In this issue
Suicide and Shame
By John A. Minahan, PhD
When you lose a loved one to suicide, you hardly have time for grief. Guilt, regret, confusion, anger: They're all clamoring for your attention, too. But none of these may be as powerful or pernicious as the need to be silent. In the aftermath of my brother taking his own life, I worried what people would think about him — and about me. After all, everybody knows that those who kill themselves have a moral infection: They're weak or cowardly; they don't care about those who love them; they want to hurt family and friends (Fine, 1997, p. 61-76; Joiner, 2010, p. 269-272). And let's not forget that they've betrayed God — or life, or the American way, or something (Melbourne, 2016). I knew none of this was true. But that didn't stop me from feeling as if an ugly stain had spread itself over both him and me. It haunts me still to wonder what shame he himself must have felt while struggling to hold onto life, shame that would have driven him further into silence and despair.
I also discovered that I had joined a secret club. Singly and in whispers, people confided to me that they had either lost a loved one this way or had attempted suicide themselves. I believe I've met only a few members of this club, because the numbers associated with suicide are staggering. About 40,000 Americans die this way every year — an average rate of one every 13 minutes (Suicide Awareness Voices of Education [SAVE], 2014). Worldwide, the number is about 800,000 per year. More women than men attempt it, but more men than women complete it, owing largely to the respective lethality of means (women tend to use poison, men guns). In the U.S., suicide is the second leading cause of death for ages 16 to 25, the fourth leading cause of death for ages 18 to 65, and the 10th leading cause of death overall. By comparison, murder is 16th. (SAVE, 2014).
What if we saw such numbers for, say, automobile accidents? Actually, the number of Americans dying annually in car crashes is less by about 10,000 (Highway Loss Data Institute [HLDI], 2014). But who is shamefully silent when it comes to the significance of seat belts, traffic signals or driver training? With suicide, however, we appear to have no trouble attributing it to character flaw and moral failure. Even when we take a more informed approach, the news is disheartening. For example, major depression is a common co-occurring disorder, but only about half of those suffering major depression receive treatment (Nock, Hwang, Sampson, & Kessler, 2010; National Institute of Mental Health [NIMH], 2010). There is also this cruel irony: the risk for suicide can increase when the mood begins to lift; for example, because they're feeling a little better, a person with suicidal thoughts may find just enough energy and focus to take his or her own life. The decision may even confer what feels like peace of mind (Jamison, 1999, p. 114-115). If shame also keeps them silent, or motivates them to dissemble, this false peace of mind may be left unchallenged to do its life-destroying work.
What if such sufferers knew they need not be ashamed? Push the question further: What if we acknowledged that some towering figures of our culture — models of moral guidance, high accomplishment, and strength of character — also suffered from suicidal ideation? More important, what could we then learn from these figures about staying alive?
Abraham Lincoln, then a young lawyer filled with political ambitions, gave a speech to a civic association. A mob had recently killed a journalist for writing an editorial condemning slavery; the event “riveted and polarized the nation” (Pinsker, 2013). In his speech, Lincoln argued that such a murder was not just about one person's death; it also revealed that America was suffering the self-inflicted wounds of inequality and lawlessness. “All the armies of Europe, Asia and Africa combined,” Lincoln said, “with all the treasure of the earth ... could not by force take a drink from the Ohio, or make a track on the Blue Ridge.” We can hear prefigurings of the muscular lyricism characteristic of his later speeches. Then this: “As a nation of freemen, we must live through all time, or die by suicide” (Lincoln, 1989, p. 28-29). It's a revealing metaphor.
Suicidal ideation often entails three markers: a perception of burdensomeness to others; a sense of failed belongingness; and an exposure to repeated painful and fearsome experiences that can lead to habituation with the pain and fear of self injury (Joiner, 2005, p. 46-47, 92-93; Shneidman, 1996, p. 129-137). Those markers seem present in the young Lincoln's life. His acquaintances had long observed his “melancholy” with concern. He had tried and failed at several business ventures, and his nascent political career had been filled with ups and downs. He had been incapacitated by depression over the death of Ann Rutledge, a friend with whom he may have been in love. Though he kept company with a rough crowd whose favorite pastime was wrestling, he claimed few close friends and had no family to speak of. (He lost his mother and sister at a young age, he never got along with his father, and he had been frustrated in his desire to marry.) At one point he declined to carry a knife, a not unusual accoutrement on the frontier, because he feared what he might do to himself. A local newspaper poked mean-spirited fun at his “indisposition”; another published an unsigned poem he likely wrote called, “The Suicide's Soliloquy.”
One neighbor grew alarmed whenever Lincoln took his gun to go hunting in the woods. He subjected himself to the era's treatments for depression, such as bloodletting, induced vomiting and diarrhea, painful mustard rubs and black pepper drinks (Shenk, 2005, p. 19, 23, 56, 59). Obviously, none worked. And yet he lived.
Ludwig van Beethoven spent one summer and early fall in a country village called Heiligenstadt. He had gone there to escape the crowds and heat of Vienna. He had also gone there to confront his condition. The hearing problems that had been plaguing him for years were growing worse, despite all the treatments he had sought; the wisdom of 19th century medicine linked his increasing deafness to his perpetually ailing stomach, such that his doctors prescribed various salves, baths and herbs whose only effect was to make his stomach worse (Traynor, 2011). Soon, he realized, he would be unable to hear at all. This would be tragic for anyone; for Beethoven, it was devastating. As a child, he had been subjected by his abusive father to a brutal schedule of performing and practicing; as an adult, he not only kept up the same brutal schedule but also shunned close relationships that would distract him from composing (probably, like his father, self-medicating with alcohol). He lived only for music, and now he faced losing that.
Beethoven wrote a letter to his brothers explaining why he wanted to end his life. The letter, now known as the Heiligenstadt Testament, was never sent but rather “stashed for posterity in a secret drawer of his desk” (Morris, 2005, p. 97). In it, Beethoven lamented the confusion and concern that his anguish had caused in others. He also explained the source of that anguish: Though he had composed some fine, even brilliant music, it had come at a high price. “I live alone,” he wrote, “like a man banished.” He went on to admit that he had yet to write the works of genius he was capable of. Beethoven never suffered from false modesty, but that didn't prevent him suffering from despair, since his increasing deafness made it look as if he'd never write those works now. “If [death] comes before I shall have had an opportunity to show all my artistic capacities it will still come too early” (Swafford, 2015, p. 301-308). And yet he lived.
Dante Alighieri set out as a writer to explore every human thought, emotion and behavior. He would therefore have to touch upon suicide. This he does, fittingly, in the 13th chapter (or “canto”) of his "Inferno." In this fictive account of a journey through the pit of hell, the lower we go, the worse the sin. Suicides are in the eighth of nine descending circles. Dante's moral judgment, then, seems unambiguous. But a little literary detective work suggests otherwise.
We can begin by noticing something in Canto XIII that occurs nowhere else in this epic poem: Dante lets these souls tell their own heartrending stories without interruption or commentary, as if he is in no position to pass judgment. Further, the few statements the narrator does make involve a convoluted and even off-putting syntax, whereas the suicides speak with eloquence and directness. True, Dante often has the denizens of hell speak in ways that show the seductive power of language, but he always points that out. No such commentary appears in Canto XIII. If he does not openly encourage his readers to be empathetic and tender here, neither does he discourage them as he does elsewhere.
This is not the only tender moment. For Dante, the punishment reflects the sin. Like many explorers of the psyche, Dante shows that hell is essentially the state of isolation within the self. His sinners choose to be damned — not that they welcome their punishment, rather that they get what they want in all its naked reality. Adulterous lovers are tormented forever by each other's presence; leaders who incited harmful passion in others are now pillars of fire; and suicides spend eternity as twisted trees that bleed from where their branches are forever breaking off. These sinners threw away their bodies, choosing instead to be immobile and wounded. One of them, not even a tree but a small bush, asks Dante for a favor. Some monstrous dogs have torn his leaves from him. These leaves are all that he has left of himself, and he pleads to have them back. Dante honors the request. This marks the only time in Inferno he helps one of the damned. Further, he does not do so within Canto XIII but rather at the beginning of Canto XIV, as if the moral issues here defy boundaries. And, though we never learn the name of this damned soul, we do learn that he was from Florence. So was Dante — another lessening of moral distance between him and the suicides.
The suicides' forest is reminiscent of the dark woods where Dante lost his way at the start of "Inferno." The word that describes his physical condition there is the same word that describes his mental condition here (“smarrita/-o” which can be translated as either “lost” or “uncertain”). Now that he has associated the image of the forest with the idea of suicide, and now that he has shown how an encounter with suicide causes him to become “smarrito” again, we realize that he never specified why he got lost in the dark woods of Canto I. That silence may be eloquent. Could the reason he strayed from the right path have been not just sinful but also embarrassing? Could that unnamed Florentine/bush pleading for its leaves represent Dante's belief that part of his own soul died and was damned because of this embarrassing sin? We should note that leaves, especially from the laurel bush, are a common folkloric symbol for poetry, which Dante himself used in Canto 25 of Paradiso when describing poetry as his sole source of hope. Taken together, all these textual details make a strong suggestion that “the lost soul whom we met in Inferno I was in some way himself suicidal” (Hollander, 2000, p. 250 n. 24).
Being a suggestion rather than an overt statement further suggests that he may also have experienced the concomitant shame.
Technically, we've been speaking about the narrator. What about the author? Equating those two in any literary text always presents complications. But Dante's work, its fantastical nature notwithstanding, is highly autobiographical, filled with people and events from his own life. Dante's narrator is in his mid-30s; Dante himself at that age experienced a “dismally disorienting period” of “extreme frustration and impatience” (Lewis, 2001, p. 85-89). He was living in exile, having sided with a losing faction in the labyrinthine and murderous politics of 13th century Florence. His many years of involvement in such politics now led to him losing his home, government position, family and reputation, and he was forced to rely on others for food and shelter (Lansing, 2010, p. 19).
The markers of suicidal ideation — a perception of burdensomeness, a sense of failed belongingness, and a habituation to the pain and fear of self injury — seem to be present for him as they were for Lincoln and Beethoven. I would therefore argue that we have grounds for a hypothesis: The real historical Dante found himself in the same hellish place that so many others have, experiencing both the power of suicidal ideation as well as the shame. He could not speak openly of his suicidal urge, but neither could he deny its power.
And yet, like Lincoln and Beethoven, he lived. We come, then, to the most important area of our inquiry. Seeing that “great” figures can experience suicidal ideation might be a first step toward removing some of the shame. The next step is to examine, openly and dispassionately, what these figures did then. That is, given that they wanted to die, how did they stay alive?
One possibility: All three appear to have discovered empirically a sort of proto-cognitive/behavioral therapy program that may have helped save their lives, no matter how hard their lives continued to be. For example:
- Seeking a higher purpose through meaningful labor and a carefully considered spirituality: Lincoln saw in both law and politics a way to put into practice his dedication to equality and justice; Beethoven reasoned that he had been given both his talent and his personal struggles in order to overcome any obstacle standing in the way of freedom, both for music and for the human spirit; Dante devoted his post-exile years to writing his epic, which in two further volumes continues the journey through Purgatory and into Paradise, thereby becoming one of the most thorough psychological taxonomies ever performed.
- Taking gratification in the doing of the work itself: Lincoln loved litigation, debate and deal-making; Beethoven revolutionized the art of composition by finding ways to develop even the smallest musical idea to its utmost; Dante clearly reveled in the creative demands of devising specific consequences for both the virtuous and the damned.
- Establishing and maintaining meaningful relationships: Lincoln was devoted to friends and family; Beethoven developed a close circle of patrons and students; Dante made it clear in his work that many people, past and present, inspired him.
- Appreciating humor: Lincoln was notorious for his shaggy dog stories; Beethoven's music is enriched by rough musical jokes; Dante's work is full of wordplay, irony and even slapstick.
- Enjoying readily available pleasures: Lincoln loved good company and great poetry; Beethoven enjoyed long country walks; Dante was fascinated with the boundless variety of human personality and behavior.
Though all three were gifted, one need not possess such gifts to implement such methods — methods that can be even more effective with the help of modern research and treatment (Colt, 2006, p. 281-357). But to benefit from this research and treatment, those who suffer suicidal ideation first have to overcome their potentially lethal shame. As I've tried to make clear, acknowledging that even “great” figures can experience suicidal ideation might be one way to help. This might be another: The struggle with suicidal ideation may itself have played a role in making these great figures great.
Listen to Beethoven's "Ninth Symphony" and consider how the glories of the "Ode to Joy" emerge, painfully but inexorably, from fragmentation and chaos. Consider the possibility that Lincoln's surviving his self-destructive impulse helped him develop the kind of leadership needed to keep a nation from destroying itself (Shenk, 2005, p. 191-192). Read the end of "Inferno," where Dante emerges from hell to see the stars again. Who but someone who has faced the ultimate darkness could rediscover “the capacity for serenity and joy” in the simple perception of lights in the sky? (Styron, 1990, p. 83-84). In fact, “stars” is the last word in all three volumes of his epic. Fascinated by astronomy, Dante used celestial events both literally and allegorically.
We may often be “smarrito” — lost and uncertain. But just as the stars can guide us in the physical world, so we can find our way within by means of rational thought and compassion. That might be a facile truism in another writer's hands. Yet when I hypothesize that Dante was tempted to take his own life, and when I consider that rational thought and compassion can become foundational to good psychology, I trust what he says. Again, one need not be a Dante, Lincoln or Beethoven. The discernment of a philosophy that can prevent death by one's own hand is itself a form of greatness.
By no means am I positing suicidal ideation as some sort of blessing in disguise. We rightly pray to be spared this kind of suffering. But should it befall us or those we love, perhaps we can remember that the human mind has a magnificent capacity for transforming suffering into wisdom. The systematic study of this transformation needs to keep moving forward. Suicide is one of psychology's most intractable and tragic issues; the more research into its causes and prevention, the better. This research is already frustrated by the obvious difficulties of gathering data on a victim's final thoughts. It should not be further frustrated by moralizing, misinformation, and embarrassed silence. What else might we discover if we removed the stigma? How many more lives might we save?
That said, we should also admit that we'll never understand suicide fully or prevent every instance of it. My brother was a lawyer whose belief in justice paralleled Lincoln's; his love of music possessed the intensity of a Beethoven symphony; his Dantean fascination with astronomy lasted his whole life. Why did his life end the way it did? I'll never know. While I can point in retrospect to the markers of suicidal ideation in his words and actions, I don't understand how he could actually do it. But I do know this: Removing the shame surrounding suicide can and does offer healing. Whoever suffers, whether victim or survivor, needs to know they're not alone. Others have been lost, too, and they can show us a way out of hell and back to life.
Colt, G.H. (2006). November of the soul: The enigma of suicide . New York: Scribner.
Fine, C. (1997). No time to say goodbye: Surviving the suicide of a loved one. New York: Broadway.
Hollander, J., trans. (2000) The inferno. New York: Anchor Books.
Highway Loss Data Institute [HLDI]. (2014). Insurance Institute for highway safety. [General Statistics]. Retrieved from http://www.iihs.org/iihs/topics/t/general-statistics/fatalityfacts/state-by-state-overview
Jamison, K.R. (1999). Night falls fast: Understanding suicide. New York: Vintage.
Joiner, T. ( 2005). Why people die by suicide. Cambridge, MA: Harvard University Press.
Joiner, T. (2010). Myths about suicide. Cambridge, MA: Harvard University Press.
Lansing, R. (2010). The Dante encyclopedia. New York: Routledge.
Lewis, R. (2001). Dante. New York: Penguin Putnam Inc.
Lincoln, A. (1989). Speeches and writings 1832-1858 (Library of America). New York: Literary Classics of the United States.
Melbourne, C. (2016). Suicidal thoughts: what happens after suicide? [Web log comment]. Retrieved from http://www.born-again-christian.info/answers/what-happens-to-people-who-commit-suicide.htm
Morris, E. (2005). Beethoven: The universal composer. New York: HarperCollins Publishers.
National Institute of Mental Health [NIMH]. (2010). Just over half of Americans diagnosed with major depression receive care. Retrieved from http://www.nimh.nih.gov/news/science-news/2010/just-over-half-of-americans-diagnosed-with-major-depression-receive-care.shtml
Nock, M. K., Hwang, I., Sampson, N. A., & Kellser, R. C. (2010). Mental disorders, comorbidity, and suicidal behavior: results from the national comorbidity survey replication. Molecular Psychiatry, 15(8). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2889009/
Pinsker, M. (Editor) (2013). Lyceum address (January 27th, 1838). In Lincoln's writings: The multi-media edition - House divided speech project. Retrieved from http://housedivided.dickinson.edu/sites/lincoln/lyceum-address-january-27-1838/
Suicide Awareness Voices of Education [SAVE]. (2014). Suicide facts. Retrieved from http://www.save.org/about-suicide/suicide-facts/
Shenk, J. (2005). Lincoln's melancholy: How depression challenged a President and fueled his greatness. New York: Mariner Books.
Shneidman, E. (1998). The suicidal mind. New York: Oxford University Press.
Styron. W. (1990). Darkness visible: A memoir of madness. New York: Random House.
Swafford, J. (2014). Beethoven: Anguish and triumph. New York: Houghton Mifflin Harcourt.
Traynor, B. (2011, May 12). Hearing Beethoven--Part II--The medical conclusion. [Web log comment]. In Hearing health and technology matters. Retrieved from http://hearinghealthmatters.org/hearinginternational/2011/hearing-beethoven-part-ii-the-medical-conclusion/