable to do on our own: straighten everything out and help him get well again.
Tragically, as you know, this was not the case. I think his psychiatrist was in almost as much denial that suicide could be a possibility for Cliff as I was. The Tuesday morning that Cliff was discharged, I skipped work at the encouragement of my director and arrived at the hospital while Cliff was in a session with his psychiatrist. When they came out, surprised to see me, the doctor told me he was discharging Cliff. He handed Cliff a set of prescriptions, gave us his blessing to go to Mexico the following Saturday, and reminded Cliff to connect with the outpatient mental health team before we left. The doctor seemed cheerful and optimistic. Cliff seemed as agitated and fixated on financial worries as ever.
At a couple points that afternoon, Cliff's behaviour concerned me enough that I sat him down and asked what was going on, what was he thinking? He reassured me both times, coming up with plausible explanations -- plausible, at least, within the context of what we'd been through in the past few months. I had no instructions on what to do if I was concerned, didn't know what support was available other than to phone 911 if he was at imminent risk. He didn't seem to be in crisis, so I didn't think of phoning the crisis line. By now, unusual behaviour had become the norm.
That evening we went to an early Christmas dinner with friends, and he seemed happier than I'd seen him in a very long time. "Finally," I thought, "the medication must be working."
In retrospect, it's easy to see the signs that Cliff was being driven toward suicide: The swings between cautious optimism and deep despair; saying he wasn't going to finish the dental work he'd started; telling me he didn't want to be burden on me; giving things away; his last happy evening with friends thinking that his suffering would soon be over. With more support and education, I might have seen those signs and been able to intervene. I was probably in a better position to do that than anyone else. I know there are many other suicide survivors who have been left with that grief, too.
Those living with a person experiencing a mood disorder may not be aware that suicide is a risk, may be in denial about its possibility, and very likely do not have the knowledge and skills needed to intervene even if they are concerned. The person themselves is not in a mental state to care for themselves and may be at varying risk of self-harm. Under these circumstances, it is vital that that those closest to them, whether a spouse, friend, adult son or daughter, or other relative, receive support, information, and opportunities for training so they can be compassionate companions, and be more capable of intervening effectively if the risk of suicide does present itself.
Some support is available. The Mood Disorder Association of B.C. runs support groups for family members in Vancouver, North Vancouver, Delta, and Langley. FORCE Society for Kids' Mental Health has a peer support network for parents. These organizations and AnxietyBC all offer information and resources online. I could not easily find information about suicide or links to suicide prevention resources on any of their websites, which makes me think this is a topic even mental health advocates find difficult to address [but please see my comments below for more information].
It is 13 months ago today that Cliff died. If we want to save lives, we have to educate ourselves and each other about suicide. We have to listen to each others' experiences, as painful as they may be. We can't rely only on professionals to assess and intervene. We can't depend on someone who is suicidal to save their own lives.
This update is a long one. When I began writing, it was short, impersonal, and off topic. Finally, I realized I was avoiding writing about what happened for Cliff and I. That was difficult to write and has also ended up being long.
With that caveat...
In the last update, I wrote about the role Cliff's workplace played in his anxiety, depression, and death. Many of you wrote to me to say you appreciated knowing more about what had been going on for him. Some of you who were colleagues could identify with some of what Cliff was going through.
Witnessing the anxiety, depression, and suicidal urges that overtook Cliff was nightmarish, even though it was mild compared to what Cliff was experiencing. When he first learned the contract at work would be ending, I was happy and relieved. I did not have a high opinion of his employer, having worked for them myself for almost seven years. The former colleagues I knew who had left the organization were much happier in their new roles. Cliff was an intelligent, creative, gregarious man with a skill set that was in high demand and a solid resume. I had no doubt he could find better employment.
The anxiety he began experiencing at the end of September surprised me. It began mildly. By Thanksgiving it was strong enough that going to friends' for a big social evening -- something that he normally would have loved -- was a challenge. He was having difficulty sleeping, and started having digestive problems. His doctor diagnosed irritable bowel syndrome, gave him a sleep aid, and also prescribed medication to help manage the anxiety.
From the beginning, Cliff tried numerous strategies to get the anxiety under control and manage the situation. He quit drinking, because he found it made the anxiety worse. He was exercising, meditating, taking vitamins, walking, being more frugal, applying for other jobs, going to yoga class. He downloaded personal growth audio files, listened to relaxation sound tracks, and read books he'd found inspirational in the past. We began doing daily check-ins during which we would each take turns just talking about what we were experiencing that day while the other person listened.
In many ways, even this experience brought us closer together. Any good front that we were still trying to maintain for each other was blown away. We opened our hearts to each other in our daily check-ins. I did my best to support him in doing whatever he needed to do to try to bring the anxiety under control. Although he was obviously suffering, Cliff continued to demonstrate his love for me, do kind things, and offer his help in my own endeavours.
Despite everything Cliff was trying, the anxiety continued to worsen. Whenever he had a better day, we both continued to be hopeful that this was the turning point, that the worst was over, but that never proved to be the case. Eventually the anxiety became so bad that without medication he felt like his skin was burning and would repeatedly jump up and pace the floor, talking over and over about the worries that had engulfed him.
Cliff tried getting professional help, but this proved challenging. Services through his Employee Assistance program were free, but of low quality. Paying for a coach or counsellor was expensive, and much of his anxiety was focused on finances. His doctor referred him to a Mood Disorder Clinic, but the groups there met during the weekday, and the last thing Cliff was going to do at that point was miss work. He became terrified that at any sign of weakness, he would be fired.
As the situation progressed, I became more and more confused and concerned by Cliff's reactions, and felt more and more helpless and uncertain about what to do. He was certain that the world was heading towards an economic collapse; that his financial situation was dire (from my perspective, it was definitely not); that no one would hire him; and that he was now incapable of continuing to do IT work (although he was continuing to do high level work capably even while he was obviously not well).
His suicide attempt at the beginning of December caught me completely off guard. The topic of suicide had arisen twice earlier. The first time was when he shared the results of a counseling assessment with me in which he'd been asked to rate how often he thought of suicide. I was concerned when I saw there was a "1" beside it, but he told me this was a very low rating, that it wasn't an issue. The antidepressant medication he was later prescribed had "suicidal thoughts and feelings" as a side effect, so we talked about how to handle that, agreeing that he would just have to tell me and his doctor if that started happening. I didn't know what else we would do.
The first weekend in December, I went to Seattle to visit friends and attend a workshop. I had repeatedly asked Cliff to come with me, but he was committed to working that weekend. When I arrived home Sunday night, I found him passed out on the bed. I managed to wake him, but he was obviously heavily medicated. Unable to convince him to go with me to the hospital, I called 911. Then I found the suicide note and the packages of pills he'd taken.
We spent three days in emergency and the Acute Medical Unit at Vancouver General. After they stabilized his physical condition, they moved him to the Brief Intervention Unit of the psychiatric ward where he stayed for another 13 days. During this time, I consulted three counselors as I looked for someone to work with, and talked with three psychiatrists within the hospital. None of them talked to me about what signs had shown that Cliff was at risk of suicide; what to watch for in case he became suicidal again; or what to do if that happened. Although I spent hours at the hospital with him every day, none of the professionals there involved me in their meetings with him.
I myself was a weak advocate, not knowing what role to play. The psychiatrists advised me to let Cliff retain as much control over everything as he was able. He didn't want to tell his children or his friends why he had been admitted. I didn't want to violate his trust in me. We weren't married, and I'd only been living with him for nine months. I was unsure to what extent I could or should question what was happening or ask to be more involved. I was also relieved that he was finally getting dedicated professional help, and hopeful that this would finally be the turning point; that they would be able to do what Cliff and I had been unable to do on our own: straighten everything out and help him get well again.
Tragically, as you know, this was not the case. I think his psychiatrist was in almost as much denial that suicide could be a possibility for Cliff as I was. The Tuesday morning that Cliff was discharged, I skipped work at the encouragement of my director and arrived at the hospital while Cliff was in a session with his psychiatrist. When they came out, surprised to see me, the doctor told me he was discharging Cliff. He handed Cliff a set of prescriptions, gave us his blessing to go to Mexico the following Saturday, and reminded Cliff to connect with the outpatient mental health team before we left. The doctor seemed cheerful and optimistic. Cliff seemed as agitated and fixated on financial worries as ever.
At a couple points that afternoon, Cliff's behaviour concerned me enough that I sat him down and asked what was going on, what was he thinking? He reassured me both times, coming up with plausible explanations -- plausible, at least, within the context of what we'd been through in the past few months. I had no instructions on what to do if I was concerned, didn't know what support was available other than to phone 911 if he was at imminent risk. He didn't seem to be in crisis, so I didn't think of phoning the crisis line. By now, unusual behaviour had become the norm.
That evening we went to an early Christmas dinner with friends, and he seemed happier than I'd seen him in a very long time. "Finally," I thought, "the medication must be working."
In retrospect, it's easy to see the signs that Cliff was being driven toward suicide: The swings between cautious optimism and deep despair; saying he wasn't going to finish the dental work he'd started; telling me he didn't want to be burden on me; giving things away; his last happy evening with friends thinking that his suffering would soon be over. With more support and education, I might have seen those signs and been able to intervene. I was probably in a better position to do that than anyone else. I know there are many other suicide survivors who have been left with that grief, too.
Strategy #4: Support, education, and training for people living with someone with a mood disorder
Living with someone who is experiencing a mood disorder such as anxiety, depression, or bipolar disorder can be a confusing, painful, and challenging experience. If the situation persists for an extended time, spouses and close friends may be at risk of burnout. In some circumstances, sadly, the stress of the situation and lack of understanding can result in conflicts or breakdowns in relationship. All of this reduces support and heightens risk for the person who is ill.Those living with a person experiencing a mood disorder may not be aware that suicide is a risk, may be in denial about its possibility, and very likely do not have the knowledge and skills needed to intervene even if they are concerned. The person themselves is not in a mental state to care for themselves and may be at varying risk of self-harm. Under these circumstances, it is vital that that those closest to them, whether a spouse, friend, adult son or daughter, or other relative, receive support, information, and opportunities for training so they can be compassionate companions, and be more capable of intervening effectively if the risk of suicide does present itself.
Some support is available. The Mood Disorder Association of B.C. runs support groups for family members in Vancouver, North Vancouver, Delta, and Langley. FORCE Society for Kids' Mental Health has a peer support network for parents. These organizations and AnxietyBC all offer information and resources online. I could not easily find information about suicide or links to suicide prevention resources on any of their websites, which makes me think this is a topic even mental health advocates find difficult to address [but please see my comments below for more information].
It is 13 months ago today that Cliff died. If we want to save lives, we have to educate ourselves and each other about suicide. We have to listen to each others' experiences, as painful as they may be. We can't rely only on professionals to assess and intervene. We can't depend on someone who is suicidal to save their own lives.
Sunday, January 6, 2013
Psychological Safety in the Workplace
Dear friends -
After Cliff died, I was furious at the leaders and managers at his workplace for the role I perceive them to have played in his death. Because I had worked for the same organization and with many of the same people, I had my own experience and perspective of what he was dealing with.
Risk stimulates us, challenges us, makes life more interesting. Workplace safety isn't about eliminating risk or not engaging in risky activities; it's about recognizing risk and taking appropriate precautions so that at the end of the day workers return home with their health and safety uncompromised. In North America, we've been protecting worker's physical safety for years. Only now are we recognizing we also need to attend to workers' psychological safety.
An important factor in that will be defining the standards which employers are required to meet. This month, the Canadian Standards Association is certifying a new voluntary standard for psychological health and safety in the workplace.
Neither Bill 14 nor the voluntary standard for psychological health and safety are yet enough to prevent deaths like Cliff's, but they are significant changes in how we hold ourselves responsible for workplace mental health. Mental illness and injury are not just individual weaknesses or problems, they are societal, cultural, and economic issues that affect more of us than we may believe; that really do debilitate people and threaten their lives; and that are often caused, triggered, or worsened by outside events.
On a much more positive side, people like Martin Shain, founder of Neighbour at Work; Great West Life, commissioners of Guarding Minds at Work; and Bill Wilkerson, co-founder and CEO of the Global Business and Economic Roundtable on Addiction and Mental Health have already been doing impressive work in this area for many years, work that is paying off in new standards and changes in legislation.
Psychological workplace safety remains a concern for me. For now I am putting my efforts into other areas where change seems possible and much needed.
After Cliff died, I was furious at the leaders and managers at his workplace for the role I perceive them to have played in his death. Because I had worked for the same organization and with many of the same people, I had my own experience and perspective of what he was dealing with.
Cliff's experience
The extreme anxiety and major depression that took Cliff's life were precipitated and aggravated by events in his workplace. The anxiety began after he learned that his employer's contract for IT services would not be renewed by BC Hydro, which put his job in jeopardy. Other aspects of the situation added to the stress and pressure:- Management of Cliff's team had changed frequently, especially in the past two years. The current manager seemed inexperienced, awkward, and unaware of his impact on the team. He was focused on pleasing his superiors rather than taking care of his employees. Some of the decisions he made and the way those were implemented caused Cliff to feel ostracized, scrutinized, or embarrassed, and Cliff did not trust him.
- Contract workers from India, paid at a much lower rate, had been brought to B.C. to do work closely related to that of Cliff's team. The employer made no attempt to educate the Canadian team members about working cross-culturally, and there were many communication challenges. The use of contract workers was perceived by Cliff and some of his colleagues as a threat to their employment.
- Some team members were already leaving to work for other employers, meaning the team was losing knowledge, skill, resources, and established relationships. This increased pressure on the remaining team members.
- Cliff's team was responsible for maintaining the integrity of an enterprise IT system, SAP, through which all of BC Hydro's customer, human resources, and financial information is managed. Despite the team being under-resourced and dealing with news about the impending end of the contract, they were still required to take on a project to integrate customer payments into SAP -- further increasing the profile and risk of the system, and the pressure on the team. The suicide attempt that led to Cliff's hospitalization in December occurred immediately after he finished work on this project.
Strategy #3: Psychological safety in the workplace
There were other factors that made Cliff vulnerable to these events -- just as there are factors that heighten people's risk of cancer, broken bones, and other illnesses and injuries. That doesn't negate the effect that workplaces have on people's lives, or the responsibility that we each have as employers, managers, and workers to take reasonable steps to promote the physical and psychological safety of our employees, our colleagues, and ourselves.Risk stimulates us, challenges us, makes life more interesting. Workplace safety isn't about eliminating risk or not engaging in risky activities; it's about recognizing risk and taking appropriate precautions so that at the end of the day workers return home with their health and safety uncompromised. In North America, we've been protecting worker's physical safety for years. Only now are we recognizing we also need to attend to workers' psychological safety.
Initial steps towards regulating psychological safety
Last June, British Columbia passed Bill 14, legislation that expands eligibility for compensable psychological workplace injuries. (Because mental stress and injury due to management behaviours and decisions are explicitly excluded from coverage, someone in Cliff's position would still not be eligible for compensation.) This legislation paves the way for Workers' Compensation Boards and other provincial health and safety regulators to begin playing a role in developing and enforcing psychological safety regulations.An important factor in that will be defining the standards which employers are required to meet. This month, the Canadian Standards Association is certifying a new voluntary standard for psychological health and safety in the workplace.
Neither Bill 14 nor the voluntary standard for psychological health and safety are yet enough to prevent deaths like Cliff's, but they are significant changes in how we hold ourselves responsible for workplace mental health. Mental illness and injury are not just individual weaknesses or problems, they are societal, cultural, and economic issues that affect more of us than we may believe; that really do debilitate people and threaten their lives; and that are often caused, triggered, or worsened by outside events.
Where I'm at with this
While I still believe Cliff's workplace conditions played a pivotal role in his death, I haven't found a way to influence significant change in this area. I tried to meet and talk with managers and leaders in Cliffs organization soon after his death, and met with resistance, fearfulness, and stonewalling. The most positive thing I was able to achieve was a brief email exchange with his immediate manager, who refused to meet in person. With the end of the contract with BC Hydro, that area of the organization is folding up shop. Many of the things Cliff was afraid would happen in that process have happened.On a much more positive side, people like Martin Shain, founder of Neighbour at Work; Great West Life, commissioners of Guarding Minds at Work; and Bill Wilkerson, co-founder and CEO of the Global Business and Economic Roundtable on Addiction and Mental Health have already been doing impressive work in this area for many years, work that is paying off in new standards and changes in legislation.
Psychological workplace safety remains a concern for me. For now I am putting my efforts into other areas where change seems possible and much needed.
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