Confronting Suicide

A recent article in The Crimson about suicide attempts, and the report of my comments about appropriate responses, led me to want to say a little more about the subject and perhaps correct some misinterpretations. Suicidal ideation is present at almost all ages from childhood on, and is certainly a concern in the age group represented by Harvard undergraduates.

There are at least three reasons why people consider suicide. The first is the result of a belief that one is in an impossible situation--no solution makes sense and the pain of facing this impossible situation leads to the conclusion that there is only one avenue of escape. This could be the case when one has a painful or terminal illness, or when one is in a social situation so humiliating that it cannot be faced.

The second is having to confront a loss of something or someone that is so essential to one's sense of self that it seems impossible to go on without it. In addition to major losses in real life, this may also occur when one feels unable to live up to expectations held by others, expectations that have also come to define one's own sense of self esteem. The third is the situation in which a major mental disturbance has led to delusional thinking and loss of reality testing, leaving one vulnerable to irrational concepts of the consequences of self-destructive behavior.

Common to all of these is the concern about aloneness, the dread of abandonment, the fear of a meaningless existence. Sometimes it is associated with anger at the perceived devaluation and rejection (the famous psychiatrist Karl Menninger said two people are often killed with each suicide); sometimes with feelings of guilt, inadequacy or fear of criticism that are so great that one punishes oneself rather than being punished by others.

In responding to these concerns there are two factors that may influence the outcome for someone who sees suicide as the only alternative. The most important is the awareness that one is not alone, that someone else cares and is available to help. The second is an understanding of what has led to this final conclusion, and the unrealistic narrowness of available choices.

What I wanted to emphasize in my remarks to The Crimson is that a caring relationship is paramount. Though its effectiveness may possibly be jeopardized if one is handed over too quickly to professional caretakers before a trusting is established, no one not professionally trained should try to be responsible for dealing with this problem, and as soon as possible should enlist professional help, obviously the sooner the better. When one is involved in this way the best step is to call the Mental Health Service, talk to the clinician on call and get advice as to how to proceed.

Unfortunately, the feelings of isolation and despair that often lead to thoughts of suicide are not rare in the Harvard population, and we need to do everything we can to identify and respond to these feelings. Harvard students may be somewhat more at risk because of the perceived need to live up to extraordinarily high expectations, and the difficulty in meeting these at a highly competitive and intellectually demanding academic environment, but it has also been my experience over the years that Harvard students possess an unusually high degree of competence and maturity that makes it possible to deal with these demands.

The suicide rate of Harvard undergraduates is less than the statistical average for this age group, and Harvard students are far more sophisticated than the average college student in making use of counseling and other mental health services. We have what is probably the largest and most active mental health service of any university in this county, and it is fully utilized by all parts of the student population. Most of the time we work with individual students, helping them understand and cope with problems of relationships, careers and becoming individuals, but we are also actively involved in working indirectly with peer support groups, advisors and administrators to help sort out solutions to a variety of students' problems.

A distinction can be made between suicidal behavior that reflects an overwhelming wish to die (and is therefore often successful), and behavior that is really an expression of a wish to live, but requiring help to do so. (It is ironic that sometimes one feels that the only way to get the help needed to live is to express and communicate a wish to die.) There may be times when suicide is seen as an appropriate death, but it is most often the result of an inability to consider and accept alternative options.

Whatever the motivation, all suicidal behavior must be taken seriously, since self-destructive behavior can be carried out without a good knowledge of anatomy or pharmacology, and a cry for help can inadvertently turn into a terminal event. As I mentioned before, the knowledge that there is someone who cares and is responsive is often life saving, but it should be seen primarily as a first step--as a conduit to professional resources where experienced clinicians can help the individual keep options open and better understand the underlying troubles and conflicts, and the range of realistic choices that life has to offer.

As a final thought, there are also times when one comes to accept alternatives to suicide by developing a new and caring relationship with oneself. Bertrand Russell in his autobiography recalled that "there was a footpath leading across the fields to New Southgate, and I used to go there alone to watch the sunset and contemplate suicide. I did not, however, commit suicide, because I wished to know more of mathematics."

Randolph Catlin is chief of the Mental Health Service at University Health Services.