“The burden of telling”: how our responses can silence people who live with suicidal thoughts, feelings and acts

By Cheryl Hunter.

Have you ever spoken to someone who lived with ongoing suicidal thoughts and feelings? How would you know for sure that you haven’t?

According to a community survey, one in five people experience suicidal thoughts at some point in their lifetime, and one in fifteen people act to end their own lives. Not all of these people access formal services and not all of them tell their friends or loved ones what they are experiencing (1). It is unclear how many people experience suicidal thoughts and feelings more than once in the community, as very little research has explored these phenomena as an ongoing experience or approached suicidality from a non-clinical perspective. From both my own personal experience and conversations with others, I know that there are people who live with thoughts about suicide and the desire to die for years. These thoughts and feelings may ebb and flow, they may recede and return in response to one’s circumstances, but they continue to have a presence in people’s lives (2). How is it that we’re not talking about this more? And what effects does this silence have?

One of the major barriers to open conversation about suicidal thoughts and feelings is unhelpful professional responses to them. When people seek help due to suicidal thoughts, the desire to die, or having hurt themselves, this is typically understood within what Marsh calls an “ontology of pathology” (3), whereby these experiences are usually framed as symptoms of mental health conditions and thereby pathologized, set outside of our ideas of normality. The idea that people may experience ongoing suicidality and take actions to end their own lives and yet not be mentally ‘unwell’ is somewhat alien within our dominant Western understandings of suicide. People who experience suicide as part of their ongoing lived reality can find themselves medicated, labelled and risk managed, with suicidality understood only as a function of their mental ill-health and not as an expression of what they have experienced in their lives. They can find that the diagnostic labels given to them then become barriers to help in the future, as their suicidality is interpreted as manipulative or unserious and their own testimony treated as suspect (4).

People who experience ongoing suicidal thoughts and feelings are often conscious of the consequences of disclosure and may make help-seeking decisions weighing up their desperation against the risks of unhelpful professional responses. Unhelpful responses that people have told me about have included: police breaking people’s doors down, being held at police stations and stripped of your belongings and clothes, being sectioned and sedated against your will, not being taken seriously, being denied therapy due to your honesty. In a recent study I conducted, one of my study contributors expressed this dilemma poignantly, describing “that fear of […] if you do go to a doctor— are they going to section you? Are they going to tell you it’s not true? Like, what are going to be the consequences of speaking?”. Both the fear of having one’s rights taken away because they believe you are suicidal and the fear of being disbelieved by professionals and denied help are barriers to being open about suicidality. In a previous study I conducted, another participant reported how she attended the emergency department three times in increasing states of desperation and with worsening self-harm because she felt suicidal, and was turned away twice for being “too articulate”, too able to express her desperation in words (5). These experiences of professional responses stay with people and affect their future help-seeking. They contribute to what another participant called “the burden of telling”, the personal and inter-personal consequences of telling the truth about one’s experience, and they can very easily silence people or lead people to edit themselves so that they are tolerable to the hearer (6).

These dilemmas extend beyond professional spaces and into the interpersonal realm. It is extraordinarily difficult for many people to share how they feel with loved ones. Sometimes this is due to the relational context, such as when hurtful dynamics within a family or relationship are part of the reason someone feels suicidal. Sometimes it’s due to how talking about suicide changes the way people see you and changes the relationship. One contributor in my study talked of how being suicidal had changed her relationship with her husband and left her feeling infantilised and untrusted. Another spoke of the guilt she experienced at laying these difficult feelings at someone else’s door. How are they meant to respond to how I feel? Is it okay to make someone else worry about you in this way? There was a thread of guilt and shame whereby people felt that they might somehow harm others by being open about suicidality. One contributor expressed it as “a feeling of I’m going to destroy our relationship {…] destroy the affection you have for me”. These feelings cannot be understood outside of the context of societal stigma around suicide. Cultural understandings of suicide as irrational and mad, as selfish and morally wrong, inform how people understand themselves and what they feel it’s okay to say to others. If we as a society don’t challenge judgemental attitudes about suicide and continue to see suicide as an individual’s failing, it will continue to feel shameful and often impossible for people to be open about how they feel in response to the difficulties they experience. Where people experience acceptance from those they confide in, this acceptance can make hope for the future and belief in their own value and worth possible.

In the recent research I conducted, I brought people together to talk about ongoing suicidality, and as part of this process, I explained that I had experienced times in my life where suicidal thoughts and feelings were common and distressing. It is incredibly difficult for me to write this publicly, as I am conscious that I cannot predict other people’s responses to it, yet the stigma around living with suicidality cannot be challenged if we are not open about its existence. In this sense, I am in the middle of the dilemma with my contributors, having to hope that I can strike the right note when I speak so that people respond to me in a way that is helpful and necessary, rather than reactionary, disempowering and shaming. The experience of creating and being in a lived experience space to talk about ongoing suicidality was extraordinary. Contributors spoke of how it was the first time they had told others of their experience and how normalising it was to hear other people share their stories. Some of them went on to be more open with loved ones as a result. The burden of feeling this way and not being able to share it was laid down, briefly, and it brought people hope and relief to be able to do so.

I have argued that our responses can sometimes silence people and multiply the burden of feeling suicidal. I am emphatically not arguing that experiences of ongoing suicidal thoughts and feelings are easy to live with or somehow okay to ignore. People can and do find ways to live, and at the same time, suicidal thoughts and feelings are often responses to difficult and painful experiences in life. They are often responses to deep suffering. If we want to respond to this suffering, we need to come alongside people and try to ameliorate the conditions that have led to suicidality in the first place. Marginalisation, discrimination, inequality, abuse often lie behind suicidality and finding ways to create more just and accepting societies would go a long way to reducing suicidality. By responding to suicidality in controlling, dismissive, or shaming ways, and only seeking to keep people alive without addressing why they feel the way they feel, we can create further harm and silence those around us. If we want people to speak, we need to be able to hear and respond. If we want people to reach out, we need to be able to reach back.

References

1. McManus, S., Bebbington, P., Jenkins, R., & Brugha, T. (2016). Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. Leeds, UK: NHS Digital. Retrieved from http://digital.nhs.uk/catalogue/PUB21748.
2. Hart, M. (2017). When You Live With Constant Suicidal Thoughts. The Mighty. https://themighty.com/2017/10/constant-suicidal-thoughts-depression/
3. Marsh, I. (2010). Suicide: Foucault, History and Truth. Cambridge: Cambridge University Press.
4. Watts, J. (2017). Testimonial injustice and borderline personality disorder. The Huffington Post. https://www.huffingtonpost.co.uk/dr-jay-watts/testimonial-injustice-and_b_14738494.html
5. Hunter, C., (2011). A qualitative investigation into the lived experience of psychosocial assessment following self-harm. [Unpublished PhD Thesis]. University of Manchester. https://www.research.manchester.ac.uk/portal/files/54508538/FULL_TEXT.PDF
6. Horrocks, J., Hughes, J., Martin, C., House, A., & Owens, D. (2005). Patient experiences of hospital care following self-harm – A qualitative study. Leeds: University of Leeds. https://www.researchgate.net/publication/228359199_Patient_Experiences_of_Hospital_Care_Following_Self-Harm-A_Qualitative_Study

Dr Cheryl Hunter (@schmoobrain) is a trainee clinical psychologist at the University of East London (Email: u1147607@uel.ac.uk).

*Featuring Photo by Volodymyr Hryshchenko on Unsplash.