There is no getting past how difficult this blog is going to be to write and to read. I have included it in Dementia diaries because it belongs there.
Let me say straight away to long-term readers that no one that you know yet, through these columns, is the suicide. My wider family is involved, especially my step-mum-in-law hereinafter the SMIL, who I have rung nearly every day since the beginning of lockdown. It is her son who has taken himself off this mortal coil in an untimely fashion leaving his mother, his sister and his daughter distraught and short of a son, a brother and a father. His daughter is only 19, he did not live with her mother.
It became apparent that he had been planning it for months; he left all of his mother’s affairs in order, and left all relevant documents, including his bank cards, neatly arranged for his daughter to find. He was not apparently ill, though he had minor heart issues. He appeared to be logical and sane. I talked to him with reasonable frequency over the last year as he was sometimes at his mother’s house when I rang. There was no indication that he had this course of action in mind and, indeed, planned to all the minute details.
The reason for blogging this is the same as the reason for the dementia diaries – you are not alone with a problem if you know someone else has the same problem. During and after the writing and posting of the dementia diaries, I received emails from all over the world. It seemed as if a large number of people in every developed country were facing the problem of how to cope with ageing relatives needing help and care at a distance, sometimes in another country, or on another continent. Former normality, where we all lived two streets away ‘from me Mam’ who was going to live to eighty if she was really lucky and then drop dead thoroughly thrilled that she managed a decade more than her three score and ten, no longer obtains. It is more likely that in our late middle age we will be struggling with our own health while trying to assist with mentally compromised relatives kept going on trays full of pills, visits from healthcare professionals and frequent stays in hospital. This stage of life, difficult for the carer, achieved with grace, kindness and understanding, can be life enhancing, both for the care giver and the receiver. Life throws challenges at us all, it would not be much of a life if you had no challenges and the spiritual growth and personal satisfaction that comes from meeting and learning how to deal with all the trickier bits of life are ultimately the measure of a person. Becoming more yourself through doing the difficult stuff is what life is about, much more than assembling a ton of money, having a great career, or simulating some aesthetic ideal. But the difficult stuff is not easy, which is where the Dementia diaries came in. They were the moral support you needed in the small hours sitting with a cup of cold tea, gazing at the carpet and wondering if it was only you had to put up with all of this, and, also, was it even possible, at all?
Hence this posting about suicide. Whilst this is the first time it has happened to a family member, it is not the first time suicide has loomed in my life. I would like to say straight away that www.Samaritans.org is the place to go if you are contemplating suicide yourself. Their phone lines are manned by trained people who can and will help you. This organisation began in 1953 in the UK, and still serves the UK by telephone. In other places of the world you can find telephone help with your search engine. Talking to a stranger, who does not have the approving or disapproving face of a family member or friend but knows how to listen and what to say, can be the greatest help in the most despairing time.
The first person I encountered the tendency to suicide in, was me. When I got eleven straight high scores in O level exams at 16, my mother, as always, jealous, decided I was too fat and that the best thing was to get the doctor to lock me up in a geriatric ward and have me starved for a fortnight while they went on holiday. I was not overweight until she started starving me. The more she suspended food the fatter I became, until the second lock-up, from which I ran away. In the 1960s it was not understood that the brains of teenagers are something like chrysalises, undergoing a metamorphosis into the adult with adult emotions, hormones, muscular development, reproductive equipment and the structures in the brain to facilitate and enhance all of that development. The very last thing to do is suspend the fuel to make the change.
I stopped speaking and after several months began suicide attempts, by various means. One involved taking a vast amount of headache pills, for which I was given an emetic of mustard, which I cannot stand to this day. I was still weighed every Sunday and still punished if I had put on weight. I was told it was my fault, that they had adopted a faulty one and that I had an endogenous depression caused by being born wrong.
The second time I encountered suicide was when we were in our late twenties. A friend we had made at that time took his own life with great determination. He was very bright, the son of immigrants, though born in this country. His father was living out his ambitions through his driven son, who did not seem able to make friendships with girls easily, we were all aware that he was very happy when he was in company and very lonely when he wasn’t.
The only reason that people commit suicide is that it seems either like a good idea or like the only possible idea, just as the only reason for you being dead is that your heart has stopped beating. There are many routes to arrive at this conclusion. Money troubles, usually debt, are a common trigger. I do know how despairing you can feel when there isn’t even enough money to eat. When my mother-in-law died we were £16,000 in debt, at the time half the value of the house we were living in and many times the mortgage we were paying on it. We’d achieved the debt by entertaining the in-laws for four days every fortnight for five years on the pay of a lab technician, once I stopped teaching to have a family.
The other triggers are lack of love and social isolation, principally. This is one of the main causes for peak suicide age for men being in the late twenties. The biological urges to find a mate and reproduce are at their peak and in sharp contrast to the financial constraints of finding paid employment and getting a roof over your head. There are additional stresses caused by the screens we are surrounded by, which present us with idealised images of people which we feel to be aspirational when they are far removed from the appearance of most normal people.
The dictum that hell is other people can be a trigger for some suicides. Bullying, abuse and other forms of aggression by groups or individuals can be a potent trigger in what seems an inescapable situation. My mother was a bully who could be charming to other people while bullying me. Caring for her in her old age whilst never visiting on her any of the things she did to me raised my self esteem considerably.
Substance abuse of various kinds, leading to despair of ever being free of addiction, simultaneously creating chemical changes in the way the brain works, can also be a trigger, as can the abusive behaviour in another person who is the one with the substance problem.
All of these triggers to suicide and a few others are almost a description of what thousands of people have been enduring during the pandemic. If these problems are yours, or you can see them in someone you are in contact with, or suspect someone you know may be thinking this way, please get help. The pandemic is a guarantee that you are not alone in suffering with difficulties that seem unsurmountable. All you have to do to find help, is to put the problem that is getting to you, into a search engine. I have had a go experimentally to see what you turn up, and my computer now thinks I am a down-and-out on major drugs regularly beaten up and about to imminently off myself. What that proves is that proper help from trained agencies in every possible problem is only as far away as the screen you are sitting in front of. The conditions of difficulty that lead to thoughts of suicide, which is described officially as suicidal ideation, cause changes in the brain. When a normal brain is sitting in your head, thinking of what you’re going to have for dinner, how you really ought to wash those joggers, or wondering if it is worth switching on daytime TV, the idea that you should take the butter knife and kill your self with it, right now, is ridiculous. Our experience of life so far has taught us that good things can happen in the future, which, in the case of a chocolate biscuit and a cup of tea, may only be five minutes away. So what happens to make the idea of ending your own life, which has already produced, usually, more good things than bad things, seem logical?
When my father died and I began caring for my demented mother, it was plain that I was the only person who would be talking to the doctor and that I needed to understand what was happening in her brain to grasp what the doctors were telling me, so that I could help her most effectively. I began by reading a children’s book about the brain and, having absorbed that, everything else that was written in layman’s language that I could get my hands on. Quite soon doctors began asking where I had done my degree in medicine. By then I realised that my clinical depression as a teenager was almost certainly caused by the starvation. Our brains use at least a fifth of the energy we consume every day. Different parts of the brain undertake different tasks, even though the brain itself, sitting in the skull like a bowl of grey jelly, with a formidable wiring system, is so plastic that in the event of injury, other parts of the organ can compensate by partially relieving the damaged part of its duties.
In my twenties I had a stroke, which was not diagnosed until I had a head scan more than ten years after the event. I was teaching at the time of the stroke, got wavy lines on the side of my vision and fell off the desk I was sitting on. I felt very strange but the head of the school I was teaching at decided I was just swinging the lead, and nagged me back to school in a week. I continued to feel odd for a few weeks. The scan years later revealed that the stoke, in which blood flow is interrupted to part of the brain, stopping it working, had killed off part of my brain at the back of my head. You could see, in the screen picture of the scan, the dark part of my brain, right next to the visual interpretation centres. Yet I had recovered, obviously nearby areas had adapted and taken over the work of the dead cells.
I believe the human brain is the most amazing thing we have found in the universe so far. The human brain took some of us to the moon with the assistance of instruments with less computing capacity than an old folk’s poke button telephone. Human babies are born equipped to learn everything every person has ever known, including every language and all maths, and make choices based on environment, over the first few years, to narrow the abilities down to the specific place and conditions on the planet where they find themselves. We are adaptable, our brains can shrink over the course of a hundred year life, yet still support life, thought and the memory of poetry we learned when we were five years old.
This comes at a cost. The organ is fragile, which is why it is enclosed in a bony box, it works by organically generated electricity, if the chemicals go wrong it can go wrong. Deductive reasoning, orientation in space, use of language, perception of smell, and endless other, endlessly astounding abilities can be lost, vanish temporarily or go on the fritz. Like the complex electrical circuitry they are, our brains can blink on and off, leaving logic nowhere, and you can’t even tell this is happening by looking from the outside.
This is the essence of clinical depression, a normal brain thinking abnormally because of nutrient deficiencies, the overwhelming presence of stress chemicals, worries, life changing events, and various other external and internal changes such as pregnancy and giving birth.
At the time, in the head of the person who is thinking so abnormally that suicide seems like a good idea, the ‘hang on, is this really what we want?’ response seems to be missing. I remember thinking, when suicidal, that the world would be better off without me, that I didn’t want to be here, that life was impossible and also, because I was a teenager at the time, that that would jolly well serve my parents right!
As has been shown by the careful preparations of the family member who took himself off, sometimes suicidal thoughts don’t just seem like an answer to current problems, they seem like a very good solution to everything. Anyone who plans to kill themselves with such dedication for so long, is probably convinced that it is the only possible response to an ongoing situation. You would have to have a brain operating at the very edges of normal parameters to think this way. When my father died my mother had a conversation with me in which she proposed I fetch a lot of pills and she would swallow them and that would sort the problem of being left alone. Very little chatting to someone who had actually been diagnosed as demented, persuaded her that assisted suicide would cause many more problems than it would solve, and her last Christmas that she was able so joyfully, to spend with her great granddaughter was proof that something wonderful may always be round the corner.
To be theoretically in your right mind, apparently lucid, holding a normal conversation and yet at the same time, be constantly planning your suicide in your head, is an indication of how abnormally my SMIL’s son was thinking. A brain that is working so poorly is not going to serve its owner well.
And that answers the question all survivors of the suicide of a family member or friend always ask first :Why?
The clue lies in the death certificate. The death certificate says that the person took their own life while the balance of their mind was disturbed.
And the second questions that survivors ask: could I have stopped it, was it my fault, what did I do? Are also answered by the same phrase. The mind of a person whose mind is unbalanced, is not working in the same way as a rational mind because it is unhealthy. The person is sick.
In the last year around the world people have encountered very challenging situations during the pandemic. We know that for many people social isolation can itself be enough to unbalance a mind. Brains are as unequal as any other part of the body in different people, some are strong, others not as strong. This is why torturers of prisoners in modern times isolate them, deprive them of sleep and have constant loud noise in the vicinity. They know that these are enough to break some people by disturbing the electrical working of the brain. They often add constant death threats, so that the person is pumping themselves full of stress chemicals. During the pandemic, many people have been isolated, not sleeping and terrified of imminent death from the virus. It is the likelihood of the situation causing mental distress, that prompted me to add a bucket of chocolate to the lockdown library on the drive. You can’t cure mental illness with chocolate, but you can perhaps make someone who serendipitously finds free chocolate, feel optimistic enough to take the actions that are helpful to lifting mood.
As I have discovered over the more difficult parts of my life which have included living without enough food for months on various occasions, living with random aggression for years, living with temporarily disabling injury, living with alcoholism and living with cancer, lifting the mood is not always easy. There are plenty of medical solutions but to balance my brain, I prefer exercise, water, sleep and good nutrition. Some of all of this in a regular way every day helps the body and the brain. In times of unavoidable stress a pastime which focuses the attention elsewhere than the stressor is helpful. Every one should have a hobby. Preferably several. Everyone should value and take great care of that person that you see in the mirror. You should make sure that your self-worth is not externally located. Do not value yourself because you know someone famous, ‘like’ celebrities on social media, or count your worth to be the same as your bank balance, or your physical appearance. All these things can vanish in a flash, leaving you with nothing.
If life calls upon you to do a very difficult task, such as living with a person whose brain does not function correctly because of drugs or alcohol, or caring for a person who is very aggressive, or a person with extreme physical requirements, your plan of action to save the day must include the plan of action to save yourself. Rest, time off, respite care, a chance to get out in the fresh air for an hour or two, participating in a physical activity, a shopping trip just for you, time spent with a friend, a nice meal, a good night’s sleep, all these need to be built into the plan for you, the carer, from the beginning.
Long-time readers will, I’m sure, be about to remind me that each time I cared for someone demented I ended up with cancer. True. I believe that in me cancer is a stress response. I would still do the caring because this is the way to grow your soul. We learn to endure by enduring. The ultimate early exit strategy robs us of the resilience we would have acquired if we had just hung on a bit longer, got a bit of help or a friendly ear, through the trickier bits. At the end of Covid those of us who have survived will have changed. We will have a new appreciation of the simpler things and different values, for some of us, than we previously held.
Not every one will make it. Those who did not, whether they succumbed to the virus, the isolation, the mental strain or anything else, should be regarded as casualties of a once-in-a-hundred-years event. This is how I am going to regard the loss of the SMIL’s son for myself. I have continued to phone the SMIL every day, twice if she seems a bit down and I will use every bit of empathy I have and my ability to make her laugh. I have started making her a lap quilt to send a hug for an afternoon nap and volunteering all the stuff I have discovered that needs to be done after a death and where to find out what to do, to her daughter. If you have suffered a death during the pandemic, or do so in the future, ask your search engine what to do in the event of a death, follow the steps, ticking off a list and keep all the official papers somewhere safe for seven years in Britain or however long your search engine tells you is the legal requirement where you are.
Surviving the death of another from any cause is one of the most difficult things we may be required to do in our own lives. Afterwards the steps to recovering our own equilibrium and living the rest of our own lives in the new circumstances are the same. Exercise, sleep, water, nutrition, a place to put your head away from the worry and time are what we need. No one is likely to live their whole life, if it is of normal span, without encountering the death of someone close to them. The only person who will be with you for the whole of your life’s journey is that face in the mirror, which is why, in the awful event, it is of the utmost importance, as well as doing all the things you have to do, to be kind to yourself. It is important to be patient with yourself, to know that your strong emotions will soften with time until all that is left in your head are the positive and happy times. Like waves washing at a fossil in a rock, often the structure of reality is not apparent for a long time. If you have lost someone in the pandemic, it may help to realise that no one will know how the world has changed until long after this once-in-a-hundred-years event. It may help to regard your lost person as part of great changes in history, as are we all.
If you are a survivor be grateful every day. Throughout the last year I have made sure to end each day with a gratitude list. Your list may be short. It may be the bird singing in the garden. It may be a spectacular sky. It may be a cheerful word through a mask in a shop. It may be a little bit of chocolate. It may simply be that we have survived another day and that we do not know what wonders tomorrow has in store for us. We do know that we have to get there to find out. We also know that we are only ever going to be asked to live with the difficulties of one day at a time. At the end of the day we sleep. During sleep we mend so that we can wake to the wonderful gift of a brand new day, refreshed, renewed.
Consider this – if you live long enough you will be able to bore the pants off your great grandchildren by telling them how you survived the great pandemic of ’20. And the third time you tell it, you’ll even know when they are going to start rolling their eyes and fidgeting.
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I reply to emails that are not spam. Click on the link where it says to Leave a comment. If you are feeling very depressed or desperate please do talk to a doctor, or look for professional help with a search engine.
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