HOW NOT TO COMMIT SUICIDE
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The priority to keep a person alive may be changing.
"There are a growing number of people in the psychiatric community," David Gruder said, "who feel privately that their patients, regardless of the law, have the right to decide whether or not to take their own life. Under certain circumstances, there are psychiatrists who won't prevent some of their patients from killing themselves. But you can't talk about this out loud too often, because it's illegal and could also be grounds for disbarment." He said an influential book for therapists on this subject is Back to One by Sheldon Kopp (1977; $7.95 postpaid from Science and Behavior Books, P.O. Box 11457, Palo Alto, CA 94306).
If you believe, as I did starting this article, that each of us has a right to commit suicide and potentially valid reasons for doing so which should be respected, you might think there's something gruesome about a system which automatically acts to preserve life, whether the person wants it preserved or not. There's an apocryphal story told in every emergency room: someone comes in for the thirtieth or fortieth time on a suicide attempt and a doctor finally explodes and says, "Look, why don't you try it this way," and the patient does next time and dies. Every professional I talked to -- doctor, paramedic, suicide prevention counselor, therapist, pharmacologist ,nurse -- said there have been people who made them thin, 'you're right. You have nothing to live for.' But the attempt to save the person's life is always made. As Dr. Richard Fein, who directs outpatient services at San Francisco General Hospital, said, to decide whether someone's life is worth living in an emergency is gross arrogance.
There are people who think suicide can be a method of natural selection in an overcrowded world. Suicides in prisons are often not saved, I was told by several people; the same is true sometimes in some cities, for the indigent suicide, the alcoholic suicide, the aged or non-white suicide. Nobody else wants them; they finally succumb to the obvious. Aren't there people who ought to be killing themselves but are not?
Brr. I'm on the side of saving lives automatically. I liked what Stuart Bair, who counsels many of the desperate and penniless suicide attempters at San Francisco General Hospital, said: "I believe in miracles. I think there's always a reason to hope someone's life will improve." And I like what psychiatrist Michael Simpson said about the terminally ill that groups like Exit and Hemlock are trying to reach: "Those who work with terminal patients, like people in hospices, say there are very few requests for suicide. People want to be relieved of pain, which we could do for nearly everyone if we were given good hospice and palliative care. We need to be sure we've guaranteed mercy living before we get around to mercy killing."
Anyway, I suspect suicidal people are automatically rescued not for their own sakes, but for the rest of us. A suicide death, unless it is rationally prepared for, devastates. The message of a suicide attempt is often: Death is better than the pain you've caused me. And the message doesn't have to come from someone you know. David Gruder, who directed crisis hotlines, told me about a woman who called up and raved: "I've had it. I'm pissed off. I'm killing myself and damned if I'm not to take someone else with me and you, you bastard, are coming. BANG!" She shot herself. And, as it happened, it was the hotline worker's first call. She went right into a nervous breakdown.
But I believe the main reason a suicide attempt devastates and fascinates us is it reminds us how fragile our own hold on life is. "Here I am struggling along with my problems," Michael Simpson said, "and here's a guy who's given up. Is it possible I'm wrong in bothering so hard to try to live? Once you start discussing suicide you're asking what the grounds are for killing ourselves. The other side of that question is, 'What am I living for?' That's an ugly question for most of us because we don't usually know."
If someone you know is thinking of suicide, or you think they are, and you don't want them to die, tell them. "Please call me or call suicide prevention before you try anything because I care about you and I don't want you to die." Don't argue with them about why life is worth living, because you can't win that one in rational argument. Tell them how you and other people will feel when they're gone. If there are mental health services you trust in your neighborhood, you may want to suggest them.
If you are scared you may commit suicide, and sometimes you don't want to, there may be more options than you realize. A good guide to whatever mental health services are around and how to find them is You Are Not Alone (NWEC, p. 327). It's worth looking around to see if there's a friend, family member or neighbor that you can talk to about it. Even if, like me, you distrust mental health services, it's probably worth calling suicide prevention. They're listed under that name in the phone book white pages, or call the American Association of Suicidology at (303) 692-0985 for the phone number of one near you.
If you want to make someone pay attention to you through a suicide attempt, you might consider leaving a note for that person and checking into an emergency room and telling them you're suicidal. You'll got through the same psychiatric hold, but without the damage to your body. Choose your emergency room carefully. Some, like Herrick Hospital in Berkeley, often have eight- to ten-hour waits for non-critical patients, in dismal surroundings that will probably make you feel worse.
Or, have you considered changing your life?
© Art Kleiner.
