Prevention or Intervention?

Nathanael Miller, 18 September 2016

Suicide “prevention” training usually includes words like, “Ask, Care, Treat.”  Military or civilian, “prevention” training normally focuses on asking friends, neighbors, shipmates, or loved ones if they they’re in crisis.

Thing is…if you have to ask someone if they’re in crisis, then you aren’t preventing anything!  You are intervening in a possible situation.  A good and extremely wise friend pointed this out to me the other week.  I was minding my business, helping keep the world safe for democracy yet another day when he pointed out the action of “asking” someone is an intervention, not a prevention.

Think about it.  If you ask someone if they would like a glass of water when you see they are hot, you’re intervening to alleviate their thirst. You have not prevented their thirst.

Better example—what is the one, dumb question we all ask someone after they bump their head?  Come on, admit it (I will)—we ask, “Did you hurt yourself?”  Of course this as they’re clutching their cranium and muttering words so foul any Dark Lord would blush with embarrassment.  We ask so we can intervene to alleviate their pain, but we have not prevented the injury.

So, the question remains:  how do we prevent suicidal behavior in those around us?

Well, to put it bluntly, we can’t.

None of us can prevent self-destructive behavior in another.  We can only intervene if they ask for help…or if we see evidence and step in.  We can no more prevent it than we can prevent heart disease in another person.  We are all individually responsible for maintaining the health of our cardiovascular system.  No one but us can make us eat healthy, or exercise.

Nor can anyone but us prevent our own self-destructive behaviors.

Before anyone reading this stones me as a heretic for blaming the victim, I’m not.  Remember—I attempted suicide in 1998 and came frighteningly close to succeeding.  I’m not blaming anyone for anything.  I am pointing out we have to alter our culture to understand stress and emotional injuries better than we do so it’s easier for people to seek treatment early.

It’s easy to recognize we need help after a traumatic event like a death in the family or a divorce.  What we fail to recognize is that slow-motion stressors, creeping up over time, can also be killers.  Slow-motion, unending stress can sap our strength without us realizing it, leaving us with nothing in our emotional reserves when a significant trauma impacts our lives.

Think of a stress fracture in your shin (and I’ve had one, so trust me, they eventually hurt with all the gusto of an MMA fighter landing on you from two floors up!).  Stress fractures do not happen all at once.  Over time repeated stress that is just slightly outside the norm begins to damage the shin.  Slowly the bone develops microscopic cracks.  As the stressor continues, these cracks gently lengthen and deepen until you start to feel pain.  Keep going without treatment and the cracks—the stress fractures—become debilitating and potentially crippling.

Emotional stress works the exact same way.  For military members, even a “routine” deployment with no wacky events is a long-term exposure to elevated stress levels.  Your ability to cope can begin to show microscopic cracks.  Once you get home from a “routine” deployment you might find you display the same symptoms as someone who might have seen actual combat—sleeplessness, irritability, inability to communicate, panic attacks, shortness of breath, even guilt over feeling so bad.

Civilians can endure the same type of stress injury by being in a continuous, high-stress environment, especially if part of that stress involves an undercurrent of threat to their well-being.

This kind of emotional damage can lead to self-destructive behaviors ranging from dangerous to suicidal.  After my suicide attempt I still had a history of burning myself for several years.  Many people cut themselves or self-medicate with alcohol or other drugs.  These are behaviors often easily hidden from the rest of world as people seek relief from unending emotional pain…but are trying to do it without admitting to the world a problem exists.

So how do we actually prevent self-destructive behaviors?  How do we prevent this is we cannot get inside anyone else’s head to alter their behavior?

We prevent it by realizing that even “routine” stress, if applied over time without relief, can cause emotional injuries that, cumulatively, are as debilitating as a major trauma.  We prevent it by encouraging others—and ourselves—to seek professional help even if we don’t personally understand why such an event is causing the person so much distress.  We prevent it by making it socially acceptable to seek professional help for emotional and stress injuries.

Just as we all have physical limits, we all have emotional limits.  Each of our emotional limits are as different as each of us are.

Finally, most people reading this will not be professional counselors.  Most of us are not equipped to screen someone for emotional injuries. I sure as hell am not—I’m a writer, Sailor, historian, poet, and Doctor Who fan.  But, if we alter our culture to remove the remaining stigmas associated with seeking help, we can move into a true measure of prevention by making it easy for people to routinely seek help after any kind of stressful situation.

This is kind of prevention will, over time, significantly lessen the need for intervention.