Suicide is not a choice

There is a common misconception that those people who commit suicide have made a rational decision between two options and picked the one that they thought was most suitable for them. I’ve read this many times, often in the context of, “I really miss him, but I respect his choice.”

For those of you lucky enough to have never experienced suicidal thoughts, I want to make something clear:

Suicide is not a choice. It is a compulsion.

Obviously, I can’t really speak individually for the million people a year who take their own lives, nor for the order of magnitude more that failed in their attempt. There are, in fact, reasons for a mentally healthy person to choose (perhaps even rationally) to take their own lives. However, I believe that most of the people that killed themselves last year did not have a choice.

Consider a different illness for a moment. Consider cancer. It is a horrible disease. When a patient is diagnosed with cancer, they know they may recover, or that they may die. They don’t have a choice in the matter. Many patients find reserves within them to battle the illness with every tool available to them. Others don’t. Some survive, many die. Some beat the illness for a period, only to have the disease attack them again several years later.

In the case of cancer deaths, the cells in the human body turn on the victim to the point that it can no longer support that body’s vital systems.

Contrary to popular belief, mental illness works in much the same way. Instead of cells, it is the patient’s brain that turns on them. Their thoughts attack them repeatedly and incessantly until, eventually, they are compelled to destroy the body that houses them. Suicide is the result of an untreated psychological cancer.

Suicide ultimately arrives when the victim believes they do not have a choice. It becomes the only option. Suicidal thoughts begin as general thoughts about death. This leads to thoughts about the patient’s own death.They becomes obsessed, and begin to think about ways to actualize one or more of these scenarios. What options do they have, what tools can they use? Next, they are compelled to pick a time. If nothing changes, the time comes, and they die.

I speak from experience. Suicidal thoughts were my constant companion for twenty years, starting at the tender age of eight. At various times, I have reached the point where I believed I had no other options. I chose dates for my death. Luckily, phrases like, “I’d rather see you institutionalized than dead,” or “Do you need to be hospitalized” helped me realize there was something I hadn’t tried yet. I survived. At the moment, I am in remission, and I am optimistic that my “cancer” will not return.

So now, when I hear someone say, “It’s hard to deal with, but I respect her choice,” I hear the truth: “I am pretending she had a choice rather than admit that I didn’t give them the choice she needed.” Saying a suicide case had a choice is as insulting to their memory as suggesting that a cancer victim should have chosen to fight harder or a rape victim should have dressed differently.

8 Comments

  1. Myra Nelson says:

    Dusty:

    I’m glad to see someone talking about this. From one who still suffers a little to one who seems in complete remission, congratulations on your recovery and your ability to address the subject in such a forthright manner.

    Myra

  2. Daniel says:

    Thanks. Good thoughts and courageous. I myself struggle(d) with suicidal thoughts and it’s good to read about the topic in such a sober and palpable manner. More important it indicates a way out and might lead some out of the vicious circle of destructive thoughts. Should be more articles like that!

  3. mia says:

    “Suicide is not a choice. It is a compulsion.”

    False dichotomy. Giving in to compulsions is a choice.

  4. Awebb says:

    This is an interesting way of saying this. I’d like to state a slight adjustment. I saw my share of friends and acquaintances go that road, some attempts, some successes. Most of them were broken beyond recovery, but there were those, who deliberately chose suicide as a coward exit strategy. It is true, that there must be a lot of irrationality (therefore no choice) involved to perform the act, as the human self-preservation instinct is very strong.

    However, having lost a brother a few days ago (not by choice, no matter the subtext), I can agree on one thing: People should leave themselves out of the picture, when communicating grief. He is gone and I will miss him. He will leave an open seat between us. And not: This is what I think about the circumstances of his death. The circumstances are nobodies business.

  5. Daniel says:

    I think that there are many cases that fit the profile you mention, and I do not intend to trivialize those in any way. I also don’t think that situational depression and suicidal thoughts like I experienced can be compared to similar effects from other sources.

    With that out of the way, I can tell you that in a particularly dark episode of my own life, I found myself facing the apparent impossibility of the tasks ahead of me and seriously considered taking my life. In my case, this manifest as almost a dialogue in which a series of three choices were presented as “escapes” from my situation, one of which was suicide, and prior to the experience it never occurred to me that any of the three could be a conscious choice.

    I think there are two main failings in the current approaches to depression and suicidal thoughts:

    1. Failure to educate people to recognize the signs of trouble in themselves and those they love.
    2. Failure to track the symptoms back to their actual cause.

    There’s a lot that can be done in education, but I’d like to focus on the #2 for now. We know of several different types of causes for depression, and while medication is sometimes the right answer, even in those cases it’s necessary to ensure that the right medication is administered as there are several options that behave slightly differently in different people. If the wrong medication is given, it may make the situation worse, which is why most antidepressants list “suicidal thoughts” as one of their possible side effects.

    To use a rough analogy, if my car isn’t reaching the destination I want in a timely manner, I can steer it left, steer it right, apply more pressure to the accelerator, change gears, start the engine, or apply any number of repairs. Too often, I see patients given the equivalent of one of these being chosen without the necessary information to determine which treatment will really resolve the underlying problem.

    If any reading this are presented a choice as I was, please make it carefully and without haste. Don’t deny the world your unique contributions, even if you can’t yet see what those might be.

    For anyone else, the only advice I can give is to try to be the kind of person with whom others can share their feelings and concerns. This may just put you in a position to help someone you wouldn’t have otherwise known was having trouble.

  6. mclang says:

    I have never known sane suicidal person (if such even exist), so your blog post opened my eyes and made me see things from another point of view.
    Thanks!

  7. André says:

    Hi, I have been diagnosed with MDD for 4 years or so. I was 22 back then. Before that time I was not much better, I think it just took some time to diagnose the illness, I believe I had GAD or something but now it’s depression mainly. I believe that I started being really bad when I was 16. Since mid last year I am taking 40 mg of fluoxetine and 300 mg of bupropion daily. I have been given other antidepressants since my first diagnosis, paroxetine and some tricyclic antidepressants, I don’t remember their names though but they did not really worked for me. I must confess I feel better, with much more energy, now I am able to move around (I could barely walk back then), to stay awake, to write something, like this very post. However, suicidal thoughts arouse me. Today I managed to put them away, but I know they will come back. I rarely visit archlinux.me even though I have it in my opera’s speed dials links. Yet maybe I came at the right time. I have been questioning whether I really think this is the only solution left or it is the product of an altered mental state of me.
    Your words help me try to stay alive, thanks.

    • Dusty Phillips says:

      André, you have shown great strength in seeking medical attention and obtaining a diagnosis. Keep showing that strength, seek help when you need it. You are important, you are loved, and you are not alone.

      I am hesitant to offer advice because I am not a professional and my first-hand experiences are not enough to pretend that I know what your situation feels like. However, I can tell you the things that I did to get me through my worst:

      1. I kept lists of local and national crisis numbers spread around my house. Seeing them reminded me that I have other choices, and they were immediately available at crucial moments if I needed to call one.
      2. I had family and friends stay with me to make rational decisions for me when I was unable to.
      3. I destroyed my firearm acquisition certificate, and discarded most of the painkillers and other pills in my apartment.
      4. I checked myself into the local emergency room. In my case, this turned out to be key.

      I promise that a life where suicide wrongly appears to be the only possible choice can be turned into a life where that option never even crosses your mind. The mid-twenties are a difficult time for many of us. I’ve been told it gets better and I’m looking forward to my thirties. I hope to see you there.

      Thank you for reading my words and taking them to heart. Take care of yourself, you are worth it.