This is not your grandmother's take on suicide. It's not just a
whole new way of looking at suicide, it's a counterintuitive view of
self-destruction that makes many mental health professionals
squirm.
But in nearly 20 years of studying threats, attempts and events
leading up to the deaths of young people who killed themselves, and
implementing policies to prevent it, psychologist Paul Joffe, Ph.D., has
come to see that suicide isn't always a cry for help. Sometimes--perhaps
more often than not, especially among people of college age--it's an
instrument of power and control.
The idea that pain and distress lead to suicide makes so much
common sense that no one stops to question it, says Joffe, who is head of
the suicide prevention team at the University of Illinois and a clinical
counselor in the student health center.
"If suicide is a cry for help we should wait and assume that person
is going to come in on their own as soon as they make that cry," he
recently told a national conference on Depression on College Campuses,
which was sponsored by the University of Michigan. There's only one
problem. Evidence he has gathered and scrutinized shows that they don't,
certainly not on their own. "They refuse to make use of
resources."
And it's not because of stigma, he insists. Rather, it's part of a
longstanding dance with death, what's known in the psych biz as a
"suicide career." These are not victims but masters of their own fate,
people for whom the thought of suicide takes up long-term residence in
the brain and for whom the risk of suicide doesn't fade after a threat or
attempt. Suicidal intent is less a natural response to distress than a
"virulent ideology." "Suicidal ideation hardens into a stiff shell of
belief. These students feel good about suicide. It makes them feel in
control," Joffe says. They contemplate, fantasize, plan, practice and
rehearse taking their own lives.
Because they have been thinking about it for years, suicide becomes
part of their personal identity. They feel proud of the power to control
their own fate. They feel superior to others in that they have this
avenue of power that others don't.
"A young adult committing suicide is in a basic power struggle
either with their feelings or the environment around them," Joffe claims.
"They're basically saying, 'You can't fire me; I quit. You can't control
how I feel; you can't direct the circumstances around me. I'm going to
trump you by making myself unavailable to those consequences.'" It's not
so much a matter of a person being in so much pain they can't see any
other option. It's more a refusal to accept either emotional or
interpersonal consequences.
"It would surprise campus administrators to know that while
suicidal student might or might not feel distressed about conditions in
their lives, they generally don't feel distressed about being suicidal.
Many will openly admit that being suicidal; it's one of the few, if not
the only, bright spots in their lives."
Joffe began his career as a psychologist by examining coroner's
reports and other data on 19 University of Illinois students who had died
by suicide between 1976 and 1983. Most had demonstrated prior intent to
kill themselves. Twelve of the 19 had made overt attempts before their
successful one. None had seen a counselor on the university staff.
When, in 1984, the university became the first to introduce a
formal suicide prevention program, the goal was to "invite and encourage"
students to meet with psychologists after a suicide threat or attempt. In
the three months the program existed in that form, it was "totally
ineffective" at increasing the rate of contact.
But when he did manage to contact students who had recently made a
suicide threat or attempt, Joffe couldn't miss a power struggle, a
"contest of privilege." Students would deny they had made threats despite
hard evidence, such as suicide notes and eyewitness accounts, they had
done so. Or they'd dismiss threats as "ancient history." Or with a
"ferocity of response," they would tell him "you have no right here; this
is my right to do this. It's not an area of my life that I'm going to
discuss with you."
Or they would agree to make an appointment with a counselor but not
actually do it, or make an appointment and just not show up. If they kept
the appointment they would never even discuss the fact of the suicide
threat. "If suicide was a cry for help and we were offering help, they
weren't accepting. We met denial and resistance. It was a power struggle
to make contact and to talk about what happened."
Even if you stick to the belief that suicide is a distress signal,
in its nature and style the request for help has a power-and-control
aspect as well, observes Joffe, "Most of us ask for help
straightforwardly; we put it on the table that there is some kind of
need."
But asking for help by engaging in self-destructive behavior has a
compulsory aspect to it that hijacks the interpersonal environment. It's
tantamount to saying, "Well, you have to help me because the stakes are
so high and my life is on the line."
Looking at it this way has enabled Joffe to evolve a suicide
prevention program that is singularly effective. The new policy,
implemented in October 1984, abandoned "invite and encourage" and
mandates four sessions with a counselor by all enrolled students who
attempt or threaten suicide. The first appointment must be within one
week of the incident or release from the hospital and the remaining
assessment at weekly intervals.
Tags:
belief,
college campuses,
common sense,
control,
depression,
grandmother,
mental health professionals,
natural response,
power,
self destruction,
suicidal intent,
suicide,
suicide prevention,
university of illinois,
university of michigan
