Who, What, Why? : The Questions of Suicide
I’ve been asked to write about suicide. Can you write about something that makes us speechless?. The news of a suicide intrudes into our lives suddenly, like an iceberg looming in front of our small unsteady boat. What is true about suicide? A few facts but none of them answer the questions that underlie essays about suicide prevention and statistics: Why her? Why him? Why not me?
What should I have done to help?
Copycat suicides do exist. The contagion effect does exist. Asking for help does help. Depression can cause suicide. People who feel a little better after depression often get a surge of energy to kill themselves. Sometimes there are clues. Statistically, the person most at risk for killing himself is a middle-aged man with no community, a history of mental illness and a completed suicide in his family. Patients discharged from the hospital who are chronically depressed or suicidal are most at risk within the first 48 hours of discharge. And the ability to talk to others truly can help change our thinking.
Sometimes, however, there are no clues. I have patients who live securely with a plan for suicide tucked into their back pocket. I have had many patients who kept knives or razorblades in their cabinets ; living with a Plan B felt safe. They were in control. My own father, a lanky oncologist, told me he had cyanide pills from WWII in his basement workshop. Although he joked “they probably wouldn’t work by now,” he wanted to be able kill himself if circumstances or his pride dictated. My mother told me in a rash confidence that she continued smoking so that she would die before my father. She died suddenly of a cerebral aneurysm- leaving us dumbfounded. She got her wish. My dad lingered for nine years in the stupefying air of Alzheimer’s Disease, listening to Schubert.
Teenagers tell me stories of walking out onto the roofs of the tallest buildings in Boston “just to see.” To see what? Whether their dizzying fear of heights will overcome their desire not to feel? I have called the caretakers of hotels to tell them to raise their security access to roofdecks.
The desire to stop pain is not the same as wanting to die.
I saw one patient every week for nine years. One day after a New Year’s holiday, he tried to kill himself. I thought I knew him well. My hubris. After I returned from a vacation, I waited for him in the office at a church where I worked. Snow piled up beautifully on the brick church while I waited. When he did not show, I was mildly surprised and picked up the phone. I began making calls to find out where he was but I was not worried.
In fact, he had taken an enormous overdose of his psychotropic medicine after living tortured by schizoaffective illness. He was saved by the odd fact that his blood thinners diffused the toxicity of his overdose. This man was lovely, tall and funny; he tried to overpower his aloneness and psychosis with joy. He wrote poems. He chanted gregorian chants. He longed for and feared intimate connection with equal force. I’m not sure his life was any better for having survived. The morning I discovered his overdose, I cried and shook. Foolishly I had believed that our connection, only of therapist and patient, was enough. But it was a gold thread thrown across an abyss of darkness.
Mostly, I wanted to rush to the hospital. Lawyers stopped me in case his family would blame me for the overdose and sue the clinic. It’s true. I would have been a terrible witness. I wanted to confess and be absolved. I sought help. I realized that my vow as a psychologist was ” to do no harm,” not to keep people alive. For my career I had confounded these intentions and they had to be untwined.
I reduce my understanding of suicide to one truth. We underestimate the “otherness” of other people. They are not thinking what we are thinking. They are not feeling what we feel. When their minds wander they do not go where ours might. A woman drops her childhood friend like a dress that is too tight. Partners turn on a dime. A child we thought wouldn’t make it, suddenly finds a passion and launches on their own. Someone we shared a life with, a team with, a class with, kills themselves. It happens again. And again. We wonder.
Do they see something that we don’t?
In my own family there has been one completed suicide. I was told it was a heart attack. My grandfather, embezzled out of his money in his own shop, stormed out of a family dinner on Riverside Drive and checked into a hotel. His body was found the next morning and my own father was called to identify it. Cause of death = heart attack. Actual cause = overdue of barbiturates.
Recently I heard three wildly divergent responses to a suicide. The first: “If she could do that could I?.” The second: “I can’t imagine this. I never could imagine. Can you?” And the third: “Who among us hasn’t imagined this before – or at least said it?” None of these responses were insensitive. None were wrong. They all came from people reasonably attuned to the range of feelings in life. Some people will never kill themselves. Some will. And some people can walk a middle line, wondering what would tip the balance.
But the assumption that we can truly know what it is like to be another person – that we walk along next to someone assuming they are like us- that assumption is inevitable but wrong. In the car last week, I asked my daughter what she ( at twelve) was thinking about. “Candy,” she replied. The next day I asked her the same question. “I just remembered I have a math test.” When I asked her if she was nervous she replied: “No, Not at all. Just don’t be late.”
I am always grateful for health. Both kinds. All kinds.