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The issue of suicide is a complex public health problem. There is no single causative factor that can be identified. For every individual who completes suicide, there is a different combination of ingredients that goes into the recipe. Each person has their own plotline with a different set of circumstances. And each one leaves acquaintances and loved ones to ponder over every conversation and every plot twist in the life that ended abruptly and senselessly. We search for clues we might have missed. We look for someone to blame because this gives us a place to put our grief and a way to find some sense of meaning.
When it comes to suicide, there are warning signs (see below). And there are risk factors, like depression, anxiety, PTSD, and substance use disorders, that can be treated. There are precautions, like storing firearms and medications safely, that can be taken. Before treatment and precautions can take place, however, an individual must recognize-and- admit that there is a problem. And the person must be willing to accept the available help.
Admitting that you need help is not a weakness, we’re told, but it certainly feels like one. If you’re accustomed to being the one providing the help, it feels especially troublesome. It makes you feel like an impostor. Even people with mental health training often have a blind spot when it comes to recognizing warning signs in themselves or their loved ones. We’re all so enmeshed in our own lives that our situations feel normal and we often don’t see how dysfunctional they truly are.
Our egos are good at defending themselves. We can always find someone whose circumstances seem infinitely worse than our own and rationalize that we’re doing just fine. We deny that there is any problem and even produce supporting evidence. “I get up and go to work every day” or “I go to school and get good grades” are commonly-cited rationalizations for denying the anxiety and depression that often precede suicide. “I’m not the problem. It’s everyone else.” is another common refrain.
Not everyone with anxiety and depression appears sad and anxious; at least not in the way you’d expect. I’ve met far more anxious and depressed people who come across as hot-tempered and agitated than mopey and fretful. And I’ve met others who are friendly, engaging, and funny. Hardly the type you’d expect to be suicidal. Most people who die by suicide do display warning signs. Too often, however, they are only recognized only in hindsight:
Hopelessness, feeling like there’s no way out
Anxiety, agitation, sleeplessness, or mood swings
Feeling like there is no reason to live
Rage or anger
Engaging in risky activities without thinking
Increasing alcohol or drug abuse
Withdrawing from family and friends
Often, it may be the person you least expect who is struggling the most. The ambitious, hard-charging overachiever who seems to have life all figured out is often grappling with shame and self-doubt. The off-putting demeanor and bravado way of hiding these perceived inadequacies from the world. And the more accomplished someone appears to be, the more difficult it is to ask for help. It often requires a crisis before a person can recognize the need for treatment. Or someone with the courage to say, “I noticed you haven’t been yourself lately. What’s going on? Are you thinking about suicide?” It sounds a little cheesy, I know, but it’s always better to ask. You aren’t going to put the idea in someone’s head if it wasn’t there to begin with.
Veterans and first-responders are better than most people at adapting to adversity and driving on. It’s what they’ve been trained to do. As long as an individual can get up, dress, and show up there isn’t a problem. Society in general, and the military in particular, judges the worth of an individual by his or her ability to contribute; to perform their job. If you’re doing your job, we’re taught, it doesn’t matter how you feel. When there are lives to be saved and messes to be cleaned up, you shove feelings in a junk drawer in the back of your mind.
Compartmentalizing is an effective way to get through a shift or a deployment. The suck-it-up- and-drive-on mindset is ideal in a mission-oriented environment where decisions are of the life-and-death variety. There’s no time for self-reflection and contemplation. When it comes to interpersonal relationships and navigating a world full of uncertainties, however, this mindset becomes dysfunctional. And that junk drawer full of suppressed grief and rage eventually begins to overflow.
Most suicidal people don’t necessarily want to be dead. They only want to stop feeling so horrible. They want the pain of existing to end and suicide feels like the best way to make that happen. There is treatment for people contemplating suicide, but too few people receive the treatment they need. As I mentioned above, denial and rationalization are powerful defense mechanisms. And the military culture isn’t exactly conducive to reaching out for help.
Soldiers are understandably hesitant to seek treatment for mental health issues. Admitting struggles with depression and anxiety could compromise fitness for duty. Family members often take on the stressors of the servicemember and developmental health issues of their own.
For those who do engage in treatment, the process requires time and effort. It isn’t a one-and-done type, take this pill and call me in the morning type of treatment. It’s a difficult and often painful process. And people seem to get worse before they get better. The most effective mental health treatment is a holistic, ongoing process involving a combination of therapies for the mind and the body. To someone struggling with the effort of being alive, this sounds overwhelming.
Despite all of these challenges, I can tell you firsthand that mental health treatment is well worth the effort.
Wendy Arena has been a registered nurse for 22 years, currently works on an inpatient psychiatric unit, and is pursuing a writing career. She is married to a combat veteran who works in a prison. They share some very interesting dinner conversations.
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