Possible trigger topics: self-harm, suicide
September is Suicide Prevention Awareness Month. According to the Center for Disease Control and Prevention (CDC), suicide is a leading cause of death in the United States, and the rates are rising. Our young people are especially vulnerable. Fifty percent of lifetime mental illness begins by age 14. Suicide is the second highest cause of death for people ages 10-34.
I don’t know how long I had bipolar disorder before I was formally diagnosed in my late twenties. My earliest memory of depression is at 15 years old, but I had no idea that’s what it was. I knew I was different than my peers at school, and I suspected I was more ‘dramatic’ and sad than what you’d expect for typical teenage angst. I thought about death and dying a lot. I day dreamed about hurting myself, and sometimes acted on it. I didn’t know how to ask for help. I thought something was wrong with me—not just that I had a medical disorder, but that there was something fundamentally wrong with me as a person. I hated myself a lot of the time and thought that I should be able to do better, be better. I was ashamed.
Thinking about suicide is not normal, but it is also not uncommon. I thought about it as a teenager. I thought about it even more in my twenties. I never told anyone, not until I started therapy when I was 26. Looking back, I tried to reach out for help in small, subtle ways, especially at school, but was never seen in the way I needed to be seen to get help.
In my junior year of high school, we had an assignment in my psychology class to keep a Daydream Journal. I didn’t only daydream about cute boys, going to college, or what I was doing with my friends later. I also daydreamed about people that I love dying, being rejected, failure, and hurting myself. I completed the assignment honestly by journaling about all of the darkness in my mind, which was a stark contrast from my usual behavior of hiding all of that pain and shame inside. My psychology teacher wrote a note on the assignment; I don’t even remember what it said. She never said anything to me in person or notified my parents. Why didn’t she do more to help me?
I asked to meet with the school counselor once. I told her how sad I felt and that sometimes I would cry for hours because I couldn’t stop. She focused solely on how I felt about things going on at home with my family. I knew this wasn’t the reason I felt such intense suffering. I never went back to see her again. Why didn’t she do more to help me?
Throughout high school, I demonstrated some of the warning signs of mental illness. I felt intensely sad much of the time and cried often. I used alcohol excessively, beginning at the age of fifteen. I was overly moody and easily agitated. I engaged in self-harm and thought sometimes about killing myself. Why didn’t those around me do more to help me?
When I look back now, I can see that I didn’t understand what was going on within myself, so I didn’t know how to ask for help. I kept my suffering inside. I kept my maladaptive behavior hidden. Over the years, I built an incredibly strong and nearly impenetrable mask of perfection. This mask showed people around me that I was well-adjusted, high achieving, hard-working, funny, and sociable. On the inside I was sad, scared, hopeless, confused, and lonely. But no one knew.
I’ve been reading a memoir written by Marsha Linehan*, who is known for her amazing contribution to psychiatric treatment called dialectical behavior therapy (DBT), which was originally geared toward highly suicidal people, but is now used to treat many people with varying psychiatric diagnoses. DBT has helped me greatly. Her memoir describes her history with her own suicidal behaviors as the catalyst to developing this behavioral therapy and thus helping millions of people struggling with mental illness. In her book she shared, “I was often experiencing intense inner pain and suffering while at the same time displaying a put-together self.” This seems to be a common thread in many personal stories of those with mental health disorders, including my own. We know something seems wrong, but we don’t know enough about mental illness to recognize what it is. Or if we do recognize we may have a mental illness, the shame keeps us silent. Marsha shared that later in life she asked her school principal why no one did anything to help her. Her principal responded, “Marsha, we did not know anything was wrong.”
Sometimes the warning signs are subtle. The more we know about mental illness and suicide warning signs, the better equipped we are to identify and help those in need; and the better equipped we are to ask for help when we need it. According to the National Alliance on Mental Illness, “comments or thoughts about suicide — also known as suicidal ideation — can begin small like, ‘I wish I wasn’t here’ or ‘Nothing matters.’ But over time, they can become more explicit and dangerous.” Other warning signs include:
Feeling like a burden Isolation Increased anxiety Feeling trapped or in unbearable pain Increased substance use Extreme mood swings Hopelessness Sleeping too much or too little Talking or posting about wanting to die Increased anger or rage Making plans for suicide
For more information on how communities, schools, health care systems, employers, and individuals can help reduce suicide rates, visit www.cdc.gov/vitalsigns/suicide or http://www.theactionalliance.org. If you or someone you know is in an emergency, call The National Suicide Prevention Lifeline at 800-273-TALK (8255) or call 911 immediately.
If we all understood a little bit more about mental illness, or mental and emotional health was part of the school curriculum, or mental illness was discussed as regularly as diabetes and heart disease, maybe that little fifteen year old girl could have asked for help.
“To anyone out there who’s hurting-it’s not a weakness to ask for help. It’s a strength.”
*Building a Life Worth Living, a memoir by Marsha M. Linehan