Assumptions, help-seeking and suicide

I think this area's become one of my bugbears for a couple of reasons. One's personal experience. The other's professional experience. This piece is in part written from personal experience and present present personal experience which I've kept off my blog.

I sat here this morning rethinking the prejudice of men's help-seeking behaviour. Mental health is a predominantly feminist movement. There is little consideration of the masculine epistemology of mental health. In all honesty I'm not even sure what that is. It might be resilience. It might be the things which men value about mental health, i.e. sucking it up and getting through the pain. These are the values of mental health taught in the public school system and considered a traditional or historic ideology which the female ideology in mental health surpasses. Supposedly anyway.

So much is based on assumptions. It's not surprising. So many people do it. Unfortunately assumptions can be informed by prejudice and they can be wrong. I'm as guilty of this as anyone. Good science, by which I mean any endeavour which truly seeks to unveil the absolutely truth (or as close as we can get to it), is a battle against this sort of practice of assuming assumptions and prejudice are in any way truths.

If I asked anyone why they thought that men in general didn't seek enough help for mental ill health they'd probably tell me to stop being boring and asking stupid questions. The people I'd have more respect for would answer it is because they kill themselves more.

I'd say that's absolutely true in that men successfully terminate their lifes much more often than women. It is a terrible fact that men kill themselves three times more successfully than women.

This does not prove that men don't seek help for mental ill health. As one might gather by the emphasis in the previous paragraph this proves that men are more successful at killing themselves. In truth the research shows that the methods they chose are more violent and that's the reason why they're more successful.

The fact that women attempt suicide a lot more than men and this effect is prevalent across the Western world seems to escape most people. While men kill themselves more women attempt to kill themselves more.

But that's not what I'm thinking about this morning. (Or what I should be thinking about which is the precarious state of my life and the fact that 4 months hard work has left me penniless. I'm avoiding the thoughts and emotional impact of my current life by escaping in a variety of ways.) What I'm thinking about is the relationship between suicide and help-seeking.

The assumption is help-seeking and suicide have a relationship. It is assumed that help-seeking stops people attempting to kill themselves. In a paper on help seeking behaviour and gender the authors struck upon a surprising result. The attitudes to helpseeking for mental ill health were only slight different between men and women in overall levels - the difference wasn't big enough to be statistically significant. The largest difference in attitudes is about help-seeking from a GP and this is reinforced by another (very poor) figure showing men use GPs significantly less than women in adult age (this figure is for working age only, the report from where it comes from states that women's problems, baby problems and family planning visits would inflate the difference and that at above working age the effect is not seen at all). This small difference in attitudes to seeing a doctor for mental ill health does not account for the suicide rate and men clearly seek help from other sources.

For the last decade men and women have sought help roughly equally from The Samaritans suicide helpline. This services is accessed by hundreds of thousands of people every year in the UK. The data is publically available on their website. It is consistent that men contact the Samaritans ever so slightly more than women - statistically insignificant though so really it's safe to say both genders contact the Samaritans equally.

Clearly help-seeking isn't helping. While men use the Samaritans as much they kill themselves more. While women use the Samaritans as much they try to kill themselves more. What's the big factor here: help-seeking or method? Clearly the method.

There is an assumption that talking helps people who are actually going to kill themselves. Again this precision is based on refining the truth. Some think about killing themselves as a solution to their present problems. Talking about these problems can help as can toughing it out. The latter isn't an accepted way of getting through things because the assumption is by not talking about it a person is more likely to kill themselves. There is little respect for personal process or the process through which resilience is developed.

Some people who I've spoken to about the high attempted suicide rate in women have explained these attempts are about help seeking or attention seeking. Those people are idiots. I have no idea where this false assumption comes from. Probanly some psychological bullshit from people who've never been through the experience nor attempted to understand the human beings who attempt suicide. The very idea that someone takes their life to either get attention or seek help is the sort of assumption which is made by people who understand fuck all about mental health. There is one and only one conscious thought which most (perhaps all but a very small handful) are thinking about when they try to kill themselves: they want to die. There are a million and one ways to seek help and gain attention which don't involve the conscious process where an individual gets to the point where death is the only option.

There are many modes, many mental states before, many circumstances and individual personalities in suicide. A lot of suicides often happen when there's a change in a person's states and almost invariably when it is a lowering of status. So it's not usually people who are alone but people who become alone (through a relationship breakup for example) who are at risk of taking their life. It is not people who are poor but people who go from rich to poor, it's not the unemployed but people who go from employment to unemployment. This category of suicide may be helped by the individual being able to talk about their circumstances but the assumption that they will or they should is bollocks. The individual is going through a terrible part of their journey in life. It gets so bad that some individuals can not see a hope. Once the decision is made to end it there is no normal or logical process of help seeking for people who are new to suicidal thoughts. What is the point of seeking help which has the aim of changing a decision which was very hard to make in the first place? Help seeking after making the decision to kill yourself is irrational. I guess these types of suicides are often quite quick - there is little time between the triggering event and action. These are the sort of suicides which people think are the totality of suicide.

There is another category. There is the suicide which a person thinks about then chooses. It may not be a circumstance of life event. More life itself. Some people want to die and this can be a choice. I don't know the numbers. There is a figure quoted that 80% of suicides are because of mental illness. I assume what they're talking about is what I've attempted to describe in the previous paragraph. The 20% is what I'm trying to explain here. People with or without a long standing mental illness can want to take their lives for many reasons. For the mentally ill it can be the life of being mentally ill which they no longer want to live. For others it's simply life without mental illness they no longer want to live. It is assumed that this comes from depression but I'm talking about the decision to kill oneself outside that clinical syndrome.

For the latter there is no help seeking once the decision is made. It might be spoken about but the decision is a long thought out decision which requires no 'therapy' to change a person's mind. This is suicide after a life of hell and a continued life of hell, one which the medical system can neither understand nor treat.

Imagine a person who waits 4 years to kill themselves. While the decision might have been made in depression the depression itself is not continuous for 4 years. The decision stays constant though and 4 years later the individual kills themselves. This sort of suicide is not mental iullness though many would want to apply the paradigm to use brain washing and behavioural modification techniques. It is a rational decision executed by a competent person, perhaps one you may not understand but your lack of understanding does not make another's decision irrational.

The only help the individual would want is in the execution of their plan. Many indiviudals want peaceful, reliable ways to kill themselves. This should be a right however we live in times where it isn't., Even the Swiss who allow people to termiante their lives have attempted to block the right for the mentally ill. We are refused dignity in dying like we are refused equality and existence in life.

This is just the tip of the iceberg of how complex suicide, help seeking and individuals are. Just the tip.