Suicide Prevention and Service Failure in the U.K.

Harry Hudson
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Waking up, I knew it was the day – it just had to be. The voice in my head had spent weeks getting louder: “Die, just die, you deserve to die.” It was so overwhelming that at times I would scream it to the four walls of my bedroom, my most constant companions. It was a radiant, cloudless day as I set out from my house, first to the local supermarket’s pharmacy, where I asked for “a pack of 32 co-codamol please,” and there it was in my shopping basket with no questions asked. Once I had paid for it and then bought some vodka and grapefruit juice (having read that the latter exacerbates overdoses by inhibiting cytochrome p450), I left. You see, I had done my research. I headed to another pharmacy, walking purposefully in a state of happiness—no, make that contentment. As I headed to the next pharmacy, due to limits on purchasing co-codamol, I should really have thought up an excuse for all those painkillers: when a diligent assistant asked, I offhandedly complained of back pain. As I look back now, how bizarre I must have looked skipping back down the street toward home, gripped by a very different kind of pain, excited by the imminent pharmacological vanquishment it, and I, faced.

A Dread of Failure

It had been a tumultuous few months until I reached that point in May 2017. The previous October, I had become estranged from my abusive father; in January, I’d met my first serious girlfriend, soon after I’d received an offer to study medicine at the University of Oxford, and by April I had had my first heartbreak. By the beginning of May, the cracks had begun to show: I became increasingly obsessed with failure. Failure has always dogged my thoughts, from my first childhood memory of being beaten right through to the university application process. Indeed, I became so afraid to fail that I simply couldn’t countenance sitting my A-Level exams; I felt certain that it would go badly. I knew so, and I knew I couldn’t cope with failure.

At age 18, I’d tried speaking to doctors about it, obtaining an anti-emetic for my nauseating panic attacks, but the 14-week waiting list for cognitive behavioral therapy (CBT) just felt too much; I had already tried therapy at age 16 and –whilst it had been the first time that I disclosed the beatings I had endured— it didn’t work for me. I didn’t want to talk about going to the police, and I didn’t want to see my Dad punished. I wanted to tell someone that when I was 14 I’d begun to cut myself, or that at the time I was burning myself with hot metal straight from my oven, but I was scared.

Looking back, I’d spent much of my life feeling scared of someone or something. Scared of being alone, scared of talking to others, scared of my Dad, scared of horses, scared of anything that felt threatening. All that talk of the police and punishment made me frightened that maybe I, too, would be dealt with punitively. That’s certainly how psychiatric hospitals seemed: places where mad, bad people got sent to be reformed.

Overdosing on Pills

Barely a month before the most important exams of my life thus far were due to begin, crucial to determining my place at medical school, I took an overdose. Sitting at my kitchen table, I popped each pill one by one, laying them out: 64 co-codamol, 35 sertraline, 20 prochlorperazine; my entire stash, laid out beside the vodka and grapefruit juice. By this point, it was midday, my Mum and Stepdad were at work, and I reasoned that I could swallow all of the pills, tidy the house, make it to bed, and die all before they returned.

I wrote a note, apologising for what I had done, offering closure to my Mum, and I found myself crying for the first time in years. By that point, as the dripping tears caused the ink to run, I poured a drink and the pills went down the hatch as I wrote further apologies. The great irony was that in my hurry to acquire (what seemed like) enough drugs to overdose, I forgot writing paper, and so my suicide note was written in a notebook with “Thoughts and Dreams of an Undiscovered Genius” on the cover.

I had taken the prochlorperazine thinking that it would stop me from vomiting; it always did during my daily, nauseating panic attacks. This time, it didn’t work. Barely half an hour after ingesting the mammoth supply of pills, I found myself in a daze, vomit pooling across the laminate flooring in the hallway of my childhood home. “It’s begun,” I thought, “death is but hours away.” As I crawled up the three flights of stairs to the top of our house where my bedroom lay, I vomited yet further and collapsed, facedown in a shallow pool of my own effluence.

The story gets a bit hazy for the next few hours as I drifted in and out of consciousness. I remember calling the National Health Service non-emergency helpline; I didn’t want to be alone, feeling frightened, and knowing that I had failed. Pulsating pains launched through my head as I sat and waited for an ambulance, uncertain what damage I had done to my body. I lay on the floor again and drifted back to sleep.

The crew came a couple of hours later and took me to my local Accident and Emergency Department. By this time, my Mum had returned home, too. She thought initially that I had accidentally taken a double dose of antidepressants; little did she realise that I wanted to die. As I lay on a gurney, cardiac monitors bleeping in response to the arrhythmia and hypotension induced by the prochlorperazine and surrounded by sick bowls, I told my Mum for the first time about my life growing up a hundred miles away from her, of the smacking I’d endured whilst screaming apologies for my inadequacy. I told her of the smashed furniture, the smashed plates, and my smashed self.

Failed Interventions

Mine, you see, is a story of failed interventions. I misbehaved a bit at school and then I was referred for counselling, aged 14, to a charity-funded therapist. We developed something of a ritual; For weeks, my first sentence would always be “I’m very well, thank you, how are you?” Sometimes we got close to what hurt, but I could never find a way to express it, lacking the vocabulary to describe a decade filled with pain and insecurity. One day, though, I arrived for our session looking appallingly dejected, short of breath, and unable to even say, “I’m very well, thank you, how are you?” My perennial platitude had failed, and I was exposed as troubled, but still unable to say by what.

Jane, as I shall call her, took me home in her car immediately, putting me to bed and updating my Dad on my evidently faltering state of mind. I didn’t leave that room for a week, as terrified by the homophobic abuse I always received at school (and the isolation I felt when walking near it) as I was of facing my Dad. At our final therapy session, when the funding had run out, Jane had cried and told me that she wished she had called the local authority to take me into emergency foster care. She must have known something was wrong at home, but I still hadn’t told her. Moreover, it wouldn’t have crossed my mind to do so: He was my world, the only person I knew in the town. To be hit by someone who loves you is better than to feel unloved, I reminded myself.

That the money ran out without Jane’s and my ever exploring what hurt most was cruelly mirrored years later in the trigger for my suicide attempt –that too-long wait for a CBT session. Looking back, I wonder whether, had Jane been given more funding, I could ever have told her what she needed to know in order to have me taken into care. I wonder, too, whether that CBT list would have been so intimidatingly long had the local mental health services had more funding.

My story ends somewhat brightly, though. I sat my A-Level exams whilst I remained an inpatient in hospital; when the results came out in August 2017, I had missed my offer for Oxford by one grade and was denied the place I so coveted. Instead, I found myself whisked off by my Mum to the University of Bristol for a tour. I loved it— the city and the university— and took up a place at its medical school a few weeks later.

New Problems, Same Old Solutions

A year later, though, after my inpatient stay, the absence of any therapy in the community began to hit me hard and the same morbid thoughts began to creep into my mind. I found a new way to cope, however: self-starvation. Starvation gave me a focus, a purpose, and a way to cope when things went wrong. It was comforting when my emotions felt out of control, but starvation wasn’t sustainable; I found myself facing university disciplinary proceedings for the many absences caused by my psychological distress. During a routine appointment with my GP regarding anaemia, she picked up on my demeanour and probed, suggesting that I might have anorexia nervosa. She referred me for an assessment but forewarned me that the clinic waiting list was four-to-five months long. That was a turning point: I knew I needed to help myself in the absence of professional support (other than carrying an unhelpful label that I resented) and so over the next three months, I regained and maintained 10 kg.

I made this decision for the same reason I wound up hospitalized the first time, namely the NHS’s failure to provide follow-up care. After I had been deemed clinically stable following my suicide attempt, I was transferred to an inpatient psychiatric unit. I’d received a provisional diagnosis of “emotionally unstable personality disorder”, and was advised that psychologists would be reluctant to work with me. However, I didn’t expect to hear nothing from my local mental health service upon discharge. Once the community nurses had spent a week visiting me daily at home, that was it – I would be abandoned by mental health services once again.

When I moved to Bristol, I visited my new GP to discuss this and the transfer of my “care” to a new NHS trust. This led to the only outpatient appointment I have ever been offered with a psychiatrist: He confirmed “emotionally unstable personality disorder” and added “cyclothymic disorder.” Reliving, for the first time, those memories of my suicide attempt was deeply distressing; I forgot all the questions I had planned to ask about therapies. In keeping with the advice I had earlier heard, no specific service for either diagnosis reached out to me; in fact, nobody has discussed wither with me since I gained those labels.

Earlier this year, three years after my attempted suicide, I was offered a therapy programme for anorexia nervosa. I had maintained a BMI > 22 for 16 months and therefore no longer needed it. This strikes me as exemplifying the problem of a care system that lacks not only funding but also holistic, dare I say sensible, organisation. There are services for people with eating disorders, people with personality disorders, child-abuse survivors, and self-harmers; what good are they, though, if you have all of those issues? Truly holistic care cannot be possible if mental health services are this stretched and this pigeonholed into categorisations that do not reflect the complex, multifactorial development of distress within those who becomes their patients. It seems like common sense, too, to posit that attending each of these individual clinics, even if you could get the necessary referrals, would never solve all of your problems. A different professional looking at each one discretely means none of them would see the whole of you.

Now in my third year of medical school, I try to look after myself. Carrying diagnoses of emotionally unstable personality disorder, cyclothymic disorder, and anorexia nervosa is a huge burden and sometimes I feel angry, — like I was failed by a system that didn’t care about me. Mostly, though, I don’t think much about it; I try to stay busy and fill each moment of my day with something to occupy my wandering mind. When I do think properly about it, though, the story has a simple moral: Maybe if the charity had been better funded and I had had enough counselling at age 14 to find the words to say “I don’t feel safe,”…maybe if the local mental health services had enough funding to reduce their waiting times or to offer me post-inpatient therapy… maybe if I’d had lessons at school about accessing healthcare openly and supportively, then maybe, just maybe, I wouldn’t have found myself starving and unable to move, effectively paralysed by malnutrition before having to put all that weight back on again.

The truth is, it’s really hard to talk about suicide. We are constantly constrained by the notion that our mental health is our individual responsibility to manage, told to “live our best lives” by a never-ending campaign of exploitative wellness fads. A more collective conversation is needed, rejecting this liberal individualism, so that those people who aren’t immediately able to access specialist support can talk to the people around them. For too long, psychiatrists have controlled the discourse on mental health –they create the diagnoses, then profit from treating those who meet their criteria – and this really isn’t working: Suicide remains a leading cause of mortality worldwide. A more collective discourse, in which thoughts of suicide can be talked about openly (such as in this article) may be the first step not only to help those who are suicidal to navigate healthcare services, but also to deinstitutionalise “mental illness,” creating a more accepting culture in which certain behaviour patterns (from hearing voices to wanting to die) are no longer taboo.

I bear the mental and physical scars today of years of abuse and neglect, much of it self-inflicted. If we are to prevent that happening to future children, even future doctors like myself, then properly resourced mental health services are needed, alongside an open culture around suicide. And to anyone who may be feeling similarly to the thoughts described above, I shan’t offer advice or comfort, because I know that “it will get better” feels hollow and mendacious. For those people, know that –like me—there are academics, activists, artists, students, clinicians, and survivors of suicide fighting for you and with you, though we will likely never meet you. If only we could just talk about it; so far, this has been a very one-sided conversation.

10 COMMENTS

  1. Nice one Harry. Probably your youth but this reminded me of a scene in the movie Full Metal Jacket where a group of soldiers are standing around the corpse of one of their brothers in arms called ‘handjob’ (he was masterbating 7 times a day and was attempting to get a Section 8). Anyway, the conversation went something like what did he die for and one of the new guys said “freedom” to which a more experienced soldier called ‘Mother’ replied that this war was nothing to do with freedom, it was a slaughter. If he was going to die for a word it would be “poontang”.

    I guess my point is that you seem to think that mental health services are about helping people, it’s not. It’s about ensuring the safety of the community (and providing the odd scapegoat when things go wrong), and all that talk about it being about helping people is to get them to enter the ‘showers’ willingly, and with as little resistance as possible. But you have time and will see.

    I do have a question for you though as someone diagnosed with anorexia. It is at present the Holy month of Ramadan and I have been having discussions with some people regarding fasting. Some of them believe in the ‘chemical imbalance’ hypothesis of addiction, and believe that addictions are caused by a reinforcement of ‘happy’ chemicals being released in the brain as a result of ‘pornography’ or ‘drugs’. If this is so then it might explain why some people who can find control of their eating the only thing they can exercise control over their environment reinforced? ie I don’t eat and it gives me a feeling of control, releases the chemicals and I feel good, therefore I dont eat it releases the chemicals ….. I assume you get the picture? So my question. Is asking someone who has this ‘disorder’ to fast for a month a bit like asking a heroin addict to take drugs for a month and then stop again?

    Anyway, good luck with your studies and don’t for a minute fool yourself that psychiatry is ‘medicine’. If you start believing that, see your Doctor lol.

    • They can also have “cerebral allergies”, where certain foods get them buzzed. Water fasting for several days is the usual method of prepping for the test meals. This technique goes back to Theron Randolph (MD’s) salad days (he was an early allergist who used to teach his techniques to professional students by having them fast and then test themselves for allergic reactions).

  2. With some reservation first, was the entry into this post your or the editor’s creation. Ironically, suicide is a sign to the Left and Support is to the Right, which might rule out going straight ahead in creating one’s path. A question might be at what scale of relationship to the world within as ecology of mind (Bateson) or outwardly as an ecologist relating to the universe, a cosmologist? Having enjoyed a microscope and not so much a telescope, the idea of learning how to see and talk about death, even suicide brings back images of those trying to destroy themselves in the hospital and then members of my family outside of the hospital setting (prescribed medications and/or alcohol at some times in our family history). A better question might be with regards to learning how to discern and read a situation with caution to one’s own bias in the search of learning how to be a better physician/human. Some of the keys may also be aligned with the ineffable, which typing on a site is not the same as to have an audio, in person exchange about this suicide. To process ethics in a post structural belief system (time is lapsing here) when time is a dimension in Art, may need some work by myself with materials. Writing, thinking on and in this topic from my perspective needs careful thinking. And that reflexivity sometimes has eluded me, and yet the reasons discovered much later in life have enhanced the way I can understand a little bit of what you write about. Thank you for moving this topic into the discussion.

  3. Hi Harry,

    Thanks for telling your personal story and I’m glad you survived.

    Have you come across the box set “Normal People” where everyone is “normal” but they still have to go through the wringer.

    Ryan Air Boss Michael O Leary went to Trinity and that’s Irelands Oxford, that’s the kind of posh chums you might have – if you got that extra mark.

  4. Hi Harry, Thank you for your awesome blog.

    Perhaps you were wise to not “say anything”. Perhaps, you knew and know best. Even in the not knowing, in the confusion, you probably know best.

    Parents. They fail, they do some good things. They don’t know, yet they too know. They also stay silent and sometimes kids get hurt.
    They act automatically often, in the process of protecting their vulnerable kids, they get annoyed at the vulnerability, because perhaps they get reminded, they don’t have enough time to process.

    But then comes psychiatry who also has no time to process. They also see distress as a reminder to DO something, quick.

    I often think, of reconciliations. Sometimes it could be possible. Wishful thinking (on my part) and realizing after time has passed that if someone, anyone knew at the time, that much could be prevented.

    Like the lady (past tense) who you wonder, if she might have been the difference. Perhaps, but perhaps in her process of doing good, someone comes along and screws up the process. Too many people busy handling.

    There are natural responses to life and chaos, they are not illness. If we are lucky we get enough time to recognize some, and we might have regrets.

    Psychiatry is not a “healing” or helpful system and never will be. I’m sure you look back and see self sabotage, but that is what we do. See it as the norm. Don’t be ashamed of scars.
    I am glad you spoke about normal things in your article. Psychiatry prefers the silence, the silence puts people into line.

    Even though your childhood was overwhelming, don’t you think that it is still better than being raised by a psychiatrist? lol. ….You might think there is such a thing as “properly sourced” “mental health services”. No such thing exists at the moment.
    As a doc, your only options to help children are what is out there, and it all stinks of psychiatry.

  5. Don’t expect an easy life as a “medical student at the University of Bristol. [Who] frequently discusses … the ethics of coercion and speaks on poststructuralist anarchist interpretations of philosophy of psychiatry.” Since one of psychiatry’s functions, and part of why psychiatry was adopted as a medical specialty, is because psychiatry intentionally agreed to systemically defame, torture, and kill those who’ve dealt with easily recognized iatrogenesis, for the mainstream doctors. And the mainstream doctors don’t want to get rid of that very profitable safety net.

    Although the primary actual societal function of both the psychiatric and psychological industries, and all their DSM “bible” believing minion, is covering up child abuse and rape.

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
    https://staging-madinamerica.kinsta.cloud/2016/04/heal-for-life/

    Did your therapist ever ask, prior to crying and saying she should have had you taken from your abusive home, if you’d been abused? I know you said you didn’t confess to her your father’s crimes. I doubt she did, however, since NO “mental health” worker today may EVER bill ANY insurance company for EVER helping ANY child abuse survivor EVER. Here’s the DSM reason why:

    https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

    The solution is NOT to further fund a systemic, by DSM design, primarily child abuse covering up, “mental health” system. The solution is a return to the rule of law, and arresting the child abusers and rapists. Not the continued funding of a systemic, scientific fraud based, DSM deluded, psychiatric and psychological, et al, primarily child abuse and rape covering group of industries, that is killing millions every year.

    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml
    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2015/mortality-and-mental-disorders.shtml

    Thanks for sharing your story, Harry, and I hope you continue to research into the truth. I also hope you will choose to help bring back ethics, and a sense of the moral responsibility to behave as a decent human, to the no longer very respectable or trustworthy medical community.

    • “And the mainstream doctors don’t want to get rid of that very profitable safety net.”

      That jumped off the page for me SomeoneElse. I’ve spent a lot of time wondering why a cardiologist might want to catch out a psychiatrist in the middle of an unintended negative outcome, and use their position to have police assist in putting that person ‘in his pocket’. How embarrassing for police when they found out the cardiologists cover up had failed and they then found out what he was up to with his ‘little bit of mischief’. Their “might be best I don’t know about thats” come back to haunt them?

      Very profitable indeed having a psychologist at your college councelling service who can make referrals to her husband psychiatrist at a hospital for ‘treatments’. Endless possibilities and with police assisting in the process by retrieving evidence/proof of any wrongdoing? And the psychologist quite prepared to have third parties plant weapons on persons after they have been spiked and use her position to lie and claim that the ‘target’ is a “patient” to public officers who will then do as they’re told. Drop this one at the hospital for my hubby would you officer? Thanks. Not that the politics at the medical faculty would necessitate such viciousness?

      Of course Boans is totally insane and the defence put forward of “they wouldn’t do that” is sound lol (as long as you don’t examine the proof. Ask our Police Superintendent whose negligence is putting our community at serious risk. Referral anyone?). Our elected representatives have taken oaths they have no intention of fulfilling, and are overseeing an organised criminal operation in our hospitals, with the full support of our police service. Still, who would dare try and hold them to account when they can simply snatch you from your bed and have you ….. uhheeemmm unintentionallly negatively outcomed while those with a duty to act neglect that duty.

  6. I would also say, Harry, that despair and hopelessness are not “mental illness”. They can be inherited, by role modeling… or it could be evolved from trying to be part of mainstream.
    We really know nothing. We don’t know if someone has a learning issue and thereby learns hopelessness because they feel as if they don’t measure up.
    Or because they simply look or act differently. Obviously if one is born with a 10 inch nose, one will feel weird about it and it WILL affect one’s life. So is the nose an illness? Is the response and behaviour an illness? WHO sets the rule that I should be so “brave” of mind, just to use mindfulness or meds to get over my “nose shame”
    Psychiatry does not promote diversity, or resultant issues from life. Life has been made into “mental illness”.
    Psychiatry itself ran short of ideas, it could not measure up to it’s own requirements, and so they continue on, running with the same false paradigm, because they feel they HAVE to have one.
    They feel there HAS to be an order to life. And it is according to whoever sets those orders.

  7. I am not sure this will help, though to read, study and learn all that one can so that when your moment comes, then be able to assist with what will be appropriate. I posted a short response http://www.jewishworldreview.com/0520/suicide_wave.php3 with the hope that maybe the diversity can be realized. I would not have to be hospitalized the first time though came close. Due to a traffic accident and a leg cast I would pretty much be immobilized. We would read Fieve’s book Moodswing at the suggestion of the psychiatrist. While others, the Dean at Hendrix College would suggest Ruell Howell and Anton Boisen, a pioneer in pastoral counseling at the Chicago Theological Seminary. Friends at the bookstore would suggest Castanada’s writing and Pirsig’s book, Zen and the Art of Motorcycle Riding. Our issues seems to be about understanding understanding as Humphrey Osmond (a psychiatrist) would write about. And I would discover a book, while at Waterloo, The Quest for Mind by Howard Gardner, the Harvard Educator. He used a Balzac’s quote in the epigraph for writing about Piaget, Levi Strauss and the Structuralist Movement.

    One experience to type and share to your post, another to hear and engage in the manner of giving a voice to receive the music inherent to what speech inside and outside the head is doing. Life seems to have an abundance of energy being created while fuel to be understood in a garden.

    Parting, a glance at England’s early city planner, Ebenezer Howard, The Garden City …

  8. I am so sorry about what you went through. You deserved to have people make you comfortable telling about your suffering a long, long time ago. It is tragic that that failed to happen. It is also tragic that people have given you psychiatric labels, and I hope you have not accepted them as either scientific (NO psych diagnostic label is scientific) or helpful or safe for you to have attached to your name. In fact, I know there are people who will read your brave article and be dismissive on the grounds that you “have” these various “disorders.” You don’t really “have” these made-up, unscientific entities. You have suffered in a number of ways and have coped in a number of ways, and finding out what is helpful in alleviating your suffering is what really matters. Diagnoses tend to get in the way of that. And they expose everyone who is diagnosed to a vast array of kinds of harm. Wishing you all the best. You might want to have a look at https://www.amazon.com/They-Say-Youre-Crazy-Psychiatrists/dp/0201407582/ref=as_li_ss_il?keywords=They+Say+You%27re+Crazy&qid=1554486859&s=gateway&sr=8-1&linkCode=li1&tag=whejohandja0d-20&linkId=9114cba73496ff5f388235a3586c6299&language=en_US which you might find of some help.

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