Decades after Shneidman started doing psychological autopsies at the request of the medical examiner, a mother who lost her son implored him to use his technique not to help decide whether the death was a suicide or not.  Arthur left a long suicide note, so there was no doubt that it was suicide.  However, she was a mom who wanted more insights about the death of her son than she could glean from the note on her own.  Autopsy of a Suicidal Mind is the report of the psychological autopsy of Arthur and an opportunity to see the process of discovery that one might follow to do a psychological autopsy.

Insightful Notes

Shneidman’s curiosity with suicide notes started in 1949.  By 1957, his study of suicide notes led to the publication of Clues to Suicide.  The Cry for Help continued his work of understanding suicide through the notes that people left behind – even when he openly recognizes the scarcity of such notes.  Autopsy of a Suicidal Mind was published in 2004, and he acknowledges that the study of suicide notes didn’t expose the profound insights that he had hoped for.  Most notes are individually banal.

Collectively, suicide notes haven’t revealed any one factor that is common to all suicides.  Despite the limitations, Arthur’s note offers a puzzle.

The Long Contradiction

Arthur’s note is unique partly because it’s composed over a long period of time and includes content written before an unsuccessful attempt on a Friday night.  An attempt to use opioids wasn’t enough.  Remarkably, he spent time with a friend and had lunch with his father between this Friday night attempt and his eventual death on Sunday evening.  It’s not the first time that Arthur’s conflict comes into view.

He previously aborted a suicide attempt – despite later insisting that the attempt was genuine.  It seems like Arthur was constantly caught as waves of a desire for death crashed over the rocks of his desire to live.  Eventually, the waves of desire for death would recede – but apparently not soon enough on the Sunday evening of his death.

Highs Before Lows

Apparently, Arthur’s times of greatest challenge – the deepest lows – came after the happiest of times.  It’s as if each moment of happiness needed to be paid for by an equal moment of pain.  I think we’ve all experienced loss as we exit a time of happiness.  We mourn the loss of time with friends when we leave after a long weekend.  We feel the pain of leaving vacation, because we know that we must work for a time before we can be freed to spend our time completely as we wish again.

For Arthur, these pains seemed magnified – and overwhelming.

No Smoking Gun

One of the challenges in Arthur’s case is the lack of a trigger, a smoking gun, that would indicate what final straw pushed him over the edge into the depths of despair.  It seemed, as far as anyone could tell, that his last day was like any other day.  No better, no worse.

That is, perhaps, a part of the problem.  Perhaps Arthur had lost his hope, because every day was filled with pain.  (See The Psychology of Hope for more about hope.)

A Mother’s Sacrifice

Thomas Joiner in Why People Die by Suicide explains that feeling like a burden increases the likelihood of suicide.  Arthur’s mother, for all her concern, felt like she had given up 30 years of her life for Arthur.  He’d been described as a problematic child.  His story had him struggling to adapt, including thumb sucking until 9.  Temper tantrums showcased his inability to control emotions from a very young age.

Without finding fault, one has to wonder how the mother’s belief that she sacrificed for Arthur impacted his feelings of burdensomeness.

Pointless

Philosophers love to ask questions like, “What’s the meaning of life?”  It’s an interesting pondering when expressed in a neutral or positive form.  However, it takes a dark tone when one asks the question, “What’s the point of it all?”  Arthur is known to have asked such questions, and his friend simply shrugged it off as a philosophical pondering.  The problem for Arthur, it seems, is that it wasn’t a pointless pondering.  He was really grasping to find meaning in life to allow him to hold on despite the self-described psychological pain.

Nietzsche said, “A man who has a why can bear almost any how.”  It seems that Arthur was seeking that why.  He sought it in becoming a physician and an attorney.  He looked for it in marriage and in love but apparently without success.

Perfectionism

Perfectionism is an insidious monster that slinks its way into people’s thinking and takes their joy.  The Paradox of Choice introduced me to the idea of maximization – where it has to be the best – and satisfaction – where it just has to be good.  Perfectionism is the concept of maximization applied to oneself.  Instead of allowing for flaws, imperfections, and acceptance of life, the perfectionist focuses on every moment where they’re not perfect and treats it as if it were a fatal flaw.

Arthur needed to be perfect.  He needed to be worthy of other’s love – and, like all humans, he wasn’t.

Holding Back the Darkness

One of the skills that Arthur learned was the ability to compartmentalize his life – keeping his pain and despair away from the eyes of others.  While this is indeed a useful skill, as it allows us to temporarily defer deep processing of events until we have the time and capacity, it can be overused.  Compartmentalization isn’t intended to be a permanent coping strategy.

However, an interesting question arises: how and why did Arthur learn this skill?  Did he learn this skill as a coping mechanism so that he could function in a world where he felt such darkness, or was it something else that allowed him to learn this skill?  While we may not know the source, it’s interesting to ponder how people have learned this skill.

Permanent Solution to a Temporary Problem

It’s been said (perhaps quipped), “Suicide is a permanent solution to a temporary problem;” but Arthur insisted that life isn’t a temporary problem.  If you’re in constant pain, then life isn’t a temporary problem.  Every moment of pain is an intense torture that seems to last forever – even if it doesn’t last forever in fact.

This sense of pain and the extended time that goes with it cannot be ignored.  It provides a sense of understanding as to why someone would find a permanent solution to what may seem like a temporary problem – to someone on the outside.

Suicidal Belief System

Perhaps one of the most interesting observations was that the people who surrounded Arthur took on his suicidal belief system.  They accepted the “truths” that existed in Arthur’s world without question and became a part of the drama that was playing out in his mind.  It’s good to understand, and understanding suicide may require an Autopsy of a Suicidal Mind.