Getting out of desperation
September is Suicide Prevention Month. It also coincided with my semestral lecture on mental health crises for my psychotherapy class. Historically, we used to spend most of our time discussing suicide risk management. This year, however, was different. Still reeling from the two school shootings in recent months, our discussion turned toward homicide risk prevention as well. How we respond to these two types of crises is more similar than people think, yet the governmental response cannot be any more different.
In order to successfully prevent suicide, we need to understand it. While intuitively, we see suicide as the problem that must be solved, we must understand that those who have these urges experience them differently. Using Dialectical Behavior Therapy (DBT), arguably the gold standard treatment for recurring suicidal behaviors, we view suicide not as the problem per se, but as the person’s attempt at solving the problem of emotional suffering. Therefore, suicide is the perceived solution to emotional pain. When we ask them to continue living, we are asking them to continue suffering. Thus, removing suicide alone does not solve the person’s problems and they are likely to consider suicide again because their suffering persists. The ultimate prevention of suicide, therefore, is to reduce people’s suffering. In DBT, we call this building the life worth living.
Extending this theory to the government’s approach to mental health, we can see that it will take more than just crisis hotlines or hiring new counselors. The government has to commit and see to it that living in the Philippines is a life worth living. Improving living conditions should be the top mental health priority. And so, whenever I see officials’ dismissiveness of their constituents’ suffering, especially in light of persistent flooding and other misery-making aspects of living in our country, I know the damage this does to people’s mental health.
Why would people resort to extreme solutions such as suicide? Lack of accessible and credible solutions to their suffering can lead to desperation. Learned helplessness and hopelessness contribute to desperation, making more impulsive and reckless decisions likely. When backed into a corner, people can be forced to commit highly irrational and/or destructive acts in order to stop their suffering. Desperation is a key factor in both suicide and homicide risk. When you lower the level of desperation, you lower the risk of impulsive and destructive acts.
Many things can restrict people’s perceived choices, leading to desperation. Socioeconomic realities can severely constrain what is accessible to us. People who are starving may feel forced to steal food in order to survive. People whose lived experiences are mired in misery can reach their limits and lash out, either hurting themselves or others.
There are also biological conditions that affect our perception of threat. Some have lower thresholds for stress and anxiety, making such experiences more painful. It is important to note that there is no hierarchy between emotional and physical pain; emotional pain can be experienced just as vividly as physical pain. What may feel like no big deal for you can be literally painful for others.
Some personality traits and temperaments make an individual more mistrustful or paranoid. These factors can change the calculation of threat. Higher perceived threat increases the pressure to act fast. This increases impulsivity and emotion-based responses, which may or may not truly solve the problem.
Social pressures and norms can also narrow our perceived choices. Rigid gender roles may make us feel that we are not allowed to feel and express certain emotions. A culture that values achievement may make a person feel worthless if they don’t attain the desired grades or other metrics. Social expectations of belongingness can make loneliness feel unbearable. In a modern society where attention is such a valuable currency, desperation can lead someone to use fear and terror to acquire it.
In desperation, long-term consequences do not matter because they do not see themselves even surviving in the short-term. Thinking long-term becomes a luxury for the comfortable. To deter school shootings, some have (re)proposed lowering the age of criminal liability—but this can only deter those who still want to preserve their future. Anyone who publicly shoots at a crowd most likely no longer has any expectation of a normal future for themselves.
For a community to combat both suicidality and homicidality, we need to help people get out of desperation. We must build a community that is worth living in. We must provide opportunities and resources that allow people to determine the kind of life they want to have. They will choose life and harmonious living when there is more to life than just suffering.
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aatuazon@up.edu.ph
