"Pastor, I thought you should know. I've made one of the most important decisions of my life. Everything has been mixed up for so long, and it just seems to get worse continuously. But I feel completely at peace now. I've found the perfect solution to my problems, and it's a relief to know that they will soon be over. I'm going to kill myself!"
The voice on the other end of the telephone was flat and emotionless, despite the urgency of the words. Somehow, almost instinctively, the young pastor knew that the matter-of-fact way in which this person spoke indicated his absolute seriousness.
The last sentence reverberated in the pastor's mind during the few seconds it took to evaluate what he had just heard. At the moment it was impossible for him accurately to analyze all his emotions. Uppermost in his mind was a feeling of helplessness—what should he do? If he had ever had a class on how to handle such a call he had failed to re member what he was supposed to do next. He was alone on the firing line, handling his first suicide call.
Every year approximately 24,000 Americans end their own lives; estimates are that another 75,000 destroy themselves but remain unidentified as suicide victims. 1 This means that at least one American commits suicide every 20 minutes. And for every person who actually kills him self, another 10 people make a serious attempt. 2
Most of these self-destructive individuals give distinct clues of their suicidal decisions, and a large number of them make overt at tempts to seek help by calling friends, relatives, or professionals such as doctors or ministers. For a professional person to be helpful to a potential suicide victim, he must have some understanding of the phenomenon of suicide.
Here are some of the most common characteristics: 1. Two or three men kill themselves for every woman who does. 2. The risk of suicide increases with age. 3. More Caucasions commit suicide than do other ethnic-group members. 4. Suicide is greater among individuals who are separated, divorced, or widowed. 5. More women attempt suicide than do men. 6. Every suicide threat should be taken seriously. Many threateners become attempters, and many attempters be come committers. 7. Once a person attempts suicide and fails, each succeeding attempt becomes more likely to be lethal. 8. Most people who attempt or commit suicide are ambivalent about dying at the time of their act. 3
Research indicates that the typical person who commits suicide is a middle-aged (50-59) Caucasian male who is employed as a skilled or un skilled laborer. He is usually separated from his wife and has a history of physical illness, with which he feels he can no longer cope. He will likely kill himself with a handgun, which he originally purchased for the protection of his family and himself. Women who kill themselves do so most often between the ages of 35 and 54. 4
Most men who commit suicide choose a method that is both fast and irreversible, such as shooting or hanging themselves or by jumping from a high place. The majority of women who kill themselves do so with an overdose of drugs, a method that is neither fast nor irreversible. This difference between men and women in their choice of methods may reflect a basic difference in approaches to life in general. Women use suicidal gestures as a form of communicating their despair while there is still hope for help; men wait until suicide becomes the only viable option that they can perceive.
If suicide is indeed actually a form of desperate communication—a cry for help that is resorted to when all other attempts at communication have failed—then all suicidal gestures (both threats and attempts) should be taken seriously. Unfortunately, many people tend to look at these gestures as offensive manipulations that are whimsical and not serious. The ambivalence toward death displayed by the average suicide attempter should not be interpreted as a sign of intentional deceit. Such an individual actually vacillates between the desire to end his misery through death and a desire to have someone show a concern that will convince him that suicide is not necessary. The majority of people who actually kill themselves have made previous threats and attempts that have failed to generate the help for which they were seeking. There fore, every suicidal gesture should be taken seriously.
Overt attempts at suicide, how ever, are only the most obvious indications that a person has come to such a point of desperation that he considers self-destruction as one way out of his problems. People who are contemplating suicide often leave clues. Some of these are very direct and fit into the category of suicide threats. Others are more subtle, consisting of hints that one would be better off dead or that one has become tired of living. Other clues involve changes in behavior and attitude that may not be recognized until after the suicidal act has taken place. Much suicidal behavior could be prevented if those close to the potential victim could under stand the suicidal clues and respond by reopening needed communication channels.
Here are some of the subtle clues to watch for: (1) unusual difficulty in sleeping, followed by periods of general sadness; (2) sudden, unexplainable losses of appetite, weight, or interest in sex; (3) an unexplainable loss of interest in work or customary activities such as hobbies or sports; (4) an unexplainable loss of interest in one's friends and relatives; (5) frequent talk about death or the wish to die; (6) unexpected preparations for death such as the making of funeral arrangements, updating insurance policies, preparing trusts and wills; (7) any sudden and unexplainable giving away of prized possessions; (8) a sudden interest in either the purchase or borrowing of guns, knives, ropes, medications, et cetera. 5
Obviously not everyone who exhibits one or more of these behaviors is contemplating suicide. How ever, the more of these common signs an individual displays, the more important it is for those around him to seriously consider techniques of suicide intervention.
Contrary to popular belief, suicide is rarely committed as a spur-of-the-moment, impulsive act. Most suicides are well planned and have matured through a long period of thought. The typical suicidal person goes through an orderly planning process from the point of inception to the point of action. Generally, the plan evolves through the following stages: 6
1. The resolution. The suicidal person must first resolve the philosophical and ethical considerations of his self-destruction. The individual generally exhibits agitation and preoccupation as he overcomes his basic cultural inhibitions against suicide. This phase will likely be continued over a long period of time, with some resolution being made each time the individual faces a personal crisis that generates suicidal thoughts.
2. The initiation phase. After the individual has overcome his preliminary abhorrence of suicide, he initiates concrete actions toward making his plan a reality. First, he must choose a mode of death. At this point the individual weighs the "virtues" of one weapon against an other; resolution comes when he chooses the means with which he will end his own life. Next, he must choose a suitable location. Consideration is given to such things as the amount of time needed, the time lapse between the suicidal act and the time of discovery, who will most likely make the discovery, and the impact it will have upon them. Throughout this phase, the individual continuously rehearses the suicidal act in his mind until he feels he has perfected his plan. During this time his family and friends may be aware of mild degrees of agitation.
3. Postponement phase. During this final stage the individual frequently becomes peaceful. Since he has resolved all of the issues of his impending self-inflicted death, he can turn his efforts toward opening communication channels with those who are significant to him. The suicidal action is still reversible, although it becomes increasingly less so with the passage of time. Yet if the channels of communication can be adequately opened even during this final phase, it is possible that the act of suicide can be averted. If the individual's efforts toward communication are thwarted, however, he may express the urgency of his needs through a sublethal suicide at tempt. If this desperate measure fails to resolve his problems, he will almost certainly make another at tempt, with each succeeding one be coming more desperate and more lethal. If another attempt is made, it will likely occur within ninety days of a previous attempt. 7
It should be reemphasized that most suicidal people are ambivalent about dying. 8 This ambivalence toward death may explain why a suicidal person quite often calls his pastor or physician and openly ex presses his suicidal intention. The important question now becomes, "What should I do if I get a suicide call?"
The first rule is to remain calm! Conveying anxiety in your voice or manner accentuates the ability of the person on the other end of the line to manipulate you. Despite the urgency of the situation, your caller has telephoned because of his ambivalence about dying and his desire for help. He needs your confidence and stability as reassurance of his capacity to survive the present crisis.
The second rule is to assure the caller that you take seriously his ability to kill himself. This indicates that you are not going to deal with his problem in an unrealistic manner. Likewise, it is often beneficial to indicate to the caller that you do not intend to talk him out of his action. These two ploys indicate your acceptance of his potency and reduce the necessity for him to convince you of his need and ability to kill himself. It is a psychological principle that in trying to convince you of the "rightness" of his course, the would-be suicide victim may very well succeed in convincing himself.
You might say, "I am glad you decided to call me and share with me your present pain. I'm sure you have carefully considered your situation and I fully realize that suicide is one of the options open to you. Because I feel it is important for each person to make his own decisions, I won't try to talk you out of killing yourself; however, I would like to take a few minutes to see whether you have fully considered some of your other options."
The next step is to review some of the possible nonsuicidal options available to the individual. This is most easily accomplished by asking him to list some of the other options that he has already considered. It is easier for him to tell you what is important to him than for you to guess. This step will make up the bulk of the conversation. To assure its effectiveness you must really listen to all the subtle messages that you will be receiving. One of the
most important things in the mind of the suicide caller is his need to be heard. The appropriate activity for the counselor at this point is active listening. Listen for ways in which you can honestly reaffirm the caller's feelings of self-worth and value. Your personal concern and love can be shown by patient and intense listening at the time of crisis, and by continued contact after the crisis has passed.
Finally, it is important to realize one's limitations in this highly specialized area. Persons who have contemplated suicide should be encouraged to seek professional counseling. Sometimes a pastor feels that referring the suicide caller to an other counselor might be viewed as another in a series of rejections. On the contrary, such a referral is commonly viewed as showing the pas tor's true concern for the individual, especially if the pastor maintains a warm and interested relationship with the person following referral. Most large communities now have suicide-prevention centers or hot lines where specially trained helpers are available on a twenty-four-hour basis. Information about local suicide-prevention centers may be obtained by writing: American Association of Suicidology, P.O. Box 3264, Houston, Texas 77001.
One of the most important links in the support network for a suicidal person is the individual's pastor the person most frequently turned to for strength when internal strength is waning.
Notes:
1 Leonard Linden and Warren Breed, "The Demographic Epidemiology of Suicide," in Suicidology: Contemporary Developments, Edwin S. Shneidman. ed. (New York: Grune and Stratum, 1976), pp. 71-98.
2 Erwin Stengel, "Attempted Suicides," in Suicidal Behaviors: Diagnosis and Management, H. L. P. Resnik, ed. (Boston: Little, Brown and Company, 1968), pp. 171-189.
3 David Lester, Why People Kill Themselves (Springfield, III.: Charles C. Thomas, publisher, 1972).
4 Vern R. Andress and David M. Corey, The Demographic Distribution of Suicide in Riverside County Between 1965 and 1969 (Loma Linda, Calif.: Loma Linda University Press, Loma Linda: Occasional Papers, No. 3, Department of Sociology and Anthropology, 1976).
5 Calvin J. Frederick and Louise Lague, Dealing With the Crisis of Suicide (Washington, D.C.: U.S. National Institute of Mental Health, Public Affairs Committee, Public Affairs Pamphlet No. 406A, 1972), p. 15.
6 Robert E. Litman and Norman D. Tabachnick, "Psychanalytic Theories of Suicide," in Suicidal Behaviors: Diagnosis and Management, H. L. P. Resnik, ed. (Boston: Little, Brown and Company, 1968), p. 78.
7 Edwin S. Shneidman and Norman L. Farberow, eds., Clues to Suicide (New York: McGraw-Hill Book Co., 1957).
8 Erwin Stengel, Suicide and Attempted Suicide (Baltimore: Penguin Books, Inc., 1964).
