
What I have learned from my suicidal patients - firstbase
https://www.theguardian.com/lifeandstyle/2019/nov/22/doctor-gp-what-i-have-learned-from-my-suicidal-patients
======
0xcde4c3db
> To feel depressed about the state of your life is to demonstrate capacity to
> imagine something different, and that spark of imagination can prove a
> motive to change.

This was arguably true for me, but not in a good way. I'm pretty sure that I
started having intrusive suicidal thoughts _because_ my depression had
motivated me to try to change. Said changes utterly failed to even make a dent
in my depression, finally convincing me that nothing I did would ever make me
feel good again (this was after multiple trials of antidepressants and talk
therapy over the course of 10+ years; it's not like this was the first thing I
tried).

All the generic "there is hope" and "antidepressants really work" and "go to
therapy" talk that tends to surround mental illness discussion really bugs me
because virtually nobody acknowledges the damage that's done when these things
fail (and they fail frequently). It doesn't just damage trust in mental health
professionals, it hurts the credibility of recovery as a concept.

~~~
sjg007
Are you still depressed? I try to have 5 good days out of 7 in a week. I found
that CBT helps especially the book Feeling Good by David Burns. He has a
podcast out now about a new team base cbt approach. The podcast is great and
the workbooks in his books are really helpful. He has an associated clinic in
Mountain View as well. The approach is practical and specific. CBT has roots
in Buddhism and stoicism as well for the life hacker types we see here on HN
from time to time. The basic idea is that your thoughts create your feelings.
There are a lot of tools to help identify and understand those thoughts.

~~~
0xcde4c3db
I'm not sure whether I'd actually meet the criteria for a depression diagnosis
anymore. I haven't been severely depressed since starting CPAP treatment, but
my emotional experience is still very flat and I still have difficulty
processing social interaction.

I've heard of _Feeling Good_ and CBT in general, and without going into the
gory details, it _really_ doesn't sound like it's the right approach for me.

~~~
im3w1l
Are you saying sleep apnea the root cause of your depression?

~~~
0xcde4c3db
No, I'm not saying that. I can't rule it out, but based on other symptoms I've
had for a long time I think it's more likely that it was "just" making
everything more stressful and reducing my ability to cope in general.

------
3pt14159
I have such conflicting views on suicide. On the one hand suicidal feelings
are often temporary across the grand expanse of life, on the other hand surely
there is a better way to handle people that have suffered such hardship than
sterile mental hospitals, drugs, and societal shaming.

It's so strange that we're allowed to have Do Not Resuscitate medical
necklaces but they're only followed if something outside the person's power
caused the trauma.

~~~
sdegutis
The more people try to decide their own “truth” instead of living in reality,
the more they will run into depression, despair, and suicide.

The real solution to these is to encourage facing reality in its entirety,
including being honest when someone has a self destructive habit, tendency,
interest, reaction, or hobby.

~~~
0db532a0
There is no one reality that we can talk about as a group. There is only
personal experience. You might be interested to read about phenomenology a
bit:
[https://en.wikipedia.org/wiki/Phenomenology_(philosophy)](https://en.wikipedia.org/wiki/Phenomenology_\(philosophy\)).

~~~
sdegutis
There is objective truth and objective reality. I’m sad that so many people
reject this utterly necessary fact and spread misinformation against it.

~~~
kruasan
Yes, there are objective mathematical truths, but you cannot be sure there
exists a physical reality or anything that corresponds to our experiences. You
just know that there are subjective experiences right now. That's the only
thing you can be absolutely certain about. So I see no sense in talking about
"reality".

~~~
0db532a0
No, there are no objective mathematical truths. I am saying this as someone
who has studied pure mathematics. We have long moved away from Plato. Godel
long ago proved that no system based on a finite number of axioms is complete.
This isn't just a comment on mathematics. It is a comment on language and
human thought itself.

Of course, the debate remains of the "validity" of pure mathematics for its
own sake. Many mathematicians, while not being religious in the common sense,
have longed for a Platonic reality. Why do you think Hardy was so derided for
his Mathematician's Apology?

Mathematics is simply another formal game of language, based on a number of
axioms which can be either held to be true or not. Look at the differences
between Euclidean and projective geometry. No one is asking which one is
"true". Projective geometry helps for some lines of thought, Euclidean works
for others.

~~~
Scarblac
Godel's proof doesn't imply that there is no mathematical truth. There is
still an infinity of things that can be proven.

~~~
0db532a0
I know. I used him as another example that mathematics is not the be all and
end all.

------
cassowary37
A colleague of mine calls suicide 'a permanent solution to a temporary
problem' \- not to diminish it, but to recognize that for most people the
desire to die is a temporary state.

Whenever depression comes up on HN (as it does with surprising frequency), I'm
both touched by people's willingness to share their own stories, and
frustrated by otherwise very rational and logical people's speed to dismiss
data. Initial treatment (meds or evidence-based therapies) work for about 1/3
of people; subsequent treatments work for another 1/3; and there are up to 1/3
where multiple treatment trials fail them. (This comes from STAR*D, plus
Cipriani Lancet meta-analysis, plus vast CBT literature). But, there are a
number of next-step treatments showing promise (rTMS, esketamine, variants of
CBT, and so forth).

~~~
jdietrich
STAR*D presents us with a "glass half full" problem. It's absolutely true that
the majority of people will recover from depression with suitable treatment,
but that leaves us with a minority who won't.

I'm not sure how to communicate those facts effectively to a wide audience. It
is absolutely imperative that people with depression seek treatment and keep
trying even if the first or second or fifth treatment fails, otherwise we're
condemning people to unnecessary suffering; conversely, a lot of people with
treatment-resistant depression are doubly stigmatised because of unreasonable
expectations about the efficacy of treatment.

I do think it's useful for treatment-resistant patients to shift their focus
away from recovery and towards symptomatic management - it's easy to get
disheartened because you're not in remission, but a treatment that takes you
from 10/10 depressed to 8/10 depressed is still useful. Eking out small
reductions in symptoms and small improvements in functioning can be tedious
and frustrating, but it's better than resigning yourself to interminable
misery.

~~~
brookside
The term "treatment resistant depression" bothers me because, I think, a more
accurate name would be "placebo resistant depression". Sorry to come off as
frustrated; I'm like others in this thread with 10+ years of trying various
therapies and antidepressants to end up feeling more, not less, hopeless.

David Burns does a good job explaining why antidepressants and psychotherapy
don't typically work in his most recent podcast:
[https://feelinggood.com/2019/11/18/167-feeling-great-
profess...](https://feelinggood.com/2019/11/18/167-feeling-great-professor-
mark-noble-on-team-cbt-and-the-brain/)

While David makes a good case against drugs and non-CBT therapy, I actually
don't find his his fantastical anecdotes of the light-switch effectiveness of
TEAM CBT therapy convincing either.

~~~
cassowary37
and HN refusal to pay attention to data when it relates to depression in
3..2..1...

[https://www.ncbi.nlm.nih.gov/pubmed/29477251](https://www.ncbi.nlm.nih.gov/pubmed/29477251)

for moderate to severe depression, the kind most posters are talking about,
they're consistently better than placebo. It is true that placebo is often
effective too. But most people I talk to would rather have that extra chance
of getting better.

~~~
brookside
"We excluded trials that included 20% or more of participants with bipolar
disorder, psychotic depression, or _treatment-resistant depression_ "

This is an honest question - is it fair to exclude people for whom
antidepressants don't work in an analysis of if antidepressants work?

~~~
chas
If “placebo-resistant depression” and “treatment-resistant depression” were
synonyms, we would expect that excluding treatment-resistant depression from
your study would result in the studying showing precisely no difference
between treatment and placebo. The fact that the meta-analysis shows any
difference at all suggests that “treatment-resistant depression” might be a
meaningful category.

------
sysbin
I theorize society would be a better place if people could choose to end their
life when they please by assistance in dying (commonly given to terminally
ill). Although the idea is controversial I'm firmly attached to it from what
I've witnessed in my life. Some people just have a terrible fate and nothing
that comes in their life changes it because not everyone gets a good job,
significant other, place to call home, and the healthy body. Some just don't
want to settle with what fate gave them and others have had enough of life.
edit: lol @ the person who downvoted every single comment of mine.

~~~
erokar
This is a horrible idea. A lot of people commit suicide because of treatable
depression, i.e. the wish to die is temporary and could go away with
treatment.

There are certainly a lot of things that could make society a better place,
suggesting more people start killing themselves is not on the top of my list.

~~~
postsantum
>>the wish to die is temporary and could go away with treatment

Stands true if you count euthanasia as threatment

------
shrimp_emoji
>The soldier who hiked out on to the moor, lay down in the heather and
overdosed. Émile Durkheim, the great sociologist, theorised as to why suicide
is so common among military personnel – not simply because of the devastating
effects of war, or because of their easy access to weapons, but because of the
depersonalising effect of army training: “Military esprit can only be strong
if the individual is self-detached, and such detachment necessarily throws the
door open to suicide.”

Is this saying that veterans can kill themselves more easily because they have
more rational clarity about the situation? If so, isn't that a good thing? To
be able to carry it out can certainly be framed as "strong" (I doubt I could,
though I'd want to if I find myself in the position). Look at these guys:
[https://en.wikipedia.org/wiki/Sokushinbutsu](https://en.wikipedia.org/wiki/Sokushinbutsu)

If you've thought about it with a level head and conclude, "I want to log off
now, that's enough existence for me," is it better to suffer under moral or
peer pressure because others offhandedly want you to exist for as long as
possible?

~~~
whatshisface
One one hand, we have a growing body of research saying that almost nothing
anybody does is rational, and that most "rational explanations" that people
deliver are post-hoc _rationalizations_ of something they did on a whim. The
popular interpretation is that this represents evidence against free will, but
that may be a little overblown. On the other hand, there is a parallel
cultural trend of people arguing that suicide is rational, and that many
suicidal patients are that way because they sat down and added up the utility
of the various options. I guess my point is, when obesity drops to zero on the
day that everybody realizes that it isn't rational to be fat, I'll start
considering the possibility that people could "decide" to kill themselves.

~~~
clarry
It's not like people become fat on a whim or have no regrets about it
happening. Likewise, you can plan suicide for years.

------
mthoms
I'd met Scott Hutchison on a few occasions. He was immensely talented and an
all-around likable, humble, and hilarious, human being. The world is a better
place for him having lived in it.

His family has since started a mental health charity in his honour [0].

To get a small taste of Scott's personality, have a listen to the banter at
the beginning of this live performance[1]. He's one line into "The Modern
Leper" (a song about living with depression) when he notices a small child
near the front. Scott becomes suddenly aware how dark the subject matter is,
and breaks from the song to give everyone a little laugh.

[0] [https://tinychanges.com](https://tinychanges.com) [1]
[https://youtu.be/ob3X77TwqEw](https://youtu.be/ob3X77TwqEw)

Edit - he also did a talk at Google before his last tour (not tech related)
[https://youtu.be/FT_UrM_L1vQ](https://youtu.be/FT_UrM_L1vQ)

Rest in peace Scott.

------
hestipod
I won't make it through the end of the year and it's all preventable. Nearly
everything I see posted about suicidal people from non-suicidal people, and
ESPECIALLY doctors get it wrong and avoids root causes in some self serving
attempt to justify their failures or live with that existential fear. Most
people I have known professionally when I was a provider, and personally since
I became a victim, who were suicidal didn't have some unexplainable mental
illness. Their depression and psychological issues were entirely rooted in
real life things that could be solved or mitigated, but people, systems,
society refuses to solve them because it costs money...and money matters more
than lives. Very few people have primary, intractable mental illnesses.

I tried one last time to talk to my family recently...very right wing, faux
Christian, self-righteous, bigoted people who think those in need are weak,
didn't try hard enough, are to blame. They have never been decent people and I
avoided them my entire adult life but was forced to grovel when my health got
worse and I was denied official assistance. It's been nothing but misery and
makes everything worse. It's a gravity well I cannot escape, I am powerless to
do anything but scream online between gurgling breaths as the riptide takes me
away and they seem to enjoy that power and getting me back for all that time I
did avoid them. Despite a career seeing the worst people did to each other,
you never want to accept those who claim to love you are that bad as well. But
people show their true selves when they have power over others, when they have
an opportunity to exercise their wills, when there is someone
smaller/weaker/needier in their path...people will show you who they are every
time. Every time.

I am not depressed because of some temporary situation. I am not suicidal
because of a chemical imbalance. I had my health stolen, my finances
decimated, and my life punched down on hard by anyone who was supposed to be
there for me...for whom I would have been there. I am clinging to Maslow's
bottom rung and losing my grip and nobody who can do anything cares at all.
Everyone I have ever known who is suicidal has some real, actionable reasons
like this underlying it. But all people say is "get help"..."take
pills"...."meditate". That's all putting a bandaid over a gunshot wound and
ignoring the trauma underneath because dealing with that is harder and costs
more. People just aren't worth that to others. I am going to die angry and
alone and they all know it and do nothing but antagonize, threaten, and make
it about themselves. They have important things to do like rage at "liberals"
ruining the world and how unfair everyone is being to Trump. Their kids and
neighbors and everyone else are tools and threats to them, nothing more, they
are so incredibly ego driven it's astonishing. They say "not with MY money" to
everything social for others, even as they collect their social security or
use subsidized systems. That's what matters to them...their own gain and
power. Not me...not others. They are legion in this country. By an accident of
birth I was both ruined and abandoned. Both rooted in selfish profit driven
mindsets. Had I been born in the fist world the profit driven surgery likely
wouldn't have even happened, but had it I would get social assistance. Not
here...here I get to go live in a ditch or die.I am too old, too broken, need
too much to survive and I refuse to suffer MORE because of this backwards
culture so option B it is. Thanks Murica.

No SSRI or deep breathing solves those situations...and most people who end
their lives didn't have to if people would do the right thing. But the right
thing isn't profitable. So they push pills, write articles, cherry pick
survivor-biased tales that show someone who "got better" who didn't really
have any problems at the core. They show this as some enlightenment or
evidence and hold it up but the light is focused on that and ignores the piles
and piles of bodies underneath who were ignored or bypassed because it was too
hard and not good for business. Most people don't care about you...they don't
care about society...they care about themselves.

I had a nightmare just last night about a victim I recall from early in my
career...in such a horrible personal situation...who died in such a terrible
way. She didn't have to. She was pushed to it and then allowed to because
nobody she reached out to would help. I've seen dozens like that...and not a
single one of them had to die. Every one of them was failed by their family,
by their neighbors, by systems...it's shameful. But enough about silly
bleeding heart things like people and the planet and whatever. There are
important things to do like get those likes, those dopamine hits, shut down
those losers in a political argument or downvote someone to signal how wrong
they are, make those dolla dolla bills convincing someone to buy that useless
to society "product" or cash out big to someone else who will because those
luxury status symbols won't buy themselves. After all anyone who is suffering
only has themselves to blame and didn't want it bad enough or step on enough
other heads to get it. Losers.

~~~
downerending
The situation with your family sucks, no doubt.

What would improve things for you right now?

~~~
hestipod
I am so stressed, distressed, angry, in pain that I don't even know at this
point. I need stability so I can assess things. See what the baseline is
without all this bullshit here. I need to get back to Warsaw where I lived
before and my only friends and reliable doctors are,or at a minimum some
European city with dense services, affordable healthcare, and transport so I
can live within a small area. This country is too costly and lacking in
services in this rural hell, and I don't trust the healthcare anymore in
general. But anything will require money. I cannot earn well or at all because
my health requires all my energy to endure most days except for basic
household stuff and even some days I don't move much at all. I simply cannot
dig down like one can when they were a 20yo and scrap and build a new
foundation. I don't know if I would EVER be able to work reliably...but for
sure never full time.The money I have access to isn't enough for anywhere and
there is no safety net. I have no insurance. When they ruined my health they
took away my means to guarantee that financial security...and then denied
assistance. Nothing went right.

People always think you should be able to do more than you say but my body is
the boss and will fall out from under me and that takes my mental state with
it...as you can see now. Nearly two years ago someone here offered me a very
bespoke job part time with the ability to immigrate, but my health problems
and personal tragedies (family betrayals and death of the person I loved
most...one I may have been able to prevent had I been back there instead of
across the world) all came at the right time to confound even THAT chance. Now
things are even worse physically, financially, and mentally and my
capabilities less. In a modern country I'd be on social aid so I could have
stability and time to assess and long term help if I couldn't improve...not
feel I would be cast out at any moment with no survivable path. Maybe I'd be
like this for the rest of my days...maybe I can improve a little and do more.
I can't know until I have that security and access to trustworthy doctors and
systems...and those are not here in America.

~~~
downerending
This is very difficult, to be sure. Betrayal is a very hard pill to swallow,
and the death of a loved one likewise.

You mention Warsaw as a place where things might be better. It looks like you
could fly there from NY for maybe $300 on a good day. Is this a plan you could
shoot for?

~~~
hestipod
I am not in NY and it costs a lot more than that as a rule. But that's not
even the issue. getting a flight is not a block. It's how to survive long term
financially when there. How to legalize without some immigration means which
is mostly predicated on money. How to do all that with poor health and people
actively fighting you and trying to take away more agency. It's a lot more
than just "moving". "Moving" has been my plan since the day I came back from
there. I'd have done it then if it was realistic. If money were no object I
would have never left, or once here packed up myself and my cat and moved
back. Back then my health wasn't good but wasn't as bad and I might have had
even some good days. Now it's worse all I want is mostly not miserable days,
mostly survivable days. I would accept that. But I cannot even get that.

------
hackerrenews
I have bit to share about being suicidal as a lifetime pursuit. I decided
around 11 years old that I wasn’t going to participate in life and essentially
committed soft suicide. I’ve had decades of persistent suicidal desire since
then.

In the past year, I’ve given away all of my money (less than a million bucks).
Just gave away a few thousand to a business owner yesterday who was being
cheap and petty. Told him to donate it to his favorite charity.

Homeless and alone, broken and finally close to absolute destitution, I’ve
thoroughly prepared for suicide. It’s a combination of gratitude for the end
being near and a nagging fear of the unknown. Sorry, but the fact is nobody
knows what happens to them when they die until it happens. You’ll either
experience nothing, or you’ll know there is existence for yourself after
death. Those who believe either way (atheist - nothingness, religious -
eternity or reincarnation, unification etc) are all potentially right, with no
scientific way of proving anything to the living.

My short time on this planet has given me a clear perception of the existence
of higher intelligences in our midst yet I remain committed to wanting to die
as soon as possible. I find the machinations of society to be utterly
disappointing. I made up my mind five years ago and I’m finally close to the
end now. Hoping to be gone before years end and would like to be left alone so
I can die in peace.

Silicon Valley is corrupt. I became a digital voyeur long ago to better
understand the machines we have built and I’m disgusted. Every moment now is
another reminder of why I’m thankful to almost be dead. The sick, cruel part
is that my suicide is likely part of a evolutionary process to “weed out”
those who can’t handle being a voyeur. I just tried typing “handle” on my
iPhone it got autocorrected to “ya die” which has been a common theme. Can’t
imagine my mind is always controlling iPhones secret CIA enabled Ouija board
autocorrect troll mechanism.

~~~
cc-d
> Can’t imagine my mind is always controlling iPhones secret CIA enabled Ouija
> board autocorrect troll mechanism.

If you're serious about any of this, and believe what you said is true, you're
currently experiencing active psychosis. These are not the words of somebody
who is rationally considering suicide.

If that's truly the case, odds are you'll be in a 100% different mindset after
a few months of medical/psychological help. Seek it.

~~~
hackerrenews
Serious about what? That the auto correct happened? I have no idea why my
hands always end up typing such troll shit. At the least it’s incompetence by
Apple.

Don’t talk to me about active theories based on an unreliable internet post.

Don’t talk to me about your theories on what constitutes “serious suicide
planning” in the context of obviously absurd theories about apples garbage
auto correct mechanism.

~~~
hackerrenews
Just for the record, my iPhone autocorrected my attempt to type the word
“handle” to “ya die”.

It’s not a phrase that I ever use, so it’s unclear to me how that became a
first choice candidate for Apple’s autocorrect mechanism.

Being in the middle of writing a suicide note, having Apple make such an
autocorrection is, at the least, unwanted incompetence. “Ya die” isn’t
something I want to see emanating from Apple’s autocorrect mechanism, ever -
whether in the middle of a suicide note or not.

There’s also a huge disconnect here. Just because I say some absurd theory
about mkultra in the 21st century, doesn’t mean I seriously believe it. I just
observe and fit in theories like everyone else trying to make sense of their
limited perception reality. Jumping on the mental illness attack bandwagon is
most of why I’m out of here. If that’s how I’m perceived, just for stating a
non-serious theory, then I’m thankful to almost be dead.

No common ground. Take notes, if you seriously want to figure out how to
relate to someone who thinks like I do, someone who truly is at the end.

This isn’t a cry for help for me. It’s to help others understand my point of
view to help others before they get to my age. I’m not going to change.

No advice, please.

~~~
hackerrenews
Ref: charter pgp akin and the rest. Not a drill.

------
sillysaurusx
I just wanted to say, if anyone is having a dark time, make an appointment
with a doctor and ask them about Prozac. Unlike most antidepressants, the side
effects don’t seem very noticeable.

I think there’s a sort of stigma against talking about mental health (except
in the third person), but it’s one of those things that should probably
change. Taking Prozac doesn’t mean you’re somehow broken. It’s like a crutch:
why go without?

Yet it’s surprisingly easy to go without, due to stubbornness. It feels like
admitting failure to go get medication. But why? That’s as absurd as feeling
like it’s admitting failure to go get a cast, or a tooth filling.

It’s fuether compounded by the fact that most antidepressants have severe or
annoying side effects. So I just wanted to throw out my one datapoint: it’s
not always like that, and your life can feel much better.

EDIT: Okay, clearly I didn’t emphasize enough that everyone is different and
responds differently to different medications. But I know at least two people
reading this are going to use that as an excuse not to go to the doctor and
try it for yourself. That’s why I’m writing this.

~~~
BuildTheRobots
This reads like advertising copy.

Prozac has a number of potential side effects as well as needing commitment
and a staged withdrawal.

This is a dangerous comment and should be burried.

edit: this isn't to say I don't think antidepressants are a fantastic tool;
just that I don't think you should be going to your doctor and asking for a
specific flavour of drugs because you heard about them on the internet. It's a
really serious discussion - people should be going to their doctor and asking
asking the possible (and best) solution to their personal circumstance.

~~~
sillysaurusx
I can tell you from firsthand experience for more than a year that the only
effects I’ve noticed are slightly decreased libido. That’s generally
considered TMI, which is why I didn’t mention it. But if I’m going to be
honest and open, well...

Other than that, the side effects have included a renewed appreciation for
life and and an ability not to have a sense of impending doom engulf my soul.

I was careful to say “my one datapoint.” Obviously, it’s not a miracle cure,
and everyone is different. But it’s somewhat remarkable to diff my life vs
what it was.

I’m a scientist at heart. I try to rule out placebo effect, and not attribute
everything to one simple change. But a hearing aid is a simple change too.

The reason I’m speaking up is that it’s incredibly tempting to do nothing and
to try to deal with your problems on your own. But it feels like that’s the
real danger. Even if you succeed, why live life that way? It’s like succeeding
in punching through a concrete wall for no reason. Much easier to use a
sledgehammer.

You can always stop taking it. In fact, it wasn’t till I stopped for a month
that I realized it had actually been working.

~~~
drunken-serval
My experience tells me you’re are dangerously wrong to portray your experience
with a single medication to be representative of anything.

I’m bipolar and spend a significant amount of time helping out in a support
group for people with mental health issues. All of them have vastly different
experiences. One medication I was on had terrible side effects while someone
else was saved by it.

My current mix of medications would put some of the people I’ve helped
immediately in the hospital. I myself have been sent to the ER by my
psychiatrist due to a medication I was on.

Many psychiatric medications can’t be stopped without serious risks yet I’ve
know people who have stopped all their medications and been fine. Others have
permanent damage.

The only thing consistent with medication is that everyone is different.

