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Book Review-Undoing Suicidism: A Trans, Queer, Crip Approach to Rethinking (Assisted) Suicide

As a cisgender, old, white guy, I have no doubt that I come from a different place than Alexandre Baril in Undoing Suicidism: A Trans, Queer, Crip Approach to Rethinking (Assisted) Suicide.  I’ve had the honor of sitting on a few diversity panels as an ally.  Despite my honest attempts to understand, I recognize that I am falling short.  The good news is that my friends – and fellow panelists – are often gentle in nudging me into a more understanding position.

I enjoy having my perspectives challenged.  I’ll often read from both sides of an argument or speak to parties on opposite sides of an issue who refuse to be in the same room.  For me, this is the heart of understanding: being willing to listen to everyone and accept multiple perspectives.  I’m far from agreeing with everything that Baril proposes, but I accept there are some interesting and challenging questions that we need to answer as a society.

Compulsory Aliveness

What right does a person have to insist that another person should stay alive?  Our current response to a suicidal person isn’t first to understand their pain and why they want to die or to see what might be done to make their life more worth living.  Instead, we focus on the requirement that someone must stay alive.  They must fight their suicidal urges and persevere regardless of their pain.  In effect, we’ve said that society can say when you should – and should not – die.  Someone else brought you into this world, and you’re not authorized to take yourself out of it on your own.

It’s important to note the separation between the current expectations and laws of the country you’re in and your religious beliefs – and what might be the right answer.  I say this in the context of understanding this is a dilemma – it’s not solvable, and there is no right answer.  Individual versus community is one of the dilemmas that Kidder enumerates in How Good People Make Tough Choices.  In Trust, Fukuyama walks through how different focuses of trust between societies, organizations, and families can lead to radically different responses and behaviors.  These are the kind of wicked problems that Horst Rittel was talking about decades ago.

That is, there is no solution, no one right answer.  Instead, if we want to be responsive, we must constantly reevaluate in the light of new information, new results, and new concerns.  Here, then, Baril is calling us to evaluate whether the current balance is right – and argues that it is not.

Start with Caring

There’s no doubt that showing care and concern for other humans is inside of the scope of prosocial behavior that we expect from everyone.  Far too often, we’re too busy in our lives to notice the struggling around us.  Even if we’re interested in others’ suffering, we must acknowledge that their struggles and their experiences may interfere with getting help.  When asked how they are, they may answer, “Fine.”  When directly asked about whether they’re considering dying by suicide, they may lie.

They’ll lie for fear of being interrogated, locked up, and forced into situations that they either know -or just suspect – will be bad.  While genuine concern for another person and even a modicum of relationship can help people share their inner struggles, we’re averse to it at a cultural level.  We know “better” than to share our problems for fear that someone will use them against us.

While a caring conversation about someone else is a good way to start, it’s far from preventing someone from believing that suicide is the right answer for them.

Immediate Detention

[Disclaimer: I’m not an attorney, and this isn’t legal advice.]

The fear is that police will use the laws the allow for immediate detention for a person.  In general, law enforcement can hold someone against their will – even if no crime has been committed – if they are an immediate danger to themselves and others.  On one side of this issue is the person who is considering suicide.  They fear that this provision in law will cause them to lose their freedom and start them down a path of problems.

On the other side is law enforcement, who are concerned that if they utilize immediate detention, they will be sued for violating someone’s civil rights.  At least in the United States, law enforcement personnel have qualified immunity when they’re performing their duties.  However, this immunity is nullified if it’s shown that the officer acted that maliciously or recklessly disregarded a person’s civil rights.  While this seems cut and dried in theory, it’s not so straightforward in practice.

The standard for what constitutes imminent danger to self or others isn’t clear.  If you were to say that you plan to kill someone on December 1, 2050, then you’re clearly not an immediate risk.  Similarly, planning to die at a specific, far-off date wouldn’t trigger undue concern.  However, that’s not generally how it’s phrased.  “I’m having suicidal thoughts” is a typical, vague response.  It puts the officer in the position of needing to decide if you intend to act on these thoughts immediately or whether they’re something that you have no intention to act on.

Depending on the officer, they’ll request a behavioral health professional who can make this decision, call an on-call judge to get input, or make the decision themselves.  Something as weak as “suicidal thoughts” may be coupled with other context clues to yield a decision that there is imminent harm and detention is warranted.

It probably happens less than the suicidal person fears – and more than the law enforcement officer would like.  Operating in gray areas isn’t fun for anyone.

The truth is that an immediate detention results in a trip to an emergency room and a more thorough evaluation.  That’s not the real problem.  The real problem is emergency detention – the kind that leads to extended stays.  Immediate detentions, are in most states in the United States, limited to 24 hours.

Emergency Detention

In many states, mental health professionals can ask for an emergency detention (sometimes called a 72-hour hold because of the duration).  This normally follows immediate detention and involves more thorough evaluation and treatment by a behavioral health professional.  This is what most fear when they say that they’re having suicidal thoughts.

The rules for these detentions vary widely, but they can sometimes be extended and sometimes lead to a longer-term commitment hearing.  Whatever the case, they’re very scary for the person involved.

Do we need a MAID?

Some states and Canada have laws for medical assistance in dying – or assisted suicide.  Conceptually, it allows medical professionals to provide either resources or assistance in a patient dying; practically, it represents a few challenges.  The basic premise is that a professional assesses that someone has carefully considered suicide and has decided it’s right for them.  Once this decision is made, the preparations are made.

However, whether we call it “carefully considered” or “well-reasoned,” the question becomes what meets this standard?  If the standard is set too low, then people will needlessly end their own lives.  If it’s set too high, then people will subvert this system and instead resort to their own means.

The benefits of reasonably set criteria to society are two-fold.  First, the substantially lower chance of medical costs for attempted rescue.  Second, the consequences of an attempt that doesn’t end in death.  To the individual, it allows them dignity and the ability to have loved ones with them when they die.

On My Terms

One could argue, then, that the person can die by suicide even if they don’t receive medical assistance.  However, that necessitates that it be done in secret with potentially painful means that may not be successful and instead permanently disable the person, making their pain and suffering worse.  The argument for an accessible, societally-accepted opportunity to kill oneself follows the same reasoning that we legalize other behaviors.

America tried prohibition and failed, because it drove alcohol underground and did more damage than good due to the rise criminal organizations and the lack of quality control that ensued.  States across the country are decriminalizing marijuana.  We’ve decided that it’s better to regulate and accept the behavior instead of criminalizing it.

On a Mission

One of the opportunities I’ve had is to sit around conversations about what works with church missions – and what doesn’t.  I’ve learned about the challenges of even well-meaning but under-informed people.  “Steel Axe Heads for Stone Age Australians” is a powerful example of how things can go wrong.  (See Diffusion of Innovations for more.)  To simplify the problem, it’s a difference between “doing for” and “doing with.”  The first is more honestly stated as “doing to.”  When we approach a mission as doing something for/to a group of people, we’ve got it wrong.  We need to enable them, so that they can do it themselves.

The shift in thinking moves us to asking questions about what suicidal people need or want instead of deciding that they need what we think they need.  I’m not saying that in every case we’ll agree with what they want – but we should at least know what it is.


Who should be allowed to decide for themselves to die?  If they’re not, then who should be allowed to make that decision?  Should executors of their wills or their heirs be able to make the choice?  This is the heart of the question about neurodiverse people who process information and emotions in ways other than is considered normal.  Some use the word “sanism” to refer to discrimination against the neurodiverse.

Here, too, I think we have serious moral challenges that have no clean solution.  If people are living with mental disabilities to the point that they can’t make all decisions for themselves, can they or someone they designate ask for assisted suicide for them?

The standard protection is that the person who is electing death for another not benefit from the decision.  That is, they can’t be an heir or an executor to the estate.  The problem with this conceptually is that these are presumably the very people who care the most for you – and if they don’t, what remedies does society have to keep them honest?

Last Chance

For those whose suicidal thoughts are persistent or at least recurring, it should be noted that suicide is the last option.  Surely, there are “impulsive” suicides who will not fully consider their options.  (See Decision Making and Sources of Power for perspectives on decision making.)  For those who’ve battled with suicide for a long time, there is a sense of clarity that suicide is irreversible.  There’s also often a sense that it’s a bad option.  However, the problem is that there are no other options that seem available.

Shneidman said that “only” is the four-letter word of suicide.  (See The Suicidal Mind.)  That’s because people who die by suicide see it as the “only” option.  They’ve lost hope that their pain and suffering can be or will be remedied by any other solution.  In the absence of other options, you go with the only one you have.  That’s one of the reasons that concepts like “safe for now,” which leaves the option of suicide open in the future but removes it from the table for now, are so important.  (See Managing Suicidal Risk, 2e for more.)

Moral Duty

Societal norms require that individuals dissuade others from suicide.  We’re expected to want the person to stay alive – whether we do or not is not relevant.  We’ve got to learn how to validate their perspectives – even if we don’t personally agree – before attempting to change the course of their thinking.  Techniques like Motivational Interviewing can help fight against the righting reflex, which invalidates the other person’s perspectives and feelings and may make suicidal ideation worse both to fight the invalidation or, if they accept the invalidation, develop self-hate.

I wouldn’t go so far as to call our desire to help our fellow man a bad thing.  I would, instead, say that we’re sometimes confused by what helping is – and isn’t.  I do believe that accepting that someone would want to leave this life, their community, and us is a hard thing.  However, if we’re not willing to accept that there are some times when suicide is a valid option – as rare as they may be – we may have to take a more radical approach to get to Undoing Suicidism.

Book Review-Suicide and Social Justice: New Perspectives on the Politics of Suicide and Suicide Prevention

We’re trapped in a view of suicide that conceptualizes it as a psychological problem.  We can’t see how to integrate multiple views of the problem from separate sociological and psychological standpoints.  Suicide and Social Justice: New Perspectives on the Politics of Suicide and Suicide Prevention aims to remove the barriers and allow us to see the problem of suicide from a wholistic perspective.  In doing so, it directly challenges some of the false narratives that we’ve been led to believe.

Mental Health Conditions

Going back to the idea that someone would need to be “mad” to die by suicide, we’ve tightly coupled mental health to suicide to the point where some, like Thomas Joiner, claim that everyone that dies by suicide has some sort of mental illness.  The problem is that the basis of these claims are weak at best.  With incredibly small sample sizes, no reference point against the general population, and other methodological issues, the belief that 90% (the more commonly quoted number) of suicides have a mental health issue simply isn’t supported by the data.

First, the proposed mental health issues are based on retrospective analysis.  It’s the psychological autopsy process created by Shneidman applied to people whom the interviewer knew died by suicide.  While Shneidman intended the psychological autopsy to help clarify the mode of death, that’s not the way the process is being used.

As a point of fact, Eli Robbins at the University of Washington at Saint Louis simultaneously developed the retrospective review.  Their study, involving 137 cases, was the first to establish a prevalence of mental health issues for those who died by suicide.  However, in their zeal to establish the relationship, they made two critical errors.  First, they failed to establish any sort of base rate in the community.

Their percentage of mental health issues was well above 90%, but only when they included undiagnosed issues.  They used the reports of friends to establish that the deceased might have had a mental health condition.  The problem with this approach is both interviewer bias leading to higher than actual numbers as well as a failure to provide a control group.

We simply don’t know what the diagnosed percentage of mental illness was for accidental, natural, and homicide deaths to know if the diagnosed percentages are different.  Nor was any effort undertaken to interview these other kinds of deaths to establish the undiagnosed ratios.

One could argue that there are other studies with similar findings – and of course there are.  However, they suffer from similar and more egregious methodological errors.  The definitions for alcohol use disorder would encompass a very large percentage of the United States population – but, again, controls are lacking to see the difference.

It’s in that context that the World Health Organization indicated less than half of the people dying by suicide in the US had a mental health condition.  Contrast this with the fact that depression and anxiety are at epidemic levels.  The base rate in the population for mental illness is higher than we’d like to believe.

If more than half of the people who die by suicide don’t have a diagnosed mental health condition, we can’t very well screen for, identify by, or even strongly correlate depression and suicide.

Henry Murray

I was first exposed to Murray’s work through some testing that should never have been.  (See TAT in The Cult of Personality Testing.)  I continued researching his work and his relationship with Christina Morgan in Love’s Story Told.  However, perhaps Murray’s greatest contribution to psychology is in his categorization of psychogenic needs.  It was Shneidman’s view that it was one of these thwarted needs that resulted in the press and perturbation that drove people towards suicide.  (See Suicide as Psychache.)  In short, it’s through going back to Murray’s work that we can see the connection between society and suicide.

If the environment that you grow up in is hostile towards your psychogenic needs being met, the models of Shneidman and Thomas Joiner places you at the threshold of suicide.  (See Why People Die by Suicide for Joiner’s model.)  This expands the perspective of psychology to include the social factors that drive someone’s psychology.

It’s important to remember that Kurt Lewin said that the behaviors we get from someone are a function of both the person and their environment.  (See A Dynamic Theory of Personality.)  Suicide is a behavior.  We can’t extract the social justice from the psychology.


Despite decades of evidence that we can’t reliably predict suicide, we’re obsessed with the idea that we might be able to.  In Rethinking Suicide, Craig Bryan is quite clear that the tools we have don’t have the precision necessary to be a reliable predictor.  He’s not the only one who’s sounding the alarm that we’re continuing to go in the wrong direction.  The sheer statistics of suicide make prediction almost impossible.  With rates measured per 100,000, they’re tragically too frequent and statistically too rare to be reliably predicted.

Bryan makes the point that we can’t predict automobile accidents either.  We can’t determine ahead of time who will and who won’t be involved in an accident.  With 20% of suicide attempters reporting they hadn’t considered it more than 5 minutes prior to their attempt – and the number jumping to 71% one hour ahead of their attempt – it’s effectively impossible to intervene between thought and action.  We’ve got to look at other options.

Gatekeeper Programs

The concept of a gatekeeper training program is that you educate the community of people that others interact with, so that they’ll know what to look for and will feel more comfortable engaging people they perceive to be at risk.  It was first described by Dr. John Snyder in 1971.  Measuring the efficacy of gatekeeper programs isn’t easy for the same reasons as predicting suicide.  How do you track how many suicide attempts are averted – and what value do you assign to each one?  Statistically, we know that most people will only make one attempt – and that if they use a firearm for that attempt, there’s about a 90% chance that the attempt will be fatal.

Gatekeeper programs aren’t a complete solution.  However, the chapter on Cultural Continuity and Indigenous Youth Suicide by Michael J. Chandler and Christopher E. Lalonde unfairly criticizes gatekeeper programs.  They cite narrowly targeted indigenous implementations where no effect could be found and attempt to apply it against the entirety of gatekeeper implementations.  Conversely, later in the book, an AAS meeting quote is provided: “The lay volunteer was probably the most important single discovery in the fifty-year history of suicide prevention.”

Given the relatively small number of deaths and trials of gatekeeper programs the best, honest answer is that the efficacy is unclear, because there haven’t been studies with sufficient statistical power.

The Economic Value of a Life

Assigning the monetary value of a life is a particularly morbid thing.  What’s worse is the internal comparisons that happen – as a result of societal conditioning – that a life isn’t worth living if it’s not able to economically contribute to a family or to society.  Instead of viewing life as intrinsically and inherently valuable, some people accept the lie that they’d be better off dead because they can no longer earn money.

Too many suicides are based on the person’s feeling that they’re no longer adding to the economic welfare of the others in their life and to their community.  Perhaps someday, we can separate a person’s value from their bank account.

Female Suicide

Across most of the world, females attempt suicide more frequently but die less frequently because they choose less lethal means.  However, in some countries, particularly countries where women are voiceless and oppressed by the patriarchy, their deaths exceed those of men.  Some of these suicides are a final, undeniable message to their society about their suffering and mistreatment.

In places where the societal roles are more circumscriptive, stepping outside of those roles can result in their murder or their suicide.  Simply speaking to a man who isn’t a relative can be enough to set a woman’s life towards death.  External pressures from the patriarchy can limit a woman’s world in ways that cause them to desire death.  From withdrawing from school, work, and romantic relationships to being forced to accept the polygamy of their husband, women sometimes use suicide as an escape.


Women are presumed to be less courageous than men.  However, this isn’t a fair characterization of the situation.  As Find Your Courage explains, courage isn’t the absence of fear but a willingness to move through fear.  Suicide is a difficult thing to do and is courageous in its own (twisted) way.  However, more than that, if you want to increase courage, you must decrease the factors that lead to fear.  When you create safety, you necessarily reduce the level of energy that being courageous requires.

The structure of some societies decreases the safety and increases the fear that women must face – making courage harder.

Suicide Training

The tragedy of mental health care is the paucity of suicide-specific training for providers.  In fact, the suicide safety plans developed by the VA clinicians has been evaluated as poor.  That is, the people who are entrusted with the protection of our veterans aren’t delivering  good care.  It’s no surprise, since few (if any) of them have more than a few hours of suicide specific training – if that.

We speak about the social stigma surrounding both mental health and suicide – but we fail to recognize that it’s a very weak correlate of service utilization.  In other words, it’s bad, but not relative to other challenges, including access.

The Role of Trauma

The sad fact is that our society inflicts trauma on some classes of people and that trauma leads to downstream problems, including both mental illness and suicide.  If we want to make our world better, we need to consider how we can reduce trauma and to teach people how to heal from trauma.  Ultimately, we want to decrease Suicide and [improve] Social Justice.

Book Review-Suicide as Psychache: A Clinical Approach to Self-Destructive Behavior

It’s dangerous to look at a multifaceted problem like suicide from a single lens, but if you had to pick a single view, Suicide as Psychache is a better place than most.  Before continuing, it’s important to recognize that Edward Shneidman is credited with founding the American Association of Suicidology and has written several other books.  (I’ve reviewed some of his other books: Clues to Suicide, The Cry for Help, The Suicidal Mind, and Autopsy of a Suicidal Mind.)


The German Secret State Police are no more, but that doesn’t stop people from imagining similar organizations preparing to knock down their door and destroy their lives.  There may, in fact, be other organizations, entities, people, and circumstances that are coming, which will radically alter someone’s life in a negative way.  However, what matters more from the perspective of suicide is whether a person believes that there are negative and particularly oppressive things to come.

Rick Snyder explains that hope is a cognitive process, not a feeling, in The Psychology of Hope.  People who are struggling with suicide have often lost their way and can’t find hope any longer.  Maybe that’s because they don’t see a way out.  Maybe it’s because they’ve begun to see the world as a negative and unhelpful place.  No matter what the cause, they need a way to feel like they’ll avoid being trapped in a negative life.


It’s anxiety or uneasiness.  It’s a sense that something isn’t right.  (See Cognition and Suicide and Suicide: Understanding and Responding for more.)  However, the impact that Shneidman saw on patients was that it caused cognitive constriction.  The more they became anxious or disturbed, the fewer options they could see – and the more that suicide seemed to become the only option.  (See The Suicidal Mind, Treating Suicidal Behavior, and Cognitive Therapy for Suicidal Patients for more on cognitive constriction.)


Suicide is sometimes conceptualized as people who desire death.  That’s probably literally correct, but it obscures an important point.  It misses the reason why they desire death.  In most cases, individuals desire death to escape life or some aspects of life.  They want to escape from the suffering and pain that they’ve endured or that they anticipate.  They’re not moving towards death as much as they’re moving away from negative aspects of life.

This creates an opportunity and an important way to reduce the probability of suicide.  If we want to reduce suicide, we need only help people see that their life is worth living – both for themselves and for others.

Over Center

There’s a technique in physics where a latch is “over center.”  In that condition, the more force that is applied, the more that the latch is maintained.  It’s an expression of the forces working in the system.  Kurt Lewin in Principles of Topological Psychology explains how forces kept people in different states, and how, at times when the forces changed, there would be enough energy to change the person’s state.

When Henry Murray conceptualized “press” – which may have been an analog for “pressure” – he was speaking of the forces that drive people to change their state.  (See Love’s Story Told for more on Murray.)  Murray was a mentor and friend of Shneidman’s.  It’s possible that both men saw the same patterns emerging as Lewin.  They saw that people could get into states that were hard to shake them from – either protective against suicidal ideation or caught in suicidal ideation.  (See also Capture for how it’s possible to get caught.)

Suicide in Genius

In 1921, Lewis Terman initiated a study of 1,528 gifted people, people selected for their above average intelligence.  Several others have picked up the mantle to run the longitudinal study to completion.  The good news is that the study has maintained a very low dropout rate over the decades.  The bad news is that, of the geniuses recruited, 22 people had died by suicide by 1960.  That means that, while the general population suicide rate was around 12 per 100,000, the Terman geniuses had a rate of about 1450 per 100,000 – or over 100 times the rate.

More recent research hasn’t shown similar results, but the rate is startling.

Mind the Gap

One of the possible reasons for the disparity may be the expectations that people have for their lives – and how their actual lives worked out.  Of Terman’s subjects, many came out with very normal, average, and ordinary lives.  If they had become wrapped up in the idea that they were special and gifted but found themselves in an average or below average social station and career, the gap between their internal expectations and their real state might have created the conditions for suicidal ideation to flourish.  (See Perfectionism for more.)

The Banal Suicide Note

Much of Shneidman’s career was focused around the promise of suicide notes (the first set he “borrowed” without permission).  However, in the end, he found them pedestrian and banal.  He found that his optimism was crushed by the reality of the completely unremarkable nature of most suicide notes.

He comments that the very act of writing a “proper” suicide note with insights might remove the conditions necessary to make an attempt.  This is certainly consistent with James Pennebaker’s work in Opening Up, where he saw that writing a narrative organized thoughts and reduced the force of trauma.

You Can Always Commit Suicide

The truth is that someone can commit suicide if they’re committed.  (See Suicide: Inside and Out.)  It’s always an option no matter how repulsive we on the other side may find it.  The key to this statement – which is echoed in a slightly different way by David Jobes in Managing Suicidal Risk – is that it allows for the idea that it could be the right answer in the future, it’s just not the right answer now.  Until we’ve taken every step, tried every option, to make life better, it’s just a future possibility.

That’s an important shift that allows the suicidal person to delay the idea without giving it up entirely based on the request of some professional that they barely know.  Of course, you want to ensure they know that life is also an option – but a life free from the suffering.

If you remove the psychache, then you remove the need to die by suicide.  That’s the power of viewing Suicide as Psychache.

Book Review-Autopsy of a Suicidal Mind

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.


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 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.

Stop Suicide This Spring

Each year, for most of us, spring brings light to the world both literally and figuratively.  Those with seasonal affective disorder (SAD) begin to feel their spirits lifting.  Flowers start to bloom, and we see the world reemerge from its winter slumber.  However, unfortunately, we also see a rise in suicide rates.

This is our third year of sharing daily posts about suicide prevention books for the start of spring.  It’s a time when we can share how much work has been done to prevent suicide and create a reminder about both how and why we can make a difference.

For the next two weeks, we’ll post a new book review at 8AM Eastern Daylight Time (UTC-4).  This upcoming Monday, we’ll start by laying some groundwork with Shneidman’s Autopsy of a Suicidal Mind, along with several other books that provide different perspectives on suicide research.  The following week, we’ll dive into more nuanced stances, beginning with Humphrey’s controversial Final Exit and ending with Weaver’s A Sadly Troubled History.

Our hope is you’ll be inspired to call one friend to check in on them.

Book Review-On Second Thought: How Ambivalence Shapes Your Life

“Ambivalence is our constant companion.”  It’s my first highlight from On Second Thought: How Ambivalence Shapes Your Life.  This isn’t the first work of William Miller that I’ve read.  He coauthored Motivational Interviewing and Quantum Change.  I’ve learned to trust his insights and recognize that there’s more to the story than we may have thought or been told.  I’ve learned that, sometimes, the power comes from the conflicting thoughts that drive ambivalence.

Indifference, Ignorance, and Ambiguity

It’s important to recognize that ambivalence is a conflicted, contradictory, and vacillating feeling between two, mutually exclusive alternatives.  It’s not indifference, ignorance, or ambiguity.  There’s a real reason to be concerned and an understanding of the situation.  Indifference is not caring.  Ignorance is not knowing – and ambiguity is not knowing enough.  These aren’t the forces that are in operation when ambivalence is present.

When listening to someone, the way that you can detect ambivalence is the word “but.”  It signals the contradiction.  It says that there’s more than one side to consider.

It’s Good

I picked up On Second Thought to support a writing effort for a journal article with a friend.  In that article, we make a key point that, while ambivalence is seen as a bad thing, it’s not.  In the lean manufacturing approach, delaying decisions until the last possible moment is seen as a positive and prevents unnecessary waste.  There’s so much that we know in decision making about the value of rational reviews – and the awareness that we don’t do it enough.  (See Decision Making and Sources of Power.)  Miller states that those with greater emotional ambivalence have been found in research to:

  • Be better informed
  • Read other people’s emotions more accurately
  • Be more creative, perceiving unusual associations and possibilities
  • Offer fair and balanced evaluations
  • Make more accurate judgments
  • Be open to new information and alternative perspectives
  • Experience greater sexual arousal and desire
  • Be less inclined to make impulsive decisions and purchases

The Inner Committee

While we tend to think about our consciousness as one thing, many scholars have a fragmented view.  Daniel Kahneman sees that we have a quick System 1, and a slower, systematic, System 2.  (See Thinking, Fast and Slow.)  Daniel Goleman, in Emotional Intelligence, explains that we have a rational mind and an emotional mind.  Jonathan Haidt expands this to explain the relationship in his Elephant-Rider-Path model.  (See The Happiness Hypothesis and Switch.)

However, the Internal Family Systems (IFS) model, as described in No Bad Parts, explains that we have different parts of our consciousness.  It’s not that we have multiple personalities, but rather we have multiple aspects of our personalities that have been fragmented.  Sometimes, we encounter the parts of ourselves that were exiled, and sometimes we encounter their protectors.  They likely have different perspectives than the rest of our consciousness.

Another perspective is that of Steven Reiss in Who Am I?, where he explains that there are 16 basic motivators, and those motivators can come in conflict with one another.  The idea that we shouldn’t be in conflict with ourselves or that we shouldn’t ever come into conflict is fiction.

Kinds of Ambivalence

An interesting aspect of ambivalence that isn’t often discussed is how it is shaped by the positives and negatives of the situation.  Some situations are choices between two mutually-exclusive, positive options.  Others are choosing the lesser of two evils seeking to minimize the pain.  The more complicated kind are those with both positives and negatives.  A depiction of this follows:

When we’re thinking about ambivalence, we’re more frequently thinking of those in the middle.  Consider a job change that requires a move to a new city that you’d like to live in.  Here is a table of positives and negatives of the move (which are opposite for keeping the current job).

Positives Negatives
Better pay, reportedly better hours, an opportunity for career advancement.  Greater challenge. Loss of work friends.  Loss of stability and predictability.  Will be harder.
Get to buy a new house without the existing problems and one that better fits my lifestyle today. Loss of my favorite features of the existing house, like the garden, the proximity to the market, and safety.
Get to live in a city I’ve always wanted to live in.  New adventures. Loss of the community spaces and festivals that I love so much.  Need to find new dentist, physician, hair stylist, etc.


Obviously, the above table is simplified and intentionally devoid of specifics.  However, it illustrates that for every positive, there is often some kind of a negative.  To gain something, you must give something else up.  This is at the heart of ambivalence.  The moment the decision is made, the alternative is removed either literally or figuratively.  Jack Canfield in The Success Principles says, “99% is a bitch, 100% is a breeze.”  That is once the decision is truly made, the alternatives disappear from consciousness.

The Internal-External Conflict

Sometimes, the expectations of society conflict with your expectations of yourself.  People with a “stable core” are aware of their beliefs and values and have the courage to stick to them – for the most part. (See Braving the Wilderness for more on the concept of a stable core and Find Your Courage for more on the courage to stick to your convictions.)  This may be a requirement to report something incorrect or a requirement to take advantage of other people (in your view).  We may be tempted to betray our morals through the temptation of going with what others want – but it often comes with great struggle.  (See How Good People Make Tough Choices for moral temptations and Moral Disengagement for how we rationalize it.)

We can see this kind of conflict working both positively – and negatively – in suicide prevention.  In the case of bullying and torment, a person’s self-worth (self-esteem) is under attack.  Ultimately, this changes the weighting for positives and negatives.  Instead of staying alive being associated with happiness and creating good in the world, it’s filled with torment and struggle.  If the person’s self-esteem collapses under this weight, suicide seems like a good idea.

Conversely, another person concerned about you can mean that there is hope that the current circumstances are temporary.  There’s the chance for things to get better based on your work and the support of others.  Instead of the world being an inherently hostile place with no use for you, one can discover the helpful, compassionate responses that are woven into the fabric of humanity.  (See Does Altruism Exist?)

In both cases, external forces “put their finger” on the scales of ambivalence and change the chance that a final decision will be made – to leave suicide behind, or, tragically, to take that exit.

The Ambivalence of Authority

Most people don’t like being told what to do.  It’s similar to Compelled to Control’s revelation that everyone wants to control but no one wants to be controlled.  While not literally and absolutely true, it’s certainly a majority.  Occasionally, you find those, like the story of Ralph as told in Work Redesign, who no longer desire autonomy.  Their spirit has been broken, and now they’ve resigned themselves to a life that exists beyond their control.

Either Or

One of the limitations of our human minds is that we have a propensity towards binary thinking.  That is, we believe that it’s black or it’s white.  We ignore the multitude of variations between the two polarities.  We see it in cognitive constriction that occurs when we’re under stress.  (See Capture.)  We see it in the studies of creative thinking under stress.  (See Drive.)

One of the best things that we can do to improve decision making is to disrupt this binary, dualistic thinking by introducing a third option.  The introduction of the third option opens the possibility to more and reduces the force of direct conflict between the two original options.

Ideal and Actual Self

It was the gap that Carl Rogers was most concerned with.  (See A Way of Being for some of his work.)  It’s the gap between the internal vision of oneself and the actual self that exists in the world.  It’s the same sort of contradiction that Immunity to Change is focused on.  How are there discrepancies between intentions and actions?  Some of that can be ascribed to the tension between the rider and the elephant in Jonathan Haidt’s model of decision-making.  (See The Happiness Hypothesis and Switch for more.)  For some, the gap may be the difference between their status orientation and their current status.  (See Who Am I? and The Normal Personality.)

When we’re looking at the unmade decisions in our life, we must ask whether they remain undecided because we’re ambivalent about them.  We must also consider whether these decisions should remain unmade in their ambivalence – or whether it’s time to make the call.  The truth is that, for most situations, there is no space left for the concept of On Second Thought.

Book Review-Gun Country: Gun Capitalism, Culture, and Control in Cold War America

It’s not a Norman Rockwell picture.  There’s no wholesome family sitting in a well-furnished home.  It’s the picture of capitalism that created a market for weapons of destruction.  Gun Country: Gun Capitalism, Culture, and Control in Cold War America explains the engine that’s driven America to own more guns per capita than any other country on the planet – by a wide margin.

Army Surplus

As World War II wound down, there were suddenly a large number of handguns sitting in boxes on shelves in warehouses.  When every member of the military wasn’t carrying a sidearm, they needed to go somewhere.  It turns out that some enterprising individuals, like Sam Cummings, began importing these weapons to market to the US consumer.  These weapons were cheaper than what could be produced by US firearms manufacturers for two reasons.

First, the surplus weapons were taking up space, and it was a good thing for the foreign governments to find a new home for them.  They were sold as used for prices intended to get them out of the government warehouse.  This led to some cases where the weapons were imported as “scrap” even though the importer knew they would be sold as-is.

Second, when the supply of surplus weapons was exhausted, the foreign labor rates and exchange rates made it less expensive for firearms to be manufactured.  Admittedly, this sometimes meant there was a lower quality of manufacturing; but for many, it was the difference between being able to afford a weapon and not.


With a supply of inexpensive firearms, it was necessary to create demand.  Marketing was rising as a powerful force in American society, and guns were no exception.  Vance Packard in The Hidden Persuaders explains how psychology became progressively more intertwined with advertising and how people are motivated to buy things to make them feel better about their lives.  Gun Country explains it as “chasing that elusive daydream of remaking the self through consumption.”  If only it were possible to elevate fear with a simple purchase – one of the two strategies marketed by the gun industry.

For firearms, the motivation took two paths.  The first path was the sport of hunting and target shooting.  It was the path of rebuilding the skills of marksmanship that the Army would have loved to have in ready supply before the war.  It was also the thing that we had lost as we moved to a more stable food supply through agriculture.  This was the positive approach.

The negative approach relied on a sense of fear – the same mechanism that is used today.  We know that violent crime peaked in the 1990s.  (See Bowling Alone.)  However, we also know that continued news coverage of violent crimes increased everyone’s perception of the rise of violent crimes.

Critical to the marketing of firearms was not just the increase in violent crimes but also the race relation tension that reached its peak in the 50s and 60s.  This tension increased fear and the belief that you needed a gun to protect yourself.  This fueled the sale of firearms in record numbers (for the time).

During the 1960s, it was common to see mail-order firearms, including the Carcano rifle:

That’s the exact ad that Lee Harvey Oswald responded to when he purchased the weapon that he used to kill President Kennedy.

Closing the Mail Order Loophole

The first firearms legislation was the National Firearms Act in 1934.  Largely, it restricted the sale of automatic weapons.  In 1938, the Federal Firearms Act restricted who firearms could be sold to – for instance, excluding those with a felony conviction.  However, the standard by which one could determine that someone was – or was not – prohibited was quite loose.  In fact, a child could sign a form that they were able to purchase a weapon and send it back, and no verification was done, nor questions asked.  Some enterprising reporters demonstrated that this was the case.

It was the 1968 Gun Control Act that finally closed the door for firearms sales by mail order.  Firearms, when transported, must be transported between Federal firearm licensees.  It wasn’t until the Brady Handgun Violence Prevention Act of 1993 that we gained a comprehensive background check system.

Killing Quality

Much has been made of some firearms – particularly the AR-15 – because of its military use.  The problem is the implication that military firearms are somehow more powerful than civilian firearms.  This is largely not the case.  In some cases, the purchasing public has more discerning tastes than the governments that supply soldiers.  Take the case of the Carcano rifle that Oswald used.

It was a cheap, bolt action rifle, which means the operator flips up and back a piece of metal that sits behind the cartridge when fired.  It gains the ability to do multiple shots by a magazine mechanism under the weapon.  It’s a military rifle with a problem.  The weapon could be fired with the bolt being fully secured in place – ejecting it backwards and into the operator.  Even trained military personnel were hurt in these kinds of accidents, so it wasn’t something that was generally safe enough for the public.  The extra attention and higher risk made it something that serious sportsmen didn’t want to touch.

But there’s more.  The ammunition that these weapons used wasn’t in standard use in the United States.  At the start of the imports, there wasn’t a manufacturer of cartridges (bullets) that would fit in the rifles.  The problem wasn’t that the cartridges were larger or packed more firepower (gun powder) but rather that they were smaller than typically used in the US.  The typical lever-action gun strapped to the sides of horses’ front legs in Western movies is a 30-30.  It’s larger and more powerful than the kinds of weapons that were being imported – and, incidentally, the AR-15 that is so sullied today.

In short, the weapons that were being sold to the public were cheaper, but they also had less power and were more likely to kill the operator than US-manufactured weapons of the time.


People look at them like they’re weird.  Militia (sometimes called “paramilitary”) are the result of the work done to control guns.  Gun advocates correctly saw their ability to own a gun coming to a close.  Leaning on the tiniest reading of the Second Amendment, they reckoned that they had to form a militia to keep their guns.  The literal language of the Second Amendment makes gun ownership a condition of a well-armed militia, so enterprising protectors of their rights formed them.

We’ve moved on from this interpretation of the Second Amendment to a broader interpretation that allows private citizens to have firearms with very few restrictions.  However, the militia have remained an artifact of gun control clamping down on gun owners and their natural defense of their perceived rights.

Law Abiding Citizen

Part of the fear being engendered into the American public was the concept of two kinds of citizens: the law-abiding and the non-law-abiding.  Gun owners wanted to be a part of the law-abiding type.  Much like the affinity groups that I explained in The Deep Water of Affinity Groups, they wanted to be connected to protectors of society.  As protectors, they needed to be armed to be able to overcome the force of mobs – should they ever come.

Few people stopped to ask if they really were completely law-abiding or not.  Speed limits were meant to be bent.  Stop signs were sometimes “stoptional” (stop-optional).  They’d bend the rules in a million different ways, justify the bending, and move on.  (See Moral Disengagement.)

Snipers on the Rooftops

It was 1967 in Detroit, Michigan, and it was a long, hot summer.  The primary conflict was between black residents and the police department.  What’s interesting about this event isn’t exclusively that it was one of the deadliest and most destructive riots in the United States.  Also interesting is the media’s role in creating snipers.

Numerous news outlets reported that there were snipers on rooftops.  The problem is that being able to shoot people at a distance is a skill – one that the residents were never trained for.  It’s also problematic that, in at least one of the cases, the “sniper rifle” was a 410-gauge shotgun – something that’s completely incapable of hitting the broad side of a barn at range, much less sniping.  Mostly, the rioters had handguns, and while some were on rooftops, the media’s inflammatory approach to reporting generated more fear and likely played a role in amplifying the situation.

A similar situation occurred in Newark, where there was widespread reporting of snipers that never existed.  That’s good news, since the presence of well trained and equipped snipers would have dramatically changed the police casualties, as they were often in exposed areas with no body armor on.

As a part of a broader understanding of the situation that drove gun purchasing, we need to consider how the media played a part (probably unwittingly) in the increase of fear and therefore the increase in the number of firearms sold.


However, these riots did create a unique situation.  In Detroit, gun owners were required to register their firearms.  Many were concerned with the problems seen in New York, where a registration was turned into a list of people to approach when the same weapons were later banned.  (See America’s Gun Wars.)  However, an astounding 75% of the weapons that were seized or recovered during the riots were not registered.  It means that when gun control advocates suggest that registering weapons is an effective way to get a handle on gun ownership, they’ve not paid any attention to history.

It’s data like this that makes the observation that if you restrict firearms at this point, the only people who won’t have them are the law-abiding citizens.

Controlling Emotions

A real challenge with gun control advocacy is the tendency to focus on the sensational, emotional component of the problem rather than what really matters.  Gun control proponents are fixated on the AR-15 platform.  That’s like being focused on the cars with ground effect lighting.  They’re regular cars in every meaningful way.  They just happen to look a bit different cosmetically.  (See Bullet Basics, and What is an Assault Rifle?)

Mass shootings are tragic.  There’s no minimizing the tragedy experienced by those injured and killed by mass murderers.  The impact on the families is unimaginable by most.  The problem is that, statistically, they’re an extremely small number of the deaths in the United States – and even those deaths by firearm.  You’re far more likely to kill yourself with a firearm than you are to kill another person.

Preventing suicides isn’t sexy.  It doesn’t make the news most of the time.  It’s where the results can appear when it comes to preventing firearm harm, but for most people, it’s barely an afterthought.  It’s much more engaging to talk about improving mental health screening for those who purchase firearms to prevent the tragedy of mass shootings – ignoring our complete inability to predict who will create the most harm to themselves or others.

The real problem isn’t that guns create violence.  They don’t fabricate arguments from thin air.  The real problem is that arguments can quickly become deadly in a Gun Country.

Book Review-DBT Explained: An Introduction to Essential Dialectical Behavior Therapy Concepts, Practices, and Skills

It never made sense to me, DBT – dialectical behavior therapy.  Where was the conflict?  That and many other mysteries were solved by DBT Explained: An Introduction to Essential Dialectical Behavior Therapy Concepts, Practices, and Skills.  Marsha Linehan’s discovery in DBT is well validated as a treatment.  But what makes it special?

A Tale of Two Approaches

Cognitive behavioral therapy (CBT) has been well validated for a while, but its focus on changing the way one thinks sometimes left Linehan’s patients feeling invalidated for who they were at that moment.  The insight was the introduction of an acceptance-based approach with meditation and mindfulness.  In this way, DBT validates where the person is – and provides them with the skills and motivation to change.  This is the essential, two-in-one conflict that is represented by the word “dialectical.”  On the one hand, we accept the person for where they are, and on the other, we hope that they can change to better and healthier approaches.

It’s important to note that Motivational Interviewing solved the same dual nature differently.  It focuses on understanding the person and accepting their current reality before moving on to focusing on the core challenges, evoking a desire to change, and planning for that change.  It solves the acceptance problem by introducing the concept of understanding with acceptance.


Most people know the short version of the serenity prayer by Reinhold Staudinger.  Most don’t know that it continues with, “Living one day at a time, Enjoying one moment at a time, Accepting hardship as the pathway to peace, Taking, as He did, this sinful world as it is, not as I would have it…”  Here, the word “accepting” is used in conjunction with hardship, but the concept is included in a broader sense when we consider that we must accept the world the way it is.

Embedded are the concepts of willfulness, when we refuse to accept reality, and willingness, when we’re able to accept “the cards we’re dealt.”  There’s a place for willfulness as we’re seeking to change the world, but in the present moment, denying reality does nothing to change it.

Acceptance of a person and their current reality is the essential first step to coming into alignment with them.  You can’t tell someone how to achieve changes in their life without knowing where they’re starting from.  (See also Richo’s How to Be an Adult in Relationships for more on acceptance.)

Emotional Regulation

Core to DBT is the improvement of emotional regulation.  I struggle here, because “emotional regulation” isn’t quite the right language.  It’s not that we prevent emotions from happening.  It’s that we can learn to let them control us less.

In Daniel Goleman’s immensely popular Emotional Intelligence, he characterizes emotional intelligence along two axes splitting into four quadrants.  On the first axis, we have awareness on one side and management on the other.  The other axis is self and other.  For both, awareness is required before management can begin.  (See also Emotional Intelligence 2.0 and Primal Leadership.)

Beyond awareness comes the management piece, which is as much a negotiating process where emotions are evaluated for their utility by cognitive processes.  This is at the heart of CBT as well.

The awareness step can be difficult for people, because they’ve learned that their emotions are scary and uncontrollable.  Thus, they’ve blocked out all sense of emotions and live without conscious awareness of them – even though they’re silently controlling situations.  (See Switch and The Happiness Hypothesis for Elephant-Rider-Path.)  Often, once people can accept and acknowledge their emotions, the management of the emotions becomes a relatively easy set of skills to be taught.

Follow Your Heart

Many people in many different contexts offer the advice to follow your heart.  Mostly, this means to follow your emotions and intuition towards your goals.  “Following your heart” uncouples you from the realities that tend to hold you back and make it difficult to take big risks.  This has its place and can be a powerful way to realize your dreams.  It’s also dangerous to radically decouple from reality.  It makes you susceptible to your feelings leading you astray.

I trained as a pilot decades ago.  They taught us that when your instruments and your feelings differ, trust your instruments.  Instruments all have backups to verify with, and if they’re telling you the same thing, then that’s what is happening – regardless of how you feel.  It’s okay to fly by feel for a little bit, but you’ve got to remember to periodically check your instruments.  You’ve got to check in with reality and make sure that what you feel is what’s really happening.

It’s like the Stockdale paradox that Jim Collins discusses in Good to Great.  You need to follow your heart – have unwavering confidence – and you need to check things against reality – accept input when the situation dictates it.

In the end, if you want to navigate these sorts of paradoxes, it might be good to start by getting DBT Explained.

Book Review-Stigma: Notes on the Management of Spoiled Identity

It wasn’t what I expected, but it was good.  I picked up Stigma: Notes on the Management of Spoiled Identity to understand the issue from a societal perspective and what could be done to address the challenges that so many people face as they’re stereotyped and stigmatized.  I was expecting a discussion on how to change society to be more accepting, like After the Ball.  I picked it up due to a reference in Suicide Among Gifted Children and Adolescents. I didn’t pay attention to the fact that Stigma was published initially in 1963 and that the author, Erving Goffman, is one of the most influential sociologists of the twentieth century.  What I found in his work was a personal playbook for managing your identity when you believe you’ve been stigmatized.

The Attribute

When someone is stigmatized, there is some attribute – normally an attribute that has some level of observability by others – upon which that the stigma is based.  The attribute can be physical, as in the color of skin – or it can be something like mental illness.

In A Class Divided, William Peters explains the experiment that Jane Elliott did to teach the impact of stereotyping and stigmatizing to her class after the assassination of Dr. Martin Luther King, Jr.  She divided her students on the basis of eye color and treated them differently based on the day.  Even though it was just a classroom exercise lasting a few days, her students quickly identified people based on their eye color – even calling her out for being one of the “lesser” eye colors on days when her eye color was treated as lesser.

The profound realizations from this experiment included the fact that these stigmas could be created very quickly and easily – and that they can be based on completely irrelevant attributes.  It doesn’t really matter.


The words to explain the relationship between the degree of stigmatization and the attribute include obtrusiveness – how obvious the attribute is.  The other words that are used to describe the attribute are perceptibility and evidentness.  For someone to be stigmatized, there must be some awareness of the attribute, and that relies on the degree to which it’s observable to others – or the degree to which they’ve been informed.  On the completely, non-evident end of the spectrum, we have the woman who has lost her virginity outside of wedlock.  There is no outward visible change.  On the other end are attributes that can’t be missed.  Consider someone with a facial birthmark.  It’s nearly impossible for another person to miss.

In between are situations where upbringing might be subtly betrayed by choice of word or language.  For instance, saying that something is “so ghetto” might betray having grown up in poverty.  Something as simple as saying that the chili you had growing up had noodles in it also portrays a certain sense of lower income.  For someone to have a stigma for those who grew up in or near poverty, they may not know until something has been said.


One of the greatest tragedies of our experience with others is when we make others subhuman.  Hitler made the Nazis view Jews as subhuman and the genocide that followed is an indelible mark on humanity.  In America, slaves were counted as 3/5ths of a person – an inexcusable representation of a human.  In moderate to extreme forms, stigma is the devaluing of other humans.  In their otherness, they are somehow less worthy of the birthright of the rest of humanity.  In this, we disengage our morality as is explained in Moral Disengagement and The Lucifer Effect.  While this external condemnation is unacceptable in any form, too many people experience it inside their own minds, berating themselves as not worthy of the kindness and respect deserved by every human.

The internal view of oneself is driven in ways that we’re not cognizant of.  If we’re attached to one stigma/stereotype, we experience better results; pick another, equally relevant, stigma/stereotype, and we’ll do worse.  We subtly pick up on the environment and how we’re treated by others and start to believe those things about ourselves.  All of a sudden, we don’t need others to tell us that we’re inferior, we’ll do it ourselves in voices that we cannot consciously hear.


When Al Campanis was the manager of the Los Angeles Dodgers, he punched a bigoted player who insulted Jackie Robinson.  The result ushered in the addition of black players to Major League Baseball.  At a time when racism was firmly entrenched, and there was great personal risk to protect Robinson, Campanis did it anyway.  He did it, because he knew Jackie personally and knew him to be more than what the stigma associated with his race said he should be.  (See Mistakes Were Made (But Not by Me) for more on the story.)

Similarly, we can avoid stigma with people who we’ve known personally prior to their stigmatizing attribute being known.  Consider people whose relative poverty growing up isn’t discovered for years, until after a friendship has formed.  The awareness of their poverty, while being quite impactful for others, will likely not apply to the friend.

There are, however, many limits to this, as Al Campanis’ full story illustrates.  While Campanis was able to override the stigma of Robinson’s skin color for the purposes of playing baseball, he still thought that Robinson wasn’t fit to be a manager.  He was wrong – but in part because the stigma leaked through, past his relationship with Robinson.

The most effective way to work past stigma is to develop meaningful relationships with individuals in the stigmatized groups – and allow them to expose where the stigma may still remain, even with them.


There comes a question for those whose attribute can be hidden: should it?  The answer is complicated.  Obviously, exposing it too early may prevent the ability to form the very kind of relationship that can reduce the impact of the stigma personally and potentially unfasten the moorings on which it’s based.  However, it may be that hiding this attribute may come at great personal difficulty – and as such, one must make an informed decision about whether they can “keep up the ruse.”

Ultimately, concealment is a psychically draining situation that should be minimized where possible.  The best advice is always to be yourself.  (See How to Be Yourself.)

Concealing the stigmatizing attribute from others may focus your attention on it and make it more prevalent in your thinking.  Stigma is a hard thing to avoid.

Journalistic Cancer at ProPublica

I didn’t intend to expose anything or pull back any rocks to see what lurked under them.  I simply had a concern about an article.  I wanted to reconcile some reporting that called a valid situation “junk science.”  The topic was parental alienation, and it’s something that I had some firsthand knowledge in.  It was a situation I was forced to walk through – but it has more or less passed for me.

The research is clear, focused, and, relatively speaking, incontrovertible.  Parental alienation exists where one parent causes a child or children to dislike the other parent.  I’d written about the pathway to parental alienation that I saw as I researched it years ago.

Still, my initial note to the author was gentle: a request to speak about the article as written and to better understand the journalist’s perspective.  There was no response.  After waiting over a week, I dropped a note to the editor-in-chief with my concerns attached.  I didn’t hear back from him but instead received a note from the author of the article.

The note was pleasant and had her manager copied.  The problem was that the email message directly contradicted the article.  The words of confirmation that parental alienation was a real issue ran directly against the characterization in the article.  One cannot have a valid phenomenon and at the same time have “junk science” – the term the article uses.

In the short discussion, there was a reaffirmation that neither the World Health Organization (WHO) in its ICD codes nor the American Psychological Association (APA) in their DSM-V recognized it as a syndrome.  This is a space that I’m also too familiar with.

In the case of burnout, WHO acknowledges it as a workplace condition – but the APA fails to recognize it.  There are good reasons to believe that WHO’s inclusion isn’t in the right spot, because it constrains burnout to work-related situations, yet many people experience burnout outside of their occupation.  In fact, in its original expression, it was about avocation instead of vocation.  It was the way that Freudenberger and his colleagues were serving and how they felt inadequate results in that service.  (Our website has numerous free resources to understand and respond to burnout in yourself and others.)

It’s not surprising that WHO and APA don’t directly recognize parental alienation, nor is it incontrovertible evidence of its failure to exist.  Nassim Taleb would explain in The Black Swan that the absence of something doesn’t prove that it doesn’t exist.  However, let’s look more closely at the claims that neither APA nor WHO accept it.

Parental alienation doesn’t fit the goal of either WHO’s ICD nor APA’s DSM-V.  Both include criteria that are primarily reserved for individuals.  ICD codes are most frequently used for billing.  The DSM is similarly used for mental health billing.  They’re fundamentally focused on the individual, but parental alienation is a three-party relational problem.  The argument was made that the DSM includes some relational issues – and that’s true.  However, the number of relational codes is limited – and typically requires a primary diagnosis code.

Consider factitious disorder by proxy – what was historically known as Munchhausen by proxy.  The “by proxy” part is a clear indication that it’s not a single party diagnostic code.  However, it’s premised on the harm to an individual.

As I got deeper into the weeds, I found two diagnostic codes for DSM-V that corresponded to parental alienation.  V995.51 is “Child Psychological Abuse” and V61.29 “Child Affected by Parental Relationship Distress.”  Neither directly speaks to parental alienation – but both do cover the condition.

The ProPublica article says that WHO denounced parental alienation, but they actually said, “During the development of ICD-11, a decision was made not to include the concept and terminology of ‘parental alienation’ in the classification, because it is not a health care term.”  That isn’t a denouncement.  It’s a statement of scope.

ProPublica also links to a National Council of Juvenile and Family Court Judges article and paper, “Navigating Custody & Visitation Evaluations in Cases with Domestic Violence: A Judge’s Guide.”  Ultimately, this paper incorrectly states the APA position on the matter, confusing the narrower Parental Alienation Syndrome (PAS) with the broader category of parental alienation.  In the APA definition for PAS, it states, “Despite the significant controversy surrounding this syndrome, the more generalized concept of parental alienation often is viewed as a legitimate dynamic in many family situations, describing the harm done to a child’s security with one caregiver as a result of exposure to another caregiver’s unfavorable actions toward or criticism of that person.”

There are two important issues here.  First, the scope of the document is domestic violence – something that is outside of the concept of parental alienation.  Quoting it seems like cherry picking.  (See Mastering Logical Fallacies for a deeper explanation.)  Second, admission of parental alienation in court cases is substantially increasing, as Parental Alienation: An Evidence-Based Approach clearly indicates.

The final evidence is a UN report, titled “Custody, violence against women and violence against children.”  Page 3 explains, “There is no commonly accepted clinical or scientific definition of ‘parental alienation’. Broadly speaking, parental alienation is understood to refer to deliberate or unintentional acts that cause unwarranted rejection by the child towards one of the parents, usually the father.”  There are working definitions for parental alienation as explained in the book referenced above.  Admittedly, greater clarity is better.  The UN report continues in the next paragraph to confuse PAS and parental alienation.  It seems the distinction was lost on the UN Human Rights Council as well.

The argument that was made to me during the email exchange with the editorial management at ProPublica that the research for the article included the work of Dr. Paul Fink.  He’d written an article in 2010 claiming PAS wasn’t a thing.  Of course, the way it was presented to me was that the author of the article had spoken with the Dr. Fink – something that would have been impossible given his death nine years before the ProPublica article published.  The response was clarified that they didn’t intend to imply that the author had spoken with him.  I responded with a meta analysis article “Parental Alienation in U.S. Courts, 1985 to 2018.”  For those that don’t follow, an individual article, no matter how impressive the author is, is trumped by a meta analysis of multiple articles in terms of authority.  In short, the editorial views of someone from 13 years prior aren’t that relevant any longer.

I ultimately escalated to the author’s manager, who included his own manager on the replies.  After several rounds of the data I was providing being ignored, I forwarded the whole mess to the editor-in-chief who affirmed the way that the situation was handled was in line with his expectations.

I sent an email to the board chairman.  I’ve never heard back.  (I waited 3 months.)

What does this mean?

There was a time when the profession of journalism meant something.  It meant integrity.  It meant making hard choices to tell the truth.  It doesn’t seem like the truth matters as much any longer – at least not to ProPublica.

ProPublica’s stated mission is “To expose abuses of power and betrayals of the public trust by government, business, and other institutions, using the moral force of investigative journalism to spur reform through the sustained spotlighting of wrongdoing.”  I was struck with a question: Who watches those that watch others?

It seems to me, based on the above interaction, that they’ve got their own agendas – which are resistant to the evidence.  Once they’ve formed an incorrect opinion, no amount of research will shake them from it.  So much for the basic principles of journalism.

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