Bootstrapping Mental Health – or an Elegy for Those Who Have Committed Suicide

Tonight I watched an episode of a (rightly long ago cancelled) TV show called Touch, in which Keifer Sutherland plays hero and “saves” a guy from killing himself… twice. The guy is physically dying, his daughter won’t talk to him, and he has no one… but Keifer gets to stand there and be the good guy on the bridge who tells him, “but I’m here.”
 
This is a common narrative, and one I find quite narcissistic and oppressive. Keifer is a total stranger. He shows up to stop the suicidal guy in the moment, but we all know he isn’t going to be around to visit him in the hospital, bring him snacks or treats, call the nurses when he needs pain meds, or be there to hold his hand when he dies. Presumably, if the guy lives, that will all just work out in the end (indeed it does in the episode: his daughter coincidentally shows up on the bridge and now all is well and he can presumably die a painful death from whatever ails him… but at least he will have died the right way).
 

The tired narrative about suicide goes as such: killing yourself is the easy way out. It’s burdensome to friends, family, and other loved ones. It’s selfish. It’s giving up. Things will always get better if you just don’t die.But this narrative is backwards.

What is easy, if not flippant, is the assumption that it is always better to live, that things can’t get worse, that they will always get better if you just tough it out and make it through. And some times it does. But it doesn’t always.

 
I understand that people do not want to see people they care about die, for any reason. But here’s the real question: what are you willing to do about it? Because we all have limits, and, oftentimes – in fact, more often than not – those limits make it quite undesirable, if not impossible, to actually be there and provide the supports to people with mental illness that they need to live.
 
Are you willing to answer your phone or messages at 3am? Are you willing to call around to treatment centers to see if they have a bed? Are you willing to accompany a friend to the ER in the middle of the night, or even during the day? Will you bring food when your friend is too depressed to get out of bed? What about next month? Will you still be up for it next year? Will you text them everyday, even if they don’t respond, or only respond monosyllabically? Will you go sit on their couch with them, silently holding hands and watching TV because they aren’t able to socialize, but part of the issue is that they haven’t seen any one or been physically touched in weeks, months, maybe even years? Will you want to date them, or have sex with them, when even they themselves can’t see any way anyone will find them attractive while they are going through this? Will you keep in contact, or invite them out, or invite them to parties, even though they’ve been depressed for months or years and never shake those blues, so most of the time they aren’t very fun to be around? Are you able to take their call, and really listen, again and again when distorted thinking takes over and they can’t find their way out? Are you able, in all honestly, to tell them that you will be there, day in and day out, when things don’t get better? Will you take them in when they get evicted from their housing because they haven’t been able to work or care for themselves to the point where problems are snowballing?
 
Because I’ll tell you the not-so-secret secret that everyone who has serious mental health issues is already painfully aware of: almost no one wants to be around you when things are bad. And with good reason. A person who is in that much pain takes up a lot of emotional energy and space and doesn’t have much to give in return because their pain, the same as physical pain, is all-encompassing. One need look no further than Freud for an explanation of this: there is next to psychical energy left over when someone is in pain. All cathexes turn inwards for survival.
 
In this sense, is it surprising that folks who are coping with mental health crises frequently feel worthless or useless? I think such feelings are actually speaking to a profound awareness of the situation they find themselves in, rather than a denial or misconstrual of that reality: that, in this state, one is in a sense functionally useless because one is unable to live up to social contracts of reciprocality. They understand that everyone is too busy being polite and pretending that this isn’t true, when it is actually quite obvious. (There is a practical suggestion that one can derive from this observation, however, if one is willing to address it: the best thing to do with a loved one in this state is not to call them up and ask them what you can do for them, it’s to call them up and ask them for a favor, for help with something, if they are available to listen for a moment and give you some advice. Something simple that they can do to be there for you, to be of use, to reciprocate and thus not feel worthless.)
 
I’m not trying to suggest that we all should stand by and do nothing if someone we know is in so much pain they can only think of one way out. I am suggesting that we first recognize that that is what is going on, that they are not exaggerating, and that there is no easy fix. I am suggesting that we reflect deeply on what we can and cannot offer, rather than making blithe statements like, “well, I’m here for you.” Are you? Or is that a statement that is actually intended to make the speaker feel better, not so much the recipient?
 
Time and again I find myself identifying with people who kill themselves and not those who survive them. The survivors throw about words like “selfish” and “cowardly” (see the meme that came across my feed earlier this week below) to describe the person who has died, all the while focusing on their own pain and grief to the exclusion of all else. There are no ends to the disparaging words people have for the people they loved who killed themselves. I hear them all, and hear so little empathy, or even attempts at sympathy, for why their loved one has made this choice.
 
I don’t blame the survivors for their loved one’s death, though I suspect many of these convenient narratives about suicide come from the fact that many survivors blame themselves when someone they know kills themself. But this to me obscures the real issues, because in most cases there is probably not anything that any loved one could do to stop it, especially as individuals living in a society that stigmatizes – and fails to provide even basic supports and care (access to doctors, therapists/ongoing therapy, medications, safe and stable housing, food) – for people with mental illness. But instead of recognizing the histories of abuse and/or lack of structural resources and supports, I see them blame their loved one for their failure to live, and those voices reverberate as confirmation of the uselessness and worthlessness of those of us who just might not survive mental illness. That is what I hear – not that there is love and support and understanding for those who have died – but that those of us who can’t just “pull out of it” or “pull it together” have failed, that we in the end are to blame, that we are selfish and useless even in death. It’s a bootstraps story for the psyche: failure to get out, even if it is just out of one’s own head, is always one’s own fault, regardless of the structures and circumstances.
 
I take mental illness as seriously as I take physical illnesses. And, as such, if I can understand circumstances in which I would support people with physical illnesses ending their life on their own terms, I see no reason not similarly support those who choose to do so due to mental illness. What I would prefer to see is a system in which every available treatment was available and accessible – not in the least of which are therapies (MDMA and psilocybin, to explicitly name two important ones) that have been absurdly banned due to the drug wars and the desire to criminalize anything that makes people feel better via altered states – and that offered a process for choosing to die in the end if no treatments prove effective. Maybe if those systems were in place no one would need the palliative care options in the end?
 
Instead, most of what I see and hear are people searching for ways to dismiss, ridicule, and literally mark for death anyone who struggles with mental illness, but particularly those who do not “suffer well.” I am talking about people who find respite and refuge from long term trauma in drugs. People who lose or are kicked out of their housing, who find a hostile and mostly full shelter system that will discipline and police them – and toss them out, if they managed to get in – for trying to care for themselves, especially if that includes using any medications that have been deemed illicit. People who do what they can to get by and/or chose to work in grey or criminalized professions because it is the best option for them. And so many more. All the people that so many of us seem so comfortable marking for death, or ignoring while they die, sometimes via suicide, or also from overdose, treatable health conditions, exposure, violence… But all of those are really just versions of suicide in the end, for “putting themselves” in that “position” to begin with, right?
 
Honestly, I envy those who have died. I look forward to it myself, even though I’m simultaneously terrified of it. But inasmuch as I imagine it to be, in some way or another, a respite from feeling, an end to pain, it sounds quite appealing. So I do not blame or seek to stigmatize others for having killed themselves, directly or indirectly. I doubt many do it wishing to hurt others. One need only to do a cursory web search to see the amount of thought that many put into figuring out the least painful way to die, both for themselves and for those they will leave behind. In fact, the guilt and shaming of survivors does work to some extent. I have no doubt that many people don’t die for the sole reason that they can’t think of a way to do it that they can both tolerate and will not put an undue burden on those they love, or even strangers (there is always the difficulty of what to do with one’s body).
 
But that is not living. That is not surviving. That is certainly not thriving. And I don’t think it’s fair to wish that people live like that so that we can feel better about ourselves and not have to face the reality of just how bad the pain is for many. I wish instead that those who have died had, and that we all had now, meaningful other options, rather than this vague idea that we should somehow always be able to pull through and address these issues on our own.

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