Suicide rates in the US have surged to a 30-year high at the same time that US antidepressant use has skyrocketed. While correlation is not the same as causation, this concurrence naturally raises questions from people comfortable challenging authorities—including mental health authorities. Does it help all people to view being suicidal as a symptom of mental illness for which standard psychiatric treatment is the most effective remedy? Or, for some people, could being suicidal be regarded—and cared for—in other ways?
First, a closer look at both US suicide rates and standard treatment realities. Then, some options for anti-authoritarians who have been failed by mental health authorities.
US Suicide Rates and Treatment Realities
In 2016, the National Center for Health Statistics reported that the overall US suicide rate had increased by 24% from 1999 to 2014, with the US suicide rate surging to a 30-year high. The American Foundation for Suicide Prevention states that in the US in 2015, there were 44,193 reported suicides and that this number is likely higher because stigma surrounding suicide leads to underreporting; and it also noted that for every completed suicide, 25 attempt suicide.
A US sub-population with an especially large increase in suicide and with high antidepressant use is middle-aged women. The suicide rate for women age 45 to 64 increased by 63% from 1999 to 2014, and by 2008, 23% of women 40–59 years of age were taking antidepressants (with more recent estimates of antidepressant use in this population stating, “the figure is one in four”).
The correlation between psychiatric treatment and suicide is not an encouraging one. In 2014, a large Danish study published in Social Psychiatry and Psychiatric Epidemiology reported that people who received psychiatric medication were 5.8 times more likely to commit suicide than people who did not receive psychiatric medication; and people who had spent time the previous year in a psychiatric hospital were 44.3 times more likely to commit suicide than those not psychiatrically hospitalized. Again, correlation is not the same as causation, as psychiatrically treated people may also be more severely at risk of suicide to begin with. However, an editorial accompanying the Danish study concluded that these study findings suggest that “psychiatric care might, at least in part, cause suicide . . . Perhaps some aspects of even outpatient psychiatric contact are suicidogenic.”
Among young people in the US, suicide is the second leading cause of death among those aged 15-34 and the third leading cause of death among those aged 10-14; and among students in grades 9-12, 17% seriously considered attempting suicide and 8% attempted suicide one or more times in the previous 12 months. Mental health authorities tell us that the problem is that treatment is not available enough; however, among those 18 years of age and younger in the US, the number taking antidepressants more than tripled between 1987 and 1996; further increased by 50% between 1998-2002, and increased by 26% between 2005-2012.
Antidepressants for young people, according to the US Food and Drug Administration, are suicidogenic. Based on placebo-controlled trials of nine different antidepressants, the FDA in 2004 ordered warning labels of increased risk of suicidality (suicidal thinking and attempts) for children using antidepressants; these warnings were updated in 2007 to also include increased suicidality risk for adults aged 18-24 using antidepressants. A cautionary note: If you abruptly stop taking antidepressants or lower the dose too quickly, one of many possible withdrawal adverse effects is feeling suicidal.
Overwhelming pain is associated with suicidality, and antidepressants and other psychiatric drugs can help some people blunt their emotional pains; but antidepressants can also create painful physical adverse effects and/or remove inhibitions against acting on suicidal thoughts. And for many critically-thinking anti-authoritarians, these drugs cannot blunt painful realities of trauma, loss, alienation and oppression in their occupation, schooling, family and other aspects of their lives. There is a significant association between suicidality and being a member of an oppressed US sub-population (such as Native Americans), as well as with poverty, unemployment and other painful states.
Other standard treatments besides antidepressants—such as the “no suicide contract”—can appear ludicrous for suicidal anti-authoritarians. In the no suicide contract, the patient agrees not to attempt suicide and to seek help if unable to honor the commitment; and signing such a contract is sometimes a requirement for release from a psychiatric hospital. Despite a lack of empirical support for the effectiveness of these contracts in preventing suicide attempts, they have been widely used by mental health professionals. To even mild anti-authoritarians, it is obvious that these contracts serve only to meet the anxiety-reduction needs of hospital staff, will not prevent suicide, and increase skepticism for mental health authorities.
Many critical thinkers have little faith in standard mental health treatments for subjective and objective reasons. Their own subjective experience may well have been that such treatments have failed them, their family or friends. And the objective facts (of an increasingly suicidal US, at the same time increasing numbers of Americans are taking antidepressants) trigger incredulity of the claims and recommendations of mental health authorities.
Options for Suicidal Anti-Authoritarians
Feeling suicidal is much about being overwhelmed by pain and becoming hopeless that your pain will ever diminish, and people overwhelmed by their suicidal impulses may need to be watched. Nowadays, society uses psychiatric hospitalizations to guard against suicide, however, a 2012 study reported that 6% of all suicides occur in hospitals. At one time, suicide watches were comprised of friends and family (effective for a suicidal Abraham Lincoln), but that was in an era when suicidality was not seen as a symptom of mental illness.
Today we often hear mental health authorities such as the National Alliance on Mental Illness proclaim, “Research has found that about 90% of individuals who die by suicide experience mental illness.” While for some suicidal people, the idea that they are mentally ill reduces their self-blame, for many others, the idea that they are mentally ill makes them feel more hopeless—an impetus to attempt suicide.
Some anti-authoritarians challenge the idea that their suicidality is evidence of mental illness. David Webb, author of Thinking About Suicide, is one of those anti-authoritarians. Webb attempted suicide several times and was psychiatrically treated. He ultimately concluded that it was unhelpful to view feeling suicidal as a consequence of mental illness, and he came to believe that the “mental illness approach” medicalizes what he views as a “sacred crisis of the self.”
For Webb, “Contrary to the assumptions behind the mental illness approach, it is possible to see thinking about suicide as a healthy crisis of the self, full of opportunity, despite its risks.” For Webb, taking the opportunity to ask questions about the self that is in crisis “has the potential to open up possibilities for a deeper experience of the self, which for some, such as myself, can be a pathway out of suicidality.”
There is little controversy that it is helpful for people who are suicidal to be open about their feelings. However, if being suicidal is viewed as a symptom of mental illness, Webb notes, “talking about your suicidal feelings runs the very real risk of finding yourself being judged, locked up and drugged.” So, many critically-thinking suicidal anti-authoritarians don’t reach out.
Suicidal teenagers and young adults—the group for whom suicide is the second leading cause of death—are people whom I have worked with for over thirty years, often after unsuccessful treatments in which their suicidality was viewed as evidence of mental illness. Many of these young people are anti-authoritarians, and so for them, similar to Webb, the idea that they are experiencing a crisis of self rather than a mental illness opens them up for dialogue.
For many young people, the healthy crisis of self can involve their sexuality, religion, family role, and other aspects of their identity. Many sensitive and critically-thinking teenagers become suicidal because of overwhelming pain from authoritarian school. On several occasions, I’ve seen school failure and the threat of not graduating high school make a teenager suicidal. Teens’ pain of failure is exacerbated by their parents’ anxiety over failure, and teens become hopeless that all of life will be as miserable as high school. They are then routinely told that they are suicidal because they are mentally ill, and that makes some of them even more hopeless. The pain of their school misery and suicidal thoughts are rarely validated as a common emotional experience of many sensitive anti-authoritarians experiencing a healthy crisis of self. That validation, from my experience, can both reduce their pain and increase their hope—and open them up for dialogue.
For many people, especially anti-authoritarians, it is often counterproductive to focus on the symptoms of one’s pain as evidence of mental illness. Society itself stigmatizes mental illness, so how can one expect a person overwhelmed by emotional pain not to self-stigmatize once they’ve been labeled as mentally ill? And this stigma creates more pain and more hopelessness.
In contrast, what’s helpful for many suicidal people is validation that their pain is evidence of their soul and their humanity. For anti-authoritarians such as Webb, it is helpful to view feeling suicidal as a “genuine and authentic human experience that is to be honored and respected.”
As noted, overwhelming pain and hopelessness are associated with suicide, and when we are overwhelmed by our suicidal impulses, we may need to be watched to keep from acting impulsively. But a suicide attempt is not always an impulsive action, and we cannot be watched forever. Long-term, reducing suicidality is about reducing overwhelming pain and increasing our hope that our misery may not be a permanent condition. And suicidal anti-authoritarians, including Webb, have found anti-authoritarian options which reframe their pain and suicidality, and increase their hope—and prevent them from committing suicide.
This article also appears on CounterPunch
I agree.
Being labeled as “mentally ill” certainly did not help me when I tried to take my own life. What helped was when someone was willing to listen to what I had to say about why I tried to kill myself, what you referred to as someone validating my feelings. I was helped by compassionate student nurses and a Wiccan nurse more than by anyone associated with the “mental health” system. In fact, the very people who would not listen to my story and who acted as if my feelings were of no account were the psychiatrists and nurses in that very system. I got my life back despite the system. I had a few good friends who cared, and the student nurses and the Wiccan I met along my way to the state “hospital” where I was held. They were the ones who helped me to change my life and to gain the balance I needed to see things more clearly. There were good reasons why I no longer wanted to live but these people listened and in the end it all helped me to move on and get my life back.
I also believe that the “antidepressant” that I took mega-doses of, was also responsible for my trying to kill myself. When I realized what a zombie I’d become from the “medicine” it was the final straw that broke the camel’s back.
Thank you for writing about this.
Report comment
Gosh, what a breath of fresh air! As a self-described anti-authoritarian, I find you to be one of the few who speaks to my perspective. The grownups’ greatest complaint against me as a child was that I had no respect for authority figures and demanded everyone earn my respect. This attitude is often not well received from children in American society.
I find the so-called “safety contracts” to be utterly useless and I stopped agreeing to sign them last year as I was finally rebelling from the system. I find them coercive at best, and a tool for punishment in most situations. I would go so far as to say their singular benefit is to protect the treatment provider from litigation if the patient does harm themself.
Report comment
Great article and post. Thank you for writing it.
I think these statistics illustrate the influence of anti-depressants on suicidality. Women tend to be more compliant when it comes to treatment and psych-drugs, and they also have the suicide rates that have risen much more dramatically than those of men whose rates show their own steep incline.
I figure life for an anti-authoritarian has got to be tough in any event, seeing as the authorities are “in charge” of about everyone and everything. However, as far as I’m concerned, one reason for persevering in the face of these odds is that by doing so I become a thorn in the side of authorities who would desire nothing better than my abandonment of anti-authoritarianism. Were I to off myself, it would be a gain for the authorities. By not offing myself, the anti-authoritarians are made all the more stronger by the presence of this one particular person adding to their numbers. If there is power in numbers, we’re not talking subtraction here, in my case anyway.
There are so many things wrong with psych-drugs, one of them being that they take control of a situation away from the individual so severely affected by them. Another is that they all seem to have their own withdrawal effects when one is trying to get back to ordinary consciousness. Sometimes, a person may need to taper off before they have a good grasp of what’s taking place around him or her. I figure psych-drugs can represent a cloud preventing a person from getting a clear grasp of the situation he or she is in, and it can be very much a contributing factor in the depths of his or her distress.
Report comment
“Women tend to be more compliant when it comes to treatment and psych-drugs, and they also have the suicide rates that have risen much more dramatically”
It makes no sense, you have been suicidal so we are going to send you home with big bottle of pills that if you swallow all of them you could die.
Antidepressants, most commonly the cyclic antidepressants, are the second leading cause of death from drug overdose in the United States, … http://www.livestrong.com/article/78083-antidepressant-overdose-symptoms/
Self-poisoning is a common method of suicide, especially in women.1 Antidepressants are frequently used for self-poisoning, being involved in around 20% of all poisoning suicides in the UK1 and in 20–30% of non-fatal overdoses. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862059/
Women were 2.5 times more likely to use antidepressants to suicide than men… http://www.google.com/search?q=anti+depressants+overdose+statistics
Searches related to antidepressants overdose statistics
how much does it take to overdose on antidepressants
can you overdose on antidepressants and die
Thats scary, Google shows people searched those things enough times to become suggested search phrases.
Report comment
I have wondered exactly the same thing. My pill regimen included narcotic pain killers, muscle relaxants, sleeping pills, and benzos, on top of the antidepressants. But I’d get out of the hospital with fresh 30 day scripts and a worthless safety contract. That’s the height of malpractice, in my no longer even resembling humble opinion.
Report comment
Being a non- or anti-authoritarian in today’s society can be a major cause of feeling suicidal. It has certainly been my experience. Calling it a “mental illness” is society’s way of continuing to assert the dominance of the status quo.
Report comment
Just like the Russian psychiatrists did in communist Russia, and I suppose the Nazi psychiatrists did in Nazi Germany. And today’s US psychiatrists’ DSM theories are no more scientifically valid than were the theories of the psychiatrists in those oppressive regimes. May we say history should NOT repeat itself again?
Report comment
If I was talking to a fellow anti authoritarian who was feeling suicidal I would say if you do it they win.
Report comment
Wonderful blog, full of the common sense missing in most of the “mental health” theology. Thank you, Bruce.
I absolutely agree, “the idea that they are experiencing a crisis of self rather than a mental illness” will open people “up for dialogue,” which can be curative.
Report comment
I don’t understand what depression feels like, but I know what delusions, hearing tormenting voices, and extreme states feel like. I wonder as it so happens if the articles and commenters about having depression make you as uncomfortable as I do when I read articles and comments relevant to psychosis.
You know what I mean. It’s still a good and informative website, but you have to pick and choose what you find interesting.
Report comment
I’m feeling hungry so I’m going to jump off a cliff. I’m feeling my colon is full so I’m going to jump off a cliff.
NO I prepare some food if I feel hungry. NO , I go to the toilet if my colon is full.
No one can feel suicidal.
People feel hopeless/lonely and think of the complex action of suicide as a solution. Who taught them this?
There is a STEP between feeling, and the action of suicide. They are NOT one and the same thing. http://dictionary.cambridge.org/dictionary/english/one-and-the-same
How many of these people “feeling suicidal” are having pleasurable sex?
I know many are eating too much food as a solution to feeling bad. https://www.cdc.gov/obesity/data/adult.html
Report comment
Thanks you everyone for your comments, which I just had a chance to read. To the extent that people are frightened, they are less likely to have the capacity to think critically and more likely to hand over power to an authority that claims to know how to handle things. And suicidality — as well as hearing voices — frightens people. So, a big part of what the MIA community can do is say to the world, “I recognize that these behaviors are frightening, but psychiatry authorities who claim to know how to deal with these behaviors have a poor record.” This can be done through research and through personal stories. The battle is much about countering an illegitimate authority exploiting fear which keeps people from thinking critically — Bruce
Report comment
Anti Authoritarian.
Or learned helplessness for the anti-authoritarian. It feels so hopeless and helpless for so long, that suicide becomes the first thought, the first solution to the problems when they get thick.
I found that “suicidal ideation,” plans, thoughts, etc., became a “default pattern” over years of depression. It was like a groove which my thoughts fell into when things got uncomfortable.
I agree that current measures are harmful and ineffective. But I’ve seen very little to address this thinking ditch or gravity well or default switch, where suicide becomes the first “solution” to the problem.
It happens. And, I suppose, self-harm (which can accidentally result in suicide) is another gravity well like this, also.
Report comment
Viktor Frankl, who created Logotherapy said that it is a sign of your humanity to question the meaning of your existence. This approach takes away the stigmatizing and offers real hope, which is why Logotherapy is effective as it is for people contemplating suicide. Logotherapy needs to be more seriously considered as an option.
Report comment
Suicide *prevention* is wasted campaign of WHO in first place.Anyone have a right to commite suicide and that’s it!
I don’t need to commite suicide ,because I have a brain tumor.And mainly because of my so called *uncurable* *Mental* Health *issues*,I refused any further neurological *monitoring* of quite problematical tumor.Coma and death will be matter for me,but I surrender *my-self* to such fate and I am enjoying in RPG games,now! Diablo and Baldurs Gate.Finished both saga’s prior I die is my priority now!
Report comment
Thanks for the great article. It makes a lot of sense to me that the medical model of mental suffering as ‘mental illness’ has significant drawbacks and that ‘crisis of the self’ may well a more productive model in anti-authoritarian suicidality. In hospitals, mental health patients often experience being unnecessarily stripped of their dignity so that if they were not suicidal to begin, they become so, or if they were, their resolve to end their lives and avoid repetition of the ordeal is further strengthened. And that is not to even mention the complexities resulting from negative side-effects of psychiatric medications —- that all too often are casually dismissed by medical personnel. To me, it is believable that the key to helping ourselves and others is like what David Webb (whom you quoted) mentioned. Understanding suicidality as a “sacred crisis of the self” instead of an illness could turn the current approach to psychiatric practice it on its head, leading to intrinsic strengthening of self-respect instead of destroying it.
I second the comment above that Logotherapy, which is a non-sectarian therapy of the spirit, is designed to meet the existential challenges and responses of every individual. Rather than ‘ultimate control’ being demonstrated by completing the act of suicide, the control resulting from ‘ultimate respect’ of self and purpose could be applied to maintaining safe boundaries and living life with all its challenges.
Report comment
Half of all suicides are caused by under treated chronic pain. Give people enough relief from their physical pain and the suicide rate will drop by half.
Report comment
And most of the rest by chronic psychological pain, for the most part as a result of traumatization or unrelenting stress. Depression is a natural reaction to feeling trapped in an untenable situation and having (or perceiving) no ability to escape. Address the pain, find another way to move from the apparent trap, and suicide no longer seems like an appealing option. Unfortunately, psychiatry does the opposite – tells you that you have no control and the only hope is to keep things “less miserable” through their drugs. They are purveyors of hopelessness for the most part.
Report comment
The question remains though —– how to ‘get through’? HOW to address the pain? How to crack the hard shell of refusal that rejects more effective help? Getting someone to participate in a process to become un-trapped when pain, or fear of pain, or fear of endless pain, creates a huge barrier. (And anti-authoritarians may be ‘anti’ to anyone they plug into the ‘authority’ slot even when promoting non-drug or unconventional treatment). When therapy does not succeed in providing tools or support for the intense pain that it might stir up, drugs (despite their terrible side effects and frequent ineffectiveness) are tried in order to mitigate the pain. Eventually the sufferer is landed with some diagnostic label that may be the result or may be the cause of continued entrapment.
Report comment
I wrote about this subject a little on my blog. 29-years of dysfunctional marriage because of my wife’s d.i.d. has had me on the ropes on and off for much that time. The emotional heartache and hopelessness of things never getting better no matter how hard I tried. Even after 20 years when we finally got the d.i.d. diagnosis, the hopelessness of ‘the unknown’ simply was exchanged for the overwhelming hopeless that comes from her disorder being systemic in ways not even the experts at ISSTD really understand from the comfort of their ivory towers.
I know I have NO mental issues: just extreme emotional and physical fatigue from a one-way relationship and then trying to help her overcome the ‘impossible’ once we finally got the diagnosis. What I suggested to my readers were 1) empathize and sympathize without belittling the pain. The pain is real and justified even if not from your perspective. 2) give appropriate physical affection. Even a heartfelt handshake can break the feeling of isolations. In our hyper-sexualized culture, we’ve lost the power of appropriate touch. 3) Ask if there’s anything you can do, but ONLY if you mean it. I was overwhelmed helping my wife heal, working 60+ hours a week, AND keeping the household running: I could have used a little bit of help… 4) Be a safe, confidential person. Those of us who struggle with regular thoughts of suicide are in a double bind. If we share, we risk our independence. Plus I find so many people uncomfortable with extreme emotions. So it’s just easier not to share rather…but then that means I just continue to struggle along alone…
There’s not much anyone could do to end the pain of having a wife with d.i.d., but I’ve thought those things might have helped a little.
Sam
Report comment
I appreciate your response. I would not have been able to do what you’ve done.
Report comment