Meghan and Cuomo accuser reveal something crucial about suicide
"I just didn't want to be alive anymore."
Of all of the disclosures by Meghan, Duchess of Sussex, on Oprah Winfrey's CBS's special Sunday night, this was among the most revelatory, a powerful example of how external environments can impact internal well-being.
After the airing, Lindsey Boylan, a former aide for New York Gov. Andrew Cuomo and one of several women who has accused him of sexual misconduct, said "I was there too. I did not want to be alive. ... Abuse environments harm so many."
One of the biggest myths about suicide, experts say, is that it's a personal problem. While biological factors can play a role in predisposition to suicidal thoughts, a person's environment is also a significant factor.
"We have really perpetuated this idea that suicide is driven by mental illness. And there are parts of suicide that do have internal components, but ... the larger part is environmental, social, cultural," said Bart Andrews, chief clinical officer at Behavioral Health Response and a suicide survivor.
Historically, experts say mental health challenges have long been viewed as moral weaknesses, rather than as the result of a confluence of environmental stressors, previous traumas and lack of social supports.
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"What is very powerful about Meghan Markle coming forward in this way, is it really cues us in to the fact that there's a lot within an individual's experience outside of themselves that shapes these issues and challenges," said Laura Palumbo, communications director at the National Sexual Violence Resource Center and an expert on how trauma impacts mental health.
"When you're having mental health concerns, not being able to talk about them and feeling as though you are being blamed for them magnifies the experience. It seems like the response that Meghan received is something that so many women are familiar with."
'Invalidating environments' contribute to suicide
Suicide prevention experts caution that there is no single cause of suicide.
Psychologist Marsha Linehan put forth a theory that a combination of biological factors and "invalidating environments" can contribute to suicidal thoughts.
She defines an invalidating environment as "one in which communication of private experiences is met by erratic, inappropriate, and extreme responses. In other words, the expression of private experiences is not validated; instead, it is often punished and/or trivialized."
In her interview, the Meghan said as a member of the royal family she felt unprotected and alienated. From being denied security detail to the institution's refusal to refute inaccurate racist and misogynistic media coverage to denying her much-needed health care, her concerns were minimized and her pleas for help ignored.
Meghan said when she asked for in-patient care for her suicidal thoughts, she was told it “wouldn’t be good for the institution.”
"They were letting these invalidating things happen to her even when she was compliant, which makes you think it's your fault, makes you think if you just act differently you can protect yourself," said April Foreman, a licensed psychologist and a member of the American Association of Suicidology's board of directors. "But both Harry and Meghan said nothing they did made it better or worse, except when she broke the environmental rules to save herself. When you have to break the social system's rules to be safe and well and healthy, something is wrong with the environment."
The women who saw themselves in Meghan
Boylan is no royal, and yet in her tweet, she said she could relate. In her post on Medium about the abuse she says she suffered in Cuomo's office, she wrote that the governor "created a culture within his administration where sexual harassment and bullying is so pervasive that it is not only condoned but expected. ... He used intimidation to silence his critics. And if you dared to speak up, you would face consequences."
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Experiences of harassment, assault and abuse increase a person's risk for long and short-term mental health issues, including suicide, Palumbo said. Trauma increases suicide risk, and people who've experienced sexual assault are 10 times more likely to attempt suicide than those who haven’t, according to a study by the National Victim Center and the Medical University of South Carolina.
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"What creates the conditions for mental health issues to really be amplified for people is when ... there is such a strong cultural message that what you're struggling with is not OK to talk about, " Palumbo said.
The risk of making suicide a personal problem
While thousands of people die by suicide each year, millions think about it. In 2019, 12 million American adults seriously thought about suicide, 3.5 million planned an attempt, and 1.4 million actually attempted, according to the Centers for Disease and Control and Prevention, which in a 2018 report noted life stressors contribute to suicide.
When people make suicide a personal problem, experts say, there is no impetus for cultures or institutions to change. Meghan remains a weak outsider who could not do the job many other royal women have done without public complaint. Boylan becomes another woman who overreacted.
"Rather than believing women, which requires actually listening to them and affirming their experiences, individuals and institutions so often respond by silencing them," Palumbo said.
Foreman said Meghan's experience with suicidal thoughts is not remarkable, but her public disclosure was. The fear she felt having suicidal thoughts, the worry she would become a burden to Harry, the shame she says she felt as she eventually disclosed – these are common feelings for people struggling with suicidal ideation. Foreman said the lengths she went through to survive tell us something important.
"She took incredibly drastic steps to save her own life," Foreman said. "Being suicidal doesn't mean you don't want to live. We can step up our understanding of these things. We have to."
Mental health resources
For pandemic-specific mental health resources, head to covidmentalhealthsupport.org.
Crisis Text Line also provides free, 24/7, confidential support via text message to people in crisis when they dial 741741.
For people who identify as LGBTQ, if you or someone you know is feeling hopeless or suicidal, you can also contact The Trevor Project's TrevorLifeline 24/7/365 at 1-866-488-7386.
The Trans Lifeline is a peer support service run by trans people, for trans and questioning callers.
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- Suicide prevention experts: What you say (and don't say) could save a person's life
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- We tell suicidal people to go to therapy. So why are therapists rarely trained in suicide
- How to find a therapist if you’re suicidal
- Funding for suicide lags behind other top killers