Preventing Suicide Among Gun Owners

Can we reconcile a most basic suicide prevention strategy, means restriction with the 2nd Amendment? Gun owners and public health people have to find a way to talk about this. In Oregon, the conversation has begun.

Gun owners in rural have a sense of responsibility and honor. It's a thing. Part of that responsibility is to protect one's family, one's livestock, and oneself. So let us begin by acknowledging that some gun owners, the ones who live in rural areas where suicide rates are growing the fastest, need guns for protection. But they have to do the protecting themselves. The government, on account of distance and distrust, cannot do the job. And then let us acknowledge that one of the things they need to protect their families (and maybe themselves) from is suicide.

Compare states to states.  Compare regions to regions.  Compare states within regions to other states within the same region.  Compare people of the same age group, in any age group, men to men and women to women.  Compare unemployed people to unemployed people, working folk to working folk.  Compare city dwellers to city dwellers, country folk to country folk.

Compare people with depression to other people with depression; people who are suicidal to other people who are suicidal; people who have a plan to other people who have a plan; people who have a past suicidal attempt to other people who have a past suicidal attempt, for God's sake!

More Guns = More Suicides.

Get it? Rural areas have more suicides largely because they have more guns.

Warning Signs and Suicide Hot Lines Won't Fix This

A psychiatrist remembered his first days on his ER rotation. He dealt with a woman who had tried to kill herself. She was homeless, had been taking meth so she wouldn't sleep ever since she had been raped on the street. The supervisor asked what the young doc intended to do. "Prescribe antidepressants?"

They both knew how stupid that sounded.

In the 80s and 90s, they thought they had this suicide thing figured out. As the number of prescriptions for Prozac rose, the suicide rate was falling. It was widely claimed by people who flunked logic that this was epidemiological evidence that Prozac prevented suicide. Just get more people into treatment. This kind of error is common enough to have its own name: post hoc ergo propter hoc. Or maybe there was some economic incentive behind that sloppy thinking...

For a hundred years, suicide rates and unemployment rates rose and fell in tandem. The top chart is the unemployment rate 1927-2006. The bottom is the suicide rate in the same time frame for different cohorts; yellow shows the total.

The correlation holds without reference to how many people are on antidepressants. Prozac didn't prevent suicide; Eli Lilly was just lucky enough to introduce it at the start of a boom. One good recession and that so-called progress was blown to bits. The much heralded fall in rates reversed, even as prescriptions continue to rise.

Now as suicide rates skyrocket (up over 15% since the start of this millenium), we are not more sick. We are just more desperate. We are especially more desperate in rural areas, the fly-over states, where people have poor education, limited opportunity, less health care, fewer social assets, and fewer community resources to cover the non-existent safety net.

And things keep getting worse. States with more rural population have been the most restrictive about extending ACA. Wage stagnation has stressed farm and ranch families who have long held outside jobs to support their primary vocation. The tariff wars are finishing off the process of pushing them off the land since the last time a president wrecked havoc on farm communities with the grain embargo of the late 70s.

Shitty life, shitty suicide.

I could turn to climate change, to school violence, to the trauma of live shooter drills to which we subject our children, to fear-mongering, to the rise of white nationalism... Babies in cages.

Victor Frankl said, Those who have a why to live can bear with almost any how

Almost any how. Almost.

For that matter, how many of us have lost our why?

As I said to my therapist the other day, my life is great right now, except for the existential despair.

Sure, it's a good idea to keep an eye on friends who show warning signs. But getting them hauled off to the hospital in handcuffs (that's how it's done when the police do a welfare check) does nothing to stem the tide. If you think the hospital and a bunch of pills will fix it, you need to know that the most dangerous time in the life of someone who is suicidal is the week after discharge. In the long haul, involuntary hospitalization does not decrease the suicide rate.

What does? Something much harder.

Suicide happens when pain exceeds resources for coping with pain. 

There it is. That is the key.

To prevent suicide, decrease pain and increase resources.

Like I said, something much harder. The psychiatrist in ER knew that he wasn't going to do a damn thing for that homeless woman who had to take meth to stay awake so she wouldn't get raped again. And finding her a safe place to sleep at night never makes it to those lists that go around during #SuicidePreventionMonth.

This post seems so drear. Is that a problem? Do you want a good news story for Suicide Prevention Month? Okay.

It was over a decade ago and I was in bad shape. Really bad shape. And then my printer went out. So I had to go outside of the safety of my home, talk to strangers, and buy a new printer. And then it wouldn't install. It was brand new, it cost more than I wanted to pay, it wouldn't install, and I was in bad shape. On top of all that, which had me teetering on the precipice, now I had to make a phone call.

On the other end of the call was a young man at a call center in Mumbai. He knew what was wrong with my printer. He was able to send me the patch over the internet. It took an hour to download. And during that hour, we talked about Mumbai. We talked about the little I knew about Indian cinema, and he taught me some more. He talked for an hour. At the end of the hour, the printer worked.

He saved my life that day.

I already have a safe place to sleep tonight. But it was a dangerous time for me. So that's what it took. 

You want to save a life? Reduce pain or increase resources. If you can manage to provide a why or fix the how, that would be great. But don't diminish the power of taking somebody to the movies or washing the dishes.

That's my story and I'm sticking to it.

charts from CDC and NIMH and in the public domain
photo of Indian call enter in the public domain

Passive Suicidal Ideation and Suicide Prevention Awareness Month

Anna Borges speaks truth about suicidal ideation. In the midst of Suicide Prevention Awareness Month, with its lists of warning signs and gearing us up for the crisis, Anna brings to light the sometimes everyday-ness of suicidal ideation.

I am not always very attached to being alive, she wrote in at article for The Outline, an online magazine. It's not about being in crisis, not about having a "plan," not about needing an intervention. It's more like an indifference to life that sometimes surges into something more serious and then falls back. Like the waves of an ocean.

At 27, I’ve settled into a comfortable coexistence with my suicidality. We’ve made peace, or at least a temporary accord negotiated by therapy and medication. It’s still hard sometimes, but not as hard as you might think. What makes it harder is being unable to talk about it freely: the weightiness of the confession, the impossibility of explaining that it both is and isn’t as serious as it sounds. I don’t always want to be alive. Yes, I mean it. No, you shouldn’t be afraid for me. No, I’m not in danger of killing myself right now. Yes, I really mean it.

Those who do not know this way of being in the world don't know what to do with it. They may be primed with their skills, ready to leap into action. I watched a video on Twitter at #SuicidePreventionAwarenessMonth of someone literally leaping into action, pulling a man away from the oncoming train. Yes, this woman is a hero, and I am glad she was there to do it. But good golly, who wants friends who are always looking at you out of the corner of their eye, ready to be a hero?

I try to imagine the friend who could simply sit with me and a cup of coffee, me being able to say, It's back. Then the friend asks, How strong? I respond, Meh, quiet day at the beach. She nods, Yeah. And the conversation goes on.

I did have such friends before I moved a few years ago. We called ourselves The Batshit Crazy Support Group. We could get into such hysterical laughter that my wife would worry whether she should drop us off at the ER. That's the thing, getting to just be and not be a source of worry.

I guess I am not alone in my ache for such friends. Anna created a hashtag, #StillTreading as a place for us all to hang out.

Then she continues: But speaking freely need not solely carry the weight of prevention. It can simply be about the comfort of social connectedness and knowing you’re not alone. Like Beeson told me, the big picture is not as much about preventing suicide as it is about planning life and fostering social connectedness — which, in and of themselves, are major preventative factors.

The big picture is not as much about preventing suicide as it is about planning life and fostering social connectedness -- which, in and of themselves, are major preventative factors.

Oh yes. David Conroy writes, [suicide] happens when pain exceeds resources for coping with pain. That is how we stay alive. We decrease pain and increase resources. Warning signs and hot lines, the memes you see for #SuicidePreventionAwarenessMonth will not solve this epidemic. Decrease pain and increase resources. That's harder work, which may be why it hasn't caught on.

In the absence of good science, one of the most helpful things you can do for chronic suicidality is curate your collection of flotation devices.

This is work best done by ourselves, I think. We hear it better when we tell ourselves.

So I started my own hashtag #AfterIDidntKillMyself. #AfterIDidntKillMyself is a collection of the things I have enjoyed, the friends I have made, the life I have experienced since I didn't... The message isn't It gets better, some attempt at persuasion. It's simply an acknowledgement that I do enjoy my life now, most of the time, and I am glad I survived, and keep surviving. I am glad I didn't jump in front of that racing truck last week. Yes, last week. Actually, not a big deal last week. The waves are always there, but they are calm lately, but yes, they are there.

You are welcome to post there, too. What dreams are you fulfilling? What places have you gone? What things have you learned since all this got to be about you, too? I send a cake, well, a virtual cake, to celebrate the survivors who post there.

Anyway, the life I live now and have lived since, remembering it, is one of my flotation devices. Who knew that that life would introduce me to Anna Borges?

Anna Borges is a writer, editor, and mental health advocate. Previously, she was a senior editor and writer for BuzzFeed. Her first book, The More or Less Definitive Guide to Self-Care, comes out in October. An Oregon native, she lives in Brooklyn with her two cats. Visit her website or say hi to @annabroges on Twitter.

photo of Mahia ocean waves by Mathyas Kurmann and in the public domain
graphic of balance scales by Belfius used under creative commons licinse

The Blues Aren’t Blue For Me - For Suicide Prevention Awareness Month

For Suicide Prevention Awareness Month, guest Margalea Warner tells a story of healing after an attempt and what happened #AfterIDidntKillMyself.

When I emerged from the gray cloud of near death, the color I woke to was blue. It was an artificial blue, kin to a chlorinated pool water or blue Jell-o or Smurfs. It was a long tube with ridges that seemed to be coming from my face. I couldn't use my mind well enough to know it was a respirator tube. I stared at this blue with bewildered wonder. 

I did not remember what caused the gray. I did not remember walking away from my job at ten in the morning without asking for time off. I did not remember going through my closet and throwing all my clothing in the dumpster until I had very little left to wear.

From deep inside my mind I did remember a room of flickering shadows where I was on trial for witchcraft or for being a bad daughter. I remembered the voices saying that I must be executed. I had to be my own executioner. I remember narrator voice saying, “The prisoner is walking into Reliable Drug.  She is walking through Health and Beauty. She is walking through First Aid.  She is picking up a bottle of rubbing alcohol.  She needs the Reliable Drug brand. It will be a reliable drug. She needs it now. No time to think about it.”

But what happened next? I couldn’t remember if I obeyed the voices. I wish I could remember if I challenged their distorted thinking. All this forgetting makes perfect sense when you consider the gray that followed it. Fortunately or unfortunately, my mind’s computer made a back up copy in the cloud and replayed it over and over years later.

But there was one thing that I should never have forgotten. I should never have forgotten that Marnetta had said, “Call me before you hurt yourself.” Did she really mean that, or did she mean don’t hurt yourself in a way that will hurt you? This way of hurting myself wouldn’t hurt, I would just fall down, down, down into sleep without dreams. I went with the half truth that was a whole lie. I made a choice that could have ended all choices. And that choice did hurt, exquisitely, the hearts of those who loved me.

And I still have no memory at all of Marnetta breaking into the apartment, finding my unconscious body, calling 911, getting me to the hospital where that beautiful blue respirator tube kept me alive.

In and out of the grayI woke a second time and the blue tube was gone. I was sitting up in my hospital bed. I looked down and saw the blue flowered print of my hospital gown. That pleased me enormously. Then the nurse brought me a toothbrush and tooth paste and wouldn’t you know it, the toothbrush was blue too. Blue. Blue. Blue. The color of life.

Suicidal depression isn’t “the blues.” And neither is blue, for me, the color of depression or of psychosis. Because I lived beyond that attempt to end my pain, my body remembered all the colors and chose to pay attention to the beauty in each one. Blue is still my favorite.

Decades later, while in the Blue Ridge mountains celebrating my father’s 91st birthday, I was walking down a mountain path alone, going to meet Dad at the bottom, when a solid mass of white air approached me. It moved slowly like a large boat in deep water. Then it surrounded me and I could only see white like paper with no words on it. And then it passed. I was released back to color. That is what it’s like to survive aattempt at ending your life and remember how much you love what you nearly lost.

Nowadays I have a closet full of clothing in every color of the rainbow. Tomorrow I will wear the turquoise kimono blouse with the deep indigo blue pants. I pick out the earrings with three beads of gradations of blue. The sandals with blue straps will go with those. In the morning I will be ready to go to work. Ready to remember and keep my promise to Marnetta. Ready to choose blue in all its delight.

Author bio:

Margalea Warner has lived with the adventure of mental health challenges since her early twenties and now considers herself differently-abled. She is a published writer of poetry and prose as well as a public speaker. She works full time as a secretary at University Hospitals and Clinics of Iowa City and has done so for 35 years. She has been free of psychiatric hospitalizations and suicide attempts for over 24 years and has collected 24 keys to wellness along the way. The title of which she is most proud is Bing the Triumphant Tai Chi Tortoise, having studied and practiced Tai Chi for seven years.

Margalea has previously guest blogged for Prozac Monologues, Seventeen Keys to Recovery.

photo by William Yoder

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