Book Review-Pathways to Suicide

What if the act of suicide isn’t a moment of desperation but is instead the result of a lifetime of wounds and hurts that just don’t seem to heal quite right?  What if we could see these hurts, and, in doing so, approach a sense of intervening before it’s too late?  This is the heart of Pathways to Suicide.  For some situations, there is a definite path that leads to someone feeling so much pain that they believe the only answer is to stop living.  However, this isn’t a complete story, as there are many others for which the path isn’t clear – if it’s there at all.

Alternatives and Coping

The first stop on the journey towards understanding suicidal pathways is to look at the conditions that seem to be present when we find suicide attempts and completions.  There are some expected answers, such as a life that has been harsh or when suicide is glorified.  Other factors, such as the lack of love and support, are present as well.  However, in the list are two related factors that bear highlighting.

If suicide is the “only” option (as Edwin Shneidman says in The Suicidal Mind), then it is the option to choose.  We find if the perception is that the “only” solution is suicide, many people take it – before finding other options.  The reality of the situation and the other alternatives that may be available disappear in the collapsed view of the cognitively constricted.  Therefore, it’s important to present the suicidal person with a set of options.  If there are options, then there’s no “only.”

Similarly, suicide represents a lack of alternative coping skills that would be more desirable.  In short, the person who attempts suicide is faced with a situation for which they have insufficient or no coping skills.  They decided that they couldn’t cope with their situation and therefore death seemed like the only option.  The key here in helping people avoid suicide is increasing their coping skills and ensuring they have support when their coping skills may fall short.

Put Out the Fire

Why Can’t We All Just Get Along

It’s the cry of Rodney King, a man who was beaten by the cops, whose video caused their trial and whose acquittal caused the LA riots.  “Why can’t we all just get along?”  Much has been made of connections and social support.  What is often overlooked is that negative interpersonal interactions may create more suicidal drive than simply not having deep relationships.  In other words, it’s not the number of relationships but their quality and their valence.  (See High Orbit – Respecting Grieving for more on numbers of relationships.)

Negative relationships don’t necessarily mean conflict.  Conflict itself isn’t bad.  However, relationships that put another person down are at risk for reducing someone’s self-esteem to the point where suicide seems like a worthy option.

Drowning in Theories

Pathways to Suicide admits that we’re drowning in theories with too little hard data.  The book was published in 1981, so one should expect that we’d have more research, and we’d know what better to do about suicide.  Unfortunately, while we’ve made progress, it’s not nearly enough.

I’m particularly disturbed by the lack of research that teases out whether things are correlational or causational.  (The topic comes up all the time in my research.  See The Nurture Assumption for some coverage.)  We’ve got data sets and statistics about all sorts of things, including the impact of age and gender on suicide risk but precious little about detection, assessment, prevention, and training.

It’s like we’re in a time before Mendeleev’s Periodic Table of Elements organized chemistry in a meaningful way.  Until then, things seemed random and chaotic; only after organization did things start to make sense.  We need that for suicide research – but we don’t have it.

Hope and Alcohol

Pathways to Suicide confirms that hopelessness has an even higher correlation to suicide than depression but adds that hopelessness is negatively correlated with alcohol.  That makes the relationship between alcohol and suicide very complex.  On the one hand, alcoholism and the related implications are correlated with suicide.  However, alcoholism normally implies trouble with relationships and work leading to unstable home situations.  It can be that the correlation we see with alcoholism isn’t the alcoholism itself but is instead the impacts to home life.

Alcohol, however, is a short-term tool for coping with difficult situations and one that seems to have a positive effect towards reducing suicide.  Obviously, the question becomes when does the use of alcohol become alcoholism – and the impacts associated with it.

Role Transitions

There are transition points in our lives that separate one part from another – when we become a parent and when our children (finally) leave home for instance.  During our adolescent development, we’re trying to figure out who we want to be and to learn how to separate from our parents.  It’s at these sorts of times, it seems, when we’re at a heightened risk for suicide.

Maris refers to Erik Ericson’s work on developmental stages and how transitioning between stages is an unsettling time.  (See Childhood and Society for more.)  Maris also refers to Piaget’s work, which precedes Ericson’s and is derivative of Emile Durkheim’s.  Durkheim wrote the first substantial work on suicide.  How Good People Make Tough Choices is a slightly different look at the moral development of an individual, which creates a similar set of disruption as the old decisions are no longer necessarily the right, new decisions.

Even more challenging than the role transitions is what happens if you’re not able to make the cognitive changes that each stage calls for.

Stuck Stages

The more that we learn about our development as humans, the more that we realize that our early development has very serious, long-term effects.  The Adverse Childhood Experience (ACE) study showed how our health as adults was driven by the stressors that we faced as a child (see How Children Succeed).  More than that, we discovered some of the problems we face as adult may come from in utero development.  Fetal Onset of Adult Disease (FOAD) is a real thing, and it gives rise to the spooky world of impacts that happen well before our consciousness (see Why Zebras Don’t Get Ulcers).  Even in rats, licking and grooming produces more well-adjusted rats – if there is such a thing.  (This is also discussed in How Children Succeed.)

When we’re unable to complete some part of our development in a stage we leave a part of ourselves behind and we end up dragging it through the rest of our lives.  It takes energy and creates dysfunctions that are hard to shake.  Those undeveloped parts of ourselves can become progressively burdensome to the point where suicide seems like the only option.

Compensating Support

Just like how rats who received proper licking and grooming as pups go on to be more “well-adjusted,” we, too, can recover from, repair, heal, and move past our broken aspects of development with sufficient, consistent love, support, and encouragement for self-image.  Maris asserts that most suicides have lives that are in shambles – presumably where they’re not getting the kind of support they need.

I’m careful to acknowledge that some suicides’ lives are in shambles, but the important piece isn’t the objective reality of their situation.  What matters is how they feel about their situation – and in the moment where they encounter a suicidal thought.  People who are objectively in quite good condition commit suicide over the most trivial or fleeting of things.

Similarly, it’s not the actual tangible support that people are receiving that matters, it’s how they respond to and accept or reject that support.  Joiner believes that burdensomeness is a factor in suicide – and that comes from a feeling that you’re weighing down others.  (See Why People Die by Suicide.)  It’s possible to receive and accept support while not perceiving yourself as a burden – and conversely someone who receives almost no support can believe that they’re a burden.  It’s truly all about how the person perceives the support that is happening.

Separation and Grief

Separation is different than loss – real, permanent loss.  With separation, we can try to regain what we’ve lost.  But the grief that is left for survivors of suicide is permanent and unchangeable and is therefore categorically different than something that seems lost only for a time, like a relative going on a vacation far away.  (See The Grief Recovery Handbook and On Death and Dying for more about the grief process.)

Perhaps the most difficult thing for survivors to accept is the reality that their loved one is gone.  They can know it to be true, and still at some level not want it to be true, and thus are caught in a powerful conflict between their knowledge and the feeling that “it just can’t be.”

Punishment

Maris quotes other researchers that draw a connection between punishment – both physical and verbal – and subsequent suicide, while also noting that punishment and closeness often come from the same parent.  I’d propose that perhaps it’s not the punishment itself that is the problem but rather the child’s inability to predict which they’ll get from a parent that may be the root cause.

I’m strongly in favor of holding children accountable – as my post, The Psychology of Not Holding Children Accountable, explains.  In fact, I believe that a failure to hold children accountable based on Benjamin Spock’s book, The Common Sense Book of Baby and Child Care, has created a world of confusion for children who don’t understand why the “real world” is so much different than the coddling that they received at home.  (See The Coddling of the American Mind for more.)

Put together with other research, I’m skeptical that punishment is the issue.

Societal Influence on Suicide

In trying to determine what leads some people to suicide and others away from it, it becomes obvious that some cultures have higher suicide rates and others lower – sometimes dramatically lower.  It seems that more individualistic cultures seem to have higher rates, and more socially integrated cultures have lower rates.  This is what one might expect when they look at the kinds of powerful bonds that Francis Fukuyama describes in Trust: Human Nature and the Reconstitution of Social Order.  When a society has tight bonds, the individual is less able to dispose of their lives so easily.

Important Occasions

Viktor Frankl in Man’s Search for Meaning explains that planning on dates for rescue can be challenging as a prisoner.  If the date comes and goes and you’re not rescued, your hope will be dashed.  The opposite seems to be the case for suicide.  Suicidal people seem to wait until after special days like birthdays and holidays before attempting suicide.  It’s like they want to be around for one last special moment before finally giving up hope.

This seems to hold true even if the special event isn’t necessarily a special event for them personally.  They need not expect gifts or a big party, just the fact that there’s something special seems to be enough to pull at least some people along life’s journey a bit further.

Power to the People

Another interesting but not totally unexpected finding is that when people live with others, their likelihood of suicide is suppressed.  There may be two factors at play here.  First, it can be that they don’t have the time and space that they need to make the attempt.  This, however, stands against many examples where people killed themselves while others were close by.

Second, it can be that the higher density of people necessarily creates the probability of warm relationships that nurture people.  Much has been said about the need for positive relationships and closeness; perhaps physical closeness encourages the emotional closeness that protects people from thoughts of suicide.  It can, of course, lead to uncomfortable relationships as well, but that seems to be a less powerful factor.

Other People Don’t Matter, Then I Don’t Matter

People who attempt suicide seem to decide that other people don’t matter more than those who die by natural causes.  For some reason, they decide that it’s no longer worth maintaining or continuing to develop relationships with others, because some part of them is already on a journey towards suicide.

Who knows what part of the person makes this decision – consciously or not – that other people don’t matter, because they don’t intend to be around long enough to get value from the relationship.  Or perhaps it’s that they feel disconnected and alone, so their behavior starts to match how they feel.

Don’t Get Dead, Get Even

For some, it may be that there isn’t a way to get even with someone who has wronged them except through suicide.  There’s often little that a child can do to harm a parent, but certainly taking their own life is a way to accomplish that.  Some 47 percent of suicide completers conceived suicide as a way to get even with someone else.

This is an odd paradox.  You get the final word, because it’s your final deed.  Somehow the hatred and malice boils to a level where it’s even worth your own life.  It’s the final power that you can wield even if you feel like you have no power in a situation.

Performance-Based Love

Sometimes the end of suicide comes from a lack of love or perceived abandonment.  Other times, what a person learns about love is a performance-based love that is only present when you’re doing something for the other person.  (See The Four Loves for more.)

The real problem is that this isn’t love.  It’s not love – the commitment – when it’s performance-based.  (See Love, Acceptance, and Forgiveness for more about love as a commitment.)  It’s hard to live in a world where your support is from those who love you but that love stops when you can’t do something for them.  Learning that people take care of other people and that love isn’t dependent upon what you can do for the other person makes the world a lot better place to be in.

Socio-Economic Suicide

Another rock that is overturned in search of the causes of suicide is socio-economic status (SES) and employment status.  In short, it’s how stable a person’s finances are.  The mechanisms for testing this statistically aren’t very good, and it’s no surprise that there are no consistent results between SES and suicide rates.  Nor does there appear to be any employment relationship to suicide rate.

The problem with identifying SES’ relationship to suicide is that the amount of assets one has and even their current income has little to do with how stable, respected, or valuable they feel.  In Thinking, Fast and Slow, Daniel Kahneman shares the research he did with Tversky how people adapt to their current conditions and how they are impacted more by losses.  Between these facts and the idea that people can live at the edge of their means, we’re led to understand that a loss is still a loss no matter how much money you make.

Change Isn’t Good for Your Health

High levels of change in your world may lead to the kind of conditions that encourage suicide.  It’s been noted other places that immigrant populations have higher suicide rates, and those rates appear to be directly related to the degree of change that they’ve encountered – not their community.  However, Pathways to Suicide goes further and explains that high levels of change in someone’s life leads to both emotional and physical health problems.  These problems can, in turn, create challenges for suicidal ideation and attempts.

It’s not necessarily the change itself though.  It’s how the person responds to that change that seems to have a great deal of impact.  In the research for the Confident Change Management course, we discovered great discrepancies between those people and organizations that prepared well for change and those that felt as if they were being tossed like waves in an ocean.

Responsive, Not Responsible

For women who attempt or complete suicide, there seems to be an underlying current related to problems with their children.  Rarely are marriages mentioned; more frequently, there are concerns about children.  This may be a result of the belief that parents – and particularly mothers – are responsible for their children.

We use the word “responsible” for our children in the legal sense and fail to separate the word when we’re referring to their behaviors, which invariably will deviate from what the parents believe they taught and what they desire for their children.  Instead, in our Extinguish Burnout work, we encourage parents to be responsive to their children’s behaviors, because they can’t be responsible for something they can’t control, and children haven’t been controllable since they could be contained by a playpen.

Dulling the Pain

There are many ways that people dull the emotional pain that they feel.  Alcohol is a perennial favorite, but others are used as well.  Some use food to temporarily blot out their feelings, while others rely on the dopamine hit from a new purchase.  Whatever the mechanism, the goal is the same – to reduce the psychological pain to a tolerable level.

What is tragic, however, is that we become habituated to these coping mechanisms and require more and more of them to be able to sustain the same wall against our pains.  The key realization that too many people miss is that alcohol isn’t the problem – alcohol is the solution.  It just so happens that after sustained use and addiction, it becomes its own problem.

If and Only If

Suicidal individuals want to live more than they want to die if – and only if – something in their life will change.  Their marriage, their job, their relationship with a sibling, or dozens of other things.  If it could only be fixed, then life would be worth living.  They could finally put away the thoughts of suicide, because all of their problems would be solved.

Of course, this is fantasy.  When one problem is resolved, others pop up to take its level of importance.  However, suicidal individuals believe that they can hold on, they can cope, but only if their circumstances change.  What they fail to realize is that they don’t have control of those external factors.  They only have control of how they respond.  (See Choice Theory and Emotion and Adaptation for more.)

Unable to Articulate

Sylvia Plath was a poet who knew her way around words.  She could articulate her points clearly, succinctly, and passionately.  Her command of the language and her willingness to plumb the depths of her emotion made her uniquely qualified to write about suicide – having attempted it several times.  However, not all those who struggle are so gifted.  (See The Savage God for more about Sylvia Plath.)

Too many people who end up dying by suicide are never able to fully articulate how they feel, their depression, isolation, and hopelessness.  Part of helping is creating better understanding of others – even when they can’t help.

Reasoned not Rational

It’s important to point out that all suicides are reasoned at some level.  There’s some reason for pulling the trigger or jumping.  If there were not, it would be accidental.  However, just because something is reasoned doesn’t mean that others will find the response rational.  Too often, outsiders see the problems that the suicidal individual is facing and recognize that it’s not that bad.  However, that’s not the view from inside their head.

From the inside, everything appears to make perfect sense, and the negative consequences don’t matter because they won’t be around for them anyway.

Worn Down

In the end, Pathways to Suicide is about the long road that everyone travels and how some of those roads lead to suicide.  While it’s impossible to predict who will take their own life and who will conquer the world, it is possible to sometimes see how the roads sometime lead towards suicide.  The worn down, oppressed, depressed, and hopeless feelings are the Pathways to Suicide.