Mental Health Training

Neurodivergence, suicide, & bereavement by suicide, by Jane McNeice

Posted by on 30 Jan, 2024 in Mental Health |

Neurodivergence, suicide, & bereavement by suicide, by Jane McNeice

Firstly, I would like to put a question to readers…

If you have lost someone close to you to suicide – a close friend or family member – have you explored the possibility that you and they could be (or were) neurodivergent? In particular, ADHD, Autistic, or both – AuDHD? 

Maybe you have, and maybe you or they, or both, identify(ied) as being neurodivergent or have a diagnosis of a neurodivergent condition. Or maybe you haven’t. I am referring to an extensive list of neurodivergent neurotypes, including Autism, ADHD, developmental language disorder, dyslexia, dyspraxia, dyscalculia, and others. There is some overlap of conditions/traits, and it is common to have more than one neurodivergence (diagnosed or undiagnosed, self-identified or not), or to meet the threshold for diagnosis in one, but perhaps not in another.

I ask this because, as an Autistic (with suspected dyscalculia) whose gift is pattern spotting, I am seeing a pattern. A sad and inconvenient pattern, which try as I might to dismiss, and objectively second question, continues to reveal itself to me. I can see a high prevalence of neurodivergent traits in people who have lost someone close to them to suicide, (combined with other evidence) leading me to conclude that neurodivergence is also highly present in those who suicide, and those bereaved by suicide. 

The noticeable traits in the bereaved are of ADHD and Autism. I hear and observe narratives of past and/or present suffering in themselves e.g. mental and physical illness (past and/or present). I hear talk of permanent illnesses – likely co-morbidities of the neurodivergence – cycles of burnout (common in neurodivergents, often labelled as depression, but typically not lasting as long as the average depressive episode which is 6-8 months), victimisation narratives e.g. workplace bullying, abuse(s), and many other examples, some more subtle than others. Along with of course… the unimaginable suffering experienced due to the loss of someone close to suicide, which may also be experienced in a more pronounced way, because, just as neurodivergent people experience most other things differently, evidence shows they can experience bereavement differently too, sometimes in a more pronounced way e.g. exacerbated grief. Note I am not suggesting one person’s grief is worse than another; there is no hierarchy in grief.

Sometimes, the person will have adopted a cause meaningful to them because of the suffering(s) and grief, in some cases because it has been experienced in a more pronounced way. In many cases, these people are extraordinarily successful, capable individuals, enthusiastic in their endeavours, will often be fighting for their cause – successful in this too – at the top of their game, and well respected by others. The latter, combined with pervasive ableism, will be one of the very reasons they won’t have entertained the possibility that they are neurodivergent, and why those around them won’t have done so either. But I would argue, these may be the very reason(s) they should. Suffering and success are not mutually exclusive. They exist together, bedfellows even. You are never too successful or too capable to be neurodivergent! Ableism in our society, denial and downplaying of suffering, the socially accepted nature of certain forms of coping mechanism over others, e.g. greater acceptance of self-harm in the form of alcohol misuse than self-injury types, and the pathologising of neurodivergence, simply stops these people from exploring the possibility of them having a minority neurotype, that they too could be ‘different’, processing and experiencing the world in a different way.

Now, I should declare here that I am not a diagnostician, nor clinically qualified, but my Autistic brain does not account for this and does not have an ‘off’ switch, the very reason I started writing this piece at 3am one Saturday morning in January! It doesn’t switch off just because neurodivergent traits and patterns do not sit comfortably with a socially constructed system that has pathologised my own and other neurodivergent brain types and grants diagnostic privilege to a system where only those who passed a test(s) can tell if someone is neurodivergent. A system that uses what are largely subjective assessment tools – assessments that have and still remain to be sexist, racist, and classist, and are also interpreted subjectively by the user. It recognises neurodivergent traits, mannerisms, behaviours (possibly better than most clinicians) and identifies patterns regardless. My brain seeks patterns and makes connections others may not see so quickly. I cannot un-Autistic my brain for anyone’s convenience, including my own. A neurodivergent brain is such whether it has a diagnosis or not, or is known to the individual or professionals, or not. My eyes are blue whether or not I have a mirror in front of me, and I don’t need a diagnostic report to tell me I have feet! Now, I believe this pattern I am seeing is revealing itself by way of three key things:

ONE: Though there are other causes, neurodivergence such as Autism is highly hereditary, it runs in families giving an immediate genetic connection. Where it exists in one family member, it is more  likely to in close family members, the deceased and the bereaveed.

TWONeurodivergents befriend neurodivergents. Neurodivergents partner up with other neurodivergents, and in many cases produce more neurodivergent family members. Neurodivergent people tend to communicate and connect well with other neurodivergents, more so than with neurotypicals, where communication challenges, misunderstandings, and disconnection can occur more frequently. We communicate far more easily with other neurodivergent neurotypes. Look around you, observe, think about the neurodivergent people you know. Check your understanding of non-stereotypical neurodivergence rather than the stereotype e.g. do you recognise how Autism and ADHD present in females or gender-diverse people, rather than in the stereotype which is very male-centric, do you recognise masking, etc? Would you be able to identify it if it were present? We don’t all work in STEM or count cards in Vegas!

THREE: Neurodivergents are at much higher risk of suicide than neurotypicals.

  • Autistics 3 times more likely to suicide than neurotypicals, 9 times if they don’t have a learning disability, 13 times if they socially mask. Sadly, I myself fall into this last group.
  • Children and young people with Autism are 28 x more likely to have thoughts of suicide than a neurotypical child. Twenty-eight times!

Add to this that there is a significant under-diagnosis of Autism and ADHD in many groups, in particular females, these figures may increase if all were identified and were included in the research.

Adults with ADHD are 5 times more likely than those without to have attempted suicide (14% vs 2.7%), and research suggests neurodivergence and related co-morbid illness must be taken into account in suicide prevention, as this is important.

Furthermore, there is overlap between the neurodivergent conditions, and the conditions often co-occurring. We must think widely about neurodivergence, not just ADHD, Autism, and AuDHD.

Combined, these three will increase our statistical likelihood of losing someone who was neurodivergent to suicide (whether known neurodivergent or not), and when doing so, that our own statistical likelihood of both suiciding and being neurodivergent increases, though likelihood of finding out may not.

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Failure to self-identify or to be identified by professionals

Not finding out that we are neurodivergent increases our risk of dying by suicide further still, because our likelihood of mental illness is then higher due to late diagnosis/identification and failure to receive appropriate support. The living non-identified neurodivergents are also not featured in research, due to their not being identified, another loss that might illustrate greater statistical likelihood. All findings are based on known and willing neurodivergent research samples. This connection also provides another potential explanation for the well documented ‘exposure to suicide being a risk factor for suicide’  Exposure being explained by the 1) and 2)?

Addressing number 3), what in the first place puts neurodivergents at greater risk of suiciding than neurotypicals. Here is a non-exhaustive list of factors:

  1. Substance misuse e.g. those with ADHD are at greater risk of substance misuse, also correlated with suicide.
  2. Late diagnosis of neurodivergence is detrimental to our mental health as support is often non-existent, amongst other things
  3. Neurodivergents are more likely to have financial troubles, addictions to gambling and compulsive buying.
  4.  Neurodivergents experience bereavement and loss differently, with unique challenges.
  5. Living in a neurotypical habitat causing suffering that can contribute to suicide. No creature can survive in an inhospitable habitat – we die off through illness (co-morbidities), or in the case of humans – knowing we exist and have the power to terminate our existence – we suicide. For neurodivergent people, they are navigating a world built for the predominant neurotype – neurotypicals – not for them. This inability to survive is seen in the wide evidence of shortened life-expectancy in Autistics, and both co-morbids and suicide have been cited as contributories to the shortened life-expectancy.
  6. Neurodivergents experience a range of co-morbid illnesses less likely in neurotypicals, including but not limited to:

Co-morbid illnesses also need to be considered in the context of the elevated levels of misdiagnosis that occur for many neurodivergents adding to their life difficulties. Many women are mis-diagnosed mentally ill, or traits and troubles explained as other issues e.g. menopause (where they are of a corresponding age). Many of the late diagnosed were mis-diagnosed with personality disorders, bi-polar disorder, and other mental health conditions beforehand. Many experience direct suffering because of this.

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Conclusion

The conclusion of this pattern – assuming I am not over attributing, or falling into confirmation bias, which I am open to the possibility of – is neurodivergence highly occurs in and around suicide, or the reverse, suicide is occuring in and around neurodivergents. Many who do not know they are neurodivergent, and whose lives are at greater risk of suicide because they are neurodivergent, added to further by the not knowing. Some may even have benefitted or may have survived if they had known. The cruelty of hindsight when it comes to suicide so evident here. We cannot turn back time for loved ones lost, but knowledge could help those at risk now. It benefits us to know, so that suicide interventions are tailored accordingly. For example, have we evaluated that all suicide interventions still work when applied to someone with ADHD? Or Autism? I attended a recent online seminar where the researcher talked about the fact that Autistics don’t always ‘plan’ a suicide,  and yet so many suicide interventions include questions centred around planning. The researcher also confirmed that Autistic people carry a specific risk factor in that they don’t fear death as much as neurotypicals.

This is important, because IF what I am seeing and interpreting does have some substance, then we have a significant reason to explore much more intensively the links between neurodivergence and suicide. If, for example, we had a pattern of ‘people of colour’ suiciding in 97% of suicides, firstly, it would be more visible and the pattern more obvious to all (few would question the actual pattern), and secondly, we would want to know precisely the contributories (proximal and distal factors) of why this was happening to people of colour, just like men’s health has more heavily focussed on male suicide prevention due to the awareness of a 3:1 ratio of male suicides to female. It is an easy pattern to spot, hence greater focus, and higher profile around male suicide prevention. This is the reason it is the most widely known statistic around suicide. Rarely do I need to share this statistic with my learners when I am delivering suicide intervention training, or the mental health training I deliver within my training business. They already know it because the pattern is (almost) impossible to refute.

The fact that neurodivergence is considered much more hidden, and therefore more room for fallibility, should not be a reason to dismiss it without due consideration. The fact that in the general population we make up just 20%, and because of such are largely unacknowledged and unsupported, does not mean the same low prevalence of neurodivergence exists in suicide and should be disregarded or go unsupported in the same way. The fact that considering one ‘at risk’ group over another could miss or risk minimising another group, is not a reason to avoid consideration, in particular because neurodivergent people fall into all the other groups, often at disproportionately high rates anyway, e.g. homelessness, those with financial troubles/debt, victims of crime, prisoners. If we just take the latter, prisoners as one example. We know that at least 1 in 4 offenders have ADHD, so here we see it is not 80/20 (neurotypicals/neurodivergents) in the prison system, but 75/25 (neurotypical/neurodivergents), before we even take into account other neurotypes such as dyslexia and Autism. Take these into account and could it be 50/50? Most people do not end up in prison, but many do experience mental illness. Imagine this figure for mental illness – 20/80 (neurotypical/neurodivergent)? Rather than the 80/20 we see in the general population? We present higher in places that illustrate our suffering. Why would we expect that not to be the case for suicide?

What we would be exploring here, is whether being neurodivergent is the most significant variable involved in suicide, the golden thread that runs through it all, albeit golden would not be my colour of choice. I recognise this as a big hypothesis to assert. We would no longer be talking about an ‘at risk’ group, we would be talking about the ‘predominant variable’, maybe even the ’cause’ of. We would not be disregarding any other group, but rather gaining more understanding of those too, since we already know that neurodivergence is pronounced in other ‘at risk’ groups – the golden thread. Add to this that most treatments/interventions to support these other ‘at risk’ groups, those suffering, were created by and for neurotypicals, we need to be asking, are they working for neurodivergents? Are they still effective in moving people towards life and away from suicide if those people are neurodivergent? Have all interventions been tested for efficacy with neurodivergents? And what does it mean if what has been created doesn’t work well for neurodivergents if they are the predominant recipient of such treatments and the most in need of them? What then if neurodivergence is the most likely cause of suicide?

What if, through empirical research, and psychological autopsy, we learned that 100% of those who suicide was neurodivergent. We already know there is a disproportionately high prevalence of Autism in those suicide based on research carried out by Cambridge University but do we have the same research for ADHD? If not, why not? What if neurodivergence turned out to be THE most significant causal factor for suicide, and could shape future research, prevention, intervention, and postvention strategies, and most importantly, give us the greatest potential for prevention effectiveness, the greatest potential to save lives and reduce these mostly preventable deaths!

If you are curious as to my thoughts on the percentage of people bereaved by suicide where I see neurodivergent traits, I see it in upwards of 95% of those people, and even if I haven’t seen it, it does not mean it is not present in the remainder – the absence of evidence is not evidence of absence. My exposure is high through my work in mental health training, and being in environment and circumstance where disclosure more frequently occurs, so the sample (whilst anecdotal I appreciate) is not small. I am exposed to it week in week out. It’s more difficult with the general public because society rarely talks about suicide, so disclosures aren’t so common, and yet most people know of someone who lost their life due to the pain that became a suicide.

As an Autistic who lives herself with managed suicidal thoughts, and has done so for most of my life, I can share that the single best intervention for both my own mental health difficulties, and thoughts of suicide, was to learn I was Autistic, that I have a different brain type to 80% of the population who are neurotypical, or in actual fact a different brain type to 98-99% of the population who are Allistic (non Autistic). Autism is one of the least common neurodivergent conditions, but there are also many who are unidentified as yet. My own neuroenlightenment has significantly reduced the power of these thoughts and my own risk. Many late diagnosed neurodivergents like myself will speak of how validating and positively life changing it was to learn they were different but not less, and many experience positive health and life outcomes from knowing. My memoir ‘The Umbrella Picker’ documents my own journey of neurological self-discovery and later confirmation through diagnosis.

It is well researched and documented that mental health outcomes are more positive the earlier someone learns their neurobiology, which also leaves me knowing that some people will have lost their lives due to the pain of feeling broken and not knowing ‘why’, and whose lives might have benefited, or been saved, from knowing their neurological truth. The cruel hindsight there again. You see, one thing is assumed of us all at birth. It is an unwritten assumption, but most definitely assumed. We are all assumed to be neurotypical, and yet for 20% of us, that assumption will be wrong. As you might expect, the world we live in has been constructed for the 80%, by and in favour of the 80%, the predominant neurotype – neurotypicals – so you can see why there is a disproportionate presence of neurodivergent people in places that illustrate our suffering and an inability to cope in such a habitat. Mental illness services, drug and alcohol services, victimisation services, unemployment, physical ill health services, homelessness, etc. The numbers of lives lost to suicide is just another place where we can be found and is, for some, their last plea to the world for change. No one brain type is superior to than another, and just as diversity benefits from biodiversity, neurodiversity benefits from neurodivergents. No neurotype is greater than the sum of its parts. Are we losing neurodivergents to suicide? If so, the whole human race is at risk. It would be arrogant of any neurotype to think it can exist without the others, predominant neurotype or the neuro-minorities.

Why am I sharing such a bold claim on the back of pattern-spotting?

There is something you should know about me…

I lack confidence, and still experience the low self-esteem and self-worth that is common in late diagnosed Autistic people. It comes from living half of my life trying to live as a neurotypical and never feeling I ‘fitted in’ or fully belonged, but never knowing ‘why’ and searching so desperately for the answer to ‘who’ and ‘why’ I was. When you don’t know ‘who’ or ‘why’ you are, it is near impossible to build self-worth and therefore impossible to build authentic confidence.  For most of my life I was an observer more so than a participant in this world. I faced the challenges and difficulties many unidentified Autistics experience in a neurotypical world. I held myself to neurotypical standards and viewed the world through someone else’s lens and ideals. I felt broken. I battled (and still do) to survive in the inhospitable habitat that was never built with my brain type in mind. My brain has a different operating system to others, and it’s over wired. I am two years into becoming more confident and learning to recognise I do actually have worth as a human being, and that I was never broken, just differnt. Nevertheless, I lack confidence, so putting a sensitive and bold piece such as this out there in the world, feels incredibly scary, but the reason I will do so in spite of all that, is because of the following…

The pain and ripple effect of suicide is huge – I have seen the pain in those around me. Allyship to my fellow neurodivergents (known or unidentified) is the reason it would be wrong of me to think I may have identified a connection that could save more lives from suicide and to simply disregard it due to fear. I post this written piece with great hesitation – fear of being wrong (I trust my pattern spotting, being wrong will cast doubt on all other patterns), fear that I am stating the obvious and there’s nothing in what I have seen, fear of telling people what they already know, or fear of upsetting someone – this will bother me the most – I most definitely don’t want to upset or offend anyone living with the pain and loss of a suicide. But I would ask, why should the possibility of anyone being neurodivergent offend anyone, unless they have internalised the ableism that being neurodivergent makes you less, or they move in and amongst others who have ableist views and would think them or their loved one less? The problem with the latter is that most of us do move in and amongst others who have ableist views. Comments I receive like “but you don’t look Autistic” regularly tell me so. I am not less, nor is my neurotype, and nor are my people – other neurodivergents. My difference was my strength all along, but it has taken 48 years to work that out.

I have drafted this article with a call to action to gain the thoughts of both professionals and non-professionals, the neurodivergent community, and neurotypicals – neurodiversity if you will. If I have made a leap to far with my thinking, or missed something vital here, please share with me why and/or how – being wrong moves us closer to finding the facts and truths – towards getting it right. Getting it right in such a life-critical area means we could save lives!

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If you, or somone you know, need support to keep safe from suicide, services can be found at Hub of Hope.