Through the years I have attended numerous Suicide Prevention training programs. They always raise a great deal of concern and many questions for me. My colleagues and I often discuss this, but rarely do so in public. Perhaps the conversation should be brought to the fore.
First let me say that I am in complete agreement that talking about suicide should not be verboten. The intentions of suicide prevention programs to eliminate the fear and misconceptions about talking to someone about suicide are admirable and worthy. Some people can be saved because another person opened up and talked to them. And that is a good thing.
Unfortunately, they often come packaged with two fallacies which seriously concern me.
1. The belief that you can control another person
My first concern is that suicide prevention trainings often suggest that saving the person will always and necessarily be the outcome. That the person will always be saved if you only bring it up.
This is not true.
There are some people who are going to commit suicide regardless of what anyone does.
I'm a trained professional and there have been people I could not prevent from committing suicide. I could talk to them until my head fell off. I could refer them to other clinicians to talk to. I could have their family members talk to them. I could have them hospitalized and medicated. But they quickly learned what to say to the treating staff to garner themselves a discharge, to the family members to quiet the family's concerns, to the other clinicians to close their cases. Once the client had freed themselves of all interventions, they completed what they started. They committed suicide.
To suggest that people talk to someone who appears suicidal is not necessarily wrong. They may be able to intervene and save someone's life. But to suggest that they absolutely will save a life is simply irresponsible. Not to warn them up front that the person may commit suicide anyway is negligent. I daresay many people would have serious trouble if they tried to prevent someone from committing suicide - and failed. They might feel they had failed in some way, that it was their fault, that they are somehow responsible. Taking it upon yourself to deal with someone else's suicidal feelings should not be done lightly or without a full understanding of the possible ramifications.
I think this is an important factor to bring up in suicide prevention trainings. The belief that we have the ability to control another person has serious limitations. We are not always able to prevent suicide despite our best efforts. The other issue is whether we should always try to prevent suicide.
2. The belief that you should control another person
The second fallacy of suicide prevention philosophy is the assumption that suicide is necessarily wrong, that we should always intervene to prevent someone from committing suicide.
I'm not sure suicide is always wrong. I'm not sure we should always intervene to stop it.
If a client is temporarily depressed and feeling suicidal, either because of fluctuating biochemicals or situational factors, it is only natural to assume that they should wait until their biology or their situation is back in balance and they can see more clearly to make sure a decision. For the people who commit suicide in the darkness of one of these temporarily blinding moments the loss to family and loved ones is profound. And I think this is the situation for which most suicide prevention programs design their curriculum.
However, there are other types of suicide. Clients who are terminally ill sometimes contemplate suicide as a kinder, more gentler method of leaving this world (as we saw with Dr. Kevorkian and his patients). For those of us who have not been faced with such a prognosis who are we to say that this is not the proper way out? I cannot be so arrogant.
I have also worked with clients who suffered severe forms of mental illness and were tortured unmercifully by it. People with severe mood swings and psychosis from Bipolar Disorder can grow quite weary of the extremes and the total wreckage their lives become as a result. These clients may have fought valiantly for years trying every kind of medication and therapy - to no avail. They are tired of their lives and wish to stop the merry go round and get off. As someone who has not had to fight this battle, how can I tell them they are wrong? When they calmly and intelligently make decisions about the quality of their lives during their sparse moments of sanity, who am I to overrule them? And what would be my motivation? That it bothers me? That is causes me discomfort? Though I have not knowingly lost a client to such a situation, I have watched them struggle through it without being around to see the final outcome. I may have saved them for the moment, but I cannot know how long it lasted. I don't know if they carried out their wishes or not. I strongly suspect some of them might have.
When their decisions are made calmly and sanely, should we have the right to overrule them? There are many who would answer with an unequivocable, "Yes!" But I would ask, "Why?" and "For whose benefit?"