By and large, mainstream society agrees that suicide rates are disturbingly high, possibly approaching epidemic proportions. Most people probably also see these issues as part and parcel of “mental illness” and are fairly content to leave the solutions to healthcare industry experts. As the story goes, suicidal people are depressed, depressed people are mentally ill, mental illness is a chemical imbalance or genetic abnormality. Ergo, better drugs or medicine should eventually provide a cure. The experts are working on it. We just need to be patient and let them do their job.
But is this a fatal mistake?
In the first place, there is something of a glitch in the comfortable rhetoric. It doesn’t comport with the actual data.1 According to researchers, a wide variety of cultural, social & economic factors — not just biological or heritable traits — impact suicide rates, e.g.:
- Disparities in health care, income inequalities, despair, loneliness, lack of belonging2
- The increased social acceptability of thinking about suicide3
- Declining socio-economic status
- Weakened forms of social integration4
- Relationship problems/loss, life stressors, and recent/impending crises5
- Increased media screen time for minors6
- Experiences of trauma, negative interpersonal/ occupational/ academic events, and feeling the burdensome responsibilities of professional life7
The implication is this:
If social factors and garden-variety life stressors like those cited above significantly affect whether or not we off ourselves, then privatized healthcare interventions are — at best — only part of the solution. Pills and other biomedical remedies aren’t designed to remedy broader socio-cultural dynamics — and they don’t claim to. Nor does conventional talk therapy. So confining our approach — and public spending — to the healthcare industry is, ironically, probably deadly. At the very least, it’s not all we can do. Perhaps it’s not even the best thing we can do (see Pridmore & Pridmore, 2016; see Evans, 1994).8
But that begs the question. Because, like, how do we even know where to start with a problem like suicide? It seems so irrational, counter-intuitive, bat ass crazy to most people. What kind of idiot would want to take their own life?
In a word: What do I do if the problem itself defies logic? If something is totally random, there’s no rational pattern to reason from. That alone makes me vulnerable. Until I know what’s going on, any crackpot can propose a theory.
History is replete with examples:
- The sun, stars and planets orbit the earth.
- The earth is flat, if you walk far enough you’ll just fall off it.
- Rabbit feet and knocking on wood bring you luck.
- Black cats and broken mirrors curse you for days or years.
- Normal birth is male, never female or queer, either of which are the mother’s fault.
- You can determine intelligence and good breeding from the shape or size of someone’s head.
- Madness is caused by masturbation and wandering wombs.
- Tooth extraction, organ removal, malaria, insulin shock, lobotomies, electroshock and psychoactive drugs are promising medical interventions.
What’s really true? Who knows? It just goes on like that — for years or millennia until someone actually nails the jello to the wall and proposes some operative principles to make sense of the territory.
Since the jury is still out, the outcomes are dismal, and the mainstream world is still mostly grasping at straws, I figure there’s room to offer my two cents.
After all, I’m a suicide contemplator and attempt survivor. Plus, I’m still alive to look back, reflect, observe some patterns and connect a few of the dots that seem to stretch across the decades of personal struggle. So here goes:
What is it, exactly, that happens for me during those critical periods when ending my life seems like a reasonable — almost necessary — solution?
The Sisyphus Cycle
1. Suicide can be understood as a stress response
You remember Sisyphus, right? The guy who was condemned to push the boulder up the hill, watch it roll back down, and start all over again — for eternity.
Truth be told, I find that story disturbingly relatable. If you wanted to capture my mindset at the peak of suicidal longings — mountains towering in front of me, huge obstacles weighing me down, crushing odds, repeated failures, futility of existence — that would be it. From there, it’s only a few short steps to exit-oriented “self-help” seeming logical and desirable. So if you asked me, that’s pretty much how I’d explain suicide.
To sum up, you couldn’t write a better recipe for normal stress-response activation:
- Everything I’ve tried has failed.
- My body is worn out, and wants to quit.
- My brain is fried and can’t think of anything better.
- No one in my known world is offering meaningful solutions.
- Everyone else seems happy with how things are.
After one too many trips around this block, enter suicide:
- The fail-safe tactic for escaping unbearable pain and suffering (at least in this world).
- Plus I get to send you a message that I hope you’ll think about after I’m gone.
If you know what to look for, those responses are also indicators that stress is at work here. In the first case, my death is the vehicle for my escape. That’s the classic FLIGHT response. In the second, my death is the weapon. I use the moral capital of my own life to attack a value system and social order that I have judged to be irreparably not okay with me. That’s the classic FIGHT response.
Kind of ironic, huh? Here I am intending to off myself. But when you take a look under the hood, it would be hard to find a more a textbook example of the flight and fight survival strategies in action.
The World My Body Doesn’t Want to Live In
2. For a variety of complex reasons, modern life is more stressful for the human body than one might think at first glance. This keeps me, more or less, in a state of constant alert, which costs energy and wears me down physically and mentally over time.
A lot of people believe that modern progress is taking us in the direction of the best of all possible worlds. We just need to sit tight and wait — it’s only a matter of time before technological advances make utopia possible and we end up with worldwide peace and ease. A hard lesson for me to get in my suicidal journey was that, try as I may, my body refused to believe that. It’s taken considerable experience, reflection and research to give my body some credit. I now believe my body was a lot wiser than I once suspected. I wish I had listened and started taking what my body was trying to tell me seriously a lot sooner. I might have saved myself a lot of pain and self-judgment if I had. In part 2 of this series, I’ll talk about some of the social conditions and physical realities that led me to these conclusions.
The Stress Response and Behavioral Hell
3. As wear and tear increases, ability to manage stress decreases. I begin cycling through a range of seemingly contradictory survival defenses, the “symptoms” of which are indistinguishable from DSM criteria for “serious mental illness.” As a result, I and others increasingly come to believe that I’m crazy and doomed — that my mind and body are untrustworthy, unreliable and irrevocably broken.
When my life started getting harder than I could comfortably manage, I did what every good citizen is supposed to do. I turned to mental health professionals. When years of talk therapy, exercise, body work, supplements and dietary changes barely made a dent, I finally gave in and consented to pharmaceuticals. Within a few years, my formerly robust body was unrecognizable and irretrievable by me. I was shaking with fear and couldn’t leave my apartment. I had no natural motivation and couldn’t think my way out of a paper bag. For the first time in my life, I was sincerely praying to die.
When I turned to professionals for answers, they basically had none. According to them, I had a “serious mental illness” and this was just how the disease progressed. For a while I believed them and dutifully accepted my fate. But I no longer do.
In part 3 of this series, I’ll share how and why I came to believe differently. I’ll explore the unfortunate, iatrogenic connection (for me) between mainstream treatment and suicide. I’ll share how it turned into behavioral hell instead of behavioral health, even though my providers were good people and none of us wanted my life to turn out this way. I’ll also lay out here why I think that happened — why, for me, “behavioral health” labels and treatment activated suicidal inclinations — and the mediating role that I think the stress response played in that.
Finally, since I’m already in the neighborhood, I’ll broaden the field a bit. I’ll look at why, for me, behavioral health concerns like “mental illness,” addiction and anti-social (inconsiderate, abusive, violent) thoughts and actions — as well as risk for homelessness (becoming “hard to house”) — tended to overlap. Here, again, I’ll be looking at stress/survival responses as a possible common denominator.
Cracking the Code on My Human Condition
4. Understanding the stress response is the key to doing something about it. There are evolutionary alternatives to the stress response, including physical and mental capacities hard-wired into my body. While chronic stress activation may have blocked my awareness, these underlying systems are essential to life, so I wouldn’t be alive if such capacities weren’t functioning and accessible to me on some level.
Just knowing this can open up a world of possibilities. What I am up against is the human condition — not a pathology. If I know what to look for, where and how, I can learn to bypass stress reactivity and generate meaningful, satisfying responses to the challenges life presents.
In this final part of this series, I’ll venture beyond the problem and take a look at solutions. The neat thing about viewing suicide as something that arises from stress and survival needs is that this perspective, in and of itself, can give me ideas and direction for finding a way out. En route to this destination, I’ll recap the essential physiology of the Sisyphus Cycle and then point out an interesting twist in the stress response that, for me, keeps that cycle endlessly churning. I’ll also explore what I think suicide is trying to tell me — both about myself and the larger world I live in.
Having poured the cement and firmly set the foundation for a broader existential inquiry, I’m going to jump off a cliff and take a huge paradigm leap in search of solutions. I’ll posit how (with a bit of magic mental judo) the exact same physiological mechanisms that leave me wanting to off myself can be harnessed to reverse the stress response. I can learn to work with my body instead of against her, generate energy and hope naturally, and point myself in a direction worth going. I’ll talk about how I practice these principles in real life and how this is helping me to make conscious contact with inborn mental and physical capacities that I didn’t even know I had. I’ll also share how this understanding of myself and life can keep me from getting stuck in old patterns and help me to dust myself off and crawl out of holes when I inevitably do.
All free of charge. No new therapy, coaching, consulting, supplements, body work, or trendy blah-blah modality required. All I have needed for it to work for me are the body, conscience and honest human longings I was born with.
If You Can’t Afford to Sit Around Waiting…
If this stuff speaks to you and you’re in a lot of pain, you don’t need to wait for the rest of this series to come out. There’s a growing community of us who are trying to figure out how to support each other to navigate this territory with dignity, conscience and absolutely no coercion. Even if there aren’t in-person options in your area, there are telephone and online groups that are accessible, literally, from around the world. You can find out more here. I hope you will join us.
- Pridmore, W., & Pridmore, S. (2016). Suicide is not the exclusive domain of medicine. American Journal of Medical Research, 3(1), 174. Retrieved from https://link.galegroup.com/apps/doc/A461608266/HWRC?u=vol_b27&sid=HWRC&xid=6e6d51a6 ↩
- Hassan, A. (2019, March 7). Deaths From Drugs and Suicide Reach a Record in the U.S. The New York Times. Retrieved from https://www.nytimes.com/2019/03/07/us/deaths-drugs-suicide-record.html ↩
- Phillips, J.A. (2019, March 21). The dangerous shifting cultural narratives around suicide. The Washington Post. Retrieved from https://www.washingtonpost.com/outlook/the-dangerous-shifting-cultural-narratives-around-suicide/2019/03/21/7277946e-4bf5-11e9-93d0-64dbcf38ba41_story.html?noredirect=on&utm_term=.602d32b21edb ↩
- Phillips, J. A. (2014). A changing epidemiology of suicide? The influence of birth cohorts on suicide rates in the United States. Social Science & Medicine, 114, 151-160. ↩
- Stone, D. M., Simon, T. R., Fowler, K. A., Kegler, S. R., Yuan, K., Holland, K. M., … & Crosby, A. E. (2018). Vital signs: trends in state suicide rates—United States, 1999–2016 and circumstances contributing to suicide—27 states, 2015. Morbidity and Mortality Weekly Report, 67(22), 617. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5991813/ ↩
- Twenge, J. M., Joiner, T. E., Rogers, M. L., & Martin, G. N. (2018). Increases in depressive symptoms, suicide-related outcomes, and suicide rates among US adolescents after 2010 and links to increased new media screen time. Clinical Psychological Science, 6(1), 3-17. Retrieved from https://www.avaate.org/IMG/pdf/suicidio2167702617723376.pdf ↩
- Rosiek, A., Rosiek-Kryszewska, A., Leksowski, Ł., & Leksowski, K. (2016). Chronic Stress and Suicidal Thinking Among Medical Students. International journal of environmental research and public health, 13(2), 212. doi:10.3390/ijerph13020212. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772232/ ↩
- Evans, R. G., Barer, M. L., & Marmor, T. R. (Eds.). (1994). Why are some people healthy and others not?: The determinants of the health of populations. Transaction Publishers. ↩
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.