History of a Suicide

"I perceive I have not really understood any thing, not a single object, and
that no man ever can,
Nature here in sight of the sea taking advantage of me to dart upon me and
sting me,
Because I have dared to open my mouth to sing at all."

Walt Whitman


In puzzling over an unexpected suicide (and how many suicides are not, at some level, surprises?), we often ask empirical questions, as a detective might. How did this come about? Who or what is the primary culprit? But arguably the challenges suicide poses are chiefly existential and interpersonal, not factual. That is, the suicide, in rejecting life itself, dissents from values that we hold very dear.

And the question of "How could we not have known?" is more relational than epistemological. That is, suicide reminds us of the perturbing basic inscrutability of human relationships. If we do not know something so basic as whether someone is suicidal, what do we really know about them? That's why psychotherapeutic relationships can be the most intimate of all--not obviously in a physical sense, but in an existential one. The therapist often hears things that no one else in a person's life hears.

I just finished Jill Bialosky's History of a Suicide, which considers the suicide of her younger sister Kim some twenty years ago at the age of 21. It is a worthwhile and reflective addition to the suicide memoir shelf, but Bialosky is, like many, preoccupied with questions of causation. The problem is that completed suicide is complex and rare (relative to the numbers of the depressed); why would we expect suicide to be any more fathomable or predictable than other atypical behaviors, such as murder or sudden religious conversion? If we had the technology or insight to predict individual suicides, what other behaviors might we be able to foretell?

Bialosky seeks out a suicide specialist who tellingly conducts a "psychological autopsy," as if we can answer the dilemma of suicide using the tools of pathology. Unsurprisingly, a number of potential contributing factors come to light: a family history of mental illness and even suicide, a father who abandoned the family and ignored or rejected Kim, a depressed and withdrawn mother, an abusive boyfriend, and alcohol and drugs. This list is noteworthy for its obviousness and for the fact that every one of these things is objectionable in its own right even apart from any possible relation to suicide. The things we might do to reduce suicide risk--maintain family integrity, shore up communities, limit drug use, and increase awareness and treatment of depression--are things that we ought to be doing anyway. These influences ultimately tell us nothing, because we do not know which is necessary or sufficient.

The other thing that suicide teaches is how little we sometimes know of ourselves. It appears that a certain fraction of suicides, at least the final determination to act, are impulsive. If we could interview completed suicides after the fact, I suspect that a significant number would express surprise, if not dismay, that they actually went through with it.