Trapped by Success: Spade, Bourdain, and Celebrity Suicide

New research on suicide risk identifies additional warning signs.

Posted Jun 29, 2018

“So much the more surprising, and indeed bewildering, must it appear when as a doctor one makes the discovery that people occasionally fall ill precisely when a deeply-rooted and long-cherished wish has come to fulfillment. It seems then as though they were not able to tolerate their happiness; for there can be no question that there is a causal connection between their success and their falling ill.” —Sigmund Freud, “Those Wrecked by Success” from A Metapsychological Supplement to the Theory of Dreams

Any individual suicide is in and of itself infinitely tragic, but when celebrities die by suicide, the impact collectively reverberates on a grand scale. With any suicide, there is a risk of contagion in the form of “suicide clusters.” With celebrity suicides, the specter of contagion looms even larger. And yet, due to the amount of attention that these high-profile deaths generate, they also hold the potential for changing the dialogue around suicide. It’s a less-than-ideal path for positive change, but one that is important to foster.

Most recently, the deaths of Kate Spade and Anthony Bourdain have again catapulted suicide into the center of the public discourse, kindling our memory of the deaths of Robin Williams, Soundgarden’s Chris Cornell, and many others. This is part of an overall uptick in suicide rates in the United States. According to a recent report from the Centers for Disease Control, suicide rates have increased by over 30 percent in at least 25 states and, in 2016, there were over 45,000 suicides nation-wide by people over the age of 10, more than half of whom did not have a diagnosed mental health condition at the time of death. Associated factors included relationship issues (including relationship loss), substance-related problems, general health issues, and stress in finances, work, and housing.

It is not what accounts for this trend, but understanding the evolution of the suicidal mindset is an important place to start in order to develop effective suicide prevention. What leads a person to consider suicide as an option? What should we look for in ourselves and those around us so we can act before it is too late? What keeps those contemplating suicide from reaching out for help, and what keeps available help from being effective?

Getting involved

Over and over again in my work, I speak with friends, co-workers, and family members of people who are in serious trouble. They may be struggling with alcohol or drug addiction, aggressively rejecting any form of help. They may be caught in the depths of depression, often grappling with overwhelming anxiety and distorted perceptions of reality leading to a sense of total hopelessness and helplessness. They may be dealing with the aftermath of developmental trauma—dealing with sexual abuse and neglect, for example, often unable even to manage powerful emotions and engaging in self-destructive behavior. Regardless of the reason for their struggles, they are all too often hesitant to speak out or seek help, and the problem is compounded when the people closest to them do not know how to effectively offer help. Somehow, even when we know we must do something, we are so afraid of saying the wrong thing that we become paralyzed and say nothing. Sometimes, it’s caregiver fatigue that leads to difficulty staying vigilant with ailing loved ones. Sometimes our desire to help is overshadowed by our own struggle with the interpersonal psychological dynamics of suicide and we remain in silence even when we know we should speak.

One of the things I hear the most is that people are afraid of violating boundaries. The perception is that either we must steer clear of any issues for fear of being inappropriate or impolite, or we must confront concerns with a full frontal assault. There is a tremendous sense that the situation is either/or, and in either case, there is no good path forward. There is the sense that there are only two choices: Either make a tentative gesture, risk getting pushed away, and wind up avoiding the subject entirely or push hard and risk that the person in need will stop reaching out or, worse, will even be driven to act.

In many cases, this maladaptive dynamic is familiar and familial. It is the result of years of dysfunctional family norms which have set the stage for creating and sustaining a culture of denial, and rigid patterns of communication organized around an idea of politeness which blocks open communication in the service of maintaining the status quo.

A stark example of this comes up in my professional life. People with family members in trouble do not know whether they can or should reach out to their loved one’s psychiatrist or therapist. They believe any contact has to be done by going behind the family member’s back and reaching out to the medical professional without prior consent from or discussion with the patient. However, I firmly believe that if there is a serious concern, it makes sense to reach out to the clinician rather than stand by and let something bad happen. We aren’t talking about an intrusive spouse or parent who calls the therapist for no good reason. Rather, we are talking about situations where the family member’s participation can make the difference between life and death.

Well-prepared mental health practitioners will be open to family communications, and, in fact, in higher-risk clinical situations, they will likely have set up the lines of communication in advance of the crisis so that concerned family members don’t have to worry about getting in trouble for doing the right thing. Without consent, clinicians are not allowed to discuss treatment (or even disclose if someone is under their care), but they are able to listen to the concern of others without disclosing any confidential information. However, in emergency situations, clinicians are not only allowed to break confidentiality, but they are required to do so in order to ensure the safety of their patients. And though concerned loved ones may have been rebuffed by the person in need, it is important for them to know that research indicates that suicide survivors who have gotten through the crisis to get the help they needed are most generally grateful that they survived. (There is a good collection of anecdotal stories of suicide survival here). So it is important to acknowledge that, in the cases of suicidal people who not only can’t reach out but who purposefully isolate themselves and push others away, concerned loved ones and clinicians are faced with the challenge of reaching in against strong resistance.

Heroic and contentious efforts aren’t usually necessary when concerned others get involved early on, before the psychology of isolation becomes entrenched and plays out in the family system. A thoughtful discussion can start with an expression of concern and a request for  consent to be more involved in care. Expressing caring with empathy, recognizing the person’s distress, and gently but insistently providing help and getting the person proper care may often be enough to prevent tragedy. Of course, as with other serious illnesses, treating more severe psychiatric illness requires the involvement of medical professionals.. But in virtually all cases—particularly conditions like severe depression, in which those affected may not believe anything can help or even that they are worth the effort required—having  family and other people close to the patient others involved in care is essential and is often an overlooked component of a course of treatment.


Warning signs: What to look for

The first step in being able to offer help to a potentially suicidal person is knowing what to look for. Traditional risk factors include prior suicide attempts, family suicide history, depression, anxiety, agitation, and related. It is thought that people recovering from depression will often have the energy to act on suicide plans just as they are starting to respond to treatment with more motivation but don’t yet feeling like living. It is critical to note, too, that many people who harm themselves don’t intend to end their lives, but inadvertently end up dying. Many accidental deaths may be suicide in disguise, expressions of desperate need which end in tragedy, or something in between.

In spite of years of research on suicide, it remains difficult to predict who will act on suicidal inclinations with lethal intent. Early research using machine learning and neuroimaging to measure brain activity and predict who is suicidal is intriguing and promising, but not ready for clinical use.

More recently, researchers have focused on additional factors to better predict suicide. Three factors (which overlap to an extent) are emerging as most critical: entrapment, defeat, and emotional pain. These factors are part of what researchers have termed “suicide crisis syndrome,” a perfect storm of circumstances which are thought to precipitate suicide attempts characterized by feeling trapped, being flooded by negative ruminations, experiencing panic and dissociation, fears of dying, and overwhelming emotional pain (Shuang et al., 2018).

Suicide crisis syndrome is “transdiagnostic,” meaning that it applies not only to depression, but has been shown (Siddaway et al., 2015) to be present across psychiatric conditions, including anxiety disorders, PTSD (post-traumatic stress disorder), and suicide regardless of diagnosis.


Perceived entrapment and perceived defeat are related factors in precipitating a suicide crisis. In their analysis of multiple studies of suicide in different psychiatric conditions, Siddaway and colleagues define perceived defeat as “a perception of failed struggle and powerlessness resulting from the loss or significant disruption of social status, identity or hierarchical goals.” There are three key common causes: 1) failure or loss of success in gaining material or social assets; 2) humiliation and attack from others; and 3) self-attack in the form of intense self-criticism, shame, loss of social status, or failure to make progress toward one’s goals.

Perceived entrapment, Shuang and colleagues write, “occurs when the usual psychobiological motivation to escape threat or stress is blocked because of no or low likelihood of individual agency, or rescue by others.” This is experienced as “a felt urgency to escape from an unbearable situation from which there is no perceived escape”. From the point of view of clinical mental health (not including euthanasia), people do not choose suicide (with the exception of euthanasia, which requires an entirely different discussion than this one). Entrapment occurs when a person perceives that options—ranging from untried treatments to attempts to change life stressors—appear out of reach, even if they seem to others quite possible. Obsessional efforts to think of options (“ruminative flooding”) when no options seem available leads to frantic, panicked searching, and infinitely spiking stress—a perfect situation for suicide to arrive as a dark and solitary possibility. It is thus absolutely critical not to romanticize suicide as heroic, appealing and seductive, requiring moral courage, or as a real choice.

I, and other

In parallel with defeat, entrapment may be in relation to inner factors (e.g. helplessness in the face of negative thoughts, feelings or states of mind or sense of oneself) and outer factors (e.g. feeling stuck in a job or unable to get out of unwanted relationships or other life circumstances). For both defeat and entrapment, it is absolutely essential to recognize that these are by definition perceived factors.

Why is it so important to keep this in mind with dealing with people facing suicide? Because the interpersonal dynamics of suicide psychology are insidious. Hopelessness and helplessness can be contagious. A suicidal person can thus be persuasive in their belief that there is no escape and/or no hope for relief or change. When these distorted and delusional beliefs became part of the conversation, those close to the suicidal person may too easily persuade themselves that nothing can be done when reasonable—though perhaps challenging—options exist. The suicidal mindset is a mindset in which flexibility has been lost and possibilities are obscured. Even when options other than suicide are intellectually acknowledged, it remains irrelevant when suicide is identified as a good and reasonable option, and factors against suicide are rationalized or frankly dismissed.

Finally, emotional/psychological pain is an important final risk factor which can be both associated with and also independent of entrapment. It is defined as a “mixture of intense and painfully felt negative emotions such as guilt, shame, hopelessness, disgrace, rage, and defeat, which arises when the essential need to love, to have control, to protect one’s self image, to avoid shame, guilt and humiliation, or to feel secure are frustrated” (Shuang et al., 2018; Ducasse et al., 2018). The suicidal person may feel trapped and defeated, ensnared within such emotional pain that suicide appears the best and most immediate source of relief.

These factors help us understand why people are motivated to hide serious problems and how interpersonal dynamics can make it difficult even for concerned and attentive loved ones to see how dangerous the situation has become. Feelings like shame lead people to withdraw from others and to pretend everything is alright. The stigma surrounding mental illnesses fuels shame and the need to maintain a false front of emotional and physical health.

Hiding in plain sight

Though some may think fame or money protects people from suicidal ideation, the opposite is in fact true. There are a variety of additional risk factors for public figures that are layered upon that of the lay person. Especially for celebrities or other high-profile people who have created an identity based on maintaining a public image and keeping their private lives private, revealing mental health problems and associated experiences of vulnerability may seem out of the question. In the case of actors and media figures, experienced performers have refined skills for appearing as they wish to appear, making it easier to hide issues.

Such public figures and media sweethearts may have built a sense of self around being successful and beloved, leaving them extremely vulnerable both to the pressures of maintaining that image for others, and the despair that comes with any loss or even perceived threat to that success and idealization by others. The pressure is increased when one considers the fear of disappointing those who admire and depend upon them. Adding fuel to the fire, high achievers are often perfectionistic, and perfectionism is independently associated with suicidal thinking (Shahnaz et al., 2018). A related issue comes up when people reach what they perceive as the pinnacle of externally-defined achievement. They may find that they are left with difficult underlying feelings without the means to effectively deal with them—possibly the same issues they had in the first place which led them to seek success as a means of flight from one’s background, and earlier identity.

Of course in a fast-paced, high-price, public lifestyle, public figures  may have other mental health issues—addictions or eating disorders, for example—which may compound the situation. An addiction might have required learning how to hide problematic behaviors and avoid dealing with difficult feelings, so suicidal ideation is dealt with similarly. They may also have fewer concerned loved ones and more enablers—mostly people who rely on their celebrity for their livelihoods and thus may be incentivized  to ignore problems for the sake of their own job security. Intervention, too, may be different, as instead of an inter-familial struggle over concern, an employee expressing any concern over the situation may simply be dismissed , potentially leading to an atmosphere of collusion.

High-profile suicides are sobering and unnerving, in the extreme. If successful people who have achieved all we imagine they could ever want to achieve don’t seem happy, what does it mean for ordinary folk? Whenever any divisive issue captures the public ear the way the deaths of Spade and Bourdain recently have done, and other before them, we are faced with a tipping point. In this case, there is a risk for suicide contagion, and an opportunity for prevention of suicide.

With each unacceptable loss, we are motivated to make definitive changes, but complacency sets back in fast. We hope each time we are confronted with senseless loss and tragedy, things will finally and fundamentally change for good, but the reality is that sustainable change requires resources on a systemic level devoted to education and prevention. Rather than perpetuating myths about suicide which increase contagion, we can share examples of when suicide has been prevented, through community, through models of people helping those in need, through destigmatizing the factors which lead up to suicidal crises, by empowering those in need to reach out more readily, and recognizing that suicide is not be be admired, imitated or sensationalized.


The following resources have been graciously provided by the National Suicide Prevention Lifeline:

With condolences to the families and loved ones of those who have died by suicide.

References

Ducasse D, Holden RR, Boyer L, Artero S, Calati R, Guillaume S, Courtet P & Olie E. (2018). Psychological Pain in Suicidality: A Meta-Analysis. J Clin Psychiatry: 79(3):16r10732.

Freud, S. (1916). Some Character-Types Met with in Psycho-Analytic Work. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XIV (1914-1916): On the History of the Psycho-Analytic Movement, Papers on Metapsychology and Other Works, 309-333

Siddaway A, Taylor P, Wood AM & Schulz J (2015) A metaanalysis of perceptions of defeat and entrapment in depression, anxiety problems, posttraumatic stress disorder, and suicidality, Journal of Affective Disorders, 184, pp. 149-159.

Shuang L, Yaseen ZS, Kim H, Briggs J, Duffy M, Frechette-Hagen A, Cohen LF & Galynker II. (2018). Entrapment as a mediator of suicide crisis. BMC Psychiatry, 18:4.

Shuang L, Galynker II, Briggs J, Duffy M, Frechette-Hagen A, Kim H, Cohen LJ, Yaseen ZS. (2017). Attachment style and suicide behaviors in high risk psychiatric inpatients following hospital discharge: The mediating role of entrapment. Psychiatry Research 257, 309-314.

Shahnaz A, Saffer BY, Klonsky D. (2018) The relationship of perfectionism to suicidal ideation and attempts in a large online sample. Personality and Individual Differences, 130, 117-121.