Over at PDintheBin facebook group, we are having some discussion around the ways in which we as people with a diagnosis of ‘PD’ are spoken about in relation to feeling suicidal. Suicide is a difficult topic to talk about. Suicide awareness campaigns call for us to talk more about suicide. Encouraging people who are actively considering suicide to seek help is one of the primary aims of suicide prevention strategies and people in need of help are often advised to turn to the NHS.
Yet within NHS MH services getting help for suicidal feelings is not easy. Some of the most vulnerable people in the UK find that when they are suicidal little help is available. Often people are diagnosed with mental disorders known to be associated with increased suicidality, and yet the National Health Service frequently leaves them unsupported. There are estimates that 10% of us who have attracted this label will die by suicide. However, statistics like this seem very unclear when factoring in the lack of over-all validity of the label. Perhaps a more legitimate question is ‘how many oppressed people end up taking their own lives’.
If a patient with chronic kidney disease needed dialysis NHS staff would not see that patient as ‘difficult’, ‘attention seeking’ or ‘time-wasting’ even if dialysis needed to be repeated and yet this can be the response of NHS staff to patients diagnosed as having mental health difficulties. The result often being a person having repeated experience of suicidality.
This is never more so the situation than when a patient has been labelled with a ‘personality disorder’, particularly emotionally unstable/borderline personality disorder. People labelled with ‘BPD’ are believed to have a suicide rate of 10%. Although it is difficult to form statistics around a disorder that has such poor diagnostic reliability, it is probably likely that people who have distress that some might label “PD” are at increased risk of suicide when compared to the general population. This is especially important given the strong association between self harm and suicide.
Going back to the kidney patient, imagine a situation in which the patient’s condition had features that increased the likelihood of death and when those features were present NHS staff responded not with increased support, such as more dialysis, but instead with a rigid insistence that ‘they’re not really going to die’ and maybe even with displays of disgust directed at the patient. This is the very response often meted out by the NHS to people labelled with personality disorder who are brave enough to seek help with suicidality.
Comparison between physical illness and supposed psychiatric conditions is problematic and will be explored in a later post. However, it is still shocking to think that a person who is clinically defined as being a high risk of suicide can be repeatedly denied help due to the constructed parameters associated with a ‘PD’ diagnosis. Yet a person without this diagnosis may be seen as more deserving of care/support.
Many of us at PDinthBin have had experiences of suicide attempts not being taken seriously because they are “just attention seeking”. The implicit and sometimes shockingly explicit message to us as distressed people is that; ‘You have to try harder to kill yourself in order to be taken seriously. Otherwise you’re just pissing about’ or ‘trying to get attention’ which obviously you can’t be given because it ‘rewards the behaviour’.
We belive that someone saying they have thoughts of suicide should be enough to be taken seriously by services. Sometimes feeling suicidal translates as ‘I can’t stand feeling like this and I don’t know what to do and I need help’. This is reason enough to warrant help.
It is said that one of the hallmark ‘traits’ of ‘PD’ is that we make frequent ‘threats’ of suicide to loved-ones and to mental health professionals. unsurprisingly, the context of these so-called threats seem to be seen as unimportant or ignored entirely. Services and staff contribute to a structural form of oppression that can generate the very suicidal behaviour they seek to eliminate.
For example, if someone finds themselves in an area that has a ‘pd’ specialist service. The current clustering system for entry into this service is often so high that many people, despite having had a label of ‘PD’ applied to them are denied help in these services. One of the inclusion criteria for ‘PD’ severity is aligned to risk, which of course is aligned with suicidality. It doesn’t take a genius to work out that the more suicidal you appear then the more at risk you seem and therefore you might have a slim chance of finding a service that offers something remotely helpful. On the flip side, the idea of being ‘treated’ in any service that labels itself as a ‘PD’ service can be positively harmful for many of us who have been harmed by the construct. The way that services are designed may mean that we have to actively accept the application of this label in order to access any form of psychological support.
Asking for help in a way that services can hear can sometimes feel like a torturous game of snakes and ladders. Many of us aren’t able to ask for help directly but when we do, we can be seen as having a sense of entitlement. If we express suicidality and are not taken seriously we may go on to attempt suicide which in turn can be interpreted as ‘an attempt to access inpatient/acute services’. Many of us use self harm in order to desensitize ourselves toward the ultimate goal of suicide. Strangely this process also appears to desensitise professionals who may decide that we are constantly ‘crying wolf’. This kind of empathic burn out in proffesionals is particularly dangerous given that the ultimate goal for some of us will be to actually complete suicide. Ignoring the boy who cries ‘wolf’ is only ok if no wolf exists or will ever exist. But sadly the wolf does exist and for many of us the over-all message from services seems to be that we are not deserving of help with it. Simply because services themselves have given us this label and have defined who we are and what we need or do not need. Whats worse is that everything we do, everything we say, comes with a question mark over it because of our ‘PD’ diagnosis. statements about our needs appear to be filtered via a lens of ‘is this manipulation?’ and ‘what is this PD patient really requesting?’.
As one CPN wrote on my notes, ‘this patients presentation underestimates the risk she presents to herself’
How many of us do not present in ways that enable us to receive the help that we need? What happens when we can not play the patient role? What can we do if we get stuck in endless cycles of harm, with professionals making judgments and interpreting what our journeys into self-destruction mean?
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