Last year, 90 Irish women took their own lives - and the numbers are on the increase, writes Kate Holmquist
When Caroline McGuigan regained consciousness in hospital after a near-fatal suicide attempt in her 20s, her first thought was: "I couldn't even get that right." Yet, even more painful than her pervading sense of failure, was the return of the constant feeling of dread that she had tried to escape through overdosing.
"I'd lost all hope. I was struggling to find a way to stay in this world and to somehow believe that things could get better, but my world had become so small that it was hard to believe that I could feel anything other than that awful sense of dread," says McGuigan (40), now an accredited psychotherapist and Irish co-ordinator for the UK-based charity, No Panic.
McGuigan awoke on a general hospital ward with extremely ill elderly women. She recalls being told off by a nurse: "Look around at these poor women struggling to hang on to life. And there's you trying to kill yourself. What are you like?" On her bedside locker, someone had placed the bottle of tablets that she had used to overdose.
BEFORE THE SUICIDE attempt, she had sought psychiatric help and was diagnosed with "panic attacks" and prescribed medication, including benzodiazepene, which, says McGuigan, turned her into a "prescribed drug junkie". She saw a psychiatrist for a few minutes each week but "talk therapy" was never offered. She didn't understand her diagnosis of panic disorder and was never educated about the drugs she was taking. After spending time in daycare at the psychiatric hospital, she would go home and hide under the duvet.
Having survived her suicide attempt, something changed for the better. She got angry. This sparked her to survive and she began to question the medical model of treatment. She says: "My 'treatment' was eight to 15 minutes per week with a psychiatrist who would ask me how I was, then write another prescription. It's still going on today. So I became passionate about finding a better way."
It took her seven years to overcome her addictions, during which time she researched her condition and got the talk therapy she needed. She became a consumer expert in best practice in treating panic disorder, then trained in psychotherapy. "I wanted to share what I had learned with others in order to help us all," she says.
McGuigan's struggle highlights the hidden problem of female suicide, particularly among young women aged 15-24 whose suicide rate trebled in the years 1990-2004. For women in all age groups, the suicide rate increased nearly fourfold from two per 100,000 in 1980 to seven per 100,000 in 2001. Last year, 90 Irish women took their own lives, compared to about 360 Irish men - a 1:4 ratio that is reflected internationally.
Suicidal women don't actually want to be dead, says Joan Freeman, a psychotherapist. She says: "The only way to end the daily torture of that awful feeling of dread and despair is either to be asleep, or to be dead. They don't know any other way of ending these thoughts."
In response to this growing problem, the Irish Association of Suicidology (IAS) is holding a conference on women and suicide in Ennis, Co Clare, next weekend. One of the speakers, consultant psychiatrist Angela Mohan of St Vincent's hospital, says: "We are concerned that the numbers are increasing among younger women, who are not coping as well with the stresses of complex modern life in an urban society. They're binge- drinking, they may lack the family supports of the past and it appears many do not have the coping mechanisms they once had."
The social pressure to look the part of a successful woman and to "be happy" in career and relationships is constantly being reinforced by popular culture, so that many young women feel like failures when they're not, Mohan adds. Among the myths about women and suicide is that women who try and fail are attention-seekers. Incidents of failed suicide, or self-harm, are 37 per cent higher amongst Irish women than men. In 2004, there were 5,850 incidents of female "self-harm" seen by A&E units: 58 incidents of self-harm for every completed suicide, according to the IAS.
THESE STATISTICS HIDE a "huge" incidence of serious attempts that are never officially recorded, says Freeman. "In many cases, usually involving overdoses, the women recover without ever telling anyone. Or they may be quietly treated by their GPs."
Like McGuigan, women who survive attempts may find themselves regarded as selfish nuisances. "Suicide is not a selfish act. Those who are suicidal become so wrapped up in the intensity of their emotions that they cannot see the effect that their actions will have on others," says consultant psychiatrist John Connolly, secretary of the IAS.
The reason women are less likely to be successful in their attempts is that they are less likely than men to use violent means. But that's changing, says Mohan: "In 31 per cent of women who complete a suicide, the method was hanging, the same rate as in men." Most suicides are impulsive, she adds: "I know of young women who killed themselves after a row with a girlfriend, when both were drinking. When meaningful relationships run into difficulty, that's when women are most isolated and therefore vulnerable."
With the highest rate of binge-drinking in Europe, more young Irish women are putting themselves at risk, says Freeman: "Alcohol is almost always the catalyst for suicide. Alcohol is a disinhibitor, making people do things they wouldn't normally do. Also, after a binge-drinking session people get what we call a 'depression session', during which they are most vulnerable to self-harm or suicide."
Prescription and over-the-counter drugs complicate the picture further, with many women - as McGuigan herself did - trying to cure the "feeling of dread" by drinking alcohol on top of medications. Mohan has seen women carrying pharmacies around in their designer handbags: "Some women have enough drugs in their handbags to take an overdose at any time. It's like having a security blanket. They need to know that they always have a 'way out'."
Women have a lower rate of suicide than men because generally they are able to express themselves better emotionally, but they aren't always taken seriously, Freeman warns: "One of the great myths about suicide is that if you talk about it, you don't mean it. The truth is the complete opposite: if you do talk about it, you do really mean it. Suicidal talk is not an attention-seeking exercise. If you hear anyone talk this way, you have a responsibility to do something about it."
STATE SERVICES ARE in "official denial" over the high rate of depression in women during the child-bearing years that is resulting in suicides, infanticides and fillicide, believes Veronica O'Keane, perinatal psychiatrist and senior lecturer at the Institute of Psychiatry, London. Suicide is the highest cause of maternal death in the post-pregnancy period, yet maternal depression is "undertreated", says O'Keane. She has observed an increase in Irish parents killing their children and taking their own lives - known as "altruistic fillicide".
"It would appear," she says, "that many of these cases occurred because parents were psychotically depressed, believing that it was in the best interest of their children to die rather than live a life of disgrace, despair and eventual impoverishment . . . Many of these cases involved very young children with the onset of depression [IN WOMEN]occurring during the peripartum period."
In 2005, 28-year-old Sharon Grace drowned with her daughters Mikhala (4) and Abby (3) shortly after she failed to get a number at Ely Hospital in Co Wexford for emergency out-of-hours help from social services.
Suicide affects many people in addition to the person who dies, or tries to die. Freeman says that having a friend or family member who has attempted or completed suicide is such a burden that friends and family find themselves at risk of depression and social withdrawal, while others put their energies into finding ways to cope and help.
Says Freeman: "Next weekend's conference is for friends and family, not just professionals. The conference will be uplifting for people to hear each others' stories and to share how they found hope." In January, Freeman opened a new centre for the prevention of self-harm and suicide, Pieta, in Lucan, which offers free psychotherapy, daily if necessary. McGuigan is co-ordinator of Suicide or Survive, a registered charity, which at the end of this month will launch The Eden Programme in Arklow, a six-month suicide prevention programme for men and women.
McGuigan is glad to be alive to help others: "I have learned that the key is to offer these women warmth, genuineness and realness. These women know what they need - we just have to give them the space to tell us what it is, then make sure they get it."
The Irish Association of Suicidology (IAS) conference, Women's Health and Suicide, will take place on Friday and Saturday, Sept 29 and 30, at the West County Hotel, Ennis, Co Clare. Cost: 190 including lunch and dinner on Friday. The cost of attending Saturday's bereavement seminar only is €50. To register, e-mail joscott@eircom.net. To contact IAS, tel: 094-92580858 or 087-1219488 outside office hours