I’m trying to remember if psychiatrists experiment with suicidal people?

There are no (or very few?) major modern high quality studies of major tranquiliser treatments for schizophrenia because a placebo arm of the trial would be considered unethical. Randomised Control Trials use Treatment As Usual (treatment with a standard major tranquiliser like Haliperidol) instead of a placebo control because not treating schizophrenia is unacceptable.

On the other hand psychiatric researchers have no such problems when dealing with miserable (depressed) people and depression research does feature placebo drug comparisons. Not treating depression is the mode of placebo control. Patients are given fake drugs in these experiments.

Now I’m to remember if trials routinely screen out people who are acutely suicidal. It would seem terribly unethical to fake their treatment. On the other hand I’m sure suicidal ideation is a common variable in the multiple aggregated variable measures typically used in psychiatric depression, schizophrenia and other psychiatric syndromes research. Perhaps people who aren’t at risk of suicide even though they’re experiencing suicidal ideation are included?

The reason I’m thinking about this is in my first Developed Document I proposed a vital piece of research evidence. In my estimation the syndrome approach – in contrast to a single symptom system – fails the suicidal. The syndrome approach uses an average of several factors to determine treatment response in empirical (numerical) evidence so it’s possible that certain treatments have widely different effects on single symptoms and patterns of symptoms (the factoral approach). Suicide is a critically important single symptom included in a lot of psychiatric multi-variable measures and by going through data from old studies in detail the effect of treatment purely on this one variable could be worked out. It’s basic meta-analysis applied across many studies but looking solely at one measure.

It makes logical sense therefore to ask for this research to be done but the flaw may be the consequence of ethical research psychiatrists.

Anyone got any thoughts?

Angel of the Abyss: an email to David Crepaz-Kaey at the Mental Health Foundation

I’d like to write to you about two issues but I’ll start with suicide because I saw you’re doing a project to create a suicide prevention pathway. The science isn’t good enough nor are the principles which are applied to psychiatric suicide practice.

I’ve written a document stating my position on the issue. It’s in two parts: the first talks about compassion and mercy especially in legalising assisted suicide and the other talks about the flaws and how suicide treatment could be improved.

I’ll sum up my thoughts here:
– if you want 100% of suicidal people to engage in the suicide system then there has to be legal assisted suicide available. Otherwise people who are certain they want to die will do so any way or attempt to without engaging with treatment. Assisted suicide is humane and incentivises suicidal people to engage who otherwise wouldn’t.
– people need the best scientific answer. The problem is there’s a lack of scientific suicide research. Psychiatric research is about syndromes so treatment effects are measured on multi-variable measures. Suicidal ideation is a common sub-measure in measures like the Beck Depression Inventory but significant effects on this one single symptom can be masked by effects on other symptoms. What’s needed is a retrospective meta-analysis looking solely at the effect of treatments on suicide both within syndrome research and across all syndromes to create suitable evidence based guidelines for suicide.
– there also needs to be scientific evidence and clinical guidelines for treatment resistant suicidal ideation. Basically this is necessary when the first attempt at suicide treatment fails. There’s nothing like this at the moment but it’s obviously necessary because standard treatments don’t work for everyone. Treatment resistant schizophrenia has guidance for treatment – alas it’s clozapine – so it’s logical that there should be something like this for suicidal ideation.
– I believe suicidal ideation is the worst state a conscious being can experience: when it wants to cease its life prematurely because it has become too awful to bear. Bearing this in mind any suicide treatments must be fast acting as well as effective. The aim should always be to minimise the duration of the personal torture of wanting to die. Psychiatric medication and psychological therapies take too long to work in my opinion. It is imperative that any suicide treatment is available quickly and works quickly.

These comments are drawn from substantial experience of unfulfilled, almost constant suicidal ideation over many years. The science is rubbish and the treatments aren’t good enough. Of all symptoms suicidal ideation is the most important but (as far as I am aware) there’s no suitable meta-analysis of old trial data. This is comparatively cheap and I’ve seen a review of 500 trials of job satisfaction on physical and mental health as well as a meta-analysis and funnel plot of publication bias using 1,000 trials so large reviews aren’t impossible. Psychiatric researchers have really failed in their remit to use the best science to tackle the suicidal ideation epidemic.

Where does the name Angel of the Abyss come from?

I named the idea thread on suicide on We Do Big Ideas “Angel of the Abyss” and to me it communicates the core of what I’ve been working on including the arguments for the legalisation of assisted suicide and fair regulation of suicide instead of the current unregulated suicide ‘system’ which prevails today.

The name is taken from the books of one of my favourite authors, Julian May, and the character Marc who takes the name Abaddon which means angel of the abyss.. It resonates with what I feel which is that change is desperately required throughout suicide policy and psychiatric practice has significant failings.

As someone who’s been suicidal for an extensive amount of time  I have witness the failings as well as conceptualised them in the abstract. I needed an angel of the abyss but there was none. There was just shite upon shite which just made things worse for me. Too worse.

My first developed document is about this. I’d appreciate any comments.

Happy Time to Change day

http://en.m.wikipedia.org/wiki/Think_different

We walk in the footsteps of giants

Euthanasia: dogs and disability

The divide which is drawn towards mercy killing for animals and people which dictates the legality of the former but not the latter is bizarre to me. Why? Surely a person driven to feeling suicidal – the pit of despair and hopelessness – is orders of magnitude worse than what pain an animal feels. We have a wider set of sensory experiences and a higher cognitive framework to our lives compared to animals. This has a wide gamut but for some there are worse experiences. The disability factor – which can be very high for serious mental health problem – embedded in prognosis associated with mental health labels is a prediction of a worse life with fewer good experiences and significant distress. This is worse for a human than a dog because we’re different

In short, our ‘specialness’ which underpins the sanctity of life principle but it can also underpin the factors which make our pain so much worse than for animals. We have a higher set of experiences and profound suffering. We have greater needs than animals too but since this isn’t realised mean people are unhappy with their lived. Sometimes this is what’s overtly given as a reason where assisted suicide is legal for all. It doesn’t encompass the awfulness which drives conscious beings to suicide. Suicide is a product of too much pain (I have so much) which drives people like me to want to die.

Sadly, there are no solutions either and tens of thousands of people try to kill themselves every year. They’re trying to escape a shit life and “shit” in ways an animal couldn’t feel. This higher capability is a source for sanctity of life but it also explains the difference of the manifestations of pain. Humans can hurt in profound ways which animals can’t but the sanctity of life principles allow a way out from the pain…but not for people? Our difference from animals is the source of wonder and happiness but it can also be a terrible ordeal which is worse than for animals.

It is a higher but more obvious mercy killing if people truly understood and appreciated the nature of suicides by the disabled as understandable escape from a worse life which won’t get better. It is a rational response and the severity and nature of the pain is different and worse than the physical pain suffered by animals which have mercy killing.

Life is sacred but not a shit life. Forcing someone to suffer a shit life without hope is awful. No conscious being should suffer so but there isn’t the required social and structural change in systems required to change this tragic fact of life. It’s not the disabled alone who choose not to live a poor life. The selfishness is in the circumstances that drive the tragedy and the tragedy is anyone at all is driven to no longer want to live their life.

Own up to the failure and have the decency to at least offer the suicidal a good death instead of a shit one on top of all the other shit which caused a higher-than-an-animal being to want to die. Don’t prolong the torture.

Suicide is about pain and fear of future pain (and escape from this unbearable reality)

This title seems like a summary of a substantial amount about suicide. It is simple and feels like truth, certainly more truth than it’s a spurious, irrelevant manifestation of a brain impairment as is the central suicide principle and understanding in biomedical psychiatry.

If you see the pain then you’re closer to the reality of suicidal thoughts. It’s also easier to accept suicide because no one wants someone else in pain, in torture. Attacking social determinants becomes the priority and acceptance of suicide central to the principle of least harms. Suicidal suffering is simply a suffering too great and the only mental health state I’d say shouldn’t exist with a sense of certainty. Torture in all its forms is unacceptable and there must be the sense to end immitigable pain the hard way by legalisation of suicide. Decriminalisation is simply unacceptable because allowing torture to happen is unacceptable.

The subjectivity of unbearable pain is high but needs no further evidence than meeting the criteria where suicide is perceived as the solution for the individual. This is significant pain and a result of pain. The severity is the tragedy that any human being is ever driven to want to end their life or stop existing. It is a profoundly awful mental state I know better than anyone should but if you’ve not lived years of a life you don’t want to live a day longer – if you want death more than life – it might seem like feeling suicidal isn’t the worst thing a human can experience. The unique, personalised suffering which drives a conscious being to want to cease its consciousness, to escape because survival is no longer possible, to cast the most damaging assertion of the inequity of the modern day by choosing self death to leave it all behind. It is the product of a murderous and torturous process.

No one should feel it and no one should have to live through it if they choose not to.

Suicide advocates

This is a quick idea based on my recent experience of the Samaritans. (Yes. Things are that bad).

They were of no value because they’re fundamentally flawed in what they offer. A safe space to talk is useful given the suicide taboo but as the only option from this country’s number one suicide organisation it is woefully inadequate. It’s why I’ve not contacted them before most of my suicide attempts. It’s not what I’m looking for.

Who would I communicate with before killing myself? The answer may not be practical but it’s true nonetheless: someone who could fix things. An advocate for the suicidal who can attempt to change the things which force people to their deaths.

Take debt and the catastrophic effect of bad debt. Many die because of it. Now though, thanks to an important victory by mental health organisations (namely Mind’s Debt and mental health campaign), health and social care professionals can intercede on a patient’s behalf and the industry is more mental health aware. This is ultimately social change but those who advocate for someone’s mental health play a vital role. This saves many suicides.

If this already established system to reduce distress and despair not by talking about it but doing something about it was widened to encompass other causes it’s clear more lives could be saved, lives of people who otherwise might never engage with anyone about their suicidal feelings.

Suicidal people need solutions, not empty words. Suicidal souls need protection against further suffering and a suicide advocate could be the buffer between those suffering intolerable despair and the world of inequity which harms them. This is how lives could be saved: not leaving the vulnerable unprotected.

This might be the remit of current mental health services but they have a history of failure, perhaps because they eschew real solutions in favour of medication and words alone. Thousands a year die when resolving the circumstances which made them suicidal could save lives.

An after thought is the possibility of this sort of idea as an early intervention in an assisted suicide pathway. Not everyone can be saved and anyone who is involved in suicide intervention must accept this truth. Its logical conclusion is the legalisation of assisted suicide because no one should have to suffer the torture of extended unfulfilled suicidal ideation. It wouldn’t be right.

Every night I pray and beg god for my death

No one should feel this way. No one should need to beg god for their death.

Don’t Exterminate Us: why do I carry the weight of the world?

Because everyone in science and social change should think of the risks and the cost.

Though I believe suicide is okay and assisted suicide should be legal that doesn’t take away the loss and deaths caused. Though I strongly believe that disabled people will exist in utopia or heaven on Earth I fear protecting this future could have a terrible cost to disabled people now.

I think of Nobel and his invention of dynamite that he hoped would revolutionise mining and his guilt when it was used by the military to kill people more effectively.

I wonder if some of the people on the project to build the first atom bomb were conscientious objectors but were drafted irrespective of their moral objections.

Scientists prioritise discovery and truth seeking above consideration of their uses. They usually leave that to engineers. Neither profession has a moral code. It is left up to individuals and I’m afraid they fail to comprehend the consequences of their advances.

A theoretical physicist should consider that their work could contribute to a new generation of power generation but also that more advanced particle physics could also be turned into uncontrolled reactions which would dwarf current nuclear bomb technology.

As a social scientist, mental health rebel or whatever you, the reader, label me as I have to weigh my actions against the potential consequences. Too often I fail to do this enough.

For example, the other prongs of Angel of the Abyss could have negative impacts I’ve not yet explored. Equality First is riddled with problems and a lack of rigorous criticism.

But the genetics problem at the core of Don’t Exterminate Us is something I’m afraid of. I see big problems and evils whatever position I take. My intellect and experience have thus far failed to find a solution I’m comfortable either. Any decision I can make thus far makes me an evil man. My heart errs one way but protecting my soul make me err the opposite way.

Ugh.

Angel of the Abyss – suicide aspect: assisted suicide pathway (prong 1 of 3)

In some earlier posts I’ve sketched the objectives which I perceive are necessary for a decent suicide system.

I think the prong that most people will have trouble with is the legalisation of assisted suicide. It is by far the most important thing to me and there are reasons other than personal interest.

Some suicidal people tell someone when they’re intending to kill themselves, even if it’s a stranger like the Samaritans. Others don’t though I’m certain they’d want to talk to someone, to hear a human voice and have one last conversation (that doesn’t have to be anything about suicide).

As I’ve explained earlier, most actively suicidal people go to their death alone. They hide their intent from everyone and when the suicide happens those who care for them are shocked and unprepared. If no suicide note is left it’s hard to understand why someone killed themselves.

These are processes I’ve gained insight into through personal experience. The current suicide system is just not suitable for people like me and that’s what’s behind Angel of the Abyss and the assisted suicide pathway.

How long should torture be allowed to go on for?

The perfect suicide system in terms of free will and liberty is one where a person can be killed or kill themselves as soon as they’re ready to die. Perhaps this might be possible for individuals who’ve completed suicide training (prong 3) but I think an assisted suicide pathway is also necessary.

The reason I believe in a pathway which delays an assisted suicide is because there’s such a thing as regrettable suicide. This is when someone kills themselves but would regret doing so later on. This is where the current direction of suicide is useful but, as I’ve written about in previous posts, it is a curse for those who would not regret dying.

The length of this delay is very hard to define. A few years ago I thought a suicidal person would have to wait years to get an assisted suicide. This is terrible and defeats the point. Years are too long because it’s torture to live for years while wanting to die. It also means people won’t engage with the pathway and, instead, do it themselves.

I thought the abortion time limit would be an indicator. Doctors kill a potential life because a woman shouldn’t have to bear a pregnancy for a child she doesn’t want whereas suicide is an adult choosing their death. I’m not sure this is the right way to determine the length of delay for assisted suicide.

In the end I’m going to choose 2 lengths of time arbitrarily and every day’s worth of unwanted life is a crime because it forces someone to endure torture.

I think 6 weeks (42 days) is the acceptable length of torture for a suicide virgin to wait for their deaths. This consists of a 5 week period and a one week period. A week (7 days) is the waiting period for a suicide veteran. The pathway has two parts, a 5 week process for suicide virgins and a 1 week process for virgins and veterans before they die.

These limits have been plucked out of the air. They can be challenged and I think they should be shorter. I can’t abide torture. 6 weeks wait could be too much pain for some people. The alternative given the hypothetical third prong of training could be for everyone to define their own torture limits.

Individuals could also decide in advance what support they’d need or accept if they became suicidal.

What happens during the assisted suicide delay period has to be the best that can be offered to resolve suicidal thoughts.

5 weeks is long enough for a chemical cocktail to work if the individual chooses the drug route. There are illegal drugs which could offer breakthroughs quickly.

Undoubtedly there would be talking options. I have my own survival belief system – in service of a dream – but it doesn’t work. My death need is very high.

The other aspect is resolving the trigger factor if there is an obvious trigger. One of the processes which leads to suicidal ideation is the ‘death of a thousand cuts’ that whittles away a person’s will to live so sometimes there’s not a single identifiable causal event.

The key point is about action to resolve the situation. This point is quite a shift in thinking but it’s based on evidence. Suicidal ideation is often triggered by a negative state change. It’s not being poor but becoming poor; it’s not about being single but becoming single; it’s not about unemployment but becoming unemployed. This is not true of all suicidal ideation but these are common situations which create suicide virgins.

The current way of thinking is centred around being resilient to these factors. They happen and they cause suicidal thoughts but rather than resolving the cause by any means necessary the current method seeks to deal with the symptoms. There’s nothing wrong with that if that’s what a suicidal wants but without the option of addressing the cause the system remains useless and the established triggers continue without being addressed.

I italicised the words ‘by any means necessary’ because that’s the attitude to investment in the pathway which is demanded. The pathway is non-judgemental except in the aspect that it is trying to save a life. A lot of good can be achieved in 5 weeks which can change an awful situation. The 1 week period has even higher need for investment.

What’s a life worth? The real answer will show itself in the funding for the pathway between decision and death.

There have been significant investment and social change in the current suicide prevention system but my belief is the Angel of the Abyss proposal is the next-generation suicide system.

It’s greatest strength is that it’s a pathway I would enter. Currently I am uninterested in what the primitive mental health system although I’ve started taking antidepressants so I’ll be nicer and normal. I don’t take meds to change my suicidal thoughts and I doubt they could. When I become actively suicidal I don’t tell anyone because I don’t want to be told not to do it.

I’d put up with the crap of small minds trying to force me to live because it suits them if, at the end of the week, I could say goodbye to them then die.

I want to die and it is inhumane to ask me to live even a week more than I want to.