Therapists, Suicide, & Stigma: My Story

Written by on September 10, 2021 in All Posts with 15 Comments

Photo by Rafael Leão on Unsplash

A phone call at three in the morning comes as a siren, especially when you work at a crisis hotline. I was alone. Newly awakened, lying in a pull-down Murphy bed in the university counseling center, I pressed the phone against my ear.

“I have a bottle of pills, and I want to take them now. I want to die.” Sobs punctuated the caller’s words.

“You must really be hurting,” I said. “Can you tell me more about what’s going on?”

The caller was a graduate student in a counseling field. After struggling with depression for months, she condemned her goal of becoming a therapist as absurd. How could she help others who had mental health problems when she suffered so many herself?

The pain she felt now could be a gift later, once she was a therapist, I told her. It could help her understand, empathize, and be fully present with clients who want to die.

More sobs. More snuffling into the phone. “You really believe that?”

As a graduate student in social work, I had to believe it. Only a year earlier, in 1996, I’d also wept in my apartment late at night, tormented by the thoughts drumming inside my head: People would be better off without me. Things will never get better. Nobody could ever love me like this.

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  1. JS says:

    I would like to comment on the following statement from your article:

    “I see parallels to LGBTQ+ people coming out of the closet.”

    While I agree that there is a parallel, it seems to be limited to what people will think of you – principally your colleagues. This is , of course, understandable;
    but as you stated, your job was secure, so it really boiled down to anticipating potentially negative responses from others. I am not downplaying this in any way, as it can cause formidable psychological harm in and of itself, but merely pointing out that the coming out process for LGBTQ individuals is much more complex than that.

    I can only speak from my experience: I agree that the anticipation of response from others, i.e. colleagues, co-workers, strangers, and (especially) family was sheer hell; the anxiety this produces is nigh-unbearable at times. The problem , for me, is that it did not get better upon revealing my truth, and I came to regret it for a long period of time.

    As someone who is both LGBTQ and suffers from anxiety and depression with suicidal ideation I would like to revisit some of my experiences as a kind of compare and contrast exercise:

    1) Family – when my family became aware of my anxiety/depression issues (and they became aware due to a “forced” hospitalization, there’s no hiding it after that), nothing really changed. Business as usual, with an acceptable explanation for my moodiness. In contrast, when I came out of the closet, everything changed – one (important) member, upon being told, got a look of what can only be described as horror upon their face, turned and went into another room, slamming the door practically in my face. We did not speak for some time after that. Ultimately, the family dynamics fractured, with some members not speaking or having contact with others for 20+ years.

    2) Home – I met someone, who eventually became my husband (of course, we had to wait until 9 strangers on a court deemed it acceptable to society that we be allowed the right to marry; a right that most people take for granted) and we bought a home together (another step in the coming out process). 2 men living together were pretty obviously a gay couple, and one day upon arriving home from work, I was greeted by a neighbor with “Fa**ot” shouted quite loudly. Shortly thereafter, my vehicle was vandalized, with all the evidence indicative of the vandalism originating from said neighbors property (things were thrown).

    3) Protection – early in our relationship, my partner and I had a talk (maybe the talk) about what to do in the event of an aggressor and/or outright assault. I told him that he is to run, to get away and try to get help, but he said he would stay. I replied that that could get us both hurt or killed; I will fight, and hold them off as long as I can, but I need to not be worrying about you at the same time, so run. This is not a conversation I ever thought I’d have to have, but this something out sexual minorities have to think about and should prepare for.

    4) Religion – simply put, due to enormous religious intolerance, I feel like I’ve lost my religion, and I’m not sure what I believe or not believe anymore. This didn’t happen when dealing with anxiety and depression prior to coming out, but the aftermath of the process just completely destroyed organized religion for me, leaving me to question what is left, if anything. I still don’t know.

    As you can see, I touched upon 4 aspects of my life, 2 (Family & Religion) with comparisons between being out with mental health issues and being out as LGBTQ and 2 without (Home & Protection). The 2 without comparisons are because being out with anxiety/depression had no major impact on those particular areas of my life, while being out as a gay man did. The point here is that while there is a parallel, it is a limited one at best. Just to give one more example, I was not forced into the hospital because of my sexuality, but because of my depression. It can be argued that one precipitated the other, but they are ultimately separate and distinct parts of being. One cannot be hospitalized for being gay, but can for serious enough depression.

    On a side note, Harvey Milk was wrong: the more people come out as, well, any minority, really, the more prejudice and violence and othering seem to come to the surface in response. The last few years have been a prime example – minority assaults are, and have been, on the increase for some time now.

    Please excuse this if it reads as some disjointed ramblings, I wasn’t going to post again, but I am home sick from work and bored and well, you get the idea.

  2. Temple Cloud says:

    Dear Stacey,

    Thank you for being so honest, and I hope this helps many people. So many people seem to assume that the world is divided into suicidal people who want to die (with the implication that this is a permanent, unchanging part of someone’s personality, like sexual orientation), and non-suicidal people who are intolerant fascists for trying to encourage them to live. You, and many of us who have had suicidal thoughts, know that life isn’t that simple, and that our feelings can change from one day or hour to the next.

    As someone with mental health problems who has tried training as a mental health nurse and gave up because I couldn’t cope with the stress, tried working in a care home and gave it up because I couldn’t cope with the stress, and since then have been turned down even for voluntary work, I am impressed that you have managed to keep on with your work and helped many other people.

    However, as a patient (and as an autistic person who sometimes tends to think in exaggerated, black-and-white terms), I must admit that I sometimes find the concept of the Wounded Healer – in distinction to the Scarred Healer – rather alarming. If I look to therapists to be role models who can say, ‘I’ve felt the way you do, but I’ve managed to recover and find hope, and so can you,’ then I’m frightened by the idea that their real message might be, ‘Nobody ever gets better, I still hate myself and want to die, but I’m forcing myself to stay pointlessly alive, and so can you.’ I’m sure this ISN’T meant to be the message, but it is how it sometimes sounds. Recently, I considered getting in touch with a therapist and author who lives locally and who had written an autobiography about her teenage struggles with anorexia and obsessive thinking, but I was frightened off by the way that her autobiography frequently repeated the mantra ‘life hurts’. I thought, ‘If it isn’t that problems hurt and we need to find ways to overcome them, but that being alive is always, inescapably, constantly painful, then does her being still alive mean she’s a masochist? Does her being a doctor and keeping other people alive mean she’s also a sadist?’

    When we suffer physical illness or injury, we expect that, most of the time, we will get better (sometimes with the aid of medication or surgery, sometimes without), or that, if we have a permanent illness or disability, there are often ways of managing it (for example, I have epilepsy, but am on a medication that works, and haven’t had a seizure for the past thirteen years; I am also slightly short-sighted, and see the world much more clearly when I wear glasses). Part of the reason that mental suffering is harder to escape from is that it becomes part of the way that other people define us (as with the prejudice you described in your article), but I suspect that another part of the problem is that it sometimes becomes part of the way we define ourselves. It wouldn’t be rational for me to tell myself, ‘Having seizures is what I do, therefore offering me anticonvulsants is a conspiracy to force me to conform to society’s norms,’ or, ‘The world looks blurred without my glasses, therefore it IS blurred, and glasses are a lie.’ My mother and my uncle have both undergone treatment for cancer in the last few years, and it would have been very irresponsible for their doctors just to say, ‘Cancer is part of you, it’s what makes you yourself, and you need to learn to love and accept it,’ instead of explaining options like chemotherapy and surgery. But when I suffer depression, I feel that it must be true that I am worthless and evil and God hates me, and when I talk to counsellors about delusional beliefs or feelings of self-hatred and self-destruction, all too often the counsellors have said, ‘Well, if that’s what you believe, then it’s right for you,’ or, ‘Well, these feelings of self-hatred and self-destruction are part of you, and in time you’ll learn to love them.’

    So yes, we need people, including therapists, to be able to be open about their own problems. But patients like me also need a reason for hope, as well as empathy. I was struck by the line you quoted, ‘As we are liberated from our own fear, our presence automatically liberates others.’ I got the impression that you were talking primarily about fear of speaking openly about depression, but I think the same applies to being liberated from fear of living.

    • Stacey Freedenthal, PhD, LCSW says:

      Temple,

      You make so many good points that I’m not sure where to begin.

      First, let me say thank you for your kind words. It took me many years to be so honest. I’ve seen such honesty help others, as I note in the article, and it also helps me to be able to live more authentically.

      I also appreciate how you depicted the false dichotomy among suicide prevention critics of people who unchangeably want to die and “non-suicidal people who are intolerant fascists for trying to encourage them to live.” Naively, I was stunned at first when people viewed me so negatively because of my work in suicide prevention. You’re right that these rigid categorizations are overly simple and rigid.

      What most stands out for me is your observation about wounded vs. scarred healers. This is a very important distinction, and I wish I’d thought to make it in my essay. I obviously believe that lived experience of suicidality can deepen empathy and understanding in others, but if the helper isn’t able to tap into their own healing and hope, then they risk doing harm to someone who is suffering. I hope I didn’t say anything in my essay to indicate “Nobody ever gets better, I still hate myself and want to die, but I’m forcing myself to stay pointlessly alive, and so can you.” I don’t think that was your takeaway, especially since you said that’s not the message overall, but perhaps I could’ve paid more attention to recovery and hope.

      It hurts me to read that when you’ve shared with counselors your depression’s edicts that you are worthless and evil, they’ve responded with “Well, if that’s what you believe, then it’s right for you,” or, “Well, these feelings of self-hatred and self-destruction are part of you, and in time you’ll learn to love them.” Those aren’t constructive messages!

      My hope for you is that you’ll either be able to challenge those thoughts – talk back to them and assert your innate goodness – or, if you’re not able to change them, then to observe them without buying into them. For example, it helps some people to say, “That’s my depression talking, that’s not truth” or “There go those negative thoughts again.” I know, this sounds both overly simple and easier said than done, but with practice, it can help disarm the depressive thoughts of their power. In acceptance and commitment therapy, this is considered “cognitive defusion.” Acceptance in this context doesn’t mean giving up trying to feel better or loving what causes you pain. Rather, it means to stop trying to get rid of thoughts and feelings and, instead, to relate differently, and less painfully, to them.

      If you’re interested, a good book for trying to talk back to and change such thoughts is The Suicidal Thoughts Workbook, by Kathryn Gordon. To learn and practice skills around observing and detaching from thoughts, I recommend the ACT book Get Out of Your Mind and Into Your Life, by Steven Hayes.

      Thank you for sharing, here and elsewhere on the site!

  3. Steven says:

    I was on that chat line for the national suicide hot line. Just expressing some depression over a health issue I was going through at the time. I stopped the chat and thought it was over.
    About an hour and a half later the police forced entry into my home.
    Saying they were concerned about something I texted on line?? Really
    . texted on line to 741..
    My god.. I almost shot these officers doing their job responding to a crisis call that was not a crisis. They rushed into my house.
    This text counselors clearly over reacted.. And people could have died..

    • ES. says:

      I’m really sorry that happened to you. I constantly tell people, at least in the U.S.A., if we disclose SI (suicidal ideation) or other SH (self harm) to a crisis hotline counselor, we must complete a crisis plan to avoid a welfare check or psychiatric hospitalization. Do not end the conversation early! A crisis plan identifies things we can do other than harming yourself or making a suicide attempt. When our plan is unfinished, we don’t have a plan to take alternate actions other than harm ourselves. You discontinued your conversation halfway through so your crisis plan wasn’t finished. Hotline counselors, at least at all the traditional coercive hotlines and peer warm lines that I’m familiar with, are not allowed to reach out to you again so that you’ll finish your crisis plan and avoid a welfare check. You didn’t finish your crisis plan, so you still fit the definition of “imminent risk” of harm, even if you have no intention of acting on your SI. A supervising mental health professional that works for the hotline decided that you met the criteria for a welfare check and virtually anyone will with an unfinished crisis plan,

      When crisis hotlines first started, they were just neighbors helping neighbors. Nowadays there’s always a supervisor that is a licensed mental health professional. It’s about as closely connected as you can get to the mental health system.

      An unfinished crisis plan for SI/SH is a guaranteed welfare check by the police. Which is exactly the opposite of how we should be responding!

      Read more about the concept of imminent risk in the best practices section of the national suicide prevention lifeline‘s website . So many people feel betrayed when a welfare check happens. This is a huge part of the problem because then we say I will never use a crisis hotline again. 99,9% of crisis hotlines and peer warm lines are coercive and will do welfare checks. There are very few non-coercive crisis intervention options out there that refuse to involve the authorities.

      I encourage people to use their non-coercive crisis intervention options instead. One is the wildflower alliance peer support line, formally called the western Massachusetts recovery learning center’s peer support line. You do not have to live in Massachusetts to use them. Go onto their website to find their latest hours of operation.

      Another is the IPS suicide prevention group (based on IPS intentional peer support model.) More details are in an article on Mad is America called deadly serious.
      https://www.madinamerica.com/2018/08/deadly-serious-talking-openly-suicide/

      Unfortunately, the reality is, as soon as we tell another human being (as opposed to telling it to a pet or writing it in a journal), we are at risk of receiving a response that we find unhelpful or harmful.

      If we don’t make it safe for people to disclose SI and we always fear a welfare check or psychiatric hospitalization, we won’t disclose it. It then becomes harder for people to cope and more people attempt suicide or die by suicide

      • Nah says:

        That article is, IMO, biased anti-psychiatry, playing on the false narrative of “the mainstream practice of reporting, detaining and drugging”. That’s fear mongering.

        There is a very low rate of crisis calls leading to any physical intervention; it doesn’t happen in 90+% of crisis calls.

        It paints a misleading picture of therapy and treatment and generalizes from a personal perspective.

        It’s valid to feel upset by personal experiences, or to hope for alternatives and change to crisis services, or to support peer services. But again I believe the article link is misleading and wrong to discourage use of crisis lines.

        I hope Ms. Freedenthal will read and comment or consider to remove the link entirely.

        • Stacey Freedenthal, PhD, LCSW says:

          Nah,

          Thanks for bringing this to my attention. I understand your concern that the article discourages the use of crisis lines and thus could lead to people choosing not to seek help. I share that concern, but I also think people have the right to know the risks of calling a hotline, if they want to avoid having the police come to their home. I don’t know about the figure you cite indicating that in 90% of hotline calls, the counselor doesn’t call the authorities. I do know that figure drops considerably when the counselor judges the caller to be at imminent risk for suicide: this study of callers to the National Suicide Prevention Lifeline found that the counselor called the police in almost half of cases (46.8%) where suicide seemed imminent. In 60% of the cases where the police were called, it was without the caller’s consent.

          I wish this weren’t true, but sometimes when the police are called, terrible trauma ensues. One study looked at the 2,000 fatal police shootings that occurred in 2015 & 2016. In 25% of cases, the person killed by police had a mental illness, and in 40% of those cases, the shooting occurred after a family member or friend called 911 requesting help. Of course, police shootings are the worst case scenario, but being taken away by the police against one’s will, even without any injuries, can be traumatic. That trauma often is outweighed by the need to protect a person from dying by suicide, but I don’t think we can say it always is; sometimes, the police are called when less invasive measures would have been fine. (This article gives a keen example of someone who was traumatized in this way, though the call was initiated by their therapist, not by a hotline. The article isn’t available online, so please email me at speakingofsuicide@gmail.com if you’d like me to send you a copy.)

          People need information about the risks and benefits of any kind of service in order to make an informed decision about whether to use it. I still think people should call the National Suicide Prevention Lifeline at 800-273-8255 if they need help. Nobody should have to struggle with suicidal thoughts alone, and research indicates the crisis hotlines help many people.

          As the commenter above states, if someone calls the hotline and participates in creating a safety plan, that ought to allay the counselor of concerns about their immediate danger and almost certainly will result in the police not being called. The study I cited earlier states that in 44% of cases where the hotline counselor thought a caller was at imminent risk for suicide, they created a safety plan with the caller and didn’t call 911. So the earlier commenter’s advice to stay engaged long enough to create a safety plan seems like wise advice.

      • lee says:

        This was many many years ago but I called a suicide line. I had been calling but feared saying anything precisely because I was afraid they would trace the call and call police. This time I told her I had taken some action and her reply was “youve called here before havent you” in what sounded like an accusatory tone. I immediately hung up. That one time has put me off calling them in times of crisis, Even though it was long ago. I wonder how trustworthy much less empathetic the folks who do give of their time to do this work, are

        • Stacey Freedenthal, PhD, LCSW says:

          Lee,

          Thanks for sharing your experience. As is true in so many places, the quality, style, approach, etc. of counselors at the hotline – and elsewhere – can vary. I always recommend to people that if they don’t like how one counselor worked with them, to please try again (and again, and again…as necessary) because the next one might be a great match. I do know many people who have been helped by calling the National Suicide Prevention Lifeline and other hotlines, so if you do need that again in the future, I hope you’ll consider it.

  4. Paul says:

    Many of us who have sought help in the past will not be surprised at all at the attitudes you’ve encountered from people in your industry. Dealing with that, you should understand why many think we’re better off without that kind of “help” entirely.

    A better system is required to remove the bad practitioners IMHO, those who impose those stigmas. It’s as simple as that. If you found out someone in your circle was a Nazi and attended pro-Hitler rallies every Sunday, would you assume you needed to win them over or would you remove them from your circle? A mental health professional who does not respect the types of people they are supposed to treat is more along the lines of that. They don’t need to be convinced. They need to go.

    What I’ve gathered from talking with other depressed people is that problems from the patient POV are nearly always related to the attitude or lack of follow up from the practitioner, rarely the meds or techniques. And this comes down to what you observed, that the respect and empathy really isn’t there in many cases. We’re not regarded as adults who can have independent, intelligent thought.

    But this kind of talk never leaves the depression forums. Sure, you can make these observations and people will listen, because you’re now a respected member of society regardless of what your past is. And that’s good. But those of us who remain over here are “unreliable narrators”. If you were to show this post to people you worked with they’d almost certainly speculate on my mental state and judgement, given what this site is, rather than take the words seriously.

    All this results in a situation where no-one whose opinion matters ever asks if a specific mental health professional is the problem, and if they should really be practicing or not.

    I’m not sure the issue of attitude is ever going to get fixed, as you can’t truly teach grown people to respect someone who they have always felt contempt for. My real hope is that one day the meds will become so good that the human element in mental health treatment will be removed or severely reduced. Science and tech has treated us pretty well in other areas, so who knows?

  5. Todd says:

    I believe that every person has the right to commit suicide. I feel it is not a selfish act but an opportunity for the person to relieve themselves of all the pain and suffering they are feeling. Living sucks and when you have nothing to live for it is the best way out

  6. lee says:

    Thanks Stacey for rewriting this. Im not sure how much it helps (at least me) to know others feel the same way but to put out the information that this is more common then we tend to think, and that ‘professional’ doesnt automatically mean no struggles may well be a new thought for many folks.

  7. Dragon says:

    Oh, Stacey … I know from what you’ve written before about your suicidal feelings but to read them once again brings tears. But it also brings a feeling of joy – that someone so many of us chronically suicidal people look up to can write so well about her feelings gives me hope that maybe we can help just one more person make it through their rough night (or life.)
    At my antique 74, I seldom drop into the depression of “I want to die!” but recently ran through a bout. Once again I’m “on the other side” of that bout but have to wonder how many more I can take … but then at 74, I have to wonder how much more of me I can take.
    At the very end of your beautifully written article you mention a new book in progress (my interpretation), I’d sure like to be able to see that while I still have the mental capability to read and understand it…

    • Stacey Freedenthal, PhD, LCSW says:

      Dragon,

      Thank you for your kind words. I always enjoy getting feedback from you. And I especially am touched by the joy of hope that you describe. So sorry to hear you went through a rough time again, and so glad you made it through. Take care.

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