“If someone’s life is so awful that they want to die by suicide, why stop them?”
I am frequently asked some variation of this question, even by mental health professionals. Once, a therapist told me about a client of hers with schizophrenia. “He is miserable, and he will always have schizophrenia. I think letting him kill himself is humane.”
I am passionate about suicide prevention. My stance often draws the ire of people who think that people should have the right to end their own life without interference by well-meaning others.
To my mind, there are many reasons to stop someone from suicide. (I am not, by the way, including “death with dignity” or “hastened death.” That’s grist for another discussion.)
Before going into those reasons, I want to make clear that I don’t take intervention lightly. I don’t call the police if someone discloses suicidal thoughts. I don’t think people should be involuntarily committed to a hospital except in the most extreme circumstances, like if someone has a gun in their car and tells me they are going to shoot themselves when they leave my office, without any desire or will to come up with an alternative. I consider myself to be a therapist who doesn’t panic about suicide.
Why Prevent Suicide?
Except in very limited circumstances, such as states where physician-assisted death is legal for people with terminal illness, I believe that therapists should never give up helping a suicidal person to stay alive.
The most important reason to prevent suicide is that suicidal crises, though formidable and painful, almost always are temporary. Even if the person continues thinking about suicide, the intense suicidal intent usually subsides. Consider that 90% of people who survive a suicide attempt do not go on to die by suicide. That number is very revealing. Even among people who wanted to die so strongly that they tried to end their life, most ultimately chose to live.
As long as a person is alive, things can change for the better. Situations change. Even if their external situation is unchangeable, they may discover things that make their life worth living. There is always the possibility that they may find ways to cope. Or they may come to appreciate different things in life. They may even find a purpose in life that gives their loss or trauma meaning.
Kevin Hines is a suicide prevention advocate who, years ago, jumped off of the Golden Gate Bridge, the site in the U.S. with the most suicides every year. Death is almost certain when one jumps from the bridge. More than 1,500 people are known to have jumped to their death, and only 30 or so are known to have survived. So when Kevin jumped from the Golden Gate Bridge, he was absolutely intent on dying. And yet, even with that intention, the moment he jumped off the bridge, he instantly regretted his decision.
His experience is one of many (including my own story) that illustrates that the wish to die is fluid. It comes and goes to varying degrees. A great many people who are saved from suicide are thankful, sooner or later, to be alive.
Is Suicide Rational?
Another important reason to prevent suicide is because, proponents of rational suicide notwithstanding, suicide is often irrational.
Some research indicates that 90% of people who die by suicide had a diagnosable mental illness at the time of their death (though more recently, some evidence indicates that not as many people who die by suicide have a mental illness diagnosis).
Mental illness distorts thinking. What is bad can seem good, and vice versa. Often, very often, when a person’s mental health improves, the wish to die goes away.
Some people contest the high estimates of mental illness in suicide. Even if we presume the 90% figure is correct, not everyone who dies by suicide has a mental illness. Other things besides mental illness can also distort one’s thinking, such as substance use, sleep deprivation, and trauma.
When people address these issues, they often join the legions who seriously considered suicide or made an attempt, and who many years later live to tell about it.
Revised on May 30, 2017, this post was originally titled “‘If Someone’s Life is So Awful that They Want to Die, Why Stop Them?'”
© Copyright 2013 Stacey Freedenthal, PhD, LCSW. All rights Reserved. Written For: Speaking of Suicide. Photos purchased from Fotolia.com
The prospect that life “may” get better, that an individual “might” find a reason to live, is a cruel carrot to dangle before a hopeless person’s eyes.
I agree. And I find it astonishing that suicide prevention advocates presume that it’s their privilege to decide on our behalf that we have to suffer endlessly just in case life eventually does become tolerable in the future. They do this not only through psychiatric holds (which Stacey confesses to being conflicted about), but also by denying people access to effective suicide methods, so that many continue to live not out of hope for a better future, but because the consequences of a failed suicide attempt can be so catastropic that, as bad as life might be at the moment, it’s a risk that doesn’t seem worth taking.
I find that aggressive suicide prevention policies (including means restriction) actually takes away hope. Anecdotal evidence suggests that once you give someone the peace of mind of knowing that they aren’t serving a lifelong prison sentence; not only do they often choose to continue living nonetheless, but life actually becomes vastly more tolerable than it was when the option of suicide was being actively withheld from them.
One such case was reported of a Belgian woman whose severe psychological suffering became bearable once she finally received the green light to die. And merely having the control over her own life of knowing that nobody could deny her the option of suicide actually made life bearable for her, so that suicide no longer seemed necessary: https://news.sky.com/story/ive-been-granted-the-right-to-die-in-my-30s-it-may-have-saved-my-life-12055578
Suicide prevention advocates have no idea how much harm they inflict on the living, and we may never know how many suicides might have actually been prevented by allowing life to be optional rather than compulsory.
In the immortal words of the late great Pete Steele “These scars on my wrist may seem like a crime, just wish me better luck next time! So what if I die a thousand deaths? You think I’m insane, but I have no regrets. One more time won’t matter no question. Suicide: is SELF EXPRESSION!”
Perhaps the conditions that grind a person down and make them want to commit suicide in the first place are what need to change, not the depressive realist who realizes that we’re all fucked..
Dying is better than living in a selfish rude world.
I have no words this is beautiful
It is indeed. Of course, those who know nothing of —having never experienced— profound, long-term depression, cannot fathom the despair, the torment those of us so crippled suffer every waking minute of the day…
Why would you want to end your suffering painlessly and peacefully?
Don’t you just want to let others decide whether you should or should not live?
Well, EVERYONE knows a stint in the crisis center magically brings back the will to live!
I want to die so bad but I’m afraid of what happens afterwards. It’s a constant anxiety that never ends. I constantly pray for the good Lord to peacefully take me out.
I believe that’s the fear that most of us who haven’t done it yet struggle with. We fear the outcome of our choice to choose death over a life of pain and misery! I refuse to believe in a God that would persecute me for wanting peace instead of pain. I’ve been trying with this life for 36 years and my death is somehow always popping into my mind! Especially when you lose someone you love, the emotional sledgehammer to the chest never gets easier. I’m praying for clarity and a right to die when I am ready!!! I am praying for you. I think in some small way our Faith keeps us going, Faith that there’s life after this, Faith that we will somehow be judged.
I agree and admire most of what you have said. However I have attempted suicide a couple of times but by sheer “chance” ??? (true) was discovered and “saved”. I’ve had what most people would regard as a good life, but as an old person I feel my life was a waste since all my friends (younger than me!) are dead so I have no friends. My adult child has an attitude towards me that makes me feel misunderstood and unloved. I “pray” constantly to die but do not have the courage to kill myself – so I feel even more of a failure. Why, oh why can I not be the author of my own life?
I truly feel for you. I won’t bore you with my story but I also “pray” to die daily. I lean more towards the idea of some form of euthanasia over suicide as I would like to address the concerns of anyone around me that would question my decision… if only that were possible in the states. I think the issue with people deciding for themselves, in this society at least, is multifaceted. The psychological industry is opposed understandably as it would mean lost revenue. Some individuals, Dr. Freedenthal I suspect, genuinely hope to help. There are religious groups whose bread and butter are fear and guilt, I believe they oppose due to a combination of established dogma and fear that cultural acceptance of such autonomy would erode their power. Some people are just weighing your continued suffering against their discomfort at the thought of you deciding to die and as they do not have to experience your suffering give it little weight. I could go… Anyway, the result is we live in a culture that has no issue with treating people as disposable but is adamant that said people cannot treat themselves the same. There are countries where this is not the case. For example, I still have hopes of going to Belgium to be evaluated, treated and if the treatment fails possibly euthanized thus allowing the addressing of concerns I mentioned before. Hopefully you will find something consoling or useful in my rambling. Just know you are not alone.
One last thing. The idea and means of suicide are COMFORTNG to a severely depressed patient, from my experience. Knowing you can step out and anytime gives you the perseverence to keep going. What has kept me alive is procrastination. What’s one more day? I feel like my work isn’t done. When my job is finished, then I will step out.
You have raised an important point, of which the author of this blog, and suicide prevention advocates generally should take note! Knowing that suicide is always an option (i.e. you have a reliable and effective method at hand, and cannot be prevented from using it) can be a great source of comfort and solace, which can help people to keep going. When life is a prison sentence (i.e. you have the feeling of being in a locked cage, because you do not have the legal right to access effective suicide methods, and the government is constantly conniving new ways to block any routes to accessing those methods which exist, such as when a Canadian man was arrested for selling a certain compound to suicidal people), then getting out of the prison turns into a state of urgency. Instead of taking things one day at a time, you have your entire prison sentence stretching out ahead of you, which makes it difficult to find hope that things will ever improve.
But when you have the LEGAL right to end your incarceration at any time you want, then you can take life one day at a time, knowing that it is nobody’s right to conspire against you in order to take away your choice to leave at a time of your choosing. The following article provides anecdotal evidence of how having the right to die can make life itself bearable again: https://news.sky.com/story/ive-been-granted-the-right-to-die-in-my-30s-it-may-have-saved-my-life-12055578
Again, suicide prevention advocates, including the author of this blog should TAKE NOTE. A prison can become a home when you have the key.
Although many/most who support suicide prevention policies such as means restriction probably have good intentions; paternalistic policies aimed at making it hard or impossible to access effective suicide methods are simply cruel and wrongheaded. What these policies are best at accomplishing is compounding the feeling of entrapment that suicidal people are liable to be prone towards, and also alienating these same people by attaching a high risk and a high social cost to the option of seeking help. When people don’t seek help, and their sense of entrapment is intensified, then they will be more prone to act impulsively, and less likely to look for other ways to solve their problems.
First of all, Dr. Freedenthal, I’d like to thank you for still responding to comments on a nearly 10-year-old post. You don’t have to do that, and it shows (to some degree) that you care, although you may care in a way that enables undue suffering.
While I could write a multi-page argument against your post, talking about rights and freedom and the cruelty disguised as empathy, many people have already brought up the criticisms I have, and you addressed them, not to my satisfaction, but that’s obviously subjective. Even though this is a ten-year-old comment section, I hope I can offer a new perspective.
This isn’t even the first time I’ve read this article. I read it for the first time back in early December. When I did, I scoffed at it and, in my mind, called it a naively hopeful and disgustingly optimistic viewpoint. That initial reaction was a bit extreme (likely fueled by my own depression), but I still think that you might have a positive bias about life. Which is fine and fair. Most people do. Human beings evolved to survive, not only individually, but cooperatively too, which would explain why most people not only don’t understand the suicidal, but try to force them to live; they can’t envision a mental state where death is preferable to life. And most people commenting here are depressed and/or suicidal (including me for both). They have a strong negative bias, just like you have a positive one, that influences their perspective.
But that makes me wonder. Humans are essentially walking, isolated biochemical processors. These processors create our “reality.” And we don’t have access to anyone else’s. For people with schizophrenia, while we may have a more “objective” view of “reality” (ignorning philosophical skepticism), to that person, for all practical intents and purposes, that is their “reality”. And if those intrusions and delusions never go away, who’s to tell a person they aren’t “real”? And for mood disorders, it becomes even more unclear. We can measure light in lumens, we can measure sound in decibels, we can measure temperature in celcius, we can use x-ray to see what’s behind something, etc. So when a person experiences something that not only doesn’t line up with our own experience but with these “objective” tools and sensors, we feel confident saying the problem lies with them. But there is no “value-of-life”-ometer that we can use. Value and what’s (in your own words) “bad” and “good” are ultimately arbitrary, relative, and subjective evaluations. You could point out that most people don’t want to die, but that would be an argument from popularity; you could say that humans naturally want to live, and you’d be right, but that would be an appeal to nature. In the same way, people could say, “You’re just mentally ill.” Someone else could say, “You aren’t mentally ill, so you could never understand.” Of course, there are people who were suicidal and now aren’t (like you) and people who weren’t suicidal and now are (like me). But people tend to favor the present. There’s a difference between remembering it and feeling it every day. Fundamentally, both the decision to live and the decision to die are irrational because we are inherently emotional creatures and rationality is a human construct. And this issue is a moralistic one rather than a debate of policy or logic. So, at least on this topic, I’m not sure if anyone is truly “rational.” Having said that, I recognize that there are real, proven cognitive deficits associated with mood disorders, and I think that should be considered too.
What I am wondering is how you feel about the “right-to-die” or “assisted suicide” being expanded to people who only have a mental illness. For example, starting on March 17, 2023, Canada will allow them to also apply for assisted suicide, although each case is reviewed individually. (https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html) I know you gave a story of a woman who felt having the right to die for her autism and depression made her want to live, but that won’t be the case for everyone. Do you think this fairly comprehensive process, that would likely only apply to the treatment-resistant, is still too far?
It makes me think of the therapist and her client with schizophrenia that you wrote about in the first paragraph. Was that his first therapist? Did he try cognitive-behavioral therapy, dialectical behavior therapy, psychodynamic therapy, or humanistic therapy? Was he already on medication? If so, for how long? At what dosage? Was that the first drug he tried? If not, how many did he try beforehand? My point is, how many medications, dosages, therapies, and years does it take before you think that someone won’t get better? Do you think that age plays a factor? The earliest you can start this process is 18. Is that too young? The brain isn’t fully developed until around 25; is that a more reasonable age? But at the same time, there is no cure for mental illness. What if time only worsens the pain? Unless you think we should never let someone go, no matter their age? But I’m rambling. Sorry for the questions without answers. While I disagree with your perspective, I thank you for allowing the discussion.
With all due respect, the title of the post doesn’t really have anything to do with the content of same.
All you’re saying is that people who tried to commit suicide usually don’t die from suicide.
Okay, as far as that goes.
But it doesn’t really say anything about their (the suicidees) quality of life afterwards.
For all you know, preventing people from killing themselves might simply condemn them to a life that they don’t particularly want, despite what society tells them.
And yes, life might offer up untold possibilities for someone prevented from killing themself.
But by that same logic, it also might offer up untold horrors.
So unless you’ve got some Delphic oracle hidden somewhere, you can’t possibly know.
And I get the knee-jerk reaction that every human life is, if not sacred, then certainly worth saving. But a knee-jerk reaction is all it is.
What I object to is the automatic inference that more life is more better.
Which is demonstrably false with even a cursory look at any 3rd world country.
Or to put it more philosophically, isn’t the most basic human right, the ability to…well, stop being a human being?
No human on the planet, alive or dead, was asked if he/she wanted to be part of this world.
So why is it such a stretch to imagine that someone might want to opt out?
I read your comment and couldn’t agree with you more. None of us, were asked if we wanted to enter this world or more importantly, how we would want to enter this world. Some of us are born dirt poor, into abusive families, with medical problems and physical features we are opposed to. I agree with the notion that if someone wants to end their life, they can without scrutiny.
Totally agree with you!
How do you know we didn’t at some time ‘ask’ to be a human being?
Because we were not born yet.
Absolutely nailed it with this one.
No one in the history of humanity was ever given a choice to be brought into this world. Their mother could have terminated them in utero for whatever reason.
If you have no choice as to whether to come into this world then the very least you should expect is to be able to make the choice to cease. The reason doesn’t have to be very specific such as in my case with major hearing issues on top of serious preexisting mental health problems.
In the field of Near-Death research, there are accounts of people realizing that their consciousness existed prior to their eartlhy existence and that they did choose to have a life on earth. It seems crazy and counterintuitive and some people may scoff at the Near-Death research field as “unscientific.” I would advise you to investigate the field first before dismissing it. I was surprised by the scientific sophistication of the reaearchers cited by the International Association of Near-Death Studies (iands.org). Dismissing something before you have examined it seriously can only be regarded as “dogmatism” or intellectual laziness or complacency. I think much of our society suffers from an appalling lack of intellectual curiosity. Suicidal survivors have also shared some fascinating accounts of their Near Death experiences where they learned that they would have to continue working out their conflicts in the afterlife. As Shakespeare wrote, (I paraphrase )there is a lot more to our world than we have ever dreamed of.
John, if you’re implying that people shouldn’t commit suicide because apparently they chose to have a life on earth before being born, then i am going to have to seriously disagree. yes, i agree we should not dismiss the field of near-death research as “unscientific” but you can’t just assume that near-death experiences definetly have hidden meanings since there’s no solid proof for this. to assume otherwise would also be dogmatism, intellectual laziness, and complacency. even if that were true, just because someone said that they wanted to live at first, doesn’t mean they can’t change their mind later and i think they should be allowed to. as for suicide survivors claiming that they were told they would have to work on their conflicts in afterlife, there is also no solid proof of that being real and it also does not apply to every person who attempted suicide.