Can suicide attempt survivors be “stereotyped”?

Fellow Philadelphian, suicide attempt survivor and suicide prevention activist Dese’Rae L. Stage regularly tweets that, “Suicide attempt survivors cannot be stereotyped.  We are anyone and everyone.”Screen Shot 2016-02-18 at 9.54.14 AM

While I think I understand and agree with why Dese’Rae says this, I’m compelled to distinguish the cognitive dissonance that arises within me whenever I see this idea expressed on Twitter or anywhere else.

The inclination to end one’s life can arise within anyone.  Despite suicide attempts occurring more frequently in some demographic groups compared to others, there is plenty of evidence that indicates that suicidal ideations do not discriminate based on age, race, gender, sexual orientation, socioeconomic status, etc.  Given the dictionary definition of the word “stereotype”:

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…and its inclusion of the phrase “fixed and oversimplified image or idea of a particular type of person,” here again I find myself nodding and thinking: yes, many people hold oversimplified and factually inaccurate beliefs about people who die by suicide or attempt suicide.  I think many people believe that people who attempt suicide are weak, selfish cowards, and I stand side by side with my fellow behavioral healthcare advocates in working to dispel these notions as false, disempowering ones that only add to the stigma reinforcing beliefs held by many people concerning individuals with lived experience of mental illness.  I’ve published thoughts on this specific subject before.

It takes courage, massive amounts of courage to willfully end your own life.  It takes a special kind of brazen audacity to attempt to intentionally cause your heart to stop beating, knowing, to some degree at least, how much pain and suffering that ending your own pitiful misery will cause for those who have the deep misfortune of loving and caring about you.  Many think suicidal people are selfish cowards.  I won’t claim that there has never been a person who has killed themselves that fits that description, as far as how they lived their life.  But I will offer that anyone who thinks those two words: selfish and cowardly—about the act of suicide itself, has no first hand experience with the morbid deed.  The biological instinct for self-preservation is an almost insurmountable force to overcome.  Death is the greatest unknown and fear-inspiring phenomenon facing every human being that ever has and ever will live.  Possessing an enormous amount of courage is a prerequisite for completing a suicide.  I don’t think that suicide can be accurately described as selfish either, although I understand why people are prone to do so.  Selfish – the dictionary defines the word as:  lacking consideration for others; concerned chiefly with one’s own personal profit or pleasure.  While many survivors of suicide, (the friends and family of people who have died by suicide) may rightfully wonder how much consideration was given to their feelings by the recently deceased, it is impossible for someone who has died to experience “personal profit or pleasure.”  The ending of psychic or emotional pain and suffering by death does not result in pleasure, and the absence of pain does not necessitate the existence of its opposite.  The suicidal act itself therefore, by definition, cannot accurately be described as a selfish one as I see it.  Suicide is the extinguishing of the self.  An act that causes the self to no longer exist is not selfish, rather it is selfless.

While I think many people have oversimplified and factually incorrect beliefs about those who attempt suicide, I believe one effective way to fight the rising U.S. suicide rate is to correctly identify and inform as many people as possible of the types of behavior that people exhibit prior to making a suicide attempt so that life-saving interventions can take place prior to an attempt occurring.  Dr. Thomas Joiner, an American academic psychologist and nationally recognized expert on suicide authored the book Why People Die by Suicide in 2005.  From Amazon.com:

Drawing on extensive clinical and epidemiological evidence, as well as personal experience, Thomas Joiner brings a comprehensive understanding to seemingly incomprehensible behavior. Among the many people who have considered, attempted, or died by suicide, he finds three factors that mark those most at risk of death: the feeling of being a burden on loved ones; the sense of isolation; and, chillingly, the learned ability to hurt oneself.

Granted, I think it is correct to say that Dr. Joiner is not attempting to “stereotype” people who die by or attempt suicide; he paints a highly nuanced portrait of the suicidal person and the types of thoughts and behaviors that many people have or exhibit prior to attempting suicide.  In other words, it seems to me that Dr. Joiner and many others working to fight suicide are rightfully trying to identify the “type” of people who attempt suicide by exploring suicidal thinking and behavior assiduously.

As a suicide attempt survivor and prevention activist who works in this cause day in and day out, I repeatedly recognize thoughts I had years ago prior to my suicide attempt in stories in the press involving  suicide.  This happened this week when UFC fighter Ronda Rousey appeared on the Ellen DeGeneres Show and publicly shared about a suicidal ideation she recently had after losing a fight.

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“What am I anymore if I’m not this?” Ronda Rousey

After reading this brief from the New York Times, I thought: if she had made an attempt, it would have been an egotistical suicide attempt, very similar to mine.  It seems to me that Rousey’s suicidal ideation stemmed from a sudden, unexpected and irrefutable challenge to her self-conception as a UFC champion.  Her seemingly fleeting thoughts of ending her own life arose out of an attachment to seeing herself (and being seen by others) as a UFC champion, and a temporary unwillingness to see herself as anything else.  The thought of not seeing herself and not being seen as a UFC champion seemed, fortunately temporarily, unbearable to her.

When I was 27 years old, a challenging work assignment in a particular business area where I had no prior experience, presented an almost unbearable challenge to my own self-identity.  The experience that I went through so challenged my positive self image as someone able to tackle any obstacle put in front of me that I became unsure of absolutely everything.  Up until the time that I began to have suicidal ideations, I had never doubted my mental faculties, but the psychological crisis I became embroiled in shattered my sense of self and stripped away any prior sense of self-esteem and self confidence, and replaced those attributes with self doubt and eventually self loathing.  Hope and excitement for what lay ahead of me in the future were replaced with fear, even dread of what people would think of me if they learned about my psychological and emotional collapse.

My suicide attempt was an egotistical one based on feeling ashamed for not living up to my own potential as I saw it, and I think Ronda Rousey’s would have been too, if she had made an attempt.  I’m happy that she did not, and I am grateful that it occurred to her to share about her suicidal ideations publicly, prompting me to share these thoughts.  Einstein, like many other scientists, believed that free will was an illusion, and a product of a belief in another illusion: the “self” or the story we’re continually telling ourselves and others about who and what we are. I believe recognizing the “self” and free will for the illusions that they are, represents a radical yet promising pathway to reduce the suicide rate.

In conclusion, I do think Dese’Rae is right:  suicide attempters cannot and should not be “stereotyped,” but working diligently to identify the types of thinking and behavior that people who attempt suicide exhibit, essentially, identifying the type of people prone to attempting suicide lies at the heart of causing the beginning of the end of suicide in the U.S. and beyond.

Flashback Friday: A look back at the beginning of “the beginning of the end of suicide”

This video includes clips from a few different vignettes from seven years ago when my strategy for sharing the story I wanted to tell and the lessons learned from it was focused on telling the story via a dramatic feature length film.  While I still resolutely believe in the story’s inherent appeal for movie-going audiences in America and beyond, I’m not married to the idea of it first being shared via that medium necessarily.

“Andy DuFraine” is the person speaking in this video;  he came across YouTube videos I was posting online back in 2009 and initiated a dialogue with me.  We barely knew each other back then when he recorded this audio where he shares some flattering and optimistic feedback about his vision of the potential positive impact of the activism work I was and am now again engaged in, to fight suicide.

I hope he’s right.

 

From suicide attempt survivor to American Foundation for Suicide Prevention speakers bureau member

In 1998 I was a 27 year old, Magna Cum Laude graduate of the University of Notre Dame who had recently become the youngest Principal consultant in American Management Systems Manhattan office.  Shortly after receiving a 7% off-cycle salary increase due to exemplary job performance, I was found unconscious inside of a running rental car in a parking lot of a warehouse in Secaucus, New Jersey.  I had transformed the car into a makeshift carbon monoxide gas chamber the night before.  After losing consciousness in the rental car and prior to waking up in the hospital, I had what is commonly referred to as a near death experience, and if I had not survived, the cause of my death would have been listed as suicide via acute carbon monoxide poisoning.  As accurate as that description would have been,  I’m compelled to share about how my lack of experience with the thoughts and feelings I had leading up to my suicide attempt, and my fears about what other people would think about me, if I had revealed the struggle I was embroiled in, dissuaded me from getting the help that I so desperately needed.  As a suicide attempt survivor fortunate enough to have a second chance at life, I hope others suffering as I did will benefit from the lessons I’ve learned over the last eighteen years.

In late 1997 while on a challenging work assignment in Toronto I began to experience insomnia for the first time in my life.  My mental health deteriorated quickly over the next few months as my five closest friends all coincidentally moved away from New York City, and I began to ruminate over what I was doing with my life.  Up until when I began to have suicidal ideations, I would have described myself as very confident with respect to my intellectual abilities, but the personal crisis I became involved in, stemming from difficulties encountered on the project in Toronto, shattered my self confidence and stripped away my self esteem.  In their place was an overwhelming sense of self doubt followed eventually by self loathing.  Hope and excitement for the future were replaced by fear and apprehension.  Night after night of getting between zero to three hours of sleep at most, and the relentless barrage of dark, automatic thoughts bombarding my consciousness ate away at my sanity, and over the course of only a few months I was lost in a seemingly inescapable, abysmal black hole of simultaneously self-defeating and self-fulfilling thoughts.

I wasn’t familiar with the diagnostic criteria of major depressive disorder at the time, but I learned after the fact, that I was a textbook case.  I had persistent feelings of emptiness, hopelessness and worthlessness.  I lost interest in activities that I normally enjoyed, and my appetite all but vanished.  It was challenging to concentrate and to make decisions, even simple, inconsequential ones.  Not surprisingly given how little I was sleeping, I was perpetually tired and lacked energy.  Recurrent thoughts about dying, the first was imagining that my Friday afternoon flight home from Toronto to New York City would crash, eventually evolved into persistent thoughts about intentionally ending my own life.  The long, sleepless or nearly sleepless nights took the greatest toll on me.  I was unable to quiet my sleep deprived, addled mind from producing a non-stop stream of negative, hyper-critical thoughts, as overpowering feelings of shame, guilt and embarrassment consumed me.  I was ashamed that I needed help to deal with how I was feeling.  I felt guilty that I was having suicidal thoughts considering my life of relative privilege and my knowledge of the depth and breadth of suffering experienced by countless others in the world.  I was embarrassed that I had ever considered myself intelligent and capable of attaining any goal I set my sights on achieving.  I was ashamed that I was considering suicide out of a fear that I would become completely incapable of doing my job.  I felt guilty that I hadn’t achieved more in life considering my talents as well as the advantages and opportunities afforded me.  I was embarrassed to be in a position where I obviously needed help and was mortally afraid to admit that fact to anyone.  I viewed my deteriorating mental health as a character flaw, because I believed that other people would see it the same way, and I believed that asking for help to deal with what was going on in my head was a sign of a personal weakness. Thoughts and beliefs like these lie at the heart of the stigma surrounding mental illness, and explain why many people suffering like I was back then never seek help.

According to the National Institute of Mental Health, in 2013 an estimated 15.7 million, or 6.7% of all U.S. adults, had at least one major depressive episode in the preceding year, making it the leading cause of disability in this country.  Sadly it is estimated that only about half of Americans suffering from depression ever receive treatment for the disorder.  Over 90% of Americans lost to suicide each year suffer from depression or some other behavioral health condition.  In 2014 alone, 42,773 Americans, or about 117 a day, died by suicide according to statistics from the Centers for Disease Control.  The tragic reality behind these statistics is that a great majority of people suffering from depression could be helped by one or a number of different treatments that help people return to living full, productive lives.

Immediately after my suicide attempt, I began taking the antidepressant medication Paxil, and seeing a psychologist twice a week, and within about three months, I was well again.  I lived with my parents during that time period, and my mother had bought me a small stack of paperback books to read while I convalesced.  While most of the books were novels, she had also bought me a copy of David Burns best selling book Feeling Good:  The New Mood Therapy.  It was the last book I read out of the stack, and although I was still too depressed when I read it the first time to appreciate the significance of the ideas it contains, over a decade and a half later, it’s clear that what this book taught me about cognitive behavioral therapy (CBT) comprises some of the most valuable lessons I’ve learned during my eighteen plus year journey as a consumer of mental healthcare services.  In the book, Beck summarizes what he refers to as, “the powerful principle at the heart of cognitive therapy,” by writing “your feelings result from the messages you give yourself.  In fact, your thoughts often have much more to do with how you feel than what is actually happening in your life.”  A few years later, my psychologist introduced me to a related idea called mindfulness –  the practice of being aware of the present moment and your thoughts and feelings in a non-judgmental way.  Both CBT and the practice of mindfulness helped me to be more reflective about my thoughts and feelings as I was experiencing them, helping me to consciously respond to them in a more discerning and intentional way instead of impulsively reacting to them.  I have never taken an antidepressant medication since the time immediately following my suicide attempt, nor have I ever had a recurrence of a depressive episode as severe as the one that I had in 1998.  By no means do I believe that I am “depression-proof”; no one knows what tribulations may befall them in the future, but it’s clear to me that years of reflective introspection and personal growth have equipped me with valuable insights, habits and tools that help to safeguard me against the self-defeating thought patterns that led up to my depression and suicide attempt over eighteen years ago.  I have developed other habits over the years that have also helped me to remain well in a sustainable way.  I transformed my diet to consist mostly of plant based foods full of fresh fruits and vegetables, and I became an avid distance runner.  I worked to cultivate a habit of unconditional self-acceptance as well as the practice of consciously acknowledging things in my life that I am grateful for on a daily basis.  Recognizing the dangers inherent in becoming isolated, I committed myself to remaining connected and communicative with my family and close friends.  Maybe most importantly, I have promised myself and those I love that I will never hesitate to ask for help from them or a professional caregiver if I need it.

afsp_logo_blue92-53-41-17-1Unlike when my silence about my suicidal crisis over eighteen years ago almost led to my demise, now I view the act of asking for help as a sign of courage and strength.  This belief led me to join the Speakers Bureau of the Philadelphia chapter of the American Foundation for Suicide Prevention where I deliver talks at area high schools and colleges about the warning signs of suicide with the aims of reducing the stigma surrounding mental illness and lowering the suicide rate.  I see making myself vulnerable to the potentially negative judgments of others by publicly sharing about my past as a powerful way to offer hope to people who are suffering, and to encourage them to seek help.

frank talk about Charleston, mass shootings, guns and the beginning of the end of suicide in America

Note:  I wrote this post before I heard President Obama’s eulogy for the Honorable Reverend Clementa Pinckney.

 

Like millions of other people around the world I was saddened and disgusted by the cold-blooded murders in Charleston last week.  In my view, looking at our nation’s entire history, you are blind if you do not readily recognize the significant strides in civil rights made by and for African Americans and other minorities in this country.  I think you are equally blind, if you are unable to see  how far we still have to go, to live in a society free of hate, hateful acts, and discrimination.

To the families and loved ones of the fallen:

Please accept my deepest sympathies  for your loss; you have been and continue to be in my thoughts.  I cannot fathom how painful it must be to lose a loved one to such senseless violence, and I was moved to tears when I first heard the amazing expressions of mercy-filled forgiveness from some of you on the news.

I heard Anthony Thompson speaking to his wife’s killer say, “I forgive you.”

I heard Bethane Middleton-Brown, Reverend Middleton’s sister, tell her brother’s murderer:  “We are the family that love built, we have no room for hate, so we have to forgive.”

And I heard Nadine Collier who lost her mother, say this:  “I just want everyone to know I forgive you.  You hurt me, you hurt a lot of people, but I forgive you.”

These incredible examples of forgiveness are profoundly beautiful and inspiring reminders of the redemptive power of love.  Thank you for having the courage, and the strength and the compassion and the grace to respond to hate with love as you have.  Your expressions of forgiveness to your loved ones’ murderer very well may have saved other lives by inspiring peace in the wake of this tragedy.  I commend you for leading with your love, and I hope that you may find peace, as you mourn, remember, and pay tribute to the memory of your loved ones.

To the people of Charleston:

The peaceful, love-filled response to these horrible murders shows me and the rest of the world that the words of Alana Simmons will never be proven wrong.  “Hate won’t win,” she told her grandfather’s killer.  The sense of collective unity and strength exemplified by your community’s peaceful response to this tragedy reminds us all again of the unstoppable power of love to continually rise up and overwhelm destructive forces of senseless hate and violence.  Thank you for your strength and fellowship during this trying time for your community.

To the person who repeatedly pulled the trigger on the gun, last week, that killed nine members of the Emanuel A.M.E. Church Bible study group:

The murder of a single innocent person is a crime against all of humanity.  Inspired by the amazing examples of mercy shown to you by the loved ones of your victims, I too forgive you.  It’s impossible for you to undo the damage that you’ve done or to make up for the heartbreak that you’ve caused, but it is within your power to show genuine remorse.  I know very little about you and the life you’ve led, but whatever the source is of your hate, I don’t believe that you were born with it.  As a result, I am sorry that whatever happened to you to cause you to think and act as you did last week ever happened, truly I am.  You still do have the power to redeem yourself by working to replace the hate in your heart with love.  I would not be surprised at all if the loved ones of your victims offer to help you do this. Make no mistake, those people are subject matter experts in love, and at the very least, you can learn from their example, and I sincerely hope that you do.

Guns and Suicide in the United States

Considering my personal thoughts and feelings about the importance of the suicide awareness and prevention movement, I’m compelled to take this opportunity to raise awareness about some important, and very probably surprising facts, for many, related to gun violence and how the overwhelming majority of its victims die in this country.

Taking a look at data from 2009 published by the CDC, the total number of deaths caused by guns that year was just over 31,000.  Of those, nearly 19,000, or about 60% were suicides, a number that represents just over half of all suicides that occurred in the US that year.  Around 37% of the deaths caused by guns in 2009, or about 11,500 of them, were homicides, 39 of which occurred during four separate mass shooting incidents, according to data in a Mother Jones report.

So, doing the math, for every one American that was murdered in a mass shooting event in 2009, about 480 Americans died by suicide via a gun.  If you compare mass shooting deaths with all suicides from that year, regardless of the method, this ratio jumps to almost 1000 suicides in America for every single person murdered during a mass shooting incident.

567 Americans have died in 70 mass shootings from 1982 up to and including the one in Charleston last week.  In 2013 about 41,000 Americans died by suicide, averaging 113 lives lost daily.  So, doing the math again, tragically, it only took five days for suicide to claim 567 American lives, the same number of lives lost in every single mass shooting to occur in this country over the last 33 years, combined.  Finally, if the suicide death toll were to remain constant over the next 33 years, we would lose more than 1.3 million American lives over that time period.

To President Obama:

After 20 six and seven year olds were massacred at Sandy Hook Elementary School you said:  “As a country, we have been through this too many times… And we’re going to have to come together and take meaningful action to prevent more tragedies like this, regardless of the politics.”  After the mass shooting in Charleston last week, you said:  “…at some point, it’s going to be important for America to come to grips with [gun violence] and for us to be able to shift how we think about the issue… collectively.”

I agree with you Mr. President, and I, and my fellow suicide awareness and prevention activists are committed to shifting that thinking, right now.

Every single innocent life lost due to murder is tragic and significant, undoubtedly, but, the facts about suicide and guns that I have presented here clearly demonstrate how insignificant mass shootings are, relatively speaking, as a cause of death in this country.

I respectfully urge you to consider using your bully pulpit to lead a conversation in this country about access restrictions on guns as a way to save thousands of American lives.  A 2014 study from the American Journal of Preventive Medicine found that: “Reducing the availability of highly lethal and commonly used suicide methods has been associated with declines in suicide rates of as much as 30%–50% in other countries.”  What’s most interesting about this finding is that restricting access to the means of suicide can dramatically impact the suicide rate without even addressing the mental health condition responsible for the suicidal ideations.   This is a vitally important insight, because suicidal ideations are often impulsive and very hard to predict.

A 50% reduction in the number of suicides caused by guns in this country would save over 10,000 lives in one year alone!  At the current rate, it would take over 600 years for mass shootings to claim that many lives in this country.  President Obama, I implore you to consider re-framing the gun control debate in this country. Focus it on the most likely way, by far, for a gun to be involved in the death of an American. Focus the gun control debate, on the least talked about major cause of death in this country. Focus the gun control debate where it belongs and has the greatest potential to save the most lives.

President Obama, please, focus the gun control debate, on suicide.

To all Americans:

In closing, I’ll add that I’m convinced that suicide will not remain on the list of the top ten leading causes of death in America for much longer.  Me, and thousands of others like me, already personally touched by suicide, are committed to lowering  the suicide rate, and we are an unstoppable force, powered by love.  It is only a matter of time before we build the political will necessary for this country to take the collective action required to dramatically reduce the number of lives claimed by suicide.  I believe this relatively small group of thoughtful, committed citizens is about to cause a beautiful tipping point in this movement, but we need more Americans to join us in this fight to finally bring about the beginning of the end of suicide in America.  Please consider volunteering your time and energy or donating money to a suicide awareness and prevention non-profit.  Here are links to the websites of three major, national ones :

American Foundation for Suicide Prevention

Active Minds

The Jed Foundation

Finally, I call on every American to either learn about or remind themselves about the warning signs of suicide and what to do about them if you see them within yourself or in someone you know.

Thank you for reading and please take the time to share this post.

Sincerely,
Francesco Bellafante
June 26, 2015

Update:  A question from a friend has prompted me to add a link for the scientific research into gun violence in this country, and a link to a recent piece from Slate.com.

For a collection of scholarly research articles on guns and suicide see the Harvard Injury Control Research Center.

For an article from Slate.com about gun violence in America from January of this year see ‘ and ‘ piece:  The Myth of the Good Guy With a Gun

National Children’s Mental Health Awareness Day at the Children’s Hospital of Philadelphia

Last Friday was National Children’s Mental Health Awareness Day, and I had the pleasure of spending it meeting and speaking with some wonderful people at the world renowned Children’s Hospital of Philadelphia.  A fellow American Foundation for Suicide Prevention Greater Philadelphia Chapter Speakers Bureau volunteer and I shared important information about the problem of suicide in children and young adults, as well as about the various training programs and resources that the AFSP provides to healthcare professionals, educators and the general public.  I was inspired by the people I met today and their sincere desire to make a difference in doing what they can, to help people struggling with suicidality.  I look forward to participating in additional events at CHOP in the near future!

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Tim Ferriss Gets Personal About Suicidal Ideations

Tim Ferriss has long been a role model and inspiration to me as far as self-actualization.  He wrote an extraordinary blog post this week about his own personal experience with suicidal ideations while a student at Princeton, and he offers his insights on the subject.

I commend and congratulate Tim on sharing his story, and I hope that I can enroll him in the idea of the two of us having a “frank talk about suicide” in the near future.

Some Practical Thoughts On Suicide by Tim Ferriss

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