A 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. In 1961, he fatally shot himself in the head.
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: Suicide is Not Inevitable for a Specific Person
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: Suicide Prevention is Limited, but a Specific Person’s Suicide is Not Inevitable
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. We are limited in other ways, too, which I describe in my post: “You Can’t Do Everything”: Limitations in Helping a Suicidal Person. My motto is, “Do everything you can but know that you cannot do everything.”
Summing Up: Hope, Hopelessness, & Suicide
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. To say that any one person’s suicide is inevitable is a nihilistic view that degrades hope, belies possibility for change, and can lead to complacency on the part of the professional.
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.
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© Copyright 2013 Stacey Freedenthal, PhD, LCSW, All Rights Reserved. Written for www.speakingofsuicide.com.Photo purchased from Fotolia.com.
Hello, thank you for your answer before.
If mental health professionals feels his/her patient’s problems are too much or may be beyond help, are there still any hope that the patient can keep living? If the patient’s country allowing euthanasia, can he/she ask for assisted suicide? Thank you
I am so mad for being created into this lump of shit and if it Is “God” who created me I have the right to be offended. What a foul piece of shit I have become. There was never any hope for me I knew what a piece of garbage I was as a kid and knew I was meant to be trash when I grew. Now I am and I can’t keep going. I have ruined so much. Nothing I do will change
Now, at age 77, I am thinking about how I can leave. The only thing that keeps me here is caring for my 3 senior dogs who are special needs-2 of them have dementia, which contributes to my own anxiety. Each day gets more depressing; I know that when it is time to euthanize the dogs that I’ll have no reason to be here. My first attempt was at 16, another near attempt at 50, and a hospitalized attempt at 64. Mother had numerous attempts, also. No shame for me as I did a lot of good works volunteering with many people, hospice, palliative care. etc., etc. for the past 35 yrs. Now I live alone and no one depends on me. Since covid there are no more social interactions and I have “aged out” of all my volunteering jobs. I do not see what is wrong with making our own decisions to leave while we still are of sound mind.
My brother recently took his own life. I live with the guilt that I could have stepped in and maybe prevented it. Seeing the terrible mental mess he became during lockdown over covid my only consolation is that he suffers no more. I deemed it inevitable that he would do it. I believed even though he had a broken mind that I should respect him for making his mind up to relieve his torment. We couldn’t keep him under suicide watch 24/7. He did it so sneakily that he wanted to die and not be stopped. His torture has now become ours. Some folk simply get too broken to be fixed.
Linda,
I’m so sorry for your loss. Your grief is evident in your comment, and understandably so. A few articles here might be of interest to you:
“If Only”: Self-Blame After a Loved One’s Suicide
“You Can’t Do Everything”: Limitations in Helping a Suicidal Person
Coping with the Suicide of a Loved One
The site’s resource section for people who have lost someone to suicide also might be helpful.
Thanks for sharing here. Unfortunately, many people have experienced a similar loss, and feelings similar to yours. Fortunately, your comment will help others to feel not so alone.
Good read. I’m not alone. I know that one day I will die by suicide. It’s the only realistic future I have in today’s world. Too expensive. Too hard to get help. Suicide is not a bad thing. A person who feels it is inevitable has already come to peace with it. They are just living rhe best life they can before they have to leave this earth.
I feel you man. When they say anything can change in the future it’s little comfort after living hopeless for years. There is no change coming to my life to reverse this. I will always struggle and my capacity to shoulder that burden diminishes with each passes day until eventually…
Some of us have completely worn out all of our relationships, family included, with our varied mental illness related depression. Absolutely no one we know will care when our suicides are accomplished.
Agreed. Sometimes people have to realize some things that hurt people every day cannot be changed by anyone and living with those things is not possible. Unfortunately, suicide, in those very few cases, is inevitable and logical.
The position that some suicides are unpreventable but nevertheless not inevitable, is simply illogical; it makes no sense. If anyone’s suicide is preventable, then everyone’s suicide is preventable. A more sensible point of view is that some people’s suicide is indeed inevitable, but it is extremely difficult, if not impossible, to predict who these people are; therefore, psychiatrists and other mental health professionals should treat each suicidal person with the assumption that they can do something to help them.
Furthermore, even if a person’s suicide is considered inevitable, this doesn’t mean there is no value in trying to help them. Suppose that a suicidal person received treatment and, as a result, lived peacefully and in relative happiness for a few years after that. Even if he were to become suicidal again later and eventually take his own life, he has objectively benefited tremendously from the treatment that he received, as did his friends and family who have gained a few more years with their beloved.
Some suicides are inevitable.
Most of you live in a bubble.
Centered around yourself.
The things you’ve seen, what you’ve done, what you know,
amount to nothing.
You cannot be in anyone else’s shoes
nor their mind.
Therefore, if someone is committed – they will die.
Even if it means doing nothing;
until their body loses function and rots.
Anyone who says anything else is fooling themselves.
This comment was edited to abide by the Comments Policy. – SF
I’ve always had a feeling that I would eventually commit suicide. Suicide has always been my back up plan but im somehow still here.
I’m adopted & have never cared to find out who my biological parents are or their medical history. It seems to run in families & I’m doing my best to stop that from happening to my family.
I do know that things can turn around in a heartbeat even though that hasn’t happened with me. I don’t even see how I can be fixed but I’m barely hanging on & struggling to make it through each day.
It’s hard to describe but most of the time I feel like my head is being crushed & I just want to scream.
It’s an end to isolated unspeakable suffering and the wanting of many that need my death for their survival. Simple! The only way to end suffering and pleasing ones who fear my living. Medical health family community was never available to me, I don’t need any more proof that my choice is the only dignified way to end suffering.
Stay.
My kids are in high school and I want them to finish university undistracted. But once they’ve graduated and launched I’m done. I’ve lived with this for so long I’ve basically thrown my life away and most days are unbearable. I have been suicidal since adolescence and it has only gotten worse, and I do see it as inevitable. For some people there’s no question we will do it.
I’ve been thinking of dying a lot lately. And it’s not out of fear but rather because I see no rational and logical reason to live. I don’t like people that much. Even my family who’s pretty close to me, I dislike them very much at times to a point where I question if I’ve ever loved someone before. My best-friend gets on my nerves. I see no real pleasure in material possessions. I’ve grown sick of the fad. When I was in middle school, I forced myself to “like” people because I remember wanting to feel something.. I may be romanticizing my own life. Outside of these things I have my small dream of becoming a polyglot and studying languages. However now I’m a junior in High school and I hate the world, the system, the law. I just don’t understand why I have to submit to the government and society in order to live a very restricted life. I’m aware that we can’t do anything without effort so even if I were to live in the woods.. it’d be hard. But the point is I hate having to do things I don’t want to do and I have no choice but to do them. Math homework.. Spanish tests.. Does this sound very productive to you?! And don’t think my reasons are school based. I am upset of the structure modern civilization has created. It includes school, but it continues after. I look at history especially, which I like, but it makes me terribly sad and upset.
I’m not religious. I often think what if there’s a ghost or demon watching me, but I do not believe in a hell or heaven particularly.. Maybe I’m just dumb. I think I’m inferior to others that want to take their life because they have better reason than me. At least I have my dream. It’s just that I have to bear this crap in order to get to it.. I study languages now too, but other obligations of life get in my way and make me want to die. I will take my mustard seed of faith and continue, but I’m bound to fall again. Good Luck to y’all.
Be a polyglot.
Very good
I think you took a much more Real approch to this Or should i say I relate to this
As i am so tired of fighting to get what i need to stay alive and pain free
No one Really cares anymore about people and i find it hard to be understood or understand this world and the people any more
Umm its like i woke up in this very dark dark place 3 yrs ago I know depression has been creeping up for the last 10 years
But i am soo close to saying fuck you to them
My animals and my giving in to them does stop me
I dont want to hurt others but lately it seems that they are deliberately hurting me
As not doing their jobs and not taking me as a person
I have a strong sense this world has changed for the worse and so have the people so insensitive
So socially messed up
Tons of lonely people besides my self
Thats not a good sign and i mean young people not just old
They stay on the computer like if its Real many cant communicate normal any more
I am so fed up with Fakeness
I lived a good life seen bad and surpassed it but now its ugly and not worth living
Why ?
My time i feel is done
They and the world are not going to change for the better soon
My dogs are cats living the quality life as they did before i got this bad etc
I am really just tired of fighting for my rights
The pain is horrible
Well thank you
I never thought i could explain myself You did it for me
Also to add Tell people ways to help one is never turn your back on them which many do thinking its catching
That just puts in more proof that no one cares any more
And what keeps me going is to get even Not letting them get away from doing their jobs
But i know when i lose that i will fight not much longer
Thank you
Peace
Your animals love you. Stay.
I hope I have the courage to take my own life someday
Dont hope that. You honestly shouldn’t. I don’t care if you’re a kid who has abusive parents or an adult who has depression. Think of reasons why you’re still alive. Is it because you don’t want to cause grief? Or maybe you believe people who die from suicide go to hell?
I hope you don’t. Stay.
Your article seems to imply that hope is a good thing. I don’t think it is. On the contrary ‘hope’ is what we call the lies we tell ourselves in order to comfort ourselves from the truth. The truth is that to many, many people life is grim, and horrible and death is preferable. As the saying goes “life’s a bitch and then you die.’ The kindest thing we can do is stop the pretense, look life in the eye, and decide for ourselves if life is worth the cost.
john, you hit the nail on the head. I struggle with the crap that everyone tells me when I fail at everything I do…. “don’t give up….keep trying.” I’m 34 yrs old, how many times do I try and something actually works out? I don’t want to be 50 years old and have failed at everything i do. The best answer is to just leave the world. I don’t have the balls to do it, but i can be passive about it. Life sucks. There are some of us that just simply aren’t “the chosen ones.” Some people have it all and others can’t have anything no matter how hard they try.
Agree 100%
So so true
When the real truth comes out
Yep you’re so right
And i am finding that i am right the world sucks no matter how i want to convince i am ok or how much I like my life ( lie)
I feel suicide is inevitable for some people with particular thought patterns. I know one day I might take my own life for reasons that may seem trivial to others or to me sometimes but I can’t just help myself. I have lived all my life desperate for some sort of attention and a plan for the foreseeable future. But I’m just so scared and feel life is not worth living if I have lived my childhood in some sort of fallacy. Might seem stupid and all but this sole reason has been the root of many years of depression and hurt as a teenager who dreams of a life he surely cannot have. It sucks so at the end, it is inevitable.
Sometimes we just need love and to feel more important than we are in people’s life.
So very true—really resonates with me.
I’m not suicidal but my son recently attempted suicide. He was in The hospital 3 days and was then transported to a mental facility where he stayed for 5 days.
I am his go to person. He talks to me about his feelings a lot!!!
That’s how I knew it was time to call 911.
Since he’s gotten out he acts surprised that all of his problems are still there. His comment last night was “ why did I even go to treatment at all? It was a big waste of time. “
He is still struggling with Asperger’s Syndrome, ADHD, Depression, Anxiety, Ventricular Tachacardia, hypertrophic cardiomyopathy, Selective IGA Defficency , and now the after affects of the suicide attempt. He’s been through a lot in his 25 years of life.
He works one full time job, a second 3/4 time job and goes to college full time.
Despite all of this he has a strong desire to be a body builder which he is very good at.
I love him so much! I’d give my life for his if I could.
Now we are two weeks out of treatment. He’s stressed again and looking to me for answers. The hang up is I’ve been doing this “dance” for 20 years and I’m not healthy at all either. I have a lot of chronic health conditions.
How do I help him when my tank is below empty.
I don’t know what to say or do anymore. My anxiety goes through the roof every time the phone rings. I’m a mess with no answers.
He needs to lower his expectations snd mature in his thinking. 1. EVERYONE has problems. They don’t go away because we go to therapy or quit self destructive behavior. Hopefully, we are more aware of the human condition and it’s attendant problems. 2 Full time student and works 1.75 jobs? So 16-18 hours of school; 70 hours of work AND body builder? Come on… He’s using steroids and destroying his body and his mind. Full time student, 1 job (or grant or scholarship if he’s really serious about elite sport) NO DRUGS for performance enhancement!
YOU: take care of yourself first. Impossible to give to him if you’re physically and mentally compromised. I don’t know if either of you has the insight to recognize how preposterous your narrative sounds to an outsider. 1 3/4 jobs?? 70 hrs/will full time student: 18 hrs/ week class and 20-28 hours a week studying. Elite fitness: 28 hours a week- so 140 ish hours a week before sleep social life, eating , grooming and other obligations. There are 168 hours in a week, leaving him perhaps 4 hours per day to eat sleep shower socialize. Either you both are in the habit of grossly exaggerating his challenges and he isn’t actually under the extreme duress you describe, or it’s all true , and neither of you has a lick of sense.
I am deeply read on the life of Joseph Merrick aka The Elephant Man. His was a life of terrible and constant physical and emotional abuse, undignified treatment by everyone he met and physical conditions which made life unbearable. In the end he knew that his situation was hopeless and getting worse. No matter what you may read or like to think he made the deliberate move to lie down knowing that it would end his life. His suicide was not only inevitable it was right and dignified. You may not believe this but I can tell you his life mirrors mine almost uncannily. I’ve tried to suicide 4 times and some of those attempts were whilst I was seeking treatment. I think Joseph’s suicide was inevitable and some people have similar lives to him or at least variations thereof. I think we need to understand that in some instances suicide may not be wrong at all.
It depends what that individual’s reason for suicide is and realistically, how likely it is that this issue will be resolved. If they are suicidal due to severe poverty (as an example) and no one is willing to fix that problem by getting them out of poverty, then suicide is inevitable (the alternative being a lifetime of continual suffering).
Esme,
What you say makes sense logically, and poverty certainly is correlated with suicide. But the reality is that millions of people who live in severe poverty do not die by suicide. And there are thousands of people who live in wealth and affluence who die by suicide. Suicide is not logical, which I suppose is not always a bad thing.
I deeply wish that there weren’t so much suffering in the world. But even a lifetime of continual suffering does not make a person’s suicide inevitable. There are countless people who suffer, with no end in sight, who do not die by suicide. It’s really hard to make sense of suicide, which is why we still have no way of predicting who will die by it.
Thank you for contributing to the discussion!
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.
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.
Fatima,
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 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!
The Suicide Lifeline is not always the answer. They are connected with local crisis lines. Our crisis line has a bad reputation. Among other things, they are quick to send out the cops, who are untrained and tend to be verbally abusive. This has happened to me twice. Now I am afraid to contact them anymore.
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.
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.
Hi feather vare
I happened to be reading this post and noticed that you were from Santa Cruz. I lived there for 15 yrs and still have ties and was wondering if you read this if you feel like replying I would like to talk. I have been through a nightmare too obviously cause I am reading this post in here. But yes I would like to talk to another Santa Cruz person . Thanks
Frank
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.
Jean,
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.
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”?
It’s not the listening part, but people willing to actual fix the problem. It’s very easy to sit there and nod and smile and make the right noises and tell someone ‘that’s terrible, I’m sure it will get better’. But then walk away and leave you with the same problems that are making you suicidal. So you remain suicidal, as the issues have not changed.
Esme,
I understand that for you it wouldn’t be helpful to have someone listen. For many people, though, true listening is very powerful. The person who feels heard and understood still has the same problems, as you note, but the act of listening just might help the person to gain clarity and hope about solving the problems.
For one person’s testament to the power of listening, see this video by Kevin Berthia, who stood on the edge of the Golden Gate Bridge for more than an hour and a half talking about his despair while a police officer mostly just listened. The officer saved his life.
Again, I understand that listening wouldn’t be enough for you. For many others, true, heartfelt listening, and the sense of connection and hope that can result, are enough. I say that so that others who come upon these words will, I hope, listen to others, and be listened to.
I found this commentary on Robin Williams death quite interesting;https://healingfromcomplextraumaandptsd.wordpress.com/2014/08/20/i-guessed-robin-williams-was-abused-as-a-child/#more-7366
I am so shocked someone speaks of my mind. I agree with zara. zara can i talk to you?
“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.
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.
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.
Dear Stacey,
Your opinion that it is not healthy or normal for a person’s survival instinct to wither is of course legitimate (as are most opinions). However, you must recognize that what is considered healthy or normal is completely subjective. Many things that are considered (by most people) normal and healthy today, such as homosexuality, abortion and transsexuality, were once considered wrong, abnormal or even a symptom of some ill-defined disease.
To support your opinion, you have mentioned a few examples of people who’s survival instinct remained present despite terrible circumstances and living conditions. I would like to present some examples of the contrary:
1. Each year, many terminally ill patients in the United States and other countries decide to sign a DNR (Do Not Resuscitate) order. Although exact numbers are hard to come by, anecdotal evidence suggests that it is at least tens of thousands of people and probably several hundred of thousands in the US. Furthermore, DNR orders are becoming more prevalent with each passing year.
2. Even more people are making conscious decisions each day that would inevitably lead to a loss of many potential years of their life, such as heavy smokers. In other words, while most people aren’t quite suicidal, a significant portion of the population is “passively suicidal”. Whatever this says about these people’s survival instinct is a matter for debate, but it certainly says something.
3. Some countries and several states in the US have legalized assisted suicide to people who are terminally ill. The number of people utilizing this new option increases with each year.
It seems that an infirm survival instinct is something that is becoming more and more commonplace. Whether this is healthy is, as I said before, subjective, but in my view, people have the right to make their own decisions, even if these decisions are detrimental to their health: heavy smoking, excessive alcohol consumption, signing DNR orders and so on.
Lastly, I’d like to point out that it’s safe to assume that no Holocaust survivors died by suicide; if they did, they wouldn’t be considered survivors in the first place.
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.
Lighten up Francis.
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…
Zara,
I agree.
And when one considers the finitude of existence, the ephemeral nature of the present, the contingency of life, the non-existence of the past, the constancy of need, the experience of periodic emptiness / boredom and, most importantly the inevitability of death…. all of this detracts from the possibility of a meaningful life.