The time bomb

If the survivor of a suicide attempt does speak out about the experience, how do they avoid others seeing them as some kind of time bomb?

I put the question to David Webb, an attempt survivor from Australia who is now a suicidologist and the most outspoken, thoughtful person out there on the topic of suicide from a firsthand perspective. You can get an idea of his overall thinking here and here.

The question came to me at the American Association of Suicidology national conference this month as I browsed what’s called the poster session _ an event where academics display the findings of recent research and chat with passers-by.

One young man had researched suicide notes for expressions of “thwarted belonging and perceived burdensomeness” and had not found many. I joined a small group around him and asked whether the notes had instead been far more practical than philosophical: “Feed the cat,” and so on. Yes, he said. (A person’s thinking has often narrowed by that point to the work ahead.)

I responded that I was familiar with suicide notes, having written more than one in the past. I thought mentioning my experience could be helpful, since the hundreds of people at the conference included only a half-dozen “out” attempt survivors.

The group looked at me for a moment, then turned back to the man and asked him another question. Nothing. Not even a casual, “Oh really?” After a short while, I smiled, did a mental shrug and walked away.

Were they used to speaking with attempt survivors in their work and unimpressed at meeting another? Or were they speechless because, despite their work on suicide, they still didn’t know what to say?

One concern for me about speaking out has been the degree to which people, worried about “setting me off,” might be measuring their responses. Do they feel it would be risky to argue or be angry, even if they disagree? Is the conversation then still not open?

Another concern is the extent to which a person who has attempted suicide is forever marked by those who know it. Clearly, many people move on from an attempt and never try again, but from the hush around the topic you’d think that all of us are likely to go off at a moment’s notice. I received kind words and support at the conference, and I was happy that no one walked out during my presentation, but one comment afterward struck me as curious. After hearing that I’d been accepted to law school, one person said, “That’s a brave law school!” I wondered, “Why?” for a split second and then, “What can an attempt survivor do to truly put people at ease?”

Here is David’s response to my original question:

“I suspect it’s very hard, sometimes impossible, to break the perception that we’re some sort of time bomb,” he wrote in an e-mail. “For two reasons. First, that perception is mostly about that person’s prejudices and fears about suicide. It’s another example of the typical panic response to anything to do with suicide. So the first challenge is to _ calmly and slowly _ try to help people see that their perception comes from their prejudices, which is always hard to do. But the second reason, which complicates this, is that some of us ARE time bombs _ i.e., suicide does remain a viable option for some of us who have gone a certain distance down the suicidal path, even if we are not ‘actively’ suicidal at the moment. Which brings to the surface the important issue _ which many people try to play down and/or deny _ that suicide IS dangerous territory to think and talk about. We all know this, of course, because sometimes, regardless of everyone’s best efforts, some suicidal people DO DIE. There’s never any guarantee or certainty about anything to do with suicide. So let’s face up to this and not deny it. It’s part of the conversation _ even if it doesn’t get mentioned, it’s present in the ether whenever we talk about suicide.”

Later, he added, “And I’m very familiar with the different reactions you get from people and yes, ‘freaked out’ and ‘unimpressed’ are both common. I think you can add to this threatened, defensive, embarrassed, horrified, offended, etc., etc. … all the usual reactions you’ll get when people’s prejudices are exposed and challenged.”

There’s a huge open space for discussion on suicide. We can let it remain a nervous void, or we can at least start to fill it with admittedly nervous conversation. That’s how you break the ice sometimes.

New: The Waking Up Alive house

The resources for people in a suicidal crisis are often pretty bleak beyond a crisis line call. I was happy to hear about a new project called Waking Up Alive, which appears to be the first of its kind in the United States and one of a handful in the world.

Sabrina Strong, a suicide attempt survivor herself, is the executive director of the New Mexico-based project, which is modeled closely on the pioneering Maytree Respite Centre in London. Maytree has been open for more than a decade as a welcome alternative to emergency rooms and psychiatric wards. It was founded by a longtime member of the Samaritans, which is well known for its “befriending” approach with crisis callers. Think of “befriending” as “making them feel more normal.”

Essentially, both Waking Up Alive and Maytree are homes, normal-looking residential homes, where people seriously considering suicide can stay for up to five days and try to clear their minds. The homes are meant to be a calm environment, with volunteers available around the clock for company and support. People can also leave whenever they choose, which certainly isn’t the case with psych wards.

An outside evaluationof Maytree after its first three years can be found here. It found that 70 percent of Maytree’s 159 guests by then had at least one suicide attempt before arriving. The report has some touching details, including one man describing life as like driving down a two-lane road, with no exit or shoulder, stuck behind a truck and trying to reach a destination he could never see.

Here is another independent report on Maytree from last year. It not only discusses similar programs in Canada and Ireland, but it also talks about other alternative approaches in Norway and elsewhere.

But back to Waking Up Alive. Opening a respite home for suicidal people in the U.S. wasn’t easy. “We’re soooooo litigious here,” Sabrina says. “We’ve hit the point in this country where people are so afraid of doing the wrong thing for someone who’s suicidal that they say, ‘You’re going to the hospital,’ and that’s it. Nobody actually wants to help someone before they’re hospitalized.”

By the way, the Waking Up Alive service, like Maytree, is free. Not bad, considering how much money they’re paying to nervous insurers.

Sabrina can tell you more:

So, where did you get the idea for this project?

It’s sort of an idea a lot of people in the suicide prevention field have kicked around, creating an in-between option for people who are suicidal but not enough to be hospitalized _ because that’s the traditional answer. Not only does that model not work, because a lot of times hospitals will not take people who want to be there, but some people are forced to be there, and that’s really a dehumanizing experience for a lot of people. A lot of people in the field say, “There’s got to be something we can do, a safe place.” But they couldn’t quite figure out how to do it. There are a lot of moving parts to creating a program like this.

Out here, we’re just so frustrated by how emergency departments, the crisis intervention system, worked. It’s obviously broken. There’s not enough capacity to meet needs. The only option was the hospital, so people waited six to eight hours in a waiting room with people who were psychotic or obviously criminally insane, escorted by police. They spend so much time in the waiting room that they start thinking, “Maybe I’m not suicidal. Maybe I’ll just go home.” And if you don’t have health insurance, nobody wants to take you. A lot of people are falling through the cracks. There’s no place to go for the specific help they need that allows them to keep their dignity and sense of control and safety.

We knew we needed something. We had an idea that that something would be a residential option. It was more of a pipe dream. A lot of people had the same pipe dream. But the liability in this country is too horrifying to wrap their heads around. Definitely in this country, but also around the world, there’s almost a critical mass that people know we need this. They don’t necessarily know what “this” is, but something better. I don’t know if it’s the way people are talking about suicide now, or those people working hardcore in suicide prevention and knowing. Regardless, I found someone who had the idea and found out how to do it. That someone was Paddy Bazeley with the Maytree Respite Centre. She started the program in London. She came from the Samaritans, the UK crisis line, and did that for years. She kept hearing over and over, “If just I could go somewhere for a few days, I could work this out on my own.” I don’t know about you, but I tried that, but you tuck all of these problems in your suitcase and take them with you. You end up in a strange place, and the suicide risk is greater.

Her idea was to have a house, a residential house, a place where people can come and stay. It’s not going to be clinical, not going to be medical. They don’t even search people, which is not an option for us. Basically, the stay there is about five days. That came about through trial and error. People get enough of a break, enough solid time to think and reflect and bounce ideas off of people. At the same time, they’re not away from home too long. It’s not like going to rehab. They’ve been doing this, I think, for 11 years now. It’s successful, and a lot of people around the world are figuring out how to replicate it. As far as I know, we’re the first in the U.S.

Do you know of others outside the U.S.?

There’s one in Ireland. And I got an e-mail from a woman in the Netherlands, though it’s not exactly the same program. I just started getting e-mails from a woman in Australia, she has some kind of fellowship on how to replicate that crisis model in their country. And because Maytree is aware of us, they’ve started referring people to us.

Just as you’re starting it all!

I know. It’s pretty scary.

Have people arrived yet? How has that gone?

Yep. It works exactly the way we thought. The first guest came through a couple weeks ago. It was kind of a trial basis, to make adjustments. We explained up front to people exactly what to expect. Part of making these models work is always having someone make the hard policy decisions. Somebody decides, “This is how it’s going to be.” Paddy’s way is, they don’t search people, and a lot of people think that’s crazy. That’s not for us. We have gun ownership in this country, and a lot of guns in the Southwest. We can’t not search them.

Clinicians are looking for that, a program that has been thoughtful about the risks. That’s why we require a referral from a mental health clinician. We can’t just take everybody on their word, that they’re going to be OK. We expect people to have problems, and we want to make sure they’re not at such imminent risk to themselves that they need to be in the hospital. We’re actually trying to get people earlier in their crisis, before the choice isn’t theirs anymore.

We are very up front with people, so they’re not surprised. I remember that kind of experience being hospitalized. It was really frightening. Like, “OK, now we’re going to strip search you.” I was like, “How did I get to this point?” Like, oh my gosh, it’s just an experience not to repeat.

So people who come don’t have to worry about insurance. It’s all free, right?

Right. As long as we can manage to keep it free. We’ll open it up to people out of state, but they’ll have to pay. We’ve had people contact us, desperate. People are looking for anything. They’ll take anything. We have a teeny-tiny bit of funding, but we keep it reserved for people who live in this state.

How many people have come through?

So far, just the one. The word is still percolating. Clinicians are starting to contact us and ask us five million questions. They like what they’ve heard. They appreciate how well thought out it is. People appreciate that. Because we’re obviously shifting the liability to clinicians because they’re making the referral, they want to make sure nothing will come back on them. We’re soooooo litigious here. We’ve hit the point in this country where people are so afraid of doing the wrong thing for someone who’s suicidal that they say, “You’re going to the hospital,” and that’s it. Nobody actually wants to help someone before they’re hospitalized.

What’s so brave about you?

So yeah, everybody asked, “You’re really going to do it?” It cost us an arm and a leg and a firstborn just to insure the program. That’s why it took so long. We couldn’t get anybody to even entertain the idea. Once we pulled together the insurance quotes, it was outrageous. I was told that was to be  expected.

How much is the insurance?

About $7,000 a year. Not cheap.

I read over the Maytree site and how it works. Have you made any changes? Especially to the policies of no follow-up contact after a person leaves and the limit of having just one stay?

I want to. The follow-up piece is something you have to be incredibly thoughtful about, and find a way to pay for it. So I do follow-up phone calls, e-mails to collect data for grants, because people want to know, “Does it work?” I want to follow up after a week, a month and a year. To me, it’s not ethical to call someone once a year and ask, “Are you still alive?” and stick that in the win column. It also opens up a world of things when you ask someone, “How’s it going?” and hear “Life sucks” and you have an obligation to do something. I have a lot of ideas. But securing the core of the program is step one. You have to be thoughtful, because you’re opening up a huge can of worms when you ask, “How have you been?”

Also, we talked about that, not being able to come back. Most people in the mental health world understand that. You have what are called repeat offenders, who come back again and again and again. Who knows. They’re hungry and you feed them, or they’re homeless, or they’re really just miserable all the time. You end up finding out more and more about that person and their life and their illness, and we’re not equipped to do that. We deal with suicide, not with the disorder or the self-injury or whatever the diagnosis is, and the more contact there is, the more you have to know about that.

I never say never. Because some people are chronically suicidal, and they might not get the same benefit out of it, there are different conditions under which some people might be able to return. But it’s not a revolving door. We’re not here to be abused, but we don’t want some people to feel they can never come back. And actually, Maytree does the same thing. If there’s a circumstance that changes in that person’s life, they sometimes take people back. And they have taken people back.

In an early article in the UK press about Maytree, Paddy talked pretty straightforwardly about the possibility of having a death there. How do you address that?

Yes. They have 10 years of data on how it works. She said that we can expect people to kill themselves in the program _ or, excuse me, to try to kill themselves. They’ve never had a death. It’s a worst-case scenario we have to plan for. We tell volunteers, “You’re choosing to do this. You’re working with high-risk people, and at some point you’re going to lose somebody.” You’re playing the odds. They had one person go home and the next day kill themselves. It’s gonna happen. People are going to make what in their mind is an informed decision. All we can control is what happens here, to a certain extent. That’s why we search, and why we ask them not to bring more than seven days of medication.

People may try to kill themselves on site, but don’t I recommend it. We will have eyes on them every 15 minutes, if they’re talking, if they’re journaling. We’re prepared as much as we possibly can be. There were a handful of attempts at Maytree, every time an overdose, and every time the person thought better of it and went and told them. I tell people, “Just don’t freak out, OK?”

Talk a bit about your background, having attempted suicide yourself, and any concerns about how this work will affect you.

Yes. I was chronically suicidal for about a decade, in my late teens and 20s. It ended in a serious suicide attempt, and I spent four or five days in a locked psychiatric unit. It was a turning point. It got me to a point where I could finally get the help I needed. But at same time, it was such a long, drawn-out downward spiral that someone should have been able to step in at some point and say, “You need help. Let me help you.” How many years do you have to go through that before an intervention? It took a few years to even figure out how to talk about it, and taking that and being comfortable sharing that in a professional setting.

Any reasonable person would be nervous going into this. I talked with my therapist. He actually helped a little bit getting this project off the ground, and he knows what I’m doing. I know at some point something is going to happen. I tell people, “I don’t expect you to be superhuman. You will trip over your own baggage. I just want you to know it’s there. If something sets you off, we’re going to sit down and have a chat about that.” I think that’s the best you can hope for.

Did you plan and furnish the house yourself?

Yeah. We got a start-up grant to do what we needed. We got a lot of stuff donated. After that, we bought things here and there. We’re renting. We’ve been lucky enough to have people who sort of believed in us and helped us along the way.

Do you have your own favorite space in the house?

I like a lot of the spaces in here. We took a lot of care selecting things, just the right setup. Every sitting area, I really love. It’s a place where people want to sit and talk. That’s what Maytree is, a lot of tiny rooms with chairs to sit and talk.

Have you been to Maytree?

Yes.

Professionally or personally?

I was on vacation, and we were at the point where we were kicking around the idea. I started Googling suicide prevention programs in the UK, and I said, “This is the thing. Someone’s actually done this.” I went and talked with Patty and got a tour of the house. It was pretty awesome. I asked her every question I could think of. The truth is, it’s a very simple model. If you don’t mess with it too much, it has a magic of its own. It’s a place where people are not going to freak out if you’re talking about suicide.

Did you have one big burning question for Patty?

It was more like, “How do we do this? What are the things that absolutely make this program what it is?” And she said, “It’s a program about talking. There’s really no structure to it. It’s really just talking and talking, and talking some more.” It’s not a place that’s a revolving door. It’s putting ownership on people where they have to make the most of their time. The last thing she said to me was, “My advice is, just do it. You’ll be surprised to find what will happen. You’ll be surprised at what kind of support you’re going to get.” And I did. Literally, I got home and I had a grant announcement in my in-box and I said, “I think we can get this.” And we got it. And I thought, “Oh my god, these people are as crazy as I am.” But people understand the need for it. They love we’re doing something _ we’re doing anything _ we’re doing something new and radical: “Wait, we’re the first one in the country, and we’re in Albuquerque?” Hey, it’s just happening. It’s just happening. And it’s been nonstop since.

It can be difficult finding people to support anything related to the topic of suicide. Would you like to thank anyone here?

OptumHealth of New Mexico, because they took a chance on us. They gave us every penny we asked for and said, “Go do it.” And our volunteers and staff, they’re kind of amazing. That anyone wants to do this amazes me. Obviously, the folks at Maytree, Patty was great. Hopefully we can pay it forward to help other places get off the ground. I didn’t realize how much of a big deal it would be not just here in the U.S., but internationally. Since we’re on the short list of places that got it off the ground.

Outside of this work and your experience, who else are you?

That could take forever to answer. I’m a lot of things. Just right now, this here’s one of the things taking up all my time. I know once we can get it off the ground, I can go back to having a life. Right now, this is where I want to be. I’m always doing something about some taboo topic that just makes my parents cringe: “What is she doing now?” I guess they’re probably happy I’m not doing safe sex education anymore.

Have they been by the house?

Oh yeah. My mom is a volunteer here. My dad actually is working overseas, but he did a few things cosmetically we needed done here.

Your mom is a volunteer!

I’m as surprised as anyone else.

‘Only cannibalism and incest …’

“Only cannibalism and incest have a greater level of stigma, I think.”

That comment is from Larry Villano, who spoke last week at the national conference of the American Association of Suicidology. He was talking about the suicide attempt survivors group he and others have created in the Phoenix area. These groups don’t form easily. The Arizona one has just six members so far, and some people haven’t joined because they don’t want their mental health case managers finding out that they’ve tried to kill themselves. The group also faces the possibility that the stigma of suicide attempts will limit sources of funding and support.

So, why are support groups for suicide attempt survivors so rare? People are scared to form them, scared to support them and scared to participate.

Changing things will take more people like Katie Ayotte, who helps to run the Arizona group. She remembers “coming out” about her own suicide attempt during a task force meeting where people were whispering about suicide. “Can I have the microphone, please?” she asked them.

In the Chicago area, Stephanie Weber started an attempt survivors support group that inspired others across the U.S. to consider the idea. It took five months just to find the first two members, she told the conference. Now the group is large enough to attract eight interns to help guide it. Still, there’s nervousness.

“Two of the interns came up to me and said they had attempted suicide: ‘Can you still take us?'” Weber said. (“You are so valuable!” she told them.)

The big concern about forming these groups is that people will compare notes on methods and try it again. But people behind the groups say the focus isn’t on war stories. It’s on learning to manage any suicidal feelings. Another concern is that discussions will be overwhelming for some. But “you’re going to have triggers no matter where you are,” said CW Tillman, an attempt survivor and student who has addressed the conference for two straight years.

“Where better to be triggered” than at a support group? Weber added. “People need coping mechanisms, and where else are you going to learn that?” Tillman said.

As always, details of other suicide attempt survivor support groups in the U.S. or elsewhere is welcome here.

National conference: ‘Where is everybody?’

I’m a shy public speaker, but today I joined two other suicide attempt survivors in speaking at the national conference of the American Association of Suicidology. Last year was the first time in the 44 years of the conference that a plenary, or full, session was devoted to the issue of attempt survivors, and one person, CW Tillman, was up there in front of hundreds of researchers and crisis workers speaking for all of us. Today’s smaller-scale talk included CW, myself and Heidi Bryan. Also with us was Stephanie Weber, who has been a pioneer in creating a support group for attempt survivors in the Chicago area.

I plan to post information from the conference on an attempt survivors’ support group in Arizona, as well as a new respite home in New Mexico for people struggling with thoughts of suicide. Another couple of interviews with attempt survivors are on the way, too. First, I’d like to share what I read at today’s session as an introduction. I had worried that people in the audience would be angry or offended by some of it, but the entire presentation went well:

I’m happy to be speaking to you today. My latest suicide attempt was a year ago. I was working in China as a reporter, and I abruptly resigned. I hiked to an abandoned village outside Beijing, took sleeping pills with a bottle of wine, lay on the ground and hoped to freeze to death in my sleep. I didn’t.

I want to be direct with you. I romanticized my attempt. And it felt good to have the attention afterwards, because I had been so alone. All of this is selfish, and I don’t know whether I’ve changed. But I’m not feeling suicidal now, and I’m back at work.

I’m also being far more open about suicide this time. I want to tell you about some of the things that have really surprised me.

– First is the silence. Where is everybody? And where are the people at this conference? How many people are drawn to working in the mental health field because of personal experience? If there’s any safe environment where people can speak openly, shouldn’t it be here? I’ve been interviewing other suicide attempt survivors for a blog I write called Talking About Suicide. Finding them hasn’t been easy. More than one has told me that people used to talk in whispers about cancer. About cancer! Look how far we’ve come. And homosexuality, more whispers. Look at it now. When will it be suicide’s turn? When can we come out? After my attempt, it seemed natural to join a support group with other attempt survivors. But New York City doesn’t have one. The number of such groups in the U.S. can be counted on one hand. That’s incredible.

– Second is the danger of suicide attempts. I have spoken to people who have shot themselves, who have jumped from buildings, who are now in wheelchairs. I have found no good research on people with permanent injury from suicide attempts. Suicide is risky all around. Desperate people are acting on poor information from anonymous websites. People who want to kill themselves end up wrecking their bodies and minds. People who don’t want to kill themselves, who want to hurt themselves instead, are dying by mistake. Suicide attempts are guesswork. Since we don’t dare talk about suicide methods, are we OK letting people take their chances? Are we sure there isn’t an intelligent way to talk about the risks involved?

– Finally, and I don’t think you’ll like this, is the fear of thinking outside suicide prevention, of understanding that after a certain age or circumstance some adults _ I stress, adults _ truly see no real life ahead and want to die. I see no bridge between the people who want to prevent suicides and the people who want to ensure a person’s death with dignity _ but even then only if they have a terminal condition. Life is a continuum, and the thinking about suicide should be one as well. What about people in middle age who can no longer be consoled with the phrase “You have your whole life ahead of you”? What about the aging and elderly who don’t want to lose their mental sharpness or their independence? What if they have made the well-thought-out decision to end their lives on their terms? So much of the horror of suicide for the person involved is the utter loneliness of the decision. And for the other people around that person, it’s the nasty surprise. All because we don’t dare approach the subject except to reflexively say, “Don’t do it.” Some people may see that response as an expression of love and support. Others may see it as a rejection and an insult to their intelligence. We, even at this conference, are nowhere close to being comfortable with the topic of suicide. If we were, we wouldn’t panic so much and say so little.

Portraits of attempt survivors, and a film

After coming across photographer Douglas Ljungkvist, who was quoted in the previous post, I e-mailed him. He says his series of portraits of attempt survivors began after a friend’s suicide. Intense research into the subject followed. “Having reached out to numerous NGOs, government agencies, the media and medical community, without getting anywhere, I came across a group therapy program in Toronto for survivors of multiple suicide attempts,” he wrote. Very few such groups exist, and this one helped him find his subjects. “They are so brave!” he wrote. “I have learned that one of the challenges is that people generally have very low sympathy for suicide attempt survivors unless they have been down that road themselves.”

It turns out there’s also a separate half-hour documentary on the Toronto therapy group, “Drawing From Life.” You can watch it here on the website of the National Film Board of Canada. The official description says, “‘Drawing from Life’ follows a group therapy workshop for people who have attempted suicide more than once. … This candid portrayal of twelve people who together, for 20 weeks, take on their fears, their behaviours and their ghosts to move towards life and away from suicide. It’s a surprisingly uplifting and universal story about what it means to be alive.”

Yvonne Bergmans, a lecturer at the University of Toronto, runs the Toronto group. Here’s a story about three attempt survivors that mentions Bergmans’ work. And here’s one description of her therapy program, offered by a project in Ireland that is modeled after her work.

Ljungkvist plans to continue the project next month in Toronto with more portraits and interviews. Here is a sample of his work that includes audio from one interview. And here is his own description of the project. He’d like to hear from others who’d like to participate:

In 2009 I was deeply affected by the suicide of
a friend and coworker. This by a young man who
was successful in his career, had a wife and two
children, and a zest for the good life. Max took
his own life by hanging. After his death I began
extensive research about suicide and decided
that my best opportunity to help increase public
awareness would be through my photography. My
project will not sensationalize or glorify the act
of suicide. Rather it’s a celebration of life
over death, featuring people that have managed to
recover to where they are happy to be alive today.

My project combines portraits of suicide attempt
survivors with powerful audio interviews. The
objective is to humanize suicide by adding faces
to the statistics and voices to the faces. These
are extremely brave people that have decided to
stand up and be counted, in the hope that it will
help others, regardless of people’s judgment. If
there is one thing I have learned from this project
already, it’s that unless people have been down
that road themselves sympathy tends to run low,
to induce anger and accusations of selfishness.
I grouped them together as victims, similar to
victims of rape, disease, incest, etc. But since
it is self inflicted it’s judged very differently.
My goal is to play the audio interviews during
exhibitions while viewing the portraits and to
include them as part of a book. Regardless of
how people view suicide attempt survivors we have
a lot to learn from their stories and in finding
solutions to decrease deaths by suicide.

Suicide is a global social problem that more
people die from annually than war and violence
combined. In the US approximately 35,000 die
by suicide every year. That’s more than all
traffic accident fatalities in 2010. This despite
only 10% of suicide attempts resulting in death.

90% of all people that attempt suicide have one
or more treatable mental health or substance
abuse disorder. Women attempt more often but
men’s attempts are deadlier. There is a strong
statistical relationship between low density
populated states and suicide with Alaska topping
the list. Firearm is the most commonly used method
for suicide in the US.

Though the US has multiple government agencies
involved with suicide prevention and bereavement
few outside the medical establishment seem to know
what they do. This might partly be attributed to
fears of lawsuits, copycat suicides, or suicide
pandemics. Except for a handful of copycat
suicides in Japan none of these have really
materialized. I’m of the conviction that suicide
is a social, not medical problem, which needs to be
addressed from multiple angles. The project will
pursue suicide demographically and environmentally
where it translates to higher than average suicide
statistics, too, including Native American’s, Gay
and Lesbian’s, teenagers, prisons, and the armed
forces.

Politically it’s sensitive, too, as we have
millions of American’s without medical insurance or
policies that cover mental health.

The media does not discuss suicide either except
for straight news reporting in the case of high
profile or celebrity suicides. It’s not sexy and
won’t sell ads for the morning shows.

Because of some of these reasons I had to take my
project to Canada to get started. It’s a less
litigious society where citizens have access to
mental health options and affordable medication.

Long-term I want to continue the project in the US
too, especially in Alaska which has the highest
suicide rate in the country, twice the national
average. I also hope to visit Russia, or one of
the former Soviet Union states where suicide among
middle age men is about three times higher what the
WHO has deemed a critical level.

Suicide is too important to be left to the medical
community and media alone!

More on veterans, and a diagnosis

New York Times columnist Nicholas D. Kristof this week turned his attention to suicide among veterans, and he began bluntly: “Here’s a window into a tragedy within the American military: For every soldier killed on the battlefield this year, about 25 veterans are dying by their own hands.”

When a prominent piece on suicide is published, it’s always useful to read the comments, many of them anonymous as usual. Here is a detail that struck me among the many angry responses about war and about the Department of Veterans Affairs: “When my husband tried to hang himself the Army hospital put the diagnosis as ‘cervical contusion secondary to falling on edge of table.'”

The woman adds that her husband walked away from their home in August, and hikers found his body four months later.

What’s wrong with putting “attempted suicide” or “tried to hang himself” on the record? How can we really know how many suicide attempts are made?

A separate comment on the Kristof column offers an answer: “The medical community is too scared to even say the word ‘suicide’ for threat or lawsuits.” The post by Douglas Ljungkvist goes on: “I hate to say it, but in our fame and celebrity obsessed society the only way suicide will get the attention that it needs is if more celebrities die by or attempt suicide and some of those attempt survivors with clout speak out and become advocates.”

It turns out that Ljungkvist is a photographer who has made a series of portraits titled “Attempted Suicide.” The six photos come with no stories, only first names.

The Pulitzer Prizes

The annual Pulitzer Prizes for excellence in journalism were announced today, and among the winners is this photo essay by Craig F. Walker by The Denver Post. He explored the life of Brian Scott Ostrom, who came home from his service in Iraq with post-traumatic stress disorder. One of the most striking photos is a close-up of Ostrom’s tattooed, stitched-up wrist a few days after he tried to kill himself with a “nice kitchen knife.” The photo essay quotes Ostrom as saying of veterans with PTSD, “Every one of us has a suicide plan. We all know how to kill, and we all have a plan to kill ourselves.”

Ostrom has been home since 2007. The photo was taken last year.

Note that the story includes a prominent link to the Veterans Crisis Line.