I have a problem with RUOK Day. In fact, I personally find the whole idea a bit ludicrous, because if people’s lives actually mattered, then surely every day would be RUOK Day. Assuming that someone were to truthfully answer that question, that no, they are not okay, then what exactly is the end goal of the conversation? And what happens if that person resists your attempts to help? This has the propensity to spiral into a deeply dangerous situation – for the suffering individual, for those trying to help, and for the professionals (likely the police) that will eventually become involved.
Then there’s those of us – myself included – who choose not to answer truthfully. There are still too many people slipping through the cracks whose lives are being lost. Every day, another eight Australians die by suicide, and that is eight people too many. Sadly, I have been very close to becoming one of the individuals included in that particular statistic.
Trigger warning: this piece will discuss my personal experience of suicide and suicidal thoughts
As someone who has experienced a wide range of mental illnesses in their lifetime, I feel like my gripe with RUOK Day is entirely justified. Because I am not okay. I am so, so far from okay. I have suffered from depression and anxiety for as long as I can remember, as well as anorexia nervosa during my early teens and bulimia nervosa following weight restoration. Then, this year, a few days after turning 21, I survived my most serious suicide attempt. It was not my first. It was not even my tenth. But it was by far the hardest to come back from.
By this time, I was a familiar face at my local emergency department. It’s pretty sad that I can consider myself well-known at the nearest hospital, referring to many of the staff on a first-name basis, and having met all of the mental health consultants. But still, nobody had any real recommendations of how I could return to something resembling normal life following my persistent attempts to end it. I believe this is because the idea of suicide is still largely incomprehensible to people who have never experienced it.
Well, allow me to clarify.
Think of what it feels like to drown: the water covering your head, entering your throat and nose, trickling into every possible edifice; smothering, choking, burning. Imagine the panic that bubbles beneath the surface, the terror that streams from your stomach to your chest and up out of your soul through tensed shoulders and a gasp. Imagine the sensation.
Now imagine drowning in distress.
Imagine that every torrent of thoughts is a wave that threatens to drown you. That your mind whispers awful, intrusive things to you over and over and over, relentlessly reminding you of your failures, that you need to just do it just do it just do it just do it.
Imagine that this is something you fight daily. Every moment is part of the flood. Every second, you are torn between drowning and death and life, stuck in a limbo where there’s only faltering hope and darkness to guide your path. You’re reminded of every mistake, as every single anxiety that has ever concerned you comes streaming back into your mind, to match the tears streaming down your face. These memories pummel you, over and over and over. See, they scream, see why you deserve this. Just do it.
But still, instead of listening, instead of drowning (even though it would be oh so easy), you let yourself hang. Struggle. Thrash between the current. There’s light at the surface, and there’s darkness down below you, but here you just drift in between, perpetually floating in an ocean of intrusive thoughts with no end in sight. There’s an escape. It’s so close, it’s within your reach. It wouldn’t take much effort to let yourself drown. But – you’re not so sure you want that escape anymore. You just want the thoughts to stop. You just want the pain to stop, and it seems like the only way out of things is to end them.
Meanwhile, everyone around you tries to convince you to take a life-ring that you don’t even really want. And you know this is wrong, this is all so wrong, but you just can’t help yourself. You just don’t care about surviving. You’re sick of fighting to stay afloat. You can’t see the hands at the surface of the water, trying desperately to retrieve your body from beneath the roiling waves. Or maybe you can see them, fleetingly, but you’re choosing to ignore them because they didn’t help you when they had the chance. The faces that accompany the rescue just out of reach are hazy, and you can barely remember why these people were in your life anyway. Were they important to you? You’re not important to them, your mind offers. Just do it just do it just do it.
This is what it’s like to be suicidal.
And thus comes the paradox. Having now experienced (albeit very briefly, maybe even for only 60 seconds if you’re a really fast reader) the utter despair that comes with suicidality, why on earth would anyone experiencing such thoughts try to disguise them, maybe even to the extent that they refuse help altogether?
Because when you ask “Rosie, R U OK?”, all I can think about is how I am a burden. How I am broken in a way that cannot be fixed, and I have a way to end this battle which I am so tired of fighting, except everyone is so determined that I keep on going. It would be better for everybody if I just went away.
I am deeply ashamed of my main diagnosis. I try not to be. I try my best to be an advocate for my fellow borderlines, by writing pieces like this, where I speak honestly about the realities of mental illness.
Hold up, that sounded a bit scary. WTF is a borderline? Well, I am, for one, along with about 1 in 100 others in the Australian population, most of whom are adolescents. Borderline personality disorder is a severe mental illness characterised by nine specific symptoms, which are displayed in varying degrees across individuals with the diagnosis. In particular, I struggle with a fear of abandonment, relating to and understanding people and emotions, self-harm and suicidality, and a wickedly impulsive self-destructive streak. BPD is essentially an emotional dysregulation disorder.
As I was writing this piece, it took a lot for me to actually admit my shame. I am ashamed that I am in and out of hospital. I am ashamed that I still can’t explain to my boss and colleagues why, every now and then, I need a day or a week or a month off of work. Most of all, I am ashamed of the way I treat others when I am unwell, while I am also terrified of hurting everyone around me. I refuse help at a time when I need it most to protect those closest to me, when, inevitably, this leads to situations that take me farther and farther away from that mysterious state known as ‘being okay’. I have been handcuffed for my own safety, restrained and hospitalised against my will, medicated by force to protect the staff trying to save my life – all because I am utterly convinced that I may never be okay. I can’t even admit to myself that I need help in these moments.
Slowly slowly though, I am becoming better at being honest about my mental health. Sometimes, I can even confess that I am not okay. Yet at the times I am most unwell, the times I am the most not-okay, these are the times I will say that yes, I’m fine. I’m just tired. Just had a late night. Just stressed.
For me, this is where the organisation behind RUOK Day fails. Sure, they list some signs that might suggest suicidality, but this is by no means an exhaustive list. Although normalising conversations about suicide is an important step, it is not the only step we should be taking in order to prevent deaths by suicide. Indeed, the 2020 motto for the charity is ‘there’s more to say after R U OK’. On that point at least, I can agree. Yet, the next steps they offer are vague at best. Although attending the nearest emergency department is often recommended, going to hospital isn’t always appropriate, and neither is contacting emergency services; these can be extremely traumatic experiences in their own right.
Frankly, there is just so much more to be done in the mental health sector. In my opinion, this would include an overhaul of triage procedures and risk assessment, creating more publicly funded inpatient units, and incorporating compulsory mental health education into the Australian school curriculum.
Normalising the discussion of suicide is a good start, but it should not be confined to a single day of the year. I am regularly suicidal. So how about you regularly ask, R U OK? In case you couldn’t hear me down the back: for f*cks sake, don’t just talk about suicide on the tenth of September, the arbitrarily designated day that we have decided to hold the conversation. This is absolutely something that should be discussed every day of the year.
So I will continue to shout from the rooftops what people fail to understand, and I will scream until they listen.
Today, I might not be okay. But one day, I hope I might be.
Numbers you can call if you or someone you know is currently experiencing a crisis:
Lifeline on 13 11 14, nationwide
Suicide call back service on 1300 659 467, nationwide
NSW Mental Health Access Line on 1800 011 511
To find free mental and physical health services near you, search for a Headspace centre
Free phone counselling is available to young people aged up to 25 through The Kids Helpline
For eating disorder resources and support, try The Butterfly Foundation
For information about the treatment of mental illness Head Meds is my personal go-to for anything medication related, via the fantastic UK based organisation Young Minds.