[storytime] At The Edge Of The Known World: What It’s Like To Consider Suicide

Somebody, somewhere in the world, kills themselves every 40 seconds.

Set a timer on your phone or watch for 40 seconds. When it beeps, another precious, beloved life is gone.

Yesterday, September 10, was World Suicide Prevention Day. Although suicide prevention entails important things like improving mental health screening and treatment, increasing access to mental health services, and decreasing the stigma of admitting and treating mental health problems, I think there’s another part that we usually miss when we talk about prevention. And that part is understanding what being suicidal is really like.

Those who kill themselves (or wish to do so) are not selfish.

They are not weak.

They are not simply having a bad day.

All of these tropes about suicide, and many others, are wrong.

I can only speak for myself, not for any of the other millions of people who have struggled with this most ultimate of dilemmas. But for me, at least, here is what it was really like.

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[In Brief] How to Talk About Mental Illness Recovery Without Shaming

Lucy Hale covers this month’s Cosmo.

Remember that post about celebrity gossip I just wrote? Well, here’s an example of how reading that stuff can be useful and enlightening.

I’m reading an interview in the September issue of Cosmo with Lucy Hale, a 23-year-old actress most known for her role on Pretty Little Liars, a guilty pleasure of mine. In the interview, Hale opens up (apparently for the first time) about the eating disorder she struggled with as a teenager:

But behind the scenes, Lucy developed a dangerous habit all too common among young starlets. ‘I’ve never really talked about this, but I would go days without eating. Or maybe I’d have some fruit and then go to the gym for three hours. I knew I had a problem,’ Lucy says of the issue that plagued her for two years. Luckily, unlike some actresses who have been unable to escape the downward slide, Lucy had the strength to turn herself around. ‘It was a gradual process, but I changed myself,’ she says.

Except for the following paragraph, in which Hale talks about cutting damaging friendships out of her life, no other details are given about how she recovered from her eating disorder, and I won’t assume. However she did it, it’s awesome and she deserves to feel great about having accomplished that.

However, the Cosmo writer takes it a bit further with this sentence: “Luckily, unlike some actresses who have been unable to escape the downward slide, Lucy had the strength to turn herself around.”

Wait…what? So people who succumb to the “downward slide” of eating disorders, or who need professional help to recover, just lack the “strength” that Hale has?

Obviously, I disagree.

If Hale really did recover without any professional help–which, again, she does not make that clear–there are many potential reasons for that. Perhaps she had a great support system of friends and family. Maybe she’s not genetically predisposed to eating disorders. Maybe her parents have healthy eating habits that they were able to model for her. She might’ve not had as serious a case as others do. Or perhaps she just got lucky.

None of this means that actresses who are “unable to escape the downward slide” have any less “strength” than Hale did. It means, probably, that they had different circumstances. Different lives.

So, how does one talk about people who have recovered from mental illness on their own without putting down those who cannot? My answer would be, by not comparing them to each other. Hale recovered? That’s awesome. Another actress didn’t? That’s a tragedy, and she deserves help and support. Their illnesses are not comparable, even if they happen to share the same name.

As Leo Tolstoy said, unhappy families are all unhappy in their own way. Similarly, people who suffer from mental illness all do so in their own way. Just because one recovers and another does not doesn’t mean that one has more “strength” than the other.

P.S. Before anybody goes all “but it’s just Cosmo, who cares!”, Cosmo has a circulation of over 3 million in the United States and is also distributed in over 100 other countries in 32 languages. Readers of this blog probably think Cosmo is silly and not something to be taken seriously (which it’s not), but the truth is that many people around the world probably get most of their information about things like mental illness from media like this. So it’s definitely worth examining and critiquing.

Abortion and Suicide: A Spurious Link

In South Dakota, it is now legal to require doctors to tell women seeking abortions that they are putting themselves at risk for suicide.

This move is brilliant from a PR standpoint. Unlike banning certain types of abortions entirely or, say, forcing women to undergo invasive screenings that are medically unnecessary, this seems completely apolitical when you first look at it. Don’t people deserve to be informed if they may be increasing their risk for suicide? Don’t we all agree that suicide is a Bad Thing?

However, something tells me that this is actually another attempt to scare women out of (what should be) a normal, socially acceptable medical procedure.

First of all, the inconvenient truth here is that credible research consistently shows little or no link between abortion and poor mental health. One 2008 study reviewed the literature and found that the only studies that seemed to show such a link had very flawed methodology, whereas the studies that were well-designed showed no links. (Damn liberal academics!) And here’s another study that showed no such links. And here’s a thorough debunking of a study that did claim such links:

Most egregiously, the study, by Priscilla Coleman and colleagues, did not distinguish between mental health outcomes that occurred before abortions and those that occurred afterward, but still claimed to show a causal link between abortion and mental disorders.

In other words, that study actually tried to use mental health pre-abortion to confirm a hypothesis about mental health post-abortion. This is simply not how you do science. And it’s especially bad here, because according to the American Psychological Association, guess what the best predictor of mental health post-abortion is?

Across studies, prior mental health emerged as the strongest predictor of postabortion mental health. Many of these same factors also predict negative psychological reactions to other types of stressful life events, including childbirth, and, hence, are not uniquely predictive of psychological responses following abortion.

That’s right. Shockingly enough, the best predictor of mental health is, well, past mental health. And poor mental health predicts poor response to all sorts of stressful events, of which abortion is only one example. Another one being, for instance, childbirth!

Compounding the bad science here is that, unlike physical side effects,suicide isn’t something that just happens to you suddenly and without warning. People don’t just suddenly wake up one morning and decide to kill themselves. Suicidality is a complex process that involves factors like genetics, family history, environment, social support, mental illness, and life circumstances. For instance, here are some things that, according to research, actually increase one’s statistical risk for suicide:

As you can probably surmise, not all of these correlations are also causations. While mental illness and drug addiction can actually cause suicidal behavior, being intelligent and being LGBT probably cannot. In the latter case, the causative culprit seems to be (surprise surprise) institutionalized discrimination and homophobia. Before I get too off-topic, let me point out the irony in the fact that, despite this well-known risk faced by LGBT youth, I don’t see any of these pro-lifers advocating for an end to homophobia.

That’s why something tells me that nothing about this court ruling actually has anything to do with suicide prevention.

Although the court’s ruling does at least acknowledge that abortion probably doesn’t cause suicide, it nevertheless states that “conclusive proof of causation is not required in order for the identification of a medical risk.” This is probably true, but it only makes sense from a physical health standpoint. If studies show that people who get a certain elective medical procedure are much more likely to, say, experience headaches or nausea or numbness, you don’t necessarily need a causative study to conclude that there’s a reasonable chance that these symptoms were caused by the procedure (assuming, of course, that there was no illness present that might be causing them). Furthermore, there’s a difference between saying “This procedure may cause you to experience cramps and headaches” and saying “This procedure may cause you to kill yourself.”

The truth is, mental health doesn’t work that way. A person who gets an abortion might experience mental side effects because of the stress of having gotten pregnant accidentally and been forced to decide what to do, perhaps without the support of a partner or family. Furthermore, any invasive medical procedure can be stressful and worrying for many people–especially one like abortion, which is consistently portrayed as more painful and dangerous than it really is.

And this is all made even more complicated by the fact that the faulty studies in question were actually studying mental health before the abortion. Perhaps a person with poor mental health is more likely to seek an abortion in the first place–say, if they feel that they aren’t mentally capable of raising a child at the moment.

Ultimately, decisions about what to tell a patient should be left up to the people who know most: doctors (with, of course, a reasonable amount of regulation to prevent malpractice). If a doctor can tell that a person seeking an abortion is going through a lot of mental distress, then that doctor may want to gently recommend counseling and perhaps give out some hotline numbers–and training doctors to recognize signs of mental health troubles is always a good thing.

But doctors should not be mandated to fearmonger to their patients. They should especially not be mandated to serve a pro-life agenda.

Surprise! Elle Magazine Editor Doesn’t Really Care About Eating Disorders

Nope, no Photoshopping. Nothing to see here, move along now.

Confession: sometimes I read women’s magazines. They’re fun to make critique and laugh at.

This time, though, I didn’t even get past the magazine’s front matter before finding something objectionable. In her opening letter for Elle magazine’s August issue, Editor-in-Chief Roberta Myers discusses the recent legislation in the U.K. that would require digitally altered photographs of models to be labeled as such. You can practically feel the derision and dismissal dripping off the page:

So now the National Academy of Sciences is getting into the act, trying to define what ‘impossibly beautiful’ means. In response to legislation pending in the UK to require digitally altered photos to be labeled out of concern for public health, as well as the American Medical Association’s campaign against changing pictures ‘in a manner that could promote unrealistic expectations of appropriate body image,’ two Dartmouth computer scientists proposed a ‘metric’ at a recent NAS meeting designed to rate how much retouched photos have ‘strayed from reality.’ The authors noted that ‘highly idealized’ images have been associated with eating disorders, such as anorexia.

Scare quotes aside, I have the feeling that Myers knows exactly what “impossibly beautiful” means, even if the idea of defining it operationally seems a bit silly. I do think that regulatory measures like these should be approached with a certain degree of healthy skepticism, because government regulation should not be undertaken lightly and without good evidence. But Myers isn’t critiquing it skeptically. She’s sticking her head in the sand and denying that a problem exists.

Furthermore, the regulations don’t even propose to ban severely Photoshopped images, but merely to place labels on them. Is putting an extra little bit of text on the bottom of an image really such a burden for Myers? I think not. Note that some countries are going even further–Israel, for instance, banned the use of underweight models in advertising entirely.

Myers continues:

Yet according to David Scott Rosen, MD…eating disorders are as old as the Bible. They cropped up in popular literature 200 years ago–long before Photoshop but right around the time when John Singer Sargent painted his famous Madame X (Madame Pierre Gautreau), a most flattering oil-on-canvas portrait that left out many a “flaw.”

I couldn’t find a citation for this, but it’s probably true. However, nobody’s claiming that eating disorders exist solely because of unrealistic beauty standards in the media. It’s not like a perfectly healthy young woman (or man, but that’s a slightly different conversation) opens up Elle magazine, sees a picture of a thin model, and immediately starts starving herself. Eating disorders arise from a complicated interaction of genetics, family life, and the surrounding culture. They involve complex cognitive processes, such as the ones described in this study. As another example, research shows that people determine attractiveness based on what they have seen the most. So if you’ve been looking at images of impossibly thin women for your entire life, that may be what you’re going to find attractive–and that’s what you may aspire to be.

We can’t prevent genes that predispose one to eating disorders from being passed down, and we can’t make it illegal for parents to teach their daughters that their appearance is the most important thing and that one should use unhealthy means to maintain it (though, with more education, we might be able to prevent that). We can, however, place restrictions on the images that permeate our media.

Furthermore, Myers conveniently ignores the fact that eating disorders have been growing more and more prevalent over the past century, especially among young women. Studies have also shown possible links between media that promotes thinness and eating disorders. It is impossible to establish a causative link with certainty, but that’s because 1) nothing is ever certain in science, and 2) we live within a culture that promotes and glorifies thinness. You can’t really evaluate phenomena like this accurately when you exist within the system that you’re trying to evaluate.

But luckily, studies done with non-Western cultures are very revealing. One extremely compelling study showed that girls in Fiji, who previously had little exposure to Western media, became much more likely to show signs of disordered eating after watching Western television shows for the first time.

Several Google searches brought up countless studies like these. Myers seems to consider them irrelevant here. She continues:

My point is that trying to define “impossible beauty,” and then regulate its dissemination by putting warning labels on retouched images, seems rather preposterous. You know, my chocolate bar never looks quite as creamy as it does in the ads; cars are never quite that sexy and sleek; and the milk in my cereal bowl never looks quite that white. Oh, wait! It’s not milk at all! It’s some gelatinous concoction meant to look like milk while it stays sturdy under hours of hot lights. Shall we label those photos, too?

This passage is as laughable as it is offensive. First of all, cool slippery slope fallacy, bro. Second, while one may argue over the sleekness of a car or the whiteness of a bowl of milk, it is completely unmistakable when magazines alter photos of models such that they appear to thin to actually be alive.

Third, and most importantly, the comparisons Myers makes are flippant to the point of inanity. The worst thing that can happen in her examples is that one’s chocolate bar isn’t creamy enough. The worst thing that can happen when magazines use Photoshop to excess is that, you know, someone develops anorexia and dies.

As I mentioned, the link between digitally altered images and eating disorders probably isn’t simple. But research is increasingly showing that it is there. It is worth noting that Myers never makes any comments about her own magazine’s use of Photoshop, which tells me that she’s fully aware of what she’s doing and is just willfully playing dumb. She knows. And she’s threatened by it, because things are starting to change.

But she’s not done. She goes on to cite an article in this month’s issue:

I wonder what the National Academy would have to say about the photograph we ran in this issue of novelist and essayist Ann Bauer, who writes so eloquently about growing up “ugly”–bearing a steady stream of abuse about her looks from classmates, strangers, and even lovers.

This bit confirms for me what I already suspected–that magazines like Elle print articles like this solely from the purpose of distracting people from the role they play in upholding our society’s beauty standards. These magazines can trot these articles out as examples of their commitment to portraying “women of all shapes and sizes,” when, in fact, they use these women as tokens.

The article in question is indeed a beautiful article. But what’s ironic is that Myers doesn’t even realize how magazines like her own have contributed to the bullying and abuse that women like Bauer face. Of course, people have always valued beauty and mistreated those who are deemed “ugly.” But lately, the box into which women must fit in order to be considered beautiful has been shrinking, whereas the “ugly” box has been growing. Magazines like Elle may not be the only (or even the main) causes of this trend, but it would be naive not to implicate them in it.

Furthermore, that photo of Bauer that Myers is so proud to have featured? It takes up one corner of a page and measures about two by three inches. Compare this to the dozens of full-page Photoshopped models in the magazine.

The most telling (and touching) part of Bauer’s piece, to me, is the end, in which she describes visiting Hungary with her husband and going to the opera in Budapest:

I turned and found myself looking into a full-length mirror. And I saw something I’d never seen before: myself, in a sea of women who looked just like me.

[…]Everywhere I looked in that lighted glass, there were women with large features, deep-set eyes, rounded cheeks, riotous hair, and delicate-yet-meaty little bodies. We were, in other words, an army of ugly people.

Only, for the first time in my memory, we weren’t. I wasn’t. I was normal, even conventionally attractive. Stylish. Interesting. Sexy. Simply that.

I stood in front of that mirror in the Hungarian State Opera House, watching couples mill. Men holding the arms and hands of dozens of women who could’ve been my sisters, mother, and daughters, tipping their heads back, kissing them lightly, gazing with naked admiration at faces like mine.

Bauer shows, ultimately, that she is not ugly. It is American culture that makes her out to be so. In Hungary, women who look like her are not bullied. They are not sent anonymous emails about how ugly they are. They are not denied jobs or pressured to lose weight and get plastic surgery.

This makes Myers’ stubborn refusal to examine the potential effects of her magazine even more ironic (and upsetting). Magazine editors seem to feel that they are being solely blamed for the devastating experiences of many women (and, increasingly, men), but no informed researcher or critic would say that magazines directly cause eating disorders. We have to examine this phenomenon as a system of interacting elements–the mass media, politics, families, and individual brains and bodies–in order to begin to understand how to prevent unhealthy beauty standards, poor body image, and eating disorders.

We can’t start without making sure that everyone knows that the images they see around them every day of their lives are not realistic. They’re not something to aspire to, because they cannot be obtained–except perhaps at a very high cost.

The editorial this photo belongs to is totally unironically called “The Surreal World.” Photo credit: Elle August 2012

When I Knew It Was Over

When I was a little kid, my favorite dreams were the ones in which I got something new–a toy I’d been wanting, some really cool gadget. (Kids are acquisitive that way.) I would wake up grasping for my new possession and feeling a tremendous sense of injustice at the fact that I couldn’t keep it after the dream was over.

Right now, I’m still dreaming the dream, hoping I never wake up and lose what I’ve just gotten.

My depression kind of has its own saga. I’ve had it since I was 12. It got much worse when I went to college. I got diagnosed and started taking anti-depressants and it got better. Then it got worse again despite the anti-depressants. Then I said fuck it to the anti-depressants and went off of them. There were a few good days in there in spite of that, to be sure, but it was always there.

That is, until a few days ago.

It’s well-known that depression can spontaneously remit sometimes, but I wasn’t expecting it to happen to me. Just a few short weeks ago I was strongly considering going back on anti-depressants and dreading the long, lonely summer ahead. I’d had many bad episodes recently, too many.

But then they started decreasing in frequency. I didn’t even notice what had happened until, ironically, an evening when I was sad. I had put on some sad music and was sitting around lamenting the uselessness of one of my romantic endeavors. There’s no chance in hell it’ll go anywhere, but I really like the person in question, and this sucks.

And then it suddenly hit me–I was sad like normal people are sad. I wasn’t crying, I wasn’t wondering why I’m such a failure in life and why everybody hates me and why I’m so ugly and useless. I wasn’t planning a lifetime alone and lonely. I wasn’t going down the list of every single person I’ve spoken to recently, analyzing our last conversation, and scanning it for clues showing that they actually secretly hate me.

I was just sitting around, kind of blue, listening to sad music, regretting the fact that this Thing isn’t going to work out, but hoping that someone else will come along soon. Like a normal person. A healthy person.

And that’s when I knew it was over.

The weekend after that–this past weekend–felt entirely new to me. All the colors were brighter, my senses were sharper. Little hurts rolled right off of my skin like water. I woke up in the morning looking forward to the day, whereas for the past year and a half, I’ve woken up every day thinking, “Fuck, another day.”

I could be happy sometimes when I was depressed, but only if I had a concrete, immediate reason. Now I don’t need one. I can be happy just because, sometimes. I can be happy just because I’m alive.

There are a few reasons why this might’ve happened now. Summer started and the academic stress went away. The weather is good. I can be outside now, go to the beach, take walks, explore the city, have a life outside of my tiny room. My friends freed up, too, and suddenly I started having plans with them all the time. It became possible to text someone in a moment when I was feeling down and have plans an hour later.

Besides that, I fell for someone for the first time in ages. Although that person is completely unavailable to me in more ways than one, it was a reminder that there really are people out there with whom I can feel a connection, despite my cynicism about these things. Nothing’s going to happen here, but I’ve already learned more from one unrequited crush than I have from the past year and a half of dating.

The final thing is that I started writing again. By which I mean, really writing–writing fiction–and not just these blog posts and the various other expository pieces that I do. I restarted a novel that I thought up two years ago but then stopped writing because I thought I wasn’t mature enough to write it. It’s a lofty project; its themes include grief, depression, suicide, marital discord, friendship, betrayal, love, and figuring out what the hell to do with your life. It doesn’t seem like an uplifting thing to write, but it is, and writing it once again has made all the difference.

For the first time in a while, I can be at ease alone. Whereas before I hated myself so much that I dreaded being left alone with myself for more than an hour or two, now my mind is a welcome presence. It writes stories for me, it promises me a bright and happy future. It points out birds and clouds and other things I used to ignore. It steers me towards my cheerful playlists, not my brooding ones.

I’m writing this now not just to share it with others, but because, as with coveted toys of my childhood dreams, I’m trying desperately to hold onto this feeling before the dream ends. Because it will. It always does. And when it does, I’ll no longer be able to understand how I could’ve ever written this.

And I’ll reread it and try to understand. I’ll remember to see my friends and to write more and to stay open to the possibility that someone will come along and change my entire life.

I’ll read this and remember.

So goodbye, depression. Until next time.