What's in your Stress Container?

I can't remember the last time I cried. I remember crying at my Mum's funeral. I'm sure I've cried since then - 18 years have passed after all!
I've recently told people that my tolerance is lower than it was than before I became a father a couple of months ago. Stress and disrupted sleep will do that. An NHS colleague described the last few months as being dumped on continuously. It does feel like that. There are days you are scrambling to keep near the top and other days you are peering like a Meerkat awaiting the next disaster.

No one is ever fully prepared for being a parent. There are quirks and phases, some last hours and others last months. There's pressure and people who know best even though it's been out of medical practice for almost 10 years.

All that being said, I wouldn't change a thing. I love my wife and I love my Son.

To any prospective parents reading this, take some time and spare capacity in your life and your mind. Be ready to ask for help and say 'No'. Be ready to do what is best for you and your clan. And when you think you have enough spare time and energy, make some more. You have a partner to support too and that had its own pressures, concerns, and rewards.

I've been so lucky to have work - so I'm not being a parent 24/7. You don't appreciate how much strain Mum is under because you are in a different mindset - stressed at work. I'm working full time in the NHS in addition to working self-employed and so recently felt very aggravated when someone suggested I do even more work - unpaid. I do quite a lot of volunteering as it is and when someone tries to take those tiny moments you have to enjoy family time, it's infuriating.

This brings me back to the feeling like I need a cry. Crying is OK. I sometimes feel like I need a good cry to let it out but for whatever reason, I can't. I've never found crying easy.

Everyone has a stress container. They are different shapes and fill at different rates. The pressures in my life and the dates in my diary are different to yours and this is reflected in the way we hold and manage our stress. This is something we discuss during the Mental Health First Aid course by MHFA England which I teach - details here. Something you find easy can fill someone else's stress container. When the bucket is full, it bulges and bursts with stress until we snap. We lash out, we snap, we cry. The expression "the straw which broke the camel's back" is great example of when something you might normally see as minor can be the event that buckles your bucket.

If you'd like to know more, then please consider becoming a mental health first aider. There are some good short courses out there for introduction, but I would strongly recommend an accredited course like the 2 Day course by St John's Ambulance or the 2 Day Online course I teach by MHFA England. Being a Mental Health First Aider helps you better support yourself, your staff and your customers in the same way a physical first aider does. It helps teach you to support and react in general everyday occurrences as well as big crisis - just as physical first aid supports you to use a plaster or to do CPR. In fact global company Deloitte published studies showing a positive case for employers investing in mental health, with an average return of £5 for every £1 spent.

Find out more about Mental Health First Aid at www.mentalhealthmatt.co.uk

No one has committed suicide in England or Wales since 1961

It may seem like the most clickbait of titles but I can assure it is 100% true. Since Summer 1961 not a single person has committed suicide. Yet in 2019 5,691 people took their own lives.

According to statistics from 2016, the United Kingdom is 109th in the World Health Organisation’s rankings of suicide figures out of 189 nations. Records from the Office for National Statistics show that between 1981 and 2019 a staggering 200,711 people ended their own lives. On average, 75% were male. [1]

Mental ill health is responsible for 72 million working days lost and costs £34.9 billion each year. [2] I’ve even spoken about my own mental health and how I survived suicide on national TV.

Given the horrible records, how can anyone claim that no one has committed suicide?
To answer that question we need to go back to the start - or as close as we can. In your mind travel back to 967 AD. Edgar the Peaceful, King of England, has been on the throne for 8 years after the last Viking King flees to the North. He’s a deeply religious fellow and works closely with Dunstan who lead the ‘10th Century Reformation’ as the Archbishop of Canterbury. Dunstan himself would later become a Saint. History records that King Edgar would take a yearly tour of his realm to ensure that his law was being upheld. History seems to remember him favourably.

His laws were recorded in Ecclesiastical history in the Charters of Abingdon Abbey – given his positive connections to the Church and that generally only ‘men of the cloth’ were literate we can imagine why. It was a law in 967 – which I’ve been unable to directly find without a paywall – that King Edgar is perhaps the first to make “self murder” a crime. His law made is clear that anyone who died from suicide would forfeit their estate and lands to the feudal lord which made suicide a felony.

Perhaps it was just a way to make money? A few hundred years later Thomas Aquinas, later a Saint himself, would document his views as scholar and an authority on religion. He felt that the Christian God had created humanity in his image as a gift and therefore killing that gift would be a little bit insulting. The commandments state that “Thou Shalt Not Kill” and so suicide would be a literal breach of the law handed down by god. [3]

It is fascinating how religion and law have become so entwined. This isn’t unique to English history either. The oldest appears to date to 1937 BC in Egypt a tale was being told where a man considering suicide is having a conversation with his soul who fears that suicide will leave the soul lost where “goodness is rejected everywhere”. [4]

With so many cultures and religions angered by the concept, it became enshrined in law on an almost universal scale. In England and Wales it was the Church who had this commandment in their law book which overtime became Common Law. Over the Centuries this has appeared in different ways. Churches would reject burials and certain rites for those who have taken their own lives. In Medieval England, tales of secret midnight secret burials, sometimes at crossroads partly due to the stigma around how the person died. This stigma of shame, embarrassment and humiliation stirred throughout history with many people being refused burial rites following suicide into the 20th Century.

With secret funerals and stigma, entire family members would vanish from history becoming unspoken gaps. Some people felt embarrassed of their familial connection whilst others truly believe that suicide was a sign of demonic possession. The concept of a burial at crossroads seem to stem from the idea that the passing traffic would somehow prevent those evil spirits rising from the grave. [5]

The fear of mental health and suicide is evident whenever you hear the world “asylum” something the horror film industry used inadvertently perpetuating more stigma. In 1914 there were over 100,000 patients in around 120 mental health institutions. The nearest to my home is St Bernard’s Hospital which was previously known as the Middlesex County Lunatic Asylum. Much of it still exists albeit as NHS offices and part of Ealing General Hospital. Like many Asylums, the buildings strike fear looking more like prison than welcoming treatment facility. When you look at facilities like these, leeching fear and discrimination into the community, they seem to mirror the historic feelings towards mental health. It is easy to understand why self-murder was a punitive offence. [5]

Records show that even in the early 1700s, a coroner’s inquest would rule around 90% of suicides finding the victim guilty of felo de se – committing a felony against themselves; suicide. The punishment would be complete forfeit to the Crown. However as the century passed, beliefs moved away from evil spirits towards more medical explanations. Juries ruled the suicides as non compos mentis which meant there was no criminal offence and would allow a simple Christian burial, often at night. [6]

First published in 1759, Adam Smith’s The Theory of Moral Sentiments questions and documents the turning opinion of the times: "If your situation is upon the whole disagreeable... walk forth by all  means. But walk forth without repining; without murmuring or complaining. Walk forth calm, contented, rejoicing, returning thanks to the Gods, who from their infinite bounty, have opened the safe and quiet harbour of death, at all times ready to receive us from the stormy ocean of human life… "
By 1800 over 97% of suicides were ruled in this non-criminal way, acknowledging the person’s long term struggle with what we would call mental health and this continued into the 1900s. [7]

Following the Criminal Justice Act in 1948, probation rather than imprisonment became the norm. There were exceptions. Edward French plead guilty to attempted suicide in 1955 and was sentenced to two years imprisonment because the evidence showed he made a serious sane attempt to end his life. The data for those trying to take their life, attempted suicide, is rather patchy prior to the 1960s. "One reason why so many suicidal attempts fail to reach the ears of the English Police is that it is against medical ethics for a physician to report them" Glanville Williams said. In the years 1952 to 1956 over 1800 people were sentenced to a probation order while 194 were imprisoned. The total number of people convicted of an attempted suicide during this period was 2,922. [7] How many others escaped ‘justice’?

During the Parliamentary Debate for the Suicide Bill in July 1961, the idea of treatment over punishment was endorsed across the political spectrum. Viscount Kilmuir spoke of “medical or therapeutic” treatment while the only documented disagreement was on whether the treatment be made compulsory.

Since the 1950s Asylums, the authoritarian, crumbling and cruel scheme, transitioned into a more supportive and nurturing care in the community scheme. I should note that the care in community isn’t perfect and we are now severely under-resourced when it comes to supporting those who need inpatient or even ‘day care’ support.   

A memo from Norman Brook, a Cabinet Secretary to Harold Macmillan from 24th October 1960 notes that there were believed to be 30,000 attempted suicides each year with around 600 being prosecuted and found guilty. “It seems to be the general opinion, both in the medical profession and in the courts, that these people be better dealt with outside the criminal law – as the majority already are.”

After a handful of discussions, often unnoticed in a world occupied with the Cold War, Royal Assent was given at 6:31pm on 3rd August 1961. Within hours a Home Office memo was sent to every Chief Constable that “it will no longer be an offence to commit suicide.”

Suicide rates steadily declined between 1963 and 1975. [8] By the early 1980s, the figures are around 5,700 [1]. Rather than decreasing the value of life, decriminalising suicide decreased the stigma and the rate of suicide by starting to make care and treatment easier to access.

The reason for writing this article is twofold:
Firstly, it is an interesting bit of trivia: that no one has committed suicide since 3rd August 1961 because suicide was no longer a crime anyone could commit. However, the main point is to show and emphasise how language and our choice of words can have such a profound impact.

Whenever someone uses the phrase ‘commits suicide’, it stirs up that fear and hatred. It scares people that they will be detained in some horror film asylum for attempted self-murder rather than being the kindness, understanding and compassion they deserve and need.  To me, ‘commit suicide’ is like nails on a chalkboard.

I try to highlight to people that while they are using a common phrase, it is deeply hurtful and actually causes more harm than good. Some people prefer the phrase ‘completed suicide’ although I prefer ‘took/ended their own life’.

People with mental health issues, thinking about suicide or not, are not criminals.
Work by Mind, a leading mental health charity I am proud to be a member of, shows that people with mental health issues are three times more like to be a victim of crime than the general population. [9] An article from The Lancet in 2020 stated “People with mental illness are much more often the victims of violence rather than the perpetrators.”  It goes onto say “It is clear that cuts in mental health service expenditure in England in the past decade have led to a reduced quality of overall care”.

Whether you hear it, see it or read it – I ask you remember this article and challenge it. Just as we would not accept homophobic, racist or sexist remarks. We all need to politely challenge the discrimination and say “No, No-one commits suicide”.


Thank you for reading my article. Please feel free to share it and consider reading some of my other posts.
Matt Streuli is a mental health writer and Mental Health First Aid Instructor. By day, he is a Secretary in the NHS. He lives with his Wife, two cats and is expecting his first child this May.

[1] https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2019registrations
[2] https://www.centreformentalhealth.org.uk/publications/mental-health-work-business-costs-ten-years
[3] https://ethicsofsuicide.lib.utah.edu/selections/thomas-aquinas/
[4] https://ethicsofsuicide.lib.utah.edu/category/author/egyptian-didactic-tale/
[5] Julie Mathias, “Victorian Attitudes Towards Self-Murder”, Curious Histories (blog on oldoperatingtheatre.com), November 11th, 2016.
[6] https://www.ncbi.nlm.nih.gov/books/NBK513543/
[7] https://etheses.lse.ac.uk/1573/1/U136493.pdf
[8] G. M. G. McClure, Changes in Suicide in England and Wales 1960-1997, British Journal of Psychiatry.
[9] https://www.mind.org.uk/about-us/our-policy-work/victims-of-crime/
[10] https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30002-5/fulltext

Empathy is a Superskill that take time to Recharge

 On the surface, sympathy seems helpful. The problem with sympathy is that while it acknowledges the hard times someone is facing, it doesn't offer them any support whether be a listening ear or something practical. 

If sympathy is looking into the pit of depression or grief and saying "Sorry", then empathy is climbing in and saying "I'm here for you. We'll get out together".

"I think we should talk more about our empathy deficit - the ability to put ourselves in someone else's shoes; to see the world through the eyes of those who are different from us - the child who's hungry, the steelworker who's been laid off, the family who lost the entire life they built together when the storm came to town. When you think like this, when you choose to broaden your ambit of concern and empathise with the plight of others, whether they are close friends or distant strangers; it becomes harder not to act; harder not to help."
- Barrack Obama - 2006

The problem with sharing someone's pain is that it will drain you. To give you an example, if someone is constantly demanding empathy from you yet dismisses your thoughts and feelings then you don't have the foundation of an equal or healthy friendship or relationship. It is possible to burn out from empathy especially if your job or role involves listening to and support people- whether you are an aid worker, a Doctor, a teacher or a therapist.  

Interestingly, Scientists have documented empathy in toddlers who showed concern for a parent - yet showing concern for another's wellbeing is often something that has to be taught or reinforced for some older children (and adults!). Empathy is something we can call do but it takes thought and effort to create a real rapport and put yourself into their metaphorical shoes.

I'll share with you a problem and see if you can use empathy while reading it. Think about what you would if we were sat next to each other. What could you say to share the problem rather than just observe it and sympathize with it?

There is a person I want to be part of my life yet the care and concern for this person and their antics can be draining to the point of frustration. Their silence in the communication can make people feel unwanted or perhaps just that they lack the care and energy to bother with anyone but themselves. Maybe they are selfish. An event happened recently, with plenty of warning, that was very important - or maybe I just felt it was important. While others made the effort, this person was no show. This person has missed or avoided or not bothered with several other events in the recent past without a message or post-event apology. A relationship should be two-way but if they don't care or can't be bothered; maybe I can't be bothered anymore either.

If you read that and your internal voice was saying "Oh I'm sorry, there's plenty more fish in the sea"; then you were sympathizing. While your thoughts on other fish/friends are true, it doesn't share the pain and make that connection. If your reply was "I can feel how angry and how sad it feels. I'm here." then you were empathizing. 

It's not easy. Much as it isn't easy to give up and cut loose someone who doesn't give equally to a friendship. Perhaps this part is even harder: you have to make a concerted effort to look after yourself so you can recharge your empathetic battery. If you are worn down and clobbered, then you won't have the emotional gusto to support yourself or give to those friendships and relationships around you.

If you'd like to read more on empathy, have a look at this fab article: https://www.mindtools.com/pages/article/EmpathyatWork.htm