The truth about high functioning depression

The truth about high functioning depression

I’m at university. I live away from home. I can cook for myself and wash myself and do most ‘normal’ things. I’m not actively trying to kill myself. So, I guess you could come to the conclusion that at the moment, I have high functioning depression. I am depressed, but I am coping.

The reality is that for me, giving up is the easy part. It’s easy for me to give up, to let go. To take depression and suicidal ideation and everything else by the hand as my old friend. To listen to and feed those thoughts the forefront of my mind, rather than pushing it aside as the nagging little voice at the back of my mind. Because once I drop to a certain point, everything else comes naturally. It is a slippery slope.

Giving in is easy. It’s fighting every single day to hold onto the little life that I have worked so hard for that’s the hard part. Recovery is a greater battle than any relapse I have ever had. It’s exhausting and it’s relentless and it feels like it could slip through my fingers at any second.

I am tired every single hour of the day. Even when I’m happy, even when I’m out with friends, it’s always there. It never goes away. Overthinking one harsh word from someone or taking one tiny little thing as a sign, and I begin to think well, what is the point?

I know in many senses, I’m a lot better than I have been in previous years. But just because I look fine and act fine and even tell other people that I’m fine, doesn’t mean that I actually am fine. Because behind closed doors I’m still thinking about how I could make my death look like an accident so my family wouldn’t hate me for giving in.

I’m giving it all I’ve got, but sometimes I just need to acknowledge the fact that it’s not normal to feel the way that I do, and just because I am coping in some ways doesn’t mean that I don’t deserve to cut myself some lack and realise that I have an illness. 

 

Suicide Awareness Month 2017

Suicide Awareness Month 2017

I want to talk about suicide and I want to talk about it now. By the time you’ve clicked on this link and read this sentence, another person in this world will have taken their own life. So many more will be thinking about it. It takes a lot of pain to make the decision that there’s nothing better than death, and it’s a decision that plays on the minds of a staggering amount of people worldwide everyday. It’s a decision that often ends in tragedy.

People think suicide is selfish. I think this is bullshit. ‘Selfish’ suggests that you’re caring about yourself and yourself only. When you’re suicidal, you care about yourself so little that you’re wishing yourself into non-existence. And often, you do care about the other people around you. You care about them so much that you feel like a burden on them, like the best thing would be for you to disappear. How can someone leave their family, leave their friends, leave everything? It’s hard to understand if you’ve never been suicidal, but the fact that these people have and love these things and yet still feel compelled to leave it all behind is so heartbreaking.

It’s thought that over 90% of people who committed suicide had a mental illness. Most will have had some contact with mental health services at some point before their death. Most will probably have felt uncertain about their decision at some point. I believe all of their lives could have been saved.

I asked over 230 people who do or have struggled with suicidal ideation questions about their own experiences. I hope you will find this really insightful and I hope that it can help you to understand it from the inside perspective.

Information about the participants 

  • 70% of the participants were aged between 18 and 25, however 16% of the participants were over 35 and 3% were under the age of 15.
  • The majority of the participants were female, however a number of participants were also gender fluid or non-binary, as well as a number of males.
  • The reason why the survey consisted of so many females is probably because not only is my social media base largely female, but because of social conditioning from an early age, men may be less willing to talk about suicide even when the answers are anonymous. This should be taken into account whilst reading the results of the survey.
  • 86% of participants reported suffering from depression, however most selected having multiple diagnoses. The other three most common illnesses noted were an anxiety disorder, a personality disorder, or an eating disorder. This is in line with what would be expected from a sample of sufferers of mental illness as these illnesses are more common with around 7% of the population suffering from depression.
  • When asked which of their illnesses they thought contributed most to suicidal ideation, the most commonly selected illnesses were depression, borderline personality disorder and PTSD. However, across the board there was variety with perceptions that any mental illness severe or untreated could lead to suicide.

Exposure to suicide

  • 75% of participants informed the survey that they had first become aware of what suicide was when they were under the age of 12. 45% of these were under 10, with 7% of those being under the age of 7. 7% reported not being aware of what suicide was until they were over the age of 15.
  • Common reasons why an individual had been exposed to the idea of suicide included: the media (particularly the news but also TV shows, films, songs and books), the social media website Tumblr, lessons at school and the suicide of someone who the individual knew. A large number of participants commented how they struggled with suicidal thoughts and wanting to die as their first memory associated with suicide.
  • A large number of participants reported having lost someone to suicide. This was in most instances an online friend (39%), a friend (37%), another child at their school (34%), a close friend (25%) and someone met whilst being cared for in inpatient treatment (24%). 21% had lost a member of family to suicide, with 9% having lost a member of immediate family.

How did the loss of this person make you feel?

When asked how they felt after losing someone to suicide, these were some of the answers:

  • Heartbroken and just clinging onto the hope that they’re in a better place.
  • Devastated for their family. 
  • Suicidal – I wanted to be with them and felt ashamed that my attempt had failed. 
  • I felt completely numb and empty. I couldn’t believe they were gone. 
  • Confused because I saw no warning signs and didn’t understand.
  • It broke me but eventually made me want to help others who have been at that point in their lives where they want to give up. 
  • Guilty because I felt like I could have done more. I felt like I was to blame and there was something I could have done to save them. 
  • Shocked and angry that nobody helped them, that services didn’t help them, that people are killing themselves as a way out because mental health services are so awful. 

If you could speak to this person now, what would you say?

  • I love you. Please don’t do it. It gets better.
  • My darling I miss you so much and I’m so sorry.
  • Please speak to me. You’re not alone. 
  • It’s not the answer.
  • I miss you and I love you so much. 
  • You are enough and will get through this pain. We can do it together. 
  • I am so proud of you and you will never understand how much I valued you.
  • I still love you and I always will. 
  • I’m so sorry. I should have done more. 
  • I’d tell them that they have the most beautiful baby girl they never even knew was going to be here. 
  • There’s always something better around the corner. 

Personal experiences of suicidal ideation 

  • Of the 230 participants, 18% were under the age of 10 when they first started getting thoughts about suicide. This really goes to show how CAMHS need to work on early intervention, especially with vulnerable children. This could save lives. 30% were between the age of 11 and 12 and 26% were either 13 or 14. This means that 76% had thought about suicide before they had even gone through puberty.
  • Common reasons listed for first having these thoughts included: bullying, traumatic events, the death of a family member, divorce, sexual abuse, being neglected, figuring out sexuality, difficulties in the home environment and a generally unstable childhood.
  • 90% of participants said that they did not tell anyone when they first started getting these thoughts.

Personal experience of acting on suicidal ideation 

  • 92% of participants had made an attempt to take their own life, with 67% having tried prior to this to tell someone how awful they were feeling and how much they were struggling. Please listen.

Perception of contributing factors towards suicidal ideation 

  1. Severe depression (84%)
  2. Untreated mental illness (74%)
  3. Being bullied or isolated (73%)
  4. Emotional abuse (72%)
  5. Pressure of exams (52%)
  6. Sexual abuse (46%)
  7. The loss of a loved one (40%)
  8. Physical abuse (40%)
  9. One or more psychotic episode (30%)
  10. Adverse effect of mental health medication (29%)
  11. Pressure of work (28%)
  12. Exposure to the suicidal ideation of others (27%)
  13. Financial difficulties (22%)
  14. Misuse of drugs or alcohol (20%)
  15. Parental neglect (19%)
  16. Being unemployed (18%)
  17. Prejudice faced for being in a minority group (13%)

Why did you feel like suicide was your only option?

  • I couldn’t think of anything else.
  • Lack of support from mental health services leading me to think that there was no hope.
  • I lost my best friend and couldn’t cope without her. 
  • I felt no joy in being alive and I felt like it was too hard.
  • I felt like everyone else was better off without me and that I was a burden. 
  • The pain was just too much. 
  • I didn’t know how to kill the mental illness without killing myself.
  • I was so exhausted and tired and I didn’t want to try any longer.
  • I was too scared to continue my life as it was. 
  • I had already lost everything worth living for. 

If professionals were involved after an attempt, what care did they put into place?

  • 80% said that mental health services were involved after they attempted suicide, meaning that 20% did not even have a risk assessment.
  • Many patients said that they were either sectioned or admitted to an inpatient ward informally, however a large number of others commented on how their life was put at risk multiple times before they were taken seriously and admitted. A considerable number of participants said that they received no help after, despite mental health services being involved.
  • Other treatment options were access to the crisis team/home treatment team, a referral to CAMHS or Community Mental Health Services, or being placed on medication.
  • 75% of participants said they had received psychiatric medication as a treatment to help reduce suicidal ideation. This was almost on par with therapy, which 74% had received in some form.
  • 62% of participants were or had been under an outpatient team and 61% had intervention from the crisis team at some point.
  • 57% of participants had been admitted to a psychiatric hospital at some point for their suicidal ideation. 2% said they had never had one appointment with mental health services, despite being in general for an attempt.
  • Participants voted therapy as the most helpful treatment for suicidal ideation, with inpatient treatment second and medication third. Many commented that no treatment so far had been helpful.

Why is there so much stigma against suicide?

  • People don’t understand. 
  • People don’t expect them to succeed.
  • People joke about it all the time. 
  • Because there are so many attempts for every completed so people think it will never work. 
  • They think if you confide in them they you won’t actually do it. 
  • People think that it’s selfish or attention seeking. 
  • They don’t know how to help so they just brush it to the side.
  • They think if you really were suicidal, you would have just done it. 
  • Some use suicide as an empty threat. 
  • From the outside, it often looks like they have nothing to be ‘sad’ about. 
  • Generally people don’t know what to say. 
  • People get confused between non-suicidal self-harm and suicide attempts. 
  • Others are more comfortable believing that no one is capable of taking their own life. 

How have family reacted to your suicidal ideation?

  • They were sad but not surprised. 
  • They were shocked and really angry.
  • My Mum was devastated.
  • They were really confused and kept asking me why. 
  • They were dismissive and almost tried to deny it. They couldn’t believe it. 
  • They called me selfish. 
  • Just went on like normal and pretended that nothing happened. 
  • They didn’t get it because I was high functioning. 
  • My parents threatened to kick me out. 
  • They didn’t know and they still don’t know now. 

How have friends reacted to your suicidal ideation?

  • It really upset them. 
  • Confused, worried, but supportive.
  • They didn’t know and it took me a long time to finally talk about my past.
  • They didn’t know what to do so they just stopped talking and hanging out with me. 
  • I didn’t have any friends at the time. 
  • They felt like I was being a negative influence so their parents kept them away from me. 
  • They seemed upset but also that they didn’t really care because it hadn’t worked.
  • Some blamed themselves and wished they had known how to help. 
  • They thought it was for attention or that I was being over the top. 

What things should you never say to someone who is suicidal?

  • Other people have it worse.
  • Suicide is selfish.
  • Just get over it.
  • Snap out of it.
  • If you wanted to do it you would have done by now.
  • You don’t actually want to die.
  • You have a life other people would be grateful for. 
  • You’re attention seeking. 
  • I would never forgive you if you did that. 

What things have been helpful for you to hear when you have been suicidal?

  • ‘I love you. I’m here for you. It’s going to get better’
  • ‘You’re loved and valued’
  • People listening without judgement. 
  • Others stories who serve as proof that things can get better.
  • ‘You are not alone in this’ 
  • ‘You’re important, please hold on’ 
  • ‘I’ll be here for you no matter what happens. I’m not leaving’ 
  • ‘The feeling will pass. You’re alive and you’re wanted’ 
  • ‘You’re at rock bottom. It only gets better from here’ 

What do you wish that other people understood about being suicidal?

  • Just because I am still here and still alive doesn’t mean I’m not struggling with it everyday. 
  • It’s not selfish and it’s not easy. 
  • It’s not something that you can just get over.
  • I am in so much pain and your ignorance is making it worse.
  • This is the point where I really, really need help. 
  • It’s not all inpatient admissions, it’s being turned away by services because nobody takes you seriously.
  • I don’t necessarily want to die, I’m just tired of living. 
  • Please do not shame me for trying to get the help that I need to stay alive.
  • This is a heavy load to carry around. 
  • It is a symptom of a treatable illness, and I will get better.
  • It isn’t easy and it’s not something that I’ve ever wished for. It’s torture. 
  • You never know what is going on in someone else’s head. 
  • We need help, and reassurance, and support.
  • I am terrified to die, but my illness also makes me terrified to live. 

What warning signs should loved ones look out for?

  1. Actively looking for ways to seriously hurt themselves e.g. stockpiling tablets
  2. Talking about death, both in a negative and a positive way
  3. Becoming increasingly withdrawn from friends and family
  4. Making threats to harm or kill themselves
  5. Complaints of feelings of hopelessness
  6. Lack of concern about the consequences of any actions
  7. Increased self-harm
  8. Losing interest in things previously enjoyed

How do you think that mental health services can help improve care for people who are observed to have suicidal ideation?

  • Support them and check in on them on a regular basis. 
  • Offer them the option of an admission. 
  • Set up support for points of crisis before they actually happen. 
  • Keeping them safe in hospital if there is any uncertainty. 
  • Providing a healthy medium where inpatient assessments are done more thoroughly so that patients aren’t institutionalised to the point where they can’t cope on their own, but also that they aren’t left with no help when they need it the most.
  • Regular support from a key worker. 
  • Having a 24/7 text service as many people struggle to phone crisis teams, or don’t have access to them. 

How do you keep yourself safe now?

  • I realised that my life is important and started actively looking after it. 
  • Keeping myself surrounded by other people. 
  • Using the crisis team as much as I can when I’m struggling. 
  • Distraction techniques.
  • Using PRN medication to calm down. 
  • Keeping regular appointments with services and frequently checking in with my GP. 
  • I try to keep my house a safe place with as little danger objects as possible.
  • Practising self-care routines.
  • Keeping busy so that I don’t have the time or energy to act on these thoughts. 
  • I’ve learned to recognise my own triggers.

And finally. The most important question. What are your reasons for staying alive?

  • My pets.
  • My partner and my family. They don’t deserve to lose me. 
  • Hope for the future.
  • To prove everyone else wrong.
  • To get my degree and carry on making victories against the odds.
  • Christmas, birthdays, nice meals out, nights out. 
  • Because I believe that happiness is waiting for me somewhere. 
  • To not let my little sister grow up without me. 
  • Seeing the sunset/sunrise. 
  • Beautiful views, hot summers, cosy winters, parties, graduation. 
  • Finding my own place on this Earth. 
  • Yummy food I still need to try!
  • I’m not going to let the abusers win. 
  • New reasons of my favourite shows and new books by my favourite authors being released. 
  • To eventually help others. 
  • To carry on learning and growing as a person. 
  • The prospect of so many opportunities.
  • Ice creams, hot tubs, face masks, bath bombs, bubble baths, crappy TV shows… 
  • Belief that things can always get better.

Thank you so much to everyone who helped me to put together this post. It’s definitely been the hardest thing I’ve ever put on my blog, and I hope that it is insightful. We need to talk about suicide and we need to pull together to change attitudes and save lives.

If you have been personally affected by suicide or feel distressed, please contact Samaritans 24/7 on 116 123 (UK).