Book Review-Facing Suicide: Understanding Why People Kill Themselves and How We Can Stop Them

Robert Bogue November 8, 2024 No Comments

It started with a movie. Facing Suicide: Understanding Why People Kill Themselves and How We Can Stop Them started with James Barrat’s film of the same name (without the subtitle). The book is an expansion of the content in the video. It’s a contemporary view of suicide in America and what the experts see as opportunities to change the outcomes.

Preventable

From the very start, there’s solid information about suicide – and there are fine points where the coverage requires clarification. A big one is whether suicide is preventable. It’s a myth I tackle on SuicideMyths.org. At some level, it’s clear from works like Suicide: Inside and Out that there’s no stopping another person from suicide if their mind is set on it. However, what Barrat is talking about isn’t others intervening. He’s saying that people’s minds can be changed and that they can see life as a better option than death. In that sense, he’s right. Some suicides can be prevented. The challenge is that not all of them can be.

Blame Barnacles

One of the challenges of being a suicide survivor – that is, being impacted by someone else’s suicide – is that you’ll be blamed for the suicide death. Fathers weren’t loving enough. Mothers must have ignored them. Friends must have dismissed them. In a vast number of the situations I’ve seen, it’s not that straightforward.

Mothers and fathers feel guilt from claims that there are always signs. The implication is that the signs were there, and they failed to act. (See Myth: Every Suicide Attempt Has Warning Signs.) They may transition from guilt about what they did or didn’t do into a sense of shame. That is, they may believe they’re bad people. (See I Thought It Was Just Me (But It Isn’t) for more on guilt and shame.)

In most cases, they’re good people who didn’t see the signs. They didn’t know that their loved one, friend, or neighbor was considering suicide. One could argue that you should always be asking those you care for whether they’re considering suicide. It won’t plant the idea. (See Myth: Asking About Suicide Will Plant the Idea.) Whether we should or not, it’s not the sort of thing that we normally ask.

Regardless of their innocence, many families and friends suffer by being shunned by others at the very moment they need them most.

Pride

There’s good reason for America’s farmers to be proud. They feed the nation and to some degree the world. They are – for the most part – hardworking, salt-of-the-Earth type people. Many have had farming handed down from their fathers – who, in turn, received the farm from their father. It’s more than a profession. It’s a legacy. Unfortunately, the desire to preserve that legacy for their children becomes a burden as they struggle against forces that are larger than so many farmers can bear. Increasing production led to lower per bushel pricing. Global trade wars changed tariffs and further reduced crop prices. Interest rates climbing on the money borrowed to buy seed to plant made it impossible for many.

There became a sort of minimum number of acres you could farm to make it work. You can’t afford to buy and maintain the equipment if you don’t have enough acreage to amortize the capital investments over. That’s why we see farms that have thousands of acres instead of the original 40 acres granted to most during the westward expansion.

The pressure between the pride for the land and the realities of the economy made far too many decide that suicide was a better option.

Gun Storage

Sometimes, the narrative is more impressive than the research – and sometimes, it isn’t supported by research at all. The data is clear that if you have guns, you should secure them. This mostly means locking them, but could mean storing the ammunition and firearm separately. The problem is that the data supporting these conclusions is weak. To get enough statistical power, they had to combine all forms of “safe” storage. That means we don’t really know if storing guns and ammunition separately matters much – or even at all.

People who sit on the gun control side of the issue have taken the research to mean that you must do everything. The result is a recommendation to store guns and ammunition both locked and separate. There is simply no research to support this approach. Intuitively, it makes sense, but we’re found lots of things intuitively make sense that don’t really work that way. Barrat falls into this trap and suggests storing guns and ammunition separately.

This is despite the fact that around 70% of all gun purchasers and gun owners say they have their gun to protect themselves (personal protection) or their home (inclusive of family). If you tell them that they need to store the gun and the ammunition separately – as many do – they’ll simply stop listening.

We can say with clarity that guns should be locked up to prevent their theft, unauthorized use, and potential use in a suicide. That’s acceptable to those who want it for protection. It’s also often not done, because we continue to message in ways that invalidate the reasons that people buy guns in the first place.

When you message in a way that people will not accept, nothing changes – and you’ve wasted everyone’s time.

Connection is Prevention

“Thwarted belongingness,” a key component of Thomas Joiner’s Interpersonal Theory of Suicide, is, Joiner claims, a fancy way of saying loneliness. (See Why People Die By Suicide for Joiner’s model). Whether you prefer IPTS or something different, we know that loneliness increases the risk of suicide. (See Loneliness and A Biography of Loneliness.) When we consider suicide risk from the viewpoint of loneliness, we can see that the solution is to increase the degree to which people feel connected to others.

In The Anxious Generation, Jonathan Haidt explains how disconnected we are. Robert Putnam expresses the relative concentration of importance on the individual in The Upswing (which could be seen, like Our Kids, as following up on the themes laid down in his landmark book, Bowling Alone). Haidt builds a case that one of the causes is our increasingly technologically connected lives, particularly social media. Sherry Turkle, in Alone Together, shared this sentiment over a decade ago.

Harried Learner in The Dance of Connection speaks to the delicate dance of staying connected to others, and Dr. Ruth Westheimer discusses practical tips in The Joy of Connections. They stop short of claiming a cure for loneliness or suicide prevention, but there is good reason to believe that the more connected people are, the less likely they are to die by suicide.

Removing Stigma

Echoes of the ghosts that we shouldn’t talk about suicide lead to fear about removing all stigma from suicide for fear that it may elevate suicide rates. After all, we don’t want others to think it’s a good idea. The argument is that we know that there is a media “contagion” effect. Glorification of deaths by suicide may set off a suicide cluster that will claim more lives. (See Life Under Pressure.)

We’re in a scary place where we know that stigma is preventing people from getting the help they need – and it’s in some ways reducing suicides by preventing those who believe in the stigma. Many people believe it’s morally wrong, and that’s enough to keep them from considering it. We’ve got to find a careful path through making it okay to talk about suicide – and to think about it – without releasing the concerns about people acting on those thoughts.

A Roll of the Dice

There’s a problem with prediction in suicide prevention. We can’t screen or assess in a way that reliably separates those who will and will not attempt suicide. Craig Bryan makes this point clear in Rethinking Suicide. Neither screening tools nor assessments are much better than a coin flip in identifying those who will make an attempt. Despite this, we want to believe these tools are predictive.

Here’s the problem. Suicide is too rare statistically and, tragically, too high societally. If we had a screening tool that always said there was no need for enhanced services, we’d be right more than 99% of the time. It would also be clinically unacceptable. We’re struggling, because we’re trying to predict the unpredictable.

You Can Kill Yourself Later

The truth of the situation is that people can always kill themselves. The goal is to get them to decide to do it later (and hopefully never). A suicide death is permanent. There’s no coming back from it and, as a result, it’s a good idea to defer that decision to the last possible moment. If we did this more often – if we could be honest with people – we’d save lives. Too frequently after hearing of suicidal ideation, clinicians rush to inpatient hospitalization. What they don’t know is that there is no evidence that inpatient hospitalization works – much less that it is best. There is, however, plenty of evidence that the highest possible risk is immediately after discharge from an inpatient setting. Clinically, there is sometimes no choice but to hospitalize someone – but it should be the very last resort, because it’s necessarily a risky decision.

Far Transfer

In the language of education, it’s called “far transfer.” It’s when the differences between the learning environment and the place that the skills must be used are large. The difference can be physical environment, but it’s more frequently frame of mind. If we’re learning emotional regulation in a safe classroom, it will be harder to recall that training in the midst of a difficult situation.

It’s one of the concerns about some of the recent research that teaches mindfulness to potentially suicidal individuals. The results aren’t positive – and that may be because they’re unable to access these ideas from the point of considering suicide.

Drivers

Many people hear of the problem with veteran suicide – how more service members have died of suicide than of combat. We fail to recognize that though military service increases risk, it does so regardless of battle experience. It doesn’t seem to matter whether they were sitting at a desk in Texas, in a base in Afghanistan, or were in a firefight. The driver seems to be service in any way.

Other, more pertinent, drivers seem to be problems with relationships, the law, or finances. All these are possible factors for veterans – particularly those who suffer from some sort of PTSD.

The Strategy That Isn’t

At the time of Barrat’s writing, the latest national suicide strategy was published in 2012. The problem is that most people who were working in suicide prevention in America weren’t even aware of the plan. The 2024 refresh of the plan suffers from many of the same issues as its 2012 predecessor.

First, it’s not a strategy. It’s a list of aspirational things that it hopes the states will implement. Thus, when it was evaluated in 2017 almost no one had fully implemented the plan. Second, the efficacy of the interventions was never measured, yet many of them are in the 2024 plan with slightly different wording.

Proponents will say that there is a federal action plan outlining what the federal government will be doing to support the strategy. However, the federal action plan is a long list of activities – most of which have been ongoing. There’s no measurement of change, just the appearance of trying to make it better.

Without a set of tools that states can use to implement the plan, we can wait another decade to realize we’ve not implemented the strategy and issue a new one with minimal changes. It may be a cynical view, but it’s the one you develop when you see the gaping holes that never get addressed when Facing Suicide.

Book Review-Long Walk Out of the Woods: A Physician’s Story of Addiction, Depression, Hope, and Recovery

Robert Bogue November 7, 2024 No Comments

It wasn’t work with addiction, depression, or hope that led to a Long Walk Out of the Woods: A Physician’s Story of Addiction, Depression, Hope, and Recovery. It was the fact that Adam Hill discussed his suicide attempts – and that his history is from Indiana and Indianapolis. A colleague recommended the book, and despite my relative resistance to reading stories, I decided it was worth an investment.

Cultural Indoctrination

Context is important. If you’ve not been a physician, it can be hard to understand the culture of medicine and its training process today. The training process is bipolar, that on one hand tells us that they’re “baby doctors” and leads them to expect greatness from themselves and their peers, while on the other hand simultaneously asks how they could have made such a stupid mistake.

It starts with the competition to get into medical school. Hill recounts his struggle as a waiter while he awaited news that he’d be accepted to school – and the internal struggle with inferiority. Once there, top spots are coveted, because they mean that there are more options. However, the winnowing process has elevated the competition so that students who were used to being at the top of their class find themselves struggling to get by. Everyone is clear that the curve has changed.

The final, unspoken, piece is the recognition that peoples’ lives are literally in your hands. Few professions routinely make life-or-death decisions, and that can weigh on physicians. It’s one of the reasons why people can be ostracized. Their peers wonder if they have “what it takes” to be a doctor.

It’s in the context of this culture that doctors are discouraged from admitting their weaknesses and seeking help – particularly if the struggle is a mental one. It’s okay to get tutoring on anatomy, but it’s not okay to say that you’re struggling to cut into a cadaver. This destructive system pushes many to the brink and beyond. Luckily, Hill came back.

Hiding in Plain Sight

Sometimes, the seeds of destruction were with us and visible all along – if anyone were able to put the clues together. Hill shares his social anxiety and his strive for perfection. It’s a recipe for concern. He had learned to hide his imperfections. Life Under Pressure explains what a culture like that does to create the conditions for a suicide cluster. Perfectionism explains the dangers of perfectionism itself – in the failure to accept that anything less than perfect is good enough. In The Paradox of Choice, Barry Swartz explains how satisficers learn to accept what’s good enough while maximizers must have the absolute best – and how the psychological consequences aren’t good. Maximizers is another way of saying perfectionist.

The problem with hiding imperfections is captured in the saying, “You’re only a sick as your secrets.” It’s such a prevalent topic that it’s come up in numerous book reviews, including Opening Up, The New Peoplemaking, The End of Hope, Safe People, and more.

Visible Scars

Hill recounts a fractured tibia requiring crutches, and how this was an outer sign of injury. For this, others questioned and commented – to the point his sister made him a t-shirt with the answers. However, while the outer injury was visible and the topic of conversation, his internal brokenness was unspoken – by either him or by others. The visible was easy. The hidden and the mental were culturally inappropriate to discuss.

Hill suggests what a shirt might look like with the inner struggle: “Yes, I am broken. It happened during medical school. It really hurts. I do not feel like a good person.” While I struggle to disagree with how someone feels, I do believe that the roots of the problems were present before medical school, like the tiniest of fractures that is barely able to be detected being aggravated by continued stress (abuse). Athletes – particularly child athletes today – encounter these microfractures and must take time for them to heal. However, that’s not a luxury we’ve ever afforded to those who are struggling with their own worth as a human outside of what they can do or who they will become.

The Stigma

Stigma is simply different than “normal.” It’s different than the socially prescribed path that you’re supposed to walk – and it matters. (See Stigma for more on the concept of stigma.) It’s important to understand that stigma is resolved by normalization. The more that we normalize a behavior, the less power stigma holds. Thoughts of suicide at some point in their lives are present in more than 1/3^rd of the population – and it appears to be growing. The belief that suicidal thoughts are rare is a myth. (See https://SuicideMyths.org.)

When I grew up in the 1980s into the 1990s, gays were to be feared. I don’t know why, but the social message was clear. (True to my nature, I really didn’t care.) Books like After the Ball, which advocated techniques for normalizing alternate sexuality, were scooped up by zealots and largely destroyed. I still think After the Ball is a great guidebook for how to make things more normal – thereby evaporating the stigma.

One of the barriers to anyone speaking out about their struggles is the fear of repercussions; one part of that is the reality, and the other is the fear. In Dreamland, Sam Quinones shares about the terror tactics used by the Mexican cartels to ensure that people would remain afraid. The incidence rate was low, but the message was clear.

We face these twin barriers in stigma within the medical community. There are some real problems with the ways that licensure boards ask questions that violate ADA standards. These must be fixed, and it’s one of the missions of the Dr. Lorna Breen Heroes Foundation. Beyond the literal requirements of the ADA, they’re pushing for licensure and credentialing standards that don’t penalize people for seeking appropriate help.

The other barrier is the stories that we hear of people who were penalized or condemned for their stories – and fear that if we share our weaknesses it could be us develops. That’s where finding approaches that maximize protecting the public (what licensing boards are for) and provider dignity are needed.

Numbing

There are echoes of workaholism throughout the medical industry, whether it’s coming back to work early after surgery, those insane number of hours in residency, or the tendency to slip back into work when things were getting harder to deal with. But, across the planet, the big tool for numbing is alcohol.

While we find books like The Globalization of Addiction and Chasing the Scream that are focused on narcotics, the number one tool for numbing is alcohol. Alcohol is not, however, inherently bad. Neither is numbing. Numbing is used for procedures to make the process easier. We encourage it for short-term use – it’s the long-term use that creates a problem.

It’s a hard line. How much numbing is too much? How much numbing do you need to be able to process the day-to-day trauma of life?

Numbing as the only strategy doesn’t work, because it becomes less effective over time. That’s the trap of numbing and how it leads to suicide. Numbing is used without healing. Short-term numbing is fine – but only when used in a pathway towards healing.

Suicide

Hill recounts the fellow medical student who died by suicide and how their death was never spoken of in a public forum. He shares that even in the first few years of his career, he lost five people to suicide. Between his words you can hear echoes of confusion: on the one hand, some of these people seemed outwardly fine – on the other, he recognizes that he appeared okay on the outside as well.

Suicide happens when the numbing is no longer effective enough. The pain gets to be too much. (See Suicide as Psychache.)

The title of the book comes from the pivotal moment for Hill when his wife called him at just the right time to interrupt his suicide attempt. The literal is a part of his figurative Long Walk Out of the Woods.

Book Review-Life Under Pressure: The Social Roots of Youth Suicide and What to Do About Them

Robert Bogue November 6, 2024 No Comments

What causes suicide clusters to form? That’s the fundamental question behind Life Under Pressure: The Social Roots of Youth Suicide and What to Do About Them. The book follows a community known by the pseudonym of “Poplar Grove.” It recounts stories and quotes from interviews to understand what has made Poplar Grove such a hot spot for youth suicide – and what can be done about it.

Clustering

Usually, a suicide cluster is two deaths plus an attempt or three deaths in a short period of time in a constrained geographic region. The real question is what causes them and what can be done to prevent them. There are several factors that lessen the barrier to suicide for those exposed to one. First, suicide is brought to mind as an option that may have never been considered before. Second, the death of someone close necessarily causes grief – and that makes life seem a little less worth living.

But not every suicide death (or any death, for that matter) sets off a suicide cluster – far from it. While suicide clusters aren’t frequent, they are painful for the people who are left behind and communities they occur in. Understanding what conditions create or allow clusters to form allows us to design interventions to prevent them – at least in theory.

The Setup

Life under Pressure is a bit repetitive. It focuses attention to the intense performance pressure and dense social ties of a “must-be-seen as” community as the contributing factors that led to so many youths deciding that death looked better than life. (See Leadership and Self-Deception for more about “must-be-seen-as.”)

Performance Pressure

Some communities value educational and professional attainment to a degree that they place pressure on their children to be the best, to be involved, and to not show faults. (See The Years that Matter Most, which was later republished as The Inequality Machine: How College Divides Us, for more.) The result is that we’ve developed youth with greater anxiety and perfectionism. (See Perfectionism for more on what it is.)

To be fair, this pressure provides growth opportunities that are needed. (See Antifragile.) It can even be argued that peak performers need some degree of pressure. (See Peak.) The problem is that this community didn’t create the kind of “air bags” that Robert Putnam describes in Our Kids. (See also Putnam’s Bowling Alone for background.)

Parents and community members said they were available for youth that needed help – but the youth didn’t believe it, or at least didn’t use it. They didn’t believe that they were psychologically safe enough to share. (See The Fearless Organization for more on psychological safety.) They also didn’t believe that others would or could help.

Dense Social Ties

Generally, we speak of connectedness and social capital in a positive way. It has protective factors. (See Analyzing the Social Web for a technical analysis of social ties.) However, as Richard Hackman explains in Collaborative Intelligence, sometimes teams (his context) have connections and boundaries that are so rigid that they inhibit growth and results. From Jesuits (see Heroic Leadership) to economics (see Trust), ethics (see How Good People Make Tough Choices), and sociology (see Delinquent Boys), we’ve learned that rigid cultural control of people can have negative consequences, and it sometimes takes real skill to avoid getting wrapped up in them.

Everyone knows everyone else’s business. That’s the problem. High performance expectations and dense social ties means that if you admit to a challenge, a limitation, or a fault, everyone will know it in an instant. This is the driver that makes psychological safety so hard.

Everyone knows that if they admit a problem, everyone will know – and everyone will judge them for it. Maybe they’ll be overt about it, or maybe they’ll be silent.

Community Pride

There’s a shared ethos of pride and expectations in the community. They’re all there because the parents wanted to give their children the best chances to succeed. They’re into athletic excellence as well as academic excellence. The parents made it far enough in their lives and careers to make it possible for their children to grow up with good schools and support. They never thought that it would lead to so many with anxiety and so many of their children considering or attempting suicide. They never saw it coming.

Warning Signs

While the repetitiveness of the book can be frustrating, it’s nothing compared to the promotion of falsehoods. It says, “To correct another myth, we should address the belief that suicide rarely occurs without warning. There are almost always warning signs. Unfortunately, our society is not very good at recognizing those warning signs and intervening.” First, if they were dispelling a myth, one would think they’d offer evidence, but no evidence is offered. Instead, the authors push forward a statement that isn’t based in fact – and is problematic on multiple levels.

The argument is often that, in retrospect, people identify signs. There are two fundamental problems with this. First, they’ll claim to see signs that were never present. Recall-based approaches have been proven faulty repeatedly. There’s no way to say that what they recall actually happened. Second, and more importantly, these signs don’t have any predictive value. Often warning signs include “behavior change.” The problem is that people change their behaviors all the time – and a vanishingly small number of people are going to attempt suicide because of it.

I have 3+1 signs. The 3 signs are when they say, “I’m going to die/kill myself/suicide,” “(It doesn’t matter) I’m not going to be here anyway,” and “I want to give you this (prized possession) because I know you like it.” The +1 is sleep disturbances. For the first three, we’ve got a clear message we can and should respond to. For the +1, it’s a reason to check in – and continue checking in. Sleep challenges lead to cognitive challenges – and cognitive constriction, which can be dangerous.

I’m not suggesting we can’t start a conversation about suicide when we see one of the signs on the numerous “warning signs” lists. I’m saying we should be starting a conversation about suicide without them. The warning signs just aren’t predictive of risk in an individual.

The problem isn’t “recognizing.” The problem is that we’ve included so many signs that they’re meaningless. If you don’t believe me, you’ll find the evidence at Myth: Every Suicide Attempt Has Warning Signs. (Direct journal articles and research are linked from this page.)

No Mulligans

In golf, a mulligan is an attempt to do the same shot again. Live doesn’t have mulligans, but too many parents treat their children like their own personal mulligans. If they didn’t get the starring role in the high school or college play, their child surely will. They missed out on an athletic scholarship to college, certainly that won’t happen with their child. Whatever dream they missed, their child won’t.

The problem is that life isn’t designed to work this way. They get their shot – and their children should get theirs. If they force their will on their children, both the parent and the child tend to be disappointed, frustrated, angry, and confused. It’s not healthy – but it’s something that I see all too often.

School Responses

The school in Poplar Grove was criticized for their responses. However, even the guide, “After a Suicide: A Toolkit for Schools,” from which the authors draw their perspective isn’t perfect. There are simple things like treating all deaths the same and ensuring that the suicide isn’t glamorized. However, as you dig into the guide, you’ll find an inappropriate coupling of mental health to suicide, implying or directly stating that this should be a part of messaging to parents and students. There is no research support for this approach – and it necessarily further couples and stigmatizes both.

While insisting that all deaths should be handled the same – and they should – the guide continues to prescribe different messaging and approaches for suicide. The guide itself (and the authors of this book) are inadvertently doing the very thing they’re telling others not to do.

Shaky Ground

Qualitative research is very difficult to get right, and often it suffers from biases. The questions that are asked (even in structured interviews) are often driven by the perspective of the interviewer. That’s just a part of the process as we move from qualitative to quantitative research. However, one can practically hear the rumblings, as statements like, “we are fairly convinced that large, well-attended memorials have unintended negative mental health consequences,” clearly reflect the bias of the authors (as indicated) – but no proof or theory is offered to support these type of statements.

While I can appreciate the delicate nature of interacting with a community in the midst of a suicide cluster, I cannot fathom statements like, “We did not feel it was appropriate for us to attend any of these memorial services or vigils ourselves, so we cannot provide an observational account.” I liken it to the person who records a video of someone else getting injured rather than rendering assistance. I see no reason why someone researching how to prevent more death can’t approach an official to ask for permission to listen to the service. It strikes me that this decision might be based more in fear of the awkward conversation. “How did you know the deceased?” The answer is simple. “I didn’t, but I want to prevent others from dying like they did so I’m here to learn from family and friends. I hope to learn more about him/her.”

There is some good to be learned from pressure. However, it’s not right to have an entire Life Under Pressure.

Book Review-The Prediction of Suicide

Robert Bogue November 5, 2024 No Comments

Aaron (Tim) Beck, Harvey Resnik, and Dan Lettieri are the editors of The Prediction of Suicide. The assembled work brings together the best minds in the prediction of suicide in 1974. The arguments made then are like the arguments that could be made today. In the preface, they state, “Despite the voluminous research reports, there is a very flimsy basis of knowledge that can contribute in a scientific sense to the problems of the worker in this field.” It’s a challenge that hasn’t changed substantially in the fifty years since this publication – but hopefully it’s one that will change soon.

The Process

The point is made that, “Suicide is the end result of a process, not the process itself.” This belies the problem of prediction and identification. We speak of the outcome, but even today, we struggle to articulate the pathways that lead to this outcome. It’s understanding these pathways that provides hope for our ability to do some level of prediction of suicide.

The one differentiation that can be made about the process – even in 1974 – is related to the outcomes. “But the unsuccessful suicides are no doubt quite different from the successful, and the former cannot be regarded as representative of the latter.” The categorization is that attempts must be categorically different than deaths, because the outcomes are different.

I think this hides the reality of the randomness to the process. Silvia Plath arguably wanted to be found and her attempt to be aborted. (See The Savage God and Suicide and Its Aftermath.) Even though she eventually died, her process may have been closer to that of an attempter who didn’t die. In short, while we can presume that there’s a difference between attempts and those who die, we can’t really know.

Zeigarnik

Blume Zeigarnik was a student and colleague of Kurt Lewin. She noticed an odd thing about the memory of servers. They could remember orders without writing them down – until they relayed the order to the kitchen. After that point, they promptly forgot the order. This led to the discovery of what we call the “Zeigarnik effect,” where uncompleted tasks are held more prominently in memory.

Joseph Subin, in the first chapter, hypothesizes that the Zeigarnik effect may have an influence on attempters, providing some subtle draw towards “completion.”

Call Centers

Suicide call centers are an important part of the overall system of care to try to prevent suicide, but the book notes that “only 4 percent of suicide attempts and even a smaller percent of the eventually successful suicides called suicide prevention centers.” So, they’re an important part of the overall strategy – even if the overall match to those who make attempts is low. We see this same sort of calling pattern in 988 today.

The Perception of Control

We often underestimate our need for the feeling of control. The belief that someone has control and the presence of options has consistently demonstrated a positive effect on mood for people. We see this in places where there are suicide options for those with terminal illnesses. The number of people who use the suicide option after having been approved is very low. (See November of the Soul.) They’ll go through great lengths to acquire the ability to die by suicide – and simultaneously decide not to use the option.

At its heart is our perceptions of control. When we feel we have control, we have a greater capacity for self-soothing and down-regulation of fears.

Mental Health Disorders

Mental health disorders are, for the most part, time-limited with or without therapy. That’s striking, but not totally unexpected, news. For most of human evolution, mental health disorders have occurred before the introduction of psychotherapies and the like. This is not to say that mental health assistance is a bad thing – far from it. Antibiotics, in most cases, merely decrease the time it takes to heal, but we still use them anyway. Similarly, mental health supports are good things. But understanding that mental health disorders typically self-resolve can help us to understand how suicidal crisis can also self-resolve.

To be clear, this is not to say that all mental health disorders will self-resolve – they won’t. However, the argument made by Zubin is that they largely self-resolve.

Actuarial Versus Clinical

One of the big challenge in the prediction of suicide is the difference between aggregating various risk factors to develop a risk score for an individual and the need to sit next to someone and make a decision about whether they are a risk to themselves. (Ideally, sit next to them rather than across from them, as still often happens – see Motivational Interviewing and Managing Suicidal Risk.)

In the development of actuarial risk, demographics and history are combined into a single score based on previous research and factors that can be identified to raise or lower the risk. Being an “old white guy” raises one’s risk – my risk. Other factors are loaded into the assessment to create a score. However, this score has nothing to do with me personally and everything to do with the statistical abstractions made for groups of people.

Time and time again, we’ve demonstrated that such actuarial risk summarizations have almost no utility in the assessment of individuals. Compiling the most comprehensive profile still doesn’t yield the ability to predict which individuals are at risk. The statistical (actuarial) process simply has eliminated all of the distinctiveness in the data and with it the ability to see the risk of individuals.

Later in the volume, Beck states it clearly: “The belief that suicidal behaviors are predictable can be valid only as a belief in principle, not in fact.”

Psychological Autopsy

Even in 1974, the limitations of psychological autopsies was well known. Alex Pokorny explains the difficulty of discovering intent: “It also appears to require a ‘psychological autopsy,’ which is not practical for general use and which also introduced the possibility of circular reasoning.” He first identifies the effort and therefore cost of doing psychological autopsies. They’re time consuming. They require willing participants of the survivors, which isn’t always the case. That makes them somewhat impractical for broad use.

The more challenging aspects of psychological autopsies are the problems of retrospective reasoning. After a determination of suicide is reached (preliminarily), the scales tilt towards that, and there is some bias towards confirmatory evidence. This is held back by the stigma and extra pain associated with suicide death, but the degree to which one of these forces is more powerful than another is both situational and effectively immeasurable.

We’re left with serious doubts about whether psychological autopsies create a real picture of the person’s mind or whether they create a fiction that roughly fits the facts. This fiction may help us feel better about understanding – but it does not necessarily create actual understanding.

The Categories

One of the challenges of creating good research on suicide is the need for clear and consistent categories. The categories proposed are completed suicide (CS), suicide attempt (SA), and suicide ideas (SI). These are good, broad categories, but they miss some of the nuances and challenging situations.

In particular, non-suicidal self-injury (NSSI) is problematic in this framework. There is a relationship between NSSI – particularly cutting – and later suicidal behavior, but the narrow and coarse framework proposed here doesn’t connect NSSI to suicide.

Screening

Aaron (Tim) Beck was one of the earliest proponents of finding scales to measure risk. He was developing what became the first risk screening tools – some of which are still used today because of their efficacy. However, he states, “Nevertheless, even the best of these produces a very high proportion of false positive errors, that is, cases that are unjustifiably labeled as high suicide risks.” Later, he continues by saying, “For there is currently no detection scheme that can be set to identify half of the available genuine suicide risks without erroneously identifying along with them a lot of people who are not suicide risks at all.” He acknowledges that because suicide is a statistically rare (and tragically too common) event, it’s hard to develop tools to identify it.

He argues that, in order to get sufficient sensitivity to detect people who may have suicide in their immediate future, many must be identified and later assessed out of the system. My “back of the napkin” calculations put the false positive rate at about 300-600 times the number of actual positives based on current tooling. Despite the insistence on the use of these tools, the behavioral health system can’t cope with the false positives that must be screened out. Even if these clinical assessments were 100% accurate, the sheer volume of work puts a strain on an already burdened system. The tragedy is that even clinician assessment is a poor predictor of outcomes, as is explained in The Practical Art of Suicide Assessment.

Predictors and Postdictors

Hindsight is 20-20. It’s a common cliché that pushes us towards an understanding that we can see things in the past that might have never been identifiable before the event. We can understand the factors and methods that lead to outcomes only after the kind of careful study and clarity that comes after the event. One of my great frustrations is with lists of suicidal risks, because they include things that frequently occur, including in a proportion of those who attempt suicide.

Things like a change in mood or behavior is often listed. The problem is that, when applied to teenagers, this is almost universal – with or without suicide risk. Also listed are statistics like 95% of people with suicide have a mental illness. That’s misleading, because a very small percentage of those with mental illness will die by suicide (<5%).

David Lester makes the point that what we call “predictors” are all assessed after-the-fact and therefore should more accurately be called “postdictors.” They have little predictive value. They do, however, encourage a great deal of guilt and shame on the part of loved ones who feel that they missed signs that they should have seen.

Infrequency

Chapter after chapter in the book has authors saying that suicide is a statistically rare event and is therefore nearly impossible to predict at an individual level. George Murphy explains how a statistically good screener would be unacceptable clinically owing to the intersection of statistics and outcomes: “From the numerical standpoint, a prediction of ‘no suicide’ in every case would be highly accurate (1,336/1,350 x 100 = 98.96%). It would also be entirely unacceptable clinically.”

Extending out some basic math approaches, he concludes, “More to the point, the predictive accuracy assumed (80 percent) is far beyond our present capabilities. The population chosen for the example (suicide attempters) is one of relatively high risk, and yet prediction of the infrequent event, suicide, is poor. It would be very much poorer in a population unselected for risk.” The threshold he used of 80% accuracy exceeds the capacity of our tooling even today, 50 years later. Screening is still required by accrediting bodies in high – and not so high – risk situations despite our awareness that they simply aren’t effective.

The funniest thing is that the more we pay attention to the details, the more we can recognize that it’s a fool’s errand to believe in The Prediction of Suicide.

Book Review-Suicide and Homicide

Robert Bogue November 4, 2024 No Comments

Suicide and Homicide: Some Economic, Sociological and Psychological Aspects of Aggression proposes that both suicide and homicide are acts of aggression that flow through different channels based on either external or internal constraints. There are others who have held – and do hold – this perspective. Karl Menninger spoke of suicide in Man Against Himself as murder in the 180^th degree. More recently, Thomas Joiner in The Perversion of Virtue highlights the common component of killing in both suicide and homicide.

Aggression as a Consequence of Frustration

There are three theories about where aggression comes from. Freud’s theory places aggression as an outcome of “Thanatos” – death instinct. Konrad Lorenz challenged Freud’s perspectives based on his observations of how animals controlled their aggression. The second theory is that aggression comes from frustration. The third theory is Albert Bandura’s social learning theory. He proposes that we learn aggression by seeing it in others. (See Moral Disengagement – The Cases for more.)

Given Lorenz’ criticism of Freud’s theory and mine of Bandura’s, we’re left with the theory that aggression comes as a result of frustration. One might conceptualize this as “Nothing else is working (or can work), so I’ll try the risky thing.” Aggression is risky. Certainly, at a physical level, one can get hurt while attacking another; but at a societal level, even non-physical attacks can backfire. One can become labeled as difficult to get along with or problematic.

However, this sense that what is being tried is being blocked or is simply ineffective leads to an escalation through aggression. We’ve been taught not to back an animal – particularly a wild animal – into a corner, because the behavior that we’ll see out of the animal in those conditions – when they feel as if they have no other options – can be harmful to us.

Business Cycles and Status

Much has been made of how suicide relates to business cycles. It turns out that when business cycles are down – and things are more challenging – we do tend to see a rise in suicide deaths. While there is some disagreement on the specific timing, the general relationship is generally well accepted. Conversely, when the business cycle is at its peak, we tend to see more homicides.

We also see that upper and lower ends of the socioeconomic scale tend to be more and less sensitive. In the low times of a business cycle, suicides increase in the higher socioeconomic status (SES) more than in the lower. The theory is that those in the higher socioeconomic status are more greatly impacted. During the peaks, we tend to see greater homicide rates but initiated by those in a lower SES.

Restraints

The fundamental theory is that weak external restraints drive suicide and strong external constraints drive homicide. In the case of suicide, those who are most at risk as those who are the most affluent. In terms of homicide, it occurs mostly in those who are at lower SES and therefore have greater external constraints.

Conceptually, those who have fewer external constraints need to impose more internal constraints to function. If these internal constraints become too tight or difficult, the aggression felt is self-directed.

Perfectionism

The internal constraints that drive suicide may come in the form of perfectionism and the constant failure to meet impossible standards. (See Perfectionism.) It could be that we’ve become exhausted on our way to peak performance, realizing that we’ll never reach the goals we set for ourselves. (See Peak.) Even in the general form of maximizing rather than satisficing, we know that we’ll be less happy. (See The Paradox of Choice.)

These are the kinds of constraints that we can impose on ourselves. It’s not the outside world setting our standards. It’s our own drive and determination that sets goals that we can’t meet and therefore suicide is a concern.

Social Ties that Bind

Social ties and strong communities are important protectors against suicide that may function in part due to their strong social conformity bond. Robert Putnam described the erosion of social capital in Bowling Alone. He later revisited how the decline of social capital wasn’t occurring evenly, with upper-middle class families finding ways to work together and insulate their children from some of the challenges of the world. (See Our Kids.)

Perhaps if we pay attention to what and who binds us, we’ll realize how little difference there is between Suicide and Homicide.

Prevent Suicide This Season

Robert Bogue November 1, 2024 No Comments

The cold weather of late autumn brings with it holidays and time to reconnect with loved ones. The holidays are a chance to spend time with those we’ve not seen in a while, whether it’s watching a football game or cuddled up under a warm blanket. When we connect with each other, we have an opportunity to bravely ask some hard questions.

Next week, I’ll be publishing a book review every day about suicide topics. These books discuss some reasons why people die by suicide and offer ideas on how to prevent suicide. One of these techniques is to directly ask if someone is considering suicide, because it won’t plant the idea in their head. As we spend time with our loved ones this year, we hope you can use some of these tools to better understand and connect with each other.

Book Review-Attachment in Adults: Clinical and Developmental Perspectives

Robert Bogue October 28, 2024 No Comments

The attachment system that John Bowlby first theorized has spawned a great deal of research and knowledge (in part due to Mary Ainsworth’s contributions). Attachment in Adults: Clinical and Developmental Perspectives shares some of the interesting and intriguing results of this continued research.

Multi-Generational

One of the more confusing results of the continued research is how a parent’s – particularly a mother’s – attachment style can influence the attachment style of their children. Securely attached mothers tend to produce securely attached infants. In short, parents can help their children’s lifelong trajectory by focusing on their own mental wellness.

Another confusing corollary is that children who are securely attached have more complex and mature representation of their parents. They seem to understand the nuances and details of how the parents will interact in ways that their insecure counterparts do not.

Timing

There’s an odd thing about the timing of attachment styles. First, attachment styles seem to appear between 9 and 18 months after birth – the same timeframe as object permanence. In other words, from the very first moments we can recognize something not in our sight – something for which we have a mental model – we start working on attachments.

As adults, the research seems to indicate that a relationship with a securely attached individual has the effect of moving an insecurely attached partner towards secure attachment – over a two-year period. It seems as if there’s an importance to the period of time that the secure relationship is available.

Individualism

The challenges with the Western/American view of rugged individualism has surfaced before. I’ve addressed the challenges with the illusion in my reviews of How Good People Make Tough Choices, Humble Inquiry, and Our Kids. However, as the power of attachment to shape our lives for good or bad is brought to the forefront, the degree to which we believe that we’re able to survive as an individual seems even more of a pernicious delusion. Whether it’s the data from Loneliness or the research around attachment, we know that we can’t live life alone.

Fathers Be Good to Your Daughters

John Mayer’s song, Daughters, includes the lyrics, “Fathers be good to your daughters / Daughters will love like you do.” Strangely, research has found that the best predictor of a daughter’s emotional security in a love relationship is a close emotional bond with her father. The degree of impact that fathers have in this regard is stunning given the relatively low amount of time that fathers spend directly interacting with their daughters.

Approval Competition

In some families, approval is a scarce resource that must be saved. It may be that there is only one person who is receiving approval at one time. There’s a favorite child. The problem with this is that it develops anxiety in the children who feel that they must earn love, acceptance, and approval. They believe that they’re one mistake away from losing their status within the family, with disastrous consequences to their long-term relationships.

Network Maps

If you ask people to map out their important relationships, they’ll often include people who are deceased. As mentioned in New Models of Bereavement Theory and Treatment, people develop internal representations for people that are no longer with them. It’s a plausible explanation that they still feel that person’s presence through the internalized concept of them. It could also be that they just aren’t thinking clearly. Either way, it signals that there’s more to our world than we realize and a great role for Attachment in Adults to play.

Book Review-The Joy of Connections: 100 Ways to Beat Loneliness and Live a Happier and More Meaningful Life

Robert Bogue October 25, 2024 No Comments

Dr. Ruth is all most people need to hear to know exactly who we’re talking about. In The Joy of Connections: 100 Ways to Beat Loneliness and Live a Happier and More Meaningful Life, Dr. Ruth Westheimer shares her direct style of tackling the problem of loneliness. Dr. Ruth was a sensation when she started talking directly about sexual needs and fulfilment on radio and television in the 1980s. In this book, the elderly (now recently departed) Dr. Ruth shares her loneliness as a child and after the passing of her (third, lifelong) husband.

Quality, not Quantity

Dr. Ruth explains that loneliness is about the lack of quality connections not the quantity. It’s not a competition of Facebook friends or LinkedIn connections. What matters, in her opinion, is having a few quality connections that help you believe that people see you and understand you. This echoes the insights of Sherry Turkle in Alone Together and Jonathan Haidt in The Anxious Generation. It’s who you can be open and honest with.

Sleeping with Loneliness

A unique quote from Dr. Ruth is, “I’ve been sleeping with loneliness my entire life.” From that context, loneliness was a companion. It’s a feeling that was relatively persistent. It started with the German Nazi party and the Holocaust, when she was shipped away by her mother (her father had already been taken) to protect her from the atrocities that were befalling Jews at the time. Traveling without a companion couldn’t help but get the loneliness ball rolling. While she grew up in a group home, her fellow refugees didn’t quiet the longing that had already started to pervade her soul.

She quotes from her diary on July 12, 1945: “Above all, I’m longing for a friend.” And the following day, “I live with 150 people – and I’m alone.” These quotes help to spark the understanding that loneliness – the feeling – is different than being without other people.

Love

One could expect that the conversation about love is going to come up in a book by Dr. Ruth – however, it’s not what you think. She starts by recognizing that there’s an absolute need for self-love. Until you can learn to love yourself, you can’t fully accept others’ love of you. (See also Compassion and Self-Hate.) She admits that learning to love herself took time. It took time to realize not only could she love herself but that she was worthy of others’ love as well.

It’s a Numbers Game

On the one hand, loneliness isn’t about the quantity of connections – but that doesn’t mean that it’s still not, in some respects, a numbers game. You don’t need many connections, but you’re going to need to make a lot of connections to find out which ones you can really count on when it’s important. You must “kiss a lot of frogs to find a prince.” It’s easy to get discouraged in the process if you don’t seem to be finding those solid people who will be your precious few. The unfortunate reality is that it’s all about probabilities.

Turning friends into good friends, it seems, is also a numbers game. Dr. Ruth quotes a study by Dr. Jeffrey Hall, who claims that it takes 200 hours over 6 weeks to turn a friend into a best friend. I don’t believe it’s quite that formulaic – but definitely it takes time to build relationships that will survive over the long term.

What About Me?

In a world that sells the idea that you must be connected to be real, valid, and included, it’s hard to accept that for a time you’re not connected with a romantic relationship. It’s hard to accept that you’re going through a period of estrangement with your family. It’s hard to feel like your best friends are so far away. It’s easy to wonder, “What about me?” It’s easy to think that we’re excluded from the rest of the world – but that’s not true. Dr. Ruth calls us to recognize that there will be a time when we will experience The Joy of Connections.

Book Review-A Biography of Loneliness: The History of an Emotion

Robert Bogue October 24, 2024 No Comments

When there’s a famous person that we’re interested in, we’ll read a biography. However, A Biography of Loneliness: The History of an Emotion isn’t about a person. It’s about an emotion that rose to prominence over the last several decades to the point where the US Surgeon General calls it an epidemic. It’s important enough that it deserves more discovery. I’d already read Loneliness by John Cacioppo, and it was a wonderful book. It seemed like some perspective from across the pond would add depth to my understanding – and it did.

Feeling Misunderstood, Estranged, and Rejected

There are many definitions for loneliness, but the experience of loneliness is described consistently. It’s the feeling that someone is disconnected from the rest of humanity. It’s a feeling that somehow a great gulf exists between us and others. It can bloom from feeling as though others don’t understand us. It can be triggered by a specific misunderstanding but more frequently is just a general sense that we’re out of alignment with the rest of humanity.

Sometimes, this sense of disconnection is founded in concrete reality. It can be that we’ve become estranged from some part of our family. (See Fault Lines.) While this is painful, it’s helpful to know that it’s all too common. Even Fred Rogers’ son didn’t speak with him for a while. (See Life’s Journeys According to Mister Rogers.)

Another cause for a sense of loneliness – and disconnection from others – is the specific case where we’ve been rejected by another, whether it was a simple refusal to join us for an event or a more serious rejection like a breakup or divorce. While, intellectually, we may recognize that this is one person (or perhaps a few people) and not the entire world, it doesn’t feel that way. Martin Seligman explains how things can feel personal, pervasive, and persistent in The Hope Circuit. It certainly can feel that way even if the rejection is a trivial one.

The Only Thing We Have to Fear is Fear Itself

Franklin D. Roosevelt’s inaugural address highlighted the fact that fear can be a problem itself. This is particularly true with loneliness, because fear changes the way we behave. Because of that, we often make choices that lead us toward loneliness. We pull ourselves into our shells like scared turtles, and by eliminating opportunities to interact with others, we intensify our feelings of loneliness.

Loneliness Visits All

If you find someone who says that they’ve never felt lonely, they’re probably lying. (See Telling Lies.) Loneliness – the feeling of disconnection – is a part of the human condition. Everyone feels it. The difference isn’t whether someone does or doesn’t feel lonely. The real concern is when the feeling becomes more consistent, persistent, or pervasive. While my loneliness and your loneliness may not line up in time or by contextual situation, we can understand the feeling.

Oneness, Solitude, and Loneliness

Thus far in this review, I’ve focused on the feeling that loneliness creates, because it’s the key aspect that separates two other conditions, which are often co-mingled with loneliness. The way that you can distinguish the state of being the only person in an area or a sense of solitude from loneliness is the emotional impact. In fact, if we were to arrange them on a continuum, where loneliness is the most distressful, oneness would be neutral. It’s a relatively benign observation of the count of people. The other end would be held down by solitude with the idea that this is oneness that is desired.

As an introvert, I crave time when I’m alone. (See Quiet for more on introverts.) I crave the chance to read and write uninterrupted. This isn’t to say that I don’t like time with my family – I need that, too. The point, however, is there are times when I want to be in a state of oneness.

Accountability Separates Online and Offline

When we start looking at how society has changed and the impact on loneliness, we cannot ignore the transformation that information technology and telecommunications have fueled. (See also The Upswing and The Anxious Generation for more on these changes.) While we can talk about the specific technologies and their specific impacts, there’s been a subtle shift that has made a big difference sitting below the increased opportunities the technology brings.

Take a trip back in time a little over a century ago. Travel is mostly by horse-drawn carriage, with railroad becoming an option for the more affluent. Rather than the population being concentrated in large cities, it was spread out in small hamlets and villages. Imagine you’re born into a little village. You’ll know everyone, and they’ll know you.

Structurally, your relationships will be different than they are today. If you don’t like someone, you can’t really move away. You can’t afford to be mean to them or to alienate them. You and all your neighbors know you need each other, even if you don’t like or even fully trust one another.

Today, we’re more mobile. We leave the city we grew up in to take a job in another state. We move when we don’t like our neighbors. We find ways to build a new set of friends and discard the friends we grew up with. The ease of finding and making new friends has made us less concerned about offending others.

It’s also made us less accountable. Instead of meeting our commitments, we collectively think that no one will notice. We can simply focus on ourselves rather than focusing on our integrity and character.

Even if we stand against these values, others may not. (I’ve been in my home for over 20 years in one of the three places that I grew up as a child.) We’re living in a world where people discard others because of perceived injustices without a second thought. (For more, see The Art of Community.)

The Fear of Social Death

Our fear of death is well researched. (See The Denial of Death and The Worm at the Core.) The proposal is made in this book is that our fear of loneliness may be a result of a fear of social death. We may feel that we’ll no longer be connected and “alive” to other humans. It’s this fear that drives loneliness.

Rituals

Rituals operate around us at every level. Joseph Campbell explains in The Power of Myth how rituals connect stories. In Anthro-Vision, Gillian Tett explains how rituals are connected with cultures. John and Julie Gottman explain in The Relationship Cure how critical positive rituals can be to relational health. In The Rites of Passage, Arnold van Gennep explains how rituals help us feel connected to history and each other.

If we’re struggling with loneliness, one place to look for a fix is to find rituals that we can find comfort and connection in. Maybe a good first ritual is one where you grab a drink and curl up to read a good book like A Biography of Loneliness.

Book Review-Marital Separation

Robert Bogue October 23, 2024 No Comments

It started with work on what happens when one member of a couple dies. What’s the process by which the bereaved person reconstructs their life? This led Robert Weiss to a broader study of all Marital Separation, inclusive of divorce. (For more on divorce, see the book, Divorce.) Weiss’ focus remained on the transformations that the bereaved make to cope with their new circumstances.

Social Responsibility

The way that we see the institution of marriage varies by society, culture, and time. Our beliefs about social structures and love are subject to similar kinds of forces. (See Anatomy of Love for more.) Arranged marriages are all but gone in America though they remain the standard in other parts of the world. In America, we believe that we should marry for love. Marriage is about two people who fall madly in love and decide that they want to make the commitment to sustain that love over a lifetime – at least in theory.

This perspective is one of individual desires and economic advancement. It’s not a social responsibility. These are the words that Weiss uses, insisting that we’ve de-sacralized marriage. He believes that the no-fault divorce has allowed us an easy escape from a difficult patch in a marriage. The data on divorce rates dramatically increased following the acceptance of no-fault divorce.

His point is that individuals are so focused on the impact to their happiness that they don’t recognize and account for the impact that their decisions to get – and stay – married has on others.

When it Breaks

Weiss starts with separations and the disruption this causes to both parties and to any children that may be a part of the marriage. His data points to half of the separations ending in divorce. Similar concerns can be raised when one member of the couple encounters a life-threatening disease and dies. There’s expected impairment of reason, rationale, and logic. (One that attorneys lament when they’re engaged.) This is, of course, trauma. (See Trauma and Recovery for more on trauma.)

Regardless of the cause, the remaining parties develop their own accounts – their own stories – about what transpired that has left them decoupled. James Pennebaker’s research illuminates the need for creating our own narratives of every serious situation that we survive, particularly traumas. (See Opening Up.)

What is interesting about these accounts for a couple that is separated or divorced is that they often agree on the things that happened but differ in their interpretation of them. The meaning that each party creates around the actual things that happened can be quite radically different.

The Ties

Weiss speaks of many times when couples would separate or divorce only to come back together for support – or sexual relationships. It’s hard to separate permanently from someone who you’ve been so close to, so reconnections are common. In some cases, Weiss reports that people speak of their ability to be friends or sexual partners with their former spouse – even if they know they can’t be husband and wife.

There is one exception to this which is if the person is understood to become intrinsically different. That is, the person they are now is separate and distinct from the person that you fell in love with and the person with whom you have shared a relationship. This can be because of extreme behavior or a substantial betrayal, which leaves you wondering how much you knew about the other person.

Rage

Anger is disappointment directed. (See Destructive Emotions.) Rage is often when you have a need that’s not being met. Rage between separated parties often occurs if there’s an unfulfilled need that continues. The need can be material or financial, emotional, or sexual. These unmet needs create more and more pressure on the individual until they’re no longer able to be contained and they erupt as rage.

Family of Origin

While not the language Weiss uses, more contemporary language calls the family you grew up in your “family of origin.” With some tragic exceptions, these are the people that one can depend upon when they’re in need. There’s an unwritten expectation that you can count on any member of your family to respond to your request for help. Despite this, most of us are guarded with our families.

There are topics that are off limits. You can’t discuss religion with Aunt Mary. Don’t get Uncle Ralph started about politics. Don’t talk about your concern for Tibet with your mother. Those are not particularly difficult, because they’re not personal. However, stories are told all the time by people who are openly gay – except with their families.

The truth is that we are careful when it comes to letting our families into our confidence for fear that whatever we share will come back to haunt us – repeatedly.

Friend Fallout

Much is made about the division of assets in a divorce. There’s the concern for who gets the house, the cars, the furniture and so on. Little is said, however, about how friends tend to divide themselves between the couple, choosing the husband, the wife, or neither. In my own divorce, there were some friends that chose sides and others who chose to separate from both of us. It’s as if they believed that divorce was contagious, or, perhaps more likely, they decided that we were both bad because of the divorce.

Even when friends stand by you, it’s often the case when you can feel out of place, because the things you did before were primarily as couples – and that no longer matches your status, so you’re inadvertently not invited, or you feel out of place when you are. Ultimately, the decision to stop being a couple can have dramatic impacts on friends as well.

Guilt and Shame

One of the barriers to being able to effectively support the children involved is the guilt over a divorce. One – or both – of the couple feel as if they’re responsible for the divorce, and as a result, they may not be able to effectively navigate the role of parent in providing support and discipline. (See The Psychology of Not Holding Children Accountable.) They may find themselves barely to accept themselves, and a small rejection by the children may set off waves of self-doubt and remorse that immobilizes them.

Shame, guilt’s evil cousin, expands from just that they’ve committed a bad act and instead associates that they are bad. The absolute of “divorce is bad” becomes a permanent stain on them. The result is they’re so focused on trying to cleanse their own guilt that they barely notice what the children need of them.

Recovery

The good news is that the effects of marital separation aren’t forever. Weiss suggests that the typical recovery is two to four years, with the average being closer to four than two. In my own experience, the time can vary widely outside of this range depending upon the work the person has done beforehand and the work they need to do afterwards.

There are ways that people can prepare – even while working hard to preserve their marriage. However, sometimes there’s nothing that can be done to prevent Marital Separation.

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