From Dr. Burn's book "Feeling Good", Chapter 15, he writes:
Dr. Aaron T. Beck reported in a study that suicidal wishes were present in approximately one-third of individuals with a mild case of depression, and in nearly three-quarters of people who were severely depressed. It has been estimated that as many as 5 percent of depressed patients do actually die as a result of suicide. This is approximately twenty-five times the suicide rate within the general population. In fact, when a person with a depressive illness dies, the chances are one in six that suicide was the cause of death.
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Ask yourself, "Is there anything that is preventing me from committing suicide? Would I hold back because of my family, friends, or religious beliefs?" If you have no deterrents, the possibility is greater that you would consider an actual suicide attempt.
SUMMARY: If you are suicidal, it is of great importance for you to evaluate these impulses in a matter-of-fact manner, using your common sense. The following factors put you in a high-risk group:
1. If you are severely depressed and feel hopeless;
2. If you have a past history of suicide attempts;
3. If you have made concrete plans and preparations for suicide; and
4. If no deterrents are holding you back.
If one or more of these factors apply to you then it is vital to get professional intervention and treatment immediately. While I firmly believe that the attitude of self-help is important for all people with depression, you clearly must seek professional guidance right away.
The Crisis Outreach and Support Team is a program of St. Joseph's Health care Hamilton. The Hamilton crisis line is available 24 hours - 905-972-8338, see:
http://coasthamilton.ca/
The Toronto Distress Center fosters hope and resilience one connection at a time. For immediate support call 1-416-408-4357 (HELP), see:
http://www.torontodistresscentre.com/resources/find-help-now
The Distress Centre Niagara provides support to individuals in distress or crisis and education to the Niagara community which assists people to take ownership of personal choices and manage their lives in a healthy manner. See:
http://distresscentreniagara.com/
CASP is not a crisis center but provides educational material, resources, and links to regional crisis centers. See:
https://suicideprevention.ca/need-help/im-having-thoughts-of-suicide/
I only discussed suicidal thoughts with professionals in a diagnostic setting on a few occasions. Since you may have a similar experience I'll describe how I was admitted to St. Joseph's psychiatric ward, and what happened afterward. I found that when I was severely depressed and my mind was filled with self destructive ideas counselors that I spoke to would often ask me point blank; "Are you having suicidal thoughts?" I answered yes to this question a few times, the one time that I described those thoughts in detail was immediately prior to my admission to the psychiatric ward at St. Joseph's.
I was extremely cynical at the time, and I wasn't impressed by what the doctors and counselors that I spoke to said. They seemed tired out to me and not very engaged and as though this question "...was I having suicidal thoughts?" was the only tool that they had. If my answer was yes, their response was a prescription. If my answer was no, then my case wasn't that serious and I should wait for 3 months to get an appointment with a psychiatrist. I felt embarrassed giving this answer, frustrated by the response I got for it, and after a while, I stopped providing a lot of details about what I was thinking. I had the rather dangerous idea that if I wanted to succeed in killing myself then I should stop talking about it and say that while I didn't feel well I was doing okay, and that I should probably leave the hospital soon. After about 10 days I was released. I went back to my apartment, threw out the prescription that was given to me, closed my blinds, and isolated myself as the winter set in resolving to "wait" and see what would happen.
So... if you are in that same position that I put myself in, refusing to talk about suicide, and yet haunted by partial plans, worrying about failing, crippling or scarring yourself through an incomplete attempt, or being found out, please reconsider and contact one of the above distress centers. I was lucky, my parents extracted me from my apartment after many months of isolation and refusing to answer the phone and took me to see a very patient and decent psychiatrist who saw me immediately, and followed up with me several times per week for an entire summer. I still didn't tell him every detail I was thinking, however I did meet with him regularly for many years. I took the medications that he prescribed, accepted his advice and ultimately he was a big part of my initial improvement. My refusal to fully trust professionals, especially after having a few bad experiences, made my journey very, very long.
At Recovery meetings we do not dig through deep dark secrets. We are not qualified to do so, and we believe that an incautious exploration of explosive feelings can amount to re-experiencing them and risks inappropriate comment or judgment from volunteers. We encourage attendees to see a professional if they want to discuss extremely troubling situations. We stick to trivialities and developing tools to handle common traps and everyday problems.
While we can't provide emergency support or address some of life's most difficult experiences in our forum, what a peer support group can offer is an interesting insight; others do improve. At first, I didn't believe my psychiatrist when he told me I would get better. I thought, "What does he know? He's got a good job, a nice home and family, and clearly he has never been depressed." But when I met healthy individuals at meetings who talked about how bad things used to be, and how they were doing much better this impressed me. I could relate to the guy who had been out of work for several months and just got a new part-time construction job. While I'd never worked construction I could see his pain, and how he was working on it, and the progress he was making. Others have been to horrible places, and others can confirm that taking small steps makes things easier. While we cannot help you in an emergency, we can help you with small things so that you won't get to a place where it is an emergency, and we have proof, we did this. You can too.
In Recovery we make a distinction between feeling helpless, and the diagnosis that your case is hopeless. We acknowledge that people do feel helpless, they feel exhausted, disgusted with themselves and the world, as though nothing will ever change and they can see no solution. However, feelings are not facts, and while it may be true that you feel helpless, you do not have all the information, you cannot draw the conclusion that your case is hopeless. In Recovery we say that no case is hopeless, not even yours. Dr. Low writes:
A patient is competent to describe his present condition, his pains, pressures and palpitations, his lack of strength and vitality, his fears, panics and compulsions. If he wishes to place the label of "helplessness" on any of these experiences I shall not quarrel with him. I have not seen a patient who was not helpless, totally or partially. Patients are helpless to stop their pressures, they are helpless when they find themselves seized with air-hunger or night terror. And if any patient claims to be helpless I shall not challenge the correctness of his statement. But when a patient declares himself hopeless I shall warn him that he has presumed to make a prognosis and has trespassed into my territory. The physician alone is capable of deciding whether a condition is hopeless or hopeful. The patient who assumes the diagnostic or prognostic function of the physician sabotages his authority. The patient can declare himself helpless but he has no right to pronounce himself hopeless. Description is the domain of the patient, prediction is the province of the physician.
Many of us suffer through depressive symptoms and years later when we are doing better we can look back on those times and realize that it wasn't that our situation was bad, it was more that we had unrealistic thoughts about our life. Everyone who is depressed will object to this and say "... but my life situation truly is horrible and I can't tolerate it". It is the case that some people are in truly horrible circumstances, and here is an odd fact, there are people who are suffering from great physical, financial or situational struggles that are not depressed and do not believe that their life is hopeless. Dr. Burns writes:
The conviction of hopelessness is one of the most curious aspects of depressive illness. In fact, the degree of hopelessness experienced by seriously depressed patients who have an excellent prognosis is usually greater than in terminal malignancy patients with a poor prognosis.
An even more compelling account is the one given by Viktor E. Frankl in "Man's Search for Meaning". Viktor Frankl survived a Nazi concentration camp as much by refusing to give up hope as by sheer luck. There is a good summary in the foreword to this book by Harold S. Kushner who writes:
Clearly, many prisoners who desperately wanted to live did die, some from disease some in the crematoria. But Frankl's concern is less with the question of why most died than it is with the question of why anyone at all survived.
Terrible as it was, his experience in Auschwitz reinforced what was already one of his key ideas: Life is not primarily a quest for pleasure, as Freud believed, or a quest for power, as Alfred Adler taught, but a quest for meaning. The greatest task for any person is to find meaning in his or her life. Frankl saw three possible sources for meaning: in work (doing something significant), in love (caring for another person), and in courage during difficult times. Suffering in and of itself is meaningless; we give our suffering meaning by the way in which we respond to it. At one point, Frankl writes that a person "may remain brave, dignified and unselfish, or in the bitter fight for self-preservation he may forget his human dignity and become no more than an animal." He concedes that only a few prisoners of the Nazis were able to do the former, "but even one such example is sufficient proof that man's inner strength may raise him above his outward fate."
Finally, Frankl's most enduring insight, one that I have called on often in my own life and in countless counseling situations: Forces beyond your control can take away everything you possess except one thing, your freedom to choose how you will respond to the situation. You cannot control what happens to you in life, but you can always control what you will feel and do about what happens to you.
Frankl's book is short, about 170 pages. I read it years before attending any Recovery meetings and it impressed me because of its overall simple message, that we can choose how to respond to suffering, and that it matters what we choose. I did not fully respect or trust many of the counselors I met in person because I believed that they were speaking from a position of affluence and ignorance. Several told me that they had never experienced depression, this created a feeling of distrust for me. Frankl's story is one where he expresses a clear understanding of the impact that suffering has. He talks not only about accepting the failings of those who suffer, but also about finding a solution within suffering.
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| Viktor Frankl |
I found Frankl's story inspiring because of the fact that despite the impossible situation that he was in, one where suicide would seem to be a rational solution, he was still able to find hope. During the darkest part of my depression I saw no difference between my feelings of helplessness, and my notion that life for me was hopeless and without chance for improvement. Reading Frankl's story in part lead me to consider whether my illness was the root of both notions, and whether there might be hope despite me not being able to see it.
Feeling exceptional is one of the traps that we fall into. I believed that I was exceptionally unwell and no doctor could dissuade me from that idea. Reading Frankl's account made me start to question whether it was my situation that was the problem, or how I looked at my situation. When I started to attend Recovery meetings I believed the stories told by others, I found them convincing. What kept me coming to Recovery meetings was not just being inspired by the success of others, but that the meetings taught tools, simple things that I could do to make my life more peaceful.
If you feel helpless and are worried that your case is hopeless I encourage you to come and meet us and learn about some of the tools we use. Our group is attended by regular everyday people, we teach simple and easy to remember techniques that address small frustrations. If you can eliminate many of the little problems from your life you will find that the big problems are much easier to manage.
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