The Dark World of the Suicidal Individual

Marja Kuzmanic investigates the workings of the deeply troubled mind.

 

It is
 about hunger, about emptiness, never-ending emptiness, never-ending darkness, never-ending depth into which you keep falling and falling… If you could only see the bottom, you would at least know that eventually you will shatter, but there is no bottom, you are only falling, and you know and see that it is black and never-ending. Are you going to be falling for your whole life into eternity? – research participant1

Suicide. A difficult topic for a researcher and even more difficult for the one who finds oneself in the midst of a suicidal crisis, as they call it in suicidology, the science of suicide. Funny enough, Albert Camus2 thought that suicide, or the questions whether life is worth or not worth living, are the most fundamental philosophical issues. Whereas for Friedrich Nietzsche3 the thought of suicide was a powerful solace with the help of which you can make it through a bad night. Is suicide then something to be prevented, regardless of individual circumstances, or is suicide a truly existential option for every human being that shouldn’t be denied, for denying it might do more harm than good?

Suicide meant different things to different people at different times – something which is still true today. However, a common understanding of suicide in Western history developed from seeing it as a sin in Christianity, to that of a crime in the legal system, and finally in relation to mental illness in today’s psychiatric and psychological discourse. These various understandings still have an impact on how we understand and deal with this phenomenon today.

One of the most commonly encountered statements about suicide in scientific discourse is that it is a serious public health problem. In this sense suicide or suicidality are considered a priori to be a problem to be solved, instead of phenomena to be understood. Moreover, suicide is seen as a complication of untreated depression, and related to mental illness, and hence is a problem in society and/or a problem of an individual (depending on the scientific approach) that should be prevented. Suicidology, psychiatry and psychology have thus focused mainly on the question of ‘why’ suicide occurs, in order to explain it and prevent it.

The mentioned focus on explanation and prevention of suicide would perhaps not be such a problem if it wouldn’t also prevent suicidal people from speaking out about their suicidal thoughts – exactly what can help them bridge the profound isolation that they are often experiencing. Just think of a simple exercise: if someone tells you that you are not allowed to think of a blue elephant for the next minute – how difficult is it to really not think of it? It might strike you as a somewhat odd comparison, but not being allowed to consider suicide or speak freely about it, might be one of the most dangerous aspects of the attitudes towards suicide in a society. Feeling guilty or bad about entertaining such thoughts certainly does not help someone entrust their problems to others. Let alone the possibility that they might be locked up in a mental health institution against their wish (so called involuntary hospitalization) since they are a danger to themselves. Suicide prevention might thus be driving suicidal individuals underground instead of towards getting appropriate help4.

So you might also ask yourself – whose life is it then anyway?5 Don’t get me wrong though, I am not saying that individuals who want to commit suicide should do so and we shouldn’t give a damn. Quite contrary. I think that people can and should be helped, if they so wish. The only problem is that they often have to keep looking and looking, sometimes for a very long time, before they find the right person to talk to. During this time they might give up and/or loose trust in others as well as themselves – every such negative experience isolates them more. My PhD project regarding the experience of suicidality has taught me that talking about suicidal ideation with someone who doesn’t judge it, but simply listens, can do much more than we might think. Being listened to, being understood, and being allowed to be who one really is, are all important aspects of such a ‘therapeutic’ encounter. Plenty of research shows that suicidal individuals do seek help, that they do try to express what is happening to them, but that they are all too often not heard, not taken seriously, and, perhaps most importantly, not understood. The attitudes towards suicide, amongst other things, make it difficult for these people to express what is happening in a straightforward matter. This is perhaps even more so in a ‘happiness society’, where we are, on the one hand, craving happiness and, on the other hand, we seem to think that life does not involve pain or suffering anymore. Being suicidal means being unhappy and is in this society seen as a failure, which makes it even harder for an individual.

Perhaps the same can be said for talking about death more broadly. Western society mostly functions according to the logic of life and has to  preserve life by all means, since it is considered to be the greatest good, often regardless of its quality. Throughout the centuries, death has been at the center of people’s outlook at life. In a modernist worldview, which emphasizes scientific analysis, progress through reason, and our ability to control and dominate nature, the question of death has become marginalized6 and denied7. Suicide means death and should thus be  prevented, as it goes against the root metaphors of society and medicine. In this way, suicide prevention is also a form of suicide prejudice, often rejecting suicide without considering the individual circumstances. Even if suicide is not criminally penalized, it is in fact not legal, because otherwise its coercive prevention would be illegal8. To a certain extent, the legislation and suicide prevention interventions also influence both the attitudes towards suicide and the prevalent norms in a particular social context.

It seems almost like we have forgotten that, as Camus tried to point out, considering suicide and, more broadly, being aware of death as a possibility, has also something to do with life. Perhaps it serves an important function? Existential philosophers and existential psychotherapists have tried to bring back the understanding of death as a fact or a possibility that is an intrinsic part of life, something that can give life meaning, significance, poignancy and can even help one live a more authentic, one’s own life. From an existential point of view, death is a part of life and one of the few certainties that define the human condition9. What is uncertain is how and when we will die. A further paradox lies in the fact that as a person who suffers from a physical disease such as diabetes, one has the right to reject treatment, whereas a suicidal patient has no such right10. What happens to an individual when this basic possibility is taken away, when someone is involuntary hospitalized even though they do not want to live anymore? This is done on the basis of a suicidal individual being seen as illogical and not capable of making rational decisions (i.e. ‘crazy’ or mentally ill) due to the consideration to end his or her life.

Besides the mentioned problems with suicide prevention strategies, a further complication occurs because of the existing myths about suicide in most Western societies. One of these is, for example, that asking if someone is considering suicide or just talking about suicide can lead someone to also act on it. This is not true – often posing the question provides relief and an opening to express what one is going through. Another myth is also that someone, who talks about suicide, will never actually commit it. This one is also quite dangerous as it contributes to the fact that someone is not taken seriously. Suicide is often not an impulsive but a well thought through act. For sure it might start with vague thoughts about life not being not worth living, on which one does not act. However, this might develop further along the suicidal process – especially if someone is not heard or taken seriously during this process of ‘slipping away’.

So why do we find it so difficult to talk about suicide? Why are we as lay people, but even as professionals, often reserved to asking the question? Besides the mentioned myths and attitudes, it also has to do with our own relationship to death or our confrontation with it. Understanding our own biases and reactions to suicide, as well as our own issues with death, and how these are shaped through social norms, our anxieties and fears, is a necessary component if we want to be available to help someone who is suicidal. In terms of therapy or professional help, it is only when the story behind an act of self-harm can be fully shared with another person that there is there a common ground for such a relationship11. But accepting suicide as a possibility of the human condition, or as an idea does not mean accepting suicide as a solution. It means assuming an open and neutral stance that might contribute to a better understanding of individual meaning behind the thought or choice, and serve as a basis of an ‘I-Thou’12 relationship.

With this contribution, I have tried to show that once someone finds oneself in the dark suicidal world, this does not have to be the end of the world. However, it can be if one does not find the right people with whom one can share what one is going through. By means of sharing it is possible to bridge the experienced disconnectedness and loneliness, and discover how one does want to live. Of course the person has to find the courage, trust and persistence to do this. It is also through such encounters that one can more easily change one’s attitudes towards life, world and oneself – find a new, different meaning in life. What seems like the end of the world can also be a new beginning or an incentive for transformation. One research participant described this process of transformation as facing his fears, establishing his own values and  understanding of the world (something to hold on to), and consequently living according to these – being more himself.

What do you think is the opposite of fear…? It is very simple. Trust is the opposite of fear, and if you trust life you can go on living. If you don’t trust life then you cannot go on. Then you are afraid. You only have two options. – research participant

 

Marja Kuzmanic (’05) holds an MPhil (’06) from the University of Cambridge and a PhD (’12) from the University of Ljubljana, both in psychology. She is finishing an MA study in psychotherapy and counseling and is setting up a private practice in counseling and coaching in Amsterdam and Groningen (www.marjakuzmanic.com)

 

1 Kuzmanic, M. (2012). Suicide from an Existential-phenomenological Perspective: Sense or non-sense? PhD Dissertation. Self-published by Marja Kuzmanić, Ljubljana, 2012.

2 Camus, A. (2005). The Myth of Sisyphus. London: Penguin Books, Ltd.

3 Nietzsche, F. (1989). Beyond Good and Evil: A prelude to the philosophy of the future. New York: Random House, Inc.

4 Webb, D. (2010). Thinking About Suicide: Contemplating and Comprehending the Urge to Die. Herefordshire, UK: PCCS BOOKS Ltd.

5 Cutcliffe, J.R. & Links, P.S. (2008). Whose Life is it Anyway? An exploration of five contemporary ethical issues that pertain to the psychiatric nursing care of the person who is suicidal: Part one. International Journal of Mental Health Nursing, 17, 236–245.

6 Cooper, M. & Adams, M (2005). Death. In E. van Deurzen & C. Arnold-Baker (Eds.), Existential Perspectives on Human Issues: A Handbook for Therapeutic Practice (pp. 78-88). New York: Palgrave Macmillian.

7 Becker, E. (1973). The Denial of Death. New York: Simon & Schuster.

8 Szasz, T. (1999). Fatal Freedom. Westport, CT: Praeger.

9 Heidegger, M. (1996). Being and Time. New York: State University of New York Press.

10 Szasz (1999)

11 Michel, K. & Valach, L. (2010). The Narrative Interview With the Suicidal Patient. In: K. Michel & D.A. Jobes (Eds.), Building a Therapeutic Alliance With the Suicidal Patient. Washington: American Psychological Association.

12 Buber, M. (1970). I and Thou. New York: Scribner’s.