I could write a whole series on suicide, because it says so much of the times that we live in. In this piece I describe two very different people who crossed my doorstep: An adolescent girl and a mid-career professional man. Both confirm my professional conviction that all behaviour is logical. That symptoms are not simply “something onerous to get rid of”, as Jung said. That symptoms are deeply meaningful, and often the most authentic voice of ourselves that has remained, when the battle inside has been particularly fierce.

Is Suicide about despair? Thus asks a friend.

Hannah Arendt, a German-American philosopher, wrote in The Human Condition (1958),

“Our short, to death-speeding life, would result in inevitable death and destruction, if we did not possess over the capacity to interrupt this death march, and begin something new.”  

“To begin something new is the best ability of a human, politically seen, it is the identity of human freedom.”  (own translation from the Dutch text)

Suicide is about not believing that something new is still possible for you.

I often think that suicide seems to point to something obvious that we are not seeing. A road sign pointing somewhere conspicuous, only we are staring down the wrong road?

At the same time as I am aware of those who take their own lives, I am aware of the effect on the people left behind. This type of death can take up permanent home in those who stay behind, deep Sunday blues, come to stay, week in, week out.

As I write this, the successful American fashion designer Kate Spade commits suicide. A chic, successful businesswoman and mother. I look at a photo on my phone that shows her with her young daughter. They look young, at ease, lovingly groomed, as if the world is bright and they in it.

As with depression, suicide is not one thing, but many. The lonely old man, the young man diagnosed with aids, the intense teenager, the mother with postpartum depression, the woman with swinging moods, and the celebrity with overwhelming feelings of inner emptiness – they may all share deep despair combined with a sense of futility, but their pathways, biological and biographical, will be different.

The highest suicide rate in the world is amongst the Inuit (whether in Russia, Canada, or Greenland), followed by the Baltic states (Russia & Lithuania leading the way). The lowest rates are found in the Caribbean, with Antigua in some years having none. The highest rates are amongst young white men (15-24), a typically at -risk group in all countries, with the other peak for old men. The lowest rates of all, is amongst Black women (Stats from WHO & Suicide.org). Reliable stats are not available for most African and Muslim countries. These findings thus reflect countries with reliable stats). Black women are a particularly robust group, with the lowest rates in the world. Black women share a strong sense of belonging (A Sisterhood. “Somebody always understands how you feel, because they are in the same situation, and they encourage you”), embedded faith (providing meaning, support and self-esteem), and an enduring conviction of a wider responsibility.  (Spates, K & Slatton, B.C. Socius (2017). I’ve Got My Family and My Faith. Black Women and the Suicide Paradox. SOCIUS: Sociological research for a Dynamic World: ASA.)

I write this, because we tend to think of suicide as an individual thing. Of the individual being “sick”. But it so seldom is just the individual. The young Inuit men represent something that has gone wrong in general. The resilience of Black women represent something core, something vital.

Loneliness.

“The biggest problem on this campus, is loneliness”, says the psychologist working on a big university campus. 30 000 Young people milling around every day.  Combine this with a meme of  non-interference: “It is none of your business”. “You can’t interfere”. “They must make their own choices.” “It is their life.” “Best is to leave them alone.” (sic). And so we do.

Is suicide depression gone way, way too far? At a conference some years ago I listened to a lecture on the correlation between geomagnetic storms and suicide.[1]  Moderate associations between major depression and variously, inflammation, omega-3, vitamin B12 and vitamin D levels have also been shown. Specific anti-depressants can have an opposite effect on individuals, where they can lead to a calamitous drop in mood. Please note: this is not an anti-anti-depressant statement; it simply means: if you are taking an anti-depressant, and then things get worse (the beckoning of the dark hole gets stronger), PLEASE be aware that you may have to change the type that you are taking, and to do so under professional guidance

Most usually the focus in suicide is on individual factors, whether biological or psychological. Mostly, the reasons are multi-faceted. Suicide can be a final heroic act in the absence of the possibility of Euthanasia. Societal shame can become a force that pushes an individual over the precipice, where the shame should be on the group, but instead is poured out on a person. Rape, Postnatal depression, Post Traumatic Stress, acute Bipolar episodes – all of these can be overwhelming experiences that only death can seem an answer to.

What differentiates ‘normal’ loneliness from suicidal loneliness?

Feelings of despair, like billowing smoke, can rise so strongly, that we are unable to contain them.

The lonely girl

A young girl of 16 is brought by her distressed mother. Her mother found an entry in her daughter’s journal, stating that she is going to commit suicide before a certain date. The young girl, fashionably dressed with torn black jeans, has no friends. None. I would like you to imagine that: Imagine one whole day in high school without one friend. Now imagine a week like that. Turn this into three years. Would you not consider suicide? Why does she not have any friends? Is there not even one single other lonely girl in her school that she could have connected to? Somehow not. Both mother and daughter do no know why this is so. Does mother have any friends? It turns out that mother has acquaintances, but not one good friend. How do they understand this? They don’t.

Making sense of yourself from the outside, and of others from inside:

Here we have what is known as the “absence of reflective functioning (RF).”  RF refers to the ability to understand our own minds as well as the minds of others. Previously named “mind-mindedness”, it refers to the capacity to hold another’s mind in your mind. To understand how others are feeling, and that they have minds different to your own, and to take this into account in your interactions. A simple example is, being irritated when you are stressed, and understanding that. “I am sorry that I am so irritated, but this deadline is really bothering me.” It is as much about speaking out (not avoiding uncomfortable feelings), as it is about being able to identify them. The absence of this seemingly simple capacity has huge consequences for socialisation as well as self-regulation. The fact that this mother could not make sense of her child’s inability to make friends, nor of her own, does not make her a bad mother. Having inherited this from her mother, who probably inherited it from her mother…

The absence of RF is always somehow connected to unresolved loss and grief. Makes sense doesn’t it? We all have some experiences that need to be resolved. How do we resolve them? By talking about them, by sharing them as stories about our own lives, by someone listening, and sharing their own stories in turn. Sometimes we have to pay therapists to play this role.

It shows how important, how vital, the minds of others are to our own well-being. And how we need to have deeply personal conversations with at least one person, why peer friendships are the bedrock of our own mental health, and how we need to be connected to others to live ‘undespairing’ lives. It also partly explains why the lonely elderly have such high rates of suicide.

Culture & Integrity

He is attractive. I did not expect this. He is important. I do a sharp inhalation.

In South Africa, under apartheid, black people were not allowed access to office positions. They could teach or preach or nurse within their own communities, but that was mostly the highest they could go. Bantu Education was used as a means to limit progress. We have the first visible generation of professional and otherwise successful black people only now, 25 years after the abolishment of apartheid.

He is the first person in his village, and the first in his extended family, to attend university. Talented, he obtains postgraduate qualifications, with bursaries to study overseas. This means that he is the first person to fly, the first to travel overseas, the first to demonstrate that “blacks are equal to whites” (his words) in his village. In his culture this means that he has held up the honour, not only of his family, but that of his community. He has risen in the corporate world through his own merit. He is a man with a quiet dignity.

Except that he is gay.

Married, with children.

Religion is the bedrock, the warp and woof that has held his family together through times both rough and smooth.

His wife, a committed secondary school teacher, cares deeply about their community, their children, and him.

Homosexuality is a sin, not because his family is judgmental by nature, but because it is Gods’ word in the bible.

He comes every week. At least here he can talk about it. At least here it is said.

Is this a good thing or a bad thing?

He commits suicide. He does.

Mea culpa

He did not talk about suicide. This is my excuse. When people talk about suicide we have a set of protocols in place. We contract, become practical. I did not know what was the solution to this man’s problem (do you?). I believed that as we sat, we would, slowly but surely get to a new place. A place where it seemed possible to breathe. Sometimes, often times, it is true; we have to do a wheelchair adaptation (you have to accept real harsh limitations to your life and learn to live with them). Was it not true after all, that many people in the past were homosexual, but could not live that identity? Only problem is/was, many people today do.

After his funeral, I had this brief fantasy that his family will one day contact me to enquire about him. Maybe his children, who could understand. But then I thought, they know anyway:

You see, he had this gay voice.

A concept that has helped me a lot is David Rosen’s idea that when we talk of “suicide” we should think “egocide” … what needs to change in the person’s approach to the world or their life?                           A friend, a psychiatrist, in an email to me.

I think what my friend also means is that we have to think of ourselves as being able to be different- that there exists a real possibility that we could be a different person to the one whom we are now. That if this possibility seems impossible, then death may seem the only option out.

The antidote is integrity. Big word that. I suppose that to live a life of integrity means one where our inner understanding of self and our outward expression of it, are in sync. When there is a disconnect, a sense of impossibility of such a life, then escape may seem the only option.

Concluding remarks

The Caribbean countries of Bahamas, Barbados, Grenada, and Antigua show hardly any suicides. What can be at play here?

Apart from cultures high on extraversion and good food, a striking finding is that they only have rudimentary mental health services. Schizophrenia that is linked to drug abuse is the most prominent dysfunction, but for the rest people somehow have to make do. This begs the question: Will it be better or worse for them if sophisticated mental health systems are put in place? What do people with low mood and anxiety do over there? If you take a seriously depressed Lithuanian and place him in Antigua for two years, will he simply get better? Or, if you help people in the Baltic States to express themselves more, and to eat a greater variety of Mediterranean foods, will they get better? I know that my arguments are simple-minded, but still: if social context plays a big role in mental state, does it not make sense to address the context as well, rather than purely focus on an individual? To help individuals to understand the connection between their symptoms and the social context? If more and more young people are suffering from depression, the answer cannot simply be more therapists and more medication.

In all countries where rates are recorded, men commit suicide significantly more often than women (although women may attempt more, or as often as men), at a rate of about 3:1. In Netherlands it is the number one cause of death amongst men (more than cancer, for example), with twin peaks in youth and in those over 60. In South Africa the highest rate is amongst young white men (aged 15-24), whereas in Canada and Australia the highest incidences are amongst Aboriginal men, where it is the leading cause of death for those between 15-44 of age. In Canada the second highest rate is amongst single, divorced and widowed men in the age group 40-59. Elderly suicide rates are the highest in central-and Eastern Europe. South Korea has the highest rate in the world for children (10-19 years), and also that familiar peak for the elderly.

Youth and old age are neither spring nor golden for many people. And it is getting worse.

What to do? Let us revisit our resilient Black sisters:

Sisterhood is described as support by others, who understand your situation because they are in the same boat, and “always offer hope”.

Religious beliefs mean that that you are connected to a higher purpose,  that you have responsibilities and a place within a cultural belief-system that is esteemed and regarded by you. The destruction of traditional cultures is the destruction of whole systems rich in meaning-making,  belonging and status.

Accepting responsibility  for others means that you have significant people reliant on you, and that you accept this responsibility.

These simple answers may contain the solutions to much of what has gone missing in the lives of many: Culturally rich experiences of connectedness and identity, a wider sense of purpose, and the acceptance of a practical responsibility towards relevant others. Is this not also what is missing in the lives of the disenfranchised aboriginal peoples, of unemployed men, and urbanised youth, of those who flee into drugs or fundamentalism in an attempt to escape the void created by the dearth of meaningful real-life connections?

Hope, Meaning & Belonging

It strikes me that in the absence of religion, self–help slogans and self-help books have taken over. Written now on t-shirts and on walls, we are encouraged to “live your dream”, “not care a f**k”, and a multitude of inspirational wall quotes – the more cursive it seems the better (be the change you wish to see in the world). A string of universal slogans, strung together to prevent us from falling apart. Psychology has its own, with concepts such as “inner child” and “self-love” being offered as balsam to a suffering soul, leaving us infantilised and empty and ever-searching. There lies a conspicuous ontological difference between the post-religious decree to love thyself, as opposed to love thy neighbour. The scariest parts lie in the false promises made, “I find that when we really love and accept and approve of ourselves exactly as we are, then everything in life works out.” (Louise Hay).  No, it does not work like that. That is much too big a law, no universe could work like that. It is o.k to be flawed, not to like yourself all that much, we are all flawed. We are in it for better and for worse: that is just how it is. Best is to speak out about your grief and your loss, and your own flaws, and then to slowly build the connections out there that can create shared meaning, and authentic joy, despite our own limitations.

One of the differences between fine art and Sunday art is, that fine art points to something beyond itself, that it is not literal. Maybe it is important that we can live again with verses such as

We are the hollow men
We are the stuffed men
Leaning together
Headpiece filled with straw. Alas!
Our dried voices, when
We whisper together
Are quiet and meaningless
As wind in dry grass
Or rats’ feet over broken glass
In our dry cellar

And that it will be o.k. to do so. Because we also know that the opposite is possible:

The flood subsides, and the body, like a worn sea-shell

emerges strange and lovely,

And the little ship wings home, faltering and lapsing

on the pink flood,

and the frail soul steps out, into the house again

filling the heart with peace.

D.H. Lawrence “The Ship of Death”

9. The Greeting

In the beginning is relation

 Martin Buber

I have always thought that way: that the relation between me and that book, or the book and the table, is still a microcosm of the relation between man and God, or God and the devil, or what have you. That the big relations and the small relations are all the same thing!                                 Gregory Bateson in the documentary on his work, An Ecology of Mind.

Sufficient research on childhood exists to fill an entire museum. Here is a room.

My architect friend Aubrey asks, “What are the signs of mental health in a five year old? “

“Joy in exploration, curiosity, eyes that shine”, I respond over coffee.

[1] Gordon , C. & Berk, M. The Effect of Geomagentic Storms on Suicide. South African Psychiatry Review. 2003;6:24-27

[2] January 2016: https://www.researchgate.net/publication/292762689 Activation of T helper 17 cells may contribute to neuroprogression in depression proposal of an integrative model.

[3] From the webpage www.suicide.org

[4] Puras, D., Germanavicius, A., Povilaitis, R., Veniute, M, Jasilians, D. (2004). Lithuanian mental health country profile. International Review of Psychiatry, Feb-May, 16 (1-2), 117-125.

[5] T. Kue Young, Boris Revich & Leena Soininen (2015) Suicide in circumpolar regions: an introduction and overview, International Journal of Circumpolar Health, 74:1, DOI: 10.3402/ijch.v74.27349

[6] Spates, K & Slatton, B.C. Socius (2017). I’ve Got My Family and My Faith. Black Women and the Suicide Paradox. SOCIUS: Sociological research for a Dynamic World: ASA.