Helping hope return

The U.S. Centers for Disease Control and Prevention recently released a report that is the closest thing we have to the quantification of despair. Between 1999 and 2017, suicide rates in America rose to their highest level since World War II. The increase can be found among women and men, and in every racial and ethnic group. But the spike among people between the ages of 15 and 34 is particularly disturbing. Hopelessness among the young seems a more direct assault on hope itself.

Researchers posit that the opioid epidemic may be partly to blame. Just as a family can be decimated by an overdose, a sense of general despair may take root in communities where overdose deaths are common and visible.

Another proposed explanation is social media, which may expose younger people to bullying while constricting meaningful human interactions — increasing the need for emotional support while narrowing the sources of emotional support. Even worse, emotionally fragile people can find perverse forms of online community that echo and encourage their despair.

Weighing and testing such explanations are important to understanding the sociology of suicide. But for people who contemplate or attempt suicide, the struggle is more personal and philosophic.

If the most important attribute of human beings is autonomy, and the purpose of life is a positive balance of pleasure over pain, then mental anguish and physical suffering can make suicide seem like a rational choice. It can even be seen as the ultimate expression of autonomy and choice.

But this is deceptive in a variety of ways. First, autonomy is a lie. Human beings are fundamentally social creatures who only find mental health in the context of supportive relationships. In isolation, naturally depressive people are more likely to enter downward spirals of despair. The inner voice that normally whispers worthlessness can become a shout of self-condemnation. And it is dangerous when there are no other voices — no kinder voices — to contradict it.

Second, in most cases, the rational weighing of suicide’s costs and benefits is a lie. Suicidal people with mood disorders are at a particularly dangerous stage when considerations that seem true to them are not true at all.

I am not talking here about a terminally ill patient wanting a “do not resuscitate” order. This strikes me as determining not the length of living, but the length of dying. End-of-life choices often require rational thoughts about horrible dilemmas.

But in the case of suicide, the instrument that determines our view of reality is malfunctioning. The computer is wired in favor of despair. The decision to commit suicide is generally informed by lies that seem very, very true in the moment. That loved ones don’t love you. That friends secretly have contempt for you. That problems are permanent. That everyone would be better off without you.

This is the reason that people with depression need intrusive family and friends around them. They need people who will gently but firmly intervene when they withdraw, or start giving possessions away, or talk a lot about death, or have a major loss (of a loved one or job), or begin saying goodbye to others, or buy a weapon, or use drugs and alcohol to dull pain, or act recklessly, or exhibit other changes in mood or behavior. In these situations, intervention is not the violation of privacy — any more than using a defibrillator on a person having a heart attack is a violation of privacy. Intrusiveness — defined by pushing a depressed person toward professional help — is the appropriate response to a medical emergency.

But people who suffer from depression have responsibilities of their own. In times when their depression is under control, they need to cultivate a circle of family members and friends who are fully informed about their illness. And this requires the exact opposite of autonomy. It requires people with depression to be vulnerable and willing to receive help. In this case, secrecy and shame can lead to death. And since the children of people who commit suicide are more likely to commit suicide themselves, death spreads like anthracnose through family trees.

It is not an easy or natural thing for people to periodically distrust their own version of truth. But that is what someone with depression must learn to do. When things that are self-condemning and self-destructive appear self-evident, that is the time to trust in some other person’s more reliable perception of reality. And then, with patience and professional help, hope can make its return.

(Washington Post Writers Group)