Editor’s note: A list of warmlines, peer support groups, discussions about suicide and other resources can be found at the bottom of this post.
Not long ago, a friend of mine called the National Suicide Hotline. He was having a hard day and needed his distress to be heard. He barely got started talking before the operator interrupted him. It was the standard suicide assessment:
- Are you suicidal?
- Do you have a plan?
- Do you have the means?
- Have you set a date?
They also made clear that if he answered the questions a certain way, the 911 van would be dispatched to his residence forthwith.
Frankly, this is why I would never refer someone I loved to a suicide hotline. If I had any doubt about killing myself before calling, this kind of response would pretty much seal the deal. There’s the basic human insult of getting asked impersonal, pro forma questions like these in my darkest hour at my time of greatest need. Heap on top of that the public humiliation of getting hauled off to the nut ward by 911, flashing lights and all, for my neighborhood to see, on the worst day of my life.
Yes, not all hotlines and hotline operators are like this, but enough of them are that I, personally, wouldn’t risk it. Suffice it to say: If I had any shred of a doubt remaining — or perhaps a threadbare hope in the good of humanity — this wholesale warping of the nature of human ‘aid’, sponsored by my government, funded with my tax dollars, would cut the cord once and for all between me and any lingering desire to live.
So what’s the solution….? After all, this crisis is real. The pain is real. The despair is real. The deaths are real. Tons and tons of Americans — as well as others worldwide — feel hopeless, worthless, disconnected… as if we have nothing of value to offer and our lives have only become burdens to those we love.
This really is life and death. So none of us can afford to stick our heads in the sand and pretend anymore: It isn’t me. It isn’t someone I love. It isn’t happening…
At the same time, the helplessness and confusion about what to do about it are also real.
And that’s exactly why peer relationships and peer-developed modalities can be so helpful. Many, many of us have been there. Many, many of us know what it is like. Many, many of us are still alive to talk about it. We know what we tried, what worked for us and what didn’t. We know what ways of relating gave us hope and helped us to continue on.
Just as important: we know what not to do, what devastated us, wasted precious resources or made life altogether unbearable. As a result of these experiences, we’ve developed countless approaches for navigating our own distress and that of our friends and families.
This is not to say that all peers are wonderful supporters, that we all magically, intuitively, say the right thing at the right time or invariably make things better instead of worse. (That is definitely not my experience.) However, we do have some important perspectives and orientations to add to the mix of the available options.
1. We are not healthcare providers
Peer support is effective largely because we are not healthcare providers. In simple fact, many people are afraid of healthcare providers and systems. This is a rational fear. We or others we know have been held, drugged, injected, shocked, secluded, restrained against our will — not to mention misinformed, lied to, pressured and coerced — by licensed professionals, accredited organizations and authorized authorities claiming to ‘help’ us.
One answer to such systemic failures is to create the kind of community relationships that would render conventional services obsolete. I don’t know about you, but I didn’t wake up one morning thinking, ‘Gosh I really want to go see a mental health provider.’ The fact is, I was in a lot of pain and they were the only game in town. If viable alternatives had existed, and I had access to them, I never would have darkened the mental health system’s door. I’m guessing that’s the case for a lot of us.
2. We don’t diagnose or label
Abuse aside, the simple fact is that lots of people would prefer to live their lives free of association with mental health providers and related institutions. No matter how good the care, stigma and discrimination run rampant. People with known or suspected mental health labels lose jobs, promotions, contracts and security clearances. We get shunned and talked about by neighbors. We get patronized and written off by family members. We are scrutinized, detained, tased and shot by police.
Peer relationships offer very real hope to people in crisis who prefer to forego mental health involvement. We are real members of real communities who are actually living with and surviving difficult life circumstances. We thus are living proof that difficult issues can be navigated with dignity, autonomy and full (label-free) citizenship intact.
3. We offer real relationships and community
Even superb mental healthcare has its drawbacks. Despite the sincere desire of providers to be helpful, I often walked away from therapy sessions feeling empty, demeaned and despairing. ‘What self-respecting adult pays for intimacy and understanding…?’ To be honest, it felt like hiring a prostitute. In a lot of ways, I think it was:
- The relationship was a secret.
- We met behind closed doors.
- No one else knew what was said or done.
- I exposed my most intimate thoughts, feelings and desires to this veritable stranger.
- The interest and attention was all one-way.
- I paid them money.
- I went to their place.
- I arrived and left at the appointed time.
- The only way to get to see them again was by appointment for a fee. (Otherwise it was called stalking and they called the cops.)
Looking back on it, I also suspect that a huge part of the pain and isolation for me was all the secrets we kept. I basically went into therapy every week and got a ton of validation for talking about a ton of socially unsaleable information that couldn’t be shared with my natural supports. This effectively rewarded me for a ton of self-focused curiosity (we were ‘making progress’ and ‘getting to the bottom of it’), which kept me looking for tons more stuff that was socially unsaleable.
The above dynamics created a vicious cycle of isolation and dependency that kept me wedded — and indebted — to psychotherapy for years on end. Basically, there was no one in my known world who thought about the stuff I told my therapist. To make matters worse, holding all that socially unsaleable information (keeping so many secrets) was stressful in and of itself. So I needed an outlet. And since mental health professionals were the only ones I could safely share my unsaleable insights with, every therapy session generated a need for more and more future sessions. This, in turn, made my mental health relationships increasingly important compared to other relationships in my life. And the more important my mental health relationships became, the more irrelevant and disconnected I felt from the people, relationships and social groups that — at one time — had mattered a lot to me. Thus, in no small part, the greatest gift of psychotherapy — its ability to encourage deep inquiry and self-reflection — actually sowed the seeds of my eventual suicidal despair.
Peer support, especially when unpaid and free from institutional constraints, offers a natural antidote to this. I’m able to find the acceptance, validation and understanding that I used to rely on therapy for. I’m also able to experience real relationships (including genuine friendships, meaningful opportunities for participation, and a felt sense of belonging) that the healthcare system, by its own design, could not offer. This for me, makes all the difference. In peer support, I feel like a valued and valuable member of a community, instead of an irrelevant, unwanted burden. In my experience, simple, practical shifts like these go a long way toward making my life feel worth living again.
4. Real safety is about relationships, not liability
Shery Mead, in her handbook Intentional Peer Support: An Alternative Approach, invites us to think about what safety actually means when one of us expresses the desire to die:
When I was a patient in the mental health system, I heard the language of safety a lot! Was I safe, was I going to be safe, would I contract for safety, etc. etc…? Through these questions, safety came to mean that I was simply agreeing not to do anything to hurt myself or someone else. But what did that leave me with? Frankly, the more safety questions I got, the less I felt reliant on my own abilities to take care of myself. So instead of feeling safe in the world, I felt like a time bomb that could go off at any time.
As Shery points out, these dynamics leave our clinical relationships with huge power discrepancies. For example, if I tell the truth — “I feel like killing myself” — practitioners feel obliged to take certain precautions. On the other hand, if I lie, I might stay out of lockup. But denying my reality — and keeping secrets in important relationships — also has a cost. The cost for me is that I have felt miserably alone. At the most vulnerable times of my life, there was no one on the planet I felt I could trust. I was out of my league and I knew it. I desperately wanted human support and counsel. I desperately wanted to get to the root of my true feelings and to be able to uncover any options I had. Yet, here I was trying to make a good decision — perhaps the most important decision of my life — without knowing a single soul I could be truly honest with.
In retrospect, I don’t think there is much that is LESS SAFE for me as a human being than being in that frame of mind. In fact, the only thing that’s less safe from my perspective is this:
EVEN MORE UNSAFE = to feel coerced or pressured by others who don’t understand my unbearable suffering into making a bad decision that makes my existence even worse.
Unfortunately, that was often where I found myself in times like these, given the mainstream practice of reporting, detaining and drugging those of us who acknowledge the depth of our distress and despair.
The painful contradictions noted above have led to a lot of reflecting on what safety actually means to me. With the help of Shery’s thinking and writing in Intentional Peer Support, here’s what I’ve come to for me:
Real safety — for me — is about creating culturally respectful, mutually responsible, trusting, trustworthy relationships. It happens in relationships where we don’t judge or make assumptions about each other. It happens when someone trusts and believes in me even when they’re uncomfortable. It happens when I’m free to share my deepest truth and you take time to reflect on what I’ve said. You make the effort and sincerely try to get to the heart and soul of what I’m attempting to get across to you.
When you make that kind of effort and actually ‘get’ me, everything starts to change. You’ve proven to me that you can put your needs aside long enough to hear me out when it really matters. So I begin to feel okay about letting you into my world and loosening my grip on the urgency of now.
You’ve also proven to me that you understand the territory. You’ve treated me like I have value and like my experiences do too. So I begin to get interested in what you think and might possibly know. I get curious about what I might find out if I stick with you. I feel buoyed up enough to risk the uncertain and the unknown. After all, you’re a pleasant companion and the spent time with you feels bearable. That alone gives me hope that there might be something on the other side to make the journey worth hanging in for.
This buys us time. The time we need to take risks, learn from them, explore new possibilities, and learn some more. All the while behind the scenes, subtly, incrementally, without me knowing it, a revolutionary change in my assumptions is taking place. The way I think about this world and how it all operates (for me, others, the planet) will never be the same.
If any of this appeals to you, or you think it might appeal to someone you care about, here’s what we offer at Peerly Human:
Wednesdays, 8:30-10 pm EDT, Deadly Serious: Talking Openly About Suicide:
|Deadly Serious: Talking Openly About Suicide|
Saturdays, 5-6:30 pm EDT, Intentional Peer Support Practice Series (beginners welcome!)
|Intentional Peer Support Practice Series|
3 Ways to Join Us:
1. Join by computer: https://zoom.us/j/119362879
2. Join by phone: +1 669 900 6833 or +1 646 558 8656 (Meeting ID: 119 362 879)
3. Local access numbers for International callers: https://zoom.us/u/jkwt3wHh
THE BOTTOM LINES:
1. Come as a human being
2. Come as you (& only you)
3. No pros, no cops, no 911
~ Your lived experience ~ Your distress ~ Your pain ~ Your needs ~ Your values ~ Your ideas & insights about what would work for you
~ Professional roles, reporting obligations and liability concerns
~ Political, social or organizational agendas
~ Opinions about the experiences of others or what is best for them
Video, voice and text are all options. Call participants are welcome to come and go. If you come late, please enter quietly and respect the discussion that is going on.
Why We Say “No Pros, No Cops, No 911”
Protecting Our Integrity
Every living system must protect the core of its existence. We live in a society that has become addicted to the fantasy that there is some external benevolent authority that has all the answers and can fix all our problems. The only barriers, we are told, are lack of funding and lack of insight. Either we need more professional services or we don’t use them right due to bad attitudes, genetic defects or chemical imbalances.
Painful experience has shown us that this is not the case. The natural enemies of self-determination, empowerment and mutually responsible, authentic relationships are, all too often, the very people and systems that have been designated by society to help ‘people like us.’ To care for the integrity and well-being of our community interactions, we therefore practice the following protective boundaries:
Boundary # 1. No Pros
We are run by ourselves and for each other. No one is paid to be here. We all have our own reasons for being here. We all have needs we would like to see met here. We meet each other as human beings. We speak for ourselves from our own experience. Outside opinions, credentials and expert authorities carry no special weight here. We are each accountable to our own conscience and life experience.
Boundary #2. No Cops
We are all here as responsible adults. We are all accountable to treat each other in human rights-informed ways. We don’t police each other. We don’t call in outsiders to police our membership. This is not easy but we believe it is necessary. We will never learn to live together and manage our own affairs until we actually take responsibility to learn to live together and manage our own affairs.
Boundary #3. No 911
The safest we will ever get is by learning to offer each other relationships worthy of trust in our times of greatest need. If we lack the ability or will to create trustworthy relationships for our own people, we can’t expect the public at large or psychiatry to do this for us. It has to start with us — right here, right now. Accordingly:
Everyone here has a right to their own reality valued on par with others. Everyone has the right to their own emergency. Everyone has the right to choose for themselves how to handle it. We don’t speak for others or substitute our judgment for theirs.
A lot of us have been kicked out of other social groups. The pain of exclusion and its harmful effects cuts deep. We try our best to reverse that here. We listen to understand instead of correct or enlighten. We make a conscious effort to include rather than exclude. We make space for all voices. We actively look for and appreciate the gifts that each of us bring.
Other online group support options:
Hearing Voices Network: http://www.hearingvoicesusa.org/
Mutual aid for voices, visions or extreme or unusual experiences
- Mondays 7-8:30 EDT on Zoom
- Thursdays 9-10:30 EDT on Zoom
Contact [email protected] for call-in info
Emotions Anonymous: http://emotionsanonymous.org
Twelve Step peer support for emotional extremes
Spiritual Emergence Anonymous: http://spiritualemergenceanonymous.org/
Twelve Step approach to spiritual emergency
- Sundays, 8 pm EDT on Zoom
- Mondays, 1 pm EDT on Zoom
Support Groups Central: https://www.supportgroupscentral.com
Support group options (some online) for mood, anxiety, voices and substances, among other things
The big picture
- Alternatives to Drugs
- Evidence that peer initiatives work
- Toolkit for starting a peer initiative
- Voices of Transformation
1. Peer respites (spaces offering safe respite)
- Directory of peer respites:
- Peer Respite Handbook
- Research on peer respites:
2. Peer support centers
- Directory of Statewide Peer Organizations
- Examples of what can be done:
3. Alternatives to Suicide
4. Support lines staffed with people who care and want to listen
- Warmline Directory
- Examples of what can be done:
- Western Mass RLC Warmline (Toll Free: 888.407.4515)
- Pathways Vermont Support Line (Call: (833) VT-TALKS)
- David Romprey Oregon Support Line (Toll-Free 1-800-698-2392)
- Durango Colorado Stop Suicide Warmline (1-970-903-4158)
- How to start a warmline
5. Intentional Peer Support: http://www.intentionalpeersupport.org/
6. Emotional CPR: http://www.emotional-cpr.org/
7. Wellness Recovery Action Plan (WRAP): http://mentalhealthrecovery.com/
WRAP plans can be developed specifically for issues like wanting to die. WRAP plans also support identification of life-promoting, capacity-restoring activities like art, exercise, creativity, writing, social interaction, nutritious eating, meaningful vocation, relaxation, meditation, spiritual development, body work, massage, yoga, dance, etc.
8. Support for veterans
U.S. vets are dying by suicide almost every hour on the hour every day of every year
9. Support to withdraw from psychiatric drugs
- Everything Matters: Beyond Meds
- Freedom From Psych Drugs and Benzos
- Life Beyond SSRI Anti-Depressants
- Harm Reduction Guide for Coming Off Psychiatric Drugs
- Inner Compass Initiative
- Mad in America Provider Directory
10. Support for creativity and resilience
Discussions, collaborations, workshops between experts by experience.
Navigating the space between brilliance and madness
- Icarus on Facebook
- Crisis Toolkit
- What helps you navigate adversity?
11. Support for voices, visions and extreme or unusual experiences
- Hearing Voices Network
- Hearing Voices Network USA
- International Spiritual Emergence Network
- Mad Pride International (Facebook)
- Peerly Human
- Shades of Awakening
- Spiritual Emergence Anonymous
- The Call of Spiritual Emergency (Emma Bragdon)
12. Support for human needs and human rights
- Absolute Prohibition Campaign
- Center for the Human Rights of Users and Survivors of Psychiatry
- Drop the Disorder (Facebook)
- End Psychiatry Discussion Group (Facebook)
- Law Project for Psychiatric Rights
- National Association of Rights, Protection and Advocacy (NARPA)
- MindFreedom International
- Recovery In The Bin / Unrecovered (UK)
- Repealing Mental Health Laws (Facebook)
- Speak out Against Psychiatry (Facebook)
- United Nations
- Wellness & Recovery Human Rights Campaign (Facebook)
Alternatives to Drugs, Shock & Psychosurgery (yes, they still do that!)
- Alternative and Complementary Treatments for Dysthymia, Major Depression, Seasonal Affective Disorder and Anxiety Spectrum Disorders
- Alternative and Complementary Treatments for Schizophrenia, Bipolar Disorder and Associated Drug-induced Side Effects
- Complementary and Alternative Medicine Treatments in Psychiatry
Power Threat Meaning Framework
- Peace for Tarpon (Florida)
- National Center for Trauma-Informed Care and Alternatives to Seclusion and Restraint (NCTIC)
- Sidran Institute
Do you know of other helpful resources that respect personhood and treat us as people first…? Please share!
Thanks, Sarah, for this list of great resources. I will give them out. People in crisis especially if expressing suicidal thoughts are routinely told to go to their local emergency room at a medical hospital to be evaluated by a physician or psychiatrist to see if meets inpatient level of care at psychiatric unit. Individuals often have long wait times in a crowded room and even if meet inpatient level of care have to wait days for a bed. This often itself is traumatizing. Having other resources available for someone to feel comfortable calling, attending, or going online to is very useful. Hope, help and healing is out there besides health care professionals and settings which unfortunately are not always helpful and even further traumatizing.
Great article and list of resources! I was particularly struck by the part about “safety.” This was something that always struck me as very odd and very skewed when I was in a psych ward — the constant concern and questions about “safety.” “Are you safe?” seemed like this endless, meaningless refrain that could only result in horrible consequences if answered in the negative. There are lots of questions like this. At the hospital emergency room now (at least in my state) they ask “Are you thinking about hurting yourself or someone else?” Only a complete fool or someone with absolutely no experience of the system would ever answer this in the affirmative. Or: “Have you been feeling down, depressed, or lacked interest in things lately?” Again, another one-way trip to the psych ward, forced medication, and then AOT, if you’re lucky. If you’re not, it’s electroshock and God knows what else. Anyway, the safety thing struck me in particular, but the whole article is well thought out and informative. Thank you.
This is brilliant and it gives me hope for the future. The analysis is superb. Particuarly like the part about the professionalisation of talking to distressed people via psychotherapy and the downside of that, for inviduals and communities.
But I have to say this. I had experience with a peer support worker when I was in a crisis (who was being paid), and found her to be the psychological abuse super-highway. One thing that struck me in the final conversation was that all her years of lived experience may have provided a kind of finishing school for her abusive behaviour. She is well regarded in our local movement, high ranking and can produce all the right slogans. it doesn’t change the fact that she is interpersonally abusive and it frightens me that it potentially sets up the same dynamic as the person in distress is trying to escape from. A nightmare.
It took me years to fully understand that there are no groups of “good guys”. Believing (as I drove myself to despair trying to, for years) that abuse, unethical behaviour, dishonesty, cruelty etc. is just a function of collective structures is naive imo and can put people in danger.
So I’m wondering about the movement’s capacity for recognising and dealing with abuse within itself.
None of this changes my respect for the movement itself and the importance of the work it is doing. It is heart-warming and inspiring to me.
ive come to similar conclusions. the most “progressive” people I’ve known are also sometimes some of the worst human beings, while the “conservative” people turn out being better for and to me, on a 1-on-1 basis.
one reason I lean more towards seriously wanting Mental Health, Inc. abolished is because…force, fraud, and coercion are the very core of the industry+its dogma. I think abolishing the massive, false, state religion of psychiatry would also benefit the -real- religions out there, and make for more clear thinking in the general population (I stole this form Szasz, btw…not my ideal human being, but an excellent writer and critic of all things mental health).
Of course…the way society+the economy, the legal system are going…I’m thinking we’re all stuck with Mental Health, Inc. in some form. At this point, they’ve got big name celebrities pushing their agenda and encouraging the masses to “seek treatment,” all that junk.
anyway…thanks for your post. im trying, personally, to free my mind from all the mental health venom that’s been put there, over the years, and…move forward, at long last.
I think that you bring up a very important point. Just because a person has lived experience and has training doesn’t mean that they won’t carry out against others the very same things that were done to them while they were “patients”. I believe that way too many peers don’t have an inkling as to what their issues are, and if they do know they’ve not really done any work on those issues. It’s not always fun to work on one’s issues and can even be painful, but it’s absolutely necessary if you’re going to work with other people.
My experience is that there are two kinds of helpers. One believes that helping means making people do what you think they should and using rewards, punishment and force to ensure compliance. The other kind could care less about compliance and focuses on helping the other increase personal power. These two subgroups exist in any profession and across the political spectrum. I try to hang out only with the latter whenever possible.
My own painfully-learned motto:
“Bad help is worse than no help at all”
I think this is really great – with a caveat. The only piece I see missing from this is direct support for those who are intent on ending their own lives. I think the supports listed, although some of them sound amazing in terms of emotional support for those who are contemplating suicide, it still sounds like it comes from a place of suicide prevention rather than a right to individual determinism and agency. I am all for helping people to choose to live if that’s what they want to do, and for sitting with them in their distress while they find a path forward. But I am also in support of a Belgian-type system which allows those who want to die to do so in comfort and peace. As we’ve seen from the backlash at allowing children and those labeled with mental illness the same right to end their lives as “emotionally stable” adults with terminal illnesses, it will be messy and contentious at first, but it is a necessary next step in allowing humans to have individual agency over their lives, which is the ultimate freedom. There’s a big difference between encouraging a suicidal person to just finish it already, and offering to sit with that person and comfort them during their final exit. The latter offers them the ultimate freedom to decide, and I’d bet that once presented with that as an actual choice and not one taken out of desperation, that fewer people would choose it than are currently doing so.
Still, I applaud MIA and the author for taking this bold of a stand on the side of those suicidally distressed.
in the usa I would have a problem with ultimate freedom
for persons under 18 y.o………….
I understand that the frontal cortex is not yet developed…
Thanks Sarah! One thing I really liked about the article is your analysis of how the special confidential relationship of therapy actually backfired for you and left you feeling worse about yourself.
I think ideally, any therapist, or even anyone who is going to have some kind of confidential helping relationship, would be trained to recognize the possibility of this kind of dynamic and ways to overcome it.
I do think there is a time and place where people want or need a space to talk confidentially about things they can’t bring up elsewhere, but ideally they get help finding ways to then get support elsewhere – either because they learn how to frame their issues in ways they can share with the others already in their lives, or they learn how to find people they can share with (if the current people in their lives are too judgmental.)
I believe in suicide as a change. Many people dies happily or feel relieved in moment of their death. Theology must be replaced by psychology. There are materialistic/shallow reasons of suicide, and there are the deeper reasons. The deeper the reason of suicide is,the more the suicide is rejected/ridiculed by psychiatry. Psychosis is similar with touching the death in the psyche–severe mental illness – those dehumanising words won’t change the PSYCHOLOGICAL TRUTH.. Material OR HOT HEADED suicides, on apollonian level are different. The intensity is different. The deepest depression is not similar to the psychosis. Depression is the problem with the ego ON APOLLONIAN LEVEL, and psychosis is when the ego lose control over psychological reality.
Apollonians should rethink their reasons of suicide (if they have doubts), titans, beyond apollonian level, didin’t have to, but it is wise to wait.. It is arrogance to think that titans (beyond apollonian level) should behave normal. They are gods (mythical side is deeper than ego needs), they didn’t have to. Plath, Kane, Michel, and A. Michel was the greatest of the titans. And many more.
Psychosis is the most demanding encounter with the death, it is far more harder than PHYSICAL DEATH. TO CONTROL IT, MEANS TO NEGATE ITS ENORMITY.
I learn it from Hillman, from the poets, who usually live in the shadow of the death. From the “mentally ill”, people should learn from them, but they usually negate their psychological archetype and hide it beneath magical words- “SEVERE MENTAL ILLNESS”. Do not play with the death and hades reality, apollonians. This is not your playgorund.
James Hillman – Re-visioning psychology, Suicide and the soul.
Solid ideas and they show how much this area has advanced. Years ago when my team was advocating to create peer support in schools, we encountered the most resistance from suicide professionals. They were worried that having discussions in classrooms about suicidal feelings and sharing experiences would lead to what they called then (and is often brought up now) as “contagion.” That is, talking about it will prompt others to take their own lives. We argued that having realistic options for empathy, relationships, and authentic safety would help youth find better ways to deal with their experienced feelings.
I think “contagion” is most likely to happen in environments which do NOT allow discussion of these difficult feelings, ironically. Too many MHPs are afraid of “negative feelings” and try to stop them instead of listening.
wonderful, sarah! i do agree with kindredspirit on the right to die (especially for the many whose bodies and lives have been utterly destroyed by psychiatry and who have no support and therefore no way out). but i love all the points that you make here, and it’s so important to talk about this stuff. as someone who has been damaged (and who knows so many others who have been damaged) by “health care providers” and their diagnoses and “treatments,” and by trying to get help from crisis lines, and by 911 calls made by concerned persons, i find it very gratifying to see all this laid out.
Thank you for this interesting contribution.
I found 2 new web pages on Open Dialogue and would like to add “the international website for the Open Dialogue approach”: http://open-dialogue.net/#