We banished the leper outside the city gates, we put the homosexual in the closet, and we file the suicide in the coroner's special folder.
What has changed? We know that stigma comes from secrecy and banishment of stereotypes we fear or hate.
Why is New Zealand's most serious, persistent health problem banished to the coroner's files?
It prevents nothing, but promotes the myth that suicide is a mysterious, fatal disease that is never talked about, even after death.
And when it is talked about in terms of prevention, there is nothing to report. The suicide rate in New Zealand has continued at the same rate for 20 years. When you read the annual reports of suicide, 500 is the magic number, give or take 25.
What we don't talk about is the double suicide rate of Maori, and that suicide is the third leading cause of death for teenagers.
My friends tell me that the same attitude used to be used about cancer. Don't talk about it, particularly to the poor suffering victim. Now cancer is the most popular health topic on the news, and research and education are reducing the rate of diagnosis and death.
What education do we have for suicide? A middle-aged rugby player talking about his depression over the years. Lavish five-year suicide prevention programmes promoted by the Minister of Health. Millions spent organising programmes throughout New Zealand.
Where are the teenagers talking about their efforts to kill themselves?
Why do we have four suicide helplines for teenagers to call? Why are they closing down the most successful crisis line in New Zealand? We haven't talked about suicide for 25 years, and it has not gotten less or gone away.
We need a new approach as well as recognising the myths surrounding suicide.
Myth #1: There is no such thing as group or cluster suicides when we publicise it. Research has shown that the number of suicides only increases when famous people kill themselves.
Myth #2: There is no such thing as suicide prevention. Fifty percent of people committing suicide are drunk at the time. It is a viciously impulsive act, which the survivors regret.
Myth #3: Discussing depression and suicide in New Zealand means you are "mental" or crazy. The stigma of mental illness still hangs over any discussion of suicidal thinking.
This despite the large number of teenager and adults who admit to suicidal ideation at times of stress and conflict.
We need to focus on a direct approach to an impulsive act that kills people. We need to educate people that suicidal ideation is a perfectly normal response to stress, frustration, and disappointment. It's not unique nor a sign of mental illness.
We need to get people out of the suicidal ideation closet to share their experiences. This should begin with teenagers, and continue with Maori men.
We need to share the grief of suicidal death by publishing the concern and sympathy that we feel for our friends and relatives who suffer this tragic death. Waiting for the coroner is too little too late.
Every teenager has a cell phone. We need to provide a single nationwide simple phone number, similar to 111, that can be programmed into every teenager's cell phone for immediate use in an emergency.
In summary, we need to destigmatise suicide, understand that suicidal thoughts are not a sign of mental illness but an impulsive, tragic solution to frustration and disappointment.
We need to support the victims and their families immediately at the time of death, not six months later following a coroner's report.
We need to have the normal people who experience suicidal thoughts share them with the community to show that it is not a unique situation.
Finally, we need a nationwide simple phone number that can be used 24/7 to call for help.
Only then will the tragic number 500 begin to change.
James Reardon is a retired psychiatrist living in Waiuku.
Where to get help
• Lifeline: 0800 543 354 (available 24/7)
• Suicide Crisis Helpline: 0508 828 865 (0508 TAUTOKO) (available 24/7)
• Youthline: 0800 376 633
• Kidsline: 0800 543 754 (available 24/7)
• Whatsup: 0800 942 8787 (1pm to 11pm)
• Depression helpline: 0800 111 757 (available 24/7)
If it is an emergency and you feel like you or someone else is at risk, call 111.