World Suicide Prevention Day 2019

It was World Suicide Prevention Day 2019 on Tuesday 10^th September. The theme for this year is “Working Together to Prevent Suicide”. How do we do this?

We all need to look out for those who are not coping. Individuals in distress are often not looking for specific advice- the key to preventing a tragedy is empathy, compassion, genuine concern, knowledge of resources and a desire to help. Warning signs of suicide include: hopelessness, uncontrolled anger, seeking revenge, engaging in risky activities, feeling like there’s no way out, increased alcohol or drug use, withdrawing from friends, family & society, anxiety, agitation, unable to sleep or sleeping all the time and dramatic mood changes. In short, the main warning sign is that there are changes to someone’s behaviour.

So what can we do?

The listening ear of someone with compassion, empathy and a lack of judgement can help restore hope. We can check in with them, ask them how they are doing and encourage them to tell their story. This small gesture goes a long way.

You don’t have to be a clinician- just ask “are you OK?” This is often enough to start a conversation, one that may be life-saving. You should ask someone directly if they have thoughts about taking their own life and then listen, really listen, to them. Reflect, with them, their reasons for life, their reasons against death, any supports they have and their ideas for their future. Be tender and be kind- it will be detected by the person you are talking to. Reassure them that they are not alone, that everything passes, that you, and others, care about them.

Pragmatically we can assist with medical intervention (a phone call or escort to their GP or to Casualty), removing any means of suicide from them (asking if you can keep their medication, etc.), do not be anxious about calling 112 for an ambulance as it may be a medical emergency. Be with them- don’t just say that they are not alone, prove it. 

Keep in touch- an email, a text, a phone call, a card, a spontaneous visit. 

Some contacts:

Lifeline (24 hours a day, 7 days a week)- 0800 808 8000

Samaritans- 116 123 (UK and Rep. of Ireland)

Aware-ni.org and Aware.ie (depression support for UK and Rep. of Ireland)

Yourmentalhealth.ie and https://www.nhs.uk/conditions/suicide/ (HSE and NHS websites for support about suicide)

https://www.iasp.info/wspd2019/ for information about World Suicide Prevention Day 2019

After Therapy

Cognitive Behavioural Therapy (CBT) is a type of talking therapy that examines the connection between what we think and how we feel. It is based on decades of evidence and it continues to develop and grow in its breadth like an umbrella slowly unfolding, shielding as many people as possible from the rain. It focuses on the way we think about things (cognition) and the way we do things (behaviour) to help break destructive cyclical ideas. For example, someone may feel themselves to be unworthy of love or of friendship which in turn affects how they socialise or chat to others which in turn can bring their mood down. This would then affect how they feel about themselves, that they may be unworthy of friendship, and so on and on in a negative cycle. CBT examines all this and cracks through the barriers that have been created. It is an extremely successful form of talking therapy and can positively address many different mental health issues from depression to phobias to psychosis. And it is used very successfully for people experiencing trauma and grief.
I recently said goodbye to my CBT therapist after four intense months of successful treatment focussing on the trauma of my grief and on my social anxiety (a decades-old problem). Psychologically I have felt stuck for two and a half years, since my mum died. I hadn't grieved for her (there is no such thing as normal grief- any old fashioned models of "stages of grief" having been superseded by new knowledge) but, most worrying for me and most affecting of my mood, was that I had not changed or progressed in my grieving for Ruby. My feelings about Ruby were no different now, in 2019, than they were when my mum died in early 2017. This was distinct from the first four years after Ruby's death (Ruby died in May 2013) when change, though not always linear, was consistent each week, each month, each year. It took me two years to realise I was now in a sedentary prison, I was stagnant, and I needed to move.
CBT hasn't made my grief vanish or done away with any of my experiences, it hasn't reduced any value of my love for Ruby or made me forget anything. CBT has reduced the sharpness of the trauma, the intensity of pain has diminished, I can cope more adequately. And this also means I can remember Ruby with greater clarity and with less distress. I hope, in time, to be able to think about Ruby without pangs of loss, without those little stabs that demand my attention in place of the joyous memories that should be my focus.

Undergoing CBT taught me many things which may be useful for other people to read. Here are some things I now know:

-Mum's death created a bottleneck in my mind. Trying to cope with my intense grief for Ruby, even four years after she died, and then coping with mum's death (and shortly after that the death of my aunt- her sister- and the near death of my sister from sepsis and coma) was too much to bear. I was incapable of processing that weight of work and so I stalled and came to halt. This can happen to anyone who may have been through one traumatic or difficult event and then has to undergo another one or more. CBT released that strain and let things flow, it let my brain do what it does best, naturally.
-CBT helped me come to terms with the way I grieve. I hadn't grieved too deeply for Mum since she died (about which I felt guilty and embarrassed) for one very good reason that took months of discussion to identify- I had already grieved for her. My mum was chronically ill all her life and all of mine too. Since I was young I had thought that she may die at anytime (or "leave me" are more accurate words, hence a great deal of separation anxiety as a child). I had 43 years of preparation of her death. When she died in 2017 it was the "natural order"of life and death, it was something I had mentally prepared for through my childhood and now, two years later when that bottleneck was opened and I had space to process her death, I am learning to allow myself to not be too affected or traumatised by it. There are as many ways to grieve as there are people on Earth and if we don't feel too badly affected or traumatised by death, this doesn't always mean it is "buried" or "latent" or that it will disable us later in life- sometimes it just means we have already done the work and that we deserve to be free from distress.
-My brain, all our brains, are extraordinarily complex and powerful machines. It can do amazing things and, most of the time, it works smoothly and elegantly. But when we experience trauma our brains don't always use the most appropriate section to process information. CBT, and some other forms of therapy, help our brains reprocess that difficult and traumatic information and so we become less negatively affected by it over time. The trauma becomes duller, more "ordinary", boring even. It becomes easier to think about and to cope with.
-I have to respect my brain and allow it the space it needs to work properly. For me this entails being alcohol-free which allows me to sleep deeper and to dream well which is extremely important to the subconscious processing of difficult information (I stopped drinking alcohol the day I started therapy for this exact purpose, I have no plans to start drinking again). To sleep well is more important than I had ever realised. I am now slightly obsessed with drinking huge amounts of white tea, partly to help me signify "nighttime" but also because the process of making it is as enjoyable as making the gin and tonic I used to drink.
-I needn't feel pain as a legacy to Ruby. I have earned the right to be free from this (in therapy, men are particularly prone to self-flagellation). No-one needs to deliberately increase their own suffering, it does no good, it is a waste of psychic space and has no value.
-I don't pointlessly and painfully ruminate anymore. I stop this process after it has barely started (I have distressing memories of the early days after Ruby died of ruminating for hours at a time over obsessive thoughts of boulders and fissures in cliffs and other overpowering immensities).
-I now reflect on her whole life, not only those last traumatic hours and days.
-Regarding my social anxiety, I now know that I am enough. I need not prepare for all social interactions as I used to do, my irrational anxiety has no use here, I am not the witless dullard I had thought, it suits me to be more spontaneous. I need practice but it is a process I am willing to adapt to.
-Thoughts are not facts. This is deeply and intensely important. It underpins much of CBT practice.
-I will make a deliberate decision to think about Ruby when and how I want to. Distress is a choice and I don't choose it.
-There exists vulnerability zones that I need to prepare for. This includes obvious times such as anniversaries but, almost ironically, also includes happier days when on holiday or when out running in the hills or cycling in the sunshine. I would think, as I am sure many people who are also grieving think, "do I deserve this" and of course the answer is "yes, I do" but it took time to realise this, it took time to allow myself to be happy again.
-I am enough. I am enough. I am enough.
-I can allow myself happiness again, I give myself permission. On some days I can decide that I will be happy for at least that full single day.
-I need creativity. I need movement. I need to be non-sedentary. I need non-routine.
-I can change the way I feel.

Sixth Anniversary: unexpected friendships and the lessons of grief

Six years have passed since Ruby died and life flows relentlessly on. The path of grief needs continual navigation but over time there are fewer surprises, fewer hard turns or stony trails.  As a runner would say, my path is less "technical"- fewer roots, rocks and climbs to test my body and mind.
The sixth anniversary of Ruby's death was only a few weeks ago. Each year I feel more confident in my predictions, to expect the unexpected, I know the weeks leading up to the day itself are the most upsetting and that the actual anniversary itself is a strange type of relief, a release of a pressure valve. I know I need to have a plan of distraction, I know I need to organise my day-job so that I can fulfil tasks expected of me prior to the build up of tension, I know I need a few days off work as a break from the psychic effort that is necessary to be at least a half-decent support worker (I am a nurse helping homeless people with severe mental health problems and addiction issues). I know I need to deliberately increase my sensitivity to Tom and Claire's needs prior to Ruby's anniversary as I can be emotionally numb in the preceding days.  I have had six years practise, I am a pro.

But if there's one thing grief has taught me it is that life's new route is not straightforward. I achieved only half of my predicted actions for this year because the unexpected, it turns out, is always more unpredictable than I'd remembered. The result was that I was very anxious and very sad even though I had prepared well. I did prepare well but I had prepared for the wrong thing.
I have learnt something new this year- no matter how much effort I put into preparation for each new anniversary of Ruby' death there will be an unavoidable sadness at this time, about which nothing can be done. I have learnt that, although my preparation cushions my landing, I must allow myself to fall. I have often written about the importance of freeing myself from the tyrannical grip of things that are out of my control and this appears to be something I need to periodically remind myself. This time I misidentified the issues in my control. I have tried, year after year, to control my emotions at the time of Ruby's anniversary but this has been a wild miscalculation. From now on I will let those feelings flow and will instead focus on the acceptance and consequences of those feelings- I will prepare as best I can, I will remember that it will be maddeningly sad and acutely painful but I will roll with those punches, I will be gentle to myself and I will focus on sharing love with other people as a type of selfish mental health first-aid.

Three months ago I met with two close friends for dinner. Year after year we are busy with work and the usual commitments of everyday life getting in the way of friendships so we get together once a season. I told them I had my first appointment for cognitive behavioural therapy with a psychotherapist the following week to address my grief and related trauma. I had been feeling inert and in desperate need of change for the last two years since my mum died and I had been unable to process this new grief on top of the old grief. I was stuck. I had been looking at new jobs, new careers, new interests, but had realised that the change I needed was internal not external. (How many therapists does it take to change a lightbulb? Only one but the lightbulb has to want to change).
Neither friend has spoken to me since. No text, no phone call, no arranging to meet again (I have seen the therapist each week since then and it has been extremely beneficial). This is another surprise about grief that I had forgotten- the unusual friendship. When Ruby died, and since then, I have lost friends. My recent experience with these two friends have shown that, even if someone's heart is there, they may be unskilled or unconfident about what to say. There are a hundred reasons why those two friends might not have been in touch- maybe they continue to not know what to say, maybe they haven't thought about it again, maybe they're waiting for me, as usual, to suggest another night out as it's now been a few months since we last met, maybe they have their own distractions and that life just goes on- but it's an interesting point to note that even though some friendships carry on just as normal before one's bereavement, others can change in dramatic and unexpected ways.
After Ruby died, other people became new friends. Some people stepped forwards not back, became new supportive partners helping me grieve and helping me reconnect to others again. I now have, for example, two new friends (I had know them both for some years prior to this but was never close)- G was one of the first people to see me after Ruby died and although he obviously had no idea what to say at the time (who does?) he stayed with me because he felt it was the right thing to do. This may sound odd to someone who may not have been bereaved but this seemingly innocuous act of just being with someone even if you are silent, even if you don't know what to say, can be immeasurably valuable. He had also become a role-model by then, helping me become fit and healthy, running and cycling, he has unwittingly extended my life by many years and he has greatly improved my health and my happiness.  The other friendship, JJ,  has also grown over the years. He is gentle and loving and kind and I am proud to know him. He is a vegetarian humanist, modest and life-changing in his work, he is loyal to his small group of close friends and to his awesome wife- a therapist who eases the burden of others' mental distress every day. These are good people to know and to be around.

An over-confident, experienced griever like me suddenly forgot the important basics of how to grieve "properly". I would do well to revisit those foundations to review my baseline every now and then- principles of bereavement such as flexibility, honesty about my emotions, considering how I want to live, being loving and kind, creating and contributing, knowing that everything passes.
It was the sixth anniversary of Ruby's death that prompted me to consider these two very important reflections- the deep effect of these new friendships (their positive influence, their kindnesses, their emancipatory powers) and the importance of identifying my emotions (and preparing myself for their effects not for their elimination). I will continue to learn forever.

What Of The Eternally Young?

Youth isn't wasted on the young,
They are the only ones who can cope with the heartbreak of it all.
Adults are the
expressionless wreckage after childhood's wake,
Smug and snug in their deep yearns,
arch surrender permitting their amelioration.
Any vestige of the child left,
becomes a detached valediction, an excuse and a reason.
At childhood's end,
We create new benchmarks using then losing youth.

And we tell the young
To love being young, to love for the love of it,
To do it, do it,
be proud of it, don't deprecate the doing of it,
Let fly the looseness, the loucheness,
be indiscreetly joyous of it,
celebrate the being,
and the moving,
and the unsedentariness,
with tender furiousness.

But youth and age get levelled,
And both can die of broken hearts, of worn aortas or loss,
And the eternally young
Leave the old to cope with the heartbreak of it all.

And Here We Are

And I remain here in our world of blood-red tomatoes and earthy spices,
Willing for change and new routine and otherness,
I can be a sentinel for others' attraction
and a beacon of rest for the grieving faction.
But I know what I am not
and who I have not.
Everyone else remains here in our world of barking dogs and carrier bags,
Scuttling, targeting, oblivious to who they have lost,
Maybe wilful ignorance helps navigate
the risks of daily comfort.
Maybe they do not want
what they have not got.
The children that know lived through homework and after-school clubs,
Their fortitude bolstered by potential and by childish romance,
Maybe distance has dulled the sharpness
and youth is resilience.
They can survive painlessly
wanting what they don't have.
But she doesn't remain in our world of red tomatoes and earthy spices,
Of barking dogs and homework and after-school clubs.
Of sentinels and beacons and places of rest
Of daily comfort from those who give peace.
There she is,
and here we are.

Anniversaries

There are a handful of anniversaries to navigate now that Ruby is not with us any more. Each has its' own identity. The anniversary of her death (May 8th, the day before my wedding anniversary) has a blanket sadness that is utterly unavoidable, there is nothing that can be done that day to reduce its effects, no distractions, no positive discussions. It is, without fuss or negotiation, the worst day of my life. I feel terrible rage at the unfairness of it all, I feel my body collapse and implode, I feel fate has assaulted me with a disability for life, I feel so much and also so little.
Our birthdays, as close relatives, have their own identity in connection to grief- we make them as fun as we can but the gap of loss is unavoidably present. There is no other day of the year like a birthday for someone who forever grieves. There are presents, laughs, cake, going out for dinner, seeing friends and all the usual shared celebrations. But the edges of the precipice are crisper than ever. On birthdays Ruby is barely mentioned, if at all. It is supposed to be day of celebration after all so sad stuff is not supposed to be brought up but of course it barely needs to be brought up, its always there.
The emotions experienced on Ruby's birthday vary every year depending on her age. Three months ago she would have been seventeen years old (when I last saw her she was eleven). The run-up to this anniversary is the longest of the year and usually takes many weeks. In public during this period I can only see young women of about her age and I am distracted by ideas of lost potential- would Ruby be in education, training, still have the same friends, would she be happy in our family, what about her relationship with her brother Tom, would she have liked a birthday party or a quiet night in with close friends?
Christmas grief has its own identity, one influenced by a monthly build-up to a holiday of family time, expected jollity, excess and conspicuous consumerism. I can experience social anxiety any time but there is a pressure on me like no other time of year to be around other people and there is an expectation to be celebratory, which I never feel. As an atheist adult, Christmas meant very little for me from the time I stopped believing in Santa Claus up until I had children of my own. Then there were eleven Christmases of childlike wonder and excitement but now that has gone. Tom enjoys it, of course, but everything is different now.
In the last five years Christmas has barely evolved from what it has always been around here- getting together with extended family, eating and drinking. This year I spent much of my time in a quiet corner online, connecting with strangers and trying to make things a little less lonely for us all on a Twitter group designed just for that purpose. That is my Christmas identity- loneliness. Feeling alone, even in company, has been the unique identity of my Christmas for the last five years. I do what is expected of me, as a relative, but there is no other day of my year that has that same quality of displacement as Christmas, of disconnectedness from my surroundings (it is for this reason that I can easily empathise, and can create good connections with, lonely people online and I try to use some of my day to ease our burdens). I am always pleased to see the end of this day. This year my dad was over from London for a week which was lovely too but he and Claire and Tom were all ill with bugs so my two weeks time off from nursing over Christmas was a busman's holiday. I had prepared myself a little for the unhealthiness of the time by losing a little weight in December (reducing bread and pasta for a few weeks and adding on a few more runs than usual which also contributed to helping me feel a little more in control of my emotions).
I spent midnight New Years Eve at home. Claire and Tom were asleep, snotty, coughing, with a high temperature, and I considered my resolutions for 2019 but came up with nothing. I think all I wanted was a return to some sort of routine combined with an escape to the forest. Maybe this is all I ever really want.
I want to get through the new year without totally fucking up. Anything else is a bonus.

This my favourite tree in the world- an oak in Castlewellan Forest Park in Northern Ireland, taken today 2nd January 2019.

Trans men are real men too

In my job as a nurse helping homeless people I have knowingly met many transpeople (I am not a particularly sociable person and so I meet very few new people outside of work). Some of them I have met because of the psychiatric profession pathologising their transgenderism under the banner of mental health (hopefully this will disappear soon) but others I have met through usual day to day interaction (poverty is a great leveller and doesn't discriminate for or against transpeople, cisgender people or others). My reasons for working as a nurse with particularly vulnerable people could appear truly cheesy and cringe-worthy but the reality is that I hate unfairness, I hate bullies and I am fully aware of the power of autonomy. We flower when we are in charge of our own destiny and I want to help people regain some of that control when it is lost without intention.
Some ignorance about trans issues is conscious prejudice because there is only cursory research, and hence evidence, about why some people are transgender so some people make up reasons to fit their own narrative (I'm very aware that explaining transgenderism via scientific research is an ugly concept for some and that the focus should be on solidarity rather than scientific explanations but I am writing this from my view of knowledge and my view of interest).
There has been very recent research in Belgium to suggest (strongly) that the brains of transpeople identify on a physical, neurological level with the brains of the gender they identify with. There has also been research for many years proving the changeability of the the physical make-up and processes of the brain throughout our life (neuroplasticity) which may also contribute to being transgender and to gender fluidity. Cognitive neuroscience is really in its infancy and will be a massively exciting field to work in over the next few decades. Also, our genetic make-up and the interaction of the environment with our genes (epigenetics) has proven the extraordinary complexity of the human condition and the million shades of colour we exhibit and inhibit. I passionately watched the Human Genome project, an extraordinary scientific endeavour mapping the human genetic code, progress through the 1990s at a cost of a billion dollars. As of today some companies are offering the same genetic mapping for individuals for $999 and it takes one day- the field of genetic science is amazing as we discover the increasing complexity of our genetic code and the lack of demarcation between nature and nurture, such is their close relationship. Clearly the old fashioned idea that our gender is defined by our genitals or by XX or XY chromosomes is over-simplistic nonsense, as has been proven for years.
But that's just the scientific evidence.
Self identifying as transgender and then sharing that knowledge is really hard. It can be terrifying. There are serious and real risks of rejection from all corners of your life and risks of serious violence. Real violence. It is no surprise to me that around half of the people who identify as trans have considered taking their own life. Half. The fault for this terrible pressure and lack of acceptance comes direct from ones' environment, from the society and media that mock and confute and use fear of "the other" to gain capital, from the wilful ignorance of friends, neighbours, people on Twitter who refuse to weigh and consider and refuse to take even a cursory glance at the subjective experience.
I think times are changing. The non-binary nature of gender is beyond serious debate. That people identify as trans, and through their subjective experience as male or female or neither, is non-negotiable and the rest of the world is playing catch up. My anecdotal experience is that, to be open with others about being transgender, one has to have gone through such a phenomenal amount of introspection and that one has to be so completely assured about it, if you say you're a man, you're a man. Of course anyone can say it but that's not what transgender means- it means you feel a different gender to the one assigned to you at birth. It isn't what you say, it's who you are.
So what to do? The main advice I give, as a mental health professional, is usually clinical advice because I often meet people who identify as trans due to the problems they experience. And those problems are usually the fault of other people around them so my support is usually about exploration of the self, information about formal LGBTQI+ services, related mental health issues (depression, anxiety, ideas of self-harm, etc) and providing a listening ear and a safe place to be as honest as they
feel comfortable. And I would encourage them to tell anybody they they feel safe to do so which may not necessarily be a close relative or friend but simply someone they feel comfortable enough ("would you feel/be safe telling them?") to confide in.
None of this should be an issue, of course, because the dangers and stressors lie with non-trans people. The more this issue is discussed, the less we pathologise it, the more we can all be comfortable around that which we do not know. Knowledge is power.
Much of the transphobia I have seen online, and which has been told to me by other people, has been about trans women not being perceived as "real" women or trans men not being perceived as "real" men to which my immediate thought is: What is a real women or a real man? It certainly isn't a chromosomal thing or a genital thing or the words you choose. An idea currently in trend is that trans women don't have a "lived" experience as women and won't have directly experienced the same sexism, misogyny, differences and other insights into female gender identity. This is such a patronising idea to me because if you identify as female you will feel the same, or very similar, internalised patriarchal pressures that many women experience. And it makes no sense to me identifying your gender based on ideas of violence, disadvantage and negativity. Is a trans man only a "real" man if they competitively earn more than their peers or like football or get into fights in a pub? I like very few typically male things I guess I am not a "real" man either.
If something is beyond your control then your worry will change nothing. If something is in your control, choose wisely. It would be blatant idiocy for me to be angry at someone because they are Kurdish or ginger or tall or a heterosexual, the same model of idiocy expressed by transphobes. If you can help your choices, being a Tory say or disliking cheese, then your shortfalls are up for contrarian discussion.
There is a spectrum here. Not all women have experiences that some women consider necessary if they want to call themselves women. Not all men have experiences that some men consider necessary if they want to call themselves men. Some experiences, and the resultant personality that is affected, are male, some are female and many people experience both types. In combining within us those lived experiences with the plasticity of our neural development and the complexity of genes and epigenetics and a hundred other factors beyond my brain power to understand, the idea that gender is binary is surely a dead idea.
There is a beautifully analogue fluidity to gender in humans. To even suggest the idea of "trans"-anything suggests there is clearly male and female and you identify as "not one but the other" as opposed to identifying as "my gender which is simply, naturally, messily, uniquely me". Our primary hope is to accept differences as natural and normal- as we do if you are a Kurd or ginger or tall or heterosexual- and just be fucking nice to each other. There is no zero sum gain here- you don't lose out if your transgendered (perceived) enemy gains some acceptance, you gain too, as we all do. People who identify as trans can be arseholes just as frequently as other people, and they can be racist and Tories and cheese-haters too. Judge people on their choices.
And if they vote Tory dismiss them from your lives forever, they only brought it on themselves.