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A 2008 article in the London Times opens, “Who is responsible for a suicide? The crude answer is: the person who takes their own life. It’s the ultimate act of autonomy.” This quotation echoes a sentiment that one hears with some frequency in clinical practice in managing suicidal patients. When suicide risk is elevated, it is wise for clinicians to inquire as to potential means of death and to engage in commonsense actions to restrict access to those means. For instance, if someone is thinking of death by self-inflicted gunshot wound, having the person bring the gun and ammunition to someone for safe-keeping is worth serious consideration. In these conversations, it is common for patients to voice some reluctance, not necessarily because they want to retain the means of death (though this can occur), but rather because they feel a sense of control in having a last-resort escape plan in suicide.
Many clinicians have witnessed this phenomenon, and I believe it is a key source for the myth that death by suicide is primarily about master or control. It is crucial to distinguish between, on the one hand, wanting an array of options, including the last-resort option of suicide, and, on the other hand, deciding to die by suicide. In the former state of mind, there are multiple options, and this alone distinguishes it from the state of mind of the truly suicidal individual, for whom there is only one option (or more accurately, for whom the option of death is increasingly towering over other options). The person who wants to keep suicide as a last-resort option is clearly implying that there are other “resorts” that can be tried out first. In saying they want control over the option to die, they are affirming that there are prior options, at least one of which involves living.
The myth that suicide is primarily about self-mastery is an instance of a larger, general category of suicide myth that involves mistakenly assigning primacy to a motive that is either secondary or epiphenomenal (and often doing so with a distinctly moralising tone). That is, although it is certainly true that some people – including suicidal people – ascribe to suicidal behaviour a “take my life in my own hands” function, imagining it to be the primary reason for suicidal behaviour, it is also true that these people might be mistaken. This kind of mistake, it should be noted, is the same kind that occurs when people confidently attribute to suicidal behaviour motives such as selfishness and revenge.
And, like the misunderstandings regarding selfishness and revenge, the myth about self-mastery contains some grains of truth. The mistake is not the assumption that self-mastery (or revenge or selfishness) is or can be involved somehow; rather, the mistake is about what is fundamental. To take a totally different example, attributing the behaviour and consequences of hurricanes to the contour of the affected shore is not wrong per se; often, shore contour is important. But it is not always important, and other, more fundamental things always are, such as wind speed and tides.
Self-mastery is of obvious importance in the course of our lives. In the time it took me to write that last sentence, I received two separate spam e-mails on impotence, and by the time I finish the paragraph, I expect to receive others on this topic, or on obesity, and so on. All of these e-mails either explicitly or implicitly prey on people’s frustrated needs for self-mastery in one or another life domain. Anyone up late at night can observe the televised version of this same phenomenon, and it is not hard to imagine that this can be a depressive experience. Though relatively little research has been done on the topic, one study of a weight-loss infomercial found that thin women appeared on the infomercial three times as often as other women, and the ad portrayed heavyweight people as particularly unhappy and unattractive (Blaine & McElroy, 2002).
It is also not hard to imagine a depressed person up at night (because insomnia is a symptom of depression) when these ads are most visible, harbouring vague suicidal ideas while absentmindedly watching a “take control of your life” infomercial. As the commercial and its host talk about “control” this or “take back” that, the message melds with the individual’s ongoing suicidal ideas. Though I doubt very much that my dad watched infomercials, his note, perhaps a suicide note, perhaps not, which consisted entirely of the question, “Could this be the answer?” rings of this motive: “Yes, here at last, might be a way, albeit a very desperate one, to regain some control.”
This description is not intended to lay depression or deaths by suicide at the doorsteps of the late-night self-improvement or teleadvertising industries. It is meant, rather, to illustrate that issues of self-mastery are prevalent and pervasive in our society, and that certain segments of the population – certainly including suicidal people – are vulnerable to messages, almost always false, that promise to fix things through a quick and easy increase in self-mastery. Although causing one’s own death may seem to the suicidal person a means of total or ultimate control, this is a lethal fallacy, because dead people have no control. Just as suicidal people mistakenly imagine that their deaths will be worth more than their lives, and this mistake proves fatal, so may suicidal people make the lethal mistake of thinking that suicide represents self-control.
There are people who fantasise about suicide, and paradoxically, these fantasies can be soothing because they usually involve either fantasising about others’ reactions to one’s suicide or imagining how death would be a relief from life’s travails. In both cases, an aspect of the fantasy is to exert control, either over others’ views or toward life’s difficulties. The writer A. Alvarez stated, “There are [people] … for whom the mere idea of suicide is enough; they can continue to function efficiently and even happily provided they know they have their own, specially chosen means of escape always ready…” (p. 154). In her riveting 2008 memoir of bipolar disorder, Manic, Terri Cheney opened the book by stating, “People … don’t understand that when you’re seriously depressed, suicidal ideation can be the only thin that keeps you alive. Just knowing there’s an out – even if it’s bloody, even if it’s permanent – makes the pain bearable for one more day” (p. 5).
This strategy appears to be effective for some people, but only for a while. Over longer periods, fantasising about death leaves people more depressed and thus at higher risk for suicide, as Eddie Selby, Mike Anestis, and I recently shoed in a study on violent daydreaming. A strategy geared toward increase feelings of self-control (fantasising about the effects of one’s suicide) “works” momentarily, but ultimately backfires by undermining feelings of genuine self-control in the long run.
A crucial difference between those who think that suicide represents ultimate control and those who think they are a burden on others is that evidence suggests all those who die by suicide believe they are a burden on others, whereas not all of that group believe that suicide represents self-mastery. This alone provides a clear clue as to the relative importance of self-mastery – it is hard to see how it would be primary if not all suicidal people endorse it.
In other cultures and other eras, the issues of self-mastery and suicide are treated differently. Cross-culturally, some of the highest rates of suicide are in Asia, where self-mastery is secondary to interdependence, as social psychological research has repeatedly shown (e.g., Kitayama, Markus, & Kurokawa, 2000). If self-mastery were fundamental, then one might expect that cultures that are very focused on such values – like the United States and Australia – would have high rates of suicide. Within this group, one might expect high rates of suicide motivated by frustrated self-mastery. Yet neither expectation is fulfilled – the United States and Australia have suicide rates that are in the average to slightly above average range compared to the rest of the world, and many of the countries with higher rates of suicide have cultures in which social connectedness and interdependence are most valued. It also seems doubtful that self-mastery has been the primary motive for suicidal behaviour in the past, though this would be an interesting research question to pursue.
Make no mistake, self-mastery is a primary motive for many other behaviours. In his 2006 book Stumbling on Happiness, psychologist Dan Gilbert states that “people find it gratifying to exercise control – not just for the futures it buys them, but for the exercise itself. Being effective – changing things, influencing things, making things happen – is one of the fundamental needs with which our human brains seem naturally endowed, and much of our behaviour from infancy onward is simply an expression of this penchant for control” (p. 20). In this context, Gilbert cites a well-known study in which elderly nursing home residents were given a houseplant; half were told that the care of the plant was up to them, and half were told that the plant would be cared for by staff. This simple difference was associated with a difference in mortality rates: Six months later, 15 percent of those caring for their own plants had died, as compared to 30 percent of those who plants were cared for by staff. The simple exercise of mastery or control appeared to make a life-or-death difference.
There are certainly deaths by suicide that appear to invoke mastery as a primary motive. For instance, the famous South Korean actress Jeong Da-bin died by hanging at age 27 in a Seoul apartment. She posted some thoughts on her Web site in the days and weeks preceding her death, including the day before her death on February 10, 2007. As reported in the May 2007 New York Times, under the title “The End,” Jeong posted, “For no reason at all, I am going crazy with anger. Then, as if lightening [sic] had struck, all becomes quiet. Then the Lord comes to me. The Lord says I will be O.K. YES, I WILL BE O.K.” The actress found a solution and was empowered by it, which left her with the feeling that all would be well.
Self-mastery seems to be a primary motive in much of human behaviour – why not in suicidal behaviour? There are a couple of key arguments against a primary role for self-mastery in suicidal behaviour.
The first is that huge numbers of people struggle with issues related to self-mastery and self-control, fueling a thriving late-night infomercial industry on exercise, weight loss, and finances. Yet serious suicidal behaviour (i.e., deaths by suicide and near-fatal attempts) are, relatively speaking, rare. If all those struggling with self-mastery issues engaged in serious suicidal behaviour, there would be even more of a worldwide problem with it than there already is.
One might protest that an important risk factor for a condition can be more common than the condition and yet be crucial. For example, smoking is an obvious risk factor for lung cancer, and yet more people smoke than get lung cancer. True, but this brings us to the second point, which is that the details of deaths by suicide show mastery as a motive only very rarely (whereas deaths by lung cancer implicate smoking quite regularly).
In The Savage God, A. Alvarez states, “I think there may be some people who kill themselves … in order to achieve a calm and control they never find in life. Antonin Artaud, who spent most of his life in lunatic asylums, once wrote: “If I commit suicide, it will not be to destroy myself, but to put myself back together again … By suicide, I reintroduce my design in nature, I shall for the first time give things the shape of my will”” (p. 153).
From Artaud’s perspective, suicide is not meant to “introduce design” in the first place – an account that would be consistent with mastery as primary. Rather, it is meant to “reintroduce” it, which implies that something has occurred in the first place to disorganise one’s design in nature. What occurs first, I believe, are repeated experiences leading to the belief that one is a burden on others and alienated from them. Mastery through suicide is a secondary, reactive phenomenon.
Alvarez also quotes the Italian writer Cesare Pavese: “It is conceivable to kill oneself so as to count for something in one’s own life. Here’s the difficulty about suicide: It is an act of ambition that can be committed only when one has passed beyond ambition.” The difficulty, really, lies in misunderstandings like Pavese’s – suicide, far from being an act mainly of ambition, is an act of profound loneliness and inconsequentiality. The reason it seems ambitious is that it is so fearsome and daunting. It is ironic that some recognise the “ambitious” quality of suicidal behaviour but do not recognise the acquired fearlessness of injury, pain, and death necessary to carry through such an act.
These same kinds of misunderstandings affect mental health professionals too. Karl Menninger wrote, “To kill oneself instead of being slain by fate, is to retain for oneself the illusion of being omnipotent, since one is even by and in the act of suicide, master of life and death. Such omnipotence fantasies … are to be regarded as infantile relics. They presuppose or assume the certainty of a future life, a reincarnation.” The briefest conversation with someone who has been to the brink of suicide and survived by chance alone – for example the rare person who survives the jump from the Golden Gate Bridge – will immediately dispel these ideas about omnipotence, reincarnation, and the like.
Consider, for example, the death by suicide of Jeong Dabin, mentioned above. It is true that she posted a message on her Web site that implied mastery as a possible motive, and indeed, in the New York Times’ coverage of her death, this is the only Web posting of hers that is mentioned. But she left others. For instance, under the heading “Finished,” she wrote, “I’m complicated and I feel like I’m going to die … I have lost my identity.” Even when mastery themes are invoked, as they were by Jeong, they are usually accompanied by other themes too, like feeling insignificant, miserable, misunderstood, or trapped. It is even more common for motives of giving up, submission, or hopelessness to be prominent in the absence of mastery, and these motives, I believe, are fundamentally underlain by the perceptions that one is both a burden to and alienated from others. Even in those instances in which people intimate that suicide is one last grasp at control, control is not the primary motive. To claim that it is overlooks the reasons why the person has so desperately lost control in the first place.