Pat put on her glasses as if they might help her focus even more closely on the caller. If she felt any tension, her voice didn’t betray it. “Do you have any idea where she might be, places she might go? . . . Does she have a car? . . . Does she have any family? . . . Have you called them? . . . They’re looking for her? . . . What’s your friend’s name?” Pat’s voice softened. “Is it that you don’t want to give her last name? . . . If she calls us, can we call you?” Pat paused a moment. “Are you frightened? . . . What of? . . . We’re not the police. And even if we were, it’s not against the law to kill yourself. . . . Is there anything I can do to help you?” Pat’s head bowed over the desk. “If you are Susan or if you have taken the Percodan, you need to get to the hospital immediately.” There was a brief silence and then the sound of weeping spilled from the phone. “What has happened?” said Pat tenderly. “Why do you want to die?”
Pat was sitting on the edge of a plastic swivel chair, leaning over a desk in a corner of the “telephone room” at the Institute for Studies of Destructive Behaviors and the Suicide Prevention Center, commonly known as the Los Angeles Suicide Prevention Center, the oldest and most famous of the country’s suicide prevention centers. (In 1997, the Institute was dissolved; since then, the Suicide Prevention Center has operated under the auspices of the Didi Hirsch Community Mental Health Center.) Pat was a volunteer on its twenty-four-hour crisis line. She was alone in the room, but two other counselors were handling calls in nearby offices. Otherwise, the building was empty. On the desk in front of Pat were the tools of her trade: a telephone with four incoming lines, an array of directories, and two Rolodexes with nearly three hundred referral options organized by category: Alcohol, Battered/Rape, Bereavement, Child Care, Employment, Food, Free Clinics, Incest, Pregnancy, and so on. Next to the telephone lay a pack of cigarettes. Pat never smoked during a call, but her hand sometimes closed over the pack during stressful moments. Above the desk, a bulletin board was covered with schedules, newspaper clippings about suicide, notices of workshops on adolescent suicide, and a half dozen messages: “Steve, Ruth called back to say she now has a volunteer job and is feeling much better” and “Erica called to thank us; she’s feeling real good now” and “Vivien called to thank everyone for helping her son Rick. She said he’d called here a lot over the past 18 months.”
The other half of the room had the look of a college dormitory lounge. A television set and a sheaf of magazines sat on a round wooden table. In the far corner were two brown couches where volunteers on the one to seven a.m. shift catnapped during lulls. A large map of Los Angeles County hung on one wall. The room had one window, whose venetian blinds were closed. The sound of traffic seeped in. The building, a former convalescent home, was in an ethnically mixed neighborhood on the edge of downtown Los Angeles. (These days the center occupies two slightly spiffier rooms at the Didi Hirsch offices in Culver City.) To the east, the neon of bars and fast-food joints gave way to the lights of houses glittering against the Hollywood Hills. To the west, beyond the downtown area, lay the Pacific Ocean. Somewhere in between was a nineteen-year-old girl who sat in her bedroom sobbing, telling the woman in this room that she wanted to die.
As Pat tried to comfort the girl, she gathered information that might help her assess how lethal the situation was and what supports the girl might have to see her through this crisis. Like a climber struggling for a foothold on a steep rockface, she searched for a way to establish a connection. Though the girl sounded timid, despair made her stubborn: She kept coming back to her first question—would the nine Percodans kill her or leave her a cripple?
“Any medication could kill you; I don’t have that information,” Pat said. “Where is your pain coming from? Is it physical? . . . Have you spoken to anyone about it? . . . Does your therapist know how you’re feeling? . . . You called her? She’s away? . . .” Pat shook her head. “I don’t know. I don’t have that kind of training—and even a doctor won’t give you that information over the phone. . . . Do you live with your family? . . . Are you close to your father? . . . How about your mother? . . . Have you talked to her about this? . . . Why not? . . . What would she say if you told her? . . .” Pat twisted slightly in her chair. “It must be hard when those you love are so far away from how you’re feeling.” She was silent for a moment, listening to the girl’s quick, anxious breaths. “You don’t trust me at all, do you?” said Pat kindly. “I won’t hurt you—I promise that.”
This was the eleventh call Pat had taken since beginning her shift at 6:30 p.m. The crisis line at the SPC receives an average of fifty-five calls a day from people who are lonely, depressed, angry, and perhaps suicidal. The lines are open twenty-four hours a day, 365 days a year. The SPC is the only suicide prevention center or twenty-four-hour general-purpose crisis line in Los Angeles County. When other hotlines and therapists close up shop for the day, many of them leave the SPC number on their answering machines for callers in crisis after office hours. Although the SPC has four incoming lines, the phone company has told the center that during its busiest hours, 7 p.m. to 1 a.m., callers must sometimes dial five or six times before they can get through.
The SPC keeps careful records of who calls and why. (After each call, the counselor types a summary of the call into the computer database and assigns it a lethality score on a one-to-five scale, with one denoting “thoughts only, no prior attempt,” and five being “potential or imminent attempt or attempt already in progress.”) They have learned that calls come from as wide a range of people and problems as seem to exist. The vast majority are from the troubled person himself. The rest are from third-party callers—concerned relatives and friends not knowing what to do about a despairing loved one, physicians or therapists seeking advice on how to handle a suicidal client. Nearly two-thirds of the calls are from women. While most calls are from the Los Angeles area, they have come from as far away as Iowa, Florida, and France. In 2003, one-third of the SPC’s calls were from people under the age of eighteen—a 300 percent jump over fifteen years earlier. Once, an eight-year-old boy called. He was lonely, he told the counselor. His mother traveled a lot on business, and he worried that he was the reason she was never home. Later, the counselor called the boy’s mother. She was initially outraged at the intrusion, but when she realized that her son had been upset enough to call a suicide prevention center, she listened.
Although the notion of a suicide prevention center may conjure images of heroic volunteers talking desperate people into putting down a loaded gun, the majority of calls are much less dramatic. Most callers to the SPC or to any of the more than six hundred suicide prevention and crisis centers in the United States are not in immediate danger of killing themselves. This has led some critics to suggest that most people who call a prevention center don’t really want to die. The SPC agrees. They believe that even the most desperately suicidal people are ambivalent—a part of them wants to live, and a part of them wants to die. By calling the center they have issued a “cry for help.” Nevertheless, many of those who call the center are at risk for suicide. A previous attempt is the most accurate predictor for subsequent suicide, and nearly half the people who call the SPC have made previous attempts. Three percent of the calls are considered emergencies—either the caller is believed to be in imminent danger of making an attempt, or she has already swallowed pills or cut her wrists and may die unless the SPC gets her immediate help.
Although contemplating suicide is not a prerequisite for calling the crisis line, counselors are trained to ask specifically about suicide on every call. “And we don’t ask whether they’re ‘thinking of hurting themselves’ or ‘thinking of doing something to themselves,’” Karl Harris, a burly ex-policeman who directed the crisis line for several years, told me. “We ask, ‘Are you thinking of killing yourself?’” It can be a difficult question to get used to asking. When Harris worked with thirteen streetwise hostage negotiators, who manned the lines as part of their training, he couldn’t get them to ask the q
uestion without pussyfooting around—they were afraid of putting the idea in the caller’s mind. But it won’t, according to Harris. “People will lie about everything else on the phone, then you’ll ask, ‘Are you thinking about killing yourself?’ Instant truth. If they’re not, you’ll hear, ‘Good God, no way.’ If they are, you’ll hear a sigh of relief: ‘Yes, I am.’”
About a third of the calls to the SPC are suicide-related. The rest are crisis-intervention inquiries not necessarily related to a suicide threat. The calls Pat had taken so far that night included an elderly widow who lived alone and said she wanted to kill herself (“What is life if you have no friends and your children don’t give a shit about you?” she sobbed); a woman worried that her teenage son, who was terrified that he might be gay, was considering suicide; an alcoholic who was drunk and said he wanted to die; a gay man who wanted and didn’t want to take the Valium he said he had, and had tried thirteen other hotlines that night, all of which were busy or had shut down for the evening; a seventy-three-year-old man who was drinking and “thinking of doing himself in”; a brain-damaged, middle-aged “chronic” caller who telephoned almost daily for an emotional boost; a forty-six-year-old woman who had just swallowed seven sleeping pills; a psychotic twenty-three-year-old man who was brilliant, incoherent, and angry. The callers seemed to have little in common except that they felt the world was closing in on them and they had no alternative but to depend on the kindness of strangers.
Karl Harris liked to compare the crisis lines to a hospital emergency room. “We’re an ER for people with emotional problems,” he told me. “They come to us, and like an ER, we do triage; some just need aspirin or a Band-Aid, some need to be seen again, and others need extensive patching and follow-up.” With each caller Pat was trained to assess the immediate risk of suicide, listen to the person’s story, focus on the problem, and discuss possible options. Each caller had a different need, and it was up to Pat to help the caller decide what might best fill that need. To the infirm, elderly widow, Pat provided several names and numbers and said, gently but firmly, “Tomorrow, call the seniors group, and go to the doctor and get some answers about your physical condition. If you need to call us before you go to the doctor, please do. Now get yourself a Coke and a book and try to relax tonight.” To the mother of the gay youth, she interspersed her sympathetic remarks with urgent suggestions; the boy needed professional help, she said, giving her the number of a gay community service group and urging her to persuade her son to call the crisis line. “Put a card with our number on it by his bed,” she said. To the elderly alcoholic she gave a referral to the nearest Alcoholics Anonymous meeting and some reassurance (“We’re here,” she said kindly when he fretted she had left the line. “We’re not going anywhere”). To a lonely, middle-aged woman she described the kinds of counseling available and patiently gave her directions to a local clinic. “Sally, are you going to be okay tonight?” she said. “If you feel worse, will you give us a call back? . . . I’ll be thinking of you.”
Pat tailored her approach to fit each caller. With the older woman she was motherly. With the psychotic young man she patiently absorbed his anger. With the man who, like certain other “chronic callers,” had a time limit on his calls, she was gentle but firm. “Well, my friend, I’m going to have to hang up now,” she said when his ten minutes were up. With the young gay man she was supportive but forceful: “You don’t sound like you mean it,” she said after he agreed to call back if he needed to. “You sound as if you’re saying it because you think that’s what I want to hear.” Pat’s voice inspired trust and confidence; even when the risk seemed high, she never seemed anxious herself, although in a moment of extreme stress she might sigh and say, “Oh, mercy.” Every caller was taken seriously, even one who apologized for dialing the wrong number, to whom Pat said warmly, “I’m glad you did”—in case he had the right number and was too scared to talk. Pat took nothing for granted; each caller was unique, each call its own world. And although she seemed so relaxed and sure, at one point after a difficult call she turned to me and admitted, “The longer I’m here, the more questions I have—and the less I know.”
The girl was no longer crying, but her breathing was heavy. Slowly, Pat had established a thin ledge of trust. “Did something happen tonight?” she asked. “Can you tell me what that was? . . . Was it something someone said? . . . Who?” After each question Pat let the girl’s answer settle for a moment before continuing. “What did he say? . . . Have you talked to him about it? What kind of compromises? . . . Sexual things? . . . Is this the person you want to spend your life with? . . . You care for him too much to leave him, but you have a hard time staying with him?” Pat paused. “You know, suicide is a permanent solution to a temporary problem. . . . Is your fiancé in counseling? . . . Do you think you’re ready to share your life with someone who thinks he’s perfect? . . . Would it be so terrible to end your relationship with him rather than end your life? . . . Why? . . . How do you know you can’t live without him? . . . You tried? . . . Maybe a month isn’t enough. . . . Everything changes. Nothing stays the same.” Pat hunched over, her elbows on her knees. “Have you ever told him you were thinking of killing yourself? . . . What does he say? . . . He doesn’t believe you? . . . Have you talked to him tonight? . . . How did you end the conversation?” Pat listened to the answer, then repeated it softly to herself: “Sweet dreams.”
Pat, who makes a living raising orchids, had worked on the crisis lines for ten years when I met her. Like many of the center’s 130 volunteers, she became involved after suicide touched her own life when her nephew killed himself. A friend told her about the Suicide Prevention Center. Pat had never heard of it. But she called the center and enrolled in their support group for family and friends left behind after a suicide. When she finished the program, she decided she wanted to work on the telephone lines. Like many of the volunteers, Pat thought she would be getting into the business of saving lives. At her first interview she was asked why she wanted to work on the lines. “Because I want to help people,” she said. Pat laughed, remembering. “I wanted to be the Band-Aid queen. I thought I’d save the world. Of course I found out it wasn’t quite like that.”
Although many of the crisis line volunteers are graduate students in psychology or social work, many, like Pat, have full-time jobs and work at the SPC in their spare time; among the center’s volunteers are a mailman, a screenwriter, an actor, a UCLA professor, a massage therapist, a computer programmer, an FBI agent, a retired stockbroker, and several full-time parents with time to spare during the day when their kids are in school. Training for the lines is rigorous. If the volunteer passes the initial interview, she (three out of five volunteers are female) attends seven all-day training sessions over two months. About half the training is devoted to lectures and discussions by the SPC staff and guests on suicide risk-assessment, mental illness, substance abuse, domestic violence, teen suicide, gay and lesbian youth, chronic callers, and survivors after suicide. The other half is spent role-playing in small groups where the trainee handles simulated calls from a variety of clients: gay callers, abusive or obscene callers, alcoholic callers, help-rejecting callers. There is homework: required reading of selected papers and articles on suicide. The prospective volunteer must also put in at least three sessions of “observation,” listening in while an experienced counselor handles actual calls. “We look for volunteers who know how to listen—which is not as easy as it seems—and who are flexible, open-minded, and able to empathize with callers from a wide variety of backgrounds,” says crisis line coordinator Sandri Kramer. Applicants who have been depressed or suicidal are not automatically rejected—in fact, says Kramer, they often make good counselors because they know whereof their callers speak—but they must show evidence that they are strong enough to handle the work. Those who have recently lost a family member or close friend to suicide are encouraged to wait a year or so, until the wound isn’t quite so fresh. Of every fifty applicants, about th
irty-five complete training and are invited to work on the lines. Once accepted, volunteers agree to work a four-hour shift each week for a minimum of one year.
Most suicide prevention lines base their work on “active listening,” a technique generally attributed to the psychologist Carl Rogers, founder of “client-centered therapy.” In “active listening” the listener affirms what the caller is feeling. If the caller says, “I feel really awful,” the listener might say, “It sounds as though you’re feeling pretty awful.” As the caller vents, the volunteer listens actively until the crisis has passed, then perhaps offers a referral. In fact, the SPC’s “active listening” has become a little more active. The staff has found that an increasing number of their callers are chronic, and counselors are urged to make sure that these callers have followed through on previous recommendations. At other centers, volunteers are “workers,” “listeners,” or “befrienders”; at the SPC they are “counselors.” The SPC counselor is trained not merely to listen but to probe, to ask questions, to solicit information, to sort through options, and to help the caller come up with a plan of action. But counselors must not make decisions, give answers, or pass judgment. Above all they are forbidden to play God or therapist. Former crisis line coordinator Beverly Kalasardo recalls one counselor who was dropped from the lines: “He wanted so badly to help the callers that he almost wanted to change their lives. He heard someone needing help and thought, ‘Quick, we have to fix it!’ When he couldn’t, he sometimes got angry. . . . Most of our callers would like us to fix their lives, they’d like to drop their problems in our lap. They tell us there’s nowhere to turn, but there usually is. And we have to help them find that person or place. I think if we had a motto, it would be to help the callers help themselves.”
November of the Soul Page 42