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Suicide

A Three-Headed Monster: Mental Illness, Stigma, and Suicide

A Personal Perspective: Overcoming a deadly combination.

Key points

  • Bipolar and other mental conditions can be challenging to recognize and diagnose, even for medical professionals.
  • Because of stigma and misinformation, when someone detects a mental condition, they may be reluctant to engage with the person.
  • Mental conditions, like diabetes, are physiologically real, and not the fault of the afflicted, and are nothing to be ashamed about. 

Suicide is one of the most misunderstood and stigmatized of human experiences. We need a call to arms, not in the sense of weapons, but rather with people working together.

Most suicides result from a combination of two things: a mental condition—depression, bipolar disorder, posttraumatic stress, traumatic brain injury, moral injury, survivors guilt, etc.—and aggravating social factors such as relationship problems, death of a loved one, loss of job and purpose, legal issues, or financial troubles. The destructive clash of these forces often ends in the loss of hope, then death by suicide.

This hits home personally.

Bipolar disorder struck me in 2003 while leading soldiers in war. The intense stress and thrill of combat set ablaze my genetic predisposition for bipolar. My DNA was but dry tinder that was lit by the match of battle.

For 12 months of combat, I was mostly manic, with hyper energy, creativity, problem-solving skills, and enthusiasm. I felt like Superman and was on a euphoric high. But, upon leaving Iraq, the adrenaline, dopamine, and endorphins of war faded, and I spiraled into months of depression.

I reported this to medical personnel, but I was deemed "fit for duty" because I was not suicidal, and I didn’t want to hurt anyone.

But, in reality, I had just completed my first bipolar cycle, from the summit of mania to the pit of depression.

For the next 11 years, I got much worse, cycling through increasing extremes of mania and depression until I rocketed into full-blown mania in 2014. My behavior was so bizarre and disruptive that I was removed from command and ordered a psychiatric evaluation. Three times that month, I was diagnosed as psychiatrically healthy and "fit for duty."

But I wasn’t.

Four months later, I crashed into severe depression and psychosis, was diagnosed with bipolar disorder type I, and retired from active duty.

For the next two years, I was in a fight for my life. Hopeless, crippling depression and terrifying images of my own violent, bloody death filled my mind and dominated my life. Psychiatrists called these "passive suicidal ideations," but for me, they were anything but passive—they were brutal, and in real, living color!

In a hellish space of absolute mental illness, I was blessed to have my strong wife and family, and a friend who helped get me into the VA, where I began a lifesaving path to recovery.

How Mental Illness Can Be Missed

In looking back, I wonder how my bipolar was missed for so many years by me, my family, and the Army.

After consideration, I have concluded the following:

  • First, bipolar and other mental conditions can be challenging to recognize and diagnose, even for medical professionals, especially for those practicing outside of psychiatry.
  • Second, family members are like the proverbial frog in a slowly heating pot of water; the slight changes over time are too small and incremental to draw attention or alarm.
  • Third, given the prevalence of stigma and misinformation, when someone does detect a mental condition, they are often reluctant to engage with the person.

Countermeasures

To move into a better future, countermeasures should include these:

  1. Train people to recognize symptoms of common mental conditions and empower them to refer the servicemember or colleague to medical professionals if they detect a problem.
  2. Develop "safe" channels of communication to report problems in a way that eliminates the need to officially record said communication.
  3. Expand the notion of a "battle buddy" to include peer-to-peer support.
  4. Implore senior leaders to have a confidante who can tell the boss "anything" about him, including how others see her behavior, the overall state of the organization, and what people are thinking and saying, all without the senior leader getting angry or punishing the confidante.
  5. Create a campaign that targets stigma as the villain to be defeated. Educate that mental conditions, like diabetes, are physiologically real, and not the fault of the afflicted, and are nothing to be ashamed about.

While I never moved from passive suicidal ideations into active ideations, I wanted to die, and I was in danger of killing myself. I share my story to illustrate how someone with a similar condition, left unchecked, could make that dark walk to suicide.

Mental conditions are complex and arise from multiple factors being present simultaneously. Therefore, they are outside the control of the afflicted and do not represent a character flaw or lack of willpower.

To prevail in this mission, we must change the perception of a person who has a mental condition. We must see them through the same lens we view a woman fighting breast cancer or a man struggling to overcome a chronic heart condition—battling a heroic cause.

And, we will know we are standing on the level ground of inclusion when the suicide attempt survivor and the person living with mental illness are extended concern, respect, and understanding, freely and without reservation.

Check yourself and your friends. If there are warning signs, get medical help immediately. It could be a matter of life and death.

Be a leader and spread the word.

Help stop the stigma, prevent suicides, and save lives!

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7, dial 988 for the 988 Suicide & Crisis Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.

With assistance from David Woods Bartley.

A version of this post also appears in Military Times.

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