The way we treat people suffering from suicidal ideation often has the opposite of its intended effect. Recent research points to several specific consequences of inpatient treatment that can put sufferers at even greater risk.
TW: suicide, police, child sexual abuse
Suicide is a leading cause of death in the United States, and yet it is a taboo conversation. The subject understandably makes most people uncomfortable. But ignoring it only adds to misinformation and mistreatment of people who experience suicidal thoughts and feelings. This can only change by allowing people with suicidal ideation to have a voice in how they are treated.
While there has been some progress regarding suicide legislation and treatment in the United States, it is by no means safe and caring. Police bully, brutalize, and shame people who have made the attempt. Suicide hotlines track your phone and send the police and ambulance, invading your privacy. Psych wards belittle and alienate you from your community. All of these are methods of stripping a person of their autonomy. We as a society have become accustomed to believing that if someone is considering suicide, they forfeit their right to autonomy.
This is the exact opposite of what people experiencing suicidal ideation need.
I know this because I have wanted to commit suicide since I was three. There has never been a year where I haven’t considered this option. For most of my life, it has been my dark secret. Every time that I have considered suicide, I needed not to be removed from society and shamed but to have society respond to my actual needs, not to see me as a problem to be contained. Suicide prevention is free housing, free food, healthcare, gender-affirming health care, comprehensive sex education, abortion access, trauma-informed mental healthcare, and community.
Preventing and treating suicide comes down to putting people first. This is miles removed from the approach of institutions claiming to serve people who have attempted suicide.
The goal of these institutions is to incapacitate the individual, allowing time for shame to compel the person to conform to social norms. Treatment in these facilities is not usually about helping the patient so much as ensuring that they re-commit to an able body for capitalism.
They don’t care how much pain you are in or what your circumstances are. They are simply here to preserve your body under the pretense of caring for your mind. As harsh as this might sound, that is how the system is set up and maintained. There are certainly people working in psych wards who care deeply about their patients, but the fact remains: this is a system that actively harms people. This could not be made any more clear than by the findings of a 2017 paper with the damning title “In-patient suicide: Selection of people at risk, failure of protection and the possibility of causation.” The researchers found a higher likelihood of suicides among those admitted to a psych ward than those who had not been. The abstract begins with a stunning statement: “Being a current psychiatric in-patient is one of the strongest statistical risk factors for suicide,” After addressing the obvious conclusion that self-selection is in play—that people with severe mental illness are more likely to be inpatients and most likely to suicide—they note further that “adverse experiences in psychiatric units such as trauma, stigma and loss of social role might precipitate some in-patient suicides.” By examining these variables, the authors concluded that there was enough cause for concern to merit a large-scale randomized controlled trial.
People experiencing suicidal thoughts desire control over their own lives more than anything else, and these institutions only offer dehumanization.
I know this because I have witnessed the harm caused by these institutions firsthand.
‘My loss of control over my own life was total’
One day in high school, I was surprised to be called into the guidance counselor’s office. My boyfriend had followed protocol: He had shown the counselor a text I had sent that said I was suicidal. Once that happened, my loss of control over my own life was total. Now the counselor had to act following the law. I hadn’t been notified of any of this. My boyfriend hadn’t asked what would be helpful to me or what I wanted to have happen, if I even wanted anything to happen.
I was forced to tell the guidance counselor that I was suicidal because I was being sexually abused by my mother and CFS had failed me in every possible manner. The counselor further followed protocol by sending me to the local hospital’s psych ward. I was promised that this would be a “nice break” and that they would “help” me.
No one asked if this was what I wanted.
At the hospital, I was stripped of my clothing, jewelry, possessions, phone, friends, anything that gave me some semblance of comfort or self. I was stripped of my basic autonomy. I was forced to wear sea foam green scrubs and slippers. I couldn’t have a decent pen lest I try to injure myself with it. As a writer, this was a death blow, the inability to write with a functioning pen. All they provided was a pathetic bendable ballpoint that always dried up.
Every inch of the psych ward was lathered in the same foam green. Later I would write in my journal that it was as if sea foam green had thrown up on the walls, the chairs, the beds, the clothing, and the tiles. I remember thinking how disoriented this made me feel, like I couldn’t tell where the walls stopped and I began. I was frightened and desperate to seem normal. I questioned every desire and action. Will they think I am insane if I do push-ups? Will they think I am cracked if I ask to shower? For new underwear? If I don’t finish my food? Can I cry? It immediately became a nightmare game where I didn’t know the rules, and the judgment of my sanity was at stake.
It is difficult to go back there. My mind wants to block out the humiliation. I was so young and frightened. I was vulnerable and naive, defenseless and alone.
After I had been there for a few days (three? four? time was meaningless) a doctor that I hadn’t seen before decided that we needed some one-on-one. I hadn’t showered since I had been there and no one had told me what to do with my old underwear, so I just wore them. I was beyond humiliated and grossed out, but I didn’t want to seem insane or demanding. The doctor upon meeting me scrunched up her face and declared that I smelled. Before we could fill out any forms, she said, I needed to shower. She asked if I knew that showering is part of basic hygiene. I was mortified. I had been trying to do sink baths in the tiny bathroom connected to my room. I had been trying. I was aware of my appearance and smell. No one had thought to tell me that I could ask to shower and for clean scrubs.
The shower was the only place I felt safe to cry. I let the cold water run over me and the sound drown out my silent aching sobs. I wanted to die more than ever.
I was allowed visitors, but only under supervision. My boyfriend came to visit often. Every time he came the nurses swooned at “what a keeper” he was, unaware of the fact that he was the reason I was here in the first place. The least he could do was visit. It was the bare minimum. Being under supervision was embarrassing and infantilizing.
During my time there, I was assured several times that what I said was confidential. The therapists and nurses there made me feel as though I was safe to share about my abuse and for the first time I talked to a professional about my abuse. To my great surprise, this was a lie, or at best a half-truth in sheep’s clothing. When my time there ended, I was forced to sit down with two psychologists (both of whom had barely talked to me) and my parents. Both had told my parents exactly what I had told several nurses, that I had been sexually abused. Neither psychologist believed me, but both were more than happy to prescribe me medication. I felt utterly betrayed and abandoned. They had just made things much worse for me at home.
What I needed was to be out of an abusive home. There had been so many signs of my abuse that went unnoticed because I was well-behaved and came from a religious family. Failed is not a big enough word for how the system mishandled my situation.
‘The message was clear: It is best to suffer alone’
The message I took away from my stay in a psych ward was clear: If you are suffering, it is best to suffer alone. Immediately afterward, I thought about plotting my suicide, because I wasn’t sure how I was going to be able to survive the tornado that was sure to be waiting at home. The only reason I didn’t is that I was afraid of failure and thus having to return. Psych wards for me became a fate worse than death. I’m sure that could be interpreted as a success, but to me, it only proved that they cared about keeping my body breathing and not about me in my entirety.
After my stay, I considered suicide more often and to a greater extent, for various reasons, and knew that I had to keep my mouth shut about it. There was no one there to help me. I became more fearful and withdrawn. What was certain from my experience in a psych ward was that reaching out for help only made things worse.
This is a tale that comes up time and time again when my mentally ill friends and I discuss our traumas. Everyone has a different version, but the gist is always the same: the institutions that promise to help us only ever harm us. We are forced to figure out how to overcome our previous trauma as well as the trauma of being in a psych ward, of being abused by police, of being betrayed and dehumanized. In some ways it ends up being a worse trauma because we can’t ever fully speak about our experience, we are silenced by the fear of being forced to return to such a place. Returning is a threat to our lives and our autonomy. So we suffer in silence.
In an excellent personal essay titled “I Am Not ‘The Problem’ for Having Suicidal Ideation, The Problem Is The World We Live In”, Walela Nehanda conveys a hauntingly familiar experience. What is added is their Black, queer, and disabled lens. It is important to note that, as with every institution, these are the very people that are harmed even more and in particular ways by our mental health system. Nahenda notes that, “the world we live in isn’t sustainable for maintaining life, for maintaining health, for maintaining anything other than capital.”
What people who have never considered suicide don’t understand is that suicide can be a rational response to a chaotic world. In a world where truly horrible things happen and surviving is a struggle, suicide is a rational response. When you are forced to endure so much pain with no sign of reprieve, all you want is for the pain to stop. Those of us who have experienced suicidal ideation keenly know that even when things are going well they can turn sour in a moment, that nothing good lasts forever, and suicide can seem like a particularly appealing permanent fix to this problem.
For the philosopher Albert Camus, suicide is a rational response to a world that is inherently meaningless and absurd. Humans are predisposed to seek out meaning, we are story-creating, story-telling creatures. Yet the universe offers no certain method of finding a definitive meaning if meaning even exists.
The act of suicide has been demonized throughout the centuries. In our particular cultural climate, Christianity has certainly played a role in this demonizing by framing suicide as a sin and blasphemous. This has only served to mark the person who is considering or has chosen suicide as selfish and childlike. It also ignores the role that society plays in an individual considering or choosing suicide. Making suicide a sin places the blame solely on the individual’s shoulders.
Before my experience in a psych ward, another friend of mine in high school told me emphatically that she and her dad had decided that people who choose suicide are unequivocally selfish. This conversation stopped my heart because, even though I had never told my friend about my suicidal thoughts, I was stunned by how easily she could talk about something she had never experienced. At that moment I decided that I could never turn to her when I was struggling. Her message was clear: suicide was my problem and I had to deal with it.
I am certainly not advocating for people to choose suicide. My heart aches at the thought of anyone having suicidal thoughts. All I want is for them to live. I also know that this is not my choice, as hard as that is to come to terms with. To me, it is cruel to force someone to stay among the living, because the cost is their autonomy.
The truth is that our rates of suicide won’t change drastically without radical structural change. This means radical change for society at large but also within our mental health institutions and making an honest evaluation of the harm caused by the very institutions that promise to help us.
My wish is that we will ask those having suicidal thoughts, as a community, whether stripping them of their autonomy is a good solution. In forming this opinion it is crucial that the people who have had these experiences are given a voice that they have been denied, except for in the corners of the internet and among themselves. Only when people are given a voice and the means to choose can things improve.
What would have happened if I had a friend and boyfriend who had listened to me free from judgment and asked me how they could help? I’m not sure of the outcome, there is no way to be, but I can be sure that I would have felt cared for and loved. In the end, that is what everyone deserves.