Understanding and Overcoming the Myths of Suicide
Understanding and Overcoming the Myths of Suicide
Myths about suicide abound in the therapeutic setting. They often inhibit the ability of clinicians (and families) to assess the severity and magnitude of a patient’s suicide risk. This special report discusses some of those myths. In Why People Die by Suicide,1 I argued that a kind of fearlessness is required to face voluntarily the daunting prospect of one’s death, and that doing so necessarily involves a fight against ancient, ingrained, and powerful self-preservation instincts. In Myths About Suicide,2 I used the framework developed in the previous book to contend that death by suicide is neither impulsive, cowardly, vengeful, controlling, nor selfish.
The tragic death of a Florida television news reporter in 1974 illustrates the fallacy that suicide is an impulsive, spur-of-the-moment whim, much like casting off peanut shells at the ballpark. In July of that year, the reporter was covering the story of a shooting that had happened the day before. When the reporter called for the news station’s video footage of the scene, the tape jammed. She shrugged and stated, “In keeping with Channel 40’s policy of bringing you the latest in blood and guts, and in living color, you are going to see another first—an attempted suicide.” She extracted a gun from beneath her desk and shot herself behind the right ear. She was rushed to a local hospital, but died 14 hours later.
The usual reaction to this tragic tale beyond shock and horror was to dwell on the seemingly impulsive nature of the act and ask, “How could the reporter have known that the tape would jam?” However, the reporter’s behavior leading up to her suicide dispels the idea that she acted impulsively:
• For years, she openly told her family that she felt depressed and suicidal
• Four years before her death, she attempted suicide by overdose and frequently discussed the incident subsequently
• Weeks before she died, the news station granted her request to cover a story on suicide; and during one interview, she asked a police officer for details on self-inflicted gunshot wounds
• One week before, she told a colleague that she had bought a gun and joked with him about killing herself on the air
• On the day of her suicide (or possibly even before), she had put the gun in a bag that she brought to the set daily
• Finally, she had prepared news copy for a fellow reporter to read about her suicide after the fact
The news reporter’s death illustrates that her suicide was premeditated. Death by suicide is extremely fearsome and daunting, and thus requires considerable thought, planning, and resolve. To consider her death impulsive is to assign primacy to that spur-of-the-moment decision as to precisely when to pull out the gun, instead of focusing on the many factors that led up to that planned moment.
In the book An Unquiet Mind,3 Kay Redfield Jamison discusses her own experience with suicidal behavior and describes how it actually works: “. . . for many months I went to the 8th floor of the stairwell of the UCLA hospital and, repeatedly, only just resisted throwing myself off the ledge. . . .” Contemplating suicide is a signature of serious suicidal behavior. Jamison’s months-long thought process and behaviors counter the notion of spontaneous death by suicide.
The suicide of President Bill Clinton’s childhood friend and White House adviser Vince Foster was of this sort. Despite wildly irresponsible speculation to the contrary, Foster died of a self-inflicted gunshot wound. Foster snuck a gun out to his car in an oven mitt; he drove to a secluded area of a park, and he shot himself. To imagine that Foster’s death was impulsive is to ignore all of the facts in what was by far the most investigated suicide in history (multiple Congressional inquiries and forensic investigations were conducted). It is also to ignore the character of Vince Foster; he was a well-organized, thoughtful, and deliberate person. No one who knew him would have described him as impulsive.
Foster’s friends and family were stunned by his death; it seemed “out-of-the-blue.” However, death by suicide can both shock loved ones and be planned for weeks, months, or even years. This is because of the human capacity, quite spectacular in some cases, for privacy and secrecy. Except in works of fiction, I have never encountered a death by suicide that was truly impulsive. Many clinicians have mistakenly deemed suicidal deaths impulsive merely because they seemed to be “out-of-the-blue.”
Suicide note myths
Foster did not leave a suicide note, a factor that spurred conspiracy theories on cause of death. To my knowledge, no study has reported a rate of note leaving among suicide decedents to exceed 50%. Moreover, most studies find rates between 0% and 40%4; a reasonable average rate would be approximately 25%.
Why are suicide notes so rare? Some have reasoned that because impulsivity is involved in suicidal behavior, suicidal persons often kill themselves before they have a chance to write a note. There are problems with this viewpoint, however. A major problem is that it draws on the distinct myth that dying on a whim is common. Another problem is the lack of empirical support that compares those who leave notes with those who do not. If it were true that note leavers are much less impulsive than those who do not leave notes, then this distinction should be easy to demonstrate in forensic studies that examine the lives, characteristics, and personalities of decedents. This difference has not been clearly demonstrated.
The relative rarity of suicide notes reveals the state of mind of those about to die by suicide. To say that persons who die by suicide are lonely at the time of their deaths is a massive understatement. Loneliness, combined with alienation, isolation, rejection, and ostracism, is a better approximation. Still, it does not fully capture the suicidal person’s state of mind. In fact, I believe it is impossible to articulate the phenomenon, because it is so beyond ordinary experience. Notes are rare because most decedents feel alienated to the point that communication through a note seems pointless or does not occur to them at all.