Notes on diagnosis and suicide and self stigma

When I was first diagnosed and hospitalised it was a horrific
experience. Initially I'd been hospitalised for making threats of
suicide. I wasn't suicidal per se. I was living in apersecutory delusion
that came about through trying to interpret the change in consciousness
I was going through or may have been part of the change.

I received a relatively high level of support following my
hospitalisation. I was seen frequently by a private psychiatrist -
sometimes more than once a week. My friends were supportive and
understanding at the time, or tried to be. My family tried to get me the
very best treatment. This is a privilege few have.

A major problem was self stigma and to this day I'm not sure I've gotten
over that problem. I hated becoming one of the mad. I was cool crazy,
not actually crazy. The stereotype of the mad, deranged fool was all I
could see and I could see no good or value in that. The deeply ingrained
stigma turns to self stigma upon diagnosis.

I could sense the immense loss of social standing that came with madness
and I thought my career was over. Who would want a mad person? The
mental picture or stereotype of a dribbling, incoherent,
incomphrensible, babbling, mental human being was not something I had
much sympathy for.

I've been debating about the renaming of the term schizophrenia and I
thought it was a dumb idea. As I've thought about it this morning I can
understand why someone might think it's a good idea.

When I was given a diagnosis of bipolar and almost 8 years ago I didn't
know of any positive stereotypes. I knew nothing of the mental illness
except that it was a mental illness, and not a 'nice' (=acceptable) one
like depression.

About 4 years ago I went to a local writers group in North London. I
ended up chatting with some people in the pub afterwards. Somehow the
conversation got round to mental illness and I revealed that I'd had a
diagnosis of bipolar. Someone said to me, "you're so lucky." Clearly my
life had changed a lot in the interim because I'd never have been at a
writing group had I not gone through crisis. I also wouldn't have been
able to hear that response in other social settings. Most importantly I
think, I wouldn't have heard that response without the Stephen Fry
program the Secret Life of a Manic Depressive.

A diagnosis of madness or severe mental illness is associated with a
high suicide rate and the epidemiological data shows the risk is highest
in the period after initial diagnosis. With time an individual becomes
comfortable with the concepts and able to believe in themselves again
though the journey to find oneself again after a diagnosis is long and
very, very painful one.

I haven't heard anyone say it yet but I'm sure someone already has: part
of the cause of the high suicide rate is the diagnosis itself (and
associated self-stigma).

If your life and hopes were taken away because of the self-stigma and
prognosis of mental illness, if your identity and self-esteem were
shattered through thinking that you were now mad, if you were told that
your mind was diseased and abnormal and if your dreams for your future
were rended asunder wouldn't anyone want to kill themselves?

It's my opinion that if the effects (and others) of a diagnosis of
severe (and maybe common) mental illness listed in the above sentence
that can lead to suicide could be ameliorated in any way whatosever this
could reduce the risk of suicide after initial diagnosis.

From the research and from personal experience the suicide risk for
those who have lived with mental illness for a long time may need a
different sort of approach. Living with severe mental illness for ages
is very different.

There's a useful snip from a paper I'm reading.
http://schizophreniabulletin.oxfordjournals.org/cgi/reprint/16/4/571?view=long&pmid=2077636
<http://schizophreniabulletin.oxfordjournals.org/cgi/reprint/16/4/571?view=long&pmid=2077636>
Schizophrenics kill themselves too: A review of risk factors for suicide.

"
Although the majority
of the studies point to a concentration
of suicides among schizophrenic
patients in the first 10 years
of the disorder (Johns et al. 1986),
there is also evidence that an
increased mortality risk exists across
the life span. M. Bleuler (1978) observed
that the timing of suicide
among his probands was distributed
throughout the course of the illness.
Based on his clinical experience,
Bleuler rejected the "fallacy" of what
he called the "outmoded assumption"
that older schizophrenic patients are
too burned out to experience suicide precipitating
suffering (p. 306).
"