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What I have learned from my suicidal patients (theguardian.com)
125 points by firstbase 21 days ago | hide | past | web | favorite | 175 comments

> 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.

> 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).

Oof, I didn't have quite as hard of a time as you, but that description resonates a lot. My experience(s) with depression have taught me to never make empty promises to people — it is cruel to present psychiatry or therapy as One Weird Trick™ that'll definitely solve your problems, as opposed to an option worth trying. In reality it's a crapshoot and you might luck out, but you also might not.

> taught me to never make empty promises to people

Yes, I suspect this is probably a key trigger for suicidal people. You get a well meaning parent/sibling/relative that quickly gets in over their head trying to deal with a seriously depressed/mentally ill person and often they resort to this.

A useful public service message would connect people in this position to contact mental health support services themselves to better understand how to help the individual they care about.

In a better world we have services available for both the mentally ill, and for the people (spouse, parent, etc) that are supporting them.

You guys are touching on something that's been grinding my gears for years: the large number of people who parrot vacuous feel-goodies from pop-psych purveyors like Wayne Dyer and Zig Ziglar as though they're user manuals to fix lives.

The only thing that helped me with decades of depression was real hope. And even then it took years of having hope with lots of support from family (generic support in life, I kept my depression a secret) before I finally beat depression.

I've been free of suicidal thoughts for about 6 or 7 years now.

I don't think there is a short cut.

Keep working at it. Look for reasons to keep fighting and you will find them eventually. If you look for reasons to be depressed and give up you will find them too.

Stick with it even if you don't feel better. What other choice do you have? It's a sucky reality while you are in it. But one thing that helped me was to focus on other people. Especially when I felt my worst. It gave me just the tinniest amount of reason to keep going. And sometimes that is all you are going to get.

I am really sorry you are stuck here. There are a lot of people who understand how truly awful it can be.

I just put an email address in my about. I don't check it often. But feel free to email me if you just want to vent.

Amen RobertRoberts. I'm with you I'm also available if someone needs to vent: www.thisismystoryjesusismysong.com

What do you mean by 'real hope'? Just curious.

I hesitate to give a specific answer here, because I think many people will find different things are "hope" for them. And if I give what I found it will come off as unhelpful.

When I was young I nearly succeeding is ending my life (early teens) and at that moment I knew I didn't truly want to die, but I so desperately needed the pain to end. So going down wasn't an answer, I had to keep going up no matter what and I tried to find any reason I could to keep going. This didn't stop my attempts, but it slowed them down some, and so I floated in a destructive despair for years while I tried to figure things out.

I have seen other people turn things around for themselves and it really turned out to be that everyone that did was looking for something important. And I don't mean figuratively here, they actually took real action, real effort to find something, anything, any reason to keep going.

And that is why I know this is so hard, because when you are in the deep end of despair, the last thing you have motivation for is to put effort into something that will make you feel better in a few years, or even tomorrow. But it's the only way out that I found.

Eventually I found a number of reasons that I really needed to stay alive. None of them on their own were enough, but I found that all of them together were enough on some days to get me out of bed or to put the knife down. That's not much motivation or hope, but it was a start. And I kept adding a little bit at a time. I reminded myself constantly, especially at my worst, that it's better to pull a splinter out than leave it in. I will feel better if I trust what I have already proven is true, even if I don't feel it right now. Especially if I don't feel it...

So, what is real hope? Something you know is true, even if you don't feel like believing it's true. There are people that would be better off for you being alive than dead. That is a grain of sand of hope for others that gives you something back. It's a start.

I made rules for myself, things I could say to myself, some multiple times a day. These things are all true, and I've proved them to myself time and time again, and I use them to overcome despair and overwhelming emotions that will wreck my day. Here's a few.

-Everything is ok right now. I am fine.

I say this when I feel like everything is going to fall apart today. But right now, in this moment, then next 30 seconds or whatever, it's ok and this is true every time I say it. I have a house, food, I have a wife and kids, I have work. Right now, in this moment everything is ok. It can get me out of the worst moments.

-I can do this one thing. (I don't have to face everything right now)

This is how I get myself out of bed and into the shower every day. (I say, "I can take a shower, I can handle this one thing") Even though I am no longer suicidal (a life altering thing) I still deal with massive waves of emotions that I must battle, but I win every battle one at a time. I remind myself that I like sitting under the warm shower and I will enjoy it when I am done. And I know it's better that my kids see a functional adult, and my co-workers don't have a smelly bum next to them. All of this are tiny things to look forward to in the future that help me do something right now.

-Don't make things worse.

I say this to convince myself not to make a destructive decision, because it will make tomorrow harder for me. Something as simple as drinking too much, or staying up too late with entertainment, anything that will make tomorrow harder is just going to allow despair to creep back in.

-I don't get to have this.

There are some things (as I have gotten older) I realize I just don't get to have, and I need to be ok with this. And often times that means, I don't get to feel happy right now. I can feel happy later. This helps me make better long term decisions.

-It's worth doing this.

I remind myself that every time I have done the right thing it has paid off. I know I will feel better at the end of the day if I get work done instead of collapsing into bed. Even if I feel horrible all day, I will be better off and grateful for making the decision later.

-I am scared of this so I have to do it.

Most of what stopped me from doing things that helped me vs things that hurt me was I was scared to do them. But the few times I was in a corner and had to do something scary, I was grateful I had made it through afterwards. So now if I can do something scary without my back in a corner, then I know I will be better off later. (something that can be scary is just talking to my wife about something personal, it doesn't have to be a big thing to be scary) I don't use this rule to make foolish decisions, I logically know I shouldn't do "everything" that I am scared of...

-There are people that need me today.

I have found that the most important element to turning things around was to do _more_ in my life not less. Less is staying in bed all day because I just can't move. And this has been a lot of days for me. I figured this was better than offing myself, and that is true. And when I put myself in a position where people needed, something that is really hard to do, it gave me motivation to keep going. It's frequently scary and unpleasant, but I have proved it works at helping me stay alive.

-I did poorly and things didn't go well. I am sorry and I will try and do better.

I found that if I openly acknowledge my failures to myself, that I can face them better. And if I admit them openly to others, I always (so far) have gotten support and understanding. This has been a life line when I have fallen apart and I simply couldn't do what I should have done. I say sorry to people and tell them what I will do to fix what I messed up. This is humbling but helps with my other rule "don't make things worse".

-Get something done, anything.

I found that if I can get myself to do _anything_ at all done, it will make nearly impossible tasks look a little more possible. This applies to work but also with my relationships. There are things I really want to turn around with my marriage, but right now I just can't. But I have made progress in the past, and I know that if I can get one thing better, it will be better for both of us. Success of any kind seems to be a lubricant for more success, and getting started is so hard and painful that sometimes all I can do is just one tiny, tiny thing. And I have to remember that that is really valuable, and that I should do it.

I imagine other people will make their own rules and find things in their life worth living for. You just can't give up and you have to actively look for something good.

This got really long, but maybe there is something here that will help someone else. Sorry if this didn't answer your question well.

This is such a good comment and really answered it better than I expected. Sorry it took me so long to respond. Hopefully this comment helped others also.

I appreciate your comment.

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.

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.

Sure I understand that. I hope you do find something that works. Depression is the world's oldest con and it's not fun to suffer. I've found my CPAP helps too. I also have to eat well and balanced as well as not drink too much. The latter was a big thing for me.. drinking made me feel better in the moment and reduced my anxiety considerably in that moment but the next day and the day after would be awful. It took a long time for me to piece together that my lack of sleep, the relatively consistent hangover and the lack of eating properly really had a major impact on my mental mood. I just kind of though this was how it was and nothing could fix it. But the CPAP and the Feeling Good podcast as well as some medication have really helped. Now I just have to get to the exercise part that everyone keeps talking about...

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

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.

Another vote for Burns. I think he’s way ahead the rest of the field. He’s kind of like the old extreme programming methodology: lots of automatic testing, consistent use of best practices, short iterations, and pragmatically focused. I took me a while to get into his podcast but it’s helped me a ton. Having listened to nearly every episode now I get it. He’s usually too nice to say it but he also gets to why most therapies (and therapists) fail. Knowing this especially helped me.

> especially the book Feeling Good by David Burns.

This book changed my life for the better, as well as The Depression Cure by Stephen Ilardi. Both of them combined got me out of a deep multi-yearlong depression and allowed me to get married, get a better job, be more productive, more active and much much happier.

I still have relapses every 6 months or so but I go back to the books and re-read my margin notes and highlights and it always helps.

I didn't know Dr. Burns had a clinic in mountain view. Interesting!

> 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).


When highly suicidal last year my reasoning was that I'd tried so many therapies (medication, talking, multiple practitioners) without success that I cannot be fixed and it's time to leave.

The typical suicide response ("call a crisis line" or "talk to your GP") is reasonable, but many suicidal people are far beyond that. For them the community sends around the Police to lock you up in a ward (ie "you're now scheduled") and many of those people - myself included - find it the most horrific experience of their law-abiding lifetime and understandably double down on getting away before they're unconscionably locked up again.

In a nutshell the mental health system often destroys the last hope someone had by imposing punitive sanctions with minimal insight or empathy. Have a read of a random selection of non-custodial suicide case studies at http://www.coroners.justice.nsw.gov.au/Pages/findings.aspx and judge for yourself.

The real issue here is how to better supervise the delivery of psychology and psychiatry programs so ineffective solutions for a specific person are gracefully transitioned into something else before all hope is lost. A severely depressed person isn't well-equipped to assess treatment and practitioners are too incentivized (or perhaps imprudent) to self-regulate their ineffectiveness.

That is very insightful thanks for sharing this.

This has been my experience as well.

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.

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.

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).

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

You might be interested in learning a bit about Wittgenstein. Here is a conversation between a Wittgenstein-denying scientist, and a psychiatrist: https://www.nature.com/articles/351010d0.pdf?platform=hootsu....

Just because some people choose to live in their own reality in their mind and reject objective reality outside their mind has no bearing on whether an objective reality exists. What a sad age of fallacies and confusion we live in where people even deny that they exist!

The psychiatrist opens the scientist up to the idea that the schizophrenic person, in his psychosis, may have insight into certain ideas which sane people do not, which nevertheless still may apply to them.

And a random dice roll (or tarot card reading) may sometimes correctly guess the number I’m thinking of. Doesn’t mean it’s generally useful.

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".

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.

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

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

This is so incredibly confused. You live in reality. You exist. The things you can observe exist observably. People who choose to believe such existential nonsense remind me of the xkcd with the super soaker.

Maybe you should increase your scope beyond xkcd.

What kind of broken logic can conclude that this is the extent of my “scope” from what I said? An easier conclusion to arrive at is that I figure it’s one of the few memes we probably have in common, and chose it because memes are an excellent source of connotations.

You're right to an extent. I absolutely believe in the utility of humour and satire as ways of illustrating certain ideas and forcing people to think. People on HN especially are much too prudish. These forms can be a lot more effective than a long piece of text.

What I mean, though, is that there's only so much information that a piece of humour or a comic strip can convey.

Also, you have to consider the crowd that xkcd caters to, and the crowd that typical American geek humour such as Big Bang Theory caters to in general.

Existentialism/Nihilism are common themes in geek humour, but negatively: these ideas are quick to be dismissed as edge-lording, and as 8-chan-incelling.

Geek culture and morality relies wholly on the self-supporting idea of science as the one and only source of truth. The geek's first reaction will of course be to dismiss any claim to the contrary, in humour and otherwise.

Have a look into Nietzsche's master-slave morality distinction, and how Christianity falls into it: https://en.wikipedia.org/wiki/Master%E2%80%93slave_morality. This page is a very short read.

Jesus rose from the dead, that's a lot more reason to believe what he said than in Nietzsche's powerless words.

I think I'm going to turn the other cheek on this discussion.

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).

> 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.

I've seen that quote floating around and never much liked it. For those afflicted with long-term treatment resistant depression, it's more like "a guaranteed solution to a permanent problem".

I've always disliked it too. It seems very presumptuous. The people repeating it typically don't know what the person in question is dealing with.

actually that statement is itself rather presumptuous. How would you know that those of us who repeat it don't know? I can state with authority that may of us do.

It's a truism in life that most people offering simplistic advice don't have long and deep personal experience of the malady they're advising on. None of us can guess about your experience personally, but that's the broad trend across large groups.

A lot of anti-suicide advice can seem like a sick joke, little more than empty virtue signaling. Want to really help? Offer a friendly ear and a sense that you really care about the person in question, and stand behind that over a period of time.

Being depressed is generally not a temporary problem. Many of us have suffered it for decades. It may wax and wane, but it's often not something that just goes away. In my opinion, it's something that many of us simply have to learn to live with, as with so many other chronic diseases.

> How would you know that those of us who repeat it don't know?

Because everybody is different and even if you have been through it yourself, your experience may be nothing like someone else's, and just because it was true for you, doesn't mean it is true for them. Yes, some people get past it, either on their own, with therapy or with medication. Some people are just numbed by it, other people learn to cope even if it never actually gets better. Other people still struggle every day. You cannot know what is going on in someone else's head or the struggles they face.

Its true that many people get better, certainly with treatment, but a large number of people do not (someone else here said that treatment does not work for approx. 1/3 of people).

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.

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...

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.

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


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.

"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?

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.

I wouldn't dismiss a meta-analysis out of hand, but at the same time...isn't there a strong pressure to publish an effect above placebo? They rated 73% of the studies as having a moderate risk of bias, and certainty of the evidence ranged from moderate to very low.

I don't think that the real cure for depression can be bought or sold.

Bruce Alexander is talking about addiction here, but I think everything he is describing absolutely applies for depression: https://www.youtube.com/watch?v=7axaXQmdBVQ

I loathe this term. It’s like they’re shifting the blame for ineffective treatments onto the depression. If the treatments don’t work, the problem is with the treatments. Come up with something else!

> I do think it's useful for treatment-resistant patients to shift their focus away from recovery and towards symptomatic management

Would be nice but it seems risky for a patient to suggest that to the clinician; depending on the exact symptomatic management being sought and the competence of the clinician (who are not, unfortunately, exempt from Sturgeon's Law), it might get the patient falsely labeled as "drug seeking". That would be problematic, to say the least.

I suspect the amount of non-responsive patients is greatly downplayed by most therapists. Obviously they have a strong incentive to do so. From SSC:

> I work in a clinic with about ten therapists. Some are better than others, but all of them are competent. I send my patients to them. In a few hundred patients I’ve worked with, zero have had the sudden, extraordinary, long-lasting change that the therapy books promise. Many have benefited a little. A few would say that, over the course of years, their lives have been turned around. But sudden complete transformations? Not that much.

> When I try all the exciting new therapies on them, they just sort of nod, say that this sounds like an interesting perspective, and then go off and keep having symptoms. It’s very rude!


He goes on to talk about how CBT success rates have been falling, seemingly due to the wearing away of its novelty-induced placebo. As a chronic depressive, my "temporary" 20-year-old problem (if you had cancer for 20 years, would you like people to call it "temporary"?), this is the most relatable and reasonable article I've ever read on the subject.

It's so hard to find the other side of the argument for therapy, I appreciate your links!

The advertising for CBT as an entry point for therapy is over valued. Therapy should really advertise more effectively as a social role rather than going deep into the task oriented stuff.

Is this data talking about a "cure" where people no longer would be labeled as having depression at all, or are we talking about clinically significant improvements/better than placebo results?

the studies (which admittedly are short-term) reflect remission - i.e., resolution of symptoms. This is a critical point: the goal is resolution of symptoms, not partial improvement.

The closest thing to a cure (for some people) can be cognitive-behavioral therapy, or long-term antidepressant treatment when indicated.

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.

> 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.

There's actually a term for this, SLS: https://en.wikipedia.org/wiki/Shit_Life_Syndrome

Apparently it was coined as a "ha ha, only serious" joke but came into more general usage in the UK: https://authenticmedicine.com/did-i-discover-the-concept-of-...

Fate is a real thing and so I can see how SLS started as a joke. I didn't know of the term SLS (thanks for sharing).

Fate is not a “real” thing. What are you talking about exactly when you say fate?

Fate is a "real" thing. Predestination is another word for it. Everything is cause & effect and you cannot change the path you're on.

"Fate" might be a real thing. But while a bunch of white rich guys are complaining about fate in the US, millions of Africans and Latinos are living happily without 1/100 of their affluence.

I think this is a uniquely western / American dilemma. I recently had an older relative decide to not proceed with treatment for stage four pancreatic cancer and my family’s response was almost of shame and aghast.

It’s still odd to me that my parents were almost offended when I signed forms that indicates I did not want to be on life support if I’m brain dead or forcibly resuscitated if I arrived at a hospital “dead”.

As someone who continues to fight depression, I don’t understand why others feel their opninions should have weight when it comes to someone else’s decision to live or not continue to live.

I assume correlation with religious ideology. The everyone must live & appreciate the unique gift given to them belief. Never considering the persons wanting to end their life don't consider life a gift but the opposite. Also fear of death is another factor in the equation. In any case I think there will be a change in 60 years.

And some people pass through terrible phases just to find happiness and fulfillment later. If we had the "right" to give up in bad times, a lot more people would kill themselves before they discovered that there is different ways to be happy. And btw, if you are deadset on killing yourself, you can choose end your life, as you don't care about anything anymore. To ask it to be legally and assisted is just more weakness.

I see you don't have TRD then.

Euthanasia is a distinctly separate topic to suicide (in my mind), but since you brought it up, here is a magnificent oration by Andrew Denton on the topic:


It's 50 minutes, and I haven't seen all of it, but it's sad and moving and somehow perfectly combines humanity and logic.

(Edited to specify my own bias)

How is suicide not an attempt at self inflicted euthanasia? I'll watch your video (thanks).

> How is suicide not an attempt at self inflicted euthanasia?

There's a specific separation in my mind of the definition of the two, whether that's reflected in the dictionary or not.

The video is fairly specifically about end-of-life kind of suffering, which is along the lines of my definition of euthanasia (rightly or wrongly). Re-reading my comment, and your questioning of it, I do present it more "black and white" than it actually is.

So as soon as we develope the ability to keep people on perpetual life support, any right to euthanasia would go out the window?

I think only in rare cases should be assistance by dying. In most cases either you can recover or you can commit suicide alone instead.

What do you think should be done if a person fails to commit suicide alone but left a note requesting a mercy death if somehow were to survive with extreme brain damage.

The only people that fail at suicide are those that didn’t truly want to die.

There are people experiencing locked in syndrome from failed suicide methods that worked for others. Maybe your comment is meant to be sarcastic.

As someone who has survived 5 or so serious attempts, I can say that it's not actually that easy unless you're a masochist, and that this comment thread strikes me as quite ignorant.

Some people have all that yet have suicidal tendencies I believe. It should be normal to try to fix those bugs.

I see that rhetoric get thrown around once in awhile and I wonder if people that use it in fact work in the healthcare field. Sure, we get anomalies in life but it doesn't make sense to oppose someone of their wish to die because of it.

I am a patient

It's not straight forward. Someone has to be involved in the process of validating that decision and then we get these kind of clowns - https://www.telegraph.co.uk/news/health/news/4215059/Dignita...

You're referencing allegations that haven't been proven.

My point is someone else has to validate the decision.

And when you allow it sooner or later you will hear "Epstein/Khashoggi/that Uygur/this narco cop" were troubled souls and we were just helping them.

I think it should get to self validation.

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.

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

Stands true if you count euthanasia as threatment

>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

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?

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.

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

Sorry, but you don't get it. Not all of us enjoy life that much. If I'm not getting what I want out of life, who are you to say that I have to stick around? It's perfectly reasonable to want to kill yourself given certain circumstances that are darker than I care to elaborate on right now, and you have no business saying otherwise. It should be up to the one suffering to decide when they've had enough. If you can't wrap your head around that, my guess is that you just haven't suffered enough. Everyone has their limit. I'm glad you are apparently far from yours but again, not all of us are so lucky.

Here's a hypothesis to consider.

Q: Is there a strong correlation between being lonely and being heavier?

H: Being lonely has several relations to eating 'worse' food, and more of it. An economical standpoint (at least in the US). A social activities promote things other than eating to fill time. A 'rewards' perspective, where lacking other forms of joy fatty, sugary, salty foods fulfill a basic stimulation requirement.

It would be interesting if a mental health research institution designed and ran a fundamental research study to determine if one, some, all, or more (possible) of these causes were related.

but that may be a little overblown

No, it's quite well established, actually.

I don't think rationality is a good way of looking at it. Rationality is defined over some goal, and there's no obvious goal here. The better way of looking at it is to say that the military teaches them to treat their own life as less valuable. Lives have no inherent value or disvalue, beyond what we apply to them, so this is neither rational or irrational. But the effect is that they are more willing to, as you say, "log off".

> Rationality is defined over some goal, and there's no obvious goal here.

Relieving themselves of (to them) unbearable misery is a goal, quite possibly the most rational of all goals.

What does it say about our society when suicide becomes a "rational decision"? Are we really so helpless to change the conditions of the people around us who are suffering that we would throw up our hands and write it off as a loss?

At what point do we admit that the structure of our society amounts to animal abuse?

It's important to note that rational clarity about the situation can also be what leads soldiers to insinuate that they are actually the bad actors in a given conflict, which can lead to depression and then suicidal thoughts.

I can't find the study now. But it was documented that Viet Cong soldiers had overall less PTSD years after the Vietnam War than Americans. And the extrapolation was that Viet Cong soldiers, defending their country and people from a foreign invader, were more easily able to justify their actions and thus didn't feel the remorse, guilt, and fear during fighting that their American counterparts did.

Perhaps that isn't the whole story, but I'd bet that part of the reason American vets struggle with PTSD so much is that not all of them can rationalize and defend the things the American army does in other countries around the world. It is almost always involved in offensive invasions, especially of lands where neither the natives nor the insurgents trust them or want them involved. And I think being so face to face with injustice and having to perpetrate it without any moral salve that you are doing the right thing is hard, especially in our digitally connected, personally disconnected world.

>Is this saying that veterans can kill themselves more easily because they have more rational clarity about the situation?

I don't think so. Doctors and veterinarians have an unusually high rate of suicide, partly because they have access to highly lethal means of suicide but also because they've become inured to mortality. For most people, the practical realities of death are somewhat foreign, which creates a psychological barrier between the urge to cease existing and the means of making that happen.

The vast majority of suicidal impulses are temporary; the vast majority of people who attempt suicide do not go on to die by suicide. While it is entirely believable that some people are afflicted with unbearable and intractable misery, that is certainly not true for most people who die by suicide.


Interesting side note about suicide among physicians (in the U.S. at least), every state license or hospital privileges (including renewals) I have applied for asks “have you been diagnosed with or received treatment for a mental health disease such as depression, anxiety, etc”. Obviously any rational person would at least hesitate to seek mental health treatment if it meant they could incur increased scrutiny just to continue to do their job, much less knowing that their peers (and sometimes competitors) on the hospital credentialling committee would be aware of their struggles. I have personally known at least 8 friends / coworkers in the medical field who have committed suicide since I entered the field and I cannot help but imagine that this contributed to at least some of them.

I think you are going in the right direction. Society needs to recognize that suicide must be some evolutionarily advantageous adaptation. Many people when pressed will say they think an individual has value, but that individual often sees no actions come from that sentiment. And if someone thinks they provide no value and are not wanted, it seems logical to unburden everyone else.

It would be similar to how cats go off alone to die when they are sick.

People may say "everyone is valuable" but will they support UBI?

Oh, so not THAT valuable.

I do not believe there's evidence or reason to say that suicidal tendencies convey evolutionary advantage to the species. Many things seem to be accidents. Does the https://en.wikipedia.org/wiki/Photic_sneeze_reflex convey advantage? Very likely no; it's an accidental mutation that doesn't cause enough damage to be selected against.

Evolution isn't directed, and there is no end state. Attributing positive effect to every mutation verges on https://en.wikipedia.org/wiki/Teleology.

What would convince you? It should be pretty clear at this juncture I don't have evidence. However I did give a reason; if in general depressed people feel they are not contributing or participating in society then that is pretty clear.

You can look into this further: a lack of physical activity tends to worsen depression, and a hunter-gatherer with reduced mobility and/or other issues that make it hard to interact with the group is most certainly a resource drain. It goes on and on.

Evolution isn't directed but structures and instinct that are truly against the organisms interest are the exception, not the norm.

> Society needs to recognize that suicide must be some evolutionarily advantageous adaptation.

Bollocks. There is very close to zero evolutionary pressure against (and, of course, even less than that for) having a small percentage of individual of a species decide to off themselves. Especially when it's older males (the most likely age group to commit suicide).

It might be a epidemic prevention, similar to apoptosis.

Better the sick person dies voluntarily than infecting everyone else with a deadly disease

Surely if a tribe can reduce the feeding burden it improves its fitness, to the benefit of all members.

If a tribe can do that, and increase calorie intake simultaneously then there's a double benefit.

Older males [who can't hunt or defend and after trained in anything else] who would end their own lives would improve the survival chances of their own offspring, it seems?

Except that suicide burdens everyone around a person terribly.

And that is a major issue for many younger people who contemplate suicide.

I think it's more that they want to unburden themselves, but knowing that doing so will burden their close ones is what keeps them from doing it.

Quite nightmarish, if you think about it.

> Quite nightmarish, if you think about it.

Your comment assumes a positive change is impossible.

I almost killed myself when I was in high school but decided not to because I didn't want to hurt my family. That bought me enough time to get things straightened out and now I am very thankful to be here.

It is a nightmare if positive change does not come about. You're stuck in pain for as long as you refuse to bring others pain.

My guess is that the burden must be worse for the person who commmits suicide. Or they wouldn't bother, would they? And similarly, if the burden is so great for those around them, why don't they kill themselves too?

It comes down to the fact that most people don't want to acknowledge their incredible privilege in being relatively unburdened by depression, I think.

I happen to know attempting suicide can be quite severely painful. Most people who try do not risk it lightly. And much of the time, in my experience, it's those "people around you" who are to blame for the person wanting to die in the first place. If we're being honest, most of us don't truly do everything we reasonably can to help those with aspirations towards suicide. Many people act as some of those in this comment section are, telling people they're being selfish and weak. How the fuck on Earth does that help matters? And before you assume I only care about myself or something, my best friend just killed himself a few months ago and I cried nonstop for days. I still support his right to do what he did.

It becomes blindingly obvious to me when a person has no idea what it's like living with chronic treatment resistant depression as soon as they open their mouths. It's just ignorance and priviliege and a total misunderstanding of the problem to blame someone who is suicidal for wanting to end their own suffering.

For a while, yes, but then they get over it. If the person would continue to be nonproductive (or in the situation being discussed -- feel they are being nonproductive) for years then there is a clear benefit to their death.

Does suicide have place in a modern society? Probably not, but at the same time the fact people continue to kill themselves show that people really don't care about the issue. Actions speak louder than words.



You wouldn't be the subject of the process of missing out if you don't exist anymore

The number of people who have put off suicide and gone on to do great things is immeasurable. Curtailed suicide is such a common story, not just from people who have been exceptional, but normal people who go on to have families and spring forth entire trees of life, which themselves produce endless greatness.

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 [1] 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

Rest in peace Scott.

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.

There are some things you simply cannot control, like who your family is. You cannot focus on them. As far as others go, they might not be doing things in the right way, but they are trying in some capacity. Some do not even have that. Everyone is dealing with their own problems as well.

We are thinking of you here on HN. I can do nothing for you, but would always make time for you.

The situation with your family sucks, no doubt.

What would improve things for you right now?

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.

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?

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.

You are not alone. It is not you that is broken, it is the world around us that is broken. Things cannot continue the way they are. This system we live under, it corrupts everything. It inserts a fundamental tension into every human interaction we have, it drives a wedge into every relationship. It rips us apart and turns us against one another.

But it doesn't have to be this way. There are other ways to live, there are other worlds we could have. We don't have to incentivize predation. We don't have to reduce human life to dollar values. We can make a world that does not find its fundamental basis in self-interest, we can have a world where everyone is not fundamentally, irrevocably alone.

I recommend that you try to see if you can find a local chapter of the Democratic Socialists of America, or any local group looking to further the establishment of a Solidarity Economy. Don't throw your life away because you know this world is wrong; make it right. We are out there, and we need you.

A broken, broke, barely breathing husk who doesn't have the energy for basic tasks often cannot be an activist. I don't have the ability to do that in addition to surviving. While I agree with social democracy I am not someone who is in a position to fight politics. My stress coping ability is paper thin. My basic needs are in constant threat and shortage. It also will not change here in time for me. My only chance is getting help and moving. I am not throwing my life away...others did that. This country and its capitalistic nightmare ruined my life. I need away from it in the way I need away from my narcissistic, cruel family. I'd happily accept a reprieve...a way out...I am not wanting any of this. But I am not throwing away life by refusing to hurt more and more physically and mentally...that's not life.

Your story alone is enough to make you an effective activist. There is nothing more powerful than lived experience. You may be surprised at the amount of help that you will be able to find if you go to the people who are fighting to prevent what you've gone through from happening. There is support out there for people who truly want things to change.

I understand the desire to get away. I understand the reluctance to believe that things can change. But you have the opportunity to help stop this. This world fights hard to make you believe that you are without agency, but that's because learned helplessness is what maintains the status quo. Collectively, we have a very real power to shift the course of society. There is more momentum building behind an end to this nightmare than you likely realize. Do you not at least want to find out if you could have made a difference?

And you might also be surprised with just how much more tolerable the pain in life becomes when you are near like-minded people who genuinely care about their fellow man.

I think this is the last post I am going to make because I find myself feeling nothing but anger, resentment, defensiveness as even well meaning people don't get it and keep saying things I feel I have to explain and justify because for some reason I still care about proving I am not a jerk, crazy, wrong somehow and fighting the idea that this is my fault or I am not doing enough or I somehow failed. I did not. I was failed.

>There is support out there for people who truly want things >to change.

A lifetime of experience tells me otherwise. What is out there is insufficient. I don't need promises of a brighter future. I don't need cheerleading. I don't need vague ideas of what should be or what someone believes can be. I need practical realities now.

>Do you not at least want to find out if you could have made >a difference?

This is deeply offensive and makes me want to scream. I DID make a difference in the ways I could. I spent my life helping in my work and doing what I could in my personal life. I walked the talk of social issues. I was ethical and honest. That I am now needing help, needing rescue rather than being the rescuer. You don't ask a drowning person to hold up a sign as they go under to highlight the dangers of swimming in the ocean. That I don't have the bandwidth to add MORE work and stress to an already overwhelmed life does not diminish that. I did my part.

End of line.

I didn't mean to talk down to you or invalidate your completely justified response to your own situation, I apologize. Nor did I mean in any way to belittle your accomplishments or the amount you have already done for others. You are absolutely right to feel the way you do; you were failed, this is not your failure, you have done nothing wrong.

You have no obligation to anyone. I'm just trying to offer you an option of where to look for aid with those practical realities. Maybe you have already thoroughly exhausted your options, but this is just one more place to reach out to if you haven't already. I don't know where you live, but it's possible they may have a similar program at your local chapter: https://dsabuild.org/medicaldebt

And I am sorry if my pain and desperation made it sound personal. I have always been a "helper" and hyper empathetic so a big psycholgical part of my problem is NOT being able to do anything useful for those in need and raging at the injustice all around. But I can't help anyone else if I cannot help myself. I think you for the well meaning...but that's not enough anymore.

Hello hestipod.

I have been in your situation, and I have had certain privileges you do not have which helped me. So, I do not want to tell you: "just do XYZ and you'll be better". In fact, I agree with you that suicidal tendencies are not due to mental health issues; rather, they are due to deep societal injustices. Since I can't fix those, I can't truly help you. There is a reason why indigenous communities are particularly hard hit by suicide...

I am also not going to try and convince you to not go through with it. That would be selfish on my part. I don't want to have to deal with the hard truth that someone chose to stop existing because of the shittiness of this world.

I am however, going to ask you to reconsider what meditation is. I don't care about any of the religious crap around it, and I am also not going to reduce it to "sitting down and breathing deeply". "Meditation" must happen in every moment. I think about meditation as a sort of self-awareness which provides acceptance, and through acceptance, resilience.

I recommend reading Jon Kabat Zinn's "Where You Go, There You Are".

I had an allergic reaction to the idea of acceptance when I first came across it: things like "opium of the masses" came to mind. This is not that sort of acceptance. This is the sort of acceptance that provides internal stability when there is no source of external stability; it is the sort of acceptance that lets go of the disappointment and frustration, and then frees mental power to consider: "what now?". It's the acceptance that provides resilience which leads to improvements in social justice (and social justice starts with small, everyday victories: moments, individuals, and then society). Or the sort of acceptance that provides the freedom to explore things you would have been too scared to explore otherwise ("a person who has nothing to lose...").

In this vein, I think mathematics is an amazing way to spend time. Not only does it not deal with people, but it also helped me see a...largeness...to the world that I find hard to describe. I suggest starting from here: http://www.cs.toronto.edu/~hehner/FMSD/

In a sense, you're free. You're free of the "chains" of life. Breathe deep, not because you're meditating, but because you should relax: the chains of life no longer bind you. Let your mind roam now, as it is meant to roam. Build palaces of systematic ideas, which lead to results that are surprising and enjoyable. Explore the world around you: forget about space, but instead consider the amazing orchestra of chaos that is biology. How the hell does a cell work? Layers upon layers of beauty that is hidden because of the shit of our human world...

Or...pick something else to study that isn't what _this_ stranger cares about. Devote yourself to it. Do not let yourself be disappointed with the boring, care only about the exciting. Let the excitement of finding the amazing fuel your devotion.

Dare I say: "don't end the freedom you have earned by going through this pain early; use it, before you end it"?

It's not freedom to "accept" being permanently and worsenginly sick and homeless or constantly living under that threat. It's not freedom to "accept" being in severe pain every day. It's not freedom to be in the "present" in those situations. Freedom is having positive choices, agency, hope. This stuff is nothing more than a psychological trick that I cannot sustain to say "I am powerless and this sucks but that's ok" and I will be some stone in the water or other bollocks. It's not ok and I will not keep living like that. I refuse. I don't WANT life to end but I cannot and will not live a life that's nearly 100% terrible and since the real and practical options to survive are denied there is no other path. I am not buddha and I reject that I HAVE to stay alive in this condition. I don't need something to do...something to study...as if I just lack purpose. Telling a drowning and tortured person to get a hobby or be in the moment is absurd. I need Maslow's bottom rungs secured. Everyone wants to fight for you not to die...but people will not help you live.

Okay, sorry for being presumptuous.

I am a fool who can't help but read things hoping something good happens even when I am so upset I want to stomp out to have SOME control of SOMETHING. So I read your long reply before you edited it. I won't tear it down because you DID remove it. I just want you to know that's the kind of thing my family does...strangers have done...the unfair and wrong beliefs about me. It's only hopes and prayers, blame like that, and ONE actionable offer that life took away in 15 years. I am sorry it's so bad for you too. I am glad you have social assistance as a foundation. Everyone should have that net and it's what I most need and not having that is why I am so distraught and angry. I have always lived a life caring about the world, other people...animals (I spend part of my meager income on a cat that was one of 12 or so from 3 litters my family never cared for properly and never spayed/neutered and all died/disappeared from their garage but her, and I took her to the vet and make sure she is cared for since they don't seem to care half the time...having to adopt her out in the end is a great stress for me because I cannot guarantee her future with me here or not)...and proved it in my actions. Always. That I am falling to pieces now and cannot even manage myself doesn't invalidate any of that.

I didn't take my reply down because I didn't mean it, or because I thought it was wrong. I took it down because I felt that I didn't know enough about your life. I was finding multiple aspects of your response grating making it difficult for me to remain non-judgemental. So, I decided it would be better to simply "apologize and move on".

I find your comparison of me with your family to be extremely insulting, as you know nothing about my life.

The mistake I made, which in your eyes makes me as good as a bunch of right-wing misers, was to 1) suggest a key aspect of what my own therapy was based around, and 2) share with you what _I_ found was something useful in improving my "suffering".

However, you decided to take it as yet another sign of how people are judging you (Jon Kabat-Zinn has a lot to say about non-judgementalness too, and that was another key aspect of my therapy), missing the fact that you are judging others, and in particular in the course of this interaction, me.

I do not have the resilience, capacity, or training to deal with such judgements.

I think that you can read my first response in many different ways. You chose one perspective, and perhaps, in the future you may choose to read it in other ways. Apart from that response, in which I gave you what I felt were the most valuable things I had to offer to anyone, I have nothing else to give you.

I'll leave you with a quote from J. Kabat-Zinn's "Full Catastrophe Living":

> Acceptance does not mean that you have to like everything or that you have to take a passive attitude toward everything and abandon your principles and values. It does not mean that you are satisfied with things as they are or that you are resigned to tolerating things as they “have to be.” It does not mean that you should stop trying to break free of your own self-destructive habits or to give up on your desire to change and grow, or that you should tolerate injustice, for instance, or avoid getting involved in changing the world around you because it is the way it is and therefore hopeless.

> Acceptance as we are speaking of it simply means that you have come around to a willingness to see things as they are. This attitude sets the stage for acting appropriately in your life, no matter what is happening. You are much more likely to know what to do and have the inner conviction to act when you have a clear picture of what is actually happening than when your vision is clouded by your mind’s self-serving judgments and desires or its fears and prejudices.

I don't know what you are on about or doing...the post you took down was full of insults and retorts to things I didn't say and simply wrong about me. It was cruel and projecting. You said several strange and aggressive things like I should stop pretending I care at all about other people, the planet, or animals...no idea where that came from nor is it true in any way. You said several untrue things what were oddly blaming. Now you say you weren't wrong and meant it and aren't sorry. I am just not dealing with that anymore from anyone, anywhere. I shouldn't have replied at all to begin with as I saw this coming. Take whatever shots you need to. None of it matters anymore. Goodbye.

At this point, I am fairly sure you're baiting me...or, that's just me reading the worst in this interaction. Not sure. I'll ask the moderators to restore my post for the record. In any case, this has been an interesting learning experience.

Have you applied for disability? Really hope you find a way through.

Yes of course. Fought for it with lawyers for years. Denied despite evidence by a very biased judge. Appealed. Same judge denied again. The system is broken. I am out of credits to apply now. I have done everything you are supposed to and that people think works. It doesn't. It's just the same advice recycled and disbelief it didn't work...then on to blaming me for it...and me getting more upset and hopeless. Over and over. I know who I am and what I have done...but it doesn't matter.

It's me again. (Sorry).

"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." I wonder if your earlier career gave you PTSD and if your current circumstances are triggering it?

You had a bad judge twice - that guy is probably retired now or has moved on. I wonder if another might be reasonable - what you need is some kind of stable income so you can get space and stability. Are there no advocates who could help some kind of claim for someone in your situation - free advisors? Don't set some kind of end of year deadline on yourself - an advocate might be able to do a lot for you.

It's too late to edit and I need to just not read or post anything anymore since it never helps and makes me more depressed and angry seeing how true my assessment of the world is. But I couldn't stop worrying I made you feel bad should have expounded on my first sentence in my last reply. You have been there kindly since my first post here. I appreciate that. You are clearly a good human being. That's just not enough and it feels like anything I say to well meaning but ultimately unhelpful advice either makes me seem ungrateful, unwilling, or deserving of this decline. None of that is true but you can only take so much, only explain so much. Only refute so much. That always results in people giving up on you as if that's your fault. And I don't mean giving up on being nice...if niceness was enough I would be ok because I know some nice people. But they give up on anything that would really help. I am not setting any artificial deadlines...they keep making threats...and I live every day wondering when the hammer will drop. I have tried to prepare things so I CAN leave if an opportunity arises but so much is still wrong, lacking, and accessible. I have no agency here but to suffer...or end the suffering...and if they kick me out even that becomes harder with less options. I can't live like that on top of everything else.

hestipod, You are a very kind person - worrying about me, with all your problems. Don't worry about me, (I was worried that I was upsetting or needling you after I posted). NONE of your problems are your fault. None of them. I just wish that there were some way soon of you getting the help you need.

Please don't worry about me, I've been through some things, (probably toughened my exoskeleton), (or something :). You are not unnoticed and I can only repeat I wish there were some real help that you will get. I am ok.

You have been kind from the very beginning, but the sort of open ended questions and wishful thinking is rage inducing and makes me feel like a bad person and makes people turn on your harder when they upset you.

"Surely there is...why don't you just....there has to be...that sounds terrible what would help?" etc NEVER F^%#$ HELP! They are vague, obvious, useless advices or ideas. Things I have usually made directly clear I have done. The direct answers to needs are never heard. You answer questions and nothing...like it was all just to satisfy someone's curiosity. People give you absurdly obvious "advice" they have never enacted, and certainly not in such circumstances, and then tut when you don't accept it or it doesn't work. The truth is there have been many systems and people who could have helped...really helped...and they said "no". THEY decided that not me. I had my agency stolen.

Yes I have PTSD amongst many issues but that like the rest has been scoffed at and said to be "playing victim" or whatever other excuse. Yes the judges, "advocates, doctors etc have mostly been shit but people won't accept that because it's easier to say it's my fault and pretend that it was just an edge case and would never happen to them. I am NOT setting a deadline....THEY are!!!! I have no idea when the threats and drama will appear again or when they will be realized. I live in constant fear of it and have been pointlessly F&^%# screaming HELP ME for years now. The ONE, MAYBE actionable plan was derailed by MORE BAD THINGS. I need support....stability....it's not coming. It never comes. It's like some trickster god is playing with me seeing how far he can push me. And when you say "I CANNOT DO THIS ANYMORE" you get "hopes and prayers". I wish I had never made this F&%^# account or ever talked to anyone about this as it just brings more pain on already unsurvivable pain. F&%%& everything.

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.

> 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.

Your tone is why I’m gone. You talk to me like a fucking goddamn jerk. I didn’t ask for your medical advice. Telling me imperatively to “seek it” is indicative of your hubris and provincial viewpoint of the world. You’re in zero position to know what technology is out there in the wild. It’s a system bigger than you and me. And it was blindly obvious that my theory was to goad people like you who would obviously jump on the offensive regarding “mental illness”.

I don’t like you talking to me that way. I’d like to be left alone. As stated. Spare your armchair diagnosis and condescending response. Please.

I really detest people like you: your mindset, your condescension, your tone. Please. Do not respond to me at all anymore. Please.

This is a request to anyone reading this to not respond to my post with any theories about mental stuff, suggestions to seek help, etc.

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.

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.

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

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.

I'm on Prozac. Mild side effects? When I started with it, my muscles hurt for weeks. I had to quit coffee (temporarily). I had to stop exercising (temporarily), and I was also very tired for weeks. Slowly all of that became less severe, though it never truly went away. Add to that, when I started my partner was about to bare our first-born. It was a hell of a time in my life, in many ways. A rollercoaster for sure. I still need to be very careful with alcohol (about twice as strong effect). One glass of alcohol at a cocktail party at Friday afternoon on work can rub the wrong way, as it did the other day.

> It’s fuether compounded by the fact that most antidepressants have severe or annoying side effects.

As does Prozac.

Nearly all medicine have side effects. People should be informed about them (it is included with the medicine, at least here).

When depressed or suicidal, the advice of going to your doctor is good. The advice to be open about anti depressants as well (though you didn't give it, one could deduce it from your post). The advice to go for this specific brand because "no severe or annoying side effects? Bad advice.

Honestly, I had less side effects from Zyban/Bupropion and Citalopram.

Full disclosure: I don't use Prozac/Fluoxetine for depression (though one could argue I suffer from depression); I used it so I can better cope with autism.

I used it so I can better cope with autism.

Has it actually worked? Your post outlines all of the bad things you've experienced, but has it, on the balance of things, been worth it?

TL;DR: psychiatrist and apothecary need to evaluate that in my country. If it wasn't worth it, I'd have quit long ago. The alcohol side effect, for example, is annoying. However being tired for weeks, and muscle pain having more severe impact, that was and is highly annoying.

To answer your question though. According to myself: Yes. According to the people around me: Yes. The people around me are more positive about it than I am, but they generally don't suffer from the side effects. Basically, I have less sharp edges. I am, basically, less sensitive. The moment I'm most sensitive is during public transport. E.g. commute. I go back from work, I sit alone, and at end of people hopping on two people sit on the other side of me and start eating Burger King. Which smells. Well, yeah, I still can't act that away (or fake it till I make it). They notice I am annoyed by it. I give them looks.

Also, keep in mind, that there are other options available, but these also have side effects. From what I gathered, the other common treatment option contained an anti-psychotic with severe side effects.

Thanks, this was interesting. I'm also autistic but have been lucky enough to adapt my life around it (short commute, private office, understanding people I delegate to, live in a very small quiet city, etc. so public transport is not even an option.) Taking medication isn't something I want to do, but I'm interested to know how/if it's working for others.

>Nearly all medicine have side effects. People should be informed about them (it is included with the medicine, at least here).

Most medicine has minimal side effects for most people. "Very common" side effects are ones that effect 10% of people taking the medication.

People should be aware that side effects are possible, but they are unlikely. Going in with the attitude that side effects are inevitable makes one more susceptible to the placebo effect causing them.

We ran a clinical trial of a very common antidepressant. Blinding was difficult because on the active arm damn near everyone had observable side-effects within 40 minutes of administration. Clearly not related to the placebo effect in this case, only the pharmacist knew what was in the capsules until the nausea started.

>Clearly not related to the placebo effect in this case, only the pharmacist knew what was in the capsules until the nausea started.

Right, and it could only be the placebo effect if those capsules contained sugar.

Most people will experience noticeable side effects from antidepressants for at least a week. It doesn't sound like you ever tried one honestly.

This is not true. Whether I've been on one is not relevant information, though my personal experience also says this is not true.

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.

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.

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.

Citalopram also works wonders, that said it’s only half of the equation to healing your psyche.

It’s important to remember that drugs affect everyone differently. But an antidepressant can be a good first step to getting out of a rut (even if exercise for SOME is as effective).

I've known many people who've been helped in a non-trivial way by antidepressants. Furthermore I had a colleague commit suicide recently due to depression.

His comment is not dangerous, it's encouraging. Pharmaceuticals all have side effects and must be taken with care, I've known literally no one that went into antidepressants ignorant of those things.

I don't think so. Buproprion is supposed to be the most side-effect free antidepressant yet it seems to have permanently messed up my sex drive. If I had the choice of the two I'd probably have kept my sex drive and tried something else.

Hmm - if it had recommended antidepressants in general it would be reasonable advice. But there are lots of them, and no a priori reason to pick a specific one.

Most medication has side effects.

Prozac has among the lowest side effect profiles for anti-depressants and is dirt cheap since it's long out of patent. That's why it's often the first thing tried despite not having the highest rate of effectiveness, as far as I understand it.


Your comment has clearly been downvoted because it broke several of the site guidelines.

In particular, it's off topic here to make insinuations about astroturfing, shilling, and so on, without specific evidence. Somebody posting an comment you disagree with is evidence of nothing, except that people have various views.


All anti-depressants have severe or annoying side effects for some people. Most anti-depressants have almost no side effects for most people. The trick is to change prescriptions until you find one you like.

(I'm on my third prescription, and have no complaints.)

> Most anti-depressants have almost no side effects for most people.

This isn't true for all anti-depressants, especially when you look at dosage.

For example, if you look at clinical trial data and studies for a certain drug, 60% of people experienced weight gain. Another drug caused nausea in nearly 70% of patients.

Paroxetine has a reported sexual dysfunction rate of nearly 75%, and patients who take 20mg of vortioxetine report a similar rate of sexual dysfunction after several weeks, but nearly none at all when taking 10mg daily.

You're right, of course. However, first, I think you'd be hard pressed to find someone who prefers depression to sexual dysfunction, weight gain, or nausea. Second, you can just try different medications until you find one that has none of the above problems.

To be honest, I find the discussion of side-effects in anti-depressants really strange. Depression is an extremely dangerous, life-threatening, life-ruining condition. The side effects, when they are present, are typically trivial. However, I have met many people who have not begun a course of medication because they were worried about them.

> However, first, I think you'd be hard pressed to find someone who prefers depression to sexual dysfunction, weight gain, or nausea.

All three of those can be depressing in their own right. In the past, I stopped what was effective treatment with certain drugs because of those side-effects.

If you look at the clinical trial data for vortioxetine, the nausea component was so bad that many people dropped out of the study altogether.

I guess I have never experienced weight gain, and I don't really care much about sexual dysfunction, but I really don't get how these things aren't completely irrelevant in comparison to depression. To me, it's like somebody saying they might not take chemo because they have such beautiful hair.

As for nausea, it's my understanding that it typically shows up pretty quickly, so I don't see what the problem is with just changing the medication.

Newer antidepressants have less/different side-effects compared to older antidepressants like Prozac.

5-HT1A agonism relieves a lot of symptoms commonly associated with SSRIs, so does antagonism of 5-HT2A, 5-HT2C (Prozac does this), 5-HT3, 5-HT7 and certain adrenergic receptors. Some newer drugs target these receptors.

Are 5-HT2A and 5-HT2C related to 5-HT2B at all? Don't psychedelics like LSD, DMT, and MDMA non-selectively target those receptors?

Traditional psychedelics are 5-HT2A agonists, while 5-HT2A antagonism or inverse agonism is associated with an anxiolytic and antidepressant effect.

Certain psychedelics like psilocybin are 5-HT2C agonists, which is responsible for the anxiety, dysphoria and nausea that some people experience when they consume it.

> Are 5-HT2A and 5-HT2C related to 5-HT2B at all?

You'd really need to look at in vivo binding profiles when it comes to serotonergic drugs. Some drugs are selective for other receptor subtypes compared to 5-HT2B, others aren't. Almost all antidepressants are tested for 5-HT2B affinity because of the association with heart disease and birth defects, and because of the lawsuits that resulted from them.

I'm glad Prozac didn't have noticeable side effects for you, but it's an SSRI - a lot of people have very noticeable side effects with drugs in this class, including Prozac.

Prozac is not better than other antidepressants. It's good that you didn't experience side effects, but you can't generalize from that.

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