Suicide: Fact and Fallacy- Part 1
© Centre for Couples, Narrative Coaching & Posttraumatic Stress, London 2022 © Jamal Alladin 2022
To be or not to be — that is the question,
Whether ’tis nobler in the mind to suffer
the slings and arrows of outrageous fortune,
or to take arms against a sea of troubles
and by opposing end them — To die, to sleep -
No more, and by a sleep to say we end
The heartache and the thousand natural shocks
That flesh is heir to. ’Tis a consummation
Devoutly to be wished … Hamlet (III.i.56)
This article highlights some fallacies about suicide that were recognised some decades ago but still being problematic or ignored by some professionals or the lay public. You may find some of the views expressed as enlightening (you can thank the contributors and me!) or controversial (happy to listen and engage with your comments). In this part 1, I look back to views that in my opinion are still relevant and current. In part 2 (to follow) I will consider the contemporary views of Mark Williams and Rory O’Connor.
Decades ago Dr Michael Simpson warned us that popular beliefs about suicide are often dangerously inaccurate: “the way many people behave towards someone who has attempted suicide sometimes compounds their problems, and enhances the chances of further attempts…”
“I remember being shocked when overhearing a professional who was stomach pumping a patient who had taken an overdose in the accident and emergency department: Next time do a better job! Don’t waste NHS time!”
How insensitive and judgemental can a professional be! Is a patient who has been badly injured in a road traffic accident more deserving? Even if some professionals think so, how do we know that the driver was not a failed suicide attempt? My position is that everyone who presents for help is deserving of our caring non judgemental attention. But let’s get to the fallacies in the field of suicide.
Fallacy 1. “Only the insane end their lives by suicide”. In popular parlance, some people say : “ you must be out of your mind to want to end your life!” Or you must be mentally ill(?depressed ?not in touch with reality…). It is of course controversial whether someone who is depressed is mentally ill. Although a majority of depressed people contemplate or attempt to end their life by suicide, the majority of people who do so are not depressed according to Davison & Neale. In other words, most people who end their lives are apparently not depressed but many depressed people attempt to do so.
Fallacy 2. “Suicides happen suddenly and are impossible to predict”. Some eighty per cent of people who ended their lives by suicide gave many clues and warnings before the act, “Hopelessness” is an excellent predictor of true suicideal intent (deCatanzaro). The Beck Hopelessness Scale is based upon this kind of evidence. Depression can be deceptive and may be transient. So, complaints of feeling helpless, hopeless and powerless should always be taken seriously.
It is sometimes claimed that if someone were determined to kill themselves there is nothing we can do about it. This misses the point. In my decades working in the field, I have honestly never come across someone who was “determined” to end their life by suicide. The point is people who contemplate ending their lives are ambivalent or still thinking about how to resolve their seemingly impossible situation. They are in despair. By definition there is no such thing as an unsolvable problem but people often have their chosen or preferred approach and then may blindly stick to it.
Sadly the Russia-Ukraine war is a good example of this boxing oneself into a corner. Being the eternal optimist, my experience (and the experiences of thousands if not millions of professionals worldwide) is that where there is a will, there is a way. Those who have considered creative problem solving strategies or conceptual block busting will know and can teach us how to release oneself from a seemingly impossible situation. For an update of suicide and suicide research, Rory O’Connor’s (2021) award winning book is illuminating and highly recommended.
Fallacy 3. “Suicides are a homogenous group”. According to Wenz, suicide occurs in people who have little in common except their behaviour….(they)…..wanted to end their life. The cause(s) of suicide are so varied that there may be many kinds of behaviours masquerading under the single label suicide. Suicide, he maintains, is not a behaviour but a descriptive label for the outcome of a large variety of other behaviours. In other words, it is the final common pathway or process of ending one’s life, once the person has made the decision as final. Wenz emphasies that the word suicide is a noun, not a verb and thinking about suicide as a single behaviour creates an illusion of a single behavioural act but it is a serious distortion of reality.
Fallacy 4. “When a person feels (s)he has reached the end of their tether and makes a rational decision to end their life, there is nothing much anybody can do, and professionals should not interfere”. It is their choice and we should mind our own business, some may say! The fact is that most people who end their lives by suicide appear to be ambivalent about their own deaths. Often a person thinks (s)he has reached an impasse but in the majority of cases this is due to distorted perception (“there is no way out”) and an exaggerated or even incorrect self-appraisal (“the world would be better off without me”).
Simpson, for example, asserts: “Suicide is much too big a decision to take alone.” I would add, if we regard fellow humans as part of the big family of the human race, then it is everybody’s business to care. [Besides, judging by social media, some/many people who attempted to end their life by suicide have turned their life around and are grateful they did not proceed with their decision].
“However hopeless the situation may seem to the person that their problems are insoluble and there’s no way out… there is another way out. This is no mere soft-talking optimism, but the result of study and working with thousands of people in a similar situation”.
In other words, what seems to be the end of the road is merely a bend in the road.
Fallacy 5. “The motives for suicide are easily established”. According to Douglas, “…..the situated meanings of suicidal acts are often very different from their abstract meanings. In other words, the meaning of a suicidal act for those who are directly involved with it will very rarely be the same as the meaning it has for those who are not so inviolved and will certainly not be the same as for the individual who, by ending their life by suicide is trying to communicate something”. For example, a person may feel so ashamed of what they have done(or not done) — acts of commission and ommission that they feel they can no longer live with themselves and so in their tunnel vision see only one solution and that is to end their life with their honour. This is akin to the motivation for when someone challenges another to a duel because their honour has been violated. Give me liberty or give me death!
Of course, some people believe that by ending their life that is the end of themselves and their suffering. For those who are entirely materialistic in their beliefs that may be satisfying to contemplate. Question is, is it really so? You don’t have to be religious and/ or spiritually minded to reflect on this question.
Can you really terminate your consciousness? Matter can neither be created nor destroyed. I have devised an existential model of helplessness and hopelessness in relation to the desire for the termination of consciousness in suicide but that is the the topic for another article.
As Mark Williams has indicated, those who attempt to end their lives are not necessarily clinically depressed and even if they are it may not simply be a cry for help- the popular view. It is, and I agree, the Cry of Pain.
I would add that it is unbearable pain and when it is unremitting, day in day out (“nothing ever changes…..it is pointless carrying on”) and this is the tipping point. Even when at a tipping point there is more than one way to go…. go ahead or stop and go back…..change track. This is where the ill thought comments of some people can push the person to jump and where the experienced senstive person’s comments can save the person from jumping as countless people have been saved and grateful they turned back.
Bakal suggests that broader sociological variables may also influence suicide rates — society may inadvertently legitimise suicide as a means of coping with life’s problems: A person who cannot accept being alone, or the guilt associated with some action, or the loss of a loved one, may see suicide as a meaningful alternative because in some subtle fashion the larger society has conveyed the very alternative. [“You’re a waste of space!”] Even suicide prevention centres … may contribute to the incidence of suicide in this fashion.”
In fact, many years ago the British Journal of Psychiatry regarded by some as the premier journal for UK psychiatrists, published a paper that showed that when more branches of the Samaritans were opened in England, the suicide rates actually went up rather than down! How do we understand this? Well, a suicidal person may regard the Samaritans as the last resort and if the help/guidance they receive is inadequate or worse unwittingly confirms their belief that they have no hope and have indeed reached the end of the road, the person may express gratitude tothe counsellor for listening, and then quietly go ahead and end their life.
Fallacy 6. “People who threaten suicide will not do so”. Parasuicide — people who survive their self-influcted injuries and overdoses are different (from those who complete suicide). They are not out to kill themselves. According to Pallis and Birtchnell, parasuicides are trying to express what in many cases they cannot put into words: they need some help. It is estimated that only one in five people who attempt suicide intends to die. In other words, for the remaining 80 percent it is really a commincation of distress and a gamble with death as the last resort.
Fallacy 7. “Suicides are surely the most sefless people”. According to Harmatz, suicide postmortems have demonstrated the imagined impact the suicidal act is meant to have on the suicidal experience suggest just how very important the “gains” are to the would-be suicide. Experienced clinicans are cognizant of just how very important is the ideation of the after-effects of suicide.
In other words, suicide is not just a dramatic cry for help. It could also powerfully communicate: “You’ll be sorry once I’m dead”. And Simpson observed that a significant proportion of motor accidents are partly or completely suicidal in origin.
One client said to me: I am not going to let my wife and children suffer or be blamed for my death after I am gone, so I am going to take them in my car when I drive off the cliff and into the deep sea.(This client was helped to change their decision).
Beier and Valens suggest that withdrawl, depression and suicide are very much alike in their communicative aspects: most often designed to punish by means of self-hurting — discordant messages which are compromises between two conflicting motivations, to care and to aggress.
In fact, Freud asserted that suicide is the result of aggression turned inwards. Suicidal persons are often angry(with themselves, another person, the system or God). This applies to a broken-hearted lover as much as to Buddhist monks in Vietnam who became human torches in their protests against the Vietnam war.
Lester points out that suicidal episodes are often viewed as crises but they can also be periods for potential psychological growth. [The trauma being transformed to resilience or post traumatic growth to use a technical phrase]. He complains that frequently psychologists view periods of negative affect as bad for people and try to eliminate them. However, existentialists (I am one) and some humanistic psychologists suggest that such periods must not be avoided, but rather explored in depth, so that the individual can grow from the experience.
In conclusion, it seems that every suicide is an indictment that someone somewhere has failed to care for another in their moment of need.
As for those who aid and abet another in suicide (no doubt in good faith) when the person throws in ‘self-determination’ as a smokescreen, are confusing collusion for compassion and wishful thinking for scientific fact. I am not referring to people who have a terminal condition and after careful reflection and discussion with their doctor and their loved ones, have decided to end their life.
Disclaimer: This article is for educational purposes only and does not constitute medical or professional advice. If you or someone you know is suicidal please get professional help in your area. In the UK this would be the Samaritans 116 123. In the US this would be 1–800–273–8255
References
Bakal, DA (1979) Psychology and Medicine. Tavistock: London.
Beier, EG & Valens, EG (1975) People Reading. Warner Books: New York.
Davison, GC & Neale, JM) Abnormal Psychology. Wiley: New York.
deCatanzaro, D. (1980) Human Suicide: a biological perspective. The Behavioural and Brain Siences, Vol. 3(2), 265–272
Douglas, JD (1968) Suicide: Social Aspects IN DI Sills(Ed) INternational Enclyopaedia of the Social Sciences, Vol. 15, pp 375–385. MacMillan & Free Press: New York.
Harmatz, MG (1980). The biological perspective in suicide: to be or not to be, is that sociobiology? The Behavioural and Brain Siences, Vol. 3(2),280–281
Lester, D. (1980) The categorization of suicide. The Behavioural and Brain Siences, Vol. 3(2),281.
O’Connor, R. (2021) When it is Darkest: Why people die by suicide and what we can do to prevent it. Penguin: London
Pallis, D. and Birtchnell, J. (1977). Suicide: why some fail on purpose. Psychology Today, Vol. 3(6),pp 7.
Simpson, M. (1977). Suicide: the most intimate murder. Psychology Today, Vol. 3(11) 27–31.
Wenz, FV (1980). Heredity, environment and culture in suicide. The Behavioural and Brain Sciences, Vol. 3(2),281–282
J Mark G Williams (2014) The Cry of Pain Understanding Suicide and the Suicidal Mind. Piaktus: London.
PS. Some papers in the The Behavioural and Brain Sciences, Vol. 3(2) special issue dealing with Suicide have overlapping page numbers because the contributions were short paragraphs. The page number citations are therefore not a misprint.