Silence, Shame or Stigma? Speaking Openly About Suicide
Setting the Scene Straight
The reader may think this is a rather ‘left-of-centre’ subject to write about, but over the past six months, I have completed a number of brief intensive courses, all organised through an Australian national charity called Lifeline.
They have all been geared towards anyone experiencing emotional distress to the point of wanting to end one’s life. Lifeline (Australia) provides access to 24-hour crisis support and suicide prevention services.
There are many reasons why it is difficult to talk about suicide. One of the main reasons is that it is a deeply personal and sensitive topic involving intense emotions, both for the person experiencing suicidal thoughts and for those around them.
Suicide is often taboo or inherently shrouded in stigma. This can make it difficult for individuals to open up about their struggles or for others to broach the topic with them.
I commence by setting the record straight. I do not have some morbid fascination in choosing to write about such a subject. Neither should it plant the notion of suicidal thoughts in any reader’s head.
Even I openly admit that researching this heavy topic was emotionally challenging for me on several cognitive levels.
With this in mind, readers with emotional intelligence, which is hopefully you, are encouraged to continue until the end.
Readers may find it a struggle to even cerebrate where to begin talking freely and openly. However, I make little in the way of an apology, as this problem is real.
This is despite the fact the concepts revolving around suicide are often ‘in absentia’ from our consciousness and may remain buried deep within our metacognition. For many, this can be all too overwhelming or cause interminable distress.
Suicide Statistics
According to the WHO, more than 700,000 people die due to suicide annually. With an increase in mental health reported globally, I felt it is essential to raise awareness on a subject that is inherently shrouded in stigma. It is a subject that is often highly uncomfortable to discuss and thrown into an everyday conversation.
Additionally, discussing suicide can be a ‘triggering point’ for many individuals, especially those who have experienced suicide or have personal connections to a loss of life. Moreover, cultural, religious, or social beliefs may make talking about suicide uncomfortable or even forbidden.
These various factors make it challenging to have open and honest conversations about suicide, but it is essential to break the silence, thus creating a space where people can seek help and support one another.
Owing to the alarming statistic that 75% of all suicides in Australia are performed by men, it is this particular gender that I wish to focus my attention on. It is also important to note that the term ‘commit suicide’ is an archaic phrase because this has connotations that imply it is a sin or crime.
Indeed, until the 1970s, suicide was considered an offence in many Western countries, including Australia and attempted suicide was punishable by imprisonment. Even today, it is still considered illegal in many countries – please click here for further information.
What To Say And What To Not
Whilst on the subject, the language around this act and mental illness, in general, must also be chosen carefully:
These tables were taken from LifemindAustralia
Let’s Be Clear In Defining Suicide
Derived from Latin, ‘sui‘ “of oneself” and ‘cidium’ “a killing”, suicide is a complex concept and is rarely attributed to any single phenomenon.
Suicide is defined as the intentional, self-inflicted, life-threatening act which results in death and accounts for approximately 1% of all deaths annually in the UK.
It is a multi-faceted behaviour driven by the motivation and desire to escape unbearable and irreversible psychological pain. It may be determined by the interaction between factors such as neurobiology, personal and family history, stressful events (such as financial hardship, relationship issues, chronic pain or illness) and one’s sociocultural environment.
By far, the strongest risk factor for suicide is a previous suicide attempt.
The Risk Factors Are Complex
The complex link between suicide in men, the array of mental disorders and drug and alcohol misuse has also been well established.
To highlight a few examples, rates of suicide are also higher in men that face any form of discrimination, such as being a refugee, belonging to an ethnic minority, having issues with their sexuality or how they compare their physique to other men, increasing age, or being in any form of correctional service.
Anybody who has been a victim of physical or sexual violence (or both) in the past, any form of conflict, or socially isolated is also at risk of a serious suicide attempt (SSA) or ending their own life.
In any case, any individual that takes their own life is tragic and affects loved ones and communities around them with long-lasting sequelae.
One study in 2019 concluded that the impact of suicide deaths are felt by up to 135 people, including family members, work colleagues, friend and first responders at the time of death.
Why Focus On Men In Particular?
According to the Australian Bureau of Statistics, suicide amongst men remains one of the biggest causes of mortality under 45 years of age.
Furthermore, one survey conducted in the UK showed that 41% of men contemplating suicide have never spoken to anyone about their feelings. A study commissioned by the Samaritans, UK, showed that a third of people polled would not talk to someone if they felt suicidal.
Moreover, one of the biggest challenges posed is that men are less likely than women to have a positive view of any form of counselling or therapy.
Men also respond to stress more than women by taking risks in misusing alcohol, prescribed medication or illicit substances.
According to the evidence, men also act impulsively and resort to more lethal, violent and ‘effective’ methods of suicide in comparison to women, such as using knives, firearms, jumping from a height to their death or hanging themselves.
What Perpetuates This Problem?
One of the root causes of why men suicide more than women is underpinned by the principles of what actually defines masculinity.
Toxic machismo aside, society dictates that men should always be strong, courageous, self-reliant and dependable.
Unsurprisingly, the reasons why men choose to take their own life may be due to the internal conflict of their expected role based on rigid ‘gender-stereotypical’ norms compared to how they genuinely admit they feel without feeling ashamed.
Death is Inevitable, but Suicide is Preventable
It is inevitable that we will have our lives taken away from us at one point, either by a terminal pathological process or perhaps by a tragic accident.
Personally, I do not feel there is anything necessarily wrong with thinking about our own death. But does that make it automatically bad to consider that we ultimately control our own demise? (My other article on death and dying can be read here).
Though macabre this may sound, we may have all wondered how our life would end in some form or another at one point. But the pervasive emotions of contemplating how to end one’s life prematurely, with intention, is undoubtedly alarming.
Yes, the conversation is starting to open up more than we once thought, but there is still a very long way to go.
Based on statistical evidence, this is particularly for men who need to reach out and confide in anybody whom they trust. Doing so should be envisaged as an act of courage and strength, not as an attempt to emasculate the individual or show any sign as a form of weakness.
Taking That Courageous First Step
The analogy to my narrative is just like the first brave person stepping out onto a dance floor or at a wedding one may have attended, even though one may initially have feelings of trepidation or apprehension. But, if one person is daring enough to take that first step, then hopefully, others will follow suit.
It is also important to emphasise that there should be absolutely no competition with women, nor should we undermine that they undoubtedly face these same problems. However, men often fail to admit to feeling vulnerable without harbouring feelings of remorse or guilt toward those around them.
Suicide in men is most definitely a global problem, is preventable, and society needs to do everything in its power to comprehend that this will perpetuate an ongoing grave situation whether we think about it or not.
From A Medical Perspective
During my medical career as an emergency doctor, I have most certainly witnessed the act of suicide amongst men disproportionately more than that of the general population.
Not only is this with the male patient population I have pronounced life extinct but also in my personal life with close friends, many of whom were front-line responders.
Healthcare facilities and organisations must keep improving their knowledge, mechanisms and facilitators that drive men to take their own lives.
It is only by tackling and challenging that there is absolutely nothing wrong with men who admit to possessing suicidal thoughts can we continue moving forward.
Undoubtedly, every dialogue will not always be easy and will certainly be uncomfortable at times. Still, this needs to be had instead of continuing to sweep the problem under the carpet.
In honesty, I certainly do not have all of the answers, as there is no fail-proof algorithm for detecting who may be a high-risk male.
Nevertheless, one must consider many questions about how we can all do more to assist in this eminently preventable cause of premature death in men or anybody for that matter.
My Final Thoughts
Perhaps you are aware of a man (or woman, for that matter) who is finding it difficult to cope with the pressures of everyday living right now but is having trouble expressing themself meaningfully.
How could we all re-frame our thinking in approaching such a delicate subject with even more compassion that is often fraught with anxiety-provoking emotion?
And by the time you have got this far, regardless of your reading speed, there will have been several other men that have taken their own life somewhere in the world.
In the UK, for instance, this equates to one life every two hours. And unfortunately, this stark fact represents the tip of the iceberg.
I leave the reader, regardless of gender, to remind any man who may have had or is currently experiencing these thoughts that they are not alone and that meaningful interventional strategies are readily available.
Stop, pause and think once again.
And if you are brave enough, this could even be you, irrespective of gender, who begins that meaningful, life-saving conversation with the person right in front of you or at the end of the telephone.
HELPLINES (WITHIN AUSTRALIA)
Lifeline: 13 11 14
MensLine: 1300 789 978
Beyond Blue: 1300 22 46 36
About Surrinder Singh
Dr Surrinder Singh is a medical doctor, blogger and freelance writer. He is passionate about healthcare, medicine and education and works professionally with B2B and B2C clients.
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