Suicidal Minds: The Societal Associations and Moral Dilemmas

‘If I don’t get an ‘A’ on this paper I’m gonna kill myself.’ That’s what someone might say, not necessarily as a joke, but to express how they feel the level of importance the consequence of the situation is. But in reality, they aren’t going to go down a bottle of pills, or get a gun and shoot themselves or even go jump off a bridge. Instead, they might heave and sigh, maybe even cry, but I can guarantee that they aren’t going to go and off themselves. But what about that kid, over in the corner, he seems alright, ‘normal’, but every day, or maybe just a couple times a week, he truly thinks about suicide. The important fact isn’t how often, it’s that he truly feels that this is a thought worth considering, and it’s not just some passing phrase. For him, it’s the truth.

Being that as of 2005, “1.3% of all deaths were from suicide” (Suicide.org. 2005) and that “on average one suicide occurs every 16 minutes” (Suicide.org. 2005), it’s no wonder that “suicide is the eleventh leading cause of death for all Americans” (Suicide.org 2005). But what about those who only attempt suicide; they jump, but not far enough, they drink, but not enough, they bleed, but not enough. ‘Enough’ seems to be the word here. It means that they did something but did not have the amount of effort or planning to make it definite.

Furthermore, “…suicide is chiefly a drama in the mind.” (Shneidman, 4) it is understood by Shneidman that “suicide is caused by pain, a certain kind of pain—psychological pain which I call psychache” (Shneidman, 4). Since “each suicidal death is a multifaceted event—that biological, biochemical, cultural, sociological, interpersonal, intrapsychic, logical, philosophical, conscious, and unconscious elements that are always present--” (Shneidman, 5) it can be understood that suicide derives from an upset in the psychology of a person.

Recognizing the Clues

Yet, how does one know if a loved one or even just a peer is suicidal? That question has multiple answers. The terms for ‘clues’ that clinicians might apply to instances which indicate a possible suicidal situation “include phrases like ‘premonitory signs’ or ‘prodromal indices’.” (Shneidman, 51). These cues signify “[t]hese are events that cast their shadow before them and serve as a warning.” (Shneidman, 52). Shneidman also states that the behavior of a suicidal mind would be similar to that of a person preparing to take a long trip, in saying “[t]hey include such obvious activities as suddenly putting one’s affairs in order, straightening one’s files, deciding to make a will, and, especially, inexplicably giving away or returning prized possessions.” (52)

The two types of clues are prospective and retrospective. The former including “suicidal communications, previous suicide attempts, self-destructive behaviors, death-oriented activities, feelings of hopelessness, profound depression, tumultuous stress, telephone calls to helping agencies,” (Shneidman, 53-54). Whereas retrospective clues would be less obvious and more implied or expected to occur due to circumstances such as “the presence of mild depression, the recent death of a loved one, unrelenting stress on the job, tension in the marriage, alcoholism, schizophrenia, physical illness, constricted or dichotomous (all-or-nothing) thinking, thoughts and talk of death,” (Shneidman, 54).

Shneidman (1996) acknowledges that,

“We can understand this dissembling in psychological terms, and see it as much more than feigning or malingering. This is so because there is at least a touch of schizophrenia or insanity in every suicide in the sense that, in suicide, there is some disconnection between thought and feelings. The current psychiatric term for this condition is ‘alexithymia,’ by which is meant the presence of conscious and apparent psychic suffering characterized by sadness, gloominess, despair, or despondency, and accompanied by the inability to connect emotional experiences with thoughts. This results in an impaired ability to label emotions, or to differentiate them into more subtle shades of meaning, and communicate them to others. It is this abnormal ‘split’ between what we think and what we feel. There lies the illusion of control; there lies madness.” (59)

Assisted Suicide

Euthanasia is a controversial issue involving the key question ‘murder or suicide?’ If a person asks for assistance or is incapable of actually committing the act of suicide, is it illegal? Should it be? Let alone immoral? Again, should it be? Then there is the issue of ‘pulling the plug’. Is that murder? The case for euthanasia has gone on for decades. But can light shed on the subject make a difference in the moral grounds of this debacle? Robert Young states in regards to a characterisation that “the important moral question about either by act or by omission, it avoids begging to respond to a competent request for assisted dying by way of allowing the requestor to die, but not by killing him.” (16). Young continues later to say in respect to a terminally ill patient refusing treatment, “whether we regard this as an instance of suicide…or one of passive voluntary euthanasia…is moot.” (16)

Euthanasia is a tough subject to talk about, even if morality could be taken out; there are those who still have strong opinions about the legality of it all. As it is, seventeen years ago, “voters in Oregon passed a law allowing physicians to prescribe a lethal dose of medication to a terminally ill patient….Under this law, patients…must end their lives while still being able to swallow.” (Shavelson,, 67). What about coming upon a situation like the woman, fictitiously named ‘Sarah’, who, from Shavelson’s account of a man also fictitiously named ‘Gene’, comes upon her friend she believed was going to merely discuss the idea. Instead, the situation went much further. Her account is thus, “’But when I got there I felt like the train was running and I had to jump on…., and I went with it; the whole nine yards.’” (Shavelson, 68-69). Here, Sarah was roped into doing something she was unprepared for and thus had a ‘knee-jerk’ reaction to help her friend. Shavelson himself recounts dreams where he would attempt to stop the act, waking up never knowing if there could have been any other outcome of Gene’s situation. It would appear to be that there are situations where one must make a snap decision and seems to be that the initial gut instinct, in my opinion, is the best. Who knows what Gene could’ve done if he’d not had a friend to turn to in the first place. His death could’ve been more traumatic for those around him.

But what of the second: “suicide-by-police” (US Legal, 2011) In this instance a victim “engages in life-threatening behavior to induce a police officer to shoot that person.” (US Legal, 2011) The person in question here is trying to force the law’s hand and create a situation where the police have no choice but to shoot. But for this tactic to be effectively attributed to someone, they must show “an intention to die” (US Legal, 2011) and that he/she “understands the finality of the act,” (US Legal, 2011).

Stigmas: Society’s View of Attempted Suicide

A study was done where the purpose “…was to determine how attempted suicide would be viewed relative to the stigmas that were studied by Weiner…drug addiction… AIDS… posttraumatic stress disorder resulting from the Vietnam War… and cancer” (Lester, 399). It was found that a “person who attempted suicide was viewed as more responsible for his or her condition…” (Lester, 400). Being as thus, the person “who attempted suicide aroused more anger and less pity than the person who had cancer, AIDS, or post-traumatic stress disorder did but less anger and more pity than the person with a drug addiction did.” (Lester, 400). This is upsetting. To see that this is what people might think of if they know someone has attempted suicide, it’s heartbreaking. If anything, it should be that they feel more compassionate towards them; it is after all, the condition that brought them there, not vice-versa. Yet, according to this study, it could be concluded that “suicide attempts may inhibit the expression of support from peers and may elicit a less helpful response from professionals.” (Lester, 400).

Effects on Children: Parental Suicide vs. Death by Long-Term Illness

There are four different ways to die: natural, accident, suicide, homicide. What happens when a child loses a parent? Thinking of the answers brings to mind the obvious. But what doesn’t usually cross the mind is how the parent died.

Although “death of a parent is one of the most stressful life events for children, few empirical studies have investigated children’s psychological outcomes after parental death.” (Osterweiss et al., 1984, Pfeffer, Karus, Siegel, Jiang, 1) which is what would bring up the fact that how the parent died is just as important as the fact that they died.

“…children whose parents died from cancer have been reported to exhibit symptoms of depression and associated psychological problems involving anxiety, behavioral problems, decreased social competence, and lower self-esteem. In contrast, children who experienced unexpected, sudden, or violent forms of parental death, including parental suicide, have been reported to manifest not only symptoms of depression but also severe anxiety, hyperarousal, and intrusive thoughts within the first year after parental death.” (Siegel et al., 1996, Pynoos, 1992, Pfeffer et al., 1997, 1)

The significance of how the parent died cannot go without recognition. If a child is treated as though their parent had a heart attack when in actuality they committed suicide, it would affect their behavior and psychotherapeutic treatment. As this states, children are more distraught following sudden or violent death and should be treated as so.

Treatment

The reality of the situation though, is that “[i]t has to sober us to realize that as long as people consciously or unconsciously, can successfully dissemble, no suicide prevention program can be 100 percent successful.” (Shneidman, 58).

As stated by Shneidman (1996), there is a simple formula to suicidal ideations of a suicidal person which is “if you address the individual’s perturbation (the sense of things being wrong), that person’s lethality (the pressure to get out of it by suicide) will decrease as perturbation is reduced.” (139)

Twenty-four ‘psychotherapeutic maneuvers’ of which “whose purpose is to craft the therapy to reflect the specific needs of a patient.” (Shneidman, 141) include “Establish; Avoid; To Be Aware Of; Disagree With; Arrange For; To Be Wary Of.” (Shneidman, 142) and each has particular meaning to the cases Shneidman discusses in his book. ‘Establish’ refers to the fact that it “is obvious that the therapist would, of course, wish to establish a good working relationship with each patient, to establish rapport.” (Shneidman, 147). With ‘avoid’ Shneidman discusses that there are “different things that should be avoided in therapy” (149). In turn, in discussing what ‘to be aware of’, Shneidman says “Not phony approbation, but genuine acceptance. The therapist should have good modicum of positive countertransference…” (150). This is to say that smiling and going along with what the patient has to say is not recommended but rather an actual reception of what they are saying and, not necessarily approval, but certainly not rejection; which leads to the next maneuver, ‘disagree with’. Shneidman proposes ‘[s]hould we disagree with the suicidal person? Disagreeing with a patient is a dicey and worrisome thing, but the fact is that some basic disagreements with the patient are fundamental to psychotherapy. (Disagreement does not mean argument or disputation.)” (153) He goes on to state that “One always fundamentally disagrees with a suicidal person;…you recognize that the person is there because he or she is sufficiently ambivalent and some important part wants to find a way to live.” (Shneidman, 153). To ‘arrange for’ is rather simple however. Being that it can be hard for a suicidal person to make their own arrangements that would further their recovery, the therapist might intervene and do something such as “act as an ombudsman—a person who does practical things for the patient, who runs interference as it were, and helps with some of the onerous details of life.” (Shneidman, 154). Shneidman lastly declares that “vigilance is the name of the game. One should always be wary of increases in the person’s lethality, in cryptic remarks that might imply suicide…and not hesitate to ask directly about them.” (155) Here, he asserts that a certain severe watchfulness is pertinent to the safety of the suicidal person. It would appear to me to be that the most important psychotherapeutic maneuver would be ‘to be wary of’ for the simple fact that the importance of being vigilant of a patient’s condition could change a life, or end it.

Theory and Actuality

The mind of a helper, a therapist or a close friend, and the mind of the suicidal person are quite different. One values the life of the other, while the latter doesn’t value their own life. What’s going through the suicidal person’s mind? For someone that’s already dead, all that can be done is a psychological autopsy; investigate into the victim’s life. Did they have any prospective or retrospective clues left behind?

What else is there to do to help a suicidal person than to tell them they are wrong about wanting to kill themselves, they should value life and that their problems are not as impossible to deal with as it may seem? This is a difficult question and having been in this situation, I can truthfully say, that in the beginning, there is not much anyone can do. For some, that period of lingering lethality can be mere moments before they are remorseful of their actions to days to weeks to months or even years. As for myself, having gone through a few different bouts of strong suicidal ideations, and one true attempt, I can truthfully say this as well; everyone is different, and that is what makes us the same.

References

Caruso, K. (2005) Suicide.org

Jiang, H., Karus, D., Pfeffer C.R., Siegel K. (2000) Child survivors of parental death from

cancer or suicide: depressive and behavioral outcomes John Wiley & Sons

Lester, D. (2001) An attributional analysis of suicide The Journal of Social Psychology

Shavelson, L. (1995) A chosen death: The dying confront assisted suicide Simon and Schuster

Schneidman, E.S. (1996) The suicidal mind Oxford University Press

US Legal Inc. (2011) uslegal.com

Young, R. (2007) Medically assisted death Cambridge University Press