The beeper next to my bed went off at 1:30 a.m. When I called the number, my supervisor said that my client was trying to kill herself. She was on the Canadian side of the Niagara Falls where she deliberately climbed over a railing, walked down a few feet and stood there, 100 feet above the Niagara River. Police cars, firefighters, ambulances, and a crowd of people stood in the dark, watching to see what happens. Does somebody save her? Is she willing to jump? Will she climb back up? She was a librarian, intelligent, with a dark sense of humor colored by an unremitting, depressive episode lasting over a decade. Before I started my car, I received a phone call that first line responders talked her off the ledge. She would attempt suicide two other times before I left the clinic and moved to another state. Every once in awhile those of us who worked at the clinic run into each other and when her name is mentioned, there is agreement that she is probably dead.
Suicide is newsworthy because life is precious. In 1993, a 6-year old girl living in Florida stepped in front of a train. She left a note saying that she "wanted to be with her mother" who recently died from a terminal illness. This is the power of the human mind. A girl in Kindergarten thinks of the past and imagines a future that is so bleak, so devoid of meaningful moments without her mom, that she takes her own life. The same mental tools that distinguish us from other animals, the same mental tools that allow us to solve problems and produce creative works that give us symbolic immortality are the same tools that allow a 6-year old to contemplate a future that is terrible enough to physically leap into an oncoming train. If a 6-year old has the cognitive capacity to kill herself, then we need to step up our efforts to understand and prevent it from happening.
There are a couple of instrumental studies that have helped make a dent in this problem.
1. Researchers dissected 20 suicide notes written by people who attempted suicide with 20 notes written by people who successfully killed themselves. The notes were evaluated on 5 dimensions: sense of burden (would my loved ones be better off without me?), sense of emotional pain (how much suffering is in my life?), escaping negative feelings (is death the answer to ending this pain?), altered social world (is death the answer to my troublesome social relationships?, and hopelessness (is there evidence that life is going to get any better?).
What they found deserves your undivided attention. The biggest difference was that the notes of suicide completers included much more detail about how they were a burden on other people and society at large compared to the attempters. In fact, this sense of burden was the only dimension that distinguished the suicide letters of these two groups. You might be as surprised as me that hopelessness, amount of pain, and the belief that death will end the pain were common themes in the letters of both groups. Other studies have replicated these findings.
In general, people do not commit suicide because they are in pain, they commit suicide because they don't believe there is a reason to live and the world will be better off without them.
2. But perhaps there is another piece of the puzzle that takes us back to the opening story. What is it that enables a person to be strong enough to follow through and swallow an entire bottle of pills, ingest poison, or push the chair out so that they dangle from a rope tied to the ceiling? It might be controversial to use the word courage, grit, or strength in this context. Nevertheless, a suicidal person often must overcome intense emotional distress to commit the final act. Leading suicide researchers speculated that a sense of burden is necessary but insufficient to understand who kills themselves. A person might also require the capacity to harm themselves. A person must be highly tolerant of pain and conflict to make room for the uncomfortable thoughts and feelings that arise when working toward the goal of ending life. This tolerance of distress must be acquired somewhere along the way. Researchers continue to find support for the notion that the greatest suicidal risk exists for people that believe they are a burden on society AND possess a history where they acquired the capacity to harm themselves. This acquired capability can arise in unusual ways such as:
- playing violent and extreme sports
- getting multiple body piercings and tatoos
- shooting guns
- getting in physical fights
These types of painful and provocative events offer a sense of fearlessness about lethal self-injury. A person might respond positively to items such as “Things that scare most people don’t scare me” and “I can tolerate more pain than most people.”
If you remain unconvinced about the importance of an acquired capacity to tolerate pain and distress, consider these sobering figures. One in 25 people who sought health care services at a hospital because of self-harm or self-injurious behavior will kill themselves in the next 5 years. By dealing with deep distress and emotional pain by harming yourself with acts such as cutting, burning, sticking objects in your skin, or intentionally preventing wounds from healing, you are becoming increasingly capable of suicide.
One of the odd things about this line of research is that in any other context, high pain tolerance is a strength, a gift, a form of emotional agility that allows a person to be more successful and satisfied with life. This is why I bring this research up. Look at the motives behind people's actions because what we might view as an admirable strength in another context, is a fatal risk factor.
Do not grow weary from the endless news stories of war veterans and emotionally distressed kids, teenagers, and adults who commit suicide. Let these stories be a call to action. And we have some valuable science to guide us in the right direction.
For more details on the science described above:
Carroll, R., Metcalfe, C., Gunnell, D. (2014). Hospital Presenting Self-Harm and Risk of Fatal and Non-Fatal Repetition: Systematic Review and Meta-Analysis. PLoS ONE 9(2): e89944. doi:10.1371/journal.pone.0089944
Joiner, T. E., Pettit, J. W., Walker, R. L., Voelz, Z. R., Cruz, J., Rudd, M. D., & Lester, D. (2002). Perceived burdensomeness and suicidality: Two studies on the suicide notes of those attempting and those completing suicide. Journal of Social and Clinical Psychology, 21(5), 531-545.
Van Orden, K. A., Witte, T. K., Gordon, K. H., Bender, T. W., & Joiner Jr, T. E. (2008). Suicidal desire and the capability for suicide: tests of the interpersonal-psychological theory of suicidal behavior among adults. Journal of Consulting and Clinical Psychology, 76(1), 72-83.
Dr. Todd B. Kashdan is a public speaker, psychologist, and professor of psychology and senior scientist at the Center for the Advancement of Well-Being at George Mason University. His 2014 book, The upside of your dark side: Why being your whole self - not just your “good” self - drives success and fulfillment is available for pre-order. If you're interested in speaking engagements or workshops, go to: toddkashdan.com