It is a stark and salutary fact that, in less than the time that it takes to read this newspaper, someone, somewhere in the country will have taken the irreversible decision to put an end to his or her life. This person is so isolated and so beyond hope that life is already all but over. The pain of the emotional anguish has become intolerable.
This may seem a strange and defeatist statement to make when addressing the question of preventing suicide. But despite the progress that has been made in recent years in reducing the incidence of suicide, it remains one of the most pernicious killers of our time. There is no respect for gender, wealth or social class.
After 35 years of listening to people in distress, I believe that there are certain questions that we all need to consider – in the context of what has happened in Bridgend – and perhaps in so doing to help to encourage a sense of societal responsibility for deaths of this sort.
Is it only a way out? There are probably as many answers to that fundamental question as there are actual suicides. Our attention is being focused on what appears to be a cluster of suicides in one part of the country. How unusual is this? Is there evidence that suggests that suicide can be "contagious" – especially among young people? Do the "suicide websites" bear a responsibility for instilling ideas of this sort in the minds of vulnerable and impressionable people?
We need to identify and to understand who may be at greatest risk and why that might be. More than a quarter of the UK population knows someone who has died by suicide, and often it is unexpected. I would argue that we all have a responsibility to be more aware of those around us and to be alert to the signs that may be evident suggesting that all may not be well. Signs such as being withdrawn and unable to relate; talking about (or maybe just hinting at) ideas about how life might be brought to an end; talking about feeling isolated and lonely; expressing feelings of failure, uselessness and dispiritment; an evident lack of hope or loss of self-esteem; the constant dwelling on problems for which there seem to be no solutions; changes in sleeping or eating patterns; the significant loss of someone (or something – including, importantly, pets, in the case of people who live alone).
It is so often the case that the first reaction of people who are close to those who take their own lives is one of complete surprise and disbelief. Probably the most important thing is to take notice of changes in behaviour. This, of course, raises the question of how familiar we are in the first place with the usual behaviour of those close to us. There has been a number of studies done using a methodology of psychological autopsy, in which those who were close to someone who committed suicide are carefully taken through a structured assessment of behavioural change. It is often revealed that people become retrospectively aware of changes that were not recognised before the death occurred. All too frequently there is the anguished cry of "if only I had noticed at the time, I might have been able to do something to help".
We also have a responsibility to make time and space in our busy lives to enable those who may be struggling to find the words for the dark, frightening and isolating feelings of despair. How many times in a typical day do we say to someone we meet "how are you" (or the equivalent)? How many times do we really want to know the answer? How often are we prepared to invest the time and emotional energy in trying to find out?
Wherever there is a death by suicide, there is the double burden of the death itself and the taboo that is all too often associated with a death of this nature. There is a natural inclination to shy away from the abnormal and uncomfortable and to remain within the confines of a sanitised reality; it is as though there is a fear of contamination with the enormity of the consequences of the unsound mind and of the incomprehensible decision to reject that most precious gift of life.
Out of this, stigma is born. Stigma is defined in the Collins Concise English Dictionary as "a distinguishing mark of social disgrace". This speaks so eloquently of the rejection and fear that are experienced by those who are shunned in this way. However, only those who have had to endure the exclusion by those around them will know the horrors of being in such a dark place. If humanity exists at all it behoves society as a whole to become more accepting and more understanding of the emotional pain that such treatment causes.
As John Donne wrote in 1624: "Any man's death diminishes me because I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee." His words are as true today, if not more so, given the extent to which modern society is so interdependent.
What, then, of the media? Put simply, the media must shoulder the very important responsibility of treading the fine line between strenuously avoiding any hint of sensationalism or, worse still, the glorification of suicide and fulfilling its obligation to help to increase understanding and awareness through sensitive and accurate reporting. There has been a number of academic studies concerning the relationship between the way in which suicide is portrayed in the media and the subsequent incidence of apparent imitative behaviour – so-called "clusters" of suicides which clearly demonstrate that such a causal relationship exits. It is too early to conclude whether this may have been a causative factor in Bridgend, but it is clear beyond doubt that extreme care must be taken in the way in which those events are reported and portrayed. As long ago as 1994, Samaritans published guidelines for the media in the portrayal of suicide, and these were republished in 2006. The guidelines are well respected, yet there are still occasions when we see irresponsible reporting that not only heightens the distress of the bereaved but also arguably contributes towards encouraging imitative behaviour.
Do so-called "suicide websites" have a bearing on the incidence of suicide? It is so often the case that someone who is reaching the point of wondering if life can continue will feel emotionally isolated and excluded, even though they may be surrounded by families and friends who care for them deeply. The ease with which they can find comfort in sharing their feelings with others who may be in similar positions can be either life-enhancing or dangerous.
The support offered bysuch charities as the Samaritans or social networking sites such as Big White Wall can save lives on the brink of being lost, whereas other sites that promote and encourage self destruction can be both seductive and fatal for those who seek the solace of knowing that they are not alone and who may be encouraged, almost as an act of bravado, towards that final and irreversible act of self-destruction.
So, there are many questions and maybe only a few answers. One thing is certain, however: that we must all recognise and accept our own personal responsibility to help to ensure that the society in which we live is inclusive of those who may feel alone and frightened. It is far better to reach out to those in distress before the pain becomes so great that there is no way forward, only a way out.
Simon Armson practises as a clinical psychotherapist. He is a former chief executive of the charity Samaritans and is currently a trustee of Maytree, a house in north London offering sanctuary to suicidal people