Suicide, not another Taboo

Book review: Tony White's Working with suicidal individuals

When is "enough is enough" for the human being? When suicide becomes a last resort? Is it the final consequence of depression, or of losing a job or loved one? Is it "the solution" only for the mentally disordered or addicts? Are those states the triggers or reasons? We tend to associate suicide with some important traumatic event or large emotions of dissatisfaction. But is this really so?

By MILENA STOŠIĆ (milena.stosic@wavemagazine.net)


According to the WHO (World Health Organization), there are 10 to 20 million suicide attempts annually. This makes one wonder if life is that hard or if we live in a dark place in this world. On the other hand, so many people who survive war, rape and bankruptcy keep living and never think of suicide. Why are they different from the others? Are they stronger, smarter or more courageous? 

This can make us think about our own capacity to cope with stressful events and our own resources to stay alive. If we were pushed to the very limit of our physical and psychological resources, would we indeed take the solution of suicide - psychotherapist Tony White asks this as well in his new book Working with Suicidal Individuals.

Blur around suicide

Sadness, depression and loss are commonly associated with suicide. However, depression is not automatically "a license to kill one self". As White explains in his book, unless the depressed individual reports recurrent thoughts of death and suicide (one among nine symptoms of depression in DSM-IV classification), it seems safe to say there is no suicide risk at the time. Of course, one can never be too cautious with statements of suicidal people, who tend not to reveal suicide planning.

Self-harm is also not a definite indicator that someone might commit suicide. Neither is being single, per se, although as White writes this can be more accurate for the "psychologically" single person. He discusses these and other quantitative measures in assessing suicidal risk, but these measures are limited and it is much better to combine them with qualitative measures in assessment.

Much more is said about the suicide decision, which is always there, not only during an acute suicidal crisis and therefore is of great importance in long term assessment.

Why some people want to die

According to White and the theory of Transactional Analysis (TA), and this is probably a surprise to many, the suicide decision is made not as consequence of some terrible event in the present, but as a decision early in life. As a response to adverse parenting in childhood, a child can decide that he/she is not OK, that he/she is worthless and therefore should not exist. Over childhood this decision becomes a "thinking error" of which people are mostly unaware. 

White also discusses imitated suicide decisions by children modeling their parents or significant others own suicidal behavior, although these decisions are not as potent as ones made by child itself. It is a mistake to believe that only battered children will make suicide decisions. Ignored child can also make such conclusions. Knowing this, we see that suicide is not a result of only the poor or tortured, but rather a universal and complex phenomenon, very much conditioned by significant other's (non)verbal messages and behavior.

Teenage suicide

A little bit different are the instances of teenage suicide. This is one of the four groups and motivations to kill oneself that White describes in his book. These are not so rare, having in mind that, for instance, a quarter of all surveyed Irish teenagers have felt suicidal, according to a UNICEF Ireland report launched a month ago. But this is worldwide trend generally speaking, and we know that there arestatistics that show suicide is the third leading cause of death for people 10-24 years of age. That's why it is important to reveal why these statistics are so high.

Apart from his great experience in working with high risk groups, author of Working with suicidal individuals reveals his own suicidal attempts in his teenage years, which gives him even more depth in exploring this topic.

Apparently, suicidal urges, actions and suicide itself at this age represent a special case among suicidal types. White reminds us thatthe teenager still has so called magical thinking and doesn't have the fully mature understanding of the consequences that suicide may cause, which differs them from adults. He also states that teenagers as a group tend to be egocentric and narcissistic, feel they are special, omnipotent and that general rules do not apply to them.

Combining this with the common issues teenagers have such as body changes, relationships and so on, unpredictable suicidal behavior is not such a surprise. In one sense this is a good thing, if it is possible to say such a thing, because it means that among teenage suicidal individuals there are many who haven't actually made the early suicide decision, which gives them a better chance of moving forward from their crisis.

More than suicide

So, we see that suicidal urges are not reserved only for "mad people". In this sense the book removes the shade of taboo and stigma from people who have made a suicide attempt or have suicidal thoughts, which, of course, should always be taken seriously. Still, knowing this, we should erase the stigma of madness or depression from these individuals (not denying there is correlation between suicide and psychiatric illness or depression), because although they need help, they shouldn't be condemned as inadequate. Nor should they be isolated or banned. Suicide contemplation doesn't have to be permanent state of mind.

Apart from providing understanding, assessment and support to suicidal individuals, as the subtitle states, Working with Suicidal Individuals can offer us the opportunity to think of our own lives too, our background and decisions in wider sense. Reading about this one may wonder - did I make some early decisions and how do they affect me now, how do I respond to stress, can something be changed? And one can indeed find that change is possible, that the quality of life can be better and to at least build a greater self-awareness. That's why this book, written in an understandable and clear style, with many real life examples by an experienced therapist, can be of use not only to professionals dealing with suicide, but also to common reader interested in inner life.

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Suicide decisions:

"If you don't change, I will kill myself"
"If things get too bad, I will kill myself"
"I will show you even if it kills me"
"I will get you to kill me"
"I will kill myself by accident"
"I will almost die (over and over) to get you to love me"
"I will kill myself to hurt you"


Purchasing book -http://www.jkp.com/catalogue/book/9781849051156.



(Published: 10.07.2011.)