Wednesday, 20 March 2019

A Heap of "S" Words and an Aitch: Stigma, Suicide, Self-Harm - and Hope

By Martin Baker and Aimee Wilson

My good friend and fellow mental health blogger Aimee Wilson recently enrolled on an online course at Future Learn, titled Understanding Suicide and Suicide Prevention Strategies in a Global Context. It took me about thirty seconds to decide to join her! This is from the course description:

On this course, you will gain a broader understanding of suicide as a worldwide issue. You will analyse global suicide rates and patterns and explore common risk factors. You will explore the social and cultural factors that can influence suicidal behaviour. You will also look at suicide prevention strategies and learn how these can be enforced in communities.

Having a study buddy is great because — as Fran and I have found many times — you have someone to share ideas and perspectives with, and to talk through any issues that come up. This is especially valuable with something as complex and important as suicidality.

As with other Future Learn courses there is an online forum where students can connect, answer or ask questions, and post comments. One of the modules, Introducing Stigma, invited us to “share examples from mental health settings that help clarify the meaning of the terms [stigma, stereotypes, and discrimination].” I posted the following to the discussion area, drawing on conversations Fran and I have had over the years:

My best friend who lives with bipolar disorder has lived with suicidal ideation for most of her adult life. [....] In her case, the perceived stigma surrounding suicide (how she would be viewed by her community after any attempt at taking her life, whatever the outcome might be) is one of the factors which in her case is protective. The stigma helps to turn her away from that edge. This is something I don’t think I have seen reported elsewhere. Not exactly a good aspect of stigma, but worth noting.

I mentioned this to Aimee on Twitter, where we have been tweeting our progress on the course. She hadn’t heard that particular point being made before either. It made sense to her, although her personal experience with stigma was different:

For me, the stigma means I find it hard to ask for help when I am feeling that way.

I replied that the impact of stigma wasn’t simple for Fran either.

Yes, and that [aspect] is also present for Fran. So it’s all very mixed up and confused/overlapping. (We go into this in our book HTLT in some detail). I guess the different aspects affect people in different ways, and not always “logically”.

Here is the key passage, from chapter 7 of High Tide, Low Tide, “The ‘S’ Word: Being There When Your Friend Is Suicidal”.

The stigma surrounding mental illness is unhelpful and dangerous to the extent it makes people less likely to seek help, or speak to someone about what they are going through. Yet paradoxically, it can be protective to some degree. As Fran sees it, the taint of suicide would follow her even in death. She would be remembered not for her successes — her career, her books, her caring relationships, or the courage she has displayed through decades of illness — but as a failure. Whether or not she survived, she would always be “Fran Houston, that woman who tried to kill herself.” As much as she despises it, the shame of suicide helps to keep her away from the edge.

Aimee and I had chance to discuss this further in person. The idea that stigma could have a protective effect gave her a perspective she’d not had before. I asked if she would share what it meant to her:

Having experienced recovery from Borderline Personality Disorder (BPD), I’ve learnt that it isn’t linear. Recovery is still a rollercoaster; it’s just that you tend to actually stay on the track a lot more! So, it feels like my recovery is constantly being tested by challenges in life and it means that I’m always looking for new inspiration and new reasons to stay on that track. Hearing Fran’s thought process around suicide was really enlightening and I have definitely added it to my arsenal of inspirations I can call on when things get difficult.

And that’s why it is so important to keep the dialogue open about such “difficult” topics as stigma, suicide, suicidal thinking (also known as suicidal ideation), and self-harm. (That’s a heap of “S” words, right there!) All too often these are hidden away or talked about only in terms of statistics and strategies (another two!). Exploring trends, causes, and effects on a societal level is important, but behind every statistic is an individual with his or her personal story, experiences, insights, and potential. That can too easily be lost. As Fran’s experience of stigma shows, things are not always as simple or clear-cut as they might appear.

No one is saying stigma is a good thing. It is overwhelmingly unhelpful, unhealthy, and damaging to both individuals and society at large. But the fact that it may, under some circumstances at least, help someone step back from the edge of self-harm or suicide deserves to be acknowledged and considered alongside other factors.

When it comes to something as complex as suicidality and self-harm, the best approach is to start from the individual person’s perspective, experiences and needs. And if we cannot guess what those are — and we cannot — we need to be prepared to ask the questions.

What are you going through right now?
What helps?
What doesn’t help?
What do you need?

Sharing our stories in a spirit of openness allows us to learn from others, expand our understanding, and can bring hope. What more valuable work can there be?

How do you feel about the topics discussed in this article? Please feel free to share in the comment section below.

Further Information

If you would like to know more about courses offered by Future Learn you can find all the information on their website. There is no enrolment charge and most courses are free to access throughout the duration of the course and for 14 days afterwards. You can upgrade for unlimited access plus a Certificate of Achievement or Statement of Participation. For the course Aimee and I are taking the upgrade cost is £52 (GBP).

Aimee Wilson is a 28-year-old mental health blogger who has used her personal experiences to develop a popular online profile. Her blog I’m NOT Disordered has close to half a million readers. Aimee’s first book, When All Is Said & Typed, is available at Amazon.co.uk, Amazon.com, and in other regions.

 

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