Suicide prevention

While the act of suicide is sometimes a long-considered, planned option which nobody can prevent, most suicide attempts are impulsive. According to one study, approximately one quarter of the people who try to kill themselves do so within five minutes of their decision to attempt suicide. Only a small fraction of people who survive a suicide attempt go on to die by their own hand. Throughout my career as a psychologist, I assessed many people shortly after a suicide attempt. A question I always asked of them was, “Are you glad that you’re still alive?” Almost all of them were glad that their suicide attempts had failed. I concluded that most suicide attempts are mood-specific behaviors, often involving intoxication on alcohol or other drugs. Once their mood changes, or they sober up, they no longer want to end their lives.

While in grad school, I volunteered as a telephone crisis hotline worker. I was trained to talk to people who were in crisis, to keep them from engaging in attempts to harm themselves or others. From early in my clinical practice I was called on to evaluate the suicide potential of clients. I learned that many people who attempt suicide are ambivalent about living. “To be, or not to be; that is the question.” At the core of this ambivalence is the issue of existential meaning.

One of the major existential therapists of the twentieth century was Viktor Frankl, an Austrian psychiatrist that I’ve written about in previous posts. His book Man’s Search for Meaning was based on his experiences as a survivor of a Nazi death camp. He observed that in such a hellish environment, those who fought to live were people who had a sense of meaning in their lives. He called his method of psychotherapy logotherapy (logos means “reason” or “plan” in Greek), and his therapeutic approach was to help patients find, or create, meaning in their lives.

Lives bereft of meaning are empty lives, but sometimes the vacuum can be filled. Although I was able to help some suicidal clients to find something to live for, one of my severely depressed therapy clients died by his own hand. It was the worst thing that happened in my career. I really liked “Allen,” saw strengths and personal qualities that he couldn’t see, and worked in therapy to help him find reasons to go on living. I saw him on Wednesday afternoons, and he always kept his appointments. When he didn’t come in one Wednesday, I immediately called his apartment. When he didn’t answer after several tries, I looked up his address and drove to his apartment. When he didn’t come to the door when I knocked and rang the bell, I intuited that he was dead, inside. Sadly, this proved to be the case. It turned out that he’d bought a gun that morning, gone home, and used it. On a Wednesday, instead of keeping his therapy appointment.

I went through predictable self-recriminations and judgments. Could I have done anything differently that would have prevented his suicide? But I recognized this as a question that could never be answered. My colleagues knew that I was grieving as if I’d lost a family member, and supported me in my grief process. A peer review of my clinical records found that I’d done and documented everything properly, in terms of recognizing and dealing with Allen’s suicide risk.

A few years ago a close friend committed suicide. She suffered from bipolar disorder, and had confided in Maria and me that she would take a drug overdose in certain future hypothetical situations. She said it matter-of-factly, and wasn’t depressed when she said it. We knew that there was nothing we could say that would change her mind. We hoped that she’d never find herself in one of those imagined situations.

Philosophically, I’m torn on the issue of the “right to die,” because if suicide were to be legalized, it’s inevitable that some depressed people would convince themselves – or be convinced by others – that it was their duty to die, perhaps because they felt useless, or they wanted to leave an inheritance, rather than spend their money on their own medical care in old age. I’m no longer a therapist, but if I knew that someone was acutely suicidal, I’d do whatever I could to try to prevent an impulsive suicide attempt. (Many times, as a Designated Examiner in the Probate Court, I recommended involuntary hospitalization for suicidal people.) But once a person has suicided, I don’t make judgments about their decision to end their life. I don’t have the authority to judge.

Most people who end their own lives do it to escape intolerable pain – whether physical or emotional. Allen killed himself because he could no longer endure living with severe depression. His life had no meaning worth living for. I tried unsuccessfully to help him find reasons to live. Albert Camus considered suicide to be “the fundamental question of philosophy.” He wrote, “I see many people die because they judge that life is not worth living. . . . I therefore consider that the meaning of life is the most urgent of questions.”

Which takes us back to Viktor Frankl, who found meaning in the Hell of a Nazi death camp, survived, and went on to be a founder of the humanistic psychology movement.

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