A note about suicide (not a suicide note).

I originally posted this as as a Facebook Note.  I’ve cross-posting it here so more people can contribute to the discussion.  Thanks to everyone who has already written comments. I’m overwhelmed by the response.

UPDATE:  Within one short week of writing this 2,000 word essay, it has received over 28,000 words of comments and feedback on this blog and Facebook. Clearly, people have a lot to share and have been holding a lot inside.  Thanks for sharing.

Let’s talk about despair.

I’m sitting in a bar in Bowmanville, the Village Inn, drinking a gin & tonic and reflecting on the funeral service I attended an hour ago. I knew David Rice through our shared community work. He was a volunteer with the Toronto Cyclists Union. He was my age, born in 1973. Last week, he took his own life.

We weren’t close friends, but I spent time with him at meetings and felt that I knew him. It turns out, I only knew a small part of him. David lived a functional, and often happy, life with many hobbies and interests. But he also lived in a world of paranoia, anxiety and despair that he hid very well. Even to close friends and family, he rarely shared his darkest thoughts. He struggled, for many years, mostly on his own – because he was scared to reach out to those around him who could help. He was scared that a mental health diagnosis could alienate and marginalise himself and cost him jobs and relationships. But by doing so, he paid the highest price.

His story is not unusual. Despite living in a society that increasingly encourages transparency and the sharing of personal information (Facebook being a good example) there are still a handful of topics that maintain a high level of stigma, taboo and secrecy. Mental health is one of those topics.

The sad irony is that our emotional and mental health benefits greatly from talking and sharing. If someone has a broken arm, they are unlikely to be embarrassed or ashamed and will show-off their cast with pride. But talking about your arm won’t help it heal. Reversely, and perversely, someone living with a mental health issue is unlikely to openly talk about it – even though sharing thoughts and fears may be one of the best prescriptions. By perpetuating the stigma of mental health problems, we are actually making people worse and sentencing them to unnecessary suffering and horrendous outcomes.

I’d like to do my small part to make a difference. I’d like to help create a new openness to sharing our personal struggles with each other. I’ve lost a few friends to suicide and I’d like to help prevent others, perhaps even my own down the road.

I’ll lead by example, by sharing a personal story. Then I’m going to ask you to participate.

I had a nervous breakdown two years ago. (Taboo #1. Don’t mention nervous breakdowns in public: Too much information! People will think you’re crazy, broken, dysfunctional, deficient, strange, and sick.) I quickly slipped into a deep dark pit of despair and had suicidal thoughts. (Taboo #2. Don’t talk about suicidal thoughts. You’ll scare your friends, alienate them, and then maybe lose them. And verbalizing suicidal thoughts make them more real. Ignore them and they’ll go away.) I immediately began crisis counseling, and then tried a few therapists, psychotherapists and psychiatrists until I found a good match. (Taboo #3. Don’t talk about therapy. Smart and strong people don’t need therapy. You’re broken. Damaged goods. Don’t tell anyone. You’ll lose friends, lovers, jobs, family.) I took sleeping pills to get through the hardest part, then I got hooked on a habit forming anti-anxiety medication called Ativan and then I was prescribed another med called Buspar, to help get me off of Ativan. (Taboo #4. Don’t talk about your meds. Keep it to yourself. No one needs to know that you can’t function normally, like everyone else.)

At first, I was scared. I was scared of a lot of things. I was scared that I might kill myself. I was scared about medication. I was scared about no one being able to understand what I was feeling. I was scared of making the wrong decisions, losing my judgment. I was scared of being scared. The despair was so strong that there were moments when I couldn’t walk, couldn’t feed myself, couldn’t think straight, couldn’t breathe. I cried so hard I pulled muscles in my throat.

I got better. It lasted about nine months. Lots of factors contributed to pulling me out of the darkness. Patience, faith, rest & exercise all played a role. But what really healed me was emotional support from my social network of family and friends and even strangers. I took a few risks early on, and started to share my feeling with people. I was surprised to find out how common despair is. Time and after time, people would thank me for being open and would share their own experiences with depression, medication, therapy and suicidal thoughts. After each interaction, I felt less alone, less broken, less alienated and slowly the hopelessness began to fade. The more I shared, the more positive feedback I received.

The hardest part was the suicidal thoughts. I had never had those thoughts before. For 32 years, life was like the sky. It was just there. I didn’t question life, just as I had never questioned the clouds. But part of me was always scared that I could, or would. My nature has always been to question everything, and often reject things that I had previously thought were carved in stone. Whether it was capitalism, religion, monogamy, meat-eating or formal education – I had a long history of deconstructing institutions, developing my own critical analysis, and often rejecting the whole thing. My deepest fear was that I would run out of things to reject, and perhaps I would reject life itself. Rejection begins with empowering yourself to choose. Seeing religion as a choice, rather than an inherent trait, allowed me to eventually reject it. “I didn’t choose this, so I need to decide for myself if I want it.” Then the math begins. Weighing the pros and cons, and coming to a conclusion. There are both benefits and drawbacks to everything, including embracing religion, eating meat and living in a capitalist economy. Those of us who are compulsive critical thinkers, make our decisions based on a series of equations weighing those pros and cons. But I was terrified of the life equation. What would happen if I actually weighed the pros and cons of being alive? What if I said to myself “I didn’t choose this, so I need to decide for myself if I want it.”

Here’s where things get tricky. You can reject eating meat, and you can reject monogamy, and you can reject formal education. And then you can change your mind, and get married and get a PhD and eat a turkey. But if you reject life, and act on it, you’re done. That’s what scared me: The thought of dipping so low, even for a moment, that I could make an impulsive irreversible decision. Because I can be quite impulsive. I’ve thrown myself down hills, rolled up like a human ball. I’ve stormed out rooms, kicking doors on my way out. I’ve said “Yes” to a million things, without giving them a second (or first) thought. The combination of passionate critical thinking, impulsiveness and spontaneity seemed risky to me.

But now that I’ve seen the effects of not talking about mental health, and despair, and suicide, I’ve changed my mind. I want to explore my fears, share my thoughts and feelings, express my fears and do the math. Life is a choice. There are two choices each day. Keep going or end it. The nature of the choices differ greatly in the sense that you can only make the “end it” choice once. Regret won’t bring you back. David Rice is gone. My good friend Tooker stepped off a bridge in Halifax 6 years ago, and nothing can bring him back.

Their equations brought them both to an impulsive moment that they can never take back or undo. Countless others have made that final decision to end all decisions.

I want to embrace life as the daily choice that it is, and consciously choose to keep living. Critical analysis doesn’t always end in rejection. I’m not scared of the equation any more, and I’d like to ask for your help. Let’s help each other. I think we can save lives–maybe not all of them, though. Mental health is a complicated thing, especially if paranoia or delusion plays a role. Sharing reasons to ‘choose life’ won’t always help. But I think in many cases it could.

Once you dip too low, it’s hard to have any positive thoughts. Hope disappears. Clarity dissolves. Faith falters. So let’s work out our equations, while we’re in a better headspace. Not when we’re on a ledge. Let’s start right now.

Here’s what I propose:

1) Let’s work against the stigma that prevents all of us from talking openly about mental health. Let’s actively work towards a day when calling your boss to say you need the day off because you’re having a mental breakdown is as comfortable and acceptable as calling in with a cold. Don’t hide your own vulnerability, and encourage everyone around you not to hide their own.

2) Let’s talk about suicide. It’s a real choice, and we all pretend it doesn’t exist until a friend actually does it and then we wonder why he or she never reached out to talk about it. Pretending it’s not an option, a reality, a choice, won’t make it go away. People need to know that these thoughts are normal and okay.

3) Let’s talk openly about therapy. I’ve been trying to get used to saying things like “Noon won’t work for me. I’m seeing my psychiatrist at 11. I can meet you for lunch at 1.” Some would consider this “too much information”. Why? Who would be ashamed to say that they couldn’t have lunch at noon, because they have to go to the dentist? Who would accuse someone with a toothache that they are providing ‘too much information.’ Let’s get this out of the closet. Therapy is a good thing, and it doesn’t mean you’re broken. It means you’re human, pro-active and invested in your own health and future.

4) Let’s talk about meds. People openly gather in bars to drink their problems away. So why are we ashamed to admit that we’re on Prozac, Ativan, sleeping pills, etc? There are two sides to this coin. And two discussions need to be sparked. The first is a heightened awareness of the risks associated with prescriptions. In many cases, these meds are overprescribed. Drugs are sometimes used instead of therapy, or instead of going to the root causes of the problem. More importantly, anti-depressants and anti-anxiety meds can actually be dangerous if not used properly, or if the user is not monitored properly. In many cases, suicidal risk can actually increase, for a short period of time, when a new medication is started or a dosage is changed. Those are the risks. The other side of the coin is that some of these drugs can be lifesavers. Once an informed decision is made, we need to be much more supportive of the choice. Just as with the broken arm example, or the dentist, there is a tremendous amount of stigma around meds. Who would be embarrassed about popping a Tylenol, or admitting that they are on an anti-biotic, or cough medicine? We need to reach a space where we feel just as comfortable shaking out a tablet of Effexor, Celexa or Buspar in front of our friends. If we can’t share this with our friends and family, then we are just feeding perpetuating and cultivating our own isolation.

5) Please watch for warning signs in yourself, and in your friends and family. Don’t be afraid to ask for help, or to offer help. Most importantly, make yourself available to listen.

6) Let’s talk about life in the context of choice, and share our reasons to choose life. This is the part where I encourage you to participate. I invite you to share your reasons, below, why you think life is worth living. I’ll compile all your reasons into a little book. I’ll make copies for everyone who contributes. I’ll make it small, so it fits in a pocket. It will have crisis numbers, and a space for you to write a short list of people to call when you are in crisis. It’s a “why, who & how” to getting off the ledge. Maybe I’ll call it “Ledge Reading”.

Feel free to share other thoughts as well, to help break down the four stigmas (mental health, meds, therapy & suicide). Share anything you want. Ask questions. Write comments on this page, but also start talking to your friends. Talk to your family. Talk publicly. Let’s shatter these dangerous taboos. Cultural norms erode with time, and you shouldn’t underestimate the role you can play in changing the shape of dialogue in our society. Leading by example is powerful and can trigger an avalanche.

I know that David Rice felt so afraid of the stigma of mental health issues that he couldn’t share his experiences with others, and this kept him isolated and unable to ask for help. I watched his parents cry in the same chapel where he was baptized 36 years earlier. I watched his brother and girlfriend struggle to hold back tears, as David’s three young nephews tried to find their own emotions amidst their confusion, trying to make sense of what had happened to their uncle.

Let’s come together, now, and shine a light on our own struggles with life, sadness, depression, anxiety, fear and suicide. We have nothing to lose by sharing, and we have so much to gain. Life is a strange, magical, random, difficult and wonderful experience. I think it’s worth living. Let’s live it together.

Now your turn. What is your experience with despair, therapy & meds? What makes life special, for you? Why is life worth living? There are a million reasons. I’d like to hear yours.

Happy New Year to all. May 2010 bring much love, gratitude, strength, warmth, growth & sharing.