We are happy to announce a new feature here at Anxiety, Addiction and Depression Treatments. It's called a Vlog Post, and for the most part, it's exactly like a regular blog post. We'll provide information, research, maybe some interviews, instead in a vlog post, it's all done with video.
So I'm very happy to present our first ever vlog post. In this clip I speak about some of the issues and treatments in play for the question of suicide and suicidal ideation.
I do not intend to discuss the studies about suicide that examine brain imaging and cerebrospinal fluid depletion, or theories of serotonin and the many other numerous “biological” studies that exist; I’ll save that for another time. I want to discuss the psychological motivations of suicidal intent, and what the purpose of these ideations and intent beget the user of such tactics.
First of all suicide is the cowards way out. It takes courage to live life on life’s terms. The unhappiness of people who contemplate suicide emanates from their unsuccessful attempts to master life’s challenges and the ensuing despair in face of their defeat. Suicidal patients lack the creativity to rise above their circumstances, and therefore find themselves at a coward’s solution: "I would rather die than face my failures and learn to rise above them." The essence of life’s challenge lies in the suicidal dilemma, "Can I accept my failures, learn from them, and reinvent myself in the light of what I learn from these very mistakes?"
The contemplator of suicide resoundingly answers this question by saying things like, “I can’t go on. My life is over. There is no hope for me. I am a failure. I might as well die. The world has no use for me and it would be better off without me.” And most importantly, "No one cares if I live or die.” It is this last refrain that leads to the next point about suicidal motive.
“No one cares if I live or die,” hints to us that suicide is not just an act of cowardice, but is also motivated by revenge. My favorite tool to discover the identity of the target of the suicidal revenge is to pose the following question to the suicide plotter: "Ok you succeeded, your dead, you jumped in front of the oncoming train. We are now at your funeral ceremony and everyone who would come to pay their last respects has assembled. I give you the power to look out from your coffin and view the assemblage. My question to you is: 'Who is the single most upset person at your funeral?' You can only pick one person.”
The answer to this question is the magic key that opens the box of the plotter's revenge. It is this choice that identifies the target of the revenge that has driven the suicidal intent. It is important to never doubt the identity, and I follow with the question: “Why are you so angry at this person?”
The response is invariably “I am not angry at this person.” This is where the work of therapy starts by beginning to uncover the rage locked up in this relationship. The resistance to this revelation is a pitched battle that must be won in the first session, or the risk of suicide will increase. This work is certainly not for amateurs or the inexperienced practitioner. These are the most serious discussions a mental health practitioner can ever have with a patient. There is no room for mistakes given the potential consequences.
What are the sources of these revengeful feelings? Frequently they emanate from the rage of neglect in childhood, neglect that leaves the victim feeling that no one ever takes them seriously. The anger that grows from not being taken seriously over a lifetime becomes a torrent of rage that turns to revenge as a last statement of, “You will have to take me seriously now!”
Sometimes the rage results from underestimation of a person, that in turn leads to too much attention and babying, rendering the suicidal person helpless. Over-sheltering and underestimation deprives a person of the experience of the much needed ebbs and flows of life that make one stronger and more secure. Other sources of the rage emanate at times from over-expectation, as when others impose goals in time frames that are impossible to meet, leaving the suicidal person feeling like a failure.
Whether the rage is due to lack of attention, too much attention, over- or under- estimation, it is still rage, and it has to be dealt with one way or another. The suicidal person has chosen a particularly cowardly manner to vent their anger and get their revenge. The reasoning is that one will hurt oneself to hurt others. This plan has one major flaw, however: you’re dead and unable to enjoy your revenge. Equally important is the fact that the after committing suicide one will be labeled as crazy, and in the end, people given sufficient time to mourn will eventually move on. Foiled, this is mostly likely enough to make you want to roll over in your grave.
Another source of this desire for revenge, the inability to express anger in a healthy manner at the target of the revenge, points to the goal of the successful psychotherapy session. The suicidal patient becomes consumed by their inability to express this rage, typically because they do not feel a right to be angry at this person. From there, suicidal feeling take root in this ambivalence and grow on the most fertile psychology. The excuses for lack of expression range from "She is the only person who cares about me,” to “I have no right to be angry at them because they have been so good to me…” Breaking through these defenses to arrive at the consensus that the rage is rightful and worthy of expression is amongst the trickiest of psychotherapeutic efforts.
The thicket one faces when confronting the desire for revenge of a suicidal patient requires a tense probing of this rage, and a partnership strong enough that it will endure until all the culprits are brought to justice. It is building that relationship that wins the day and allows the suicidal plotter to ally with someone who finally takes their concerns seriously, and allows that person to give up their deeply flawed plot of revenge.
I hope this discussion opens some fresh perspectives on the notions surrounding suicide, and how the approach to these symptoms must be proactive and well seasoned to be effective. As always, I am deeply indebted to the departed son and daughter of Alfred Adler, Kurt and Allie for their knowledge and inspiration.