It’s just two people trying to figure out what it takes to keep living
November 16, 2018 1:06 PM   Subscribe

Jerome Motto's research found that simple acts of showing people that someone was there for them, and expected nothing in return— would make suicidal patients feel less isolated, less in conflict with themselves. So his team wrote letters, simple and direct, without clinical jargon that demanded nothing. Motto's goal was to convey a genuine sense of kinship—“simply what one might say to a friend.” Motto's data found that the suicide rate of the control group was nearly twice as high as that of group his team had contacted. The Best Way To Save People From Suicide is a Single Link Huffpost from their Highline series by Jason Cherkis.

Metafilter has previously featured Jason Cherkis work on the Runaways' Jackie Fox and heroin addiction and rehab.


Note: If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also text HOME to 741-741 for support from the Crisis Text Line. Please use the International Association for Suicide Prevention for a database of resources outside the US.

Information about the Motto treatment approach including basic DBT methods can be found at Now Matters Now.
posted by zenon (24 comments total) 77 users marked this as a favorite
 
That was really powerful. It reminds me how important just staying in touch can be with those I am worrying about. And I will share it with friends and family in mental health.
posted by narancia at 2:19 PM on November 16, 2018 [4 favorites]


This is great but it shouldn't be revolutionary. The ways to help suicidal people are so obvious, but we shuffle them off to hotlines or nowhere like they aren't. I'm not saying hotlines can't help, but I am saying suicide is a societal problem which for all our talk about changing the conversation we don't allow it to be. Yes, a feeling of not "you matter" but "you specifically matter to me" is important. Yes, the things most likely to kill people are hopelessness and lack of connection to people who love them, for them. It just feels like...so many of us got lost, didn't make it, and to see the idea that personalized attention and genuine alliance helps, well yeah! Yeah! We've been saying that! What if it is that simple? It's not simple, but it's also always been that simple.

If we stop fearing suicidal people (and nobody fears suicidal people like mental health professionals as this article points out) and pushing them away and keep taking steps to treat them with dignity and centering THEM in our conversations, just being their friends, that's - that's something. And it's not here yet. Even the kindest rhetoric can have hidden "you're a burden" notes underneath. I hope real change that's consistent and sustainable is here in my lifetime.
posted by colorblock sock at 2:26 PM on November 16, 2018 [21 favorites]


There's a difference between sending one heartfelt note of connection to a person in pain and sending notes consistently, over the course of years. That difference is cavernous. On the one hand the internet makes this a lot easier to do, but on the other it also makes it so simple that those notes often feel disingenuous, especially to a suicidal person who has built up a series of false beliefs and cruel worldviews so thoroughly over time. So you have to keep trying and make the notes feel different in a way that you can only figure out if you really get to know the person, and that is in itself a challenge. Then you need support yourself because of all the effort spent on this other person - but of course, if the other person becomes fully aware of that this can trip them over into feeling like a burden, and repeat, and repeat, into infinity.

So yes. It's a societal problem with a societal answer. Having been suicidal on and off since I was 11, I can tell you that consistent and kind communication with the same people over the course of years has been a huge thing that's kept me from attempts, and so has being open about my state of mind when I'm having serious lows. I've been so lucky. I can speak to people about myself without fearing horrific repercussions. This is not something others have, and building it up organically just doesn't happen in a medical setting. We have to support each other, and ask for support from outside of our smaller networks so that we become intertwined in a way that is stronger than just a few people dragging each other down. The way that mental health is compartmentalized is so unhelpful for suicidal ideation - in many cases actively harmful.

The solution might be simple, but it's not easy, and it's in opposition to our current culture in so many different little ways. I wish I knew if I would stop wanting to die occasionally if I lived in a totally different society, but there's no way for me to find out. The only thing I can do is try to slowly change my own culture, by talking about it, by keeping in touch with my other friends who feel this way too, and by accepting inevitability without letting it stop me in my own tracks.
posted by Mizu at 2:44 PM on November 16, 2018 [29 favorites]


This article really highlighted how much of my own mental health treatment has totally sucked. It talks about people losing faith in therapy and psychology, and yeah, that's me. I spent two years with a therapist who did pretty much everything this article recommends against. The moment I completely lost faith was when I had to wait a month for an appointment, and then because I was 15 minutes late, my appointment was cancelled and I was charged a $25 "missed appointment" fee.

I'm really glad to know so many people are so invested in treatment that works, so I'm not putting down the field as a whole. I feel selfish that this made me think of myself, but I'm jealous that anyone has ever gotten that level of care. That kind of thing is so far out of reach for me that it might as well be on the moon.
posted by shapes that haunt the dusk at 2:54 PM on November 16, 2018 [14 favorites]


...there are now more than twice as many suicides in the U.S. (45,000) as homicides...

As someone who struggles with depression and ideation, this doesn’t surprise me one bit. I can’t really explain it, but there’s...something...rotten and black and soul-crushing about trying to make a life in this country. And, if you’re like me, you feel it to your very core, and it drains you. It’s very, very easy to weigh the pros/cons of continuing to struggle through it and determine that your best option is to simply check-out.

I wish I had an answer for it. But, it’s only going to get worse.
posted by Thorzdad at 2:55 PM on November 16, 2018 [42 favorites]


Yeah Thorzdad, I absolutely feel what you're talking about. For me it's actually helped me to separate my low key always wanting to be dead feelings from my anxiety and depression. It is so draining, and so... rotten, yeah, but it's outside of me. I can feel that it isn't coming from me and that's a new thing that I've only been able to discern in the past like, three years or so of a lifetime of this stuff. I haven't been actively suicidal in about two years but hooboy has my anxiety been ramped up to 11. It's been kind of amazing to find out that when the shit is coming from outside the house I'm actually pretty stubborn.

I don't blame anyone else for a split second for feeling otherwise - checking out sounds like a dream, but of course, checking out isn't what killing yourself actually is. I've had to remind more than a few friends this since 2016, but luckily so far nothing final has happened in my personal sphere.

It's definitely going to get worse on a global scale. People I know who struggle with their mental health but don't have suicidal concerns are beginning to touch on it in ways they haven't before. Society is shifting fast and in unexpected ways. There's already been fallout. I'm just going to stay braced for the foreseeable future.
posted by Mizu at 3:11 PM on November 16, 2018 [6 favorites]


As someone that has made two attempts, I passed that link on to my current counselor, explaining that it seemed to cover why I keep coming to sessions, with a codicil that this was not indicative of anything worrisome. I like the fact there is someone "outside" my support network that will speak to me, basically non-judgementally (I say basically because she will only comment if she thinks she sees a bad behavioral pattern forming. I get to make mistakes, but if I am heading down a path that is OBVIOUSLY bad, she will ask me about it.)

> Mizu:
"It's definitely going to get worse on a global scale. People I know who struggle with their mental health but don't have suicidal concerns are beginning to touch on it in ways they haven't before. Society is shifting fast and in unexpected ways. There's already been fallout. I'm just going to stay braced for the foreseeable future."

I don't see this as a bad thing. It's become much less of a stigma which leads to less shame which leads to more people being willing to address their own mental health. It's not a cure all or anything, but it is a great first step.
posted by Samizdata at 3:42 PM on November 16, 2018 [1 favorite]


I loved this article, thank you. I think the western ideal of professional boundaries are not helping people seeking care. I know the indigenous mental health community has been focusing on the community and traditional care which falls far outside what current western psychological care looks like. A criticism of this approach though, is that like most pyschology it treats the individual, but does not include the community/support system. Pyschologists may say: “build your support network, join a curling club!”, but they don’t take an active role in creating those community organizations or personally connecting the people in their care with such organizations (very difficult to walk into a room where everyone knows everyone else when you are alsready feeling vulnerable). Nor do they reach out or meet with other caregivers or people that care for the person they are also trying to help.

This issue of professional boundaries is a huge one, hampered by the billing and liability issue. Handled poorly, it can also set up power imbalances that can be devestating, or result in the professional never having a life outside of co-dependent service to the people they care for.
posted by saucysault at 4:21 PM on November 16, 2018 [12 favorites]


I have posted this in more than a few comments, and will keep posting it: How not to commit suicide. We need you here, every one of you, in this heartless world.
posted by theora55 at 4:44 PM on November 16, 2018 [15 favorites]


What did for my best friend last year was the deadly triad of depression, alcohol, and firearms. People tell you not to blame yourself, but I wish I had tried harder to persuade him to let his brother keep his guns or something like that. I probably talked him into living maybe another 6 months, at least.

It’s very, very easy to weigh the pros/cons of continuing to struggle through it and determine that your best option is to simply check-out.

I see a lot of this "depression lies!" idea here, but my friend did have some pretty rough circumstances that he was in despair about: advancing age, poverty, medical debt, declining health that made working at a job that would get him out of the poverty unlikely. I don't know how effective is the idea that everything is fine, and the problem is that your illness makes you see life in a distorted way, when everything is not fine.

I have always been angry at people who rush to moralize and stigmatize suicides as cowardly or selfish. That's just so ignorant and lacing in basic compassion for people who are tired of fighting terrible pain. People who fought it until they could do so no longer. Being a survivor is challenging in many ways, and one of them was that it was hard to keep up that sense of compassion. My friend left his wife pretty well screwed, for example, and I felt angry at him for that at times. Angry that he didn't try more resources for help, but I think he talked himself into thinking that it was hopeless due to his other medical debts. Probably some of the idiotic male stubbornness and pride preventing him from asking for help too (not that I am clear of that either). A little more than a year later, that stage seems to be over, and I'm just left with a deep sadness. The aftermath of suicide is just terrible for loved ones; please take care of yourselves and each other!
posted by thelonius at 5:05 PM on November 16, 2018 [47 favorites]


Lots of people are out there walking around, contemplating suicide. It's impossible to know who, but I figure I see enough people that surely I interact with at least one person a day who is walking that edge. Sometimes it just takes a small push either way. So it's good to just try and be kind—so that when you meet that person, all unknowing, you can at least know that you nudged them toward life.
posted by Anticipation Of A New Lover's Arrival, The at 6:26 PM on November 16, 2018 [13 favorites]


I see a lot of this "depression lies!" idea here, but my friend did have some pretty rough circumstances that he was in despair about: advancing age, poverty, medical debt, declining health that made working at a job that would get him out of the poverty unlikely. I don't know how effective is the idea that everything is fine, and the problem is that your illness makes you see life in a distorted way, when everything is not fine.

This. Treating an older adult who's life is diminishing and they know it like a teenager who just had their first breakup is condescending and not helpful. Some people do have fairly intractable problems and the total lack of social services in the US compounds that.
posted by fshgrl at 12:14 AM on November 17, 2018 [25 favorites]


Yeah, the absolute worst feeling is when no one will take you seriously because “depression lies.”

I’m like, fuck you, my loan provider doesn’t lie, and they tell me I owe more than I make in a year, is that “depression lying,” too?

I think that’s the hardest thing of all. Feeling like you’re not allowed any dignity.
posted by shapes that haunt the dusk at 1:56 AM on November 17, 2018 [21 favorites]


We have so many evidence-backed solutions to some of our biggest problems, but one of the biggest problems to implementing them is home-spun, often conservative, ideas about human nature.

I often think about the suicide barrier debate for historic bridges and the Duke Ellington Bridge in Washington, DC. Duke Ellington Bridge is about a 6 minute walk from an identical bridge -- the less romantically named Taft Bridge. There are suicide barriers on the Ellington Bridge and none on the Taft, and yet the Ellington Bridge barriers have been successful in lowering the suicide rate in the region.

The solutions for at least making a statistically significant dent in our problems are simple, but having the will to implement them is not. Someone will always argue "they'll just find another way," or some other hokey, home-spun idea that doesn't bear out in the research.

I often also think about how many mass murders are just suicides that want to have a headline attached. If we can have the societal will to make a dent in the problem of suicide, we are halfway to solving the mass murder crisis as well. The ease of access to guns is no different than the romantic ease of jumping off a historic bridge, sometimes an unintuitively small intervention can prevent big tragedy.
posted by Skwirl at 4:23 AM on November 17, 2018 [10 favorites]


My sister killed herself, 20 years ago this year, and suicide has struck multiple generations of my family. It hasn't gotten much easier, but it's definitely made me open to talking to people who need to have an ear. I think subconsciously I feel as if I couldn't help my sister, so maybe I can help others.

Somewhat connectedly, I have a job that results in a ton of strangers following my Instagram feed. I've recently stopped being shy about talking about my sister. On siblings day and suicide awareness day I'll put up a pic or two of she and I and talk a little about it. I'm consistently surprised at how many friends and coworkers are in similar situations, and it's those pics that prompted them to talk about it.

When Anthony Bourdain did his thing this past year, I had a pic of him where I work from last year. I put it up, talked about my sister and uncle and grandmother and simply said "here's a hotline number, my DMs are open if you need someone to talk to." I was surprised at the number of people - total strangers, every one - I heard from. I chatted with all of them for months, until one by one they seemed to stabilize and drop away. They all said various versions of "it really meant a lot to have a stranger say "Hey, I'm here, you can talk to me, I've seen some of this." The fact that I was a stranger seemed to matter too. It's certainly been an interesting year.
posted by nevercalm at 4:45 AM on November 17, 2018 [35 favorites]


I've often struggled with, but never acted on, suicidal thoughts, and yeah some of it is isolation but some of it is definitely living in a country that says fuck you if you are poor or get sick, we don't care if you die. After awhile you start to think, maybe it would just be easier to get out before things get worse.

I wouldn't do that to my kiddo, though, and that's my main argument that keeps me taking my meds. But sometimes I just get so tired and afraid. I can understand not wanting to feel that way anymore. The national suicide rate doesn't surprise me.
posted by emjaybee at 8:30 AM on November 17, 2018 [7 favorites]


Best gift my counselor ever gave me was permission to go to my “worst place” on the promise that I would call her and let her take over my will to live after I’d completely lost the ability to maintain it myself.

In practicality that meant if I was “there” I would call her, she would call me back, and I would wait for her and paramedics and cops to arrive to take me to a hospital. I knew what “her taking over my will to live” meant in reality, and it was scary as fuck. But having permission to completely fall apart and give up gave me the courage to see myself through that inner black hole and come out on the other side all glowed up like a brand new star.

My last session with her after 4 years was last week because I’m moving to Seattle in 9 days. I haven’t cried yet, but I’m gonna because she literally saved my fucking life.

Also, metafilter, you helped keep me alive too. Thank to everyone who has been checking in with me since I posted on ask over the summer asking for help.
posted by nikaspark at 8:32 AM on November 17, 2018 [23 favorites]


That's fascinating, nikaspark. Reminds me what I was reading in Michael Pollan's new book, and in the literature, about psychedelics being used to treat depression. That many patients experience something dark or scary during their trip and are told to go towards it, be curious about it, not to resist it in any way. When participants do this, what started out feeling like a bad trip transforms into a revelatory experience, specific to each participant's particular situation, where they face their fear/trauma/etc., and come out the other side with a different perspective and the depression is gone. It sounds like you had a similar experience, minus the chemical aid.
posted by antinomia at 4:17 PM on November 17, 2018 [1 favorite]


I think that we can't ignore the real difficulties of implementing this approach--a treatment modality that requires no boundaries of time for the provider is not going to be able to retain more than a few insanely-committed providers. Writing the letters/sending the texts, relatively easy to implement. Being available within an hour to answer any text from a suicidal person? Quite different. It's all very well to say that boundaries in treatment are a Western concept but I doubt there's a culture in the world where treatment providers are expected to have that much availability over the long run.
posted by praemunire at 12:46 PM on November 18, 2018


praemunire, that is the modality of midwifery in Ontario. Midwives have a set caseload (somewhat skewed that if they have high-needs clients they have less clients but are paid the same) and a set salary from their clinic. They are on-call a lot, but they also control their own time to compensate for appointments that may take hours, or a labour that lasts a long time. They set boundaries with their clients (contact me in an emergency ... and then define what is NOT an emergency to avoid 2am txts asking if tuna is okay to eat). They also have a secondary midwife (that also has appointments with the client) who shares the load so when they are off-call they are REALLY off-call. It definately requires someone who can be flexible and ideally they work less than 40 hours a week to compensate (as well as getting two months off a year). It also needs to be paid fairly. So, it can work if it is a priority for the funding body/society - but honestly, I think we know what the priorities really are.
posted by saucysault at 3:04 PM on November 18, 2018 [2 favorites]


Having on-call rotations where you might need to give someone some nutritional advice is not the same as being expected to respond to a suicidal person's text within a relatively short period of time during waking hours (which is totally incompatible with working less than forty hours a week and being off two months a year). You can see very clearly from the way the article describes the practitioner's lifestyle that it's a recipe for burnout.
posted by praemunire at 7:00 PM on November 18, 2018 [1 favorite]


Having on-call rotations where you might need to give someone some nutritional advice

...ummm, that isn’t what midwifery is? Pregnancy can be a life-threatening condition, both physically and mentally (the hormones really affect some pregwnant people severely). In addition, pregnancy is one of the most dangerous times for intimate partner violence. So midwives respond to psychosis, to people needing immediate escape from dangerous situations, to someone bleeding out, as well as the usual being on call to actually catch the baby, whenever it chooses to come (which, again, much like a sucidal txt, is very much a life or death situation).
posted by saucysault at 7:32 PM on November 18, 2018


I'm more and more uncomfortable with drawing parallels between mental and medical health treatment. I'm not saying it isn't helpful in some ways to think of mental illness as genuine illness, and I love Maria Bamford's thing about "what if we talked about physical health the way we talk about mental health -- sure Bob has cancer, but he needs to suck it up like the rest of us do."

But I think that really has more to do with society than with how my treatment should actually look. In other words, yeah, it's great to think of mental illness and remind myself that I'm not a failure, that I'm dealing with real problems. But the parallels really end there, as far as I'm concerned.

Mental illness is not a simple matter of brain chemistry, or of life circumstances, or of any single thing or combination of things that can be easily understood across whole populations. I think there are real problems with treating desperate and unhappy people as if they're sick. If someone is sick, we're that much more likely to ignore that maybe they're dealing with something objectively difficult, or maybe they're not in the right situation. I think even compassionate views of mental illness are often still built on the same foundation that saw, say, suicidal people as moral failures. "Pull your shit together" has something in common with "things aren't as bad as you think, you're just not able to see that right now."

I understand that there are practical difficulties in treating large numbers of people, but I also wonder if a lot of mental health treatment is built on a flawed foundation that tries to handle desperation and unhappiness the same way you handle a broken bone or a root canal -- hours billed to insurance, providers on call at certain times, that sort of thing. An alternative may not be possible, but that doesn't mean what we have now is the best approach.

I appreciate what the person in TFA is trying to do, because that feels like a truly different approach. I get why that has its own difficulties, but it's saving people's lives. I've been dealing with this stuff since I was 6, and I still haven't found treatment that helped. I've spent the majority of my life feeling like a patient, and it would be nice if I could be treated differently for a change. At the very least, it would be nice to feel like I had more to offer than billable hours. I don't mean to sound too cynical, but I hope it's also clear why I might feel this way.
posted by shapes that haunt the dusk at 1:29 AM on November 19, 2018 [3 favorites]


@praemunire: I agree with you that it's not something that scales. I paid out of pocket a lot of money (and some weeks I prioritized paying her over eating 3 meals a day in order to be able to afford her). She is specifically focused on trans and queer people. I don't have any answers that are going to work the world over.
posted by nikaspark at 3:55 PM on November 19, 2018


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