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Faith, Hope, and Suicide

EDWARD

V. S T E I N

P e r h a p s no subject crowds the scientist a n d the theologian into the same c o r n e r quite as does t h a t of suicide. It is a n a r e a of u l t i m a t e c o n c e r n a n d c o n c e r n a b o u t ultimates d e m a n d i n g o f the scientist t h a t he r e a c h certain decisions a b o u t the m e a n i n g of life a n d death, a n d the position he will take t o w a r d t h e m , so that he m a y work effectively with the person who is considering the t e r m i n a t i o n of his own life. F a t h e r L y n c h , whose work on hope has been most germinal a n d helpful in the p r e p a r a t i o n of this paper, writes: " W e all hate people who go a r o u n d transcending things. TM I agree. T h a t is God's job. W h a t e v e r vertical dimension we m a y i n t r o d u c e into the p r o b l e m of suicide should be well rooted in the h u m a n being. S i g m u n d F r e u d himself, o f all people, has something to say a b o u t the d y n a m i c of faith ( a p a r t from his dismissal of its religious p o r t e n t in his The

Future of an Illusion): Faith repeats the history of its own origin; it is a derivation of love and at first it needed no arguments. Not until later does it admit them so far as to take them into critical consideration if they have been offered by someone who is loved. Without this support arguments have no weight with the patient, never do have any with most people in life? THE REV. EDWARDV. STEIN, PH.D., Professor of Pastoral Psychology at the San Francisco Theological Seminary at San Anselmo, filled several pastoral, counseling, and teaching posts in California before joining the Seminary faculty in 1959. He is the author of two books and many articles in periodicals devoted to his field of interests. He is a member of the American Psychological Association and of the Academy.

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This observation is most pertinent to the subject. Faith precedes reason and is more a problem than is logic to the suicidal patient. It m a y also be so to his therapist. The Judaeo-Christian tradition has taken a varying approach to suicide not unlike the ambivalence that much of the rest of the culture has shown toward the subject. Suicide is mentioned six times in the Old Testament, but without specific proscription, unless one so interprets Moses' C o m m a n d m e n t " T h o u shalt not kill" in this way, as of course m a n y do. T h e New Testament is silent about it apart from the report of Judas' death. O n e Jewish community in 73 A.D. committed mass suicide in the Fortress of Masada, on the western shore of the Dead Sea, when capture by the Romans became inevitable. Nine hundred and sixty persons killed themselves rather t h a n fall into hands of the R o m a n soldiers? Early Christians commended the suicides of young women who took their own lives in preference to losing their virginity to assaultive m a l e s - - a preference that it might be said has undergone some slight historical modification even in the church. St. Augustine was the first to go on record against suicide as a crime, and this influence (reinforced by Aquinas) has pervaded the thought of the church for almost fifteen hundred years: 4 Eventually Christian burial was denied the suicide, and indignities were often committed upon the corpse by public exposure, presumably in some kind of belated punishment. A stake was driven through the heart and the body was buried outside the churchyard, frequently at a crossroads and in an unmarked grave? J o h n Donne, the dean of St. Paul's Cathedral, was one of the first to start a reaction against such barbarities and the existing attitudes of the church toward suicide. His position was soon echoed by many secular writers and philosophers. Today the church, though not entirely, leans heavily toward a contextual or a situation ethic that would modulate legal pronouncements about suicide and would consider the ethics of every case individually on the basis of love. The best example of contextual ethics in my knowledge is pictured in the movie, The Sand Pebbles. The story takes place in China in the 1920's. A

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g u n b o a t crew has orders not to fire lest it provoke a n i n t e r n a t i o n a l incident. A crowd o f C o m m u n i s t s on shore has c a p t u r e d one of the boat's crew a n d is torturing h i m in plain sight in an effort to provoke retaliation a n d a war. T e n s i o n m o u n t s as the crew wants to shoot, b u t the c a p t a i n reaffirms the orders. Finally, one m a n c a n n o t stand the growing anguish of his t o r t u r e d friend, so he shoots h i m a n d hastens his sure death 9 F r o m a legalistic point of view, this was murder. F r o m the viewpoint of love, it was a m o r a l act. M a n y still consider suicide self-murder. R e v e r e n c e for life a n d patience in the context of suffering are powerful a n d p r o f o u n d ethical concerns t h a t have ingrained themselves deeply. Hegel reminds us t h a t " I t is of the essence of Spirit to suffer d e a t h a n d nevertheless to r e m a i n alive." T h e r e is always a risk a n d a p r e s u m p t i o n in a n y decision to sever life, however p o i g n a n t the rationale. I a m at present on a c o m m i t t e e of doctors a n d clergy discussing the issue of when, if ever, the doctor should t e r m i n a t e life, a n d the problems are towering. Dr. V i k t o r F r a n k l relates the following unusual case: A man lay semi-comatose in bed for a full five years, kept alive by artificial feeding, until the muscles of his legs atrophied 9 If this case had been drawn to the attention of the type of doctor who is often guided through mental institutions, he would characteristically have asked whether it would not be better to put an end to such an unfortunate 9 However, the case took an unexpected development. One day the patient asked to be allowed to eat in normal fashion, and wanted to get out of bed. He practiced walking until his atrophied muscles would support him again9 A few weeks afterward he was discharged--and was soon delivering lectures in secondary schools on travels he had undertaken before he fell ill. One day he spoke before a small group of psychiatrists, reporting his impressions in the course of his illness--much to the dismay of some attendants who had treated him not too well, never reckoning that in years to come this living corpse would be able to describe in sensible words everything that had happened to him. 6 9

.

.

H o w e v e r we evaluate such a situation, it gives us pause a b o u t h u m a n decisions c o n c e r n i n g " t h e e n d . " Christian tradition sets quality of life over against mere quantity 9 It sees d e a t h in the context of a larger perspective t h a n that of duration. T h e

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theological concept of eternity has far more to do with flavor of life than with frequency of days. Temporality is only one dimension of an ethical decision. In similar but lighter vein, the play Porgy and Bess has Sportin' Life commenting on the 900-year longevity of Methusaleh. H e remarks, "But who calls that livin'?" The H a r v a r d biologist, Dr. George Wald, reminds us that mortality is typical of all animals and plants that reproduce sexually. The more primitive organisms that reproduce by subdivision, like the amoeba, live indefinitely. Therefore, he argues that mortality originated part way down the path o f evolution. It is his contention that, for man and other sexual organisms, death makes up part of the pattern of life's fulfillment. (Quite a price to pay!) " W e need have no quarrel with death," he said; "death has its uses. It plays a positive part in the economy of life. It is not that it defeats life. If anything does that, it is perhaps meaninglessness.'7 This shifts the problem to a somewhat different focus. It is one of Hillman's contributions to the problem of suicide to point out that there is a danger of therapeutic panic in dealing with the issue. It is Hillm'an's contention, in Suicide and the Soul, that "death cannot be put off to the future and reserved for old age. ''8 The confrontation of death must be a repeated experience within life if a person is to grow and to reach a life of full consciousness. The analyst may be enabling his patient to live more fully if he can see the significance of his wrestling with death. "Living and dying . . . imply each other, any act which holds off death prevents life. 'How' to die means nothing less than 'How' to live. ''9 Again, "Until we can choose death, we cannot choose life. Until we can say no to life, we have not really said yes to it, but have only been carried along by its collective stream." M a n y a person, he implies, is, when he talks about suicide, actually talking about transformation and change, a process of growth. "Suicide is the attempt to move from one realm to another by force through death. ''~~ Recognition of the fact that suicidal preoccupation may frequently be a movement toward meaning rather t h a n a desire to terminate selfhood is an important emphasis. Every human being must fit his own ultimate demise

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into his picture of the world. M a n y philosophers and theologians have avowed that it is in the contemplation of death that man truly comes to understand the value and significance of his life. Hillman's point is that the therapist, in his eagerness to preserve biological life, should not miss the depth-significance of the psychological struggle that m a y be going on. In his words, "Some choose life because they are afraid of death, and others choose death because they are afraid of life. ''~ T h e therapist m a y abet an escapism in either case. One "escape" of course affords somewhat superior possibilities for redressing error. It is important to emphasize the difference between a carefully structured analysis and an emergency therapeutic contact. W h a t role does faith play in the problem of suicide? If one describes faith as reliance upon a structure or process (I would prefer to say God or Ground of Being) who orders life in a way that permits some dependable repetition through time, then faith becomes very relevant to the suicidal person as well as to his therapist. It makes a great difference whether one construes reality to be life-affirmin'g or basically indifferent to life, whether one sees the universe as a home in which a loving Creator intended man should grow in participant fulfillment or a madhouse where man survives only by the cynical acquisition of power, having to be his own God. Faith provides some structure of confidence and meaning, an integrative context. Durkheim and William J a m e s saw its presence to be an important force staying suicide, the former as an objective sociological fact and the latter as a subjective reality in the face of recurrent depression in his life. The schizophrenic child, Goldfarb reminds us, is classically unsure of his relational world, is terrified of unstructured space, the endless and openJ 2 His panic may subside when he returns to the world that is articulated by fences and roads and hedges. Is he an exception or a paradigm? He is little different from any h u m a n being who has lost his bearings in life, who floats weightless without co-ordinates or loses touch with reality. Experiments have shown that people totally cut off from contact tend to produce their own fantasy worlds, hallucinating private meanings and substitutes. To what extent is it the biological presence of a person who cares that sustains the suicidal individual,

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and to what extent is it that plus the faith with which the helping person construes his world? Would a frightened, pessimistic carer have the same effect? The work of Kobler and Stotland poses questions here. Obviously, it cannot be a faith that shuts its eyes to the brutal negativities of our world. It cannot ignore the doubts that come when horror is plain: gas ovens and brutality; gangsterism, war, and crunch of tanks on h u m a n bones; starving children with bloated bellies; cancerous agonizing death; sadistic parents permanently distorting helpless lives; rage-filled mothers watching their children fester in tenement filth; integrity helpless before rottenness in p o w e r - - n o n e of these can be ignored or denied. But one must ask, how is it there is something to measure them against.) This is the real mystery. Where did it come from? W h a t is it--some accident, some blind falling together of atoms in space? This I do doubt. Our experience is that of effort expended, of life extended, of purpose reaching out. Is it the result of chaos, of chance, of indifferent energies expending themselves aimlessly? Ernest Jones tells the story of a surgeon "who said that if he ever reached the Eternal Throne he would come armed with a cancerous bone and ask the Almighty what he had' to say about it. ''13 Such tragic fact cannot be ignored, but neither can the mystery of life in which we know them as abnormal, as tragic, as material for the surgeon's brain and researcher's imagination, as challenge to h u m a n response. Behind the mystery of the cancerous bone is the mystery of the surgeon who cares about it, and about his patient who asks such questions of the universe, who, in spite of hearing no answer, continues to act in the faith that there is an answer, if not "out there," then hidden somewhere in the nature of things, because there is a fidelity about the universe that rewards the seeker, that ultimately answers the questions of him who has the faith to continue asking in ways that can be answered. It is a fidelity that responds only to truth, that is truth that, once m a n listens to its summons, stays faithful to what has been given. It is a fidelity that ultimately unmasks phantasies, even well-meant phantasies about itself. Every therapist knows that he operates by some faith. I respect the

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therapist whose faith seems only in himself, yet I c a n n o t help wondering about this w h e n I a m told t h a t psychiatrists are high on the list a m o n g professionals who c o m m i t suicide. Does it m a k e a difference if one has the conviction that m a n is a biological accident in a universe t h a t is indifferent to him, where love is a freakish t e m p o r a r y e p i p h e n o m e n o n , or w h e t h e r he construes love to be the very essence of reality? Carl Rogers, in a dialogue with Paul Tillich, remarked, I feel at times when I am really being helpful to a client of mine, in those sort of rare moments when there is something approximating an I-Thou relationship between us, and when I feel that something significant is happening, then I feel as though I am somehow in tune with the forces in the universe or that forces are operating through me in regard to this helping relationship that--well, I feel somewhat the way the scientist does when he is able to bring about the splitting of the atom. He didn't create it with his own little hands, but he nevertheless put himself in line with the significant forces of the universe and thereby was able to trigger off a significant event, and I feel much that same way, I think, often times, in dealing with a client when I really am being helpful. 14 T h e therapist of the suicidal patient lives by faith even w h e n the faith gives no answers. Faith is most real in the midst of puzzlement. Its power is only discoverable apart from easy answers. I was talking once with a psychiatrist at the University of California who h a d come from Switzerland. H e r e m a r k e d t h a t he h a d formerly been a surgeon. I said, " T h a t ' s interesting. H o w did you h a p p e n to go into psychiatry?" A n d he replied t h a t one d a y one of his post-surgery patients h a d gone into a schizoid episode a n d refused to talk to anyone--staff, nurses, or f a m i l y - - f o r several days. T h e r e was a nearly complete withdrawal, a n d the doctor began to fear for the patient's life. In his concern for the patient and puzzlement, he went to the patient's bedside a n d sat there in a chair for a couple of hours trying to think of something to say or do. T h e patient said n o t h i n g all this time. Finally, having to go about his duties, he stood up to leave; just then the patient grabbed his a r m a n d said, " D o n ' t leave me now." He said, "That's when I decided to go into psychiatry."' Does the patient discern something working in us t h a t transcends our puzzlement? Some perspective a n d prehension of reality t h a t moves him to trust?

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It is hope t h a t moves a person out o f suicidal preoccupation. K o b l e r a n d Stotland emphasize in their studies t h a t suicide is frequently the result of the person's e x p e r i e n c e o f a response of hopelessness or fear to his c o m m u n i c a t e d message o f hopelessness? ~ " A c t u a l suicide follows," they say, " u p o n a helpless, fearful response to c o m m u n i c a t i o n of suicidal intent. ''6 In o t h e r words, hopelessness of the therapist or persons s u r r o u n d i n g the suicidal individual, as well as h o p e in such persons, b e c o m e d e t e r m i n a t i v e elements in the outcome. L y n c h writes: " W e m a k e fun of people who hope a n d we p u t people in hospitals w h o do n o t . " " H e has studied t h e p h e n o m e n a of h o p i n g a n d helpfully a r t i c u l a t e d t h e m in his book, Images of Hope. Several of his insights are worth mention. 1) Hope must be realistic in its appeal. Christianity at its best has resisted Gnostic dualism and kept its feet on the firm soii of Hebraic psychosomatic man. Never abstracted souls but souls in human bodies. It is important that it be differentiated clearly from the hopeless. They "must keep their absolute identities and not contaminate each other . . . . Not everything can be hoped for. ''8 If a ship goes on the rocks there is a great difference between hoping to swim to the near shore and hoping to reach the other side of the ocean. 2) Hope is most engendered by mutuality and an honest capacity to depend. "Hope is truly on the inside of us, but hope is an interior sense that there is help on the outside of us. ''9 3) Hope springs from a capacity to wish (not fantasy). The person who cannot hope is frozen in his wishing and needs a boost to his imagination. Often he is hooked on one end of a polarityi passivity vs. activity, dependence vs. independence, relationship vs. autonomy or love vs. hate. Without an imaginative reconstruing, he cannot hope for one without experiencing despair concerning the other. He needs to learn that he can love without denying his honest hate, that he can be in relationship without abandoning his identity to another, etc. M e n n i n g e r tells in his book Man Against Himself 2~ a b o u t a n e x p e r i m e n t p e r f o r m e d with rats p u t into water. Rats t h a t were given no visible m e a n s o f escape could sometimes swim for several hours. T h o s e that were p e r m i t t e d to see possibilities for the hope of escape could swim four or five times as long. N o r m a l l y , one would d e d u c e from this the biological a d v a n t a g e s of hope, but, as often as not, the suicidal p a t i e n t m i g h t envision the a d v a n t a g e s o f being a rat. For his p r o b l e m is often t h a t he is fixated on his tragedy. H e is almost

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hypnotized by it and is the victim of w h a t Erikson calls "totalizing," m a k i n g a part into the whole, m a k i n g a m o m e n t a r y misfortune into the total m e a n i n g of life. Incidentally, this is an identical parallel with the theological m e a n i n g of sin, which a m o u n t s to the idolatrous centering of one's faith on something less t h a n God, putting a part of reality in the place of reality. L y n c h relates the classic psychiatric joke about how people tend to brood until they e x p a n d their hopeless expectations out of all proportion: A m a n whose car broke down was trudging along toward a farm house a mile away, thinking his own dark thoughts. H e intended to ask for a jack. As he walked, a mental picture of the hypothetical farmer a n d his expected refusal grew in his mind. W h e n he finally knocked on the farmhouse door he h e a r d himself yell out, " Y o u can keep y o u r d a m n e d jack! ''21 H o p e c a n n o t be pushed. It must grow at its own speed. K a z a n t z a k i s has his Z o r b a the Greek say: I remembered one morning when I discovered a cocoon in the bark of a tree, just as the butterfly was making a hole in its case and preparing to come out. I waited a while, but it was too long appearing and I was impatient. I bent over it and breathed on it to warm it. I warmed as quickly as I could and the miracle began to happen before my eyes, faster than life. The case opened, the butterfly started slowly crawling out and I shall never forget my horror when I saw how its wings were folded back and crumpled; the wretched butterfly tried with its whole trembling body to unfold them. Bending over it, I tried to help it with my breath. In vain. It needed to be hatched out patiently and the unfolding of the wings should be a gradual process in the sun. Now, it was too late. My breath had forced the butterfly to appear all crumpled before its time. It struggled desperately and, a few seconds later, died in the palm of my hand. That little body is, I do believe, the greatest weight on my conscience. For ] realize today that it is a mortal sin to violate the great laws of nature. We should not hurry, we should not be impatient, but we should confidently obey the eternal rhythm. 22 T h e wise therapist does not try to plaster hope on the suicidal person but to evoke it out of the experiences of the patient. H a r r y Stack Sullivan's suggested question, " W h e n did all this begin?" forces the counselee to move back to a time before his despair, to a more favorable m o m e n t a n d context t h a t break him loose from the present. 23

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It is frequently to break the psychic logjam of hopelessness that an individual attempts suicide. Death has become his only hopeful goal. H e needs also the help of new goals, imaginatively explored, that will free him to act. Viktor Frankl reminds us in his book, From Death Camp to Existentialism, 24 that h u m a n beings can survive almost intolerable agonies if they can see before them possibility in the future. Something, some goal, some ideal, some person to love. When I was on sabbatical at the University of Hawaii, a young engineer about thirty years of age came to the door. He was handsome but depressed looking. H e had been directed to me by another professor. H e said, " W h a t do you have to say to someone who is about to die?" H e had a terminal illness and was having to give up his work, his girl, and his life. Suicide was in his thinking. W e talked many hours that day and others. One evening he called me to his apartment. H e couldn't see the use of going on. I was groping for some answer. Casually I asked, " W h y don't you adopt a war orphan overseas?" H e nearly.fell off his chair leaping at the idea. He had a goal, whether he lived or died. There was a meaningful continuity, some future. The change in him was visible. H e could perpetuate love in some real way. It is the death of love that evokes the love of death. This, of course, brings us to the most critical element in all considerations of suicide, the need for h u m a n relationship. With his frequent guilt and lowered self-esteem, the suicidal person needs to experience vividly the sense that it is all right for him to be. This fundamental affirmation and acceptance are the pivotal point from which all hope tends to move. Guilt usually weighs heavily upon the suicidal person. H e often hates himself and feels depressed and empty. He has rejected himself. At no other time can it naean as much to have a human being care about him, accept him, and affirm him. It is at this juncture that I think sometimes therapists run the risk of seeing all the guilt as neurotic. Nor would I side with Mowrer's caricature that all pathology or all guilt is authentic guilt (what Freud called "remorse"). It is often a confusing mixture of b o t h - - e n o u g h of each to reinforce the other. Dr. George Buttrick tells of watching a television enactment of a psychia-

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tric c a s e - d o c u m e n t a r y . A f o r m e r serviceman was being t r e a t e d for a t r a u m a t ic neurosis: His ship h a d been t o r p e d o e d in the Pacific. H e a n d a n o t h e r sailor h a d been on a life raft several days. O n e night his c o m p a n i o n slipped off a n d drowned. T h e psychiatrist w o r k e d with him to help him see that, after all, he was fatigued a n d w o r n - - " h o w could he be r e s p o n s i b l e ? " - - a n d ostensibly enabled him to work out of his guilt anxiety. Buttrick r e m a r k e d , " N e a t little t h e r a p y ! W h a t if the m a n h a d pushed his c o m p a n i o n off?." Is there ever a dimension of guilt t h a t goes b e y o n d our t h e r a p y ? T h e r e are times w h e n I a m glad I can say to a person, " Y o u are forgiven," times w h e n I a m grateful t h a t m y h o p e in a n d for m a n is based in a reality b e y o n d m a n t h a t enables m e to assert w h a t I believe will also last b e y o n d m y death.

RgfeTences 1. 2. 3. 4. 5. 6.

Lynch, F., lmages of Hope. Baltimore, Helicon Press, Inc., 1965, p. 37. Freud, S., A General Introduction to Psychoanalysis. New York, Liveright, 1935, p. 387. Dublin, L. I., Suicide. New York, Ronald Press, 1963, p. 104. 1bid., p. 119 ft. 1bid. Frankl, V. E., The Doctor and the Soul. New York, Alfred A. Knopf, Inc., 1955, pp. 53-54. Copyright 9 1955 and 1965, by Alfred A. Knopf, Inc. 7. Quoted in Sullivan, W., "Biologist Links Death and Sex." In "Preaching from Unexpected Places," United Church Board for Homeland Ministries. 8. Hiliman, J., Suicide and the Soul. New York, Harper & Row, 1964, p. 62. 9. 1bid., p. 61. 10. 1bid. 11. 1bid., p. 64. 12. Referred to in Lynch, op.cit., p. 74. 13. Jones, E., The Life and Work of Sigmund Freud. Edited by Trilling, L., and Marcus, S. New York, Basic Books, 1961, pp. 25-26. 14. Tillich, P., and Rogers, C., A Dialogue (given at San Diego State College, March 7, 1965). Robert Lee, ed. 15. Kobler, A. L., and Stotland, E., The End of Hope. London, Free Press of Glencoe, 1964. 16. Ibid., p. 10. 17. Lynch, op. cit., p. 185. 18. Ibid., p. 47. 19. Ibid., p. 40. 20. Menninger, K., Man Against Himself. New York, Harcourt Brace, 1938. 21. Lynch, op. cit., p. 205.

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22. Kazantzakis, Nikos, Zorba the Greek. New York, Simon & Schuster, Inc., 1952, pp. 120-121. Copyright 9 1952, by Simon & Schuster, Inc. Reprinted by permission of the publisher. 23. Lynch, op. cit., p. 35. 24. Frankl, From Death'Camp to Existentialism. Boston, Beacon Press, 1959.

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