Opinion article by Angela Vorster, Clinical Psychologist at the School for Clinical Medicine, University of the Free State.

If you are reading this you may be interested in better understanding why there is a need for a World Suicide Prevention Day each year on 10 September. For some it may seem morbid, while for others it is just another awareness initiative. But for too many, suicide is personal. You may have lost someone you love in this manner. Or you yourself may be struggling with thoughts of ending your life. If you fall into the latter group you may want to skip over to the very last paragraph, because I know your attention may be waning and your energy may be low. Everybody else, please join me in better understanding the need for awareness of thoughts of self-harm and attempts at ending one’s life.

Mental illness can be fatal 

In most instances dying by ‘suicide’ is more accurately described as dying from a psychiatric disease. Mental illness can be fatal if left untreated and we need only refer to suicide-related statistics to realise the magnitude of this plague in South Africa. The World Health Organisation indicated that South Africa is ranked 10th on the list of international countries with the highest suicide rates, while The South African Depression and AFnxiety Group (Sadag) reports 23 deaths by suicide per day. For each person who dies by suicide in our country; 10 others attempt to end their lives. Up to nine out of 10 people who die by suicide in South Africa had a mental health disease such as depression at the time of their death. If we take a look at these facts, it becomes almost absurd that we still regard mental illness and thoughts of self-harm and the act of causing self-death, as shameful and abnormal. But that is still very much how mental illness and particularly suicidality are viewed in our communities. Perhaps if we are able to really understand what it feels like to feel so terribly sad, empty, hopeless, worthless and guilty that you would rather end your life than suffer through another hour; perhaps then we would be able to create safe spaces for those who feel suicidal to express how they feel. It is only through connection and communication that we can provide the right support at the right time in order to save lives.

The black dog

There are many descriptions of what it feels like to be so ill that death seems the only cure and these vary across cultures and countries. The Black Dog Institute in Australia derived its name from the description of depression as feeling as though a menacing dark dog-like creature is following you around and no matter how hard you try, you just can’t shake it. Winston Churchill used this metaphor to describe times when he felt melancholic, demotivated and down. Now I love dogs, so I imagine this particular type of canine as being almost monstrous, not leaving you alone, but also not giving you anything. Instead of the loyalty and companionship and protection that our pet dogs give us, this dog demands constant feeding, does not allow you any freedom and prevents you from making contact with other people. The moment you start to reach out to someone, this black dog starts growling in the background and you give up or scare them away with your dark mood. And the black beast has you all to himself once again. This type of depression sucks your energy and your motivation. It makes you irritable and tired and isolated. Difficult to like.

Another metaphor for depression is ‘feeling blue’, one which we use so frequently that we have perhaps not stopped to consider where it originates. There are many theories, and all of them quite bleak. One is that the description derives from the human body that turns blue after death; another that ships used to fly blue flags if their captain had perished at sea, and yet another, that Zeus, the Greek God of the sky and thunder, would make it rain when he was sad. Have you noticed how flippantly people comment on ‘the baby blues’ as though this were something almost endearing and expected that is associated with becoming a mother. This while the stark reality of post-natal depression has been highlighted in the recent trial of Dr Lauren Dickason in New Zealand. I cannot comment on the legal aspects related to her case, but what I found jarring was the number of times that she told the people around her that she wanted to die or that she wanted to harm her children. I have worked with many women diagnosed with post-partum depression who describe feeling as though they are drowning. Having nothing to stand on, being pummelled by waves, unable to catch a breath and with no sight of help or the shore. This type of depression is a torturous combination of distress, anxiety and hopelessness where you just cannot stop the negative fearful ruminations swirling in your mind. There is no calm, no silence and no peace.

Feeling nothing 

The metaphor I find most disturbing is when depressed patients describe feeling ‘nothing’. So often people will express feeling empty and their lives as grey. Nothingness. And I am always reminded of the 1980s movie ‘Neverending Story’ where everything that was magical and creative and hopeful had been swallowed up by ‘The Nothing’ – an empty energy that consumed everything in its way. How terrifying it must be to feel nothing. No hope, no joy, no excitement, not even sadness or fear. Just nothing. Blank. And no matter what you do or how hard you try, you just feel nothing. How horrifying it must be to hug someone you love, or have to get up each morning and go to school, or go to work and have to paste on a smile and chat about the weekend while you feel nothing. I can only imagine the desperation to feel something. Anything. This depression is you sitting on your bed and staring at the ceiling for hours. Waiting for it to end. 

Something that stands out to me as a common theme among all of these metaphors is this: if a monster is following you around, nobody wants to come near you. If you are gasping for breath and swallowing water drowning in the sea – there is nobody around to save you. If you float through your days in a bubble of nothingness – you are alone. The antidote to suicidality is connection. It is being willing to spend time with someone who has a growling, slobbering, and mangy stray dog following them. It is listening to someone who is struggling and thrashing, terrified of drowning. It is being brave enough to enter nothingness and to realise that you too could horrifyingly easily feel empty and grey too. Now we need to be cautious. It is dangerous dealing with an angry dog, or trying so save a drowning person or rescuing someone floating off into space. We cannot do it alone and we cannot do it without experts. But the first step is to shout, or speak or whisper: ‘Hello’. ‘I’m here’. ‘I’ll get help’. Without fear or judgement or discrimination. But with the deep understanding that being human is a treacherous thing. And recalling the times when a safe, strong hand reached out to pull us away from danger. Because you see, we are all vulnerable to being followed by a black dog. Or being washed away by a wave. Or being consumed by The Nothing. 

Grab hold of the stretched out hand 

What makes us human is our vulnerability. To diseases of the body. And diseases of the mind. And what makes us human is our willingness to see our own vulnerabilities in others. I will reach out and help you because I too have needed help. So this World Suicide Prevention Day let us tame black dogs and send life rafts out to stormy seas. Let us be the solid ground to tether those who are floating away into outer space. And when we find ourselves followed or drowning or adrift – let us too reach past the snarling and swirling and emptiness to touch the outstretched hands of those who are here for us. Because they are here. We are right here. But in order to be rescued from the attacking beast, or the crashing waves or the airlessness of space, you have to grab hold of the hand stretched out toward you. 

If you or someone you know are experiencing suicidal thoughts or feelings of depression please tell someone you trust how you feel and make contact with one of the 24-hour support lines such as The South African Depression and Anxiety Group (Sadag) (+27 800-567-567) or LifeLine (+27 861-322-322).

Also take a look at these websites: