Everybody you meet has a secret smile, and a secret pain.
If your secret pain feels like a weight you can no longer carry, please talk to someone. Anyone. Lay down your burdens, and give your shoulders a rest.
If you're in the US, there's the National Suicide Prevention Hotline: 1-800-273-8255
LGBT folks in the US might also consider The Trevor Project Lifeline: 1-866-488-7386
I don't know about international numbers or other region- or culture-specific services; perhaps others can reply with the ones they're aware of.
There are numerous examples of the police turning up on a suicide call and killing the individual, even when unarmed. They simply aren't qualified to deal with suicidal individuals and should only be used when other's safety is at stake.
My sister attempted suicide as a teenager and the police that responded spent hours ransacking our home and further tormenting my family for no good reason. Then to think of her being locked up in the hospital (I wasn't able to see her for at least a week).
If I were having such thoughts, I certainly wouldn't tell anyone for this precise reason.
Maybe I'm a nutcase, but I've taken the time to prepare a set of scenarios under which I would no longer want to live, and think about what would need to be taken care of to exit the world without undue burden on those that depend on me. That seems like an eminently rational thing to do.
I believe professionals would categorize what you wrote there as "planning suicide". So long as you have not started "taking care of" those things you have not begun executing your plan. Planning is a rather big step beyond contemplating - I hope you're doing better now. You may also want to consider that actually getting your affairs in order could be an enabler.
It's evaluating a set of contingencies. Like, the general staffs of armies make war plans that they will never execute, unless the particular parameters fall in place, all the time. To do otherwise would be irresponsible.
The public health responses to you should be very different to the people who experience rapid onset despair.
When I was a kid my oldest brother enrolled in some free counseling from a church. They had him fill out why he was going to counseling so he honestly wrote down that he had been having suicidal thoughts.
So this church freaked out and sent a pastor and someone else over to force him to promise not to kill himself.
Which as you can imagine was horrible and completely broke his trust in the system.
Also taught me to never ever be honest with people about serious things like suicide unless you've already know how they will react or you think you are a real danger to yourself.
Suicidal thoughts from time to time are fine. The issue is when you start to have real intent to carry them out. That's when you need help.
There was a situation in Canada where police incident reports were shared with the U.S. border authorities under a law enforcement information sharing agreement, and a few people were denied entrance to the U.S. as a result of historic crisis encounters with police. Cops aren't bad, but institutions can be callous. Similarly, the record of a mental health crisis (or failing to disclose it) can have an impact on certain kinds of insurance, security clearances, (as above) travel, custody agreements, and by extension, jobs.
Learn to stay mentally healthy, and realize that it is an investment you make, often at the cost of other immediate things, which pays off as the result of sound decisions compounded over years.
Many officers don't receive sufficient training on how to deal with mental health crises, and sometimes the result of contact is bad.
> Police Broke Into Chelsea Manning’s Home with Guns Drawn — in a "Wellness Check"
She wasn't home. But the surveillance video is frightening. At least, it wasn't a SWAT team. But damn.
You may not like it, but the system utterly sucks and you can be easily, even casually, abused. In fact the likelihood is high this will happen. And the kicker? No one gives a damn if you do get abused, and if you die then your mental illness will be used against you for the reason that some cop killed you.
I don't know how other people who've suffered depression most of their lives feel, but I can't stand this advice. It reeks of being the lowest effort possible by someone who has no understanding whatsoever of what they're talking about and prefers to just parrot something that sounds good to them. I'd honestly rather have people tell me they think I'm a weak pussy who should just suck it up, because at least their being open and honest about their lack of give-a-damn.
He spent two years just keeping me accountable on the little day to day things and while it didn't immediately cure my depression my quality of increased dramatically. The idea that something like keeping my room tidy would help with my depression sounded absolutely god damn insane at the time, "I want existence to end and you're telling me to make my bed?" ..but somehow those hundred small things mattered, life's pretty good these days.
God damn brains are dumb.
Being home, alone, unshaven, unclean, in an unkept house made me feel worse because of all the things I saw that needed to be done, and the isolation allowing me to think about that and only that.
A bit of tidying made my space feel better (less cramped) and a bit of tidying each day reduced the sense of burden compared to seeing the whole place as one big mess. Same for the self-care and other aspects.
Every undone thing is an extra stressor because it's an extra thing that you know needs to be done, but in a depressed state you do not feel able to do or that there is sufficient time to do (it seems overwhelming, even when in reality it's a small chore).
Being somewhat social (even as an introvert), being physically active and getting my sunlight, and maintaining a decently tidy home (I still suck at cleaning the shower often enough, and I never make my bed), have made an immense difference.
There's also the benefit of routine and ritual. That's part of what the showering and shaving did. I'm lying in bed and I haven't shaved yet, I need to shave, let's get up and shave. I have to do this, once it's done it's done and I can move on. Now I'm out of bed and I can maybe do something else or not, but the ritual helped force me out of bed and gave me even the chance to have a healthy day.
> (I still suck at cleaning the shower often enough, and I never make my bed)
I stopped using the top/flat sheet, which means "making the bed" is as simple as fluffing the pillows and shaking your duvet/comforter/quilt out over the bed. The flat sheet is responsible for probably 95% of the effort in making a bed. Coming home to a made bed is nice.
Bonus: when you buy sheets in the future, you can invest the top sheet savings into a comfier bedspread.
I hate making my bed so I can't be happier now :)
He begins by telling me, "If I take this baseball bat, and smash your knee, would you come tell me, or would you go tell a doctor?"
I said, well obviously the doctor. He said "Ok, go and do likewise."
I went to counseling that week, which included temporary relief via SSRI's. I am still coping, but it is _worlds_ better than it was years ago.
Talking to people, especially that have the same philosophies, helps. If you haven't found the right people to talk to, keep looking. They are out there. It took me 4 tries, but glad I did. I live with a spouse that does not understand depression what so ever, so it is an absolute lifeline to be able to talk to an understanding professional.
In other words: less than 25% of them are right. About the same experience here.
My personal gripe: Most psychologists are feminists. If you explain them a problem you have, they’ll percieve it in a gynocentric way. They are in denial that men can be on the receiving end of a problem or injustice, so much that one of them posited to me that male and female suicide rates were the same. Which tells a lot about the state of science on men’s problems.
Many years back, my partner was sexually assaulted, so I attended a few of her counseling sessions with the local Rape Crisis center as a support person. The female counselor commented that I was "very brave" to do that - something I found very odd.
Years later, my partner said that the sessions I didn't attend were little more than "man hating" and "man-blaming" for all of the world's wrongs.
I have also attended counseling, as I've recently started to understand the level of physical and psychological abuse that was inflicted upon me by my mother (and her boyfriend, as well as my stepfather) while I was growing up. My counselor was also female, yet not once did she belittle my suffering as less because of my gender. As I described a few events, I'd even hear her let out a gasp or draw a sharp breath, or a few words of concern.
It seems possible to me that you've come across individuals with their own concerns and agendas that lie outside the requirements of their jobs, but I couldn't write off an entire profession based on that.
Yea I'm in agreement with this. No direct effort to "help" has been useful at all.
You know what would be helpful, is if people actually started being honest about how not together their own lives are. Forget depression, I just want the average person to actively acknowledge and vocalize that they don't have all the answers and haven't figured things out.
One of the biggest sources of anxiety for me is looking around and seeing all the people who "have their shit together" and thinking that I'm the only one over here drowning. Yet when you talk with them one on one, it's pretty clear they don't have any better handle on things than anyone else.
I’m sorry that talk therapy didn’t work for you. It has, however, shown to be effective at disarming suicidal thoughts long enough for other outcomes to seem attainable.
But besides that, what is there to do? Is depression even something that can be helped with?
I've been thinking this topic today. I happened to lose a (young) family member to suicide a couple days ago and, shit, that bothers me immensely.
Every time the subject of suicide comes up the first thing that is said is "call the hotline," however, in the last couple days, I have been questioning if suicide hotlines are evidence based. I have zero idea if the topic even has been studied, or even if it could be studied. I wonder if our resources can and should be better allocated. I wonder if people are calling suicide helplines instead of calling their doctor.
Or even people are saying it just because it makes them feel good. Because preventing suicide is actually hard and telling someone to call a phone number is easy.
I'm just pondering right now, I have no answers.
Personal story: I called a suicide hotline once and it was extremely unhelpful. It was the opposite of helpful, it actually made things worse.
No such luck.
When the media adds the number for Lifeline it’s just lazy and backside covering. Hell, for a long time the media were so badly informed aboutvsuicide they wouldn’t even report on it.
So yeah, suicide hotlines are not only ineffective, they can be positive detrimental to your health.
If you already mid attempt, and yet you are also calling a helpline, in that case there's nearly no reason to complain if the cops come.
Call Centers are not particularly effective. It's also true that there aren't widely available good options.
It's a difficult situation, and the tools to address it are inadequate.
Maybe not a great thing to do on a high-traffic website on the day of a high-profile suicide.
It's the only time people seem willing to discuss suicide. A week from now everyone will have forgotten that suicide is a real epidemic. I'd rather see people discuss real solutions instead be of endlessly repeating the same pointless things.
Has self-directed CBT actually been studied?
As far as I understand most people receiving CBT who have been studied have received it in a professional setting with weekly meetings.
Then yes, there was actually a study of the book Feeling Good (kind of meta), and told to read it with a checkup every 6 weeks just like you guessed it in the quote. There are other CBT books that are smaller and to the point, more tactical approach to learning the methods (I think one is called Learning CBT) of Feeling Good. The second half of Feeling Good goes into drugs, which at the time was written no long term studies had been done or possible. From my personal research, these drugs do not work and cause more damage then good. I have found that through suffering and depression, and then working my way out of it, I believe I am better off then just taking a drug. I feel they are supressing some kind of natural force that is needed to build character, but for some people they are needed as a "backstop" to get out of a hole. On another note, depression has grown several folds since the introduction of antidepressants. I do not even consider that there is actually a thing as a drug that can do what they claim, but that's my personal belief.
Star Trek V!
Sybok: Let us explore it together. Each man hides a secret pain. It must be exposed and reckoned with. It must be dragged from the darkness and forced into the light. Share your pain. Share your pain with me, and gain strength from the sharing.
There's another good quote I've heard: “Be kind, for everyone you meet is fighting a hard battle” (https://en.wikipedia.org/wiki/Ian_Maclaren) I have heard it with " you know nothing about" at the end.
It's like a weird dream. If you have a weird dream, you don't think, "oh I'm weird", you think, "that was a weird dream". It's the same with depressed thoughts: if you see them as "oh that's a depressing thought", rather than, "I'm depressing", then it's easier for those thoughts to go away. (usually when your blood sugar goes up or something like that)
I am not qualified to suggest that meditation is beneficial specifically for depression, but I think there is sufficient evidence to advise the practice in general.
I thought it was pretty hippie-dippy stuff when I started, but I was desperate enough to give it a good honest try, and damned if it didn't help more than talk therapy and everything else.
That IMHO seems to be as much of a taboo as having depression itself for a lot of people... it's hard to convince someone that depression is seriously real, and equally hard to convince people [affected by their loving one's] depression is not like terminal cancer.
It's indeed possible to get near normal, but it's very hard to convey to someone in such pains.
Rationality also goes out of the window when emotion storms strike. Even though I knew that the previous day I was alright, if the next I go down, it's not always enough to help me go through the bad times.
ps: also give pills a chance, they might not work, but it might lessen your load tremendously and avoid further damage.
You don't forget what it's like to start to suffocate in the abyss.
You don't forget what it's like to know that dying is easier than any other option available to you and that it's a blink of an eye away.
It scars you
We equate openly suicidal people to attention seekers because they talk about it without doing it. Facing that disbelief was one of the things that scarred me the most.
The importance of connection and trust, at least from my experience, cannot be stressed enough.
Empirical evidence has indeed proven that there are many cases of depression which are rooted in chemical imbalances or physical abnormalities and can't be cured by shifting one's thinking patterns. But that represents a portion, not a rule or even a majority of cases.
It's frustrating and saddening to try and help someone when they deeply believe that they can't be helped.
I can't figure out how to start loving the person again.
I don't regret it now. I could not and still cannot keep my empathy separate from the suffering of others. The alternative would have been to harden my emotions and become like a rock. My opinion is that depression does transfer and it is contagious. Just as laughter and joy is contagious. I choose my company wisely now and cannot bear to be around negativity anymore, it just catches and makes me numb to everything.
I choose being sad and ecstatic even while they alternate to extreme highs and lows. I refuse to heal anyone anymore.
It is possible to leave in a nice way. My divorce followed telling him "I'm tired of hurting you. I'm tired of being hurt. I think we both really gave it our best. If we could do this dance, we would have figured it out by now. I want a divorce." He breathed a sigh of relief and agreed. We both cooperated in making it amicable and not a disaster for any involved party.
Leaving doesn't have to be a case of abandonment or rejection. It can be a case of gently setting both parties free.
That takes emotional energy and strength. You have to find that somewhere other than out of that relationship.
I highly recommend watching it to better understand the disease.
> In some cases, calling 911 may be the best option.
It seems so tone-deaf. More accurate is:
> In cases where life is at stake, consider calling 911, but if you do, know that police will likely respond first and may not be trained to deal with a mental health crisis. In some cases, people have been brutalized or even killed after seeking help from poorly trained law enforcement.
> But remember that interactions with law enforcement can vary wildly, depending on race and socio-economic background. In cases where you’re concerned that calling police could put a person in danger, try to come up with an alternate plan in advance.
> Rangers act as non-confrontational community mediators, providers of reliable information, facilitators of public safety, and navigators of the edge of chaos.
And/or, train police in these techniques. More empathy and patience, less judgement.
Two and a bit years ago I was having suicidal thoughts. I had an episode and left the house in distress, but eventually arrived back home where my wife comforted me and my suicidal thoughts went away, and yet I was ripped from my bed and taken to hospital where I was thrown into a seclusion room for five and a half hours. There is no clinical documentation, I’m not in the seclusion register, there was no explanation given, I wasn’t assessed until hours later someone turned up, said I was fine and not only did I leave the room - I left the hospital!
The authorities do not care, they leave you powerless, stripped of your dignity and autonomy and in some cases your life can be at risk. The following review was done last year by the NSW Chief Psychiatrist and it is absolutely damning:
I have been trying to get justice and answers for two and a half years. I went to the body who is meant to investigate these matters after the health service denied I was even in seclusion, they did nothing.
The Hospital has now acknowledged I was in seclusion. They have literally just now started to find out about my lack of clinical records it’s, but they don’t think they’ll ever find out who threw me in that room.
I now have severe PTSD, completely distrust the medical profession and will never speak of suicide to any medical professional ever again, and I strongly believe that anyone who does so takes a grave risk of being abused or mistreated by uncaring “professionals” who act more like jailers than carers. Certainly an ED is the very last place you want to go to - they simply do not care about depressed or suicidal people and you will almost certainly be thrown into a psych ward. Your rights will be servely curtailed, your decision making ignored and removed and it can be very hard to get out of such places.
It was really helpful in helping me understand in a way that I hadn't been able to before.
It's unfortunate to see the events bringing it to light, but I'm glad to see the issue receiving greater public attention.
In the US at least, suicides have been and continue to be much more prevalent than homicides.
> But remember that interactions with law enforcement can vary wildly, depending on race and socio-economic background.
I honestly don't have any numbers to backup my feelings, but I know that a lot of people truly fear the police, and possibly for good reasons.
A while ago we had to call the police on a loved one that we were fearing was suicidal. By the end of the whole night the only thing that happened was the loved one was stuck with a rather large hospital bill as they were admitted (then discharged the next day), and they were cited for having the registration of their car be several months past due BY the cops that were sent to their house.
There are also countless stories online of people (often minorities) calling police or having the police called for them, but they end up getting injured or even killed in the process. There are also reports of cops entering the house of someone that was reported as suicidal with their guns drawn...
Not to mention that with drug laws in the US, someone with contraband or illegal drugs in their house or on their person might be risking everything just interacting with police.
I don't really want to get into the debate about how police should act, or a debate about guns or laws or racism or what is warranted or not or drug laws or whatever else right now, but I do want to point out that for some people, the police might be more of a "threat" than help. And even if statistically the police aren't that likely to hurt someone, the frequency that it's happening and the growing resentment on both "sides" can make it so that many people will want to attempt other solutions before involving police.
That's very sad. I feel bad not knowing that's the way things are now.
And I'm kind of upset that your comment is getting downvoted so much, as it's a very valid question.
Growing up I was taught to trust the police, that if something was wrong to go to them and they will help, that they were safe and would protect me. But at this point in my life I'm honestly not sure if I would teach the same to my children. And that thought terrifies me because I honestly can't think of a scenario where these kinds of feelings end well for society in general.
The discussion is largely rooted in anecdata and can be interpreted multiple ways due to the relatively low number of lethal events:
What about the problem of police causing massive medical bills? What about the issue of fearing police involvement because they may charge you with a petty crime that can cause you significant issues? Or the worry that you could be arrested and jailed for having small amounts of marijuana which is legal just a few states over during an interaction with police? What about the worry of putting an office with their gun drawn in front of a suicidal person?
And even if none of that actually happens ever in "real life", the fear of it happening can be just as bad. It causes resentment, it causes kids to grow up fearing the police, it causes police to fear those who hate them, and instinctively act less friendly and helpful to them.
It's a problem that from where I'm standing looks like it can only get worse and worse. The police are no longer thought of as on "your side", and telling people that "statistically they aren't that likely to kill you" isn't going to solve anything.
It's not that way everywhere, but many cops are going to look at the big picture and try to do what's "right" rather than be anal about arresting people for minor transgressions.
Most cops will want to help a suicidal person. The ones who handle it badly make the headlines and the viral internet stories.
The other problem is that "the system" is not really set up to help people who are suicidal to the point that the police are called. They will be sent to the psych ward at the nearest public hospital for evaluation, where they will be seen by overworked staff who know nothing about the person's history. Especially if they have no means to pay, they will be discharged as soon as possible and there will be little followup.
Then you don't know what's true and you should want to find out. Otherwise you risk spreading very harmful anti-intellectual and anti-science misinformation.
> And even if statistically the police aren't that likely to hurt someone, the frequency that it's happening and the growing resentment on both "sides" can make it so that many people will want to attempt other solutions before involving police.
Consider that you might be contributing to this very problem. You're spreading a meme here that you don't even seem to believe is backed by data because of your feelings on the topic. Now multiply this attitude by millions of people and you've got an entirely self-inflicted societal problem.
Humans developed scientific tools precisely to overcome our biases and emotions. Leaving them behind in the name of feelings is the path towards chaos.
You can throw out stats that say it's not likely, but that won't cause me to really worry any less when I need to decide if I call the police on a loved one, or if I call the neighbor.
I honestly wish I didn't bring up the "hurt or killed" aspect of this, as that is always the thing that ends up devolving into internet fights. Worries of ending up with large medical bills from police interaction, or being charged with a small crime and losing your job, friends, house, etc... are much more worrisome in my opinion.
Regardless of how based in reality these feelings are, the police need to handle it. The solution isn't pulling out stats and saying "this isn't really an issue", because it clearly doesn't work.
Health insurance reform is so badly needed in this country, and the police need to work with the communities, they need to build trust, they need to show the community that they aren't dangerous, they need to show that they won't jump at any opportunity to charge someone with a crime.
I fully understand that asking police to go more lenient on arrests and charges when on a wellness call will end up with some possibly very bad people "getting away with it", and that asking police to put their guns down and even possibly disarm themselves in some situations will lead to officers getting injured or killed. But the arms race of everyone distrusting everyone else is going to end up with a much larger amount of harm in the long run.
My ex attempted suicide. I came home from work and found him. I called an ambulance, naturally. The cops came.
While the ambulance was taking him away (to the opposite hospital they said they were going), the cops questioned me. The male was rather nice in mannerisms, but the female...
She told me it was my fault and berated me for my messy house. I was accused of hiding a meth lab (My house was messy, but it wasn't that bad. Seriously). They asked to search the house. I said no. Seriously, at that point I wanted to go to the hospital. I think if I we were a different race, I wouldn't have been able to opt out of the search.
I still hate that female cop.
I hope you and your ex are doing well now.
I'm personally doing well. A good amount of time has passed since then (15-16 years), so lots of positive life changes and healing and stuff.
Not so sure about the ex, in part because I lost contact with him some years ago and in part because his suicide attempt was caused by major mental illness. He was on disability last I knew and I was pretty sure he still suffers. But it also wasn't a situation I could stay in. His mental illness kept me there longer than I might have done otherwise, honestly.
I hope everyone involved in your situtation has fared well.
Somewhere between the 911 Dispatcher and the police that showed up, the only salient points communicated were "black man" and "drugs" and they rolled up on him as if he was a drug dealer. Very easily could have gone another way.
This is one example, but the article has advice from several experienced people. https://theintercept.com/2018/06/05/chelsea-manning-video-tw...
How many people here would have said the same thing a few years ago before the issue became more mainstream?
Interactions depend just as much on the cop(s) in question (and the bad interactions seem to depend more on the cop) as the person but the statement from the article is basically true at face value. It's always been true. That said, NYT wouldn't have said this a few years back because it wasn't a fashionable issue for folks in ivory towers acknowledged (or at least not enough of them for NYT to feel comfortable mentioning it casually) and NYT obviously does not want to rock the boat too hard among that crowd. Now that it is acceptable I can't say I mind seeing it stated so bluntly.
(There are many other, more dangerous places in the world where you shouldn't call cops for things like this, but probably everyone there knows why, so you don't have to caution the statistically unlikely subset not to do this.)
1) I can kill myself, at any time, if I want to. I'm in control and nobody can take that away. Paradoxically, understanding that made me feel better, because if I know I can do it at any time, why do it now? May as well wait a little while.
2) Make a checklist of essential tasks and get into a habit of doing those things no matter what. Some examples: shower, brush teeth, floss, use mouthwash, clip nails, walk 10k steps, do dishes, make bed etc. Check them off. It doesn't matter what's on the list, but it is important to check off 100% of the items each day. Put every small task you can think of on this list and you'll feel good when you check each of them off.
3) Take a good multivitamin + vitamin D
4) Eat healthier. Fresh steamed spinach and wild salmon always made me feel a little better for whatever reason.
5) Get out of the house! Walk! This is really important.
6) Go to the gym. Aim for at least a couple minutes of sprints per day (I like the rowing machine for this). Sprints are holy time in that suicidal thoughts will completely disappear, if only for those few minutes.
7) Walk through a dangerous part of town. Nothing gets rid of depressive thoughts faster than rising blood pressure and a fast heartbeat.
8) Get rid of as much decision-making as possible in your life. Turn decisions into mechanical rules. e.g. don't think "do i want to brush my teeth today?" You need to brush your teeth in order to cross it off your list.
9) Sleep will naturally improve on its own, over time, if you exercise, move around, and eat healthier, so don't worry if you currently have trouble sleeping.
10) This book is pretty good, but only read after you've eaten healthy, gone outside, and exercised: https://www.amazon.com/Guide-Good-Life-Ancient-Stoic/dp/0195...
What didn't work for me was: thinking about all the people i'd hurt, calling a hotline, any decision-making that wasn't mechanical and required reasoning, insight, or motivation.
If you're suicidal right now, start by putting some shoes on, going outside, and sprinting until you can't breathe anymore. Do this 3 times.
I can't believe I actually paid money to see her.
And research has found that anxiety and depression are tightly linked.
It's also important to rule out any life stressors that could be causing the depression, such as an unrewarding/stressful job, or living somewhere that you don't want to be.
I teared up because it is so true.
Give it a try if someone you love has depression.
This is an example of a troubling pattern often seen when talking about "depression". Depressed mood can be a symptom of numerous medical conditions. That means you need to write down all observed symptoms and see a doctor to diagnose or rule out those conditions. It's a bad idea to jump straight to psychology or psychiatry just because your most distressing symptoms are psychological. It's an especially bad idea to get committed to a psychiatric hospital with an undiagnosed chronic condition that psychiatrists don't specialize in treating.
The agony is temporary. The not being alive is permanent. It's an irrational suboptimal decision that they would regret 2 years later. It makes sense to help them.
It's like helping your friend quit smoking. They will be agonized for a few months, but eventually will get out of the addiction and be thankful.
However, some people suffer with chronic depression for their entire lives. What makes me uncomfortable is that no exceptions are ever allowed. Every sufferer must continue to stay alive indefinitely no matter how much pain they are in.
I understand why this idea will forever be taboo, but it still bothers me.
But there is a third option and that is you work on finding ways to improve quality of life. That's what I do for myself.
I suspect a lot of depression is biologically based and it should be treated first as a medical condition, not a mental health issue. A very large portion of my mental health stuff is a side effect of medical stuff.
I don't know how to popularize that approach.
It needs at least an adjective in front of "agony". I don't expect you're suggesting euthanizing someone with acute appendicitis or a severe cluster headache.
ETA: At the same time, it's important to recognize that suicides inflict dramatically more pain on those left behind than other causes of death.
If it's close to or actually zero, then maybe it's a strawman.
Treatment-resistance is relatively common in cases of Major Depressive Disorder. Rates of total remission following antidepressant treatment are only 50.4%. In cases of depression treated by a primary-care physician, 32% of patients partially responded to treatment and 45% did not respond at all.
I'm not advocating withholding help from any of them. It's more of a philosophical quandary.
If you believe (as I do) that the universe is indifferent to human suffering, that life has no greater purpose beyond this one life, and that minimizing human suffering is worthwhile; then the idea of forcing someone to live a life of pain bothers me. And at the same time, the idea of a suicide increasing the suffering of those left behind also bothers me.
It's probably impossible to avoid this degenerating into a religious debate, but those are my thoughts.
Woah.. treatment resistance is nowhere near the same as being untreatable. It's an alarmingly huge leap to make, especially since the definition kicks in after only two anti-depressants have failed.
> minimizing human suffering is worthwhile;
> then the idea of forcing someone to live a life of pain bothers me
But I still take issue with the seeming over-simplicity of this statement, as well as your original comment, because it (dangerously, in my opinion) brings the notion of euthanasia/suicide  into the dicussion merely because of some pain.
If someone's life is going to be, essentially, nothing but pain, then, OK, I agree it's inhumane to force that someone to live, but that just hasn't been established.
Meanwhile, philisophically, I'm uncomfortable with not pursuing all the other avenues of pain relief before resorting to death.
 Assisted, unassisted, whatever.. I'm not categorically opposed, by any means.
However, to clarify, the threshold I was suggesting was of severe, unrelenting pain, as I alluded to in my previous comment. That's hardly impossible.
> like the abortion debate
This reference unnecessarily draw contentiousness into the discussion, contrary to the guidelines.
> no common ground
Demonstrably not the case, since I agree with rectang regarding suffering in general, and, I believe, regarding the right to die with dignity in the face of unavoidable suffering. I merely disagree with the nuance (or lack thereof) as applied to the situation of depression.
Also, characterizing a country that doesn't support physician-assisted suicide as one which forces people to live strikes me as a non-sequitur. Merely decriminalizing suicide is enough to remove any "force".
This is why I, again, object to your glossing over the details when speaking on this issue. The details matter, especially if you're not just trying to gratuitously stir up emotion or controversy.
What helps (I would think) with depression would be things like "fitting in", "feeling valid", "feeling purpose", "not feeling shame", ""not having social anxiety", "sleeping well", "being fit", "having a healthy community", "having fulfilling hobbies", "having a healthy friend group", "having healthy family relationships".
not "knowing more about how depression works".
I also don't believe that doctors really talk what the 'various causes are'.
I've been depressed, very much so, and I've read books that summarize scientific reading about depression like The Upward Spiral, and I feel like they miss the point, somehow. Like: we're great at finding treatments and things that work for individual people, but I sort-of think that the problem with depression is fundamentally everyone else, ie, 'society is sick', and we treat it as a personal problem because well of course doctors can't prescribe fixes to society, but they can for a person, so it's all stopgaps that don't address the "real problem".
I think that often depressed people have an idea of this -- that it is the existence around them that is sick, somehow -- and so no amount of suggestions (which indeed might actually help) quite gets to the bottom of that because it is the world that is fundamentally wrong. (Or specifically it is the nature of how they currently fit into the world.) From a treatment standpoint yes of course they should do the things that will probably help them, and people around them should be empowered to get them to do the things that will help them. But for the person that is struggling that really doesn't feel like the answer, and I think that they're not wrong.
(By 'society is sick' I mean that the person does not, for whatever reason, exist in the mentally healthy setting that their brain was 'designed' to exist in -- a healthy community, the right kinds of relationships, the emotional mentors and sources of wisdom that provide the right kinds of useful guidance, a body that works the way that it's supposed to, physically and mentally, etc; and a world around them that makes sense, that they can feasibly cope with, which is exactly the opposite of the nihilism induced by news of politics and global tragedies.)
"Don’t try to cheer him up or offer advice
... it could backfire by reinforcing his sense that you just don’t get it, said Megan Devine, a psychotherapist and the author of “It’s O.K. That You’re Not O.K.”
“Your job as a support person is not to cheer people up. It’s to acknowledge that it sucks right now, and their pain exists,” she said."
My parents also read a bunch of books on depression and tried to teach me about it to help me.
It was the last thing I wanted to do. I didn't have any energy to learn anything, I was having enough trouble trying to hold myself together as much as possible every day. Whenever someone tries to help someone who's depressed, I guess they don't get it because most of the time, the depressed person is probably barely keeping it together, and asking them for anything more is not going to work.
"Folate deficiencies may lead to an increased risk of depression and poorer antidepressant treatment outcomes..."
"...deficiencies may be caused by improper absorption and utilization, often due to genetic polymorphisms."
"Supplementation with the active form of folate, (methylfolate), which is more readily absorbed, may be effective in the prevention and treatment of both depression and dementia."
"...(methylfolate) indicated efficacy as adjunctive therapy or monotherapy in reducing depressive symptoms in patients with normal and low folate levels..."
Supplementing diet with a modified form of folate appears to diminish depression in patients with these particular polymorphisms.
My understanding is that this is still a matter of controversy.
1) Prevalence of MTHFR gene variants you refer to is very high, e.g. 10%/50% for homo/heterozygous C677T SNP  (with frequencies varying substantially between ethnic groups).
2) Effects tend to be stronger with two copies of a variant (homozygous), but a single copy (heterozygous) may still be a concern, e.g. for C677T: "Individuals with the 677TT genotype, have approximately 30% the MTHFR enzyme activity of those with the 677CC genotype, whereas heterozygotes 677CT have around 65% of enzymatic activity" 
3) It seems odd to me that pharmacological dosages of folate are getting prescribed (I mean, it's a nutrient so why take it in doses that exceed the nutritional range?):
"The most active form of folate has recently been approved in the United States as a prescription medical food for depressed patients with folate deficiency. Doses are usually 7.5 to 15 mg/d". 
"Another concern is that folate doses > 800 μg/d can result in high levels of unmetabolized serum folic acid, reducing
the amount of brain l-methylfolate and leading to decreased monoamines, an outcome that potentially increases the risk
of or exacerbates depression." 
Folate RDA is 400-800 μg/d depending on pregnancy status 
In fact, if you need one, if you are severely depressed or hallucinating, a hospital is exactly the place for you. You will most likely love it there. They can help. They can really help. Everyone gets better in the hospital. Everyone. Not "1/3 get better, 1/3 stay the same, 1/3 get worse." Everyone in that sheltered environment rapidly improves. It is a vacation for the mind.
The question then becomes staying out of the hospital. Many people come back every few years, get to know the staff quite well, etc. Others develop a plan to address mounting depression early through ongoing treatment, partial hospitalization, etc.
I think it's important to be clear that there are interventions that work that precede crisis hospitalizations, and that even if hospitalization is the right call, you can improve the experience by getting people connected with a good doctor first. The belief --- not irrational --- that there's no available intervention other than psychiatric lock up is a part of the problem for some people.
Even if you're forced to go a mental facility by family/friends/other, it must be legally addressed within 72 hours, and a physician must see you within 48.
Without getting too far into anecdotes, I’ve personally seen multiple people reach out to hospitals for help, and all of them were in a worse condition for it - Both by their own account of the events, and from my outside perspective.
While you might be right in an ideal world, real experiences don’t live up to that standard.
> If you have admitted yourself into a psychiatric hospital, you can not simply sign yourself out and leave when you decide to do so. There is a process which must be followed in order to leave.
So I check myself out. Great, they petition me. Now I spend the next Monday locked in the same holding cells they put the accused in before they appear before the court.
The hearing itself seemed like a total formality. Doped up on medications, without internet or phone to contact people, no 'real' legal representation, it was basically all for show. They did my case and five others in less than 5 minutes total.
The end result? A possible court order giving them permission to keep you locked up longer than was legally able beforehand.
It's not even worth attempting. You end up with less rights than you started with.
I've also never seen it go all the way to court; rather, there's a statutory period of time after a voluntary admission where you have to either be released or taken to court, and that period is something on the order of an entire business week.
The pattern I've seen is (even at the nicer facilities) one of facilities staffed by nurses and counselors but with very overbooked psychiatrists, and all decisions about care are ultimately delegated to those psychiatrists. It can take days to make a decision happen just because of round-trip and scheduling delays.
The (call it) 5-day clock only starts ticking when you're formally acknowledged to have made a request to leave, too, so those same round-trip delays can keep you confined for longer than the statutory window.
When things go wrong, it's a frightening experience. Psychiatric hospitals carefully control your access to the outside world. Visitors are allowed only during limited visiting hours. Phone calls are allowed only during specific phone hours. You reside in a room with one or more strangers also suffering from psychiatric conditions, often significantly worse than your own. You're required to take medication, and the medications issued are rarely the same as a careful psychiatrist you had a preexisting relationship would issue. There's not just a loss of personal freedom but also of body integrity.
Like I said: however suboptimal it is, this can all be for the greater good, if a crisis situation has spun out of control and what's really needed is some kind of circuit breaker to arrest the crisis and ensure that someone ends up with access to professional psychiatric care. I'm not saying people shouldn't go to the hospital! I'm saying that people encouraging others to go to the hospital should be aware of what they're saying.
I also think you could stand to be a little bit less strident and a little more specific. I think it's likely that you have a set of experiences with acute psych care that differ from other people in this community. I've seen good acute psych care too --- in a university system --- but it was acute outpatient, not inpatient.
To me, having control over when I leave is being able to walk out of the building at any time. Full autonomy. Having to petition some entity is the antithesis of control from my point of view.
Of the 35,000 or more suicides per year in the United States, about 1800 (6%) are inpatient suicides.
It is estimated that a psychiatric nurse will experience a completed suicide every 2½ years on average."
source: Personal experience helping member of wife's family who was hospitalized for disabling chronic refractory depression and intense suicidal ideation. This was about two years ago.
One institution (in San Mateo County) was great, the other (in Santa Clara County) was awful. She was very lucky in being transferred to the better facility after two days in the awful one.
It's not clear she'd have survived a more extended stay at the first. Slightly over a week in the second helped her enough to go back home and live safely.
In Australia, what it means is that you are involuntarily held in a psych ward, you have no right to leave and you don’t get a say in your own treatment. That includes no choice in your medication.
If you have never been in a psych ward and never met crazy people, you will now be surrounded by crazy people and you will also be considered a crazy person.
While crazy might be offensive, the people in these wards need serious help and most of them are people you do not want to be around. And you definitely do not want to be locked for days with them either. If you have never experienced this, it will be traumatizing especially if you come from a sheltered environment. If you're suicidal, you were a threat only to yourself. Some of these people in the ward are there because they can be threats to others. That means you will probably see someone be knocked down by nurses and tranquilized. You will hear people yelling, singing, talking to themselves, doing destabilizing things. You will literally be in a horror movie.
You will lose most of your clothes and your belongings. Your first day you will probably be in a hospital gown. You won't be allowed to have shoelaces or even pens or pencils until they determine you're not a risk.
You have to listen to everything an authority tells you to do and comply. You need to eat even if the food is bad when it's meal time. You need to make sure you do everything right so you can leave as soon as possible. Don't want to do some bullshit music, meditation, or arts therapy? Not cooperating. Not socializing. Negative marks. You need to take the medication they give you, even if you don't want to.
If you had the great misfortune to be admitted to the hospital on a weekend, you might be screwed until business hours so they can get the medical records they need or when the regular doctors are back.
Want to make a phone call or use the computer? Last one I was at you were limited to less than 15 minutes, there were only 2 phones, and they were always being used.
Can't sleep at night because you're sharing a room with someone else or just anxiety ridden because you're in an uncomfortable psych ward? Negative marks or ask the nurse for benadryl.
I was grateful to be in a safe place and get the help I needed but every psych ward I've been to has not been a pleasant place because I was stuck there for almost a week without much freedom surrounded by crazy people. That's why most people never ever want to go back to a psych ward even if they're suicidal. It can be that bad.
I knew how to follow the rules and get out as fast as possible but some people don't or can't. They're not good at following the rules. Some of the people I met in these wards had been there for 2 weeks, 4, or even longer. It was really sad and even more depressing. Children whose families abandoned them. Adults who didn't have anywhere to go.
All from arts/creative fields (Avicii, Kate Spade, Bourdain, Robin Williams, Heath Ledger, I'm sure there are more). Is there any scientific research that has explored the possibility that the wiring in the brain that makes people creative has a propensity for depression?
Of course the sample size is small and could be selection bias, but would like to hear from people who are knowledgeable on the topic.
Covering suicides in general were somewhat taboo unless they involved someone noteworthy:
It could be true that "the wiring in the brain that makes people creative" increases the risk of depression while also being true that there are other things that increase it too.
Your comment also implies that whatever that wiring is, doctors don't have it, and I don't know if that is an assumption we should make.
Suicide is common. There are lots of doctors. Some doctors die by suicide.
> The frequency of suicide in different occupational groups was examined, and rates of suicide were calculated by sex and age group for these categories. Persons working in the farming, fishing, and forestry group had the highest rate of suicide overall (84.5 per 100,000 population) and among males (90.5); the highest rates of suicide among females occurred among those working in protective service occupations (14.1). Overall, the lowest rate of suicide (7.5) was found in the education, training, and library occupational group.
One book on the subject is, Touched with Fire: Manic-Depressive Illness and the Artistic Temperament.
I have suicidal thoughts regularly, but I am not going to act on them. From most objective standards, my life is generally good. I've never had problems getting dates - at least once I got the courage to try, though long term relationships are hard. I have a job I like and find fulfilling. I'm well on my way to having "fuck you money". Still depressed.
Since childhood (25+ years) I've been taking antidepressants. Have changed them a few times, though not for many years. They allow me to be mostly functional most of the time. Switching now might put me in a hole I can't get myself out of.
Talk therapy has never really helped me. I don't really have any hope left of ever not being depressed. I've thought about trying psychedelics or ketimine therapy, but can't really find the motivation to do anything.