November of the Soul

by George Howe Colt

  Completers tend to be older than attempters; 50 percent of all attempters are under age thirty; attempts peak between sixteen and eighteen years of age. Completers tend to be male: four times as many men as women kill themselves. Attempters tend to be female: three times as many women as men attempt suicide. “Suicide is masculine, suicide attempts are feminine,” summarizes Diane Ryerson, a social worker who runs suicide prevention programs in the schools. “Girls use it as a form of communication, guys use it to permanently punish.” In Night Falls Fast, psychiatrist Kay Jamison suggests that part of the gender disparity is attributable to the fact that females are at least twice as likely as males to suffer from depression. “Although depression is more common in women, their depressive illnesses may be less impulsive and violent than those of men; this in turn may make women less likely to use violent methods and more likely to use relatively safer means such as self-poisoning,” she writes. Seventy-five percent of completers shoot or hang themselves, while 70 to 90 percent of all attempters swallow pills and about 10 percent cut their wrists, methods that allow more time for rescue. Men, Jamison adds, are more likely than women to feel there is a stigma attached to a “failed” attempt; less likely than women to seek psychiatric help; and far more likely to abuse alcohol or drugs and to own guns—risk factors that make a suicide attempt more likely to end in death. Attempts are often made in settings that make survival not only possible but probable. Ninety percent of adolescent suicide attempts take place at home, 70 percent while parents are in the house.

  Given these figures, it is tempting to assume that people who complete suicide truly want to die and people who attempt merely want attention. However, many people who complete suicide don’t intend to die. Some lack knowledge of pharmacology and unintentionally overdose. Some mistakenly count on rescuers arriving in time to save them. On the other hand, some attempters who seem bent on dying end up living. People have survived six-story jumps or bullets in their heart. In King Lear, when blind Gloucester leaps from what he believes is a Dover cliff but is actually level ground, he is, in intent, making a serious suicide attempt. With adolescents, who are prone to risk-taking behavior, the line of intention is particularly difficult to draw. Suicide attempts range from swallowing a dozen aspirin in full view of one’s mother to jumping off the Golden Gate Bridge. Clearly, one attempter has a greater determination to die than the other, but every suicide or suicide attempt has its own degree of ambivalence. “Most people who commit suicidal acts do not either want to die or to live,” psychiatrist Erwin Stengel has written. “They want to do both at the same time, usually the one more, or much more, than the other.”

  While a suicide attempt is a move toward death, it may also be a way of moving toward other people. The person who threatens to jump from a building is an example. “The man up there is saying, ‘Look at me. See how bad I feel,’” says psychologist Norman Farberow. “Sitting on the ledge of a building is a tremendous effort at communication.” People use such an extreme form of expression—“a desperate version of holding their breath until turning blue,” psychiatrist Mary Giffin has called it—because other forms have failed or because they have never learned more effective ways of asking for help. It may also be a last-ditch attempt to change a seemingly intolerable situation. In A Cry for Help, Giffin described a thirteen-year-old Illinois girl who, one week after her father moved out of the house, slashed her wrists in the bathtub shortly before she knew her mother would be bathing. “I didn’t really want to die,” she said later. “I just hoped and prayed that if Mom and Dad knew how upset and unhappy I was, Dad would move back in.”

  Clinicians have used a variety of expressions to describe such lowlethality attempts: manipulative behavior, histrionic suicide attempts, abortive suicides, fake suicides, psychological blackmail, suicidal gestures. Because death is clearly not the object, these attempts are often dismissed as not serious. But the line between serious and not serious is a fine one. “Gesture?” says Warren Wacker, former director of Harvard University Health Services. He smiles ironically. “If someone slashes her wrists lightly, it’s a gesture. If she cuts deeper, it ain’t.” As Wacker suggests, making that distinction can be dangerous. “Clinicians use these terms pejoratively,” says psychiatrist Douglas Jacobs, “but just because an attempt is minor does not mean a patient is not suicidal.” A Michigan youth hospitalized after a suicide attempt was chided by the doctor, “This wasn’t very serious, was it?” The young man says, “It’s like if you’re saved, it wasn’t serious. If you succeed, they should have taken you seriously.” Indeed, those who make a low-lethality attempt may be even more troubled than those who make a medically serious attempt; one study concludes that they are more likely to have chronic psychiatric problems, a higher number of previous attempts, and greater rates of physical or sexual abuse. Those who make repeated low-lethality attempts, often by wrist-cutting or overdosing, may be another psychologically distinct group: they generally use self-destructive behavior as a way of dealing with stress, tend to have more chronic symptomatology, poorer coping skills, and a higher rate of suicidal and substance abuse behaviors in their family histories.

  Clinicians and parents, dismissing an attempt as attention-getting, may refuse to give that attention—or they may give the wrong kind. Some doctors show anger toward attempters: A woman who had made numerous cuts on her wrists was told by her emergency room physician, “If you really want to do a good job, why don’t you just take a knife and make a real good, deep cut.” A sixteen-year-old Texas girl who slashed her wrists says, “The doctor told me he’d sew me up so I could see the scar and for the rest of my life I would never forget what I’d done. And he did, too.” Parents—anxious, terrified, angry—may minimalize or deny the attempt. One study found that only 38 percent of treatment referrals after an adolescent attempt were acted on. Another found that only 41 percent of families came for further therapy following the initial session. “It’s often difficult to get parents to acknowledge the problem because they are the problem,” says child psychiatrist Peter Saltzman. After making an attempt, one of Saltzman’s patients was told by his father, “Next time, jump off the Bourne Bridge.”

  An adolescent whose suicide attempt is belittled or ignored may feel forced to take more drastic action. One young girl, after an argument with her parents, slashed her wrists lightly. For several mornings in a row she appeared at the breakfast table wearing short-sleeved shirts that clearly revealed her fresh scars. When this attempt at communication failed, she slashed an artery.

  If dealt with improperly, a “failed” suicide may lead to a face-saving “success.” Long-term follow-up studies show that 10 to 15 percent of those who attempt suicide will eventually kill themselves, 2 percent within a year. An estimated 25 to 40 percent of those who complete suicide have made a previous attempt. Among adolescents, those who have attempted suicide are at far greater risk for completing—one study puts the figure at three times greater for girls, thirty times greater for boys. In A Cry for Help, the authors describe a lonely sixteen-year-old Minneapolis boy who believed his father paid more attention to his Cadillac than to his son. One night after leaving a note on his bulletin board saying that he was an outcast at school, he stole the keys to the Cadillac and smashed into an oak tree in the front yard. After spending several months in the hospital recuperating from his injuries, he was pronounced “straightened out.” But he came home to find little had changed. Eight months after his first attempt, his mother found him behind the wheel of his father’s brand-new Cadillac, dead from carbon monoxide poisoning.

  A bright, outgoing girl, Dana Evans received good grades in elementary school, played war with the neighborhood kids, and went home to a hot supper each evening in a split-level ranch house in a small town eighty miles north of Manhattan. “We had a dog, two kids, a two-car garage, and two cars,” she says with a touch of sarcasm. “It was all so perfect.” But all was not so perfect. At nine months she developed spinal meningitis, and not l
ong afterward her mother noticed Dana had difficulty bending her right leg. Over the next eighteen years dozens of specialists would be unable to pinpoint the problem. As a child Dana did prescribed exercises daily, had a slight limp, and wore a shoe with a built-up sole to compensate for her shorter left leg. At school she was called names like “peg leg” and “the polio kid.” Although Dana tried to ignore the taunts, she was self-conscious about her leg and never wore a dress except on Thanksgiving and Christmas.

  Dana was also affected by the friction between her parents. She felt intimidated by her father, a quiet, remote engineer whom she desperately wanted to please. He often gave her the vague feeling that he would have preferred a son. When she was seven, he asked her if she wanted to be in a swim meet. She said yes. “When the gun went off, everybody dove in except me,” Dana recalls. “I didn’t know that was the signal. Eventually, I dove in. Halfway down the pool I started crying because everybody else had finished and I was still in the middle of the pool.” But Dana was determined to please her father, and she doggedly went to swim practice. Swimming soon became an important part of her life.

  When Dana was nine, her parents separated, and she and her mother and older sister moved into a massive apartment complex in a neighboring town. To support the family Mrs. Evans returned to work full-time as a secretary and also took a weekend job as a waitress. To relieve her loneliness she went to singles bars with friends several nights a week. “Before, my mother had always been there when I came home from school,” says Dana. “Now I had to carry a key because I was the first one home. At first I thought, ‘Hey, this is great—no one around to tell me what to do.’” Dana learned to smoke, and she and her sister smuggled boys into the house when their mother was out. “But after a while it wasn’t so much ‘Great, there’s no mother around,’” says Dana, “as ‘Where’s my mother?’”

  Even when Dana’s mother was home, there was little communication. A pragmatic woman, Mrs. Evans had her hands full trying to support her family and move on after her divorce. She was reluctant to discipline her daughter because she felt Dana had suffered enough already from the leg problem. When Dana didn’t do her chores, her mother overlooked it. When she caught Dana smoking, she let her off with a warning. When Dana got drunk for the first time, her mother said, “All kids try it—just don’t make it a habit.” Dana found herself wishing that she could get a stronger reaction from her mother. Dana never talked about her problems, and her mother rarely asked. “I don’t think we ever sat and chatted about our feelings,” says Mrs. Evans. “I think it’s because parents in my generation did not. Adults were adults and children were children. There was no such thing as ‘parent effectiveness training.’ Today, if the kid comes home and kicks the cat, you’re supposed to say, ‘Did you have a rotten day at school?’ Back then you’d scold them for kicking the cat! My father and mother didn’t deal on a feeling level with each other, let alone with their children.” She shrugs. “So my children and I did not get into personal, emotional subjects. But I perceived that as being the way all parents were with their children.”

  Dana’s father, who lived with his second wife and her two daughters, was even less of an influence. Dana dreaded their weekends together. Although he rarely criticized her, she believed that nothing she did ever pleased him. Yet she longed for his approval. One day when Dana was thirteen, after picking up Dana and her sister for the weekend, her father told them that his company was transferring him to Texas. Dana felt wounded. “I think I knew rationally that he was not moving to get away from us, but I didn’t understand why he wanted to move so far away when his children lived here,” she says. “I remember feeling, ‘Jesus Christ, if they transferred you to the moon, you’d go.’”

  Dana also had difficulty getting noticed at school. Because of a series of operations on her knee, she missed fifty-three days of her seventh-grade year and found it hard to make a place for herself in the huge new junior high. “At school there were the jocks and the nerds and the heads,” she says. “I swam, but for a club team, not for the school, so I wasn’t a jock. And I had a deep aversion to the nerds. That’s not a group you become a member of by choice; you’re born into it. So I never really fit in anywhere.” But late in her seventh-grade year, when Dana was twelve, she found a way of belonging. A classmate asked her if she wanted to buy a joint, and Dana said sure. “I took it home and hid it in the back of my desk, and one afternoon after school I sat on my bed and smoked it. It was great. I loved being high. It put me in such a different head than I had been in all my life. Everything looked so different. Everything looked okay.”

  Once Dana found an identity, she pursued it with a vengeance. Dana and the other druggies would meet at lunch in the woods in back of school and get high. She stopped wearing the corduroy slacks with color-coordinated blouses that her mother bought her and wore old jeans, T-shirts, and concert jerseys emblazoned with the names of favorite rock bands. She wore mirror sunglasses and a cloth cap pulled low over her eyes. A Walkman filled her ears with rock music. From her weight lifting and swimming she developed huge shoulders, arms, and biceps, which she liked to show off by rolling up her sleeves. She cultivated a swagger and a glare that kept people at a distance. She became friends with a tough girl named Stacey. “We’d meet in the girls’ bathroom and get high next to the open window so no one could smell anything,” says Dana. “If anyone was there when we went in, it was like ‘This is our office, get out.’ And they would.”

  Dana also began to drink heavily. She had first tasted alcohol as a child when, fetching beers for her father, she was rewarded with the first sip. At age eleven, at a family dinner in an Italian restaurant, she and her cousins managed to sneak a carafe of wine down to the children’s end of the table. Dana drank most of it and blacked out. By thirteen she was stealing from the liquor cabinet and pouring water into the bottles so her mother wouldn’t suspect. “She kept one bottle of everything, so I’d take a little of each and have a mug with vodka, gin, and bourbon.” By the end of eighth grade, Dana was drinking or getting high almost every day.

  As Dana began to get attention for the first time, her behavior became more and more extreme. “In trying to fit in somewhere and to get people to realize that I existed, I did some really weird things.” In the hallways she was apt to push girls up against a wall and threaten them. In science class she stole her classmates’ lab books, ripped out their homework if they were ahead of her, and poured hydrochloric acid on their experiments. She even intimidated some of the teachers. At the end of class when her science teacher asked the students to push in their chairs, Dana glared at her and kicked her chair out from behind her. “My general attitude toward the world was ‘Don’t mess with me or I’ll kill you,’” says Dana. “I loved it when people were scared of me.” Dana was proud of her new nickname: Tuffie. She liked the idea that she cared about nothing, and nothing could get to her.

  For years swimming had been the one thing Dana truly cared about. She loved the feel of her body hitting the cold water and the grueling discipline of laps. During the day she might get high, mouth off to teachers, and wear sloppy clothes, but every weeknight she worked out with her club team. “I occasionally went to school,” she says. “I always went to practice.” But the more she partied, the more practices she skipped. Sometimes she’d show up high. She kept a pint of J&B Scotch in her gym bag, which she sipped on “trips to the bathroom.” She quarreled with the coach, a gentle, earnest man who had gone out of his way for Dana ever since she had joined the team, picking her up for meets and staying late to help her develop a new racing start because her knee didn’t bend enough for the standard position. After a race she would ignore his congratulations, leaving him standing there with his hand out. Sometimes she swore at him or gave him the finger. “I’d get kicked out of practice about once a week,” she says. “Afterward I’d try to apologize, but it would come out all wrong. He’d say, ‘You can’t tell me to go fuck myself in front of the other kids,’ a
nd I’d want to say, ‘I don’t know why I swear at you because I really like you,’ but I’d end up saying something stupid like ‘Well, you deserved it.’ And he’d say, ‘Don’t talk to me like that.’ And I’d say, ‘Well, fuck you.’” Dana shrugs. “I wanted to be friends with him, but I was holding back so much from everything. I was like a snake keeping people away from me.”

  In March of Dana’s junior year she and her coach argued over whether she would be allowed to miss part of an important meet to attend the junior prom. The coach excused her from a few events. Dana says, “If you don’t go to the prom, the word is out, like ‘She’s a loser, she’d have to pay somebody to take her.’” Nobody had asked Dana, so, as time was running out, she invited a boy in her chemistry class whom she hardly knew. “It was a disaster,” she says. “We were assigned to a table with people we didn’t know. We hardly talked the whole night. Afterward we went with another couple to an Italian restaurant where I got smashed. My date didn’t drink a drop. He thought we were all pretty stupid. So the rest of us drank and drank and drank, and then we all drove down by the tracks to watch the sunrise. I passed out in the car.”

  Four hours later Dana stood on the starting block for the hundred-yard freestyle. She was still drunk. “When the gun went off, I dove into the water and my stomach turned. I swam to the other end, did a flip turn, swam back, and did another flip, and when I came up and took a breath, I got some water in my mouth, which happens occasionally. But this time I just stood up and got out of the pool. It was the first time I had ever not finished a race.”

  Dana stayed on the team for two more months. One day in June she threw her sweat suit at the coach. “I don’t need your shit anymore,” she said, walking out. “Swimming was my life,” says Dana. “I spent ten years doing it, and in one day I just threw it all away.”