Jacob Z. Hess, Ph.D.
Despite all the valiant efforts to reduce suicide rates in the U.S., a study by the National Center for Health Statistics released in April of 2016 reported that suicide in the United States had surged to the highest levels in nearly 30 years, with an increase in every age group except older adults. The rise was especially pronounced in middle-aged women (up 63%) and middle-aged men (up 43%), with the overall suicide rate rising by 24 percent from 1999 to 2014.
Why do these numbers keep rising? You might expect the numbers would have decreased with all the effort to de-stigmatize treatment for mental illness over recent year. But the reverse has happened.
Is it time for a broader conversation about suicide (and mental health) in America? Something many people agree upon is that the dynamics involved in suicide are complex, with many different potential contributors to any given tragedy (as evidenced by nearly 15,000 references to “suicide” and “risk factor” in major medical journals).
And no doubt, many important and notable efforts have been made to reduce suicide. As my own contribution to a robust, wide-ranging, no-stones-unturned conversation about what more can be done, I propose here 10 additional steps that could be taken today to ameliorate suicidal risk: steps that have virtually no cost attached.
These proposals arise from years of study and conversation with those facing mental health challenges, and are offered as public health considerations. They are not causal claims, nor are they intended to suggest “if we had only done these things, we could have easily prevented past suicides.” The intention is to expand the conversation, not weigh anyone down.
Lastly, these possible recommendations are directed specifically at common themes in our current public conversation about mental health and should not be taken as a substitute for medical advice from a licensed professional. I have no financial ties to any mental health or medical industry that would present a conflict of interest.
1. Stop telling people that an enduring brain deficiency underlies their emotional/mental distress when most scientists have rejected that hypothesis. There is no question that the body and brain are involved in many ways with the experience of mental and emotional distress. From inflammation to head trauma to hormonal regulation to gut bacteria to neural networks, we’re still only just beginning to understand the many ways that states in the body distinctly influence our mental health.
Rather than hearing about these many possibilities and the growing complexity of our brain understandings, however, many people continue to be told a much simpler story: your brain is fundamentally, chemically deficient (in an enduring way).
Although there’s no question that the moment by moment configuration of chemicals and the overall patterns of neural networks play a role in our mental health, most brain scientists have now rejected the idea that mental illness arises from permanent states of deficiency in the brain (see here and here and here). There’s also evidence to suggest that those who embrace a view of their own brain as deficient end up seeing their own prognosis as worse and feeling more pessimistic about the role of other non-medical treatments as being effective (something I observed in my own interviewing study as well).
If that’s true, then why do we keep encouraging patients and families to accept this belief? Dispelling this notion of permanent, enduring deficiency – whether in the brain or body – is one thing that we can do immediately to help encourage those facing mental or emotional challenges. Once again, this is not to deny that real problematic physical patterns can and do exist in both the brain and the body (nor is it to deny a role for short-term medical support) – but instead to disabuse people of the despairing (and scientifically false idea) that these patterns are somehow permanent.
2. Start helping people understand what most all neuroscientists and genetics now know about the brain and body. Scientists have known about the remarkable changeability of the brain and body for almost two decades now, but the general public is just barely starting to catch up. Why?
When one woman facing depression found out about brain changeability, her immediate response was, “wow, that means I can DO something about this.” Similar hope can emerge from the knowledge that genes turn on and off depending on what we do (what one Nobel Prize-winner called the “fluid genome”).
This does not mean, of course, that people can just suddenly “choose to get better” – which is a well-intentioned and clearly unhelpful notion. But neuroplasticity does open up the possibility of real, iterative, gradual movement towards long-term healing – yes, even at the level of the brain and body.
To illustrate, even two months of extended meditation has been shown to lead to structural changes in the actual physiology of the brain. Many other kinds of interventions are showing similar power to shape the brain (especially exercise). Even research on victims of traumatic brain injury confirms startling change that can happen over time.
If the only thing we did was ensuring that every person facing serious mental or emotional problems in America knew about brain changeability to their core, there is reason to believe that alone could be a huge protection against the metastasizing despair that underlies suicide. The reality is that most people have still either not heard about or grasped the relevance of neuroplasticity for their own lasting healing from mental illness.
3. Stop telling someone facing a serious mental or emotions distress that he/she will likely have to face it for “the rest of your life.” Many people have been told that what they are facing in their mind and body will likely be a life-long problem. What does this mean for people’s own hope in the future?
One young woman told me in an interview that her suicidal thoughts started the day her doctor told her that her depression would be life-long. Another woman told me in my interview study: “never predict the recovery of another individual.”
In other words, let’s leave future possibilities open! Rather than telling people how long they will be sick (or how soon they will be better), let’s allow the future to remain uncharted and open. That means not putting a timeline on the healing process – and allowing as much space and time as needed. And yes, this also means leaving open the door to at least the possibility of fundamental and lasting healing over time.
4. Start helping people understand the many ways that they can move towards long-term, sustainable healing. The truth is that many have found long-term, sustainable healing from some of the most painful mental health conditions – including schizophrenia, bipolar disorder, severe depression and anxiety, ADHD, and serious eating disorders.
I have met many of these people: a gentleman in England diagnosed with schizophrenia, who went on to recover and receive his PhD, a younger woman in the U.S. given the same diagnosis, who now trains hundreds on how to support others facing similar conditions. And one woman I interviewed enjoying her own apartment was previously told she would “never be able to live independently.”
There are hundreds of other examples. Why are people not hearing these kinds of stories?
The reality so clearly revealed in the enormous medical literature is that there are virtually hundreds of root contributors to mental and emotional distress over time (see here and here as illustration). If that’s true, it’s good news – since it suggests there may be an equally large number of ways to address some of the root contributors to these problems. However, given the overwhelming attention we give to basic symptom management for these conditions, the potential ways to address root contributors are almost always being overlooked as sources of intervention.
Let’s stop ignoring them! And maybe starting talking about what it really takes to help someone move towards long-term, sustainable healing. Even the possibility of this happening in the future can be a source of real optimism and hope for people. As one individual commented, “the difference between some hope and no hope in the future is huge.”
5. Stop insinuating to patients that their mental health condition is somehow reflective of “who they are.” When people face cancer, we don’t say “you are lymphoma” or “she is breast cancer.” But regularly, I overhear people saying things like “I am bipolar” or “my son is ADHD” or “my wife is anorexic.”
As the contemplative tradition has understood for thousands of years, identification with something has a unique power to both shape our future and cause additional suffering. If that’s true, maybe we should all pay more attention to how and when we use the “to be” verb to describe the experience of facing serious mental or emotional problems.
6. Start helping people relate to their mental health condition as something workable that they are “facing.” One alternative to the identification with mental/emotional distress is simply to acknowledge the experience as something legitimate and hard that people are facing (right now). That’s what we do with cancer – so why wouldn’t we do that here?
In contrast to personal identification with depression or anxiety or ADHD or schizophrenia, this experience-oriented language opens up the possibility of working with this experience in new ways – and once again, coming to even perhaps see it fundamentally change over time.
7. Stop pretending that willpower, or gratitude diaries, or weekend retreats, or meditative techniques or breakthrough medications will ever have the singular power to make emotional suffering go away. Given our urgency to help people feel better, we can understandably get anxious to help introduce real answers to alleviate suffering…and now! Thus I once observed a counselor tell an audience of patients that “if everyone started a gratitude diary, depression would go away.” And thus supplement makers and drug reps and meditation teachers say similar things about their products.
Let’s stop telling “salvation stories” about this product or that intervention. The nature of human experience suggests otherwise – so let’s stop pretending anything different. While many various interventions can have their place in offering real relief, and while together they may powerfully move someone in the direction of lasting relief, clearly no single product or intervention has the independent power to take away emotional distress. In the absence of this kind of a clear acknowledgement, I’ve watched individuals come away profoundly discouraged after a so-called miraculous treatment “didn’t work for me.” Rather than seeing the treatment limitations clearly, I’ve seen people go away from a failed treatment more convinced that they are even “sicker than I realized” (with a little help from the professional label of “treatment refractory”).
8. Start talking about the many different ways that human beings have learned to work through emotional suffering as a meaningful experience. Imagine an American mental health conversation focused less on what will “work” to make X or Y go away – and more focused on understanding the nature and meaning of X or Y: Why do they seem to be increasing? What meaning is there in X and Y and what are its root contributors? And especially: what are the ways that people over history have worked with X or Y in a way that led them to sustainable relief?
Compared to focusing alone on what presumably “works” to take away distress (as soon as possible), the conversation could then shift towards more deeply looking at all the rich ways to work with a problem and help change it over time.
9. Stop pressuring people towards one single path of healing. Again out of understandable urgency, it’s common to see family members pressuring an individual into a particular intervention or line of treatment. This includes forced medication, electroshock and impatient/residential treatment (I haven’t yet heard of a confirmed case of someone forced to practice meditation or yoga…!).
Although these assertive and aggressive approaches are successful in sometimes forcing some kind of immediate change, almost no one (even their proponents) believe they offer any sort of a real long-term answer. And those who have examined more carefully the trajectory of associated outcomes have cautioned that these power-plays can lead to merely superficial changes in the short-term and enormously damaging consequences later on (for instance, here).
Let’s Re-think Pressure!
10. Start making (more) space for people to make the right choices for them. Virtually every therapist or counselor knows that client self-determination is key to any sort of meaningful change happening. So let’s preserve that, and promote it, and widen it!
In place of the pressure to do A or B or C, let’s make sure that individuals and families have all the space they need to be able to explore and navigate the set of options that feels best to them.
And there you have it! My own starting point for this all was original research exploring how particular depression narratives can complicate or add to an individual’s mental health burden (see here and here and here). In this case, I believe the abundant presence of certain messages (#1, 3, 5, 7 & 9) in our current mental health conversation is not helpful – and may, in fact, lead some to a more despairing place over time. Without suggesting these beliefs “cause” suicide, I am convinced their collective influence as an overall narrative is not helping – and may, in fact, add to the mental and emotional burden people often face leading up to suicide. The following video illustrates some of the unnecessary burden of what I call “learned hopelessness”:
Based on the experience of watching students in my own courses feel an almost immediate relief upon learning about brain changeability and the possibility of sustainable recovery, I have great confidence that a set of different messages (more of #2, 4, 6, 8 & 10 above) could make the reverse difference. By reminding people about the real scientific basis of possibility and hope, we could go a long way to helping restore people’s confidence in the possibility of lasting, sustainable healing.
And by the way, once again, moving this direction would cost very little extra money – if any – in term of a public health approach. It’s simply about ensuring a very different kind of mental health conversation.
If you’d like an easy way to dive into that conversation yourself, check out our online class Mindweather.org. This class reviews everything above in a detailed way – and yes, it is entirely, completely and forever free.
The only real cost of any of this is staying open to new ideas and being willing to critique our own accepted ways of doing things. As I’ve learned so far from many conversations with individuals, families and professionals, that may simply be too hard for those who have spent decades relying upon and vouching for other approaches.
But for the sake of those who are hurting, I hope more and more people will be willing to explore these possibilities. The conversation is simply too important to assume we know enough, and we’re doing enough…
I hope you will agree.
Photo credit: Man with half face on shadow Canon EOS 5D Mark III
I found this really excellent! Thank you. I will share it with friends.
Brilliant!! Brilliant Briliant!
Thank you! This does give hope. As one with Complex PTSD, post psychosis episode after coming off 30+ years of psychiatric meds, it has been important to keep my faith and continue with my goal of having a full life again. I will never give up hope that my brain is capable of improving even more than it already has. I am so much better than I imagined possible.
Thank you, Lori! I’d love to interview you sometime.
With such a dramatic rise in the rates depression, isn’t it possible this emotional dysfunction is a result of a sick and broken world? I’d say it’s normal to feel utterly despondent in the face of environmental destruction, endless war, a life of debt/indentured slavery, corrupt circus politics, and a sense of total helplessness.
When is it appropriate to stop assuming everyone is just ‘coming down with the sads’ individually, and start looking at a bigger picture that actually does justify feeling like jumping down a dark hole and never coming back?
I really resonate with this comment, Zwicky – particularly the outward focus on a society “incubating” these feelings very effectively. Researchers at the University of Washington & Clark University suggest that we are living in a “depressogenic world” that is doing just as you say. Precisely because we spend so little time acknowledging that influence, there’s very little (relative, collective) attention into considering how or what we might do to intervene *there*…in our relationships to this “sick and broken world.” I’d love to converse with you more sometime about this.
I tend to stick with Dr. Kay Jamison on the topic of suicide and bipolar or schizophrenia in terms of suicide. I do believe, as she and Johns Hopkins does, that the brain in these disorders Is defective or disordered to some extent, and that though treatable, these brain disorders are not curable and have the highest risk of suicide. Am I reading this wrong, or are you debunking the team at Hopkin’s stance on suicide as related to brain disorders, or that brain disorders like these don’t lead to more numbers of suicide than non brain disorder conditions? Or that schizophrenia and bipolar and that classification is a chronic genetic brain disorder treatable but chronic? Please reply..I think everything I’m learning about mental illness and suicide in grad school is opposite of your claims in this article. Many people I have discussed this with that suffered get relief from the diagnosis, and empowered by the knowledge of its nature and chronic yet treatable information out there. Thank you