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An Honest Discussion About Mental Illness and Suicide

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Sally Littlefield lives with schizoaffective disorder (a combination of schizophrenia and a mood disorder, in her case bipolar). She wrote this piece with her mom, Sophie Littlefield.

Sophie: We know that suicide is a serious problem among people living with serious mental illness. Can you give a sense of the numbers?

Sally: Suicide is the second leading cause of death among people aged 10–34 in the United States and 46% of people who die by suicide had a diagnosed mental health condition.

Sophie: Did you ever consider ending your life, before or after you were diagnosed?

Sally: I wouldn’t say I actively considered suicide, but I “get it.” The statistics about schizophrenia and suicide are particularly grim. 40% of people living with schizophrenia attempt suicide, and 15% die by suicide. A risk factor for suicidality is thriving right before your diagnosis, as I was.

Because of my disorder, my career was derailed, I had to move back in with my parents, and I lost contact with all my friends for nine months. After I came out of psychosis, it was an additional nine months before I was able to return to work full-time. That was the most difficult period of my life.

Sophie: What is it about the experience of serious mental illness that you think leads people to decide to end their lives?

Sally: For me personally, my symptoms alone definitely did not make me want to end my life. My delusions and hallucinations were often happy and fun, and I never thought about suicide at all during the nine months I was experiencing psychosis. And once I found the right combination of medications, I’ve been completely symptom-free for the past several months.

While I know that I’m one of the lucky ones since many people with schizophrenia experience much more unbearable symptoms — sometimes even when they’re on appropriate medication — I still think that the hands-down worst part about having schizophrenia is the stigma.

Even though I was able to get my disorder completely under control, the label of schizophrenia still made me feel unworthy of life at times. I’ve personally encountered people who have explicitly told me I should have fewer rights — that I should sign away my assets, for example — solely because I experienced a psychotic episode, despite the fact that I’m symptom-free. It’s hard to feel worthy of your own humanity in the face of treatment like that.

Sophie: Long before the onset of your illness, a number of family friends ended their own lives. How did that experience affect your understanding of suicide?

Sally: When I was exposed to suicide for the first time at a young age, I made a promise to myself that I would never end my own life because I knew it would destroy my parents and brother. However, when I first came out of psychosis and began to understand that I had schizophrenia, I came to feel that I genuinely did not want to live if my self-hatred, internalized stigma and symptoms didn’t get better.

Thanks to the history and prevalence of severe mental illness in my family, I knew that disorders like this can get better with treatment. I also knew on some level, even if I wasn’t able to completely internalize it, that my illness was a disability and nothing to be ashamed of. I would never judge a family member for having a mental health disability, so I worked hard not to judge myself.

It was a long road to get to a place of self-acceptance, and for the first several months after I came out of psychosis, I survived by numbing with substances and emotionally dissociating from the conditions of my life. However, with time it’s gotten a lot better, and I’m so glad I chose to continue my life.

Sophie: One thing that frustrated me in the days following our friends’ deaths was hearing people call the act “selfish.” I feel like those who’ve never experienced suicidal ideation may not be able to appreciate the pain that drives such a decision.

Sally: I think that a lot of times suicidal ideation is driven by self-hatred and the idea that the world would be a better place without you. I think people who experience that kind of ideation view their own suicides as selfless, not selfish, as they think they’re improving the world by leaving it. Having witnessed the aftermath of those suicides before the onset of my disorder, I’d come to believe that suicide always devastates the families and communities that experience it. This made me appreciate that as much as I hated myself, my suicide would still hurt others.

Sophie: There are other ways in which suicide is misunderstood in our culture, among them the unhelpful notion of mentally ill people being “too beautiful for this world.” Artists living with mental illness in particular are especially vulnerable to the suggestion that their creativity somehow led to their suicides, as in the deaths of Hunter S. Thompson, Zelda Fitzgerald and David Foster Wallace.

Poet Anne Sexton’s death is described in a biography in a romanticized way. And of course Van Gogh’s severing of his ear preceding his suicide is an enduring image in our culture. There seems to be a temptation to create a poignant composition around an artist’s suicide.

Sally: I do think it’s important to remember the beauty and positive traits of people who die by suicide, but it’s problematic to think of the act of suicide in and of itself as beautiful.

Sophie: From a mother’s perspective, the thought of losing a child to suicide is nearly unbearable. I have found it helpful to learn everything I can about the subject, but in the end I must also accept that you and your brother are on your own paths, over which I have no control.

Sally: Because our family was confronted with suicide when I was growing up, I was able to forge a picture of how you might react to my death, and it made me decide that I would exhaust all my possible options — including reckless behavior, substance use, and other “quick fixes” –before making the decision to end my life.

It’s extremely important to remember that suicide is not the fault of those who love them. I’ve had friends who are professional caretakers whose clients have ended their lives, and I’ve seen how much guilt they feel about it. But it’s not their fault. Like many illnesses, mental illness can sometimes be fatal. It’s tragic, but it doesn’t do any good to blame oneself.

Sophie: How can families find a common language to discuss suicide?

Sally: This is a topic that many families want to avoid at all costs because it’s so sad and can be so triggering. However, our family was unable to avoid the topic of suicide, and I honestly think our open conversations about it are a large part of the reason I decided that I would never kill myself. Because we talked about how suicide affects us all, I understood that even if I felt unlovable, those who loved me would be devastated by my death.

I think being honest, open and vulnerable is the best way to go. Talking about suicides you’ve experienced and how they affected you can make a huge difference, even if it was a suicide in the news or someone you didn’t know personally.

Sophie: It seems fitting to close with the first few lines from Anne Sexton’s poem “Wanting to Die.”

Since you ask, most days I cannot remember.
I walk in my clothing, unmarked by that voyage.
Then the almost unnameable lust returns.

Even then I have nothing against life.
I know well the grass blades you mention,
the furniture you have placed under the sun.

But suicides have a special language.
Like carpenters they want to know which tools.
They never ask why build.

Sally Littlefield graduated with honors from U.C. Berkeley and began a career in the nonprofit sector before experiencing the onset of schizoaffective disorder. She has since returned to a full time position in a non-profit organization and uses her lived experience to educate, support, and advocate for others experiencing serious mental illness.

Sophie Littlefield is the author of over twenty novels in several genres.

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Getty image via Matthias Lindner

Originally published: February 19, 2021
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