Three years ago I was asked a series of questions by a high school student from Medellin, Columbia. One of those questions was "How Can People With Suicidal/Homicidal Ideation Be Helped".
Because September is National Suicide Prevention Month, I decided to reprise the blog post I wrote then in response to her question with some revisions/updates.
Because September is National Suicide Prevention Month, I decided to reprise the blog post I wrote then in response to her question with some revisions/updates.
Disclaimer: To be very clear right from the get go on this blog post.....
I am NOT a medical professional, nor do I claim to have any medical training in the areas of mental illness and criminology. I'm not a doctor, a psychologist, a psychiatrist, a therapist, a social worker, or any other member of the medical community anyone can conjure up. I'm not a member of law enforcement of any kind, either.
I am merely someone in the lay community having a modicum of personal experience as a direct result of the near homicide of two of my children and the successful act of suicide of my first wife, Carla. As such, what I'm about to present must also be taken with that old proverbial grain of salt.
My experiences do not, in and of themselves, make me a 'subject matter expert' by any stretch of anyone's imagination. They do, however, give me a basis or platform from which to be able to speak to the issue of mental illness and the role it may play in causing some to engage in the acts of suicide and homicide, and I do so strictly from my own personal perspective and biases.
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| Random Sputterings |
If one approaches trying to help someone exhibiting symptoms of suicidal or homicidal ideation, both of which I believe are symptoms of a mental illness in some form, does trying to help 'someone' mean someone else, or does it mean ones' own self? This is an extremely important distinction in my opinion.
Mental illness takes many forms. We've all heard of depression as one of the more common mental illnesses. Many have also heard of schizophrenia as another. Bipolar disorder is just one more in what could ultimately be a very long list.
But when it gets into more complex and pervasive psychoses such as delusional paranoia with psychotic episodes, what we do know is that we know very little!
I can tell you that when delusional paranoia and psychotic episodes manifest together, the symptoms basically consist of hallucinations during what might be compared to a very bad trip on LSD...sans the LSD. At least that's the modality Carla presented from her initial diagnosis in 1996 forward.
She also suffered from severe depression, very...severe...depression. But that's about all I can tell you other than it was incurable according to every single one of her medical caregivers.
I do not know what caused it. I do not know what treatment regimens might have been more effective than the ones she was on. Neither did the medical profession. They were quite literally flummoxed by not being able to effectively treat her symptoms and in formulating a treatment regimen they knew would need to be consistently re-evaluated and tweaked as symptoms ebbed and flowed. They told me the disease of mental illness is pretty much fluid in its manifestation, and, as such, it demands flexibility in treatment regimens being designed and used.
Because Carla suffered from delusional paranoia with psychotic episodes accompanied by severe depression, that will be my focus from this point forward in this blog post relative to suicidal ideation. Those details are details of my own reality in trying to help her to at least be able to cope enough to be able to live a reasonably 'normal' life.
Please note, however, as the quote in the meme above should be interpreted, 'normal' is a relative term applicable to any number of situations. After all, we all define our own 'normal' as being unique to ourselves, do we not?
In the final analysis, when we talk about mental illness we're basically talking about mental capacity affected by an illness that no one I'm aware of, not even in the medical community, can actually pinpoint a cause of, much less prescribe a treatment regimen that will control it with 100% efficacy, a treatment regimen that may include both medications and hospitalization with intense therapy. Medical professionals know there is no cure for this malady. They also know helping control the symptoms of it is on the order of being a crap shoot of sorts.
To be fair, I believe the medical community was stymied by Carla's condition. She was on what they called a medical cocktail of 9 different medications when she put that gun to her temple and pulled the trigger to end her life.
And, to be brutally honest, I struggled for a very, very long time wondering if I did everything I possibly could have to help her cope, to help her so that she would have chosen life over death.
She was smart. She was meticulous in her planning. She was almost diabolical in the methodology she chose to end her life. But, most of all, she was determined.
Nothing was going to stop her from carrying out this act. Not the medical profession. Not me. Not the knowledge her kids would grow up without their Mother there to attend those special events in their lives and to watch them as they matured into adulthood. None of those things were considerations for her. That is not a condemnation. It is simply how it was.
To those having a more 'normal' mental disposition/capacity, this is almost beyond comprehension, and therein lies the frustration in trying to effectively answer the question posed by the blog post title from my own personal perspective because I failed to prevent her from taking her own life. The question I must ask myself is what makes me qualified in any way, shape, or form to speak to this issue with any modicum of knowledge when the end result of my efforts was failure?
Pretty morbid thinking, eh? It's my reality, though...like it or not.
Ultimately, though, I've come to accept that the decision to end her own life was hers, and hers alone....sort of like the decision made by the shooters of Columbine to wreak such havoc on the lives of so many others when they did what they did. Their decision to carry out an act of homicide was theirs and theirs alone.
Speaking of homicidal ideation....
This area is more nebulous, especially for me. The shooters of Columbine were both homicidal and suicidal. I don't know if they started their mayhem being suicidal, but that's how it all ended.
Honestly, I don't know if I can even provide any insight whatsoever into helping someone with homicidal ideation.
In many respects, the same treatment regimens might apply to homicidal ideation as apply to suicidal ideation as long as those ideations present themselves and a clinical diagnosis can be made in which case evaluating and implementing a treatment regimen takes place.
Medical professionals are supposed to be consulted and they are supposed to be relied upon to provide their best, most professional help possible. Or so the thinking goes, but, once again, in reality it's almost a crap shoot.
In the case of the shooters of Columbine, the ensuing investigation revealed certain indicators, red flags if you will, that were definitely missed by many professionals in their respective fields. Those red flags, had they been acted upon, may ultimately have prevented this massacre, but no one knows with 100% certainty that they would have. I say this only from the perspective there's also no way I am 100% certain that had I done anything different I would have prevented Carla's suicide.
With Carla's mental illness, I had the advantage of basically knowing she was suicidal. I'm still not so sure that knowledge was evident with anyone involved with the shooters of Columbine, at least not blatantly so.
And, if none of the above seems to offer any modicum of how to help someone presenting with suicidal or homicidal ideation, perhaps what we should really be discussing is a pervasive negative stigma that is all too often associated with virtually any form of mental illness. Perhaps understanding that negative stigma associated with mental illness should be the first step in being able to effectively help those suffering from this malady.
Negative stigma associated with mental illness is arguably the single biggest stumbling block preventing those who suffer from this malady from seeking the help they may so desperately need.
Far too many of those who consider themselves to be 'normal' do not understand, much less know how to acknowledge, accept, and interact with someone suffering from mental illness. That is simply a statement of fact.
Those who consider themselves to be 'normal' often times react to aberrant behavior of any kind as the perpetrator being 'crazy' or perhaps 'bonkers' or perhaps some other derogatory label. Every single one of those labels contributes to the negative stigma associated with mental illness in any form. That, too, is simply a statement of fact.
In all the research I've done since my own family's trauma, in all the heartache associated with that trauma one thing stands out: There is an almost unrelenting ignorance of those on the outside looking in.
Ignorance is bliss.
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| Calvin and Hobbes by Bill Watterson for May 20, 2012 |
Being ignorant doesn't equate to stupidity. Rather, it just means someone isn't knowledgeable about something if they are ignorant of, or ignorant in, that something. That's all.
So, when people hear or read things about the shooters of Columbine, as just one example, their reaction is one of disgust, anger, and sometimes even a modicum of fear of 'the crazies' who did this. A fear of 'the loonies' who commit other massacres.
But to so casually refer to the shooters in massacres as 'the crazies' also displays not only a sense of ignorance of the disease of mental illness, but an insensitivity toward those who suffer from it.
That...that right there is what needs to be addressed first and foremost in a very long process of increased awareness and self-education necessary in overcoming the negative stigma associated with this disease. If we choose not to do this, we may very well end up like Calvin and Hobbes did in the cartoon above....being careful so as not to have learned anything from our own experiences regardless of how traumatic those experiences might be.
So, in the end, have I answered the question posed in the blog post title? I guess it depends upon one's own perspective.
If readers of this blog post were looking for a clinical diagnosis or dissertation on how best to go about helping those suffering from mental illness, this question will, by virtue of the fact I am not a medical professional, remain unanswered.
If, on the other hand, readers of this blog post choose to take what I've provided based upon my own experience with that proverbial grain of salt I talked about at the very beginning, then perhaps the question has been answered...to a degree.
No one ever promised anyone a rose garden. Mental illness in any form is a complex disease accompanied by complex issues. How anyone approaches providing help to someone else or seeking help they, themselves, may need is a very personal choice.
One final thought....any choice made to follow whatever treatment regimen one might come up with is going to be fraught with inherent risks. It's ultimately going to be up to the individual suffering from mental illness to decide which risks to address.
Perhaps some of them.
Perhaps all of them.
There are no easy answers....a simple statement of fact.
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