Is Suicide Inevitable for Some People?

Print Friendly

Is suicide inevitableA 61-year-old man, E.H., survived suicide attempts, received care for depression in psychiatric hospitals, and battled alcoholism for many years. His father died by suicide. E.H. was convinced that one day he, too, would kill himself, and he did.

Was his suicide inevitable?

Ernest Hemingway, the famous author and the man described above, died by suicide in 1961. Eventually suicide also would claim two siblings and a granddaughter. A controversial article uses Hemingway as an example of what the author calls “inevitable suicide”: “the patient whose suicide will occur regardless of the most expert and skilled therapeutic intervention.”

The article’s author, Benjamin Sadock, MD, blames this (supposed) inevitability on the unfortunate confluence of factors that can create excruciating despair, pain, and pathology: “When all of these areas—mental illness, genetics, and other risk factors— reach a critical mass, the extent of which remains to be determined, the likelihood of a particular patient taking his or her own life is increased to the point of inevitability.”

Dissenting Views

Two letters to the editor came out a few months after Dr. Sadock’s article. One letter, by psychologist Thomas Ellis, PsyD, states:

“…the word inevitable is appropriate in some contexts, such as, ‘It is inevitable that some suicides will occur among psychiatric patients.’ But it is a different matter to suggest that some individuals’ suicides are or were inevitable. To do so is to risk rationalizing patient care practices that should be examined and corrected.”

The other letter, by Thambu Maniam, MBSS, MPsychMed, likewise objects to the notion that any one person’s suicide was inevitable:

“I remember a psychiatrist, whose patient had recently committed suicide, saying ‘You can’t stop suicide. Whatever you do, they will still die.’ I wonder what consequences such a fatalistic view would have on his practice.”

My View 

It is true that suicide is not, with our present state of knowledge, 100% preventable. So in that sense, in general, some suicides are inevitable. But – and this is an important distinction – the suicide of any one person in particular never is or was inevitable.

As long as the suicidal person is alive, there is hope for change. Anything can happen in life at any moment to change the person’s situation, suffering or outlook.

For our part, as mental health professionals, we have many tools to help a suicidal client recover hope, strengthen reasons for living, learn to cope better with emotional pain, and recover from psychological problems such as depression. Cognitive behavioral therapy and other evidence-based treatments, active listening, risk assessment, safety planning, skills training in mindfulness and other coping techniques, and the therapeutic relationship itself are just some of the healing tools that mental health professionals can draw from. Physicians and prescribing nurses have the added tool of medications.

So why would Dr. Sadock declare some people’s suicides inevitable? He has good, if misguided, intentions. He writes that the concept of “inevitable suicide” can lessen the guilt of clinicians who unfairly blame themselves for the suicide of a client.

The implication seems to be that if a specific client was going to die by suicide no matter what, then the people treating that person are not to blame. But this is a false dichotomy. A suicide need not be “inevitable” for a clinician to be blameless. 

A great many factors that can lead up to a suicide are well beyond the clinician’s control. This fact does not mean that any one specific person’s suicide is inevitable, only that psychotherapists and other mental health professionals are inherently limited in what they can do to prevent suicide in general.

“Inevitability of Suicide” versus “Limitations in Suicide Prevention”

As I said above, anything can happen at any moment to change a suicidal person’s path. This works both for us and against us. Although positive changes can occur suddenly, so can negative changes. There are so many things beyond the clinician’s control that the suicide of a client does not necessarily mean that the clinician did a bad job.

With our current state of knowledge and tools, it is impossible to predict who will or will not attempt suicide. Some clients understate their suicidal intent, to avoid psychiatric hospitalization or interruption of their suicidal plan. On top of that, mental illnesses respond unpredictably to psychological and pharmacological treatments, with no treatment offering 100% effectiveness. 

And those are only a few of the limitations inherent to suicide prevention.

Summing Up

Even when mental health professionals bring all their skills and training into the room, even when they conduct a thorough risk assessment, even when they develop an attentive, empathic, therapeutic relationship with the client, even when they do do everything they can, the client still might die by suicide.

It might sound like I agree with Dr. Sadock about the inevitability of some people’s suicides. I do not. Recall that he defines inevitable suicide as “the patient whose suicide will occur regardless of the most expert and skilled therapeutic intervention.” I agree that some people will die by suicide despite their clinicians’ “most expert and skilled therapeutic intervention.” I disagree that this means those people’s suicides were inevitable.

Instead of deeming suicide inevitable for any specific suicidal client, we need to look at the limitations that mental health professionals face with every suicidal client. These limitations merit research and other efforts to diminish them. I am grateful that we usually can help suicidal clients in spite of those limitations.

© Copyright 2013 Stacey Freedenthal, PhD, LCSW, All Rights Reserved. Written for

Photo purchased from

Related Posts

Comments are welcome!

15 Reader Comments

Trackback URL Comments RSS Feed

  1. Ted says:

    Yes some people are just meant to commit suicide, pills and therapy are not the answer to everything, it’s sad that people don’t want to admit it like the late great George Carlin once said “not everyone can be saved” it’s best to let the people who want to die die it may sound cruel but it’s not, would you rather these people live miserably or in pain or both for the rest of their life also suicide is not selfish or cowardly, what’s selfish is people wanting suicidal people to stick around for their benefit not the benefit of the person wanting to die. My suicide is inevitable tried pills and therapy none of them worked.

  2. Fatima says:

    In a way, yes it is inevitable in the sense that mental health professionals can never really prevent certain individuals from carrying it out. I, for one, am guilty of downplaying my suicidal intention to my psychiatrist and psychologist. But that’s just how it is.

    I don’t even know why I’m seeing them when I have a solid plan in place in a few days anyways. I don’t see my life going anywhere given my personality flaws and I know myself better than anyone else, hence I choose the end of the road.

    Sometimes, it really is the better road. For me, I know it is.

    • Stacey Freedenthal, PhD, LCSW says:


      Personally, I hope that you are wrong and that this is not the end of the road. It does not need to be. I hope you will consider calling the National Suicide Prevention Lifeline if you are in North America, at 1.800.273.8255 (TALK), or 911 (or your local emergency number if outside the U.S.) if you are in danger of acting on your plan (which it sounds like you are or will be soon).

      There is also a list of resources on this site, where you can get help by phone, chat, text or email:

      I believe that a part of you does not want to die. That part of you visited this suicide prevention website even when you have “a solid plan in place.” That part of you, I believe, has hope. Please honor that part of you and speak honestly to your psychiatrist and psychologist about the extent and intensity of your suicidal thoughts. They cannot fully help you if they do not fully know what you are thinking and feeling!

    • Feather Vare says:

      Fatima! Plz tell me u r still here! I would love to chat with u. I’m safe and friendly, compassionate and understanding. I have had suicide in my life first hand. Ibhave also felt like ending my own life. Lets help each other. Plz contact me. I live in Santa Cruz.

    • Feather Vare says:

      Hmmm, just commented but cannot find posting.
      Fatima I pray u r still here. Your post was from nearly a yr ago.
      I would love 2 chat with u. I have personally had suicide in my life and have even considered it.
      We could help one another if u r open to that. The search for strong mental health is lengthy and not easy. A friend to listen and listen to, would be great. If this interests u, I live in Santa Cruz, and would be happy 2 connect.
      I am compassionate and safe.

  3. Jean E says:

    I have attempted suicide. I spent four days in a coma after taking a month’s worth of venues. It wasn’t a suicidal gesture, but if I had felt anyone was actually listening to me I probably wouldn’t have done it. I’m not suicidal now, but I believe I will eventually die by suicide. That’s just the way it is.

    • Stacey Freedenthal, PhD, LCSW says:


      I can only imagine the pain you were in that led you to almost die. I’ve heard many people say the same thing as you: that if someone had just listened, they wouldn’t have taken the drastic measures that they did. How many people have died because no one would listen?

      And yet there are many places where people want to listen to those who need to be heard. A good one in the U.S. is the National Suicide Prevention Hopeline, at 1.800.273.8255 (TALK). It is staffed by trained professionals 24/7.

      I list other places where people can get help by phone, text, email or chat in the Resources section of this site:

      One minor note: You said you took a month’s worth of venues. I don’t know what that means. Did auto-correct change something to “venues”?

  4. ... says:

    I am so shocked someone speaks of my mind. I agree with zara. zara can i talk to you?

  5. Zara says:

    “For our part, as mental health professionals, we have many tools to help a suicidal client recover hope…”

    I don’t see many supposed treatments other than talking or pills. The truth is that neither is terribly effective and they won’t likely be of help to a person whose life circumstances are so dire (real, intersubjectively verifiable misery not just imagined problems) he doesn’t see any other way out than taking his life. Hell if all you needed was some attention to make it better (the weaklings who swallow some harmless pills or make shallow incisions in their wrist and claim they made an actual suicide attempt) chances are your problems weren’t very great to begin with and your main problems are a gigantic ego and a weak personality. Something tells me that someone who’s gravely ill, homeless, elderly with no-one who gives a damn about them, incurably mentally ill or suffering from any other of life’s nasty little torments will think his problems will just go away with talking to a smug, self-appointed beourgois professional (most likely young, healthy and well to do) who has no clue about his problems for the simple reason that they never experienced them themselves. Same goes for drugs that aren’t cures but merely palliatives and often they fail at that too.

    Neither pills nor talking have the power to actually alter reality and someone who isn’t delusional about his situation will quickly realise this. Only those whose thinking is completely unrealistic (e.g my girlfriend left me therefore I’ll never be loved again therefore I need to kill myself) and who are prone to acting impulsively may benefit from these things, for the others it’s likely a waste of time and will merely prolong their suffering. Sometimes the worst thing you can do to another human-being is offer false hope since (as Nietzsche famously remarked) hope truly is the worst of all evils for it prolongs the misery of man. I really don’t get how it’s apparantly so difficult to understand for supposedly well educated people like the above mentioned professionals that life can indeed and often does become so bad extinction becomes preferable to living a pointles existence full of torment but then again ideology and economic benefit usually go a long way in explaining such apparant anomalies. In the simplest terms: pain = bad, a lot of pain that just won’t go away and haunts a person day in day out = cause for suicide. No cure for the pain = no prevention of suicide.

    If at one point in time they’ll actually know what the causes of mental illnesses are and what to do to correct them then and only then will be there true mental health care (although these problems will probably be called neurological diseases instead of mental disorders) but even then life can still become so bad it’s rational and sane to want to escape a life that contains (far) more bad than good. This has been shown and defended by quite a few notable philosophers (Seneca, Hume and Schopenhauer for example) and wisdom is clearly not the area of expertise of either psychiatrists or psychologists. The arrogance of claiming that there are no inevitable suicides is more than enough proof of this. Even if this were true it would be quite a blow to the reputation of the mental health profession, especially if the patients were under their care at the time of death, since it would mean they are in large part responsible for the high suicide rates in most western countries.

    I’d say sometimes suicide is not only inevitable (can’t lock up and drug people forever) and constant pain is a very strong motivator) but smart, wise and courageous, in short a commendable moral action instead of the brain gone haywire, no free will at all shameful accident it’s made out to be these days.

    • Stacey Freedenthal, PhD, LCSW says:

      Your comment is very incisive and raises many of the arguments about why and how suicide can be “rational.” As you convey so well, a major argument is that if a person’s suffering is profound and with no foreseeable end, then suicide is rational.

      One of the things that keeps me going as a therapist and researcher specializing in suicide prevention is my constant exposure, both in real life and in historical literature, of people who experienced unfathomable suffering yet did not, as the proponents of rational suicide argue, inevitably die by suicide. Instead, even in the most extreme cases, the survival instinct enabled them to endure physical torture, traumatic loss of family members, starvation, and more – conditions for which others would consider suicide to be a rational response.

      Here I am thinking most intently of Victor Frankl, who experienced the above conditions as a concentration camp prisoner in the Holocaust and who, in his book Man’s Search for Meaning, wrote passionately about people’s ability to endure any degree of suffering. There are legions of others, too, who did not die by suicide even amid years of sexual slavery, captivity, etc. You might argue that they did not have access to the weapons for suicide, but the forces of suicide can inspire almost maniacal creativity and resourcefulness in the service of death. Means for suicide are never absent.

      What prolongs life amid excruciating suffering? The survival instinct is an overwhelming life force. Every part of our being is programmed to survive, no matter the horrors we endure. (Again, you may find inspiration in accounts of Holocaust survivors. As with any group, some did die by suicide but the vast majority did not.)

      In some people, this survival instinct somehow becomes impaired or deadened, whether due to mental illness, substance abuse, extreme stress, or some other force. Again, in the face of so much evidence of people whose survival instinct remained intact amid extreme suffering with no end in sight, I do not accept that it is healthy or normal for this survival instinct to wither. Instead it is a sign of severe emotional injury, and this injury, like so many other injuries, can be healed.

      Thank you for sharing your insights. Let me add just one thing: thousands of people die every year from overdoses and a smaller number die from lacerating their wrists. To call these people (or those who survived attempts by similar means) “weaklings” as you did seems inconsistent with your otherwise eloquent and compassionate recognition of the formidable suffering that people can experience in their life. Words such as weakling and coward have been applied over the ages to people who survive a suicide attempt and, paradoxically, to those who die by suicide. They are, in my opinion, simplistic judgments that belie the complexities of suffering whose depths and nuances inherently make us outsiders to the person’s inner world.

    • Zara says:

      Thanks for the compliment, I’m surprised you actually approved my comments. Mental health professionals aren’t usually very open-minded (probably because a lot of what they say rests on the argument from authority), especially about a taboo topic such as suicide.

      I’m afraid you mistook my meaning: obviously it’s possible to commit suicide by cutting the wrist(s) or overdosing on over the counter or prescription medication but it is a fact that these usually very low lethality methods are often used to make so called suicidal gestures and that is something I find quite unacceptable, at least in grown men and women. I’m no stranger to mental suffering and I’ve seen it in quite a few others so my fundamental attitude is one of compassion, what I do take issue with is people who act all dramatically by swallowing a few pills and making shallow cuts (making sure someone is close by or calling someone right after) just to get attention or manipulate the people around them. There’s no shame in suffering but if you require help be an adult and speak out instead of making a fool out of yourself, if your situation is so grave only death can release you from your pain then surely you must know such a ridiculously theatrical act will accomplish nothing.

      People who call suicide cowardly are idiots since they obviously don’t know what they’re jibbering on about (surely the most rudimentary reflection and knowledge will show that the fear of death is the greatest fear any mortal being can experience, therefore it follows that to conquer that fear takes a great deal of courage which is the opposite of cowardice) and deserve to be thoroughly ridiculed but those who merely play at being suicidal make a mockery of the courage and composure of those poor souls whose only option was a self-inflicted death. That was the meaning of my statement and nothing else.

      I’ve had up close and personal experience with such inane, childish and passive-aggressive behaviour and at the time I was foolish enough to actually care and lets say it wasn’t beneficial for my own peace of mind.
      Obviously given your profession it’s understandable your attitude’s different than mine (can’t very well insult clients or potential clients and of course you don’t have to interact with them in day to day life) but I for one am sick and tired of being drained mentally and used by those who are too weak and cowardly to stand up for themselves. I can’t and don’t respect people who expect others to just put with their crap, including faux suicide attempts.

      I’m a libertarian and I’m all for the free distribution of any kind of drugs and even (though that’s highly unrealistic in today’s completely manipulated and shallow public debate) euthanasia for those who are suffering mentally (with the necessary safeguards: even I don’t think it’s a good idea to give lethal drugs to someone who’s drunk or in a psychotic state and in any case there should be a certain time period between the requests which should be thoroughly examined to exclude any sort of external pressure): if the means to die a peaceful and painfree death are widely available it’ll quickly become clear who’s serious about suicide and who’s not. The first category deserve our respect, help and compassion, the second category only when they’re actually willing to constructively work on their problems instead of laying the guilt and burden on others.

    • Dave27 says:

      Some good points Zara. After going through the full gamete of suicide management I realise there is no cure. At most treatment has a 4% benefit, but probably none. It is a horrible condition. After 2 years of deterioration I feel my suicide is inevitable, sadly.

    • Turlough says:

      Lighten up Francis.

    • Jess says:

      I’m in a very difficult and painful situation. The man I love has endured mental and physical pain for far to long undergoing countless treatments and therapy for over 16 years. We’ve only know each other for a short period of time and during this time I have witness his downfall day by day. When he was r as bad as he is now he asked to please do not allow him to suffer and go crazy. He said he did have the energy to fight any more . That even on his best days his choice would still be that one is final resting in peace…
      Knowing only bits and pieces of his life and not being familiar with mental illnesses and pain and what it could do to someone such as robbing them of themselves it was hard for me to comprehend and I instead of empathizing as I should have I fought him at every turn only doing what I felt was best. Trying to find any and all help and solutions and alternatives because it didn’t fit in my brain that something could not be done . I mean there has to be something in my hopeful mind and heart.
      Instead of I prolonged his suffering pushing him further and further away and his mind started to deteriorate. And even in his madness I could see the logic of his wish to finally be allowed to be at peace.
      I though about calling the police many times to do a wellness check on him but it seemed cruel and I have done so much reaserch and I found so many horror stories that it seemed it was not a good option..
      I’m at a loss . I don’t know what to do and in the meantime I watch him get worse day by day ….
      I need help. I can’t watch him suffer any longer and he won’t even see me or talk to me.
      He won’t see anybody …
      I feel he should have the right to finally rest in piece but my hands are tied …. I can’t do anything about it…