vignettes from a psychiatric history on #worldbipolarday

I can tell you about all the time I have spent among the thyme
thinking of the dark Thames that river I’ve seen
both in TV shows and up close
its dark waters inviting me to sink in its good-bye waves and
ink its darkness on my arms and there is a river dell I see
when I close my eyes and wonder what Virginia Woolf felt in her river
a wolf in me is ready to jump through (s)now and fall through the ice.
Sometimes it’s frenetic energy with a voice of reason that
falls flatter than the paper thin hospital gown that I wore,
highlighter butterflies on my wrists.
I can (out)pace the world, wield
every word as a razor sharper than
the knives I wanted to use for an off label use.
I can be higher than the hills I once wanted to die on
and still see the rivers from on high.

When I was a child, I loathed my psychiatrist. He made me take tests every time I visited him. He condescended to me. He diagnosed me with anxiety and ADHD (accurate) and denied that I was autistic (inaccurate). He told me to focus, focus, focus, also calm down. I ended up throwing child toys at him. He put me on Clonidine first, then more ADHD meds.

I later found out he is held in high regard in the area of ADHD.

Seven years ago, I went on a potent drug ostensibly as an adjunct for a depression diagnosis at age 16. I don’t know what the psychiatrist knew about being angry all the time at home and aggressive at school. The drug gave me uncontrollable urges to move, far different from merely wanting to stim. My mother called the psychiatrist to explain that I seemed to feel like a “Mexican jumping bean.” The doctor prescribed a muscle relaxant.  

I later learned the side effect was akathisia and could have been much worse.

When I told a psychiatrist years later that I was aggressive in high school, he nodded.  “Yes, that’s why they put you on it.” He was an autism specialist a second hospital found and seemed to agree with the decision to put me on it.  “Well, now that you’re not aggressive, we could probably take you off of it.” Besides the issue I had with medicating for compliance, I already had tried to go off it several times. . No psychiatrist ever told me there would be withdrawal, even with tapering, that would last for months.

Each time was so hellish from withdrawal that I asked for it again.

In college, one time, I objected to eating outside on the campus quad on the grass – some of my friends wanted to. They went anyway. I ditched dinner and left the dining hall, almost in tears. I sat near my dorm building. Another friend found me there and asked if I was okay. I wanted to lie, to keep pretending that my brain hadn’t been trying to kill me for the past several months, to talk in circles around my friend and the thoughts. Instead “I don’t want to exist anymore” burst out like Gusher fruit snacks breaking open. My friend took me to our dorm’s resident assistant, who got me an appointment with the campus psychiatrist  for the next day. She upped the dosages of the medications that hadn’t been working.

I pretended things were fine after that.

Fourteen months since college graduation. I’d been at a new job seven months. Six months since the first psych hospitalization. One month since the second. There were still people who didn’t know about them. My mother, who was in town, mentioned I had been published. We were at a lunch table with relatives. But the publication was on my experience with those hospitalizations. My cousin asked if they could read it and I realized a hole had been dug, pushing the conversation in a dangerous direction. “It’s something I don’t really want relatives to read,” I said. I pushed dirt back in the hole the same way I used to pat down the earth around flowers and herbs in the garden, alone.

I pushed dirt back in the hole the way I once imagined filling my early grave.


The featured image for this post is a neurodiversity necklace from Spacerobot Studio for a reason. The need for neurodiversity and mental health movements to intersect is vital.

Not every person with a mental health disability has to see it through the neurodiversity framing, but we should be at times working together to push back against the narratives that frame autistic people, people with intellectual or cognitive disabilities, people with mental health disabilities, as inherently Other. Ableism manifests in different ways toward disabilities that have been categorized in different ways. But the end message is of Other.

As we approach Autism Acceptance Month, we should take care to remember that neurodiversity values all kinds of minds.

A history of progressive ableism that remains today

For clarity: I know that other progressive activists do great work. This is an anti-ableism post. It should be interpreted in this manner rather than as anti-progressive. 

Introduction

Too often, progressives use ableism to accomplish their goals. I do not mean just using some words that many disabled people consider offensive.  I mean things like advocating for ableist gun reform laws. I also mean things like attributing people’s worst traits to mental health disabilities, like people do with Trump.

In the 20th century, progressives gained momentum. Progressives of this time were not the same as they are today, but the ableism is still around.  Then, the cause to rally around was eugenics. I am providing eugenics as a historical example of progressive ableism – and will point out how it still lurks in undertows of thought.

Historical example: The early 20th century and Progressive Era eugenics

Eugenics was a movement that gained some level of popularity in the early 20th century (and still continues in modern forms today). Supporters of eugenics wanted to prevent the procreation of the “unfit” and promote “better breeding.” Eugenics was popular with progressives, including reformers and activists, of the early 20th century.

The Eugenics Record Office (ERO), intended to serve as a hub for American eugenics research, was financed at one point by the Carnegie Institution. Teddy Roosevelt once wrote a letter to eugenicist Charles Davenport of the ERO about “degenerates” that said:

Farmers who permitted their best stock not to breed, and let all the increase come from the worst stock, would be treated as fit inmates for an asylum. Yet we fail to understand that such conduct is rational compared to the conduct of a nation which permits unlimited breeding from the worst stocks, physically and morally… Someday we will realize that the prime duty… of the good citizen of the right type, is to leave his or her blood behind him in the world; and that we have no business to permit the perpetuation of citizens of the wrong type.

A reformer included Victoria Woodhull, a suffragist known for being the first woman to run for president (in 1872). Another was inventor Alexander Graham Bell. Several groups of feminist reformers, including the National League of Women Voters, had eugenics-based legal reform as part of their goals.

Stop making me have to defend insidious people from ableism

Bigoted actions and words from Trump are the result of bigotry. And bigotry is not a mental health disability, though people with mental health disabilities can also be bigots. We are people and vary in thoughts and opinions. But I’d really like prominent progressive activists to acknowledge this and stop making the case for Trump being crazy. That way, people with mental health disabilities won’t face as much ableism. And I won’t have to keep defending insidious people from ableism. 

I defend even people I loathe from ableism because public figure he may be, but attributing bigotry to disability hurts all people with mental health disabilities. And I do it also because when progressives pull out the “But no sane person would do that!” or “Trump is crazy!” lines, this is what they are saying:

Only crazy people can be responsible for such vile acts.

It’s the line of thinking that mental health disability must be responsible for acts society can’t explain, acts society considers terrible. The unintentional undertones of this speak of eugenics to me. Eugenicists of the past posited that many people, especially marginalized people, had increased rates of poverty and crime due to mental and moral “deficits.”

Today, mental health is blamed for everything, from mass shootings to having a poor moral compass – and Donald Trump’s actions and bigotry. Right-wingers and the GOP are the party of eugenics themselves, for sure, and I find that loathsome. But progressives should stop blaming mental health as they oppose damaging policies and actions.  

Related Posts:

Rewriting the Narrative on Psych Ward Abuse in Journalism

Psych Ward Reviews gained a new feature in January 2017: a news article repository of staff-on-patient abuse in hospital psychiatric wards. It is an ongoing effort, both of searches and a morbid set of daily Google Alerts with phrases such as “psychiatric patient abuse.” As part of my search process, I have read over about two hundred articles so far.

One thing of note was that many of the articles on staff-on-patient abuse I found were not in major publications. They were in local news outlets or smaller magazines. And as I knew, there are many failures of psychiatric wards as a crisis care model. These failures can involve staff-on-patient abuse, suicides, ill-maintained facilities, and Medicaid fraud. My focus here is how journalists cover abuse and other failures.

Journalists do so with a few different lines of thought. Many fail to address issues that come with psychiatric wards as the main method of crisis care. These problems include taking away patients’ rights and ability to make decisions. Instead, they discuss issues such as funding and staffing shortages, and overcrowding and bed shortages. However, the reasons for psych ward abuse are power dynamics and ableism.

The system requires institutionalization in secured wards away from the public. Patients then lose their rights (available in theory). The power shifts to doctors and staff, who make decisions about a patient. Many hospitals seek patients for profit. These are settings prone to abuse. We must build a stronger network of community-based crisis care, including peer respite centers and support. There must be meaningful oversight and accountability for any community care providers.

But why don’t journalists talk about creating alternatives to psych wards? The reasoning by many journalists is that shortages result in increased abuse and neglect of patients by staff. They then describe hospital failures as inevitable because of these shortages. But the psych ward system’s issues are structural, rather than wholly solvable with money. Journalists could instead talk about these structural failures. They could do so in many ways.

They could cite the various works around abuse in institutional settings, and question power imbalances. They could push for more accountability and data on abuse rates in articles. They could interview former patients, to see what community options they want. Depending on the size of their platform, they could craft a new crisis care narrative for the broader public. The narrative would present alternatives entrenched in community-based, rights-affirming crisis care.

 

an exploration of autistic mad pride: part one

Introduction:

exploring the possibilities of neurodiversity, mental health, and autistic mad pride intersections

Recently, I found an article on Medium talking about schizophrenia fitting into neurodiversity, which got me thinking about how mental health more broadly fits into neurodiversity.

There are a lot of people I know with mental health disabilities/[a person’s preferred terminology] who dislike the idea of categorizing mental health things as neurodivergence, who feel that claiming mental health stuff as neurodivergence by definition means claiming it as an intrinsic part of the self that can’t be separated from oneself- and thus can’t be recovered from.

Currently I’ve been trying to think about and sort out the various models of mental health. For instance, the recovery model as it was conceptualized and formed after the period of large-scale, long-term institutionalization talked in part about recovering from the effects of society.

Then a lot of what “recovery” means, as I’ve seen it discussed, not just recovering from society’s effects, but primarily recovering from the effects of the mental health disability. I do know people with mental health disabilities who support this idea of recovery insofar that it means that they experience a significant reduction of symptoms along with developing coping strategies for symptoms.

However, as a disclaimer, I am not in fact trying to tell people that they cannot want to recover – experience a significant reduction in symptoms etc. – from their mental health disabilities.

But I think the recovery narrative, if pushed onto us by others, is, if not harmful, not exactly beneficial, because then it is not a choice. And a lot of times that’s the only narrative people are given.

And then a lot of autistics have co-occurring mental health disabilities, as I’ve discussed in this AACC presentation (PDF) and in this blog post series (the transcript for the AACC presentation is here as a PDF). And the autistic rights movement is rooted in neurodiversity and neurodivergence as identity. 

Then the questions I have are, that I will address in blog posts to come:

  • Part Two: Should mental health disabilities be fit under the category of neurodivergence as identity? (I can’t answer this for everyone, but I can answer it for myself and the way I see it).  
  • Part Three: Why haven’t the mad pride, mental health rights, and autistic rights movements intersected nearly as much (to my knowledge)?

 

Carrie Fisher (Princess Leia) Wrote Books and Had a Service Dog

carrie-fisher

[Image description: Three images related to Carrie Fisher. From left to right, Carrie Fisher wearing glasses and kneeling next to her service dog, the French Bulldog Gary, at a red carpet event; Carrie Fisher dressed in white as Princess Leia with her iconic hair buns, surrounded by Stormtroopers; and Carrie Fisher’s book Wishful Drinking, which has her name, the title, and an image of Carrie Fisher with hair buns facedown on a table with a martini glass in her hand.]

In high school, it was mentioned to me in passing by someone that Carrie Fisher, whom I knew as Princess Leia, had bipolar disorder.

I shrugged, and said, “Oh, okay.” She was still Princess Leia.

Sure, depressive episodes and generalized anxiety made up a majority of my days, a damp humid cloak like the Georgia summers I liked to wander down the streets in – alone. An autistic, depressed, anxious wreck, isolated and considered socially unacceptable. But Carrie Fisher was just Princess Leia, right?

I never thought she meant much to me besides her role in Star Wars until a short while ago. In college, I became invested in disability rights and later, after my first and second hospitalizations in a psych ward, mental health rights as well. Each discharge from the hospital read that I had major depressive disorder, not bipolar disorder. Each hospital had only seen me for suicidality. They didn’t see the times I felt higher than the hills I once wanted to die on, and faster than the too-fast DC Metro trains. I find the Metro a relatable metaphor. I too sometimes go too fast, experience frequent malfunctions, and occasionally derail.

But I find her more than a relatable metaphor. Carrie Fisher was a bipolar person who dealt with substance abuse issues. She was often considered socially unacceptable. She openly spoke about her mental health disability, and substance abuse issues (which were in part an attempt to keep her manic episodes in check). She was open about her dog Gary’s role as a service animal and took him to public events. And she was also the actress who played Princess Leia, a mother, an author, and a script doctor who edited scripts.

She was Princess Leia, and she was also an outspoken mental health advocate.

I owe her a lot.

For talking about about everything in the open. For being Princess Leia but also someone who employed a great number of coping strategies for her mental health, and talked about them. For sometimes being considered socially unacceptable.

For showing me that she, Carrie Fisher – Princess Leia – was as outspoken in real life as she was on screen. For showing me that it’s possible to be vocal about personal struggles and what you don’t like – and what is good – about your brain and yourself.

On #WorldMentalHealthDay

In much the same way I am tired of awareness for autism, I am tired of mental health awareness. I understand that autism is different from mental health disabilities, that there are also many autistic people with mental health disabilities who dislike autism awareness but don’t mind mental health awareness. I am not one of them.

When I hear you talk about awareness for mental health disabilities, when you say, “This is a serious condition affecting this many people,” or “this many people have a mental illness!” or “we need to focus on access to care,” I hear, much like many autistics hear the same when autism awareness campaigns occur:

We are an epidemic. We are a public health crisis (and get named as such). We are only DSM diagnoses and flight risks and patients and if we’re not trying to hide ourselves we are a failure to a model that teaches us the best patients are telling their stories of how they got better to end the stigma. We are merely the rates of our mental health disabilities among people.

In fact, I would argue that only having stories of getting better hurts those people who may not get better. And why can’t we talk about issues like employment (or better benefits for those who would have a hard time working), access to housing, before access to care? Access to care, if desired, should follow meeting basic needs. It’s a little hard to focus on any sort of treatment when basic needs aren’t being met.

I am tired of awareness. Why do we have more people talking about access to hospitalization instead of peer respite care? Where are our community-based supports? Where are our warmline projects to prevent crises? Where are our self-directed services? Where are they?

Autistics in Mental Health Crisis (third in a series)

Autistics in Crisis Part Three: Stop Mishandling First Interactions with People in Crisis

Even if we had the best resources for Autistics to access, mental health crises in Autistic people will still sometimes occur, and there will still be situations where a non-crisis gets reported to authorities as such. I feel fortunate. My experiences, particularly at GW, were not ideal. But I did not have forcible intervention from authorities. I feel fortunate because even though I am at lower risk of injury from crisis intervention teams (as I am white), forcible admission to a psych hospital (also known as, you know, forced institutionalization, whether short term or long term) is probably doubly traumatic.

I want to talk about a couple of things in this post:

  • How crisis intervention often goes wrong in regards to the police, and the disproportionate risk that autistics of color (with and without mental health disabilities) face here, along with autistics of other marginalized groups
  • Some steps to improve the first interactions by police and first responders with autistic people in crisis, both policy and otherwise

How First Interactions with Autistics in Crisis Go Wrong

For Arnaldo Rios-Soto, an autistic Latino young man now institutionalized in Carlton Palms because the state of Florida fails to provide enough community supports to its disabled community members, even playing with a toy truck in the street resulted in a person calling 911 to report Rios-Soto being suicidal and a threat. The police shot and injured his black therapist, Charles Kinsey, and then claimed they meant to shoot Rios-Soto. The police responded to the scene of an alleged mental health crisis involving black and brown people, and shot Charles Kinsey.

As Autistic activists of color Lydia Brown, Finn Gardiner, and Manuel Díaz wrote for Sojourners:…Whether the officer was actually aiming for Kinsey or Rios-Soto, he has become part of a national pattern. Disabled people represent between one-third and one-half of all people killed by police. Black and brown people are extremely disproportionately likely to die in police-involved shootings… If you’re black or brown and disabled, your likelihood of being targeted by police only increases.”

When I asked Timotheus Gordon, Jr., who in his own words is  “an autistic African-American blogger, writer, event photographer and self-advocate in Chicago” what he felt when he heard what the police said about aiming for Rios-Soto, Gordon told me: “…the fact that the police tried to shoot Rios-Soto instead of Kinsey confirms my fear of walking on the street as an autistic person of color… Disabled people of color can play with a red toy truck, calm down from a meltdown, or rollerblade peacefully on the block and still get harassed by people.”

Finn Gardiner, who co-authored the Sojourners piece, added: “The issue of police violence is compounded if you belong to more than one marginalised community. For example, if you’re an autistic, trans person of colour, the combined effects of racism, transphobia and ableism will make you even more at risk for harm… You may have your identity completely erased. People may only see your race and not your gender identity or your disability.”

Crisis intervention also went wrong in the case of Kayden Clarke, a trans man in Mesa, Arizona. Denied a recommendation for hormone replacement therapy by his therapist because of an Asperger’s diagnosis (placing him on the autism spectrum), he became suicidal. In early 2016, after receiving a report from a worried person, the police arrived at his apartment – and shot Clarke, killing him. The police knew Clarke had an Asperger’s diagnosis.

And in February 2012, Chicago-area police shot and killed Stephon Watts, a Black Autistic teenager as he panicked while holding a knife. I wrote in February 2016 (on my previous blog), “…the police had shown up to “subdue” him…. many, many times in the past. To have had such encounters with the police, which were undoubtedly physical in nature, would be traumatizing.  Even if Watts had not been panicking in the first place, to lash out from fear of being “subdued” again is the result of a fight or flight response… As a Black Autistic, Watts faced multiple marginalization from society, with ableism and racism as a reaction that killed him.” The police knew Watts was Autistic.

And the New York Times recently reported that the NYPD uses “restraining bags” for arrests and crisis intervention, particularly in situations involving those with mental health disabilities – as the Times noted, “the bags are used to restrain those judged to be emotionally disturbed.”

These are just a few examples of the way police handle crises. 

What Are the Solutions?

Like Brown, Gardiner and Díaz, Gordon notes which people are often the targets of such harassment and police shootings: “I also dislike [the] repetitive connection between police violence and victims being disabled people of color.” Gordon went to say what he thinks is a solution to police shootings and mishandling of crisis intervention: “I want racial justice and disability rights/justice organizations to collaborate…  The collaboration MUST include organizers and activists in the disability community and ensure that actions are accessible to all participants.” Gardiner agreed with Gordon on the need for collaboration.

In terms of policy work that advocates can work for, a broad measure for police accountability overall as opposed to just crisis handling is H.R. 2302, the Police Training and Independent Review Act, which would cover comprehensive reform – not just police training on disability and racial/ethnic bias, which many of the officers involved in shootings receive – it also requires states to appoint independent prosecutors to investigate and prosecute police-involved shootings before receiving certain federal funding.

More specifically, we also need to create mobile crisis teams that aren’t police. 911 operators can dispatch those teams instead of law enforcement. Gardiner told me that crisis teams that know how to “engage with marginalised populations” are vital.

Gardiner also recommended the creation of “comprehensive peer and community-based supports that take into account the effects of marginalisation.” He also recommended “peer support like… warm lines*, advocating for comprehensive, long-term training for law enforcement, [and] encouraging police departments to hire people who are aware of racial justice issues.”

*Warm lines are like hotlines people having a hard time can call when they are not yet in crisis and need someone to talk to. I elaborate on them in Part Two of this series. 

. . .

This is the third out of a series of posts.

About the Interviewees

Timotheus Gordon, Jr., also known as Pharaoh Inkabuss, is (in his own words), an autistic African-American blogger, writer, event photographer and self-advocate in Chicago. He is the creator of “The Black Autist”, a blog that emphasizes autism/disability acceptance among people of color, including people in the black community. Gordon is a first year Ph.D student at University of Illinois-Chicago, pursuing a degree in disability studies. Follow his Tumblr blog for updates: http://blackautist.tumblr.com/

Finn Gardiner is a Black, queer, Autistic advocate and activist in the Boston area. He currently works for the Autistic Self Advocacy Network (ASAN) as their Boston Community Coordinator, leads the ASAN Greater Boston chapter, and previously worked for the Institute for Community Inclusion as a Gopen Fellow. He has a B.A. in sociology from Tufts University and is currently a public policy masters student at the Heller School for Social Policy and Management at Brandeis University. Follow his blog for updates: http://expectedly.org/blog/ 

Autistics in Mental Health Crisis (second in a series)

Autistics in Crisis Part Two: Crisis Aversion or Resources We Need

But knowing all those things I talked about in part one would not have kept me out of their ERs (preventing the crises in the first place). Knowing all those things would not solve the systemic issues contributing to crises. There are a lot of reasons Autistic people have crises. Quality of care if accessed, past or current trauma, isolation, a lack of community mental health resources, and other systemic barriers – often alongside co-occurring mental health diagnoses – combine to put people in crisis mode.

Both access to and quality of mental health care are issues for Autistic people. Many of the Autistic people who do access mental health care have reported pressure to “treat” their autism, and other mistreatment by mental health professionals. Even among professionals who do not seek to “fix” autism, Autistics’ distinct and various methods of expressing emotion and language can leave unprepared professionals at a loss and Autistic patients frustrated. There are also other factors. Some have difficulty navigating the health care system and lack support. A large number of Autistics can’t afford care for any number of reasons.

One Autistic writer highlights many of the above systemic barriers in a piece on autism and suicide (suicide crises are not the only mental health crises that occur, but Autistic adults without intellectual disabilities are nine times more likely than non-autistics to die by suicide). The author also discusses unemployment along with barriers to autonomy and social connection as contributing factors to Autistics’ high suicide rates. Here are some of the solutions the author offers:

We can be attentive to people who seem isolated and intentionally include them. We can check up on people who are known to be struggling… We can make our community welcoming to newcomers who desperately need the shelter of Autistic space. We can spread the word about autism-friendly mental health services… We can advocate for policies that support independence, like employment first and walkable communities.

For me, it would have been really helpful to have a 24-hour drop-in center or peer respite center (an alternative program where people in crisis can stay, staffed by people who have experienced mental health needs) somewhere nearby. There weren’t other options for me to stay safe. One study has indicated that peer respite centers result in better outcomes (for a variety of mental health needs) than psychiatric inpatient treatment, and there is a growing evidence base for supporting peer respite centers. 

Another resource would be a mental health phone (and text-based as Autistics can have a hard time with phones) line geared for connecting a person with services or other peer support when they are not at a crisis point. They would get connected based on level of need and which care they wanted. It would have a diverse staff to help make sure people did not end up with people mistreating them if they have a certain identity. Some similar projects, though not quite with that scope, already exist. One project called Project Warmline – people who need someone to talk to can speak to someone who has mental health needs – is in Oregon and has received state funding. Some other warmlines are listed here. It is not inconceivable that these projects could expand. 

There are significant gaps in community-based mental health resources. There is also a failure to address systemic barriers for Autistic people and improve quality-of-life research and supports by the largest sources of autism-related funding. These factors create a complex push into crisis mode for many Autistics. We can push for policy changes and support one another as fellow Autistics.

. . .

This is the second in a series of posts.

Autistics in Mental Health Crisis (first in a series)

Autistics in Crisis Part One: The Personal or What I Wish Professionals Had Known

In January 2016, I sat in a large chair in the ER of George Washington University Hospital (GW), with my gown tied on backwards because I had never gone to a hospital for feeling unsafe and suicidal before. The ER nurses thought I would know how to tie a gown; I didn’t. Nurses came and went, occasionally conversing with me or asking questions while I waited on the social worker. Once she arrived, the social worker said to me, “more like Asperger’s, right?” I had told the nurses I was Autistic.

She didn’t seem to believe me when I corrected her.  “I’m Autistic.” It made me uneasy even in my fight or flight panic mode. At least it was something I could actually manage to put words to through rote memory. I gave her a rundown of why she should call me autistic as I had said, and I don’t know if she took any of it to heart. She also seemed to blame being autistic for my social isolation. I wish she had known that correcting someone’s statement of identity because of how they present is not okay. I wish she had known that a lot of my social isolation didn’t come from autism itself, but from factors like adjusting the area, where I was living in the area, and a lot of non-disabled people being weird about autism and visible neurodivergence.

The fluorescent lights hurt and left me with dancing spots of color in my vision. The chatter of nurses around me, other patients calling out (just wanting to go home), and the ringing of phones and intercom announcements pierced my hearing. I cried from emotional pain, but also from being in sensory hell. Not being someplace quiet and dim made it even more overwhelming.

Later that year, in June, the ER was bright and loud at Georgetown University Hospital, but I did tie my gown correctly this time. They took me to a quiet room so I could be in a less overloading area to talk to the resident, but then they brought me back to the main ER section. I wish both places had known that it’s really hard for Autistic people and people with sensory processing issues to be in an ER. I wish they would have tried to find a way to reduce the sensory input, like giving me earplugs, and putting up a partial curtain to block the lights.

At Georgetown’s ward, they were a lot kinder and had different expectations, though I still felt confined, because it was a psych ward. There weren’t the assumptions about autism this time. They gave me earplugs to help with the lack of absolute quiet on the ward. In the ward at GW, yes I was in a depressive episode. No, I didn’t want to talk to a bunch of people I didn’t know in a place I’d never been before (with no Internet or cell phone access). No, I didn’t want to go to groups – they should have stopped pressuring me. I’m Autistic. Strangers and new places are hard for me. I wish GW had known that.

. . .

This is part one in a series of an unknown number of posts.

 

Staying Silent During National Suicide Prevention Week

I watched people write posts and tweet with the hashtag with a bit of muffled, tamped-down fascination. This was my first National Suicide Prevention Week after being twice-institutionalized in one year. The hospitalizations weren’t my first times being suicidal. But National Suicide Prevention Week had always been a dull echo – mental health hotlines plastered over social media and onto the bathroom stalls at my college – much like the suicidal ideation that was constant static in my mind, sometimes flaring up like microphone feedback.

* * *

But this is not a post about my journey through suicidal ideation and tendencies.

It’s about how National Suicide Prevention Week allows society get away with mistreatment, discrimination, and other systemic factors by placing responsibility square on the suicidal individual, and then expects us to tell our suicide survival stories like we’re in a spectator sport, rather than bearing witness to society’s shortcomings.*

Yes, people with mental health needs seem disproportionately more likely to die by suicide (I looked long and hard for these suicide rates on a national scale, but only found data that “the consequences of undiagnosed, untreated, or undertreated co-occurring disorders can lead to a higher likelihood of experiencing homelessness, incarceration, medical illnesses, suicide, or even early death,” of course without talking about societal factors). But discrimination has a negative impact on mental health, and many populations experience imbalances in suicide rates. (What I mean by societal factors are: discrimination and mistreatment – including incidents that seem small, part of everyday life, and/or seem more overt and blatant).

What’s to go wrong with preventing suicide, though? I know suicide results in lost lives. I know it hurts the living. I know there’s a reason people close to me cried when I admitted myself to the psych ward both times for suicidality. I know how they would have cried further had I actually died. I know people with mental health needs die by suicide and their deaths could have been preventable through access to certain care.

But… SAMHSA saysIdeally, these [suicide prevention] efforts address individual, relationship, community, and societal factors while promoting hope, easing access into effective treatment, encouraging connectedness, and supporting recovery.” That sounds great to most people. Parts even sound nice to me on the surface. But the “community, and societal factors” parts feel like they’re still in the “ideal” stages. One of the largest charities involved in suicide prevention, the American Foundation for Suicide Prevention (AFSP)** focused on firearms and suicide, emergency department screenings and primary health care screenings as part of their Project 2025 model for National Suicide Week Prevention 2016. None of these include factors other than individual (that match the factors I’m talking about). None of these come near addressing mistreatment, discrimination, and the like. None of these address communities often impacted by trauma and/or high rates of mental health disabilities (in part due to mistreatment and discrimination).

Mistreatment and discrimination also preclude many from seeking mental health care. As I’ve said before regarding the public conversation on mental health: “[it] doesn’t factor in the many other reasons why people might not seek care. These reasons include… forms of bigotry in health care. Medical professionals are not exempt from casual or blatant forms of bigotry.” If no one addresses causes of suicide in terms of the toll of discrimination and mistreatment on individuals and communities, it is my opinion that we will not be able to reduce suicide rates as much as we want to. Further, not addressing systemic issues allows society off the hook entirely (which is a problem I have with a lot of disability and mental health awareness campaigns).

* * *

Do I believe in suicide prevention? Yes. But I believe in comprehensive suicide prevention. Suicide prevention must encompass both the individual and society. I believe in suicide prevention that reduces the amount of discrimination and mistreatment in the mental health care system. I believe in suicide prevention that works as more general mental health advocacy to provide stable housing and community services as opposed to institutionalization and lack of in-home settings. I believe in suicide prevention that addresses whole people and their relationships and communities and the impact society has on them.

What would my vision of comprehensive suicide prevention look like? My vision would look like addressing individual needs through crisis support and preventing a crisis from even happening, but also addressing societal barriers and discrimination. It would look like 24-hour drop-in centers staffed by peer support specialists. It would look like at-home services as opposed to locking someone in a hospital. It would look like collaboratively working for many forms of lessening discrimination against various marginalized people through multiple methods of advocacy, including direct action and incremental change. It would look like supported housing and late-night cafes and be a broad approach.  

Do I believe in suicide prevention? Yes. Do I believe in this particular awareness campaign of suicide prevention? Not as much as I could. 

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*I do not speak for all people with mental health needs. I do not claim to. I know some people with mental health needs find these campaigns to be enough and/or to be the most appropriate thing. My opinion differs.

**I must note that I am not, in fact, wholly against AFSP, and that I don’t want to sound like their approach will do nothing at all. I just argue that it’s not enough.

I do welcome thoughts on this blog post, but I will remind you of my comment policy.