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Recognising stigma, in all its guises, critical to tackling suicide crisis

In Australia, suicide is the highest cause of death for those aged 15 to 44, and there are growing fears the rate will continue to spiral. Campaigns like this week’s RUOK? Day can play a role in tackling damaging, pervasive stigma around mental health. Jakeb Fair reports.

Recognising stigma, in all its guises, critical to tackling suicide crisis

Stigma - that is, feelings of shame manifesting in a variety of forms - can be a powerful impediment to distressed people finding the help they need, says Dr Alexa Hayley, a psychology lecturer at Deakin University.

Words by Jakeb Fair
 

Warning: The following story discusses issues of trauma, suicide and mental health and may cause distress for some readers.  

“I’ve been thinking lately about cells and suicide,” says Jared*.

“Healthy cells can undergo apoptosis [programmed cell death] when they are weak and are at risk of becoming cancerous. They suicide rather than becoming a disease to the organism.

“What if we’re the cells? What if the world is the host? And what if the ‘cancer’ is mental illness?”

Jared is a medical researcher completing a PhD investigating ovarian cancer. Last year, cell death wasn’t all that preoccupied his mind. He was plagued with thoughts about killing himself.

Image: Ian Espinosa/Unsplash

Image: Ian Espinosa/Unsplash

In Australia, suicide is the highest cause of death for those aged 15 to 44, third highest if you are 45-64, according to statistics collected by the Australian Institute of Health and Welfare. The ABS analysis says “mood disorders” including depression are the highest reason for suicide across all ages.

There are fears that suicide rates in Australia may escalate even further. New research on behalf of Suicide Australia, published this week, warns that it could spiral up 40 per cent in the next decade unless risk factors such as debt, isolation and loneliness are addressed.

World Health Organisation figures track the global toll of suicide at 800,000 lives a year – that’s one death every 40 seconds. Stigma plays some part in many of these statistics, says Dr Alexa Hayley, a psychology lecturer at Deakin University. She blames stigma – that is, feelings of shame manifesting in a variety of forms – for preventing vulnerable people from seeking help when they experience suicidal thoughts.

She highlights and defines three types of stigma as key stumbling blocks that inhibit people who may be at risk accessing the support they need: self stigma; public stigma, and structural/systemic stigma. Definitions of each of these, and an exploration of how they can play out, is explored through the case studies below.

Self-stigma: Negative feelings about oneself

One of “the biggest things I didn’t want to do was ask for help, I wanted to deal with it myself cause I’m a 27-year-old man,” says Jared. “Who needs their mum to come take them to the doctor’s? It feels more pathetic asking for help.”

Jared experienced something of a perfect storm in his personal life – a harsh break up, a fracturing in his social life, uncertainty about his future in studying biomedicine – and found himself spinning into depression. His reluctance to seek help reflected hard-wired masculine default settings and his own unforgiving insistence on achieving high standards.

He knew that “something was wrong”, he recalls, but didn’t get help straight away. His brain was caught on a loop where he heard himself repeating a mantra:“I want to die, I want to die, I want to die”.

He became fearful of his own thoughts. He felt trapped, convinced that the only release was to kill himself.

“I felt so low that I couldn’t do anything, I wasn’t adding any value to the world. And so, I was just consuming precious resources and oxygen.”

He laughs now, ruefully. “I just wanted to end myself. I felt like I was bringing more pain and shit to the world than I was any good.”

Many people affected by mental illness fall into this hole of self-loathing, observes mental health advocacy group SANE Australia. Self-stigma emerges when negative stereotypes and prejudices about a particular group of people is internalised. For example, “all people who are at risk of suicide have depression or another mental illness”. In fact, “thoughts of suicide can happen to anyone regardless”, according to Everymind, a national institute focusing on mental health and suicide research and prevention.

People suffering this kind of stigma will generally believe they are weak or abnormal for having these thoughts, becoming even more reluctant  to seek help.

One widely cited 2012 psychological study published in the Canadian Journal of Psychology suggests, however, that there is a flip side to self-stigma, and that is ‘’empowerment’’. The authors argue that for some people, “coming out of the closet’’ with mental illness is associated with decreased negative effects of self-stigmatization.

Dr Hayley reiterates this. “A large part of overcoming stigma is acceptance. Once you accept it, then you have control over it.”

Public stigma: Assumptions society generally holds about suicide.

Public stigma is how a person perceives they are or might be seen by society if their suicidal inclinations become known. So it’s less about self-loathing than fear of judgement by others.

These thoughts have been associated with avoiding access to services for fear they will be seen as weak, unemployable, or worthless.

Many people deal with this kind of stigma by diagnosing themselves as having just a bad day, or a lot of bad days, rather than a serious problem.

Dr Anthony McCosker, associate professor in media and communications at Swinburne University, says that public stigma is one of the reasons “people can’t talk about (suicidal thoughts) with their family or friends”.

He is researching whether there might be opportunities for people to open up about their suicidal thoughts and feelings online, suggesting that “online spaces where people are anonymous” allow individuals to talk about their emotions more freely.

In the past, there has been a reluctance to open up more discussion and confrontation of suicide. There are “fears, that if we talk about suicide, we’ll encourage it”, says McCosker. But a 2014 UK review of literature asking if talking about suicide increases suicidal ideation, found that talking about it doesn’t increase the risk. In fact, it may reduce suicidal ideation and, in some cases, may improve mental health.

More recently, Australia’s Beyond Blue mental health advocacy group commissioned research reassuring people wanting to help friends in distress that asking and talking about suicide did not increase the risk that they would attempt suicide.

The core ambition of RUOK Day, the annual suicide prevention campaign which falls this Thursday, September 12 –  is to break through public stigma by encouraging meaningful conversations that could help prevent suicide.

While the notion that a single day can have a substantial impact has its critics – as one bereaved commentator argued in The Sydney Morning Herald, “the idea that all a chronically ill person needs is a good cuppa and a chat and they’ll be right as rain” signals serious problems in our approach to mental health – McCosker argues that the campaign has its merits. “It gets us in the habit of talking about mentally ill-health.”

A 2014 US study on stigma showed people were often less judgmental than sufferers might believe. Only 3.4 per cent of participants said that if someone got help, they would be seen as weak.

Dr Hayley says public stigma is harmful because a person exposed to assumptions that society holds then uses that to self stigmatise.

Jared recalls that he avoided seeking any help for fear of being seen as weak. That changed, he says, after a family gathering.

Walking to his car with his mother, he “broke down to her” and said, “I think I’m depressed”. She opened her arms and shared more about her own life and struggles as reassurance.

Thanks to a combination of psychology, antidepressants, being closer to family and friends and by acknowledging his triggers, Jared says he’s today “made a full recovery”.

Structural and systemic stigma: Organisations rejecting people based on assumptions of poor mental health.

Sometimes stigma is hard-wired into policy, systems, structures and general community attitudes.

This can occur through policies or legislation that discriminates against a certain population or individuals based on some characteristic that is seen as undesirable, says Deakin’s Alexa Hayley. She cites the example of laws and policies that have historically stigmatised Indigenous populations. “The same with people who have disabilities, mental health, [or] women as a population.”

Indigenous Australians are dying by suicide at twice the rate of the national average. The incidence of suicide by young Indigenous people, including young children, is recognised as being at crisis levels.

Gender is also a risk factor. In Australia, the ABS statistics show that if you are male, you are three times more likely to die by suicide than females.

In his darkest moments both Jared and Hayden Kerger (his case study is shared below), both judged themselves for not being “man enough”. By abiding by the cultural norms of the stoic man, both found difficulty in showing vulnerability to others for fear of being unemployable, or unreliable.

“Health issues are social issues just as much as medical issues,” says Swinburne’s McCosker.

Deakin’s Alexa Hayley cautions that even with personal and professional support, awareness and vigilance are critical. “There is always something around the corner. Speaking from experience, it is important to recognise that this isn’t just a one-off, that mentally ill health can always come back.

“Make use of the resources available to you, and it will be easier to manage the next time it does come back.”

CASE STUDY: FROM VICTIM TO SURVIVOR

Bullied at school, by age 12 Hayden was thinking deeply about suicide and believing that he wasn’t normal, that he wasn’t good enough. Picture: Jakeb Fair

Bullied at school, by age 12 Hayden was thinking deeply about suicide and believing that he wasn’t normal, that he wasn’t good enough. Picture: Jakeb Fair

Hayden Kerger, a recent science graduate from Geelong, has battled with suicidal thoughts from a young age.

Educated at a private boys high school, at the age of 11 he was harassed and bullied. Taunts such as “chinga, chode, faggot” bombarded him daily. Outside of school he was part of a local soccer team. The team was filled with kids from a co-ed college; at that time, his team would call him a range of homophobic slurs, most colourfully “a gay c—”.

By 12, Hayden was thinking deeply about suicide and believing that he wasn’t normal, that he wasn’t good enough, that he might not be man enough.

He never sought help but somehow managed to ride it out. Eventually, the bullying was redirected and he found a network of supportive friends. Looking back, he recognises that despite his vulnerabilities, he also credits himself with finding great strength.

He still struggles at times, but carries an attitude that “everything gets better. It’s not so bad. There are people who have it worse than me.”

*Jared is a pseudonym. 

If you know someone in crisis or needs support, please call Lifeline on 13 11 14 

Anyone between 5-25 can call kids helpline on 1800 55 1800 

For more information on getting help please go to Headspace, ReachOut.com, and BeyondBlue. 

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