Suicide Archives - Embodied Living

Suicide is terrible but we need to talk bravely about it. It is terrible for those who take their own lives and also for the friends and family involved.

Leaving others with impossible feelings

Those left behind in suicide can experience unbearable feelings of guilt. These ‘whys’ and ‘what ifs’ can seem almost impossible to reconcile. Suicide is not a proportional response to anything. It is a desperate act to escape pain that is seemingly unbearable and unmanageable.

A desperate act

We need to talk about suicide because the figures are appalling. In 2015 1,732 people died of road traffic accidents yet in the same year 6,188 people died by suicide in the UK. On the face of it, men are more at risk. However, if you include the number of attempted suicides, or para suicides, it seems that both sexes are equally at risk – and across all adult age groups. This year the number of children and teenagers who are taking their own lives has hit its highest rate in 14 years.

For the sake of those at risk

But mostly we need to be brave enough to talk about suicide for the sake of those at risk. Contrary to opinion, people don’t have to have a mental illness to be at risk of taking their own lives. Yes those with depression, personality disorders or self-harming tendencies are more at risk. But many who have suicidal ideation, battle with it for many years and have no such presenting factors.

Common factor

The one common factor with those at risk is that their feelings are unbearable and their motivations unconscious. These feelings often include a sense that they are a burden and the world will be a better place without them. They often feel that their problems are somehow bigger and more overpowering than anyone else’s: a displaced sense of being special but in a terribly negative way.

Outside of conscious awareness

Motivations for suicide are mostly outside of conscious awareness. It is obviously an act of killing and destruction. However the less obvious intention is that it is an act to both destroy the self and also to save part of the self that can benefit from the act. For instance, the motivation may be a longing for peace. Indeed if the person has a lifetime of having no sense of peace whatsoever, they may feel that killing their self will bring peace. However integral to this (but outside of conscious awareness) is a belief that part of the self will remain to experience peace. Clearly this is not true.

Another motivation can be revenge. A person may have long-held (real or imagined) grievances against others who didn’t care enough. Or they may have deep hurt from being thwarted or abandoned. All this remains deep in the unconscious. Nevertheless behind the suicide action is a fantasy that some part of the self will survive in order to gain satisfaction from the act. This is the tragedy that makes suicide so heart breaking.

We need to be brave

And this is why we, as family, friends, or therapists, need to be incredibly brave to have careful and appropriate conversations with people at risk of suicide. In this way they can feel someone can bear the unbearable with them and begin to help them explore the unconscious nature of the act.

 

(Please note: anyone at risk of suicide needs specialist professional help and support from a registered mental health professional)

This article was first published in the Staffordshire Newsletter.

Neuroscience and neurobiology are now confirming what we know in our hearts to be true. That the role of the ‘good enough’ mother in the infants first 3 yrs of life is crucial in right hemisphere brain formation.

Development of self

This attunement that generally happens between mother and infant in the first few months of life affects the development of the ‘self’.  More importantly, it will impinge on the individual’s ability for self regulation and processing of negative emotions particularly rage.

Brain development through sensitive mother

It is absolutely essential to brain development that the infant has a sensitive, responsive mother to help be a ‘container’ for the developing self. This is a limbic-to-limbic brain relationship and if the infant does not get enough of this it is akin to a kind of ‘brain damage’. This is the concept of the ‘good enough’ mother.  Good enough means that we don’t have to be perfect or get it right all the time. In fact if we get it right just 40% of the time with our kids this is ‘good enough’.

When parenting is not ‘good enough’

Yet if the parenting is not good enough, the wiring goes wrong which has significant implications into adult behaviour. Traits or behaviours such as sarcasm , judgementalism (sexism being one) being a couple. Even worse are addictions, depression and withdrawal. Of course the inability to ‘do’ relationships will be a key factor in anyone who didn’t get enough correct attunement with a good enough mother. And sadly the risk of self harm, suicide, violence or sexual abuse, and serious mental health disorders increases when we haven’t had our emotional needs met in childhood. The ‘good enough’ father is also crucial but for different reasons at different ages.

Vicious cycle

Where is individual choice in this? If the mother’ right hemisphere was not nurtured and sustained by her mother, in turn she will not be able to nurture and sustain her own child. And so the cycle continues, into a ‘sick’ society. So for those of us who want to try to dismiss or rationalise this, it can useful to remember the miraculous plasticity of the human brain. In that even this deeply embedded wrong wiring can be changed with effort and acknowledgement.

Individual choice

That’s wherein individual choice lies. But it is not a rational process, we cannot ‘think’ our way out of the problem. But psychotherapy can be a limbic-to-limbic brain relationship that can change the very wiring and change lives in the most positive ways imaginable. Amazingly, even the repeat rate of sexual offending of children is dropped to 5% or less. And these are the reasons why mothers are ‘culpable’ but should not be blamed.

The signs of depression vary from a general sense of unhappiness and meaninglessness to persistent changes of mood and feelings, and to psychosis (Hale & Davies, 2009). Whilst depression can have a deep impact on our lives, it can be helped with therapy.

Depression is classed as an affective disorder involving a prolonged and fundamental disturbance of mood and emotions (Cross & McIlveen, 1996). The signs of depression are associated with changes of behaviour and even physical symptoms (somatisation) such as backache and headache (Hale & Davies, 2009).

Core symptoms of depression

Depression’s core features are:

  • pervasive low mood
  • loss of interest and enjoyment (anhedonia);
  • reduced energy and fatigue and diminished activity (withdrawal).

Other features include poor concentration attention and decision making, diminished or increased appetite and loss of libido and disturbed sleep (waking early or over sleeping). Increased agitation or restlessness (pacing about, complaining) and irritability can also show for some. And of course we all know the risks of ideas or acts of self-harm or suicide that go with depression. In the depressed person self-esteem and self-confidence are incredibly low. And they are plagued by feelings of guilt and /or unworthiness. There is a bleak or pessimistic view of the future and depersonalisation (a feeling of I’m not me anymore). Some people may show multiple physical and behavioural symptoms in the absence of low mood (‘masked depression) (Hale & Davies, 2009).

Feeling flat

Another feature of depression is a loss of reactivity, individuals will show a blunted or ‘flat’ affect to life events (Sims, 1995). They show a failure to express feelings either verbally or non-verbally, especially when talking about issues that would normally be expected to engage the emotions. The difference is in degree. The client himself is not aware of his deficiency but when pointed out to him, may agree that there is a lack of any sort of emotional reaction (Sims, 1995). This may be experienced as a feeling of a loss of feeling made worse by the client’s own questioning of himself, feeling guilty about the lack of feeling.

Depressive episodes

A depressive episode may be classed as mild, moderate or severe. Nevertheless, diagnosis lies in skilled clinical judgement (WHO ICD 10), and usually symptoms have to be present for at least two weeks. A diagnosis of mild depression requires that at least two of the core symptoms are present (low mood, anhedonia or fatigue) and at least two of the other symptoms. For more severe depression more of these symptoms are present.

The Hidden Side of Depression

Clients often come to therapy presenting the physical symptoms of depression: lack of energy; loss of libido; disturbed sleep; absence of periods; unexplained aches and pains; difficulty making decisions; low motivation and inability to start or complete things. However they may not call it depression.

In an intake conversation a client talked of many symptoms of depression but presented them as problems related to her ‘tiredness’: ‘when I get tired my default position is negative, like I’m useless and no one likes me’. This client was clearly preoccupied with her lack of motivation to go into work. Her fear of not being able to get into work, ‘I cannot afford not to go into work’.

Alcohol and depression

Depression may also present itself as excessive alcohol consumption, this is perhaps more common in men (Rowe, 1983). Rowe (1983) observes that many men use alcohol to hide their weaknesses from others and to hide from themselves their own fear and despair. They drink excessively in social situations and also alone at home.

Anger and Depression

Many people learn early on in childhood that it is wrong to get angry. (Rowe, 1983). This may be through having seen too much anger expressed in parents’ relationships with each other or with the child and the child then ‘decides’ that to be angry is bad and so represses it.

Schiffer (1988) proposes that this leads to depression because when a young child’s needs are not being met they will protest loudly (raging tantrums). This makes them even more difficult for the parents to handle so that parents become threatening or unresponsive.  Eventually the child may become anxious (threatened) then ultimately defeated (depression) thereby establishing a limbic brain tendency towards depression. (Schiffer, 1988)

Depression is anger turned inward

Freud and Abraham posit that depression is anger turned inward against self (Schiffer, 1988) when the child internalises the parent figure and then attacks the parent inside. People often perceive depression as a failure or weakness and as humans we have an innate tendency to get angry with those that fail.This is why depressed people often attack themselves.

In addition a tendency towards ‘identification’ with the persecutor means that sometimes when a person feels overpowered by someone else there is a desire to befriend them. In this way, the mind of an abused or mistreated child seeks to befriend the abusing adult. But to join the tormentor the child’s troubled mind must take sides with the abuser and therefore turn to attack himself (Schiffer, 1988).

Internalising the critical parent

Exacerbating this for many clients is the critical parent that has been internalised in the child’s superego, and which will serve to torment the adult client with lifetime barrage of criticism and negative self-talk (Schiffer, 1988).

Case Study

(A fictional client assembled from real life experience)

For MN anger was an alien emotion. He stated that he rarely got angry and was proud to be a very placid man most of the time. He can remember two occasions when he did ‘lose it’ and he was shocked and scared at his reaction. This reinforced further repression of the emotion. In fact MN had a lifelong pattern of repression of emotions. This meant that he was not in touch with emotions to be able to talk about or express them. It was clear to the therapist that he had unresolved anger, as well as sadness and guilt about his wife’s death: ‘I wasn’t brave enough to challenge them,’ and ‘why do bad things have to happen to good people?’

Repression helps us cope, somewhat

Repressing anger by burying it deeply , perhaps because of fear of rejection or that it may escalate out of control, may be a good coping strategy to survive childhood. But the trouble with this is that it is the coping strategy itself that becomes problematic in adulthood causing many of the somatic presentations.

Depression as people pleasing

Another defence mechanism in dealing with anger is reaction formation where the unacceptable ‘bad’ feeling of anger is turned into its opposite extreme of needing others’ approval to feel good. This ‘people pleasing’ (Parker-Hall, 2009), shows itself in putting others before self or needing excessive amounts of approval from others. External behaviour presents as trying to please others all the time, being the peacemaker, going out of one’s way to never offend others, or a preoccupation with what others think about you. (Rowe, 1983). These types of people often find it difficult to say no and get put upon a lot and go to great lengths to avoid conflict.

To summarise, depression or depressive tendencies can show themselves in many varied and surprising ways. However, by understanding the patterns that present in our adult life and linking their origins to our past, we can heal. By recognising unmet needs and addressing them, we can begin to be more whole and become our authentic self.