Lurgan (Northern Ireland): On a cold February night in 2001, as Joe Holbeach was jogging along the pebbled shores of Newcastle in Northern Ireland, he imagined being taken in by the vicious tide and drowning. Days later, he stood on the edge of the Giant’s Causeway cliff top and gazed down at the steep drop, trying to find the courage to jump.
He didn’t, but like many other survivors of the paramilitary violence during the Troubles in Northern Ireland, he experiences post-traumatic stress disorder. And to this day he battles the demons that tell him to end his own life.
Twenty years after the Good Friday Agreement ended the Troubles, Northern Ireland has one of the highest suicide rates in the world.
Experts point to numerous factors including poverty, underfunded mental health services and a recent uptick in paramilitary violence. But a leading cause, they said, is PTSD.
Holbeach, who has received a diagnosis of PTSD, is among the thousands who were caught in the crossfire of Northern Ireland’s guerrilla war, in which bombings, shootings and maimings were enmeshed in daily life for nearly three decades.
His PTSD manifests in the form of flashbacks, feelings of intense emotional stress, depression and anxiety, which lead to suicidal behavior. On some days his suicidal thoughts become so incessant that he struggles to see certain objects as anything but tools he could use to hang himself.
In 2001, when he reached out to his local mental health hospital in the town of Lurgan, he said he was turned away because, as he admitted, he had been violent toward another patient during his last admission. He said the rejection pushed him over the edge.
“I told them I was going to kill myself, but they still didn’t take me in,” he recalled on a recent day in his living room, where family pictures decorate the mantelpiece.
“I couldn’t take it,” he said. “I cracked and went straight to the deepest point of the Craigavon Lake and threw myself in. I can’t swim well, but I didn’t even try. I wanted to drown. I wanted to die.”
Northern Ireland has the highest suicide rate in the United Kingdom, with 18.5 age-standardized suicides per 100,000 people in 2017, a figure that puts it among the top 15 countries in the world, the Northern Ireland Statistics and Research Agency found. The rate for men is far higher, approaching 30. The rate in England was half that, at 9.2 per 100,000 people.
The Republic of Ireland has historically had a high suicide rate as well, though it has seen a steady decrease in recent years.
Most striking is that the suicide rates in Northern Ireland have doubled since the region’s militant groups struck the peace deal more than two decades ago.
A spike in the rate from 2004 to 2006 reflected a change in recording practices by the Coroner’s Service that synchronized Northern Ireland with the rest of Britain. In the following years, the numbers tracked generally higher, prompting mental health experts to carry out research that found a direct link between suicidal behavior and the traumatic events experienced by thousands during the conflict.
In 2017, the highest number of deaths by suicide in Northern Ireland occurred among men ages 35 to 44. They grew up in the shadow of the war, many of them experiencing daily violence, forced migrations, loss of jobs and deprivation.
“For anxiety disorders and PTSD, 22 years was the average time between symptom onset and treatment, because people didn’t want to talk and ruminate over the terrible things they went through,” said Siobhan O’Neill, a professor at Ulster University who carried out a detailed study into mental health in Northern Ireland’s history.
Of 28 countries and regions that participated in the World Mental Health Survey in 2017, Northern Ireland had the highest rate of PTSD.
“During the Troubles, the suicide rates in Northern Ireland were actually lower than they are now,” O’Neill said. “It seems that the conflict gave those who may have otherwise been suicidal a sense of purpose — to fight, to live.
“But when the Troubles ended,” she added, “many people struggled to make sense of what all that fighting was about and what had been achieved, and then the suicide rates went up.”
The uncertainty over Brexit and the collapse of Northern Ireland’s power-sharing coalition has empowered dissident groups in recent years and threatened the region’s fragile peace. Paramilitary-style punishment shootings and beatings in dissident-run, deprived areas — primarily to punish young people for things like petty crimes and drug dealing — rose 60% last year, an increase that experts said has contributed to the high suicide rate.
Bernadette O’Rawe, an activist who provides support for victims of paramilitary shootings in western Belfast, pulled out pictures of some of the worst casualties: a young boy with bloody bullet holes the size of golf balls under his kneecaps, another with a bulging ripped lip. Many of the victims are left crippled.
Of the nine victims the couple helped, three took their own lives. “Suicide is like an epidemic here; there’s about one a week,” O’Rawe said.
Holbeach was struggling and splashing in the Craigavon Lake when he was spotted by a fisherman, who swam out to him and pulled him back to the shore using an abandoned basketball hoop.
As he was drowning, Holbeach had flashbacks to Nov. 8, 1987, the day he went to the parish town of Enniskillen to attend a memorial service for British soldiers and a bomb planted by Provisional Irish Republican Army militants exploded yards away from him.
“Everyone had gathered — friends, family, children — and then suddenly there was a big bang,” he recalled, scrunching his face up tight as if reliving the moment. His hands started to shake. “I fell to the floor, and it was like asteroids coming at me from space. You’re dead, you’re dead — I believed I was dead.”
The attack was among the deadliest of the conflict, killing 12 people and injuring more than 60.
“I dug myself out of the rubble,” Holbeach recalled. “It was like I was in the middle of the desert in a sandstorm — stepping over bodies flat on the ground like cardboard, blood and broken limbs everywhere.”
Libyan dictator Moammar Gadhafi supplied Semtex to the IRA paramilitary group during the conflict, and victims of the bombings have long campaigned for the British government to release more than $12 billion in frozen Libyan assets — currently being held in Britain — to compensate victims.
Holbeach said that beyond obtaining justice, he could use the money for private medical care after he was left injured by the bomb. About 5% of Northern Ireland’s health budget is spent on mental health, half of the 13% allocated in England.
Last month, Northern Ireland’s Department of Health published a suicide prevention plan that aims to reduce the number of suicides 10% over the next five years, but experts worry that there is not enough funding to fully implement the strategy.
A culture of silence around the conflict has also contributed to the issue, as many of the victims are reluctant to ask for help.
“It wasn’t safe to speak about so many things,” said Roisin Martin, who worked as a nurse during the conflict. “Even if you recognized that you needed to, you didn’t know who anyone really was or what their beliefs or involvement was in the paramilitary world.”
Many people would not confide even in their families and friends or share details of the atrocities they witnessed on a daily basis. In some cases, experts found that parents could transmit their post-traumatic stress to their children, even if the child had never experienced a traumatic event.
Only now, 20 years later, are people starting to confront the emotions tied to their experiences.
“I feel that we were so used to living with the effects of the stresses, it was just part of who we were,” Martin said.
Today, a similar silent and stoic response surrounds suicide, especially in Catholic communities, where ending one’s own life is still widely considered a sin.
After her 15-year-old daughter killed herself in 2005 in the rural county of Tyrone, Catherine McBennet started the Niamh Louise Foundation, a suicide support charity in her daughter’s name, which she said has made a big difference in raising awareness. “But we still have a long way to go, especially in rural Northern Ireland,” she said.
Eamonn Baker, who works for a peace-building foundation and who has dedicated more than three decades of his life to conflict resolution in the area, is still haunted by the events he experienced in his hometown, Derry, Jan. 30, 1972 — Bloody Sunday, one of the most violent days of the conflict.
Growing up, like many who lived through the conflict, he dealt with the trauma by turning to alcohol. But now he takes a positive approach by working to bring people from both sides of the conflict together to establish a dialogue.
For many, the process of reconciliation has been cathartic, but the trauma of the conflict is still so deeply embedded in society that many still struggle with the emotions tied to their experiences.
“The past sits like a weight on the present,” Baker said. “It’s a big challenge to live in the present.”
Ceylan Yeginsu c.2019 The New York Times Company