15 August 2018

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The Problem With “It’s Okay To Ask For Help”

I was considering the number of high-profile suicides over the last year or so: Kate Spade, Anthony Bourdain, Chris Cornell, and Margot Kidder. The list doesn’t end, really, especially when I consider the new documentary on designer Alexander McQueen. Most recently there is the story of the Alaska Airlines ground crew member, Richard Russell. Inevitably, particularly on social media, I will come across people — well-intentioned folks — sharing the same sentiment: it’s okay to ask for help. It’s assumed this is aimed at those who might also be, in the minds of these well-wishers, harbouring their own suicidal thoughts.

As much as I respect where the sentiment comes from, it’s growing into an irritating refrain, along the lines of the “thoughts and prayers” meme attached to school shootings: a hollow epitaph. Why? The answer is complex, but hey, so is life, but I’ll give it a try…

Let’s start with suicidal ideation. There are so many different reasons why someone might contemplate taking their life. From having an irreversible and debilitating medical condition to processing the ghosts of  trauma and its resulting depression, suicidal ideation comes upon some people as an option — not a final solution, but one option out of potentially many. I respect the right of someone who wants the freedom to contemplate suicide. I do not treat suicidal ideation in and of itself as a fire that needs to be put out, which I will admit may not be in line with mainstream “suicide prevention” practices. In extreme cases, particularly where people with infrequent suicidal ideation are institutionalized against their wishes, treating suicidality like a fire can have negative results: creating more shame, more confusion, and, ironically, a sense of helplessness where before the person in question might have felt they at least had agency to contemplate suicide but never act upon it. I don’t think suicidality should be met with what often must feel like punishment (especially when I consider that suicidal ideation often comes from some sort of physical or psychic injury already).

Let’s move more generally to mental health issues. The most common symptoms clients present in my practice are depression and anxiety. There are so many ways these two things might manifest. Let’s use a fictitious example:

Deb admits that she was raised to be a “proper young woman.” This meant staying at home during her mid-to-late teens when her friends were going to house parties. A byproduct of this was that she had few opportunities to date. Another byproduct of this, due to the religious background she was brought up in, was the belief that sexuality was synonymous with carelessness. As an adult, many years later, she struggles with relationships, particularly romantic. She finds herself choosing partners who are self-involved and cold to her needs. This latter part — having needs, particularly emotional and sexual — is a radioactive no-go zone. Whenever she feels she should advocate for herself, her head spins with self-flagellating thoughts. She has trouble sleeping as a result, and sometimes punishes herself by oscillating between starving herself or eating to an unhealthy degree. She wakes up many mornings and her first thought is how worthless she is. No direction feels like a good direction, and so she often feels paralyzed.

In this example, it wouldn’t be surprising to learn that Deb has from time to time considered suicide. Let’s now see how it’s okay to ask for help might not work…

Asking for help, first off, puts the burden on the afflicted. It’s like telling someone who was struck by a cyclist while crossing the road, “It’s okay to call an ambulance.” In Deb’s situation, it wouldn’t be surprising when we consider the above synopsis, that talking about her needs might be a concept that sets off intense discomfort.

Why doesn’t she talk to a friend? Well, I can tell you that even the best of friends can say or do things that may unintentionally injure someone looking for help. Have you ever sat down with a friend  in order to share something cool that happened to you only for them to monopolize the conversation so that you don’t get to talk about what it was you got together about in the first place? Now, imagine that situation but regarding something terribly personal.

Why doesn’t she talk to a therapist then? As a therapist, I should be self-interested here, but even faced with this question I can understand someone in Deb’s situation having reservations about speaking about such a deeply personal issue with a complete stranger. For the It’s okay to ask for help crowd, if you’ve never struggled with mental health issues you have no clue how not okay it is to tease out one’s darkest issues. Also, not every interaction with a mental health professional is guaranteed to be beneficial, and one bad experience, whether by accident or carelessness on behalf of the provider, can scare someone like Deb away for years before she tries again. Oh, and then there’s the cost. Therapy isn’t cheap, so if Deb isn’t financially comfortable, this would be one more barrier for her.

One last point I’ll make on the problem with it’s okay to ask for help is that the act of asking for help is not a finish line. People can and do spend months and years in therapy; sometimes progress is frustratingly slow, and sorting out our demons can be a potentially retraumatizing experience. In other words, blithely asking someone to ask for help is like asking them to do hard labour.

Some suggestions:

See a friend with a problem? Reach out, gently. Keep it open-ended, and stay inquisitive and non-judgemental — Dr. Phil is a jerk, so forget everything you’ve ever seen on TV about the effectiveness of interventions. Don’t pressure your friend or hyper-focus on goals. And if they brush you off abruptly don’t get offended — an unfortunate byproduct of depression and anxiety (particularly if its weighted by chronic shame) can be a reflexive, sometimes defensive way of responding to anyone who might find out the truth of their struggle. No one said this was easy. It isn’t for them, so why should it be for you?

Repeat after me: Life is complex, people are complex, and mental health is a complex reaction to a complex world.