Autoethnographic

Introduction

This autoethnographic study will look at the some of the stigmas of mental illness and suicide from a sociological perspective. For this study we will be interviewing two individuals with two different views on suicide with one being an individual that has lost a loved open and another that hasn’t lost a loved one to suicide. Through this study we will look at the suicide and mental illness stigmas from a sociological perspective. According to Merriam-Webster a stigma is, “a set of negative and often unfair beliefs that a society or group of people have about something” (Stigma, 2021).

My Personal Struggle with Suicide

A turning point in my life came one April Sunday evening. I had just got down working the longest twelve-hour shift at the hospital. I was excited to get home and video chat with my girlfriends whom I hadn’t talked to in two days as she was the maid of honor in a wedding, I was unable to attend due to previous commitments. Usually, we would text throughout the day, but this day was different no text messages back until around 5:30 that night saying she was busy all day and that we would video chat when I got home. Little did I know that the drive home would be the last time I would feel any excitement in my life.

When I got home that Sunday evening, I quickly got changed and got on the phone to video chat with my girlfriend, but no answer, so I tried again, still no answer. About twenty minutes later she finally called me. Only problem was she wasn’t the girl I had fallen in love with, she was nasty, contradicting, degrading, and overall not interested in talking to me. I should have known something was wrong, but I didn’t want to let myself accept something was wrong because I didn’t want my world to come crashing down. Thirty minutes into the conversation that reality was about to come true, my life was about to never be the same again.

The next thirty minutes of my life were about to become the thirty minutes that would shape my life to this day. As she began speaking my mind froze and I was unable to react to what I heard over the next thirty minutes. That conversation went like this, “Nathan, you know I went to the wedding last night and remember how I told you I was going to spend the night with the bride’s children in their hotel room.” “Well I didn’t, I meet someone at the wedding that my mom, dad, sister, and the bride all encouraged me to go after.” “We kissed and danced all night long” “After the wedding, I slept in his room, and we had sex.” “He was more attract than you will ever be.” After the story of what happened at the wedding, the next twenty minutes were spent throwing insult of me never caring, never supporting her, never loving her, and being unattractive. After she was able to visibly see that she destroyed me, she hung up.

Over the next five minutes the reality began to set in, my mental health instantly deteriorated and all I could feel was an emotional pain and mental pain I never felt before. I had been through breakups before, no one had ever been able to destroy me this way. Once my mental health was gone, I started to hear voices in my head telling me to take my life in an effort to stop the pain. Luckily for me I still hadn’t lost all my mental power in that quick five-minute deterioration, and I was able to dial a call off to my best friend some work, James. James didn’t answer at first, which didn’t help the situation as my mind was telling me to take my life through the use of my truck and side by sides in the garage through carbon monoxide poisoning. In the meantime, 0James had sent me numerous text messages that I didn’t respond to, which like an act from God prompted him to call me. James was able to talk me out of taking my own life that night. But what was to follow over the course of the next couple of weeks was further mental health deterioration, battles with the demons in my head, and voices in my head telling me take my life.

At first, I only told the two people closest to me of what had happened, but my mental deterioration began to show itself, through my over one hundred and twenty hours of no sleep my struggle began to show itself. As my mental health struggle began to get worse more people began worrying about me and questioned those that knew of my struggles. Before I knew it, I was getting text messages from my managers and co-workers. Over the next two weeks I would begin to see the effects my struggles were having on those closest to me, which would further add to the struggles I was facing because in my mental state I was unable to see they didn’t all hurt because of me that instead they hurt because I hurt.

Two weeks after the destruction from my girlfriend and the insults she sent my way over that period, my mental health would finally reach its breaking point. This downhill spiral began with me seeing my now ex-girlfriend for the first time in person since the incident. She decided to take the metaphoric knife and stab me one last time with face to face insults of how I got what I deserved, never cared, and that I was unattractive. The second event that would be the final tipping point for me was a fellow co-worker who had lost her father to suicide and been the one to find him at the age of ten years old. She became so emotionally worked up because of my mental health struggle that evening that she was unable to come out of the breakroom to clock out. The bad thing for me was I was informed of this and now had the voices and demons in my head telling me that I was truly ruining other people’s lives and that I needed to end things to stop hurting others and to stop the emotional and mental pain I had been enduring for the previous two weeks.

That evening while lying on the couch due to being unable to sleep in my bed I had shared with my ex-girlfriend, I kept thinking about how I was destroying everyone’s lives around me and my mental pain began to creep to an all-time high. The difference this time was I had the mind set I was destroying people’s lives by getting them involved in my mental health struggle, so I didn’t want to call anyone to stop me from executing my plan. My split-second plan in that moment was to tie a rope I had found in my basement closet to my rafters and hang myself. By a miracle of God, my rope broke, but I didn’t escape without any remnants of what I had just attempted. I had cuts and marks all over my neck, that I now had to go to work with knowing people were going to notice the scabs and bruises on my neck. In that moment I had became someone that not only had a mental health struggle going on, but also someone that has attempted suicide.

It didn’t take long for my neck to be noticed by someone. Within the first hour of work, my friend, Kristina, that I had initially told about my struggles was interrogating me about my neck. I was able to downplay the situation and said it was a cut from shaving. Little did I know Kristina had conspired with another one of my friends at work for the two of them to get the answers they wanted at lunch. When I finally confessed to my suicide attempt, I could see they were disappointed, but also extremely concerned. The rest of our lunch was spent talking about what had happened, and deciding on a course of action. There initial response was to try to get me admitted to the hospital, but through our lunch time discussion, we agreed that wouldn’t be the best course with having a psych admission on my health record, so instead we agreed to proof of life checks and that I would seek mental health help on my own through a therapist and support groups. For me I hoped this would be the end of interrogations about my neck, but it was just the beginning, A few days later another lady at work had figured out I had tried to commit suicide and instead of talking to me about it decided to go to our team coordinator and operation manager. This resulted in me being taken to the emergency department for mental help. In this moment I told myself I needed to fix my life and get back on track, but the doctors had other plans. They made me sign a voluntary admission form to commit myself for mental health treatment and recommended a week stay in the psych unit. That plan however feel apart and when it was realized there was a two week wait for a bed on the psych unit. In addition, the doctor told me before my discharge that he felt I was attention seeking, manipulative, and truly had no mental health problems. So, I was discharged with just having to sign a suicide contract and create a safety plan. Left once again to try to fix my mental health problem on my own.

Not everyone that found about my suicide attempt were as supportive and accepting. As more and more people found out about my attempt, I began to experience the negatives that comes along with a suicide attempt by being called a failure, being told by a co-worker they will show me how to do it right the next time, being told I was selfish, being told I was faking, and that I was just being an attention seeker. It was this moment that I truly realized some people in the word had stigmatized me based upon my mental health issues and suicide attempt. In my many years of working in the hospital I had heard my co-workers talk badly about people that were on the floor for mental illness, but never did I feel I would experience that same treatment by people I was close with. At that moment I realized that I needed to start utilizing what I now know as Goffman’s Theory of Self by putting on different metaphoric masks to hide my struggles.

My personal experience with Suicide in a Healthcare Setting

Working on an inpatient floor at Geisinger allows me the opportunity to work with a variety of different patients. Some of these patients are patients suffering from mental health issues that have failed in their suicide attempts or are seeking mental health treatment and must go through the process of getting admitted to the psychiatric unit by first going to an inpatient floor. Being a suicide attempt survivor lets me relate to these patients, something that is not shared with all of my coworkers. In my years at the hospital, I have heard nurse that are caring for these patients discuss how the patient is a failure in life, shouldn’t be taking a hospital bed, selfish for hurting their loved one with their attempt, the patient should be comfort care and let us finish the job, and that the patient doesn’t look like they have a mental health issue and therefore is faking. I have personally expe2rience this very same treatment from my co-workers when they found out I had attempted suicide. Many of these statements made by my coworkers go hand and hand with the stigmas attached to suicide and mental illness. These thoughts by healthcare workers are unfortunately not limited to the unit I work for and echoes the thought of healthcare workers through the United States. In 1963 Erving Goffman came up with the idea stigmatization of illness which will be discussed later in this paper to describe this issue in healthcare by medical professionals.

Socialization and Suicide

In a society that is socialized through the channels of media, religion, and in some regards school suicide and the act of attempting suicide is given many stigmas. Stigmas about mental illness and suicide have contributed to the elimination of the most valuable resource for those that has attempted suicide, had a loved one commit suicide, or are having suicide thought. The most valuable resource of course being the ability to create cultures, subcultures, groups to help those in need. The most valuable resources to those going through a mental health struggle is having a culture of people that have been through a similar struggle, but unfortunately many people don’t tell their stories because they want to be in the in group and don’t want to be seen as a deviant from cultural and societal norms or be looked down upon by people in their society. The stigmas associated with suicide makes people unwilling to share their experiences. Stigmas of suicide and mental illness make people see those going through a struggle as depicted by the stigmas. Stigmatization was the leading cause in my personally experience of being told by coworkers, that I was selfish and a failure. Stigmas associated with suicide have been skewed by societal beliefs and as a result people going through struggles are not able to get the help they need due to fear of stigmatization.

Stigma: Suicide People Show Their Emotions

A major stigma related to suicide is the thought that all people that are depressed and suicidal show their emotions. In truth this stigma is nothing close to the truth. Only a small amount of people that have mental illness show it. Those that are not showing their emotions instead put on a fake front that includes a fake smile because they don’t want people to know they are suffering from a mental illness due to fears of being look down on and being stigmatized. The idea of putting on the fake front comes from the ideas of Erving Goffman and his self-theory. Goffman’s self-theory is called stage-theory and involves the idea that the social part of people’s lives involves them put on different metaphoric masks based on the situation and who they are interacting with. Goffman saw social interactions and the idea of self as a stage show where actors are putting on different masks from their normal self to play a part in the stage show. Goffman’s stage-theory involves two different types of behavior front stage and backstage behavior. According to Thoughtco.com, “people engage in “front stage” behavior when they know that others are watching” (Cole, 2021). “Front stage behavior reflects internalized norms and expectations for behavior shaped partly by the setting, the particular role one plays in it, and by one’s physical appearance” (Cole, 2021). Front Stage behavior is the reason why most people that are depressed and suicidal look happy and smile. Front stage behavior allows those that are having mental health issues to hide their true feeling from the rest of society to avoid judgement based on stigmatization. In my personal experience, I utilized front stage behavior especially around those who I knew were not accepting of people that have mental illnesses. In addition, I used Front Stage behavior a lot to hide my mental illness when I started to feel as though I was hurting those who cared about me. The idea of putting on a fake happy mask when dealing with mental illness, can be attributed to societal and cultural views on mental illness and an individual desire to not be looked down upon and to fit with an in-group. In my family, mental illness is not something we talk about at all and even to this day none of my family has ever admitted or acknowledge I was anything more than just being a little sad. It is because of this that I always have to use front stage behavior around my family and am never able to let my guard down around them. “When people engage in backstage behavior, they are free of the expectations and norms that dictate front stage behavior” (Cole, 2021). “People are often more relaxed and comfortable when backstage; they let their guard down and behave in ways that reflect their uninhibited or “true” selves” (Cole, 2021) Based on backstage behavior this when in private someone with a mental health problem may let some of their guard down and may not put that happy front on as much and may show a little of their depression and struggle. In my personal experience I was able to let my guard down around certain friends and truly show a different side of my feelings than I was showing while using front stage behavior. In a backstage environment you tend to be around people that are close to you so there tends to be less of need to fit with societal norms allowing the person to leave your guard down without fear of stigmatization.

Stigma: Suicide is a selfish act.

One of the major stigmas associated with suicide and those that attempt it is that they are doing so for selfish reasons. When you look at this from a sociological perspective, you can see that this stigma primary comes from how people are socialized and the type of culture we have in the United States. The United States is an individualist culture which is a culture that focuses on the individual and individualistic goals rather than the goals of the group. Therefore, when you look at suicide from an individualistic perspective, suicide is seen as being the goal of the individual to take their own life. This stigma is far from the truth and would be more as a combination of the views of an individualistic culture and that of a collectivist culture, which is one that is focuses more on the goals of the group rather than the goals of the individual. The truth about suicide is that it is one of the most selfless acts someone can commit. The only thing about suicide that can be related to individualist culture views is that the individual in that moments doesn’t truly want to die, instead they want to eliminate their own mental and emotional pain or struggle they can no longer handle. Suicide is more like the views of a collectivist culture because in the moment leading up to the suicide attempt the person truly thinks they are bettering the lives of those in their group and society. Suicide attempters see the ending of their life as a better life for their social group by not being a burden anymore because others wouldn’t have to deal with their mental health struggles.

Stigmatization of illness

According to Introduction to Sociology, “Goffman suggests we might view illness as a stigma that can push others to view the ill in an undesirable manner” (Connerly, T. pg. 561). This idea in sociology is known as stigmatization of illness. “Stigmatization of illness has the greatest effect on the patient and the kind of care they receive” (Connerly, T. pg. 561). In my personal experience working in a hospital, I have seen this take place firsthand with nurses admitting to not providing care great to patients with mental illnesses because they feel if they wanted to try to commit suicide they shouldn’t have come to the hospital. In addition, I have seen nurses treat these patients unfairly and rudely because in their eyes they are lesser people because of the stigmas created by cultural norms. Those with mental illness are also often labeled as drug seekers by medical professionals when they try to get medications to help with symptoms they are experience, such as anxiety, the feeling of bugs crawling on their skin, and voices in their head. Through my own mental health, I have seen the results of stigmatization of illness firsthand when other healthcare workers ridiculed me and treated me poorly due to my mental illness. I was told by healthcare workers I was attention seeking, faking, a failure, selfish, and one nurse would teach me how to do it right next time. People with mental illness feel society and our healthcare system discriminate against patients with mental disorders which is seen by quality of the treatment they receive, the lack of facilities, quality of facilities, the separation from the rest of the hospital, and the quality of the environment the facilities are in (Connerly, T. pg. 561). The stigmas associated with stigmatization of illness often keeps people from seeking help for their mental disorder which results in the illness getting worse (Connerly, T. pg. 561). In my personal experience working at the hospital, I have been to the psychiatric unit and it feels like a prison with no windows and in my eyes I feel if I would have ended up in Geisinger’s psychiatric ward during my mental health crisis that it would have made it worse. Another area that mental illness falls under is the idea of contested illness (Connerly, T. pg. 561). Contested illnesses are those illnesses whose symptoms are not easily seen and therefore their diagnosis is based solely on the opinion of the medical professional if you truly have the illness (Connerly, T. pg. 561). Because of this stigmatization of illness by healthcare professionals can become a serious problem because medical professionals may stigmatize the illness and therefore not provide appropriate care to the patient (Connerly, T. pg. 561). In my view when medical professionals stigmatize the illness and the patient it results in patients being discharged without receiving the care they need and in some case these patients end up getting discharged and committing suicide. I have seen this firsthand as I was labeled as a faker and attention seeker despite having all the symptoms of severe depression and anxiety disorder and having marks on my neck from my failed suicide attempt days earlier. As a result, I was discharged without any further treatment than the pills my primary care physician had prescribed to be before my suicide attempt.

Four Major Sources of Stigmas

Stigmas for suicide and mental illness an come from a major variety of different sources. For college students and adolescents these stigmas often come from four major sources: family, peers, teachers, and media. Although these four major sources are for aoldescents and college student, family, peers, and media translate for adults and teachers translates into bosses for adults.

According to Seattle University’s website, “A Family members’ relationship to person may affect the extent to which the patient stigma is transferred to family members” (What is the stigma behind suicide?). As a result, family members may being to stigmatize the person with the mental illness and beginning to act different toward the individual that then leads to the individual believing suicide is the only solution for the situation (What is the stigma behind suicide?).  For many this stigmatization comes in the form of unwanted assumptions about the individual and their illness by family members (What is the stigma behind suicide?). I have personally seen this firsthand as my family to this day have never acknowledged my mental health illness or depression. In my family when my depression and suicide attempt are mentioned it is that I was just a little sad for a couple weeks not that I have a mental illness or that I attempted suicide.

Suicide and mental illness stigmas from teachers affect over a third of all students with these type of illnesses in school (What is the stigma behind suicide?). Teachers often treat student with mental illnesses different result in the teacher showing fear and dislike of the student, avoidance of the student, and the underestimation of the abilities of the student (What is the stigma behind suicide?).. For adults, teachers translate into bosses because most bosses that have workers with known mental illnesses and struggles avoid the worker and overlook the employee for promotions and awards due to them underestimating the ability of the employee.

Peers play a huge part in stigmas related to suicide and mental illness with over sixty two percent of adolescents and college students with mental illness experiences stigmatization by their peers (What is the stigma behind suicide?). Stigmas from peers often lead to the loss of friendships and social rejection (What is the stigma behind suicide?). Therefore many people hide their mental illness from their peers because it results in them being stigmatized due to them not fitting in with cultural norms. In my own struggle I suffered from this form of stigmatization from my co-workers who labeled me unfairly and treated me different due to my mental illness.

Media is the leading perpetrator of stereotypes and stigmas related to mental health (What is the stigma behind suicide?).. According to Seattle University, “Film, television, and music portrayals of suicide perpetuate and glorify stereotypes that may lead to imitation acts” (What is the stigma behind suicide?). Seattle University also says this about social media sites such as Tumblr, “the exhibition of self-harm, suicide, depression, and self-loathing are placed under the pretext of something that is “beautiful, romantic, or deep” (What is the stigma behind suicide?).  The major problem with the media’s portrayal of suicide is it drowns out the stories of those that truly have mental illness with the stories of the glorification of mental illness (What is the stigma behind suicide?). This is one of the reasons there are not many stories from true survivors and true suffers.

Why are Stigmas Damaging For Suicide?

According to Seattle University suicide stigmas are damaging in three different ways. The first way in which suicide stigmas are damaging is, “the stigmas does not promote a healthy recovery” (What is the stigma behind suicide?). According to a study published in the British Journal of Psychiatry, “83% of participants felt conscious of the stigma associated with mental illness and had difficulty seeking help” (I. Mancinelli, 2003). “Only 54% of participants had discussed their suicidal thoughts with their family, peers, and/or spouses” (I. Mancinelli, 2003). A Second way in which suicide stigmas are damaging is, “The stigmas negatively affects treatment outcomes” (What is the stigma behind suicide?).  When the person suffering from mental illness perceive that there is a stigma it invokes a feeling of shame within that person that leads to a decrease in treatment outcome. A third way suicide stigmas are damaging is, “The stigmas negatively affect the perception of self and others” (What is the stigma behind suicide?). “Those with depression and schizophrenia were viewed as unpredictable and dangerous, and those people would be less likely to be employed” (What is the stigma behind suicide?). Fear of not being able to get employed or fired from a current job makes people unwilling to seek the help they need and leads to the mental illness progressively getting worse.

Views from Two Healthcare professionals

For my two interviews on suicide and the stigmas attached to it I choose to interview two different nurses named Kelly and Ashley. Ashley has personally dealt with suicide in her family as her father committed suicide a few years ago and has now been a nurse for 8 years. Kelly on the other hand has never had to personally deal with suicide in her family but has been a nurse for over thirty years so has treated many patients in the hospital that are admitted for suicide attempts and other mental health problems. My question and answers are as follows:

Do you view suicide as a selfish or selfless act?

Kelly: Suicide is one hundred percent a selfish act and those that attempt it are only looking out for themselves and don’t care about the repercussion for others in their lives.

Ashley: At first when my father committed suicide, I felt he was the most selfish man in the world, which made me hate him so much. But as I got over the initial shock of losing my father to suicide, something inside me told me I need to start doing my research. Through my research I truly began to realize why my father committed suicide and realized he did it as a selfless act. My father was suffering from cancer and truly didn’t want to continue putting our family through that fight. So, in his eyes he truly felt he was doing the right thing to lessen the overall pain he saw he was causing. So, in my eyes I see suicide as being a selfless act and the true act of doing it is one of the most non selfish things someone can do.

Do you see people that try to commit suicide but fail as failures?

Kelly: I feel if you are going to try to commit suicide and fail you didn’t do it right and shouldn’t come to the hospital. Those that fail should have made a better plan so they wouldn’t fail.

Ashley: I feel those that try to commit suicide are not failures. I feel it is more of a failure of the system to get them the help they need and a failure of society to create an environment where it is okay to say you need help without being looked down upon.

Being a nurse what is your overall view of patients that are admitted for mental health issues such as a failed suicide attempt?

Kelly: I feel those that are admitted especially for a failed suicide attempt are waiting hospital resources and taking beds away from other patients that need the bed. If the person wanted to die why come to the hospital to get care. I feel that most of the patients that come in for mental health problems are drug seeking and have figured out ways to work the system to get the drugs they want.

Ashley: I feel patients with mental illness are just important as every other patient. Mental illness is just as important as any other illness. Mental health is a serious problem in our area, but little to no resources are invested in fixing the failing treatment methods in our area.

Do you feel that mental illness in the United States in heavily stigmatized?

Kelly: Not at all. I feel what some people call stigmas and stereotypes about mental illness are true and our society is driven on pushing pills. As a result of our society being about pushing pills, we create addictions in people in our society which makes them come up with fake illness that are hard to truly detect such as mental health problems. When they come to the hospital, they are given all the pills they want.

Ashley: I feel in our society mental illness is such a taboo topic that people are afraid to talk about it for fear they will be criticized. With those truly suffering from it being unwilling to share their experience it results in only the negative information being out there about mental illness.

Conclusion

My two battles with mental illness have shaped me in the person I am today, they have given me strength and showed me anything is possible. My first mental health struggle was done solely on my own because I was heavily stigmatized and trashed by members of society. My second battle with mental health was entirely different because even though it ultimately was a battle, I had to win myself, I had a lot more people on my side along the way. With my second mental health crisis I was a lot more open about it resulting in me seeing the good in society toward mental illness. Being more open however brought stigmatization front and center for me. This course has allowed me the opportunity to apply concepts, theories, and terminology such as Goffman’s Self Theory and frontstage and backstage behavior to the struggles of my past where my mental illness was seen as a deviation from cultural norms and heavily stigmatized. In addition, this course has given me an added knowledge of stigmas and stigmatization of illness that will benefit me in my current plan of sharing my story to make positive changes in society as it relates to mental illness and suicide. With my added research I got to explore some of the major sources of suicide stigmas to which I completely agree with the ideas mention for all four. Mental Health is a major issue in the United States, that doesn’t get the treatment or attention it deserves. We need to end the stigmas that go along with it and praise those that are willing to tell their stories rather than ridicule them.

Works Cited

Cole, N. L. (2021, February 16). Goffman’s Front Stage and Back Stage Behavior. Retrieved from Thoughtco.com: https://www.thoughtco.com/goffmans-front-stage-and-back-stage-behavior-4087971

Conerly, T., Cody-Rydzewski, S., Griffiths, H., Holmes, K., Keirns, N. J., Sadler, T., Scaramuzzo, G., Strayer, E., Tamang, A.

I. Mancinelli, M. P. (2003). Stigma as a cause of suicide. Brisitsh Journal of Psychiatry, 172-174.

Stigma. (2021). Retrieved from Merriam-Webster: https://www.merriam-webster.com/dictionary/stigma

What is the stigma behind suicide? (n.d.). Retrieved from SeattleU: https://www.seattleu.edu/wellness/mental/stigma/