Psychedelics before Suicide

DESCRIPTION____A conversation which explores the mental state of a suicidal person and how this may lead to a breakdown in communication with others.

Q

So why did you shave bald?

A

Well, for me it was a method of avoidance. Avoidance coping describes an individual’s efforts to avoid dealing with a stressor.

Q

What were you avoiding?

A

Shaving bald was a way of avoiding suicide. The idea I had was that I would look really bad in a coffin if I was bald. And so that was an attempt to stay alive - to keep the body going. One might say it was a resolution to keep living.

Q

Normally you don't seem too preoccupied of your appearance.

A

Normally I'm not. I do have minimum standards for my appearance. And, as they say, when you're at the end of your rope, you just grasp at whatever's necessary.

Q

What do you think about the advice to someone who's suicidal that they should try everything before attempting to commit suicide?

A

So it's kind of hard to evaluate that advice, because the standard for whether that advice is good depends on the outcome. Here's a case where it could be good: Someone is very suicidal, takes this advice and finds something which prolongs their life or gives them some interest in living. And that's a good outcome. But one can imagine a bad outcome where someone is suicidal but they would have kept going, maybe in a very miserable way, but they would have kept going. And then they try something which then pushes them over the edge into suicide. And that seems like a bad outcome.

There's that saying: always reverse every piece of knowledge you hear, because knowledge is very specific to the particular person.

One concrete place I've seen this advice was someplace on Reddit. It was a thread which said: If you're certain that you're going to commit suicide, try psychedelics. This thread could be one of the following:
Thread #1
Thread #2 At worse, you'll try them, it won't do anything and then you'll commit suicide and you're in the same place. At best, it will change your life.

Now take that kind of advice for someone like me. So not uncommonly, I'm suicidal. But the state of my life which I've accepted; is just kind of being baseline miserable for often quite long periods of time and going along with it until that period ends and something better happens. Eventually I know that this will probably recur.

And so if I took that advice, it's possible that the worst case scenario might occur - I'll try psychedelics, it'll leave me more unstable and I would end up committing suicide and that would seem to be a bad outcome.

Q

I feel that trying psychedelics would be a last resort once you've tried everything else first. For example, first trying hobbies or the usual kind of recreational activities.

A

Yeah, so to be fair to the reddit poster, he or she did say that: 'This is if you're absolutely committed to already committing suicide'. They are assuming that this is someone who is definitely taking that end and so they might as well try this.

Q

Did it have many upvotes?

A

I think it did because I didn't have to try very hard to find it.

Q

What do you think of general advice (not going straight to drugs), but of the general advice to try everything? First things first, try the usual recreational activities but eventually try everything before you attempt suicide.

A

So that's good advice. But that's not just because it's good advice for suicidal people. That's because it's good advice in general, to try new things. In computer science, there's this distinction between 'explore' and 'exploit'. The explore-exploit dilemma arises where there are limited resources to be allocated between options with unknown payoffs. An individual has a choice between ‘exploring’ to find the optimal choice or ‘exploiting’ an option they already know, though it may not be the optimal choice. There are two different paths you can take: you can explore new things, or you can exploit a path which you've already taken and try to go deeper. I think this originally comes from things like the algorithm tree idea and searching a landscape, but there is an obvious application to real life. You can explore new things, or you can exploit what you've already done. Typically the standard advice is something like: explore in the early stages, and when you've gotten a feel of the land, exploit particular points which you know you're good at.

One might say that there's something similar going on here; that more people probably 'exploit' rather than 'explore'. So 'explore more' is good advice for everyone except for the people who are already doing too much exploring.

Q

Typically, the people who you think are least likely to commit suicide, would be the people who are exploiting and are infatuated with a particular aspect of life.

A

Yeah, that's true. I do think that is a fundamental psychological issue here which you've pointed out.

We need to distinguish between people who have suicidal ideation, from people with particular kinds of mental health issues. But it's quite likely that people who think about suicide are also likely to have less energy. And it's not just that they don't have energy to let's say, exploit or explore. It's that they don't have enough energy to brush their teeth or shower, or take walks and go out for regular meetings with friends.

Q

Would you say that the advice to ‘try everything’ is missing the fact that people with suicidal ideation are less likely to have enough energy to actually try everything and take that advice? Is it impractical advice in that sense?

A

It's impractical advice for some people. The problem with all advice, is that the advice is either trivial, in that it's so obvious that applies to everyone (for example, if it's raining, take an umbrella), or it's overly specific. Once advice becomes helpful and specific, it applies to some people but not others.

So I'm hesitant to say that advice is wrong. It's going to be helpful for some people - the kind of people who are depressed but have some energy to try new things. And it's not going to be helpful for other people - the people who are depressed and don't even have the energy to brush their teeth. If you don't even have the energy to brush your teeth, having someone tell you; "Why don't you try skateboarding?" is going to be more of a discouragement. But if you do have enough energy to brush your teeth, and you're feeling like "Okay, great. I've done my basic hygiene. What do I do now?" this could be helpful advice.

Q

In the context of suicide, what type of advice do you think would be helpful for most people?

A

The problem is, as the saying goes: nothing that is important can be taught.

This is not a problem of rationality. It's not that suicidal people don't know what needs to be done. It's that it's hard to put things into practice because of energy levels and mental blocks. So just telling people advice is not going to be very helpful. In the case of someone with depression, all that can be done is for them to systematically try things out as their energy levels allow them to, and to see what sticks. At least for me, I saw a psychiatrist - that somewhat helped, I talked to friends - that someone helped, I tried new things - some of them helped, some of them didn't. I went for social anxiety therapy, and that kind of helped even though it wasn't directly related to depression. Some things I tried, I stuck with and some things I tried, I didn't keep up with. All you can do is just keep trying things until you find things that stick.

So in terms of generally good advice, the generally good advice for depressed people is probably the same as genuinely good advice for anyone. Like if you're uncertain of what to do, don't think ‘what will make me happy’ but think ‘what will help me grow?’ Because often its quite uncertain what will make you happy. Or if it does make you happy, it will make you happy for a very short time. What will make you grow is more obvious, and growth is an easier long-term determinant of wellbeing.

Q

Would it be fair to describe your advice as; be aware of your ups and downs in terms of energy and mood, and when you have the capacity to try new things.

A

Yes, when people have the capacity to try new things, they should. And sometimes, it's good to have a reminder. You can imagine someone who has depression as learned helplessness. Learned Helplessness arises after a series of repeated negative events, beyond one’s control. It strongly correlates with depressive-like symptoms. So they've been unable to do things for so long, but now they finally are able to and they ask "What do I do now?" At this point, a reminder that you should try new things might be helpful. But at the same time for someone who is not at that stage, saying "you should try new things", is just going to be discouraging.

Q

How helpful do you find external prompts from other people when you're in a heavy state of depression.

A

Not very helpful. Mostly because, at best, it feels like they don't understand. And at worst, it feels like they're trying to get me to do something which I want to do, but which I'm not capable of. And this just makes me feel bad as a person, because I'm not able to live up to people's expectations.

Q

So what would be the best way to help anyone in that state?

A

I don't know. It's kind of hard to say because: looking at it from the point of view of someone who has depression; obviously you're going through a hard time. But looking at it from the point of view of people who are around those who have depression; if they haven't gone through depression (and I hope that they haven't); it’s also hard for them because then they just see this [depressed] person who just isn't doing things which should be obvious.

So for example, a friend was telling me that they have this family member and sometimes they feel frustrated with this family member because the family member is diagnosed with something and often feels like: "Okay, they are diagnosed with this thing and their life is hard, but it seems like they almost make their life harder for themselves by not doing these things which are just plainly obvious." The moment I heard that angle, I was like: "I understand where you're coming from, I understand where he's coming from and it's not that either of you are in the wrong. The social situation is such that there's going to be feelings of frustrations on both sides." Both sides have legitimate feelings of frustrations and there's just nothing else which can be done about it except to communicate, talk it out and understand that this frustration is normal.

So I don't know. This is probably my bent, but I remember that there were all these short philosophical sayings (very commonly from the existentialists) which I would keep with myself to keep my spirits up. For example, Albert Camus'

There's another quote which is often attributed to Camus:

The idea is that: just existing is a very hard thing to do for some people. This is difficult to understand for other people for whom existing is easy.

It's the kind of thing where: if you've gone through it [depression], you instantly get it. If you haven't gone through it, you think: "Okay, I intellectually understand but what on Earth is he talking about? Living is just living." Which in part, accounts for the very polarised reaction to shows about mental illness and the like. People who get it become huge fans (e.g. Bojack Horseman, and Neon Genesis Evangelion). Neon Genesis Evangelion leads into it further at the end, but you have this even at the start where Ritsuko says:

There's this theme from the beginning that you can be bad at a living; you can be bad at being a person. And if you're the kind of person who understands that - you feel like you're just bad at living, then that show will strike a chord with you. And you'll feel a sense of validation and understanding in a way in which, if you just haven't felt this [the feeling of being bad at living], you won't.

So to go back to your question - What can be done?

It's unreasonable, I think, to say to the people who are not depressed: "Well, you shouldn't have any expectations and you shouldn't express how you're feeling." Of course you should. Everyone should express their feelings in a healthy way by talking. But at the same time there's also this understanding that talking may not help. And here I feel that nothing more can be done. It's just something which both sides must understand - that frustration may come about from the situation and that's part of being human. It's an inevitable thing that happens when two people have different experiences.

There's this problem that open communication isn't something that just happens. It requires cultivating an environment where telling the truth is possible. So for example, if each time someone expresses how they feel they get mocked, then obviously this person is not going to be able to talk about how they feel regularly. And why should they, because they shouldn't feel the need to hurt themselves and if communicating is hurting them, then they're not going to do it.

And so in the same way, there is this kind of inevitable facet of this; that, someone who is depressed and suicidal might think that: "Even if I'm feeling suicidal, I shouldn't say anything because it'll trouble people. These kinds of emotions come and go. I just won't bring it up because I don't want it to look as though I'm seeking attention or as though I'm shirking my work. If this succeeds, then in a way, this person is then trapped in a Morton's fork Morton’s fork describes a situation where someone is presented with multiple options, all of which lead to a similar bad outcome. where each option is bad. Either they succeed in projecting this facade and their feelings are not expressed, or they don't succeed in projecting this facade and other people may be frustrated at them for not being capable. Once again, it's not that others around them are unreasonable for not understanding them, because they also have a legitimate point of view. It's just that this is the unfortunate, almost inevitable outcome unless people are unusually understanding.

Q

But wouldn't you think that communication is foundational to getting help and improving one's mental condition? The worry is that a lack of communication might lead to no one knowing that someone is struggling with depression and an eventual suicide.

A

Well depressed people and people having suicidal ideation are very bad at projecting into the future. So in the mind of a depressed person, the cost of the keeping silent is not the possibility of suicide in the very long term. However the cost of talking about it with others is an immediate lack of understanding from others which is painful and frustrating. The alternative to communicating with others is trying to tough it out, which is the familiar road. And when I say the familiar road, I mean, that the costs of it are clear to them and they've known so far that they can deal with this cost.