Suicide

Suicide is a touchy subject. It’s complex topic that many people have strong feelings and opinions about. At the same time, it is an issue that not many people are really educated on. Suicide makes many of us uncomfortable and in this society, whatever makes the majority uncomfortable gets pushed under the rug at best. However, the misinformation that many people have about suicide leads to those in need not receiving the kind of support necessary from their loved ones, from healthcare professionals, and from society at large. In this piece, I want to talk about suicide: what suicide is, the difference between thinking about suicide and being at risk of actually doing it, bodily autonomy, and suicide prevention. I hope with this information, people are able to better support their loved ones and/or find the support they need while going through difficult times in their lives.

Suicide Is…?

Suicide is the act of ending one’s own life on purpose. As a psychotherapist, I know that people who are suicidal don’t necessarily want to die. They want an escape from their current situation. Many people tend to see someone killing themselves as the problem when actually suicide is usually a symptom of other problems. Something or some things else are going on in that person’s life. There are other issues adding stress to their lives, bringing them to what feels like a breaking point. And a person who is suicidal sees suicide as a definite way to escape from their pain.

Now, being at risk for committing suicide is different from having suicidal ideation. Suicidal ideation aka thinking about dying or killing one’s self is actually very common. Most people have had times in their lives where they have thought about wanting to die in their sleep or wishing they were dead/not alive anymore, which are examples of passive suicidal ideation. Many people have also fantasized about jumping in front a train or car, etc. for a second as it’s about to past them. This urge/fantasy is usually short and most people never actually do it. It’s so common that therapists are not generally concerned with just thoughts of death. Thinking about their death by itself does not make someone at risk for committing suicide. Thoughts of committing suicide without a method, intent/desire to die, and a clear plan are usually on the low risk end. However, someone is in immediate risk of suicide if they have a way to kill themselves on standby, a specific plan of how they’re going to do it, and the intent/desire to do it. Otherwise, thoughts of suicide on their own are opportunities for conversations.

I believe in bodily autonomy. There are times, unfortunately, when someone’s problems are not resolvable for them. All the suicide prevention efforts (which I’ll get into next) could have been attempted and everyone could have put their all into it and, for whatever reason, it is not enough for someone to want to stay alive. I believe people ultimately have bodily autonomy and even if they want to end their lives, it’s their body and their life. At the end of the day, when everyone leaves and goes back home and/or goes to sleep, they have to be alone with their pain. I think it is selfish and torture to force someone to stay alive who doesn’t want to be. If every measure of suicide prevention available has been used and every bit of support in the person’s life has been accessed and the person still does not want to be alive, from a humanistic perspective, it is unethical to force them to live with their pain for someone else’s personal values. If you want someone to stay alive, then it’s time to put in some work.

Suicide Prevention in Treatment

Because I believe in bodily autonomy, it is my obligation as a mental health professional to 1)provide a safe space for people to process what they’re going through, 2)help them receive as much clarity on their situation as possible, 3)find and weigh other options to escape their situation, and 4)help them build a support system. All with the hope that with more resources and more options, the person will be able to resolve their situation in other ways, using other options. Ultimately, suicide prevention is addressing people’s stressors and problems. Again usually people struggling with suicide want freedom from suffering, not necessarily to die. It’s a common reaction to want to avoid talking about suicide out of fear of pushing the person “over the edge” or “giving them any ideas,” but that’s not how suicide risk even works. In mental health treatment, when dealing with someone who is suicidal, it’s time to get curious, ask open-ended questions, and not be afraid to go deep with a client. What symptoms is the person experiencing? What is going on in their lives and how can that be addressed? Who is around that can support them?

With these kinds of questions in mind, therapists usually encourage at-risk clients to use a safety plan. In treatment, therapists help clients brainstorm and create their own personal safety plan, which usually involves about 4 steps.

Step 1: Identifying the situation. What are some signs that let you know you’re starting to feel hopeless, sad, frustrated, etc? Do you feel it in your body? Do you feel tired all the time? Do you lose your appetite or eat more than usual? Or is it more in your head/thoughts? Do you get racing thoughts, for example? Mindfulness techniques [Here’s a piece I wrote about how to find the find one for you] are great ways to get a clearer idea of how you’re feeling if you aren’t sure.

Step 2: Self-soothing. What can you do for yourself to go back to how you were feeling before? What are some things you can do to cope with these feelings/this situation? How did you get through difficult times in the past? What stops, if anything, you from you using these coping skills now and how can you get around whatever is in your way?

Step 3: Who your people? (I said what I said). Being able to self-soothe is important, but also don’t be afraid to reach out to trusted people in this difficult time. Who can you ask for help? And what kind of help do you want from each person? Do you wanna vent? Do you need to leave home for a couple days? Do you need someone to make sure you eat? Do you need help going to the Dr? Do you need help with classes? Do you need money or transportation? Do you need help filling out paperwork? Do you need someone to babysit your kids for a couple days? If your social circle is fairly small, what social agencies are in your area that provide free or low cost services? A lot of community organizations can provide resources or referrals to free or low cost assistance that many people are not aware of.

Step 4: Emergency services: Do you feel comfortable calling emergency services? What hospital would you want to go to in a worst case scenario? It’s better that you choose than to have a stranger choose for you. How would you get to the hospital if needed? Do you have any suicide hotlines handy (See the post on depression here for a brief list of hotlines at the end)?

I always suggest suicidal clients have multiple copies of their safety plan in different areas for emergencies. Keep copies in your bag, jacket pockets, wallet, car, in your room, at your partner’s place, in a few trusted friend’s homes. etc. Tell the people on your safety plan what their role is and what kind of support you need from them at those times.

How You Can Help Someone Who Is Suicidal

Let me start by saying that no amount of positive thinking and yoga is going to “fix” suicidal ideation and stop someone from wanting a permanent escape. It’s like trying to cure a tumor with just positive thinking and a vegan diet. Not gonna happen. You got to get at the root of the problem. What is making them want to escape from their lives in a permanent way? If you want to help people who are suicidal, listen to and support them in addressing the issues that led them to feeling this way. Go at their pace. Let them lead the discussion and ask them what kind of support you could give to them during this time. While also making sure to set firm boundaries for your own mental health. Here’s the piece I wrote here on how to set firm boundaries. Or if you can’t help fix the major issue(s), support them by listening to them when they ask AND do small things to make their life easier. What everyday struggles could you help them with? Laundry? Food? Do they need help with child care? Or do they need your company? The suicidal person has to wrestle with their main issues while trying to stay alive. Your support could go a long way in easing their burden and increasing their chances of survival.

Too many ppl use the hotlines as the first level of defense and I want to dispel that. The first level of defense should be community-based prevention. Meaning building up strong friendships, chosen families, community bonds, etc. to the point where it’s normal to sincerely check in on each other’s mental health and actually step in to help when needed. Yes, give people hotlines to call. Hotlines are good resources if you need to speak about something anonymously, if you literally don’t trust anyone else in your area, etc. Hotlines are incredibly important…and also is there anyone in their personal lives who can talk to them? Sometimes people don’t want to talk to a hotline. They want to know that someone in their personal life cares about their situation and supports their fight for survival. Check in on your friends and I’m not talking about hollow check-ins between acquaintances. The “You good, fam? I saw your TL…” and “Yeah, I’m good. Just tired and a little stressed from work/school, lol”. Not the polite, fake checking in. Most people don’t get real about checking in because they don’t believe the other person actually cares and/or wants to take on the extra burden of helping someone else. Let’s get real though. Who’s your crew? Them? Those folks? Protect them. What keeps a pair or a group strong is sincerely opening up to each other, checking in on one other, and supporting each other through life’s mess.

I talked about squads checking for each other in the 4th part of my parenting series here where I also briefly talked about how it’s “very Western, very colonizer, to rely on a nuclear family (spouse and kids) for everything”. And it honestly doesn’t work. And going the individualistic Western way of pulling yourself up by your own bootstraps is literally impossible. That phrase was originally meant to describe something impossible that no one should be expected to do. And look, capitalism twisted the original meaning to trick us into fighting towards an impossible goal. Draining us of our health and life to feed the machine. There are so many lonely people in this world under this system. We should be relying on each other too.

If someone is opening up to you and talking to you about their suicidal ideation, it is a huge sign of trust. More often than not, they just want to talk about/process their experiences without feeling like they have to protect other people’s feelings, comfort, etc. And they trust you to be that non-judgmental, not pushy person for them. If someone you know tells you they are suicidal, don’t make it about how sad you and others will be if they die. It’s cruel to emotionally blackmail people into staying alive if they are suffering. Psychological suffering is just as earth shattering and life changing as physical suffering. Guilting them makes their pain about you so now they have their personal hell AND your feelings to manage all at the same time, which can make their own symptoms even worse.

Suicide is not selfish. You don’t know people’s lives and people’s pain. If suicide offends everyone’s sensibilities and morality so much, it would be in everyone’s best interest to do their part to make life bearable for everyone. Many of the problems and stressors that make life so painful are made worse by and/or are ultimately caused by systemic oppression of all kinds. In this way, disability rights, racial oppression, misogyny, transgender rights, capitalism, etc. are all public health issues. That all said, again, there are situations that cannot be solved for some people and assuming all efforts were made towards prevention, that person’s bodily autonomy should be respected.

I want to make a separate note to highlight this point: Calling the cops is the very last option if someone is suicidal, especially for Black and Brown people. What are ways you can maintain safety before reaching a point where one might consider calling the police? If you can get the person into the hospital or other other forms of safety, without calling the cops and possibly further endangering a life, great.

Suicide is a very difficult topic to discuss and it’s even harder to actually be in a situation where life doesn’t appear to be worth living anymore. It feels like a losing battle and people can find themselves wishing for any kind of peace or escape. This is where support from chosen and/or biological families, friends, and ideally the community can come into play along with any necessary treatment. Coming together and addressing the actual problems going on in that person’s life instead of guilting them into living a life full of suffering without their consent. All this…while also coming to terms with the possibility that maybe all the words and support in the world might not be “enough” to prevent loved ones from making that final, permanent choice. And realizing, as I said before, that people ultimately have bodily autonomy. The sadness and loss experienced by people still living are real and legit, but those feelings are not more important than the deceased person’s pain. And finally, it’s not anyone’s “fault” for them doing what they felt needed to be done. I hope this was helpful in giving people some clarity on how to better support those in need and/or find the support they need themselves to make informed decisions.

Thanks for reading. The next piece on Sunday 11/11/18 will cover grief. I will be explaining what grief is, what it can look like, and the psychological importance of mourning and mourning/memorial rituals.

Detransitioning

This is a seriously misunderstood topic. I was inspired to write about detransitioning when I saw a tweet by a bigot spreading misinformation. Bigots love to pretend that the rare cases of people deciding to reverse the effects of social and medical transitioning are somehow a sign of an “agenda” forcing people to become transgender. For the record, this isn’t a trans 101 post. There are hundreds, if not thousands of trans 101 resources and websites out there for any “But what does transgender mean?” questions. Google is your friend. Or pay a trans person to explain it to you. Either way, that’s not what this post is for. The goal here is to explain the basics of transitioning, detransitioning, and how you, cisgender people, can support trans people regardless of the choices they make. I want to demystify detransitioning for y’all.

What is Transitioning?

Before I get into detransitioning, I’ll explain transitioning real quick. There are 2 types: social transitioning and medical transitioning. Social transitioning deals with how you engage with society and people. Examples of social transitioning would be coming out as trans (to friends, family, coworkers, classmates, doctors, etc. over and over again throughout your whole life), using different pronouns, changing your name and gender markers on IDs, and/or changing the clothes you wear. Medical transitioning includes the medical procedures/treatments that some trans people decide to do to ease dysphoria, to overcome the puberty they were forced to endure, etc. Hormone replacement therapy, hysterectomies, the multiple kinds of top and bottom surgeries, etc. are a few of the many examples of medical transitioning. Cis people, in their ignorance, think there is this 1 surgery, THE surgery, that does…who knows what…and that’s how trans people become trans…like baking a cake or something. Transitioning in general is not a 1 size fits all kind of deal. Some trans people socially transition, medically transition, or some combination of both. Not all trans people choose to transition the same way. Transitioning, like life, is unique to each person. It depends on what living their truth looks like for each person and what is realistically possible for them due to financial restrictions or society’s transmisia/transphobia. Some trans people do not socially or physically transition in any way for their own reasons.

Note: Transgender people do not transition for cisgender people’s pleasure, comfort, permission, etc. Trans people transition to live their truth. Trans people do NOT transition to look like or copy cis people. Trans people do NOT transition to attract or trap cis people. Trans people transition for their happiness, peace of mind, satisfaction, etc. The only time trans people factor cis people into their thinking is when they are worried cis people will harm/kill them or when discrimination leads to them losing jobs, access to healthcare, right to pee in public bathrooms, child custody, etc.

The medical health and mental health needs/concerns of transgender people are not taught in med school/psych programs and there are so few in depth trainings available. Most cisgender professionals don’t know anything and don’t have the training to provide care to trans ppl. And most of them don’t even know how to help people process their own feelings about gender. Most professionals don’t know how to help anyone determine for themselves whether they are transgender or a cisgender person with gender-related concerns. So it is rare, but possible that a cisgender therapist with no proper training could encourage a another cisgender person with gender role/gender presentation concerns to transition. That’s SO rare because usually cisgender people go out of their way to do whatever it takes to stop people from gender transitions. Despite what most cis people seem to think, nobody is passing out hormones, etc. to transgender people like candy. It can take months at minimum to receive clearance for any kind of trans-related care, assuming you have insurance that will cover anything.

Though transgender people have always been around, trans people are becoming more visible in mainstream society so, as a result, more and more people see that being trans (and transitioning) is possible. At the end of the day, the rare cases of detransitioning that result from cis people mistakenly transitioning speaks more to systemic transmisia/transphobia in the healthcare field AND the desperate need for medical providers who are properly trained in transgender healthcare and working with gender-related concerns in general. Mental health professionals and doctors/nurses should be trained by trans people (a great way to create jobs) to be able to provide quality care and to be able to help all people process any gender-related feelings without judgment and/or bias.

What is Detransitioning?

[CW: I’m going to talk about detransitioning, putting it into the context of living in a transmisic/transphobic society. This may be hard to read and/or dysphoric for trans people. Self care, y’all.]

So I want to make it clear in this section that when I’m talking about detransitioning here, I am referring to transgender people who detransition. I already talked about cis people who mistakenly transition earlier. Again, the rest of this piece will cover only transgender people who detransition. Detransitioning could be social and/or physical. It’s usually due to systemic transmisia/transphobia (living in a society that is pound for pound stacked against you and wants you dead/disappeared) and a lack of social supports. Systemic bigotry and individual experiences with transmisia/transphobia can cause or exaggerate mental health symptoms like anxiety, depression, and/or trauma reactions. In addition to making physical health symptoms worse because the mind and body are connected. Exposure to other kinds of bigotry like racism and misogyny does the exact same thing so if you are a transgender person of color and/or a trans woman of color, you are dealing with even more burdens and stresses on your mind and body all the time at the same time. Detransitioning then can become a survival tactic in a bigoted, violent world that wants you dead.

Imagine being forced to cosplay as another gender for most of your life, with society constantly making jokes about trans people (trans women in particular) and killing them on a regular basis. Comedians make whole comedy specials about these murders. You then realize that you’re actually 1 of those people you’re taught to think is weird/disgusting/worthy of dying. Living your truth as a trans person is not a breeze, contrary to what a lot of cis people seem to think. This is an uphill battle: people you thought you trusted will abandon you and possibly actively try to harm you. Support can be hard to find depending on where you live. In many states, changing your name and gender marker on IDs is made purposefully too expensive for many people with mandatory doctor visits and/or surgery requirements. Really think about that. Think about being forced to have surgery (an expensive surgery you might not have really wanted) that you could die from because there’s a risk of dying in any kind of surgical procedure…and/or because your medical providers and/or case workers might have little to no experience working with actual trans people and/or might have anti-trans views. There have been many cases of medical providers refusing to treat trans people and/or letting trans people die on the operating table. This seriously happens. This is something that many trans people on some level worry about especially if you don’t live in an area that has quality transgender-specific care.

Let’s keep imagining here though: you need money to pay for your transition expenses, but no one will hire you to make that money because job discrimination against trans people is legal in most states. But any delay in transitioning could lead to more mental and emotional symptoms because there’s a serious risk of violence from cis people who routinely attack anyone who doesn’t look like them. And honestly that’s not even close to everything that trans people deal with. It’s draining to be trans in this society. It’s literally traumatic because bigots make it that way. And if you have other marginalized identities: being queer, asexual, intersex, Black or another POC, disabled, etc., it’s even more complicated. It can wear someone down to deal with all that bigotry stacked on top of each other alone for years. And with all of that, detransitioning can seem like the only option to find some peace. How messed up is that: Being forced away from living your truth and then dealing with all the psychological/emotional pain of that becomes the way to avoid society’s constant torture.

The most common reasons I have ever heard for a trans person detransitioning are for safety, a stable job/income, and/or to avoid being alone. I’ll never forget: in 1 of my old jobs, a coworker had a Black trans woman client who lived in a SRO (single room occupancy) building. I remember her coming down to see him in “boy-mode” suddenly one day. She told me casually that she decided to detransition over the weekend because she was terrified and tired of cis men attacking her basically every night. She was trying to find her own apartment and a job, but she couldn’t if she was constantly healing from these assaults. After almost a month, she started taking HRT again. When I saw her, she told me she started HRT again because (I’m paraphrasing) she had to do her regardless. I had so many mixed emotions in that moment. On 1 hand, it’s powerful as hell, but it shouldn’t have to cost her so much power and so much energy just to go to the corner store. Despite detransitioning being so rare, she isn’t the only one dealing with this.

I decided to ask transgender people on Twitter back in April the following questions: “What was happening in your life when you made the decision to detransition?” and “Is there anything else you want me to know/understand about this?”. 2 people graciously reached out to me to tell me their experiences with detransitioning. 1 person, a trans man made the decision to detransition in order to become financially stable. Due to job discrimination against trans people being very legal in this country, in order to receive “a serious paying job”, he made the choice to detransition. To put it blankly, he knew that “if I had walked into the interview binding with a shaved head I wouldn’t have been hired”. I’m using the word “choice” loosely here. Decisions made in coercive situations aren’t the same thing as decisions made when you have freedom. Having to choose between being yourself and being able to eat and keep a roof over your head is a symptom of larger problems in society. Suffer psychologically and emotionally and keep a job or be homeless and financially unstable. That’s not a real choice. And that’s a man-made problem that can easily be solved.

The 2nd person to share their story with me on Twitter was a non-binary trans POC who came out as trans 5 years ago and was isolated from their family for 4 years as a result. They decided to detransition because they are “in dire need of community”. They described the trans community at the school they are attending as “racist” and after being alone for so long, they said they are “in the process of detransitioning to talk to my parents again”. Humans have many different kinds of survival needs: shelter, clothing, food, stability, and a sense of belonging/community are some of them. Many marginalized/oppressed people are forced to trade some needs for others and have to figure out how to exist without fully being allowed to live. It’s painful. It’s messed up. Again, it’s a man-made problem. Many bigots will point to trans people who detransition as evidence that their trans experience and their gender was never real. One thing that this 2nd trans person wanted to make clear was that being forced by their situation to detransition was “very painful” and did not make them any less trans: “I guess I’d like you to know that I’m still trans”. This sentence reminded me of that Black trans woman approaching me to tell me that she’s still trans. I really felt that. Cisgender bigots try to capitalize on the rare detransitioning cases because they want to pretend that transgender people are accidents, signs of mental illness, a recent fad, and something that can be reversed with enough hate and abuse. But transgender people are still here. They have always been here and there’s nothing cis people can do to change that. If anything, detransitioning is a sign of a cisgender agenda: an agenda designed to prop up white supremacy, colonialism, patriarchy, etc. that traumatizes and kills children and adults, whole human beings, everyday.

What Can Cisgender People Do To Support Trans People?

This is why it’s so important for you to challenge transmisia/transphobia in yourself and the people in your life. Look into yourself. If you are a person of color and would want white people and other POCs to speak up if someone ever said some racist mess about your culture, you’d be a hypocrite if you wouldn’t do the same for an oppression that isn’t yours. This society makes being transgender so damn hard. Deadly actually. Especially if the trans person is also Black, queer, disabled, etc. There are trans people in your communities that you have abandoned to be as bigoted as colonizers. You can’t be a leader in a revolution with all that hate/disgust/aversion in your heart for your own people. You can’t be a leader and a leading cause of death at the time same time.

Some Basic Ways Cis People Can Help:
  1. Introduce yourself with your name and pronouns to everyone, even if you think you know their gender. If anyone asks, say you’re just being polite: You wouldn’t like people to assume anything about you and you don’t like assuming things about people.
  2. Use whatever name and pronouns you are given. With practice, like anything you put effort towards, pronouns are easy.
  3. Don’t let anti-trans jokes fly without challenging them. If it makes people uncomfortable and feel like they can’t make those kinds of jokes around me anymore, good. I didn’t want it anyway and I made the area a better place.
  4. Stand against laws and policies that hurt trans ppl because it creates a safer world for everyone. Creating laws where medical providers can turn away trans people for religious beliefs creates loopholes so doctors could reject cis people for wanting birth control, being Black, having an undocumented immigration status, etc.
  5. If you don’t understand something, google it. If you can’t find the answer after googling, ask a trans person if you can give them some money in exchange for them taking the reasonable amount of time and labor to educate you.
  6. If you have some extra money, donate directly to a trans person.

Transphobic cisgender people love to jump on detransitioning stories as evidence of a “transgender agenda”, but if cis people let other people live their lives freely, there would be no need for detransitioning. Being real and true, the real agenda is assuming everyone is cisgender and heterosexual and then forcing everyone who is different to pretend for the rest of their lives…unless they want to risk housing discrimination, job discrimination, terrible medical care, not being able to get custody of their children, etc. On some: be like us or we won’t let you be a full member of society…assuming you survive all this. Staying silent doesn’t make you a witness. It at best means you’re an accomplice, holding the torturer’s beer. Trans people aren’t aliens. There are Black transgender people, Latinx transgender people, etc. There are trans people in your communities that you could be supporting. There are trans people in your hood you could be looking out for. Because bet money throughout history when one of us was killed and a march needed to happen and/or hashtags needed to be shared, your transgender community members were out in the streets. But who stands up for the trans people in your community?

 

Thanks for reading. The next post on Sunday 10/28/18 will be covering suicide: what it is, the difference between thinking about suicide and being at risk of actually doing it, bodily autonomy, and suicide prevention.