Suicide prevention

Day 647

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”No history of self harm” said the discharge summary from the Home treatment team to the GP. This sentence was one amongst many on the four page long letter.

Saagar was seen by at least 3 psychiatrists – 2 senior trainees and one Consultant and they all missed it. Did they ask him and he didn’t tell them the truth or was it an omission? The scars could easily be seen on his left forearm. They were clearly visible. Did they find the scars and questioned him about them? Did he make up a convincing story for them as he did for me? Or were they missed altogether? No one asked me about his history of self harm. He was mentally ill at the time and I don’t think I was.

At the Coroner’s inquest when this question came up, the psychiatric team said that the remark was made because Saagar never presented to the Emergency department with self-inflicted injuries. Is that a valid criterion?

Self harm is a personal and often a very private act. Given it is an important clue to the extent of a person’s emotional suffering, we as carers and professionals cannot afford to miss it.

“The only antidote to mental suffering is physical pain.”
– Karl Marx

Day 645

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Being is Enough

“We are not always clear about what we are experiencing, or why. In the midst of grief, transition, transformation, learning, healing, or discipline—it’s difficult to have perspective. That’s because we have not learned the lesson yet. We are in the midst of it. The gift of clarity has not yet arrived. Our need to control can manifest itself as a need to know exactly what’s going on. We cannot always know. Sometimes, we need to let ourselves be and trust that clarity will come later, in retrospect. If we are confused, that is what we are supposed to be. The confusion is temporary. We shall see. The lesson, the purpose, shall reveal itself—in time, in its own time. It will all make perfect sense—later.

Today, I will stop straining to know what I don’t know, to see what I can’t see, to understand what I don’t yet understand. I will trust that being is sufficient, and let go of my need to figure things out.”

  • From the daily readings of Co-Dependents Anonymous (CoDA) , a set of informal self-help groups made up of men and women with a common interest in working through the problems that co-dependency has caused in their lives. CoDA is based on AA (Alcoholics Anonymous) and uses an adapted version of their Twelve Steps and Traditions as a central part of its suggested programme of recovery.

 

 

 

Day 644

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Impulsivity has been variously defined as behaviour without adequate thought, the tendency to act with less forethought than do most individuals of equal ability and knowledge, or a predisposition toward rapid, unplanned reactions to internal or external stimuli without regard to the negative consequences of these reactions.

Impulsivity is implicated in a number of psychiatric disorders including Mania, Personality Disorders, and Substance Use Disorders. Yet, there is significant disagreement among researchers and clinicians regarding the exact definition of impulsivity and how it should be measured.

2014 Publications Graphs

The Houston study interviewed 153 survivors of nearly-lethal suicide attempts, ages 13-34. Survivors of nearly-lethal attempts were thought to be more like suicide completers due to the medical severity of their injuries or the lethality of the methods used. They were asked: “How much time passed between the time you decided to complete suicide and when you actually attempted suicide?”

One in four deliberated for less than 5 minutes!
Nine out of ten deliberated less than a day.

1 in 4 said 5-19 minutes
1 in 4 said 20 minutes to 1 hour
1 in 6 said 2-8 hours
1 in 8 said 1 or more days

While this personality trait brings to question the predictability of some suicides, it most certainly makes a strong case for removal of means.

It appears that impulsivity does play an important but small role in suicidal behaviour. Research has demonstrated that impulsive individuals are more likely to engage in painful and provocative experiences and that these experiences appear to make them less fearful about death. Given their greater acquired capability for suicide, if these individuals go on to experience perceived burdensomeness and thwarted belongingness, they will be at high risk for death by suicide.

Day 642

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What makes a good life?

An answer to this age-old question was attempted by a huge study at Harvard. It followed 724 men from their teenage years for a period of 75 years. Half the men were students at Harvard and the other half were disadvantaged inner city boys of Boston. They all went on to pursue various fields of work – brick-layers, teachers, solicitors and one even became the president of America. Every year, each one of them answered a paper questionnaire and was interviewed in person. Bloods tests and brain scans were performed on them and a large body of data was collected and analysed.

What did they find?

Loneliness is toxic. Loneliness kills.
The way to health and happiness is through good relationships.
Cholesterol level is not a predictor of good health but the quality of one’s social connections is.
Good relationships protect the brain too. People who have friends and relatives they can count on retain their memory for much longer than the ones that don’t.
So, while relationships can be messy, difficult and trying, they are worth leaning into, be it with family, friends or a community.

How can this be done in real terms?

  • Replacing screen time with people time?
  • Doing something new – going for a long walk, gardening, volunteering, watching a black and white film, trying a new recipe?
  • Calling an old friend you’ve been thinking of for a while?
  • Putting a grudge or mistrust aside and reaching out?
  • You know best.

“There isn’t time for bickering, apologies, heart burnings, calling to account. There’s only time for loving. An instant for that.” – Mark Twain.

Good life = Good relationships.

 

Day 641

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images

Some of us may not know it but we all belong to the Suicide Prevention community. We all make a difference in our own unique way. With every interaction, every smile, every kind word we shift the energy around us. By truly listening without judgement, creating a space for self-expression and understanding, with care and compassion we all can save lives.

Suicide is often a disease of loneliness. Modern values of individualism and capitalism perpetuate the feeling of being alone. Schools, universities and work places encourage competition as opposed to collaboration creating a higher sense of desperation and isolation. As a result each of us is more disconnected than ever before, not just with others but also with ourselves, blindly chasing time and seemingly important goals.

We look for individual wealth and glory. We look to be rich and famous. We look to leave a legacy that people will remember us by. But our true legacy lies in every life that we touch, in every interaction with another being, in each kind word, in every smile, in every authentic connection we form. Our legacy is in every person who gets hope because of us. The only true gifts we can give to someone, anyone, even a stranger are – our time and the gift of hope.