On the Difficulty of Preventing Suicides and Managing Mental Health Problems in the Community / by Muhammad Amir Ayub

From the New Yorker (shared by a friend on Facebook):

Kate Spade’s handbags were playful and fun. Her quirky look was unmistakable and bespoke exuberance. Anthony Bourdain was almost inconceivably high-functioning, and won so many awards that he seemed ready to give an award to his favorite award.

One's outside appearance and achievements have almost no correlation with what's going on inside. And the above proves it.

If life wasn’t worth living for people such as Bourdain and Spade, how can our more ordinary lives hold up? Those of us who have clinical depression can feel the tug toward suicide amped up by this kind of news. The gap between public triumph and private despair is treacherous, with the outer shell obscuring the real person even to those with whom he or she had professed intimacy.

I've many a times thought/talked about preferring to die early as the challenges to trying to achieve "success" is too overwhelming, and at times the only way to manage it is by managing expectations and prioritizing other things in life at a cost to career development. And occasionally talking to Siri about it. And I doubt that I'm the only one dealing with it; it's just that nobody talks about it (or is willing to hear/understand about it).

A new Centers for Disease Control and Prevention report shows a vast increase in American suicides over the past decade, and asserts that fifty-four per cent of the suicides reviewed didn’t have a previously known mental-health issue. “Instead, these folks were suffering from other issues, such as relationship problems, substance misuse, physical health problems, job or financial problems, and recent crises or things that were coming up in their lives that they were anticipating,” Deborah Stone, a behavioral scientist at the C.D.C. and the lead author of the new study, told NPR.

Aka "real issues". You don't need to be "clinically depressed".

Opioid dependency drives self-annihilation, and many of the drugs to which people become addicted are easy to take in fatal doses, especially opioids in combination with benzodiazepines. A third of Americans are sleep-deprived, and sleep deprivation has a devastating effect on mental health.

I wonder if there's a correlation with being a doctor and the above? Or being a doctor trying to achieve "career success" and the above?

Rates of teen depression have risen since 2011, and students are carrying more debt and face more uncertainty about their lives.

Earning power has continued to deteriorate with no end (and in Malaysia probably will stall for a while with the GST's elimination, but never improve)

I hear from people who wake up, eat breakfast, go to a job at which they interact with a machine all day, pick up food on the way home, eat in front of a television, and then go to bed.

Replace machine with patients (who aren't there to cheer you up), and you may get a doctor or two.

Dr. Kelly Posner, who helped develop the Columbia-Suicide Severity Rating Scale (C.-S.S.R.S.), pointed out that more policemen die of suicide than die on the job; more soldiers die of suicide than die in combat; more firefighters die of suicide than die in fires.

That the author misses out the extremely high suicide rate among doctors is unforgivable. You know, whose job is to in theory save lives.

“There was a point where I realized that, if I died of old age, I would win, because so many people with bipolar disorder kill themselves that simply not to kill myself would be a big goal. And I thought, ‘That’s really a low bar.’ And then I said, ‘No, it’s not a low bar, because it can be that hard.’ ” It’s hard for people who have never been suicidal to understand how seductive it can seem. Though their acts may have been impulsive, the likelihood is that both Kate Spade and Anthony Bourdain had struggled with demons for many years.

It's never truly impulsive. And like I said, setting the bar low helps. But it's not easy for doctors, who are used to achieving academic success throughout their lives, until they meet the grueling training with its high attrition rates during both undergraduate and postgraduate training phases. With its real financial ramifications. And the "significant" collateral damage. And never having a so called "study break"; you study during whatever free time you've sacrificed out of your life after work to study. And maintain yourself as a high achiever with Special Forces-like physical and mental stress, minus the training (nor the mental health services) to build yourself up to be that resilient.

Mental health solutions will continue to be difficult to find, even more so in Malaysia. We even have a hard time accepting the existence of post-partum depression (and our Malay worldview of marriage = shit ton number of kids early or it's a failed marriage does not exactly help things); our community would just not accept other "more abstract" issues of mental health easily.

And that's unfortunate.