"Ask for help," we tell those who are struggling mentally and emotionally. "Ask for help," say psychiatrists, doctors, and representatives of institutions that can offer support. "Ask for help," say those of us who have lost loved ones to suicide, in the hope that others might avoid the same grief.

The problem is, not everyone is able to ask for help. Not because they lack vocal cords, but because they simply do not understand that help is available.

This is something that isn't discussed (at least, I have never seen it mentioned in relation to mental health or suicide prevention), and it can—and does—lead to fatal consequences. What's worse, it seems the psychiatric field is unaware that some people are incapable of asking for help.

In the early morning hours of 20th November 2018, my younger sister took her final breath. She succeeded in what she had tried to do many times since her teenage years. She took her own life.

From the moment I received the news of her death, long before the autopsy could confirm what had happened, I knew it was self-inflicted.

Marianne, my sister, had been seeing a psychologist and had recently started trauma therapy through the DPS when she took her own life. Shortly after her death, an internal investigation was launched, and once completed, I received the results.

Having gone through similar treatment myself a few years earlier, I knew that anyone undergoing such trauma therapy is supposed to have their own therapist for the duration of the treatment, precisely because it deals with intense issues. I can also confirm from my own experience that the process is indeed intense, and there is good reason why extra support in the form of a dedicated therapist is required.

In the report following the internal investigation, I learned that Marianne's psychologist had been on sick leave for an extended period, roughly from the time her trauma therapy began. Instead of assigning a temporary replacement to support her through the treatment, a decision had been made that she could request one herself if she felt the need.

This was the moment I almost choked on my coffee and exclaimed, "Don’t they know anything about deeply traumatised people?" I knew instantly that Marianne would never have asked for a substitute or for help in any other way. Not because she was unique in this, but because people who are as traumatised as she was, and who have experienced life and society as brutally as she had, are simply not capable of doing so.

How can I be so sure? I’ve been there myself. I know what it’s like.

I’ve just finished reading the book Unlovable: On Psychopaths, Narcissists, and Other Relationship Tyrants (a translation of the original Norwegian title “Uelskbar - om psykopater, narsissister og andre relasjonstyranner), and I think the author, Harald Vestgöte Kirsebom, describes the consequences of living with a relationship tyrant very well. I grew up in an extremely dysfunctional family with a psychopathic father, and I recognise much of what is described in the book (which I highly recommend, by the way).

My father was a classic psychopath. He was never formally diagnosed, of course, but his behaviour left no doubt in the minds of those of us who grew up with him, or in the mind of the woman who was his partner for many years.

My father used all the tactics described in Unlovable. Divide and conquer within the family. Threats and violence. Emotional blackmail. He presented himself as the family’s victim, misunderstood and poorly treated by everyone, yet also the only one who had any worth. He was unpredictable, and we never knew what might get us punished. It could be something he ignored or even laughed at the day before. All of us who lived with him were constantly shown and told how worthless we were.

My father was also an addict, and the egoism of an addict combined with the personality of a psychopath made the neglect complete. You might be wondering, where my mother was in all of this? She was his helpless victim, for many years unable to escape the total control he had over her.

I won’t go into detail about who my father was or what he did. The point here isn’t all the horrors a psychopath can resort to, but rather the consequences of growing up in such circumstances and how it follows you through life, leaving you incapable of asking for the help you so desperately need.

When you grow up in such an environment, you are left with an unwavering certainty of your own worthlessness and the belief that there is something fundamentally wrong with you. All you know is that people and the world cannot be trusted. That what seems pleasant and safe can, at any moment, turn against you and become terrifying and dangerous. All your instincts are focused on protecting yourself from others, never letting them get too close. This worldview becomes so entrenched that you become helpless. Helpless in the sense that you cannot comprehend that help exists. Helpless because you believe so firmly in your worthlessness that you can’t imagine anyone genuinely wanting to help. Helpless because you've never known anything other than fear and distrust, so you don’t realise that there is another way to exist. Helpless because you might not even believe you can feel differently, no matter how much help you receive.

Once, I heard the following in the context of pursuing one’s dreams: If you don’t believe you can get your dream job, you won’t apply for it.

The comparison is trivial, yet it serves as a good illustration of helplessness, described in a way that those who haven’t grown up with a psychopath and felt that evil firsthand can relate to. If you don’t believe in or know that something is possible, you won’t pursue it.

Moreover, if you know (or fear) that you are truly worthless and a burden to others, you will do everything you can to avoid bothering those around you. You won’t go to the GP and say you’re struggling with anxiety. You won’t visit A&E until your colleagues insist, even though you’re in severe pain. You won’t tell anyone about the deep emotional pain you live with. And you certainly won’t ask for a replacement when your psychologist is on sick leave for months.

Anyone who has lived long enough has experienced how brutal the world and people can be, saying and doing things that hurt. When you’ve grown up in a situation like mine and haven’t yet healed enough to find a solid inner sense of safety, every nasty glance from a random passerby feels like confirmation that the world is cruel, that people mean you harm, and that you are worthless.

When you focus on something, you see it everywhere—that’s how our brain works. Therefore, when you seek evidence that you must guard yourself against other people, you will find it. If you desperately want others to show you that you are valuable, and fear they’ll show the opposite and reject you, then—to keep yourself as safe as possible in your wounded state—you will almost exclusively find rejection and confirmation of your worthlessness. Nearly everything will validate your fears, even things that have nothing to do with you at all. New relationships might seem promising, but sooner or later, everyone will reveal their treacherous nature. The safest option is isolation—at least emotional isolation, if you’re functional enough to hold a job and maintain something resembling a normal life.

With this comes another painful realisation: If so many people treat you badly, it must mean that it’s true—you really are worthless. And if you are the one person in the world worth less than everyone else, then surely others have the right to treat you poorly, don’t they? Maybe they even should, to stop you from deluding yourself into thinking you have any worth. In this understanding, you allow a lot of mistreatment from others, which of course proves and solidifies what you already believe and fear.

People who have been indoctrinated into believing that they are worthless, a nuisance to everyone, and perhaps even a burden to the world, don’t necessarily realise that such thoughts aren’t their own. They only know that this is the truth—the cruel, shameful truth. Even if they recognise that these thoughts come from their caregivers, that doesn’t necessarily help. The shame is still there. The truth remains the same. After all, the people who brought you into this world and were supposed to be your safety and love—they wouldn’t have told you that you were worthless if it weren’t true, would they?

I have memories from what seems like a completely different life—it’s so long ago now, and I was so deeply wounded back then. Memories of various people who, from time to time, would ask me, “Is there anything I can help you with?”, “What do you need from me (or this service)?”, “Is there something I can do for you?”, or variations of such questions. And I remember how baffled I was by all such questions and how incapable I was of answering. I always responded with things like “No,” “Nothing,” “I’m fine,” “It’s okay,” or other reassurances to let them know I didn’t intend to be a burden. So even when people—including psychologists and psychiatrists—asked me directly if I needed help, I couldn’t bring myself to say yes.

I was in the psychiatric system on and off for many years without ever being able to ask for help, because I didn’t believe it was possible, and because I was more concerned with not being a burden to psychologists and psychiatrists who surely had sicker people to deal with than me.

I knew I was in pain, but I thought something was so fundamentally wrong with me that help or healing was impossible. I simply believed that that was who I was. I couldn’t ask for help, and others with the same understanding I had cannot ask for help either, because they don’t know that help exists. But they might be capable of ending their own pain and the imaginary burden they are to the world by taking their own lives, just as my sister did.

There is much more I could write. Details from my own upbringing and the feeling of living with that excruciating, shameful sense of worthlessness. More stories from my experiences with the psychiatric system—things that helped and things that didn’t. Thoughts on what could have saved my sister. But I won’t. Instead, I’ll end with two wishes and a story about how things can turn out quite well, even for someone with a truly bad start."

Wish number one.

I wish the psychiatric system, NAV (the Norwegian Labour and Welfare Administration), and everyone working in all kinds of support services understood that there are people who are unable to ask for help, how to identify those trapped in deep trauma or delusions to the point where they can’t ask for help, and how they can guide them towards a new understanding of themselves.

Based on both my own experience, my sister’s, and the stories of many others, it’s not enough to have entered the system and secured a psychologist. The person sitting across from you, with a notepad in hand, may not necessarily see, understand, or be able to help.

I wish that when a situation like my sister’s arises, the professionals would realise, as quickly as I did, that it’s absolutely not sufficient to tell someone to reach out if they need a replacement psychologist. Not even if the person is asked if this solution is acceptable, and they agree to it.

People who seem to have control over their lives, who are articulate and thoughtful, who openly share what they’ve been through, and who, all in all, appear to be doing quite well may still be entirely incapable of voicing their deepest pain and asking for what they need most. I wish mental health professionals were aware of this.

Wish number two.

I want a kinder society. A society where we see and care for one another. When I talk about making the world a better place, this is what I mean. There are some missing links in our society that we sorely need. We need to chat with our neighbours in the stairwell or over the garden hedge. We need to take the risk of being rejected and ask slightly deeper questions, so the person we’re speaking with has the opportunity to feel seen (and you have the chance to make a difference). We need to dare to be a bit more inclusive than we are comfortable with. We need each other.

Making the world a better place isn’t about leaving your job and local community to speak on grand stages in front of thousands of admirers. I believe the bigger, more important work is in being more present in our lives—more present for family, colleagues, neighbours, and even in random encounters with strangers. If each of us managed to meet the world and those around us with just a little more warmth, a little more presence, and a little more generosity, the world would soon look very different and much better.

A story about things turning out just fine

Maybe you, the reader, are struggling with the aftermath of growing up with a psychopath or enduring neglect. Or maybe you know someone who is suffering deeply, both mentally and emotionally. Here’s my story, or at least a bit of it, which shows that life can become beautiful and healing is possible, even when your starting point is really terrible.

Above, I’ve written about living with the painful and shameful certainty of being worthless. I’ve experienced extreme anxiety, deep depression, and strange reaction patterns that neither I nor others understood. I’ve been given a few diagnoses by previous therapists, and I’ve rejected a few extra ones they wanted to throw on top. Who knows, maybe they assigned me the diagnoses on paper even though I refused to accept them. It doesn’t matter.

Long after I’d become an adult, had a child, studied, worked, and started my own businesses, I was in so much pain that I didn’t want to live anymore. I didn’t want to die; I just couldn’t bear to be in so much pain any longer. By “so much pain,” I mean emotional and mental agony that was devouring me and never seemed to offer any reprieve. I kept shrinking as the pain grew bigger and bigger.

None of the diagnoses I received were relevant, except for the one I gave myself and eventually insisted on getting help for—complex PTSD.

What helped? Several things over many years. Healing an entire childhood, an entire upbringing, takes time. It’s important to know this in a society obsessed with quick fixes.

Therapy and healing processes are often described as painful, but they don’t have to be. Not always, at least, and the short-term potential pain is better than the pain from trauma that never disappears on its own. We have to actively do something to heal it.

One thing I know for sure after having gone through my own healing journey and eventually being fortunate enough to help others through theirs is that healing and liberation from the past are always possible.

I have a beautiful life with close friendships and other amazing relationships. I have deep inner security. I feel deep love and care for myself. I am not the result of the traumas I’ve endured—I am free. I love life, and I trust that, for the most part, people are good and wish me well. I have a great life.

I am not some super unique case. What I’ve achieved, anyone can. But probably not alone, because people need people. And we need help to see and understand ourselves in a new, healthier way.