Suicide is the biggest killer of men under the age of 45 in the UK. The title of the anthology reflects the staggering statistic that suicide takes 84 men each week in the UK. The causes of suicide are many and varied, and you surely have your own opinions about prevention, but one paragraph from Helen Calcutt’s introduction stuck out for me:
“Women cry, men do not. Men hit women, women don’t hit men. Both examples of what we would consider a socially accepted norm, denies either party their natural complexity. Women do hit men, and though a violent and harmful act, it also highlights a particular type of vulnerability (perhaps a trauma too) that needs addressing. Men weep. It’s probably one of the deepest, moving sounds I have ever heard. Denying this as a normal attribute to male behavior, almost refuses them the bog-standard right to grieve, to shed a skin—to let it out.”
In the end, this is a book about grief but also hope. Many of the poems are from people who have experienced loss to suicide, some from those who experience or at least describe the feelings that lead to suicide, and some are about the possibilities for better lives and better approaches to male vitality.
I don’t want to quote or describe the poems as I think it takes from their power for the reader, but this book is not only for a great cause, it is great poetry. If you love poetry, you are likely to see names you recognise, but you may also be delighted to discover fresh talent. As you would expect, the poems are moving, but never maudlin or overly sentimental.
I am thrilled to have two poems in the new anthology, “Please Hear What I’m Not Saying,” edited by poet Isabelle Kenyon. The profits of the anthology will benefit the UK charity, MIND, which promotes mental health services and support while also working to reduce the stigma around mental illness. If I’m completely honest, I’m most excited to have my poems in the anthology because it is the first time any of my poems will appear in print anywhere, so I’m grateful to Isabelle for that.
Secondly, though, mental illness is a subject with deep meaning for me personally, which is why I decided to submit to the anthology in the first place. It is my personal belief that 100 percent of people experience mental illness at one time or another, but a fairly high percentage of us struggle for longer periods or with deeper pain. Over the course of my life (57 years as I write), I’ve had many happy times, but I have also been diagnosed with major depression, general anxiety disorder, insomnia, high blood pressure, migraine headaches, and the all-inclusive diagnosis of “stress.” In addition, I’ve pretty much diagnosed myself with Avoidant Personality Disorder just because I relate to every item on the list of diagnostic criteria.
If you look up statistics, you find that more women report depression, but more men die from suicide. You can make up your own mind about why this is the case, but I can tell you that over the years I have been told that my depression was a “luxury” and that it made me seem weak, pathetic, and selfish. If other men get the same message, it isn’t too surprising that fewer men report being depressed. When they do report mental illness, fewer services are aimed at them. Even when services are available to both men and women, the décor of offices and language of materials often has a stereotypically feminine feel that makes men feel unwelcome.
All of this makes me especially sensitive to the high-price of masculinity. We hear quite a bit about toxic masculinity, but toxic masculinity is a by-product of what philosopher Tom Digby calls sacrificial masculinity. Men are taught from the crib to ignore their own physical and mental health. In the past, men ignored their health in order to be better protectors and providers. Increasingly, emotionless brawn is less needed and less valued in society, so men are left with poor mental health with no obvious purpose, which only exacerbates the problem.
For a time, I facilitated men’s bereavement groups, and all the men said some version of the following: “I’ve been told how I’m not supposed to grieve (crying and emotional breakdown), but no one tells me how I am supposed to grieve.” Almost every man in every group I facilitated broke down in tears, and almost every one apologised for it. For this reason, I think if we can fight like men, we must learn to cry like men. Although I haven’t been successful at getting others to use it, I occasionally post information on men’s mental health with the hashtag #CryLikeAMan.
The anthology will be available from 8 February 2018.
I was fortunate enough to be included in Isabelle Kenyon’s new poetry anthology supporting the mental health charity, UK MIND. I was happy to participate in the project because I think any effort to remove stigma around mental illness and to provide support for those suffering is a good and necessary thing to do. I don’t think I am unusual, really, but I’ve had my bouts with depression, anxiety, avoidance and attendant health problems. The more open we can be about our struggles, the easier it will be for us, collectively, to cope. I’m very grateful to Isabelle Kenyon for her efforts, which she describes below.
Isabelle Kenyon is a Surrey based poet and a graduate in Theatre: Writing, Directing and Performance from the University of York. She is the author of poetry anthology, This is not a Spectacle and micro chapbook, The Trees Whispered, published by Origami Poetry Press. She is also the editor of MIND Poetry Anthology ‘Please Hear What I’m Not Saying’. You can read more about Isabelle and see her work at www.flyonthewallpoetry.co.uk
Thank you to Randall Horton for letting me guest blog today! I wanted to spread the word about the MIND Poetry Anthology, which I have compiled and edited. ‘Please Hear What I’m Not Saying’ will be out in early February, expected date of release to be Thursday the 8th, on Amazon. The Anthology consists of poems from 116 poets (if I include myself!) and the book details a whole range of mental health experiences. The profits of the book with go to UK charity, MIND.
The book came about through my desire to do a collaborative project with other poets and my desire to raise money for a charity desperately seeking donations to cope with the rising need for its work. I received over 600 poems and have narrowed this down to 180.
As an editor, I have not been afraid to shy away from the ugly or the abstract, but I believe that the anthology as a whole is a journey – with each section the perspective changes. I hope that the end of the book reflects the ‘light at the end of the tunnel’ for mental health and that the outcome of these last sections express positivity and hope.
‘Please Hear What I’m Not Saying’ is a poetry anthology, the profits of which will go to UK charity, MIND. The book consists of 116 poets (I’m happy to be one of them) from around the world and details a whole range of mental health experiences. The expected date of release is Thursday 8th, on Amazon.
Editor Isabelle Kenyon answers questions about the project.
Question: How did this project begin?
Isabelle: I knew I wanted to work collaboratively with other poets and it was actually the theme of mental health for a collection, which came to me before the idea of donating the profits to charity MIND. This was because I knew how strongly people felt about the subject and that it is often through writing that the most difficult of feelings can be expressed. I think that is why the project received the sheer number of submissions that it did.
Question: How did you select the poems – was there a process?
Isabelle: In some cases of course personal taste came into my selection, but I tried to be as objective as I could and consider the collection as whole. I wanted the book to have as many different personal experiences and perspectives as I could find. Because of this, I have not been afraid to shy away from the ugly or the abstract, but I hope that the end of the book reflects the ‘light at the end of the tunnel’ for mental health and that the outcome of these last sections express positivity and hope.
Question: Why should people buy this book?
Isabelle: Easy – to support the fantastic work which MIND does and to support the fantastic poets involved. Rave about their work because I believe the poets involved are both talented and dedicated.
I’m a depressive. It has been some time since suicidal ideation, depersonalisation, and derealisation enveloped my pshche and smothered me in a warm fog. Still, being a depressive is like being an alcoholic. It never really goes away. “My name is Randall, and I’m . . . .”
When my depression comes, it usually greets me in early spring along with the new blooms of fresh gardens and reinvigorated old trees. I have no idea why spring is such a difficult time for those of us who struggle with depression, but I do know I am not alone. When most non-depressives think of depression and seasonal sadness, they think of winter when the skies are dark and the holidays strain the resilience of family ties and over-burdened budgets. But it is spring that brings the spike in suicides.
I don’t think anyone can say for sure why suicides peak in the spring. Some say it is due to allergic responses to pollen. Some say people tend to take action in the spring after a relatively dormant winter. You can click here for a brief overview of theories.
Whatever the reason, please be aware of the increased risk of suicide as spring rolls on. Many of the warning signs are straightforward: talking about suicide, buying weapons or poison, becoming withdrawn, expressing feeling of hopelessness, or mood swings. A less obvious symptom, though, is an increase in energy and mood after a period of depression. Sometimes people may feel happier or energised after deciding on what they see as their only way out. You can click here for a list of suicide warning signs.
Women report suicidal thoughts more often than men, but the majority of completed suicides are men. That doesn’t mean you shouldn’t take women seriously if they are having suicidal thoughts, of course, but it may be that men are less likely to seek help or admit to feelings of weakness, so it would behoove us all to make support available to men and to help men feel more comfortable seeking help.
Finally, some people may threaten suicide in a bid to get attention, or they may be judged that way, anyway. I can only say that if someone will go to those lengths to get attention, they desperately need attention. Please try to give them some. Attention in the form of care is a human need as real as the need for water or air.
Over the years, I’ve spent a considerable amount of time discussing anger, apologies, and forgiveness with therapists and survivors of child abuse and other traumas. Survivors and therapists alike are often passionate in the their belief that forgiveness is the only way to move forward from traumatic abuse. Without forgiveness, they feel, healing is impossible.
Having a typically transactional view of forgiveness, I always held that it makes no sense to forgive when there is no acknowledgment of wrongdoing on the part of the abuser. Asking a survivor to forgive unilaterally and unconditionally is bereft of meaning at best and morally repugnant at worst. Only if the abuser were to apologize and make some effort at amends, at least, could I see then extending forgiveness to the abuser, and I would consider this a charitable act on the part of the survivor.
Others have hastened to tell me that such an exchange is not necessary. They insist that unconditional forgiveness, freely given, is more meaningful and more liberating to survivors than the transactional form of forgiveness. Besides, they say, forgiveness is cleansing and is, indeed, the only way for survivors to rid themselves of the burden of intense and destructive anger.
I have always countered that it is possible to put anger aside without offering forgiveness to someone undeserving and unrepentant. Choosing a somewhat less emotional and inflammatory example, I can point out that I once had a moderately expensive lawnmower stolen from me. It wasn’t the end of the world, but it certainly made me angry. The thief was not caught and, I assume, never suffered any pangs of guilt for the crime. Over time, I was able to get on with my life, though I still remember it 30 years later. I decided to stop dwelling on it and get over it, so I tried to stop thinking about it and focus on things that could improve my life.
My interlocutors quickly countered that losing a lawnmower is nothing like the pain of having your innocence robbed (some described it as theft of a child’s “soul”). I am quick to agree, but I see it as a difference in degree, not kind, and I still cannot see how offering forgiveness to a remorseless abuser can aid healing.
My view was bolstered by the work and words of Alice Miller, the famed psychoanalyst and child advocate who died in 2010. In her 1991 book, Breaking Down the Wall of Silence, Miller writes, “Forgiving has negative consequences, not only for the individual, but for society at large, because it means disguising destructive opinions and attitudes, and involves drawing a curtain across reality so that we cannot see what is taking place behind it.” Instead, she tells us, “Survivors of mistreatment need to discover their own truth if they are to free themselves of its consequences. The effort spent on the work of forgiveness leads them away from this truth.”
third way of viewing anger and forgiveness. Nussbaum agrees that therapists should not force forgiveness, but she offers a more nuanced and philosophically grounded way of viewing the work of anger and the way forward from even extreme wrongs and injustices.
While many philosophers have ignored or dismissed the moral relevance of the emotions, others such as Aristotle have noted the importance of anger to a good life. While anger is a negative emotion, it has benefits for people seeking to flourish in life. Namely, anger is said to enable us to recognize injustice when it occurs and then motivate us to action to correct the wrongs inflicted on innocent parties. For Aristotle, anger occurs when someone’s status is lowered without good cause. Indeed, an attack on one’s character or social rank is likely to provoke anger and, in many cases, a wish for revenge. Nussbaum notes that revenge has few or no practical or moral benefits. Other than a temporary sense of satisfaction, payback accomplishes nothing of importance for us.
But if payback isn’t a useful result of anger, then perhaps contrition, apology, and forgiveness are necessary components of a moral and flourishing life. Most of us have grown up in a culture that stresses the importance of apologies and forgiveness for wrongs. Nussbaum traces ancient Jewish and Christian (primarily) texts dealing with the role of forgiveness. The most familiar form is transactional—if someone reduces the status of someone else, the perpetrator shows remorse and asks forgiveness. When the wronged party bestows forgiveness, the proper ranking of the parties is restored, and justice, it seems, is served.
Of course, contrition and apologies are not always forthcoming. Sometimes the perpetrator is simply stubborn and sometimes the perpetrator is no longer alive. This is often the case for survivors of child abuse. In the absence of an apology many therapists, as noted above, advise survivors to offer unconditional forgiveness. This kind of forgiveness is said to release the victim from the shackles of anger and enable a flourishing life to happen. Of course, contrarians such as Alice Miller claim this type of forgiveness traps survivors in a life-long lie that destroys them emotionally.
Nussbaum recognizes these challenges and takes a different approach. She offers several examples of people who move forward without offering forgiveness but in a more positive way than Alice Miller would likely think possible. In the example of the Prodigal Son, the son returns to his father to be greeted with open arms. Although the son has behaved quite badly, his father thinks only of the future with his son and not the past (his other son is not quite so ready to embrace his wayward brother). It is the focus on the future that makes all the difference for Nussbaum.
In an even more painful and poignant example, she describes a father from Philip Roth’s American Pastoral, whose daughter becomes an addict and kills several people. The father finds his daughter and realizes he is helpless to change what she has done or her future prospects. He does all that he can do. He loves her and stays with her. Nussbaum says, “There is no apology, and there’s really no question of forgiveness on the agenda, whether conditional or unconditional. There’s just painful unconditional love.”
When anger is useful, Nussbaum says it is useful as a transition from a wrong to a focus on a better future. In the transition, someone would say in anger, “That’s outrageous! Something must be done to prevent this in the future!” Nussbaum applies this model in three realms: the intimate, the middle (public), and the political (social) realm. Simply because of my interest and background, I found her discussion of the intimate realm the most interesting and compelling.
In the middle, or public, realm, I think most of us realize our anger at strangers is rarely helpful. Minor wrongs (e.g., someone cutting in line at the grocery store) are best forgotten as quickly as possible. More serious wrongs are a matter for law enforcement and the court system. Being consumed with anger is only a form of self-torture.
In the political realm, though, anger is said to be a great motivator toward justice, and surely anger has propelled many social movements to success. Again, though, Nussbaum warns that it is easy to get caught up in concern for revenge or payback rather than creating a better world. After great harms, we need to focus on truth and reconciliation, not punishment. Indeed, the most successful social movements have focused on the future and not redressing wrongs.
Nussbaum sees Nelson Mandela as an exemplary role model for looking to the future rather than the past in response to injustice. She says, “Mandela frames the entire question in forward-looking pragmatic terms, as a question of getting the other party to do what you want. He then shows that this task is much more feasible if you can get the other party to work with you rather than against you. Progress is impeded by the other party’s defensiveness and self-protection.”
For years, I have had difficulty clearly delineating exactly what I found problematic with our accepted model of anger and forgiveness. Nussbaum has provided a welcome bit of clarity for a universal yet surprisingly complex human problem. Realistically, we will not be able to let go of useless anger and focus only on transitional anger, but at least we have a better target. When we do succeed it will be because we rely on another human emotion—love.
Recently a woman in the UK known only as C won the right to effectively end her life by refusing dialysis treatment. Owen Bowcott, writing for The Guardiandescribed it as a “highly unusual judgment,” but, in making the decision, the judge said, ““This position reflects the value that society places on personal autonomy in matters of medical treatment and the very long established right of the patient to choose to accept or refuse medical treatment from his or her doctor.”
The judge is correct; the right to refuse treatment is one of the bedrock principles of medical ethics. In most medical decisions, autonomy trumps all other considerations, including efficacy of possible treatment. In other words, you are not obligated to accept treatment simply because it will prolong your life. This is the way things work in the world of medicine, but there could be other approaches.
Given the facts of this case, it seems a suicidal person sort of “lucks out” when an unrelated medical issue arises. Unlike C, not everyone seeking death is able to find a legal way out. Those who are so physically incapacitated that they cannot possibly end their lives without help often find too many roadblocks to death to ever carry it out. Even when healthy people try to commit suicide, the rest of us are obligated to prevent it when possible. If we find someone who has taken a drug overdose, for example, we try to save him or her. If someone is trying to jump off a bridge, we try to prevent it. And if someone asks for drugs to commit suicide, only a few places in the world allow them to be prescribed.
It is clear that we do not always respect the autonomy of suicidal individuals. Even in the case of C, the judge said, “My decision that C has capacity to decide whether or not to accept dialysis does not, and should not prevent her treating doctors from continuing to seek to engage with C in an effort to persuade her of the benefits of receiving life-saving treatment in accordance with their duty to C as their patient.” The judge seems to feel that the doctors ought to continue trying to save C, even while recognizing that she has the right to refuse treatment.
Clearly, the law in this case is built around autonomy, but perhaps it shouldn’t be. Autonomy assumes a rational and unimpaired person making a fully informed decision. The judge notes that C is fully functional and has no cognitive impairments. At the same time, though, C is facing a diagnosis of breast cancer and a severely damaged self-image. It isn’t clear that she may not modify her view with a little time and, perhaps, psychotherapy.
If her mental health is impaired, she may not be fully autonomous in the first place. If she isn’t, then perhaps she needs care more than freedom. An Ethics of Care would possible guide us to respect her wishes as well as her needs. A little more time may be needed to assess whether her decision, which is not reversible, is truly the decision she wants to make. With a little time and support, she may come to believe that sparkle is still possible for her.
I also think a focus on capabilities might be relevant. An ethics focused on capabilities would try to enable her to have a fulfilling life by maximizing the abilities she still has. Care and capabilities both emerged as feminist approaches to ethics and justice. While on the surface, this may not seem to be a feminist issue, but the judge also said, “It is clear that during her life C has placed a significant premium on youth and beauty and on living a life that, in C’s words, ‘sparkles’.”
It is clear that C has operated under rather sexist values for most of her life. That is her choice, to be sure, but it might be possible to find new values. Many who have experienced crippling injuries have sought suicide only to later find their lives are valuable and meaningful even without the activities and relationships they once held dear.
Reid Ewing of Modern Family fame recently wrote publicly about his struggle with body dysmorphia in a personal essay on the Huffington Post. Ewing revealed that his dysmorphia led him to seek and receive several surgeries. He feels his surgeons should have recognized his mental illness and refused to perform surgery. He wrote, “Of the four doctors who worked on me, not one had mental health screenings in place for their patients, except for asking if I had a history of depression.”
The principle of autonomy is by far the most discussed principle of bioethics. Discussions typically focus on the rights of patients to refuse treatments, not to seek them. On either side, the issues can be thorny. If a depressed and suicidal patient refuses life-prolonging treatment, is it ethical to respect the patient’s autonomy or should mental health services be provided first? As in Ewing’s case, the ethical problem arises from the claim that the decision is driven by mental illness and not reason. If someone is mentally ill, they are not fully autonomous agents as they are not fully rational.
This is a problem with autonomy in general. Our ideas of autonomy come largely from Immanuel Kant, who claimed that all rational beings, operating under full autonomy, would choose the same universal moral laws. If someone thinks it is okay to kill or lie, the person is either not rational or lacks a good will. How do we determine whether someone is rational? Usually, most of us assume people who agree with our decisions are rational and those who do not are not rational. If they are not rational, they are not autonomous, so it is ethical to intervene to care for and protect them.
Earlier this year, a woman named Jewel Shuping claimed a psychologist helped her blind herself. She says she has always suffered from Body Integrity Identity Disorder (although able-bodied, she identified as a person with a disability). Most doctors, understandably, refuse to help people damage their healthy bodies to become disabled, which can lead clients to desperate measures to destroy limbs or other body parts, sometimes possibly endangering others.
Jewel Shuping never named the psychologist who may have helped her, so it is impossible to check the story. It is possible to imagine, however, that some doctors would help someone with BIID in the hopes of preventing further damage to themselves or others. Shuping says she feels she should be living as a blind person, and she appreciates the help she received to become blind. In contrast, Ewing feels he should have undergone a mental health screening before he was able to obtain his surgery and that his wishes should not have been respected.
Plastic surgeons are often vilified as greedy and unscrupulous doctors who will destroy clients’ self-esteem only to profit from their self-loathing. On the other hand, these same plastic surgeons are hailed as heroes when they are able to restore beauty to someone who has been disfigured in an accident or by disease. Unfortunately, we do not have bright lines to separate needless surgery to enhance someone’s self image and restorative surgery to spare someone from a life of social isolation and shame. Some would argue the decision should not be up to the doctors in the first place but should be left in the autonomous hands of clients.
Many have similarly argued that doctors should refuse gender confirmation surgery to transgender men and women. As with BIID, many assume that transgender individuals are mentally ill and should see a mental health professional, not a surgeon. Transgender activists (and I) argue that transgender individuals need empowerment to live as the gender that best fits what they actually are. If surgery helps them along that path, they should have access.
All this leaves us with the question of when to respect autonomy and when to take the role of caregiver, which may involve a degree of paternalism (or maternalism for that matter). Is it more important for doctors who ensure the patient’s rights to seek whatever treatment they see fit, or is it more important to provide a caring and guiding hand to resolve underlying mental health issues before offering any treatment at all?
One of Ewing’s complaints is that he was offered plastic surgery on demand with no screening at all. The process for people seeking gender confirmation surgery, by contrast, is arduous. Before surgery, transgender people go through counseling and live as their true gender for an extended period of time. At the far end of the spectrum, people with BIID rarely find doctors willing to help them destroy parts of their bodies and resort to self-harm. These three cases are not the same, but make similar demands on the distinctions between respect for autonomy and a commitment to compassionate care.
It seems reasonable to accept Ewing’s claim that mental health screenings should be a part of body modification surgery, especially when someone has no obvious flaws that need to be repaired. In all these cases (dysmorphia, gender identity, and BIID), mental health support is necessary. In each case, patients describe depression, emotional turmoil, and, too often, thoughts or attempts of suicide. Mental health care does not require a violation of autonomy, but it may help a person’s autonomous decisions to form more clearly from deliberation and not desperation.