Is Suicide Really a Choice?

The Stigma of Suicide

That we must even ponder: “Is suicide really a choice?” reflects a still pervasive stigma of suicide that somehow, losing a loved one to death by suicide can be controlled–that losing a loved one could have, might have been prevented; that we missed something, a fatal flaw in the way we loved; that we somehow failed at what is elemental to all love: we failed to control death.

Oh that death could be controlled. That we might live past pain, past illness, past affliction, past disease, past accidents, past the constructs of the frailty of all life.

That we might understand all illnesses can be fatal. That we might understand we cannot separate mental illness from physical illness. That we might acknowledge we cannot see inside an other’s pain. That while advances in medicine, advocacy, and breaking the stigma serve all of us well, no one of us can escape succumbing to what we still don’t understand: Death in itself.

In having lost my child to suicide, I lost everything. I lost myself. I lost hope. I lost the will to live. And in losing my son to suicide, I lost my ability to make sense of anything. “Is suicide really a choice?” haunts survivors of suicide loss. It seems a senseless death, an avoidable death, a preventable death.

On Depression

Depression is a disorder of mood, so mysteriously painful and elusive in the way it becomes known to the self —to the mediating intellect  —as to verge close to being beyond description. It thus remains nearly incomprehensible to those who have not experienced it in its extreme mode, although the gloom, “the blues” which people go through occasionally and associate with the general hassle of everyday existence are of such prevalence that they do give many individuals a   hint of the illness in its catastrophic form.

William Styron, “Darkness Visible”

No light; but rather darkness visible. . .

Where peace and rest can never dwell, hope never comes

That comes to all; but torture without end

John Milton, Description of Hell, “Paradise Lost”

Darkness Visible

Of the many dreadful manifestations of the disease, both physical and  psychological, a sense of self-hatred —  or, put less categorically, a failure of self-esteem—is one of the most universally experienced symptoms…[a] dank joylessness. . . .

William Styron, “Darkness Visible”

Antonin Artaud wrote on one of his drawings, “Never real and always true,” and that is how depression feels. You know that it is not real, that you are someone else, and yet you know that it is absolutely true.”

Andrew Solomon, The Noonday Demon: An Atlas of Depression

It is not an immediately identifiable pain, like that of a broken limb. It may be more accurate to say that despair… comes to resemble the diabolical discomfort of being imprisoned in a fiercely overheated room. And because no breeze stirs this cauldron… it is entirely natural that the victim begins to think ceaselessly of oblivion.

William Styron, “Darkness Visible”

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“Is Suicide Really a Choice?”

(A Reflective Narrative in its Entirety)

“Is Suicide Really a Choice?”

by David W. Covington

After multiple trips down the hall, I dumped the last bucket of ice into the bathtub, then topped it off with cold water. Just a couple hours earlier, I had completed my first marathon in New York’s Central Park, finishing fifteen minutes north of three hours. My legs cramped badly in the last half-mile, and after returning to our hotel, my friend Michael and I thought it would be a good idea to do what the professionals do to expedite recovery: take an ice bath.

With his teasing encouragement to go first, I stepped into the tub and quickly sat down, immersing my body in the ice and water up to my neck… Jesus! I have always tried to avoid the cold, but the pain I encountered upon entering the tub was instantly and completely unbearable. I don’t really recall the specific nature of the pain, but the memory is vivid. I was filled with an all-consuming terror that I would not be able to get out of the water fast enough. In the next moment, I was thrashing in the water, desperate to escape the acute pain I was experiencing.

That type of reaction is hard-wired in all of us. Our immediate response to acute pain is physiological: our pupils dilate and eyelids widen, our heart rate and blood pressure spike, our breathing quickens. It is part of our body’s built-in defense system, and in a micro-second we are into fight-or-flight mode. I didn’t choose whether to exit the ice bath; my primal reaction was to simply GET OUT.

Last year, at the American Association of Suicidology annual board meeting, I challenged a friend of mine regarding the relative absence of survivors of suicide attempts at the meeting, and told him how incongruous I thought it was. “What if the American Cancer Association meetings lacked survivors of cancer?” I asked. He replied that such a comparison was inappropriate. “Individuals choose to die by suicide; no one chooses cancer.”

Perhaps we have all thought about suicide in this same way, but I’m not sure how helpful or even how accurate that frame actually is. In “A Darkness Visible,” one of our most-skilled American authors, William Styron, expresses his frustration with finding the words to adequately convey the utterly crippling nature of his suicidal depression. Depression is a disorder of mood, so mysteriously painful and elusive in the way it becomes known to the self—to the mediating intellect–-as to verge close to being beyond description. It thus remains nearly incomprehensible to those who have not experienced it in its extreme mode.

Styron says that for those of us who have not experienced this kind of darkness, it is extraordinarily difficult to grasp how much like physical pain this anguish can be. Our more typical life experiences of disappointment and sadness, grief and loss, and the normal ups and downs of being human do not provide any accurate translation.

When my friend talked about choice, I relayed my experience with the ice bath. I told him I didn’t go through a decision-making algorithm on the benefits and drawbacks of leaving the tub, nor did I white-board potential solutions. Like any animal in pain, I instinctively bolted away from the source of it. No one needed to offer me the idea of exiting the tub, because that idea had already filled every neural pathway of my mind. (Many who have experienced psychic anguish are offended by the concept that someone who mentions suicide might give them an idea that they have not already had.)

My example references an acute pain, but extend that into a chronic day-over-day anguish that blinds the person to the possibility of a better day tomorrow. Perhaps people do not choose suicide so much as they finally succumb because they just don’t have the strength, supports, resources, hope, etc. to hold on any longer.

Recently, I have been offering a multiple choice question to audiences.

The idea that “suicide is a choice”is central to our disbelief that we could actually save everyone. But, we know we can extend and strengthen a person to hold on, even in spite of desperate pain.

Last year, I had the pleasure of meeting Major General Mark Graham and his wife Carol, who tragically lost two sons, Kevin and Jeff, in the military within seven months of one another. One died as a result of an IED in Iraq; the other was taken by suicide. You expect courage from leaders in the army, but I was so inspired by the choice this couple made to speak out about their pain and make themselves vulnerable in order to help and support others. Their choice demonstrates bravery to the tenth power.

In his appearances, Maj. General Graham speaks of Rabbi Kushner’s famous book “When Bad Things Happen to Good People,” in which the author highlights a study done regarding how much pain one can endure and for how long. Individuals were timed on how long they could hold their feet in a tub of ice water, first by themselves, and then with another individual in the room with them. The study found they could persevere almost twice as long when they were not alone. Kushner’s conclusion: “The mere presence of at least one caring person doubles the endurance of an individual.”

Suicide is preventable:

A. Never in Those Truly Intend Suicide

B. Sometimes, but Only in Advance of Acute Risk

C. Always, but Only in Advance of Acute Risk

D. Always, Even Up to the Last Moment

David Covington

I think it’s a fair statement that almost no one chooses cancer. We simply would never frame someone’s struggle with such a disease in that fashion. Why should suicide be any different? Yes, the individual did something: they pulled a trigger or they took an overdose. But I would argue that all of us react to pain, instinctively and immediately. The vast majority of us can only remain in a tub of ice water for so long. Imagine living day after day with extreme psychological pain and anguish.

Many of us have considered the phrase “committed suicide” as an inappropriate way to talk about the deaths of individuals who, despite their most tenacious efforts, could no longer endure unbearable pain. Perhaps Maj. General Graham has a better focus. I haven’t heard him talk about choice; he talks about sitting with the person in pain and helping them hold on. That’s even better.

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