My Mind & Me

Written by Andi Bazaar, dr Khaan MD, Gryffen Seth, Tydalé-Oliver Schofield and Benjamin Schenkkan Joseph | Sep 15, 2023

Each suicide that happens on this planet is a failure of society and directly on the institutions in place, to die from something treatable because we don’t have anything in place to lessen the cracks in mental health treatment is on all countries worldwide.

“if you are feeling suicidal and reading this, please know that no matter what our thoughts tell us. there are always solutions, being in the field i saw so many people who were completely hopeless and ready to be gone who are now happy."

There are certain events that happen that bring mental health to the front of the conversations, the main issue is that we tend to forget about it during normal times. We don’t pay much attention unless a tragedy happens, mental health is a constant those suffering are all around us. We can’t let these conversations die just because they make us uncomfortable, we all know people who may be depressed or suicidal but we are scared to reach out because they may reject us or suck us in.

"Every single day of my life is dedicated to mental health but even people who message me tell me they are forgotten by their peers and even family members." — Dr Khaan, MD

Suicide is entirely preventable, it is lack of options the lack of support and lack of treatment. It is helpleness that has lasted for years, it is not something out of the blue. There are countless opportunities to help someone who may feel suicidal but we feel more comfortable turning a blind eye to it or saying that someone else will deal with it.

PS: please don’t use “commit suicide” we can say “pass away due to suicide” or in with my colleagues we use “Suicided” same as “depressed” / “stressed” etc people don’t resort to suicide without exhausting so many options.

A reminder to allow people who are struggling with their mental health be the leader of their recovery, it is not our job to pressure them to do things. Go to therapy, judge them because they want to be alone. We can’t invade their space and pretend it is for their own good!!

I hesitated to write this and went back and forth but decided to do it. We are going to talk about suicidal ideation, the permanent solution to a temporary and something that took away two very close people in my life. Despite working in the field of mental health.

For almost 3 years and working with clients who have suicidal ideation, the triggering part has not gone away. The devastation of losing a loved one to suicide is one of the most traumatic experiences, as life is cut short suddenly and loved ones feel guilty that they couldn’t do anything about it.

Suicidal ideation has different categories, in the passive suicidal ideation an individual wishes they were dead. They think the world is a better place without them or that passing away is the only solution to stop the pain but are not actively trying to take their own life.

When individuals start to make a plan, that is when it alarming and needs immediate intervention. These can things such as writing a will, making sure their pets or family are taken care of leaving their belongings in order before they leave.

This is the phase when it can be stopped before it is too late. No matter what someone is going through, there is a solution out there. It may take a while but it is there, if you know someone who is exhibiting some of these behaviours or hints at a goodbye talk to them.

Sometimes, breaking that isolation is enough to get someone to a treatment before it is too late. Suicidal ideation especially with a plan is the only time I would agree to going behind someone’s back and calling emergency services if they are not open to going on their own.

One of the reasons why I have a dedicated write to mental health is because I vowed to not lose another person to suicide. After losing my partner, it was the hardest experience I have had in my life. Suicide rates are constantly on the rise and this is something we can treat.

If you think about suicide or know someone that is, connect with me and we will go through it together. If you are scared of being identified or anything like that, create a throwaway account and message me. I don’t need to know your name, age, gender or anything. Let’s just talk!

⚠️ TW: SELF-HARM, SUICIDE ⚠️

The impact of the pandemic has been detrimental to many people’s mental health. Its physical, psychological, social, economical and grief impact has been widespread and this can lead to a lot of hopelessness that can result in self-harm.

I want to help people understand signs that someone may be feeling suicidal, it can be very difficult to notice. If you haven’t or have lost someone to suicide, please know that this isn’t your fault. It is really hard to notice.

These signs I am about to lay out aren’t absolute, they can vary widely from person to person. However, even if they can save one person, it is more than enough so let’s get right into it. First of all, deep depression can be very isolating and lonely even if others are around us.

One of the biggest prevention methods is to break that isolation. When we are in our minds all the time, thoughts and emotions can twist our reality and make us feel as though there are no solutions. We may start to truly believe that the world would be better if we are gone.

Therefore, social withdrawal is a big one. This is because depression especially when severe leads to a drastic drop in energy, to the point that we can’t pick up the phone or talk to anyone even when talking there is no energy to our voice "it is monotonous."

We may even start to push away people because we feel that they won’t be hurt when we are gone because they will hate us if we get them angry at us, there is also the planning phase where we start to plan our departure. Usually, this is the phase where we can notice some signs.

We may notice our loved ones putting their life in order by writing a will, saying their account numbers and how to access them and organizing all their belongings and even finding places for their pets when they are gone. These are signs that the preparation phase is underway.

By that time, there is a date in place and we will notice that all those plans stop before a certain day where it is believed everything will get done. There are a few things that may blind us to this happening, first of all it is rare that someone would admit outright.

Second, the stigma around it is so entrenched in societies and religions that it is hard to ask someone about it. We feel we could be insulting that person or offending them by asking if they are okay or need help, there is nothing wrong with asking that.

It is better to be wrong, earlier I said breaking that isolation is the best prevention. When it is broken and another person is aware, the plan is no longer in play. We can get that person help and convince them not to get through it.

"if you are feeling suicidal and reading this, please know that no matter what our thoughts tell us. there are always solutions. being in the field, i saw so many people who were completely hopeless and ready to be gone who are now happy."

They are people who were loved by many gone because society through its stigma and lack of resources has failed them, it is not their fault they are gone and not ours either. Any prevention is an amazing thing to happen.

I hope that this part shared from a professional and personal perspective has provided some information and ways that as loved ones, we can help people going through this dark episode and break that ice wall of isolation.

In the past few days, there have been many posts about suicide but so much misinformation. I want to talk about what suicidal ideation means and to debunk certain myths about it.

The first is that suicide is a choice, suicide is not so much “A” choice as it is “the last choice” for so many people. It is a last resort when everything else doesn’t work out, it is a failure of our societies, a lack of resources and or a price tag to healthcare that is too high.

The fact that suicide rate is so high is one of the biggest failures of humanity. Furthermore, there is the myth that only depressed people suicide. That’s not true, while depression and suicidal ideation have a strong correlation it is not absolute. Sometimes, there is an event that is so traumatic or a big stressor that precipitates it.

• Another one and I see it a lot especially in religious tweets and in certain countries that suicide is a crime and should be treated as such, that’s stupidity on another level. It is like having a physical illness as a crime.
• Another myth is that suicidal ideation will lead to suicide, that’s not true at all. Suicidal ideation can mean that the person wishes they were gone or could do it but don’t formulate a plan to do so. Someone can be suicidal without ever going through with the act.

It is when a plan is formulated that there’s a danger, one myth we often hear about is the idea that “we don’t see it coming.” — that’s not true in many cases. Many people will reach out and show it in subtle ways, they will use words like farewell, thanking someone for closure, forgiving people, calling a charity to allocate money, etc...

These are some signs that someone is getting “their stuff in order” before leaving, it is something that can be picked up on when we actively listen and try to understand the person. Finally, suicide is so preventable.

There are so many forms of treatment from medications to hospitalizations, intense forms of therapy. There is something for everyone, our jobs as friends, colleagues, parents and all that is to pay attention to those around us, reaching out and looking for signs.

This is something that we can all do a better job at, we need to reduce our suicide rates as much as possible.

MENTAL HEALTH DISCLOSURE REQUIREMENTS ARE BARRIERS TO TREATMENT FOR HEALTHCARE PROFESSIONALS

Requiring physicians to disclose mental illness regardless of current impairment is discriminatory and dangerous, in states where medical licensure applications ask sweeping questions about mental illness physicians are less likely to seek treatment:

https://www.mayoclinicproceedings.org/article/S0025-6196(17)30522-0/fulltext

I've heard from numerous med students, residents and physicians who have forgone mental health treatment over fear of repercussions and disclosure reqs on medical licensure applications. This ranges from refusal to take SSRIs to avoidance of hospitalization when experiencing SI.

• Physicians who do seek mental health treatment are faced with the decision to lie on licensure apps or undergo an invasion of privacy.
• >50% of med students report they wouldn’t disclose a mental health diagnosis on a medical license application due to fear of stigma or repercussions.

https://pubmed.ncbi.nlm.nih.gov/32054420/

Those who defend disclosure requirements commonly cite our duty to protect patients.

HOWEVER:
 — We don’t have evidence that disclosure reqs protect patients, We do have evidence that these reqs harm physicians.

“The ironic thing is that the unfair question defeats the boards’ purpose”

“If a doctor is impaired but is discouraged from seeking help, the patients are not being protected. We want doctors to get help before they are unable to do their jobs.”

https://www.statnews.com/2017/10/16/doctors-mental-health-licenses/

Revoking licensure or otherwise preventing a physician from working due to mental illness is actually illegal under the ADA. The ADA defines “employment tests or other selection criteria that screen out or tend to screen out an individual with a disability or a class of individuals with disabilities” as forms of discrimination covered conditions include depression, bipolar disorder, and schizophrenia.

WHAT CAN BE DONE?

Ask your state board to change medical licensure application questions to reflect national recommendations!

FSMB recommends that state medical boards “consider whether the information (mental health disclosure) questions are designed to elicit may be better obtained through means less likely to discourage treatment-seeking among physician applicants.”

The AMA recommends limiting medical licensure questions to current impairment only.

THE CDC RELEASED NEW DATA ON SEPT 12, 2020.

• The suicide rate among ages 10-24 in the US increased 57.4% from 2007-2018.
• When examining the change in rates between 3 year averages of '07-09 and '16-18, the nat’l percentage increase was 47.1%
• More from the CDC from (2007-2009) to (2016-2018), suicide rates increased significantly in 42 states.

These aren't just numbers and figures, these are people. Friends, family, people. Let's be mindful of this has we discuss these figures, so what happens now? Organizations will talk about how bad it is and then implore people to do the same stuff that we've been doing.

I'll just say it, "it's not working!" — we have to do something different, suicide prevention has to be more than asking people who are hurting to find the strength to help themselves. We need to make sure suicide prevention is inclusive of everyone, systemic racism and white supremacy has to be addressed. Social determinants of health have to be addressed.

Small children as low as 5 are dying by suicide more and more and Black children have the highest rates in that area, how is that being ignored by so many? We can't afford to allow that to continue.

I appreciate the Action Alliance for thinking outside the box and engaging unique partners, it's going to take new minds at the table to get this done. So please, let's do more and let's think differently.

We owe it to our kids to listen to them instead of talking at them, why are they leading US because we are complicit in silencing them when they are begging to be heard.

"WHO IS AT RISK OF SUICIDE?"

Going by epidemiological data, risk factors for suicide are numerous and multi-factorial. However on this permit me to restrict these factors to just two, namely: individual and environmental factors.

INDIVIDUAL FACTORS FOR SUICIDE INCLUDE

• Sex: (more females attempt, more males succeed)
• Age <20 / >40years
• Presence of depressive illness
• Previous suicide attempt
• Use of alcohol and illicit drugs
• Lack of social support
• Being single
• Chronic illnesses

These factors above among others may make a person more at risk of suicide than others.

ENVIRONMENTAL FACTORS INCLUDE

• Economic recession
• Conflicts and natural disasters periods
• Access to firearms
• Social media (where people post suicidal acts)
• Cultural (some societies see suicide as an honorable exit out of life) and so on

Consequently as we can see, everyone at some point in their lives may be exposed to these risk factors for suicide and if not handled well may succumb to it.

ABUSE FROM A PSYCHOLOGICAL LENS

Abuse is very common and discussed a lot on this platform, plenty of people have gone through it (some men, many women and non binary).

• Why is it hard to leave when there is abuse?
• Why is it not reported to authorities?
• What impacts does abuse have on victims?

Many times when people report that they have been abused for (x) amount of time, the first question is why didn’t you leave earlier?

You let yourself be in this situation, let’s talk about why that happens.

The abuser usually starts with being kind and charming, there may be some red flags but the good seems to outweigh the bad. Feelings of romance and attachment occur, tgen the nightmare starts. Abuse starts (physical, sexual, psychological).

“At first, it may seem like isolated incidents. After all, this person is still “good” most of the time.”

Or “it may be my fault because I did something bad” that cycle of questioning and diminishing self-esteem becomes key for the abuser to keep their survivor under control. The survivor starts to think that they are not good enough, at least they are lucky to be loved and if only they get “better” it will stop.

Take a moment and think about how that happens, it is usually not overnight. Abusers are very strategic in the way they operate, they won’t do it at the beginning when feelings are not yet anchored. This is very general and does not apply to every person or situation.

Now let’s move on to why it is hard to leave. Well, as you can see above the trap was set. The survivor now has feelings for their abuser, their self-esteem has been reduced and they are isolated from their original social circle either because they won’t be believed or the abuse can reach a new level. Leaving becomes problematic. Sometimes, there are kids born from that marriage and the survivor wants to power through for the sake of the kids.

For parents who abuse their kids, it can be bad too. People are quick to say, “your parents gave you birth, a roof and food. Be thankful!” — this idea that life is a gift is simply bullshit. You didn’t ask to be born and your parents doing the bare minimum is the law, not something you should be thankful for.

It is okay to realize the toxicity of parents and their abuse and cut them off even if that process takes a long time. Now let’s move on to why it is not reported to authorities, the answer to this question may vary depending on location but generally speaking unless the survivor has scars or visible bruises, chances are nothing will happen.

Many forms of abuse don’t operate this way, in some countries even if authorities believe the survivor they may not care or not have resources to deal with it.

The person may feel like there is no support, they are not believed and that this is their life. These are in psychology vocabulary “helplessness” and “hopelessness” and basically means well this is my life now, I hate it but there is nothing I can do.

Suicide starts to become a viable solution and an ultimate way of showing that we still have control over our fate. The sheer trauma, depression, anxiety are so intense. This is what is important to understand, this is but a brief overview and some scenarios that a survivor has to go through.

The goal here is to paint a picture that everyone can visualize in order to start to imagine and empathize with what survivors go through. Now let’s talk about some potential solutions for survivors and for you as someone who may suspect that your friend or loved one is going through it.

Remember how I mentioned isolation as key to keeping the survivor under control, if your friend or loved one suddenly withdraws "don’t give up on them."

Something may be going on, if you are a survivor reach out to anyone. Someone is bound to listen and do something, breaking that isolation is a great step towards getting out of this. When the survivor is out of the relationship, it is important to start therapy and treatment as soon as possible.

A SPECIAL THANKS TO:

• Andi Bazaar (Writer)
• Mark J. Levstein (Co-Editor)
• Yevhn Gertz (Director Photography/Co-writer)
• Dr Oliver Schofield, MD (Consulting/Co-writer)
• Dr Seth Gryffen, MD (Consulting/Co-writer)
• Timothée Freimann schofield (Photographed)
• Clayton Euridicé Schofield (Editor/Journalist)
• Scott Wynné Schofield (Publisher)
• Henrie Louis Friedrich (Analyst)
• Jwan Höffler Conwall (Art Interior Design)
• Hugo-licharre Freimann (Ass Director)
• Shot at GQ’s Studios by José Schenkkan and Benjamin Schenkkan Joseph (Co-writer)
• In appearance by "Dr Khaan, MD" (Model/Co-writer)
• In collaboration with "The Me You Can’t See UK" (TMYCSUK) / @tmycsuk