21st Century Issues: Suicide

Very often, when Orthodox Christians discuss the devastating issue of suicide, they restrict themselves to the question of whether or not someone who takes their own life – which is what sui-cide means, should receive a Christian burial or not. I hardly want to consider that perspective at all. It seems to me to leave the pastoral engagement of the Church with those who face suicidal thoughts much too late altogether. It is to make suicide only a matter of the classification of human behaviour into sin and virtue, without considering at all the experience of those who find themselves considering suicide, or even attempting it. So I will not be discussing the issue of whether or not a person who commits suicide should receive a Christian burial.

I do want to take note of the teaching of His Holiness Pope Shenouda on this subject, echoing the universal and compassionate practice of the Church. He says…

We can make an exception to this rule in the case of a person who proves to be completely insane when committing suicide, since an insane person should be absolved from whatever wrongdoing he does.

and

If the person who commits suicide has complete mental disorder, he will not be responsible for his behaviour. Likewise, if he has no will nor freedom, because responsibility requires that one be wise, free and willing.

and according to the Eastern Orthodox Church…

If it can be shown that the person who has committed suicide was not mentally sound, then, upon proper medical and ecclesiastical certification, the burial can be conducted by the Church.

It is important that we do not consider suicide only from the legal perspective of whether or not a burial service should be conducted. On the contrary, we must take always in mind this universal view that those suffering from mental illness should not be considered to have committed suicide in the same deliberate and willful manner as those who are denied a Christian burial. This requires us to have compassion towards those facing suicidal thoughts and to be supportive of them, not to treat them as being the worst kind of sinners and beyond any demand on our pastoral care. When we treat people in this manner, we should not be surprised that they hesitate to turn to the Church, to the shepherds of the flock of Christ, in their greatest need.

There is a difference between a person willfully and deliberately committing suicide, and a person who finds themselves driven to it by mental illness or other compulsions. Both are the taking of a life, but they do not have the same moral weight, just as a soldier taking the life of somebody while defending others is not the same as murder. Yet both are serious. Nevertheless, if our only concern is to prohibit a Christian funeral, and we do little or nothing to support and bring healing to those facing mental illness and other challenges in their life, then we are also worthy of judgement, we have also failed to live out the Christian life as God requires of us, in service to the least of all.

There are about 6,000 suicides in the UK every year. We must not imagine that these are all committed by non-Christians in their right mind, and who are therefore entirely responsible for their actions. The official NHS statistics find that perhaps 90% of those who take their own life have a mental health condition, but these mental health conditions have not always been formally diagnosed. This means that of the 6,000 people who committed suicide last year, only 600 did so with the full understanding and responsibility of their actions. While 5,400 did so while their mental state was unbalanced due to illness, or a mental disability or some other influence.

It seems to me that it would be very foolish and complacent to imagine that mental health issues had no effect within our own Coptic Orthodox Church. And if there are Church members facing many of the same mental health issues, then we should expect that some of them, as indeed is the case, will take their own life. If 90% of the general population do so as a result of mental illness or other mental health conditions, then it is reasonable that in the Church community these effects will be even higher. It would certainly be compassionate to presume this was the case. But this post is not especially about what we should do when we have failed our brothers and sisters facing such mental health pressures – though we should be aware that when we seem to take only a legalistic and hard-hearted attitude it does drive people away from the Church.

Rather I want to ask what we should be doing for that silent and hidden minority in the Church who are facing mental health issues, whether diagnosed or not, and who are finding themselves trying to deal with suicidal thoughts. There is something very wrong with our pastoral care if people are not able to share these pressures and thoughts with others, and especially with their priests, without a fear of being isolated and considered sinful, or lacking in faith. If someone has broken their leg it would be an inconsiderate person indeed who ignored their pain, and simply told them to have more faith. If someone had spent their life in a wheelchair or coping with blindness, it would be a harmful person indeed, who told them that their disability was due to sin, and that the solution to their problems was repentance. Yet, it seems to me, we do often treat people facing mental health issues, serious and life-changing issues, in just such a manner. We say that depression, for instance, just needs a person to pull themselves together, as if depression was the same as feeling a bit miserable. On the contrary, depression and many other mental health issues and conditions cannot be fixed by simply praying more, or attending Liturgy more often, or cheering up. These are real, medical, physiological and psychological conditions which cannot be healed in an instant, and should not be dismissed as evidence of moral or personal weakness.

Some of the conditions which lead people to take their own life are listed on the NHS websites, from which some of these definitions are taken:

Severe Depression – Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home.

This isn’t the same as waking up feeling a bit low. It is a condition in which, as the definition states, there is a negative effect on how people feel, think and act. Sometimes I feel a bit low and I reflect on which might be causing my mood. Sometimes it is tiredness, or frustration with something. But a person who is depressed cannot think their way out of a state which is persistent and which becomes all encompassing. A person struggling with depression cannot think straight. Those who are facing depression, and there will be many in the Church, have a low self-esteem, feel worthless and guilty. It is very easy for us to make their condition worse by adding to their sense of guilt and worthlessness, especially if their illness has produced thoughts of suicide.

In any year up to 1 in every 15 adults will have an episode of depression. Not just feeling sad, but being clinically unwell with a mental health disorder. And perhaps up to 10% of the population will experience depression in their lifetime, with all of these uncontrolled feelings, and even thoughts of suicide. In a congregation of 300 people it is reasonable, and statistically likely, that 20 people will be facing the severe consequences of depression each year. Their suffering is often invisible, but we must take action to ensure that it does not add to their burden.

Depression can also be caused by the process of pregnancy and child-birth. This form of depression is called Post-Natal, or Past-Partum Depression. Often a new mother is left to cope with these feelings herself, with the added stress of caring for a new baby. But this is an illness, and their is a medical scale which is used to measure the effects and severity of Post-Natal Depression. This is also a mental health issue. It will not go away with a little more prayer, beyond a miracle, or by pulling ourselves together. We must ask what it is that we, the Church, should be doing, to support those facing Depression of various kinds, not treating them in a judgemental and condemnatory manner.

Bipolar Disorder – This condition causes a person’s mood to swing from feeling very high and happy to feeling very low and depressed. About one in three people with bipolar disorder will attempt suicide at least once. People with bipolar disorder are 20 times more likely to attempt suicide than the general population.

We should not imagine that Christians within the Coptic Orthodox Church are immune from such an illness. Indeed, I have been in contact with many people in the Church, who exhibit just this sort of pattern of behaviour, and whom I discover are suffering from Bipolar Disorder. But it is a disorder. It is an illness and a disability. We should not asking what they should be doing to change their behaviour, but we should be asking ourselves what is required of us to serve those bearing such a mental illness with compassion and humility.

Schizophrenia – This is a long-term mental health condition that typically causes hallucinations (seeing or hearing things that are not real), delusions (believing in things that are not true) and changes in behaviour. It’s estimated that one in 20 people with schizophrenia will take their own life. People with schizophrenia are most at risk of suicide when their symptoms first begin. This is because they frequently suffer loss at this time – for example, loss of employment and relationships. It’s also increased when people with schizophrenia experience depression. The risk tends to reduce over time. People with schizophrenia are also at increased risk of self-harm.

Borderline Personality Disorder – This is characterised by unstable emotions, disturbed thinking patterns, impulsive behaviour and intense but unstable relationships with other people. People with a borderline personality disorder often have a history of childhood sexual abuse. They have a particularly high risk of suicide. Self-harm is often a key symptom of this condition. It is estimated just over half of people with borderline personality disorder will make at least one suicide attempt.

Antidepressants and suicide risk – Some people experience suicidal thoughts when they first take anti-depressants. Young people under 25 seem particularly at risk.

These are the main causes of suicide in the UK. It is under the influence of these mental health conditions that up to 90% of those who take their life each year are acting. All of these are found among Christians, because they are not signs of moral weakness, or sin, but are mental illness. Christians are not immune from illness. Depression is the predominant mental health problem worldwide, followed by anxiety, schizophrenia and bipolar disorder. All of these increase the incidence of suicidal thoughts and attempted suicide.

It is too late for us, as a Church, if we are only concerned with refusing a funeral to someone who has taken their life. We must be working to support and sustain those who are facing these mental health problems, especially our brothers and sisters in the Church. We need to become better educated, both laity and clergy, about how these mental health issues manifest themselves, and what we need to do to help people become healthier rather than more ill.

One American psychologist developed a theory which suggests that there are three main factors which can cause someone to turn to suicide. They are:

• a perception (usually mistaken) they are alone in the world and no one really cares about them
• a feeling (again, usually mistaken) they are a burden on others and people would be better off if they were dead
• fearlessness towards pain and death

We cannot, perhaps, easily affect the attitude towards pain and death, in a person suffering from these mental health issues. But we should be very concerned indeed about these first two.

This is what strikes me…

• We encourage people in suicidal thoughts when we make them feel that no one cares about them.
• We encourage people in suicidal thoughts when we make them feel that they are a burden and we would rather they were not around.

Of course we make people feel miserable when we act like this. But if a person is facing mental health problems then we not only make them feel miserable, but we confirm their perception that they are worthless, and that they are entirely isolated. We can make their mental illness worse. We can bring about an increased severity in their symptoms. No one is worthless. No one is a burden. But if someone is dealing with a mental health condition, especially an un-diagnosed one, then our actions, attitudes, conversation and behaviour will reinforce the wrong ideas about life and the world which these conditions produce, and they can increase, even in Christians, the incidence of suicidal thoughts.

My concern is especially for younger people in the Church, though these mental health problems can affect people of all ages and backgrounds. Almost 20% of people over 16 years of age display symptoms of anxiety or depression. Some of these symptoms are:

• Feeling sad or having a depressed mood
• Loss of interest or pleasure in activities once enjoyed
• Changes in appetite — weight loss or gain unrelated to dieting
• Trouble sleeping or sleeping too much
• Loss of energy or increased fatigue
• Increase in purposeless physical activity (e.g., hand-wringing or pacing) or slowed movements and speech (actions observable by others)
• Feeling worthless or guilty
• Difficulty thinking, concentrating or making decisions
• Thoughts of death or suicide

If we have responsibility for youth, and young adults, then we need to be more observant and become aware if any of these for whom we are responsible have some of these symptoms. This requires us to be close to those in our care. Perhaps, we see some of our friends having some of these signs, and withdrawing into themselves. We need to be with them more at these times, not less. And if there are those that we have not made our friends at Church, those on the edge of the group, those who leave early on their own, we need to become responsible for these, as those who are becoming mature in our Faith, and ensure that they are not left to feel worthless and isolated.

Why is this important? It is because these are real illnesses, that cause many life-changing problems, and which are at the root of most suicidal thoughts, and attempts. There is more that is required of those who have these illnesses in finding treatment and healing. But the way in which the Church community treats those with mental illness, and the way we treat each other, can cause an increase in the severity of mental illness symptoms.

10% of 5-16 year olds have a clinically diagnosable mental health problem – a real medical illness – but 70% receive no appropriate intervention at an early age. These statistics are as present in our own Orthodox community as in the wider society around us. This matters because 50% of long term mental health issues are established by the age of 14, and 75% of mental health issues are established by the age of 24. It is these mental health issues, not willfulness or lack of faith, which lead to the overwhelming majority of suicides. Indeed recent studies have shown that there is a very increased risk of suicidal behaviour among those who are under 24 and who have been prescribed anti-depressant medication. This is not a moral or spiritual issue, as if the person was morally or spiritually weak. This is a consequence of medicines, of the nature of our body and mind.

I have hardly scratched the surface here, but I feel obliged to express my concerns. Suicide is not a canonical issue, as if the only question was whether or not a Christian funeral should be permitted. It is a pastoral issue, and one that belongs to us all, not only to the clergy. We must educate ourselves about mental health issues so that we can more easily understand and support those facing these problems. We must become more Christian, sympathetic and compassionate towards those who struggle to fit in with the crowd. We must become more including of others, more generous in our time and attention. When we fail to do so then we can make it harder for those who are suffering mental illness to cope, and can push them even to the edge.

I hope that we can be a community where anyone facing mental health issues is able to speak to others in the Church who will offer compassion, and support, and counsel. I am considering taking a Mental Health First Aid course this year, to help me become more aware of the signs and experience of mental illness.

Mental Health First Aid – https://mhfaengland.org

Suicide is not an issue for someone else. It is not a legal issue. It is about how we care for the most vulnerable among us, and how we do all that we can to become a community that understands and supports those with the mental illness that leads to suicide. It cannot be right that a secular organisation provides more support to those facing mental illness and suicidal thoughts in the Orthodox Church than does our Orthodox Church itself. Suicide does not expose the weakness and sin of others. It manifests our own weakness, lack of compassion and inadequate service. By the grace of God we can prepare ourselves to be so such service as this issue requires of us.

If you do feel suicidal then there is help. Speak to someone. Your priest. A close friend.

Or call the Samaritans – 116 123 on their free number or their website – https://www.samaritans.org/how-we-can-help-you/contact-us