Foreword to Watching Myself Be Borderline: A Smart Sufferer Says How It Started and How She Survives, by Jansen Vee, 2020, Outskirts Press
Jansen Vee’s account of her life should be read as a critical exploration of a person’s journey of choosing life or death.
Depression and mental illness are often blamed as causes of suicide; as a result, suicide prevention policymaking is firmly placed within mental health services. Suicide prevention policies are based on the assumption that depression and/or mental illness is present in suicidal cases. With this approach, suicide is never addressed, because the focus of suicide intervention is to seek out, diagnose, and treat a mental illness or depression.
This method is not preventative for the main reason that it relies on intervention only after a mental illness has manifested itself or when suicide has been attempted.
Suicide is not a new social and health concern. Suicide research involving analyses of historical, religious documents, and literature provide accounts of suicide due to various causes but rarely because of mental illness. Suicide is mystifying because, firstly, for the living, it is hard to comprehend ending one’s own life, and secondly, why, despite advancements in medicine, has suicide not been eradicated?
Over the last century or so, suicide has been medicalized and firmly placed within the domain of psychiatry as a mental illness. As a result, most suicide research is biased because there is the assumption of the presence of mental illness and/or depression from the outset. Unfortunately, the problem is that researchers have consistently failed to account or correct for such biases.
Repeated data on suicide outcomes are necessary to gain insight into suicide. The problem with suicide research is that death only occurs once. On average between two-thirds and three-quarters of all suicide cases are successful in their first attempt – therefore, we know nothing about this group’s social and health status and their process of decision-making.
For the other one-quarter to one-third who failed to complete suicide initially, intervention methods focus on diagnosing and treating a mental illness. Yet, this group still went on to complete suicide. So the question as to why some people choose death over life whilst other people with similar characteristics choose life over death is never addressed and explained. Only when we have insight into an individual’s process of decision-making can we develop effective suicide prevention strategies.
Our current knowledge of suicide and mental illness raises more questions than answers, making prevention and intervention policies irrelevant and inappropriate. In a recent book–Shahtahmasebi and Omar (2020), The Broader View of Suicide, Cambridge Scholars Publishing–we argue that research shows that mental illness is not the cause of suicide, and that suicide prevention policies based on assuming the presence of mental illness are not working. Suicide data suggest that it is not wise to assume that there is one single adverse life event that causes suicide. Suicide occurs in groups where mental illness is present but also in groups where mental illness is not present; individuals who are bereaved attempt suicide but so do those who are not bereaved; unemployed individuals commit suicide but so do those still employed; and so on.
It is not surprising that decades of using a mental illness approach to suicide prevention has failed to prevent suicide and failed to reduce national and global suicide rates. In 2018, the United States Center for Disease Control and Prevention (CDC) warned of the rising suicide rate in the USA and across the globe.
Research also shows that non-medical approaches performed at a grassroots level have a much better chance of successfully preventing suicide.
This book should be read in the above context. Jansen Vee’s life story enables an exploration of suicide as an outcome of a decision-making process, while at the same time examines life with mental illness.
In March 2020, in response to one of my papers on suicide in which I argued that we do not know the process of decision-making of most suicide cases because they were successful in completing suicide in their first attempt, Jansen contacted me and offered her life story to shed some light to help understand the process of decision-making which leads to suicide. She has been providing updates ever since. I was surprised but delighted when she invited me to write a Foreword for her first book. In writing this piece I am mainly focusing on suicide rather than mental illness.
Jansen bravely writes about her life to describe her decision-making process. She is candid about herself and her life. Her analysis of her own life events and herself as a human being who frequently considers committing suicide leads the reader to understand her process of decision-making as it relates to her life ordeal, which has been explained as mental illness.
Jansen accepts and seems to take comfort in, the fact that the medical approach had mapped her life into a series of mental illness diagnoses. Jansen admits that receiving conventional treatments: psychiatric, cognitive therapy, and counseling, for most of that period, had done nothing to alleviate her symptoms. She still felt suicidal following medication and treatment. Jansen’s suicidality manifested late in her life – in all probability as a result of the medical interventions for her mental illnesses: she recalls feeling suicidal after taking prescribed medications.
Jansen’s experiences provide an example of how medicalizing behavior when one illness category does not fit the symptoms then creates more. Jansen expresses the wish for an alternative, non-medical approach culture, where the community as a whole is part of the solution to improve and support mental well-being for people who need it.
A grassroots approach to protect and support vulnerable people in the community is very rare in the medicalized Western world which tends to leave individuals to either face their dilemmas alone or accept medical intervention. Jansen’s account provides insight into the reasons why some individuals may refuse medical help.
Society and communities are often let off the hook by describing suicide as a sudden death which occurs without warning. Policy-makers and service-providers across the globe frequently claim that if they had advanced knowledge of mental illness, they could have intervened and prevented suicide. In this book, Jansen’s life story challenges such claims. A suicide attempt is not sudden to the majority of adult suicide cases. Individuals often provide signs about their suicidality, such as changes in behavior, or out-of-character behavior, but very few people talk about death directly. We tend to miss the signs for suicide and dismiss talk of death as spiritual beliefs or as personal opinion. Suicide has been kept under wraps in the psychiatric/psychology domain for so long that the public, various professionals, and medical staff have no idea about suicide discourse and behavior.
Interestingly, in telling her life story, Jansen expresses a desire for some form of community involvement in supporting people with mental illness and suicidality. Her process of decision-making was not influenced by her mental illness, but by the mental health services she sought help from. Not only has her mental illness not been alleviated or treated, but also Jansen has been given additional mental illness diagnoses.
Jansen’s life story clearly indicates that she does not want to die by suicide, but that she feels suicide may be inevitable. Perhaps an explanation for this feeling lies in Jansen’s many examples of mental health interventions/treatments she has received. Jansen seeks psychiatric help at the first sign of suicidality, but the medical interventions she receives often fail to pay sufficient attention to her suicidality.
I highly recommend this book to everyone, from psychiatric/psychology practitioners to medical professionals to the general public. This book makes an important contribution to our discourse on suicide.
Said Shahtahmasebi, PhD
July 2010
The Good Life Research Centre Trust