Not Always a Cry for Help

Suicide may be an attempt to exercise power and control.

By Hara Estroff Marano, published on May 06, 2003 - last reviewed on August 30, 2004

Students are informed that if they don't follow through they risk withdrawal from the university. The program takes considerable effort; sometimes a counselor has to make 20 phone calls to get a student to complete four visits.

It has cut the death rate by more than 55%, while the suicide rate at other universities has remained stable over the same time frame. In the seven years before the suicide prevention program was started, there were 16 suicides at the University of Illinois, or 2.3 per year. In the 18 years since, there have been 19 suicides, or 1.05 suicides per year.

The program has been 100% successful in eliminating suicides among students who engage in "public rehearsals" prior to their actual suicide. The suicides that have occurred have been limited to those that were "out of the blue," in which the students made no prior attempts or threats.

The percentage of students in therapy following a suicide attempt is now more than 90%. By contrast, a mere 5% engaged in therapy before the program was instituted.

Now in its nineteenth year, the program has had experience with 1,531 reported incidents. Twenty students, all of them male, have died--representing an overall decline in suicide deaths of 55%. All 20 of the completed suicides were so-called "out of the blue," or unforeseeable, in which the students had never had prior contact with a mental health professional.

The dramatic decline of suicides at Illinois stands in high contrast to what has been going on elsewhere during this time. The national rate of suicide among all 15- to 24-year-olds increased 2%. The suicide rate among students at Big Ten universities increased 9%.

While the program has been remarkably successful in reducing suicides among undergraduates, it has not impacted deaths among graduate students. These students are more private about their intent.

The conventional "distress model" of suicide is actually dangerous, Joffe contends. To regard threatened or attempted suicide as a cry for help that flows naturally from overwhelming distress invites compassion and pity. But not attempts to challenge that or intervene--because of the prevailing belief among professionals that that just might push someone over the edge, that the suicidal are fragile and on the brink and the caring response is to pull back and support them.

But to Joffe, the suicidal students he dealt with didn't seem too frail, certainly strong enough to engage in a power struggle. And he came to see that "it doesn't pay to give that person that kind of power. There's a community responsibility to challenge that person and to make a statement about violence and violence to yourself." He thinks the community-based challenge to the student's privilege to heap violence upon himself may be the most important ingredient of success.

The program not only saves lives, it keeps students in the educational system. What it isn't is politically correct. It recalibrates rights and responsibilities to put some responsibilities on students.

In general, universities promote rights and privileges, Joffe asserts. While agreeing with that general trend, his program singles out two areas in which responsibility is emphasized. One is that students have a responsibility to self-welfare, self-guardianship and self-care. The second is that they have a responsibility to the university community to carry themselves in a way that is not violent or disruptive.

Students are held accountable. Among those students who have threatened or attempted suicide, protecting themselves becomes a condition of living in the community. That's the leverage a college can exert: as the University of Illinois does, it can make self-guardianship a condition of continued enrollment.

It's the standard of guardianship that is novel. "The main problem with suicide prevention is that in the absence of a standard of self-welfare, there's little the mental health community can do to help." He points out that suicide prevention has something to learn from statutes to prevent cruelty to animals. "In at least 48 states, it's now a crime to commit violence to companion animals, and in six states there's mandated treatment. The privilege of ownership that permitted violence towards a pet has been replaced by a standard of guardianship. Something similar needs to happen with suicide. Perhaps we don't have the privilege to harm ourselves."

College and suicide are "unlikely companions," says Joffe. College is a time of promise and hope. Suicide is seen as the last resort of the hopeless. If college is an unlikely setting in which to commit suicide, it is the ideal setting in which to prevent it.

Phil Satow agrees. Satow knows a lot about suicide, and he learned it the hard way. He runs the Jed Foundation, named for his son, who committed suicide "out of the blue" while a student at the University of Arizona in 1998. The foundation has a very clear mission: to dramatically lower the suicide rate on college campuses.

He thinks Joffe's approach to dealing with kids who talk about or attempt suicide is necessary. And he admires Joffe's concept of self-guardianship. "You have a responsibility for taking care of yourself," says Satow. "It becomes part of the culture of the campus. And you take care of other kids in the community. That creates a healthy environment."