How Are You, Really? Eight Things I've Learned About Suicidality and Self-Harm

Suicidal ideation has less power when it is verbalised. — Fran Houston

I’ve written a few “things I’ve learned about” articles, including Three Things I Wish People Knew about Loving Someone with Mental Illness, Three Things I’ve Learned About Mental Health Medication, and Four Things It’s Hard for a Mental Health Ally to Hear. This time, I want to talk about two of the most challenging topics of all, suicidality and self-harm. In doing so I’ll draw on my experience with Fran and other friends over the past dozen years or so, as well as training I’ve undertaken including Mental Health First Aid (MHFA), ASIST, and a range of other suicide prevention and awareness courses. I’ll close with a selection of relevant articles we’ve shared previously, and links to crisis lines and other support resources.

1. You know someone who lives with thoughts of suicide or self-harm

According to suicide prevention charity Grassroots, one person in four in the UK experiences mental ill-health in their lifetime, one in five thinks about suicide, and one in fifteen attempts suicide. Young Minds, a UK charity working for children and young people’s mental health, says that in 2018-19 almost a quarter of seventeen-year-olds reported having self-harmed in the previous year, and seven per cent reported having self-harmed with suicidal intent at some point in their lives.

I struggle to get my head around numbers like this, but most of my friends live with a diagnosed mental health condition. Many have experience of suicidal thinking or self-harm. Some have hurt themselves or attempted to take their life. I know this because we’ve talked about it. Whether you realise it or not, whether they mention it to you or not, you know someone who lives with thoughts like these. Probably more than one. That may or may not be an easy realisation, but it’s true.

2. There are many kinds of suicidality and self-harm

I have no first-hand experience of suicide or self-harm. Before talking with Fran and others, I had only the most naive idea of what these terms represent. If I thought of them at all, I thought only of desperation and crisis. I’ve learned how dangerous such naivety can be, and how important it is to appreciate the variation in people’s experience.

In our book Fran and I explore five kinds of suicidal thinking: relentless thinking, suicidal thoughts triggered by situations and stress, hopelessness and despair, suicide by proxy, and focus on suicidal methods. Our discussion is based on how suicidality presents for Fran, but every person’s experience is different. The same is true of self-harm. There are many ways someone might hurt themself, and a wide range of motivations for doing so.

3. Focus on what’s happening not the labels

The distinction between suicidality and self-harm isn’t always clear-cut. As described by the Centre for Suicide Prevention, some researchers place all forms of self-injury on a “suicidal continuum” whilst others consider suicidality and self-harm to be completely different behaviours.

Part of the problem with labeling someone’s behaviour or actions as suicidality or self-harm (or both, or neither) comes down to intention. That’s never easy to gauge. Is my friend suicidal or just having a really rough time? Are they handling suicidal thoughts and feelings with no intention of acting on them, or do they have a plan? Was my friend’s injury self-harm, an attempt at suicide, an accident, or a symptom of something else? It’s important to respect the perspective of the person concerned. I’ve written about this previously.

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.

This is important because while labels have their uses, they can also get in the way. A few years ago I wrote a blog post that explored how I felt when one of my friends hurt themself badly. I was proud of the article. It was raw and honest, and paid due regard to my friend’s experience and mine. We agreed to publish it, but at the last moment we clashed over my labeling it self-harm. By insisting on my interpretation of events, I lost the opportunity to share my experience of a challenging, but ultimately valuable, episode in our relationship as friends.

However we label them, these thoughts, feelings, and impulses arise in situations characterised by distress. I wrote the following notes while taking Carolyn Spring’s online course Dealing with Distress: Working with Suicide and Self-Harm:

The assumption that suicidality is driven by mental illness (rather than by distress) leads to a focus on treating the illness (medical model). The suicidal person doesn’t want diagnosing and treating. They want relief from their pain, and the hope that their pain can get better in the long run. So the focus should be on relieving their pain.

I’ve learned to pay attention to what my friend is going through, and what that means for them, rather than worrying too much what we call it.

4. Holding a safe space is profoundly protective

It’s easy to react out of fear if someone tells you they have thoughts of suicide or self-harm. Knee-jerk responses are unlikely to help, though, and can be unhelpful. As Fran told me recently, “[t]he worst thing someone can do is to be shocked. A much better response is ‘tell me more about how you feel.’” If we’re prepared to listen without judgment we open a space in which both people can feel safe.

It’s hard to overstate how important this can be. Fran’s told me many times over the years that she wouldn’t be here if it wasn’t for our friendship. I take her at her word. We all have a role to play in normalising talking about suicide and self-harm. I agree with Fran when she says, “[t]he most important message is not keeping suicidality in the dark, because when it’s kept in the dark people either have to shut down or shut up. Suicidal ideation has less power when it is verbalised.”

If you’ve never been in so dark a place, think about it this way. If there was something that was always or often in your mind, a part of your lived experience, and there was no one you could mention it to or talk to about it, how alone would you feel?

5. It’s not easy to hear but it’s harder to live with

It’s not easy to listen as someone we care about shares thoughts of suicide or self-harm. It’s okay to acknowledge this. Our feelings are valid. But if it’s difficult for us, imagine how much harder it is for them. What your friend or loved one is going through may be a one-off. It may be the first time it’s happened, or a repeat of something they hoped was behind them. It might be something they deal with all the time or on a recurring basis. Whatever it is, this is part of their reality. If they trust you enough to tell you about it, that says a great deal about your relationship. How you respond says a great deal about you.

6. It’s not selfish and it’s not a failure

This one divides opinion but for me there is no moral component to suicide or self-harm. People who live with suicidal thoughts and feelings, people who have attempted to take their lives or have hurt themselves in the past, are not worse for having done so. They haven’t committed a sin. They’re not being selfish. They’re not attention-seekers. They’re not weak or failing at life.

I’ve always told Fran I’d do anything I could to help her stay alive, but if she took her life, I wouldn’t hate her for it. My promise may seem naive but it was instinctive and heart-felt. I feel the same to this day. I explored my response to friends telling me about self-harm or other “failings” a few years ago, in a post titled I Wasn’t Disappointed in You When.

I wasn’t disappointed in you when you told me you cut yourself. Although maybe it seemed that way when I said remember I’m here. Don’t ever feel you’d be a burden or that I’d be too busy or asleep. As though I can make the demons go away.

Although I’m not disappointed in my friends if they experience a set-back, they might well be. Their feelings, be they of frustration, anger, or shame, deserve my respect, whether I agree with them or not. As I’ve written elsewhere, “[i]t takes enormous courage to acknowledge you’ve resorted to behaviours you’re trying to leave behind, to pick yourself up, and continue the journey. That’s the hallmark of a hero, not a failure.”

7. Don’t assume it’s a crisis

Suicidality and self-harm come up regularly when I’m talking with friends. They’re not in danger. They’re simply sharing what’s going on for them, the way any of us might discuss issues we’re dealing with. In my view, this aspect is overlooked in almost all public discussion and awareness training. As valuable as these are, they tend to treat any mention of suicide or self-harm as requiring intervention. I believe people need to feel safe sharing their thoughts and feelings without it leading automatically to someone pulling the emergency cord.

I’ve had friends wary of talking to me at all because they were scared I’d escalate things and call the police or an ambulance. Fran expressed this perfectly in a recent conversation. “People seem to want to fix us,” she said. “We don’t need fixing. We need acceptance, just as we are.”

8. Be prepared in case it is

That said, sometimes it is a crisis, and we need to know what to do. Supporting someone in crisis can take many forms, from calling an ambulance, giving them a ride to hospital, or keeping them company in person or online. It helps if you’ve discussed in advance what your friend or loved one might need in such a situation. They might have a crisis plan they’re happy to share with you. Examples include Fran’s travel wellness plan which we describe in our book, and the Wellness Recovery Action Plan (WRAP) developed by Mary Ellen Copeland.

It’s a good idea to keep a few emergency contact details close to hand, such as those listed on our resources page. I have a number of local hospitals in the GPS (satnav) app on my phone in case I need to drive there at a moment’s notice. Consider taking some self-harm or suicide awareness training. Many such courses are low cost or free to access online.

Once the immediate crisis is past, let them know you’re there for them if they want to talk about what they’ve been through. Respect the fact that they might not wish to do so, at least not immediately. Being there when things were desperate doesn’t give you an automatic right to an explanation.

Further Reading

We’ve shared a number of articles dealing with suicidality and self-harm over the years.

Selected Articles for World Suicide Prevention Day 2020

17 Online Suicide Awareness Courses and Podcasts

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

She Is So Not OK: Being There When Your Friend Is Suicidal

Self-Harm, Addiction, and Recovery: Thoughts Inspired by My Friend’s 365 Day Milestone

How to Take Care of Yourself When Your Friend is Suicidal

Attending a Self-Harm Awareness Session at ReCoCo

Our resources page includes links to suicide crisis lines / support organisations, training resources, and books. UK mental health charity Mind offers a range of help and information if you need support or are concerned for someone else.

Over to You

In this post I’ve shared some of the things I’ve learned about suicidality and self-harm. I’d welcome your thoughts and experiences on these subjects, whether in the comments below or via our contact page.

 

Photo by Finn at Unsplash.

 

Waiting for the Kettle to Boil

A friend knows when to talk things through, but, most of all, a friend knows when to keep absolutely quiet. And to put the kettle on.
— Pam Brown

Standing at the kitchen door as the kettle boils for my final drink of the day, I’m flooded with memories. They don’t come all at once, or in order, but they come. Maybe they’ve been here all along, and I’m simply dipping in and out of them.

My triggers are mundane. The line of neighbouring roofs beyond the ivy-covered fence. The washing line that bisects the little square of garden. The grasses and nettles bordering the short path to the gate.

The memories that arise span decades but the most potent are from 2020 and 2021 when lockdown brought the walls of my world in close. Local walks for exercise or groceries. Working from home. And this garden.

Evening video calls with friends I could no longer meet in person. My drink — coffee or beer — on an upturned cardboard box on the grass beside my chair, or the little table I eventually bought for working from home. Talking until it got chilly or too dark for my friends to still see me. Worries shared in a spirit of trust. Hopes and fears and the day-to-day events of lives upended by the pandemic. Laughter too. The teasing only really good friends can do safely. Little things that mean so much and keep friendships alive. Keep friends alive, sometimes.

One memory comes at me, intense and immediate. It’s daytime. I’m on the phone with a friend, idly plucking at the branches of the tree by the gate as she tells me of her fears of hospitalisation. She’s scared but accepts it’s what she needs right now to stay safe. I can’t help, really, but I can listen as she talks it out. We part, unsure how long it will be before we can talk again but certain we will.

Another day. A morning. Another friend and big news I’m almost the first to hear.

Taking a new friend on a virtual tour of the garden as she sits in hers, hundreds of miles away.

Behind me, the kettle is coming to the boil. I think of the many times I’ve started evening calls with Fran here at the open door so I could share the view with her, before going inside where it’s warmer.

Another memory comes hard now. My gaze fixed on the mess of knots in the washing line as I hear hard truths from a friend who needs things to change if we are to continue.

Another. Sitting on the concrete doorstep, holding space as a friend unburdens herself of the frustrations and anger of her day. It helps, I think. We part after a hour or so, neither of us aware it would be the last time we’d talk.

Friends are not the only visitors. So many times I’ve stood here watching birds at the feeders I kept stocked so diligently. A family of hedgehogs. A squirrel. The cat that befriended me during lockdown.

The grass is longer now. I’ve not cut it in ages. The ivy I spent hours trimming back during lockdown serenaded by Taylor Swift is out of control. The tree which dominated the garden is no more, having fallen victim to storms two winters ago. The gate no longer closes.

The click of the kettle brings me out of my reverie. I sigh for all that is past. All that has changed. All that is gone. There is sadness, for sure. The poignancy of loss. But there is joy too. The privilege of trust that allows space to be held for whatever we need to bring into the open. This little garden is a physical representation of that kind of safe space. Physical or otherwise, such spaces are vital to our health and wellbeing.

I make my coffee, bring it to the open door and sip at it for a moment. A friend told me once, “You have your good memories. And I have mine.” It’s true, and there are new memories to be made, in this garden and wherever I find myself. It’s not too long since I brought my chair and table out for an evening call, and I will do so again.

I close the door and lock up for the night.

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This piece was partly inspired by “Reflecting Upon a Summer Sunset” by Liz Kay. Read it on her blog or listen to the podcast.

 

Photo by Laura Adai at Unsplash.

I Hope We All Make It

I’m not interested in competing with anyone. I hope we all make it.
— Erica Cook

The inspiration for this post was an unattributed quotation I saw on social media: “You can’t compete with me. I want you to win too.” It reminded me of a similar quotation by psychologist and author Erica Cook: “I’m not interested in competing with anyone. I hope we all make it.” Later that day, I saw another meme along similar lines: “It’s OK to clap for your friends if their dream takes off before yours.”

Bowing to coincidence, I thought I’d write about success and competition. It’s not the first time I’ve done so. A few years ago I discussed competition and collaboration in the blogging world. More recently, I explored living second-hand through the experiences of other people. Whether we’re living vicariously or not, it’s easy to fall into the trap of comparing ourselves to the people around us. For one reason or another, we tend to judge their lives, situations, and successes, as better or more worthy than ours. Having taken that step, envy, jealousy, and resentment are rarely far behind. Why do we do this? Why should the success of other people leave us feeling poorer?

Life Isn’t a Zero-Sum Game

The term zero-sum game derives from game theory. It describes a situation in which the one player’s gain necessarily involves the other player’s loss. While there are real world situations in which this applies, the term is often used out of context. The socio-political dangers of doing so are explored in The Zero-Sum Fallacy at Poverty Cure. I want to focus on some of the personal implications, because in the majority of situations, individual success is not a zero-sum game. You might disagree with that assertion, so let’s look at two seemingly win–lose scenarios: job interviews, and sport.

If you and I apply for the same job and there’s only one position available, your success necessitates my failure, and vice versa. We can’t both win. This seems a clear zero-sum situation, but success and failure are not always so easily distinguished. My first post-graduate interview was for a hospital pharmacist role. I was unsuccessful, but a couple of weeks later they got in touch and offered me the job. Their first choice had dropped out. I’d made other plans in the meantime, but it’s an example of apparent failure turning into success. Three years later I applied for a job with a major pharmaceutical company in the northeast of England. I didn’t even get an interview this time, but was that a failure? They kept my application on file and a while later offered me a research position in Newcastle I was happy to accept. I’ve lived here every since.

Successful or not, preparing for and attending an interview focuses you on your skills and experience, which can improve your chances in the future. It can also help clarify what you’re looking for. One dreadful all-day interview at Oxford University convinced me I never wanted to work in such an environment. It was the only time I’ve left an interview hoping they wouldn’t select me. The successful candidate and I both won that day.

What about sport, though? Surely, that’s one sphere where winning is everything and second-place is nowhere at all. It’s true that certain sports are geared to zero-sum, win–lose outcomes. Golf and tennis spring to mind. Others such as football (soccer) and cricket allow score-draw results in which both teams win (or, to put it another way, neither loses). Other activities eschew zero-sum logic altogether. Roleplay gaming is a great example, focusing as it does on collaborative storytelling, character development, and team work.

No matter the gameplay, sport can bring benefits regardless of whether you win or lose. These include socialising, physical fitness, and improved mental health. For more on this check out the website of Sport in Mind, a charity founded “[to] improve the lives of people experiencing mental health problems through sport and physical activity.”

What Is Success, Anyway?

In the modern world, the prime metrics of success are academic achievement, money, and power or influence. As I explored in Celebrate Your Successes in Your Own Way,

[t]his is fine if it fits with our aspirations, desires, and abilities but what if it doesn’t? If we are not ticking those boxes, by choice or otherwise, we can be left feeling outside the norm. Worse, we can end up feeling a failure for not succeeding in the right ways. [...] Maybe there’s a different way to think about what success means and how we go about celebrating it.

What might such a different way look like? There’s a clue in the famous passage by David W. Orr, often misattributed to the Dalai Lama.

The plain fact is that the planet does not need more successful people. But it does desperately need more peacemakers, healers, restorers, storytellers, and lovers of every kind. It needs people who live well in their places. It needs people of moral courage willing to join the fight to make the world habitable and humane. And these qualities have little to do with success as we have defined it.

It’s noteworthy that the roles David Orr highlights operate outside the zero-sum “I win, you lose” context. What he proposes, in fact, is a mutually beneficial “we can all win” worldview. This fits well with the alternative successes I suggest are worthy of celebrating in For the Win!. These include asking for help, being there for someone in need, self-care, saying no to something that doesn’t feel right to you, moving forward when you’ve been stuck, or recognising you’re not ready to move forward yet. There’s an echo too in the lyrics of the song “Small Victories” by RØRY.

Some people climbed Mount Everest today, and made history
While I was still asleep
Well, I got myself dressed today

Small or large as the world might judge them, our victories matter, and are not invalidated by other people achieving more.

All the Successful People

I know many people who are more successful or accomplished than me. My friend Aimee Wilson achieves many more pageviews and far greater engagement with her blog I’m NOT Disordered than I do here at Gum on My Shoe. Author and coach Julie. A. Fast is a world-renowned expert in the management of bipolar disorder. Through her coaching, books, speaking engagements, and social media she helps many more people than Fran and I could hope to touch with our books and blog.

At work, I’m learning unix shell scripting and developing routines that simplify our team’s processes. I get a lot of enjoyment and satisfaction from this, but my boss knows far more about it than I’m ever likely to. For the past eighteen months I’ve been teaching myself Teeline shorthand, but I’ll never surpass the proficiency of my friend Robyn who’s used it professionally for many years. I’ve explored various art and craft media in my time, but I’ll never come close to the creativity of friends past and present. These include Canadian artist and illustrator Ted Nasmith, author and artist Yuri Leitch, and Maya Hayward whose craftwork and creativity have delighted and inspired me throughout our friendship.

Surrounded by such excellence and success, it would be easy to become envious or discouraged, but that’s never been an issue for me. On the contrary, I find friendly competition a healthy thing. One of my best friends at school, Saranjit, was the only person who took the same three A-levels as me: pure and applied mathematics, physics, and chemistry. Having previously attended one of the top schools in India, Saranjit was far ahead of me in maths. I was stronger in chemistry. We were about equal in physics. Our rivalry spurred each of us to excel, and I remember him with great affection.

Aimee and I enjoy a similar friendly rivalry with our blogging, which inspires me to keep going and try new things. Blogging — indeed writing of any kind — can be a lonely pursuit. Without Aimee’s support and encouragement I would probably have given it up some time ago. It’s a mutual thing, and means as much to Aimee as it does to me. We’re proud of each other’s successes and are neither embarrassed nor afraid to say so.

You might expect this from a close personal friend like Aimee, but without exception the people I respect for their achievements have been supportive of my endeavours. Julie A. Fast is a generous and steadfast supporter of other writers, including me and Fran. She’s an example to me of how to handle success and engage with people who may be less experienced, proficient, or acclaimed. Author, speaker, and mental health advocate Rachel Kelly was no less generous when Fran and I approached her for advice. She offered valuable suggestions and guidance, and contributed the foreword for our book.

In the workplace, it’s not uncommon to find people who guard their skills and experience jealously. They resist sharing what they know in case it renders them less valuable or important. I’ve known a few such — usually self-professed — “experts” but my boss isn’t among them. He’s immensely supportive of my unix scripting, which encourages me to learn more and do the very best I can.

The World I Want to Live In

This generosity of spirit was expressed perfectly by my friend Paul Saunders-Priem. “I’ve always found I maximise my potential best,” he said, “if I admire, respect, learn from, help and encourage everyone to get ahead. It’s the world I want to live in!” It’s the world I want to live in, too. There will always be people who do it better or achieve more than us. Envy and jealousy can get in the way if we let them, but a difference in success needn’t be an issue. If we approach life in a spirit of openness, colaboration, and cooperation we can all win. I’m with Paul, and Erica Cook on this. I hope we all make it.

Over to You

In this post I’ve explored a few aspects of competition and success. What do those words mean to you? Do you ever feel envious or jealous if friends enjoy greater success than you? How do you handle such feelings if they arise? Is life a zero-sum game, or can we all win? Fran and I would love to hear your thoughts and ideas, either in the comments below or via our contact page.

 

Photo by Hudson Hintze at Unsplash.

 

Our Top Posts of the Month (May 2023)

Check out our top posts for the past month. Posts are listed by the number of page views they attracted during the month, most popular first.

1. Disassociation Episode Inbound
2. Anxiety and Me
3. One More Cup of Coffee: A Few Thoughts on Knowledge Transfer and Lifelong Learning
4. Second-hand Experience: If a Life’s Worth Living, It’s Worth Living Vicarously
5. How to Write the Best Acknowledgement Page for Your Book
6. Our Top Posts of the Month (April 2023)
7. How to Use a Spreadsheet for Wellness and Self-Care
8. RØRY and AMK: Two Brilliant Bands Living Rent-Free in My Head
9. 21 Things You Didn’t Know About Marty
10. The Stress Bucket and Other Models That Help Me Talk about Mental Health

Our most visited pages were:

1. Contact Us
2. Resources
3. About Us
4. Our books
5. News and Appearances
6. Testimonials

 

Photo by David Todd McCarty at Unsplash.