“I believe for a vast majority of people, suicide is a bad choice.”  It’s not the first highlight in the book, but it’s close.  In How Not to Kill Yourself: A Portrait of the Suicidal Mind, Chancy Martin exposes his thinking after a lifetime of suicidal thoughts and attempts.  He shares the losses and poor choices that led to his extreme suicidal thoughts and his rationale.  This isn’t the first book I’ve read written from the perspective of a suicidal person attempting to illuminate the mental machinery of the chronically suicidal, but it is perhaps the most direct and raw.

The World as It Is, Not as I Would Have It

Most people stop the serenity prayer before its conclusion.  They recognize, “God give me the courage to change the things I can, the serenity to accept the things I can’t, and the wisdom to know the difference.”  It continues, “…taking the world as it is, not as I would have it.”  It’s a constant source of challenge for humans, whether addict or not.  We all want the world to be the way we want it – not the way that it is really.  It’s easier when the world conforms to our beliefs and expectations than when we need to shift our expectations and behaviors because of the world.

We’re eager to ascribe a reality on the world when it’s just our perception.  We assume that our friend overdosed rather than died by suicide.  We would prefer to believe that our friend got distracted rather than ghosting us.  It’s easier to take our predictions and believe they are reality.

The End of Unhappiness

It’s not a novel idea that people consider suicide to eliminate the pain in their lives.  Shneidman called it “psychache.”  (See The Suicidal Mind.)  However, the degree to which this desire to end unhappiness drives not just the suicide attempt but also suicidal thinking cannot be overstated.  When we’re in intense pain of any kind, our natural response is to end the pain.  Since emotional and physical pain are almost indistinguishable to the body, there’s no limit to the approaches we may try to eliminate the pain.

Survivors often ponder whether the person who has died by suicide thought of them or what the loss would mean to those who remained.  The short answer is no.  The longer answer is complicated.  In the long answer, they thought about those they’d leave behind, but it happens in a way that is not nearly as important as the need to end the pain.

Psychological pain is different.  It’s hard to quantify and hard to understand when others seem to have everything going well.  It’s hard to understand how the longings of their heart cannot be quieted or how they blame themselves for something they’ve done or the current state of their life.  These pains are often hidden from the view of others.

Emotional Pressure Vessels

For some people and some families, emotions aren’t safe.  Somewhere in their history, they’ve learned that emotions aren’t to be trusted.  If you expose anger to the light of day, it may lash out and harm others.  If you express fear, sorrow, or longing, you may infect others and the infection may consume them.  Like a Chinese finger trap, the inability to deal with emotions becomes a self-fulfilling prophecy.  There’s no opportunity to learn how to have healthy responses to emotions, because it’s not possible to experience or share them.  (See Descartes’ Error for more.)

Over time, we know that the pressure of not having emotions builds, and it can do severe damage to psyches and relationships when emotions finally force their way to the surface.  Invariably, when emotions are contained, they’ll find their way out.

In the world of suicide, we realize that unresolved, unexpressed, and unmanaged emotions can be the source of suicidal impulses.  Like the proverbial white bear that can’t be considered, so to do the things that we deny get bigger.  (See White Bears and Other Unwanted Thoughts for more.)

Irrationality

Many are quick to describe suicidal thoughts as irrational or the result of mental illness.  However, as Dan Ariely explains in Predictably Irrational, we’re all, well, predictably irrational.  This, however, isn’t always a bad thing.  Martin explains how he was afraid of a gun and not afraid of death.  It might be more accurate to say that he had a different fear relationship with death than most.  (See The Denial of Death and The Worm at the Core for more about the fear of death.)  No matter what his fear of death, he explains that he was afraid of his gun.  This seeming contradiction makes sense when you evaluate the fear of guns as a tool for violence separately from death.

Shifting the Hand of Fate

To this point, I’ve written as if Martin’s perspective was one of always wanting to die, always wanting to silence the voices of unhappiness, but that’s not fair.  Like everyone, Martin struggled with a desire to live and a desire to die.  It’s ambivalence, not knowing whether it is better to live or to die.  (See The Suicidal Mind for more on ambivalence in suicide.)  It’s quite possible, as Martin asserts from his own experience, that the person doesn’t know for sure whether they want to die or not.  It can be that there is no clear winner in the battle to live or die.

One way to bias towards death without overtly making a suicide attempt is to make risky decisions.  Risky choices can be thrill-seeking rather than a wish to die.  It’s more socially acceptable to die in an accident than to die by suicide.  (See The Rise of Superman for many deaths that were connected to risky behaviors.)

Consider for a moment an automobile accident where a car runs off the road and strikes a tree.  Was the person asleep at the wheel and drifted into the tree – or was the turn towards the tree intentional?  We cannot know.  Was it carelessness and risk-taking to drive while extremely sleep deprived?  Was this, as Menninger describes, “suicide by degrees?”  (See Clues to Suicide for more.)

One way to bypass internal prohibitions about suicide is to set up situations where death is a possibility rather than to directly make an attempt.  Who would be the wiser?

How to Speak with a Suicidal Person

Martin embeds clues to how to speak with a suicidal person.  He shares the widely held belief that you should be direct, specific, and fearless.  There’s absolutely something to be said for fearlessly asking whether someone is considering suicide.  There’s more to be said for the person who listens and hears yes but doesn’t run away.  It’s scary for everyone.  You don’t want to be responsible for someone else’s death, and even though you wouldn’t be, it doesn’t make the fear go away.

Martin is right that it’s the secrecy of the thoughts that provide the energy, and simply holding space for the thoughts can move towards resolving them.  What’s harder to see is that you shouldn’t directly try to contradict their perceptions that lead to the desire.  If they say that they feel unloved, you cannot tell them they’re wrong, you need to invite them to discover the cognitive constriction of their thinking.  (See Capture for more on cognitive constriction.)

The tools in Motivational Interviewing are particularly useful here.  Rather than trying to convince them they’re wrong, you can and should ask them for evidence supporting their conclusion – and for the evidence that contradicts their conclusions.  The process itself unwinds the thinking that leads to poor conclusions.

Heritage and Legacy

Martin shares some of this family history of mental illness and violence not as a way to justify his struggles but for further context.  These stories are startling because of their raw nature.  I’m not sure how I could respond to learning that my mother was the woman with whom my father was dancing at prom after he had tried to kill his own mother just hours before.

We all have a heritage we’ve inherited from our ancestors, for better and for worse.  The question is always what legacy we leave for others.  Perhaps Martin’s legacy is teaching people How Not to Kill Yourself when you want to.