Stay: The Social Contagion of Suicide and How to Preempt It

http://www.amazon.com/Stay-Jennifer-Michael-Hecht/dp/0300186088

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Stay: The Social Contagion of Suicide and How to Preempt It

If you've ever known someone who committed suicide, or have contemplated it yourself, or have admired a personal hero who died by his or her own hand, please oh please read this. Because, as Jennifer Michael Hecht so stirringly argues in Stay: A History of Suicide and the Philosophies Against It (public library), numerous social science studies indicate that one of the best predictors of committing suicide is knowing suicide – a fact especially chilling given more people die of suicide than murder every year, and have been for centuries. Suicide kills more people than AIDS, cancer, heart disease, or liver disease, more men and women between the ages of 15 and 44 than war, more young people than anything but accident. And beneath all these impersonal statistics lie exponential human tragedies – of those who died, and of those who were left to live with their haunting void.

To be sure, Hecht's interest in the subject is far from the detached preachiness such narratives tend to exude – after two of her dear friends, both fellow writers, committed suicide in close succession, she was left devastated and desperate to make sense of this deceptively personal act, which cuts so deep into surrounding souls and scars the heart of a community. So she immersed herself in the science, philosophy, and history of suicide searching for answers, emerging with an eye-opening sense of everything we've gotten wrong about suicide and its prevention. She writes:

As I examine the history of how, in the West, we have understood self-killing, I also will put forward what might seem to be a contrarian position, a nonreligious argument against suicide. It is a philosophical argument but parts of it can or even must be told in terms of history, and parts must be demonstrated through modern statistics. One of the arguments I hope to bring to light is that suicidal influence is strong enough that a suicide might also be considered a homicide. Whether you call it contagion, suicidal clusters, or sociocultural modeling, our social sciences demonstrate that suicide causes more suicide, both among those who knew the person and among the strangers who somehow identified with the victim. If suicide has a pernicious influence on others, then staying alive has the opposite influence: it helps keep people alive. By staying alive, we are contributing something precious to the world.

Hecht argues that, historically, our ideologies around suicide have set us up for "an unwinnable battle": First, the moralistic doctrines of the major Western religions, Judaism, Christianity, and Islam condemned suicide as a sin that "God" forbids, one more offensive than even murder because you were stealing directly from divinity with no time left for repentance – a strategy based on negative reinforcement, which modern psychology has demonstrated time and again is largely ineffective. Then came The Enlightenment, whose secular philosophy championed individual agency and, in rebelling against the blind religiosity of the past, framed suicide as some sort of moral freedom – a toxic proposition Hecht decries as a cultural wrong turn. Reflecting on such attitudes – take, for instance, Patti Smith's beautiful yet heartbreaking tribute to Virginia Woolf's suicide – Hecht makes the case, instead, for two of history's relatively unknown but potent arguments against suicide: That we owe it to society and to our personal communities to stay alive, and that we owe it to our future selves:

Both religious and philosophical writers have written marvelous things about both these ideas, but they are often in the background. The reason is that a foreground argument has gotten all the press: Religious people have tended to lean heavily on the argument that God forbids suicide. Meanwhile, in response, secular, philosophical people have insisted that we are free to take our own lives. In my experience, outside the idea that God forbids it, our society today has no coherent argument against suicide. Instead, many self-described open-minded, rationalist, sophisticated thinkers emphatically defend people’s right to do it. How did the secular philosophical worldview come to claim people’s right to suicide? How did those in the modern world – who fight death so fiercely elsewhere – come to accept or at least leave unchallenged an ideology that kills? The answer is a fascinating story of a reaction against religion that somewhat accidentally led to a dark fatalism.

She traces the evolution of these attitudes:

Religion took a wrong turn by relying so heavily on divine disapproval of suicide, and on corporal (even postmortem) punishment of the offender, and secular philosophy took a wrong turn when it concluded that without God and religion, man was his own master and thus people should be free to kill themselves.

[…]

The Enlightenment enhanced the value of the self above that of community and tradition and made of each man and woman an independent being. … Thus, built right into the world’s most momentous revolution about the value of average individual human beings was a mechanism by which they were invited to judge their own lives, possibly to find them without value or worth, and to end them.

[…]

The advance of modernity brought new concern for individual rights and private property, and these, as well as the rise of the scientific medical profession, began to have an effect on government policies. In the seventeenth century suicide had still been seen, in part, as the work of the devil. By the eighteenth, “melancholia” was the dominant term in discussing suicide – and melancholia was the purview of doctors. From the worst sin possible, suicide became relatively value neutral; it could even be seen as virtuous when enacted in protest against an insult to one’s ideals. By the twentieth century, there was a general sense among secularists that people had a right to suicide, and a right to make the decision on their own.

And yet our deep-seated unease about suicide is as old as antiquity can record: Even Plato, in crafting history’s best-known image of a suicide – Socrates's famous death scene – paradoxically had Socrates state in that very same dialogue that suicide is wrong. Plato's Socrates also urged his countrymen to stay alive because of what they owed their country and their fellow citizens. Even among the Enlightenment philosophers who condoned suicide as honorable, there were the essential voices of dissent, perhaps most notable of whom was Immanuel Kant with his moving meditations on the important relationship between the individual and society – he condemned suicide as an assault against humanity, an act by which you rob the universe of your own potential goodness. Hecht synthesizes:

We are humanity, Kant says. Humanity needs us because we are it. Kant believes in duty and considers remaining alive a primary human duty. For him one is not permitted to “renounce his personality,” and while he states living as a duty, it also conveys a kind of freedom: we are not burdened with the obligation of judging whether our personality is worth maintaining, whether our life is worth living. Because living it is a duty, we are performing a good moral act just by persevering. In one of the most crucial statements in the history of suicide, Kant writes: “To annihilate the subject of morality in one’s person is to root out the existence of morality itself from the world as far as one can, even though morality is an end in itself. Consequently, disposing of oneself as a mere means to some discretionary end is debasing humanity in one’s person.” Human beings must understand themselves as a force of good, a force of morality. As human beings, it is our job to preserve these ideals. This goes a step beyond Aristotle’s community or Rousseau’s reminder of survivor’s pain, and speaks instead of something larger. To be human is a powerful, profound thing that deserves a lot of patience.

Victor Hugo made that point even more poignantly when he wrote inLes Misérables:

Die, so be it, but don’t make others die. … Suicide is restricted. … As soon as it touches those next to you the name of suicide is murder.

Hecht continues:

Often people demand a great deal from themselves and their lives and are despondent when reality does not measure up. Milton has long been understood as having offered consolation for this affliction, reminding us that we do not always have a say in the role that we play in the world and that sometimes we must learn to see the service we are giving when we are doing nothing but waiting.

One particularly glaring modern disconnect Hecht points out is that while many people today don't subscribe to any religion, our culture's main argument against suicide remains about God. Instead, she seeks to excavate and reinstate those saner, sager historical arguments about suicide asserting "that it is wrong, that it harms the community, that it damages humanity, that it unfairly preempts your future self." Even the title of the book speaks to this conviction and the moral firmness with which Hecht believes we should address suicide, in such stark contrast with the Enlightenment's negligent permissiveness – it isn't titled Please, Stay, like a gentle invitation encouraging the desired behavior, but simply Stay, like a strict directive against the undesirable, a command issued to a dog who is about to do the wrong thing. (She offers, however, one important disclaimer: Her argument is about what's known as "despair suicide," or what she calls "darkness in the midst of life," and not about end-of-life management for the fatally ill. Nor is she passing judgment on those who have committed suicide. "I assign no blame to those already lost, I only feel sorrow for them," she writes.)

The firmness of Hecht's argument befits the findings of modern psychology – suicide is exceptionally socially harmful:

Throughout history an optimistic cavalcade of people has sidestepped the religious debate and put forward sound reasons to resist suicide based on each of our relationships to humanity, especially friends and family. Today’s sociological studies back up the historical claim that we need one another – or, rather, the specific claim that suicide causes suicides.

The most profound and chilling contagion of all, however, happens during childhood – Hecht cites a Johns Hopkins University study, which found that if a parent commits suicide before their child is 18, that child is threefold as likely to commit suicide at some future point as her peers with non-suicidal parents. (For some heartbreaking anecdotal evidence, look no further than Sylvia Plath – her son Nicholas, despite the timelessly life-affirming letters his father sent him and the charming children's books his mother wrote for him, took his own life at the age of 46; Plath had gassed herself to death when he was a year old.) Childhood incest survivors are also found to be particularly vulnerable to suicide, as are female rape victims, who are 13 times more likely to attempt suicide than the average women.

Reflecting on the social contagion of suicide, Hecht writes:

Rejecting suicide is a huge act within a community. I also think it changes the universe. Either the universe is a cold dead place with a little growth of sentient but atomized beings each all by him- or herself trying to generate meaning, or we are in a universe that is alive with a growth of sentient beings whose members have made a pact with each other to persevere.

Additionally, Hecht argues that the tenacity we develop as we endure even the most blinding of that "darkness in the midst of life" blossoms into a most valuable kind of character-building. She cites Keats, who called the world a "veil of soul-making":

Keats saw the terrible pain of life as necessary to the development of a full human being. While the heart suffers acutely, the mind is nurtured and matured through the information garnered by the anguished heart. In his extended metaphor there is no other way for a human being to be tempered into personhood. In that sense the world, with all its difficulties, is a school.

[…]

Childhood formed us all, and the more we suffered then, the harder it can be to accept ourselves as adults. True, the road to self-awareness is arduous. Some realizations bring us to low feelings much like grief, and much like grief the only solution is to live through it. We come out wiser on the other side. As Robert Frost wrote, “The only way around is through."

Nietzsche, too, argued that human suffering is necessary for the soul's growth and admonished against "the religion of comfortableness," which he believed hindered true happiness. Like Albert Camus, he envisioned happiness and unhappiness as "sisters and even twins that either grow up together or … remain small together":

Nietzsche urges us to see that human suffering is necessary, but what is not necessary is painfully regretting that suffering. Our condition hands us difficulty, and unless we are careful to stop ourselves, we add more difficulty to our lot by fearing and loathing that difficulty. We suffer and then hate ourselves for suffering. We are much better off accepting the pain, seeing it as universal, noting that it can be borne, and, when possible, expressing it.

Returning to those Enlightenment philosophers like Hume and Rousseau who opposed suicide as socially unjust, Hecht writes:

If you have any energy at all for participating in this world, perhaps live now only for those small kindnesses and consolations you can render. Perhaps seek to help those equally burdened by sadness. Confess your own sadness to those in sorrow. Your ability to console may be profound. The texts urge human beings to try to know that they are needed and loved. We all deserve each other’s gratitude for whatever optimism and joy we can hustle into this strange life by sheer force of personality, even by that most basic contribution, staying alive.

She later adds, referencing Hamlet's famous contemplation of suicide by way of "a bare bodkin":

It is an intellectual and moral mistake to see the idea of suicide as an open choice that each of us is free to make. The arguments against suicide ask us to commit ourselves to the human project. They ask humanity to set down its daggers and cups of hemlock and walk away from them forever. Let us be done with bare bodkins.

Citing David Foster Wallace – one of modern history's most worshipped, even fetishized fallen heroes, who shared some of the most memorable wisdom on life yet took his own at the age of 44 – Hecht points to his famous words on heroism and reframes it:

Often our courage is needed not to dramatically change reality but to accept it and persist in it.

She cites another celebrated author who took her own life, Anne Sexton, and this heartbreaking note on the pain of life, found in one ofher letters:

I don’t want to live. … Now listen, life is lovely, but I Can’t Live It. I can’t even explain. I know how silly it sounds … but if you knew how it Felt. To be alive, yes, alive, but not be able to live it. Ay that’s the rub. I am like a stone that lives … locked outside of all that’s real. … I wish, or think I wish, that I were dying of something for then I could be brave, but to be not dying, and yet … and yet to [be] behind a wall, watching everyone fit in where I can’t, to talk behind a gray foggy wall, to live but to not reach or to reach wrong … to do it all wrong … believe me, (can you?) … what’s wrong. I want to belong. … I’m not a part. I’m not a member. I’m frozen.

Hecht pulls from it a universality that lies at the heart of her case against suicide:

Sexton’s expression of anguish is extraordinary. Yet such feelings are not uncommon. To live through this painful feeling is hard work and requires prodigious courage. That courage comes first from recognizing that we are not alone. Sexton’s confession here is of feeling cut off from community, yet she expresses something that a huge number of people experience. If we can grasp that commonality, the pain can become easier to bear.

Ultimately, Hecht argues for cultivating a culture of suicide resistance and attaching honor not to the act of suicide, as some Enlightenment philosophers did, but to perseverance itself. By equipping ourselves with alternative responses to life's suffering, she proposes, we'll work towards removing suicide from our list of options – a strategy that hopes to bar it as a psychoemotional possibility much like a barrier on a bridge can preempt the physical act of jumping. Optimizing for such a moment of pause, Hecht suggests, might be the small miracle that allows us to catch our breath and persevere:

If we can take suicide off the docket for the moment, that moment may turn out to be enough.

The very reason to do that, Hecht reiterates in returning to her core argument, is not for our present suffering selves but for each other. She puts it beautifully:

We are indebted to one another and the debt is a kind of faith – a beautiful, difficult, strange faith. We believe each other into being.

Stay is more than a must-read – it's a cultural necessity. Complement it with what the psychology of suicide prevention teaches us about controlling our everyday worries.