Suicide is preventable. Suicide calls for intervention.
Augustine reasons with Donatus and against the calling of martyrdom: I hope to “drag you away from your disastrous errors,” writes Augustine, “which make you your own enemy, and lead you to recognize and choose the truth.” [1]
He warns Donatus that Donatus will die a double death: the death of a life and the eternal damnation of the dead as “everlasting punishment.” Augustine promises Donatus a better life in renouncing martyrdom. He bargains with him. He describes a different path in life: “come now: curb your spirit of injustice and rebellion; and then you will find the banquet of salvation within the true church of Christ.”
Augustine grounds his concern on the “calling of love,” which “refuses to allow you to perish.” He justifies intervention accordingly: “… if we have the power, we should both keep them from what is bad, and push them towards the good” so that they might be “healed by deterrence.”
The suicide prevention movement in the United States began in 1958, with the establishment of the Los Angeles Suicide Prevention Center. Founded by Norman Faberow, Robert Litman, and Edwin Shneidman, LASPC combined research, treatment, and a crisis center in order to engage the many dimensions of suicide. Their work established suicide as a public health issue, rather than an unspeakable taboo.[2]
And it inaugurated the building of a nationwide system, adding advocacy and education to the movement.
Shneidman left LASPC to co-direct the newly established Center for Suicide Prevention at the National Institute of Mental Health. Through the support of the National Institute of Mental Health, he gather scholars from around the world to meet in Chicago on the topic of prevention. This first meeting led, in 1968, to the founding of the American Association of Suicidology, to continue research and crisis intervention.
In 1976, AAS launched a certification program for crisis centers to establish and promulgate best practices around the country. Currently, eighty centers around the country operate with ASS certification. In 1989, AAS began certifying individual crisis workers as well.
In 1971, Shneidman founded Suicide and Life Threatening Behavior, a peer-reviewed journal. Suicide and Life-Threatening Behavior keeps professionals abreast of the latest research, theories, and intervention approaches for suicide and life-threatening behaviors. The journal publishes scientific research on suicidal and other life-threatening behaviors, including research from biological, psychological, and sociological approaches.
Issues examine such topics as risk factors for suicide in particular populations, assessment and risk-management approaches, advances in evidence-based prevention, methodological and ethical issues in intervention research, cross-cultural and international findings, and mental health needs of those bereaved by suicide.
The Suicide Prevention Resource Center lists the following national organizations and federal agencies, in addition to the AAS and NIMH, concerned with prevention: American Foundation for Suicide Prevention, National Suicide Prevention Lifeline, U.S. Substance Abuse and Mental Health Services Administration, National Center for Injury Prevention and Control, Indian Health Services, Suicide Awareness Voices of Education, Children’s Safety Network, and Injury Control Research Center for Suicide Prevention.
For the Suicide Prevention Resource Center, suicide is a problem — “the suicide problem” — that must be solved. Suicide correlates to “serious mental illness” and opioids, as well as sex and gender, race and ethnicity, age and geography. The solution advanced by the center comes by way of strategic planning. Prevention is a logic model of problem and goal-setting, resource inventory and obstacle analysis, intervention design, implementation, and evaluation.
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[1] Augustine, Letter 174.
[2] Shneidman and Faberow, “The Los Angeles Suicide Prevention Center: A Demonstration of Public Health Feasibilities,” American Journal of Public Health and the Nation’s Health 55, no. 1 (1965): 21-6.
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Just after the hard winter a corpse was found floating in a remote mountain lake carved by glaciers, crowned by sheer cliffs, and fed by the deep snow from above and ever-flowing springs from deep down below.
From the heights we discovered footprints charred and in full sprint to the edge. It was determined that the corpse leapt off the mountain while experiencing third degree burns from having set itself on fire and that during the fall the corpse shot itself through the heart.
The corpse was also mildly crushed from impact with the water and slightly shredded by chunks of ice. Traces of a lethal poison were found hiding in the tissue of the flesh. The corpse was emaciated from obvious starvation and dehydration.
By design or mere chance the head was severed by a sharp rock jutting up through the surface resulting in decapitation. The head was found a stone’s throw from the corpse-proper bobbing like a rubber duck.
We would never have found it without Foxy the Bear, who was on scene and called it in.
It’s my pleasure, said Foxy. I was looking for the stray salmon morsel neglected last fall, he added, and saw this fireball rain from the sky. What a crazy sight. Foxy just shook his head.
Based on evidence the death was ruled suicide-by-overkill, or, more technically, suicide as overdetermination.
At the completion of the medical assessment, which concluded that the corpse was truly dead, the moral examiners descended. The moral examiners are a team of experts adept at reading suicide. Suicide literacy they call it.
To understand a suicide is merely to read closely, said the lead moral examiner. This is suicide autopsy as self-seeing as being seen and told about by others since who should speak memory for what cannot look to tell. He paused.
Importantly, no suicide note was found, which, said one moral examiner, makes the autopsy funner and more challenging.
The examiners rejoiced that the icy water preserved the corpse. Hallellulah!, they danced round the corpse in a little circle tambourining hands to the sky. If this was a tropical lake, said another examiner, hands still jingling lightly, then this lump of flesh would be more like broth by now. Just add carrots onions potatoes and a pebble and you’d have soup. Instead, our particular specimen will be an open book with a bounty, a veritable embarrassment, of fresh wounds to read and write about. He blushed.
We will wring a confession out of you!, said the second examiner with good-humored menace, wringing a figurative dishrag in his hands and scrunching up his left eye in devout concentration. The first examiner, named Randolph, motioned his hands with two quick flicks of the wrists as a bell ringer ringing two bells during the holidays first in unison as one shared ring and then one and then the other as in ring and then ring. The second examiner, also named Randolph, continued, It’s like a squeeze of the hand to release the juice. It’s lifting the cup to partake of words mixed with blood. The first Ralph’s bell-ringing hands shifted to motions more like the rhythmic milking of a cow. Squeeze the teat. Squeeze the teat. Let milk run freely.
The team circling the corpse readied to begin.
Before giving the word the lead examiner, Dr. Randolph, stepped forward to explain how a suicide autopsy is conducted.
We know that suicide is in this case, said the lead examiner. That is to say, this is a suicide. But what is this suicide? Randolph and Randolph fixed their eyes on the lead examiner waiting for his answer. They did not have to wait long.
The answer, answered the lead examiner, will be a Mad Lib®.
This suicide is ____.
We just need to fill in the blank. Randolph and Randolph let out a sign of relief. For instance, said the lead examiner, suicide is demon possession. Suicide is divine calling. Suicide is rational. Suicide is stark madness. Suicide is outrageous courage. Suicide is yellow-belly cowardice. Suicide is the great escape. Suicide is eternal return. Suicide is mighty justice or vengeance.
Our task is to complete the line so the sentence is true and correct. We have a case of suicide, we just find the right word for this suicide that is truly the case.
There are secret arts to this method. The first is to sort truth from fiction. The corpse contains the story of what the suicide was. This is indisputable. But the story is really the story of the story since the story is most often the fiction of living that writes the truth in dying since the corpse when living is blind to what we see now when it is dead. We are part amanuensis to move the cold hand across the page and we are part ghostly overwriter to tell the real story on what this suicide truly would have wished to say.
Remember that Socrates thought his suicide was protest against tyranny or a cure for the disease of life or whatever, and these fictions only helped us to discern that in truth he was a plagued by little voices of grandeur and immortality, probably as a schizophrenic with hints of dementia. Here we puncture the surface of an event and delve into the little lower layers of a life.
By reading deeply we know that the suicide of Socrates was not in fact suicide as self-killing by the singular self, for the self had already been overthrown by a welter so that they all were to blame as a very disorganized mob would effect the hanging of a poor soul.
Another secret to our method is to reel in the chain of cause and effect. There are causes and effects and these effects are causes to more effects. Here you can see the effect-effect as the scorched skin and the toxic flesh and the penetrated heart. The causes of these effect-effects, such as fire or poison or gunshot, are also the effects of effect-effects of the causes of the suicide. To get to the source we begin with the corpse as a work of effect-effect-effects and work backwards.
While fire sought to erase the skin it really only especially prepared a new parchment with magic markings already indelled. To read this parchment we skin the body as one complete piece and soak it for six days to remove foreign objects that would garble the story. We dry and stretch the skin until the tension irons out wrinkles. In effect, we are simply smoothing out a sheet of paper to read its writings. You will see, said the lead examiner.
With poisoning one might think to reach for the antidote to expose the true condition, but this method will prove fruitless. We don’t need the antidote. The corpse is already dead, he chuckled. Instead, we found that we can extract poison from the tissue with mother’s milk from the breast of a virgin and that this essential reaction produces froth that can be transcribed and translated. Bubbles speak volumes in the patterns and pictures they produce. We must simply listen. Hearken. Take heed.
The heart offers a special opportunity to extract expression. At first we sent electrodes through the muscle to induce a kind of Morse code but that produced gibberish. Buy bananas and dish soap. Why so many commercials? Who’sa what’sa? Et cetera, said the lead examiner with a touch of weariness. That’s the kind of story we used to get.
Then we discovered that a hole in the heart can open up the acoustics of the organ and that by piping air through the vent we get music. Piping down the valleys wild, said Randolph wistfully.
This music is then interpreted and rated according to composition, theme, and performance and together they reveal the true intent and meaning (and quality) of the performer. In some cases, most cases to be honest, we are forced to give a passing grade for effort, using a pass-fail grading system, but an F for originality. The second Randolph cinched an imaginary noose, pulled tight, let his head go slack, and rolled his eyes dead, while the first Randolph put two fingers to his mouth and blew his brains out. All three chuckled.
In some cases we also interpret the music through dance. This is not always possible though. Some music does not have a great beat and you simply can’t dance to it. You just can’t.
Since we will employ so many methods to tell the same story you would think that we get bored, said the lead examiner.
We do, they all nodded. But the point isn’t to entertain. The point is deep corroboration. Each method will tell the same story by a different means and medium. Stack them up, string them together, and we have a seamless fable that reveals the truth of the matter. This is the elegance of the suicide autopsy. We turn the corpse into its own chorus, its own informer, its own tattle tale.
Most important, concluded Dr. Randolph, a suicide autopsy is both rigorous and delicate requiring an abundance of technical empathy. We are dealing with the deep (and sometimes shallow) waters of the psyche. This requires a level of pathos that you won’t find in your average bear, he said proudly. We study the pathos of the psyche. We plumb the depths of the psyche’s pathos. We are ministers of the psychopathos, in the Greek. We bring good tidings. We are in all humility nothing but consummate psychopaths. The lead examiner paused with immense satisfaction at being him here and now. He paused some more. A tambourine played on in the distance. And with that the word was given and the examination began.