Grief, Loss, Death & Dying

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Suicidal ThoughtsReview - Suicidal Thoughts
Essays on Self-Determined Death
by Max Malikow (Editor)
Hamilton Books, 2008
Review by E. James Lieberman, M.D.
Dec 1st 2009 (Volume 13, Issue 49)

Suicides outnumber murders in the United States, at a rate of almost 2:1. The latest data: 33,300 suicides and 18,600 homicides (Centers for Disease Control, 2006). A few years ago the ratio was 3:2, but suicides have gone up while homicides decreased. Among causes of death, suicide is 11th, homicide 15th. This fine little book lacks only a statistical overview. The editor, Max Malikow, teaches psychology at Syracuse University and practices psychotherapy. He assembles 17 brief essays dating from 1938 to 2007, most from the last two decades.

A. Alvarez writes on Sylvia Plath in an excerpt from his The Savage God (1972). He makes a cogent case for her having gambled that she would be saved from death (by gas from kitchen stove) but circumstances coalesced to make her action fatal. "Uncle Camp's Suicide" by Olive Ann Burns comes from her 1984 bestseller Cold Sassy Tree. Set in 1906, it is narrated by a 14-year-old who is confronted with an awful suicide, then made poignant by his reaction. Sue Chance, M.D. wrote Stronger than Death (1992) after the suicide of her troubled son. She learned the technique of thought-stopping. She got angry. "You have to go by way of anger," she writes, "It's intrinsic to the survival process. Only by doing it can you begin to experience forgiveness--of the suicide and of yourself."

Chapter IV is Rabbi Earl Grollman's concise summary of religious attitudes and doctrines toward death and suicide through the ages. Then, in two powerful narratives, Eric Hoffer and Kay Jamison tell how close each came to suicide. Philosopher Hoffer turned back, but "on that Sunday a workingman died and a tramp was born." Psychologist Jamison's preoccupation was intermittent, sometimes pervasive; she was able to put in in the service of science and clinical understanding of "the moods of death." Psychiatrist Gordon Livingston writes of the suicide of his son, who developed severe bipolar illness at 19. Psychologist Malikow, who also has a theological degree, explores the question of altruistic suicide, declaring that he would be pleased to die as did the pilot of a plane that crashed away from a schoolyard or the mother of a newborn who chose to forego cancer treatment in favor of the child. A peculiar essay follows from Karl Menninger's Man Against Himself (1938) purporting to analyze the symbolic meaning of bizarre acts of suicide. It takes the reader through a grisly, unnecessary horror show in the service of psychoanalytic speculation.

Sherwin Nuland, M.D., in How We Die (1994) defends physician aid-in-dying as done by Timothy Quill with a patient while condemning profligate interventions with strangers by the likes of Jack Kevorkian.  Walker Percy posits "Suicide as a Cure for Depression" whereby the sufferer can choose life rather than just endure it. The cure is contemplation. Then comes an essay from Sports Illustrated about the eighth grade athlete who got depressed, took Paxil, and ten days later shot herself with her father's gun.  Author Rick Reilly, describes a friendship between the bereaved father and Len, the recipient of her donated lungs. The two eventually ran a marathon together, both focused on Korinne's lungs breathing inside Len.

Two essays by Edwin Schneidman, who coined the terms "suicidology" and "psychache" sum up his 40-year focus on the complex topic of this book. His life-saving aphorism: "Never kill yourself while you are suicidal." Rod Steiger and William Styron contribute essays on their own deep depressions and Judith Viorst gets the last word. She reflects on suicide as a choice and supports the right to end life humanely when living is reduced to endless suffering.

This is a useful, perhaps unique resource, compact and provocative like a good poem. Yet only Sherwin Nuland touches on epidemiology: "elderly white males take their own lives at five times the national average." More on this would help. Among nations of the world, the U.S. is middling with its suicide rate of 17 per 100,000. More such deaths could be hidden among our extraordinary highway carnage. We have perhaps 200 million privately owned guns, the weapon of choice among those older men. Guns are highly effective suicide devices on first attempt unlike pills, used more by women--who then get another chance. Gun owners are impressive in their restraint: for every gun that kills each year, 10,000 others do not. The National Rifle Association might take pride in that estimate, while hushing the fact that most deaths due to our guns are suicides of the owners.


© 2009 E. James Lieberman


Link: Publisher website


E. James Lieberman, M.D., Clinical Professor of Psychiatry, Emeritus, George Washington University School of Medicine


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