Suicide: Falling Through the Cracks of Stigma

By Cortland Pffefer (with Irwin Ozborne)

If you have ever lost a loved one to suicide, you know the tremendous amount of pain it causes. There may not be a worse feeling in the world.

In my experience as a psychiatric nurse, I believe that nobody commits suicide because they want to die — they commit suicide because they want the pain in their lives to go away.

Years ago, I survived a suicide attempt myself, and spent years receiving treatment in rehab centers and psychiatric hospitals. However my friend, Joe, did not survive. He spent many years on the streets and in jails before taking his life on February 25, 2010.

The fact is, there was little difference between us, besides our access to resources and the subsequent treatment and support we received. He grew up in a rough environment which affected his home life, neighborhood, school, friends, and life experiences. I grew up in a family that had some money, offered support, and always knowing I had a ‘security blanket’ if things went awry.

That is how our stories began and unfortunately how one of our stories ended. But did it really have to end this way?

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Suicide Statistics

According to the Centers for Disease Control and Prevention, suicide is the tenth leading cause of death in the United States, taking more than 40,000 per year (or 12.1 suicide deaths per 100,000 population). At this rate, the U.S. loses 400,000 people to suicide each decade – equivalent to the entire population of Oakland, California. Similar suicide rates (per capita) are also recorded in comparable socio-economies, including the United Kingdom, Australia, Canada, Sweden, New Zealand, France and Ireland. (source)

Notably, males make up the overwhelming majority of all suicides.

The Stigma of Suicide

There is enormous stigma associated with the word “suicide”. But if we are afraid to talk about it, how on earth do we think we are going to prevent it?

People often cringe when the word is even mentioned, or immediately change the subject. When someone is suicidal and expresses their tendency, a typical reaction is to dismiss the problem by saying “don’t talk like that!”, or “that’s not funny”; or over-simplifying the situation with phrases such as, “other people have it worse than you”, “just snap out of it”, or “don’t worry, things will get better”. Suicidal people may even be told they are selfish for having those thoughts, and for loved close ones behind; particularly children. But the reality is, people who are suicidal can’t see the forest for the trees, and truly believe their loved ones will be better off without them.

Yet, from my experience working in mental health services, most people just aren’t prepared to deal with these facts as reality; in fact most will adamantly refuse to even discuss it. Why? Because as a society and as individuals, we don’t know how. We haven’t learned to overcome the stigma of suicide much less the reality of its causes and effects.

But, when suicide does actually occur, the response from people becomes quite the opposite. Suddenly, everyone is there, and attentive, and they feel terrible. They did not see the signs, never saw it coming, and talk about the amazing qualities of the deceased. Many ask, “Why didn’t they just reach out for help?”

There are so many unanswered questions and regrets; so many “what ifs” and “should haves”. But the time to ask those questions is not after suicide, but before.

One Tendency, Two Different Outcomes

I attempted suicide, Joe committed suicide. Part of the reason Joe is dead is because of the stigma associated with suicide, along with the professionals he worked with that neglected him and labeled him. He was not treated as he deserved.

Joe didn’t have money, my family did. He went to jail and stayed long-term, I went to jail and got bailed out. He stayed in jail, while I was offered treatment instead. His crimes were all non-violent drug possession charges, mine were DUI, assault, and disorderly behavior.

The difference? I had access to money and resources. Since Joe’s crimes were non-violent and victimless, while mine were not, is there any other reason for the difference in our penalties?

Joe and I were born with a similar temperament, which highly sensitive and in tune with the emotions of others. This is neither good nor bad; like so many others, it’s just the way we were born. This is not to say that being emotional is guaranteed to create such issues, but it makes one more sensitive to the subtleties that can lead one down a path to emotional instability and suicidal tendencies.

Living at this far end of the emotional spectrum, consistently being denied much-needed support, and being held in an unhealthy environment such as prison, is a formula for addiction. Experts refer to this as the biopsychosocial model. The ‘bio’ relates to the biological and the genetic factors, the ‘psycho’ refers to the psychological, the emotional neglect and the trauma, and the ‘social’ refers to the sociological aspects, such as growing up in a broken home, attending overpopulated schools with minimal resources, living in poverty, and lacking positive role models.

But the social factor also relates to the denial of the needed support, both on consistent basis and in particular, in times of crisis.

Some people are born more sensitive than others, which means they are going to get hurt more easily. That is a fact of life. But in our society, being an extremely sensitive male is considered vastly unacceptable. Although we treat violence as a crime, we expect men to act out in anger when they are hurt; we are more accepting of a man react in anger than we are of those who break down and cry, which is treated as a weakness, particularly by other men. These perceptions of masculinity result in the ongoing invalidation of the deepest emotions we experience, such as “you are overreacting”, “you shouldn’t be feeling that way”, “men don’t cry”, “tough it out/harden up”, “don’t act like a ‘girl’”, or “what’s wrong with you?” Such invalidation leads to feelings of being greatly misunderstood and isolated, and reinforce the notion that there is something inherently wrong with one’s nature.

So, the only way many men find to gain acceptance and a sense of belonging (albeit conditional) in situations of emotional crisis is to create a mask or a false self behind which to hide. Over time, as we project that masculine stereotype, we learn that people are more accepting of you when you wear your mask, which makes it all the more difficult to remove.

But deep inside, we know it is not our true self. And so the spiral begins.

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Addiction: Living Behind The Mask

Initially, the mask brings us the feeling of power to finally feel alive. The more acceptance and connection the mask gains for us, however superficial, the more we try to fulfill these roles. In fact, we start to believe that we are the mask we wear, and hiding our true feelings becomes the norm. No matter how much inner conflict it creates, we become ‘addicted’ to the mask.

Then something bizarre happens. Often, people turn on us for ‘being’ that exact same mask that they once accepted and praised us for. Suddenly it seems we took things too far, and we are now being labeled and judged for the same behaviors that were once accepted and even glamorized aspects of our mask. The walls created by our outer strength and ‘masculinity’ become a problem — because it was never a genuine expression of our emotional being.

This conflict between our inner and outer worlds leads many of us to other addictions and comforts, and that can involve any substance or activity ‘outside of ourselves’ that allows for a temporary escape from the pain of our lives. We may turn to alcohol, drugs, sex, gambling, co-dependency, aggression and violence, or any number of compulsive behaviors that temporarily provide us a sense of self and satisfy the emotional needs that are not fulfilled — as we live life peering through the cracks in our mask.

Each culture and society has its own version of acceptable addictive masks, but they all serve the same purpose; as individuals, they help us to escape the pain of our reality and hide from any difficult emotion, and as a society, they prevent us from facing the societal problems that help to create and sustain that sense of pain and isolation. The mask of addiction grants us temporary relief, which is reinforcing of itself, as it seems quite simple to take a pill, smoke a joint, or drink a beer, and the pain instantly vanishes. But this creates a pattern of depending on our preferred substance or behavior, making us believe (on some level) that we are killing the pain. But in truth, we are only adding fuel to the fire.

Our need for a substance or behavior becomes a perceived matter of life-or-death, and we may start doing things we normally would never imagine, all in an effort to ‘use’ again and ease the pain. We may chase illegal substances, and even steal and lie in order to obtain them. And while I don’t necessarily condone these behaviors, it does not help that our society judges such actions as a cause and not a symptom, and labels those suffering as a “bad person” or a “criminal”, which only adds more layers to the mask and more emotional problems behind it.

Ultimately, our society begins to hate the monster it has helped to create. And what our society doesn’t realize it that — so do we! Although we are suffering and feeling suicidal, we don’t hate ourselves; we hate the false self, and the mask that we have been wearing. We learn to use it as a protection, and when it doesn’t solve our emotional problems, we don’t see any way out. Then, when we reach a point of crisis, nor do the people around us. They just tell us to “buck up, it will get better” — until it’s too late.

But the truth is, when a suicidal person says “I want to kill myself”, we have actually reversed the problem. It is not the “self” that we want to die, it is the “I”; the ego, the false self, the mask that we have come to depend on for our emotional protection — the mask which inevitably fails us. In truth, what we actually mean is “My self wants to kill ‘I’.” We want to kill our false self, and all the barriers, burdens and expectations that come with it.

Only then can the healing begin.

Eckhart Tolle once stated: “The secret of life is to die before you die, and find that there is no death”. In this, he is referring to the death of the ego. And he is right; in order to overcome suicidal feelings, we must learn to commit a suicide of the ego. Only by removing the mask and re-learning who we truly are can we begin to heal and put those feelings behind us.

Lessons From Joe

Unfortunately, no health professional ever reached out to Joe. No one even talked to him, nor did they even know how to approach him. Instead, our system of crime and punishment saw a “criminal” who was angry and broke the rules. Without ever finding out why, and what led him there, Joe was misjudged and mislabeled, and in the end, he simply couldn’t cope living behind that mask. While I went through the same difficulties, I was referred to as the “patient” that had a “mental disorder” and needed proper treatment. And that was the only difference between us; they never tried to see the Joe beyond his mask.

Joe was the most sensitive, caring, loving and loyal person you could ever meet. However, as those qualities were not understood or accepted as a normal part of masculinity, so he wore his mask his entire life, hiding his true self from the world. Over time, he became angry, arrogant and drug addicted, and our society’s response – to treat him as a criminal not a man in crisis – led to more drugs, more crimes, and more erratic behavior.

The reality is that, as a society, we invest more time, money and energy into maintaining institutions that deal with crime than crisis. And we have not learned to distinguish one from the other. We treat addiction as a cause of social problems, not as a symptom of emotional problems. And the legal system treats individuals who don’t have the support of a family or financial resources as second-class. While my rap sheet was far more horrendous than Joe’s, I was considered “a poor sensitive kid that needs someone to love him”. On the other hand, Joe was considered “unreachable.”

No one in the field ever stopped to think, “This is a genuinely caring kid who has never learned to be himself.” Once the label of addict or criminal was created, everything Joe did was judged by that label. Mental health professionals, judges, in fact most representatives of the state; they all read your chart or your priors and make an assessment of the individual before their first encounter. But the difference in our outcomes is directly related to how we as individuals were treated.

One of my favorite sayings is, “you can get anyone to tell you their secrets if you love them enough”. Yet, working in the field of ‘mental health’, we are told to get the deepest secrets of our clients but not to get too close. Having lived on both sides of the fence, I can tell you from experience that it simply doesn’t work that way.

I won’t show you what is behind my mask until you show me what is behind yours.

Joe let me see behind his mask and I let him see behind mine. And that is how true connections and healing relationships are built. I knew the real Joe, something the “professionals” who were charged with his care never took the time to do. Nor, I would suggest, did they feel empowered to do. That is just not how our current system works.

Although I received the better treatment, I believe Joe was the better man. One time he ended up in jail and had no place to go after his release. We would always reach out to each other in times of need, and he called me this time, and we let him stay in our home for a while. On the first night at dinner, he looked to my wife and said, “this is the best food I’ve ever had”. And he meant it! To him, that meal we shared was everything, while I had grown so accustom to these things that I had learned – like most of us – to take them for granted.

Joe had a unique following of people. He loved to love. If he had two dollars to his name, he would spend it on others. He gave – just to give – never expecting anything in return. This is what attracted people to Joe; he was pure of heart, once he trusted you to let you see behind his mask.

Joe also had a son, Anthony, who he loved more than anything. You could see and sense the love these two had for one another. Joe would always say, “I love you buddy” and kiss Anthony. At that time, I never saw a man kiss his little boy before, and it was admirable, and beautiful. I make sure that I do that with my three-year-old son now and I think of Joe every time. I only wish our society was more encouraging of that kind of masculinity; the kind that embodies love, compassion and inner strength.

Anthony never saw the labels of “drug addict,” “bipolar”, or “criminal”. That is the beauty and genius of children; they do not see masks or labels. Anthony only saw him as I did — as an angel; a kind, beautiful human who suffered from so much emotional pain, which most others in his life never knew existed.

After a while, Joe’s friends started showing up at the house, and I came home to see my 10-year-old daughter sitting at home with a bunch of strange men I had never met. I wasn’t happy with this. After a few warnings, we told Joe he couldn’t stay here anymore if these people kept showing up at our house. Joe told his friends to wait until he was back at his own place, but they did not respect our boundaries or Joe’s, and kept dropping in. And Joe kept allowing it. That’s the downfall of being so pure-hearted, I guess — if you don’t learn to assert your boundaries, people will take advantage of your good nature. It broke my heart, but we finally had to ask Joe to leave our home, for the safety of our daughter.

I didn’t hear from Joe for some time after that. Then, a few years later, I received an email that still gives me chills just thinking about: “Joe is dead. He hung himself.” He didn’t call me this time. Perhaps the pain grew too great that he didn’t want someone to talk him out of it one more time. Perhaps he no longer felt he could turn to me when he needed help the most. I had been his support, and I had kicked him out, and the guilt I carry with me is insurmountable at times.

So, when people ask me why I fight so hard as an advocate of my patients, Joe is one of the main reasons. If we lived in a just world, Joe would have received the same care that I received, and he would still be with us today. If we lived in a world guided by love and compassion, not judgment and punishment, somebody would have built trust with Joe, got to know him and what made him tick, and offered him the guidance he needed to help him finally take off the mask. But in a society guided by fear and misunderstanding, we judge and label those who struggle the most, and we allow 40,000 cases like Joe to happen each year in the U.S. alone.

People do not go away when they die. Only the false self dies, along with the physical body. Our spirit lives on forever, in the hearts of those we truly touch. The lessons Joe passed on to me, I still carry and pass along to my children. He is with all of us who remember him. And he is here with you and I, right now, as long as we allow him in.

I love you Joe.

Recommended articles by Cortland Pfeffer (with Irwin Ozborne):

About the authors:

Cortland Pfeffer founded his website Taking The Mask Off in 2014 to help shine a light on the mental health industry. Sharing insider perspectives and real life stories that have been gathered over 20 years in the field, Cortland (a pen-name) is a psychiatric Registered Nurse who was himself once a patient in psychiatric hospitals, jails, and treatment centers. He now wishes to share his experiences with others, and has recently made several public speaking appearances.

This article was co-written by Cortland’s partner Irwin Ozborne (also a pen-name), who is also a contributing writer for Taking The Mask Off. A survivor of childhood abuse and torture over a period of 13 years, and a recovered alcoholic, Irwin is now a Mental Health Practitioner and Public Speaker. He practices holistic care and incorporates eastern philosophy into his work with clients. He is available for speaking engagements as well and can be contacted via email: [email protected]

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Suicide Statistics

The Stigma of Suicide

One Tendency, Two Different Outcomes

Addiction: Living Behind The Mask

Lessons From Joe

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