For many of us, psychiatric illness is fatal, ending in suicide. Despite everything, help isn’t always enough. Tormented beyond bearing, misunderstood, often rebuffed by the people who could be trying to help us, we may turn to that last desperate act, hoping by it to find relief.

I have had many dark nights when I sat alone with razor blades or a bottle of pills, trying to think of a reason not to use them. Sometimes I couldn’t think of one. I tried to kill myself, often doing considerable harm. I have scars on my wrists and other mementos of those nights. Several times I spent days in a coma in intensive care. Probably because of my youth and robust physical health, I survived.

Many of us don’t survive. Age, less robust health, access to firearms or other more certain methods, all play a part. Some of it may just be luck.

Some of us are less direct. Risky behavior – driving recklessly, drinking and drugging without care, brawling, walking in traffic without looking – all these and more contribute to fatalities or severe injuries. They’re not quite suicide, but they are somewhat akin to it.

Why do we do this? I can only speak from my own experiences. However, I believe that many of us have similar experiences that lead to despair and suicide.

First, we’re in deep pain. We may have been wounded and not healed. We may suffer from chemical imbalances in the brain causing extreme mood swings or psychosis. We’re likely to have difficulties in ordinary living. We may slip into substance abuse, as we try to ease the pain. That leads to more pain. Many of us are unable to find or keep jobs, relationships, friends – the things that make life worth living. Unemployment may lead to homelessness.

All of this can leave a person lonely and cut off from society. Lacking the interaction with people, a victim of mental illness may grow increasingly isolated, his behavior becoming less social over time. It becomes a vicious circle.

Help may not be available or adequate. For some of us, no combination of medication and therapy is effective. And so we bleed and die.

If you have never considered suicide, the idea my seem utterly puzzling and strange. How could anyone ever give up hope? It’s not difficult. Sometimes it’s almost inevitable.

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