Occasionally, a caller is in a crisis in which he cannot be helped to help himself, and more direct action is needed. While some prevention centers, to preserve confidentiality, do not trace calls or mediate with third-party callers, the SPC does both. (In recent years, the counselors’ task has become harder because an increasing number of callers use cell phones, which are difficult, although not impossible, to trace. Another telephonic advance, caller ID, has made their job easier by enabling them to recognize previous clients.) Although “we try to avoid it as much as possible because it can be so traumatic,” says Sandri Kramer, about once a week a counselor must send the police or an ambulance to a caller’s home. In keeping with the SPC’s philosophy of helping the clients to help themselves, the counselor will first try to get the caller or someone else in the home to take such action or at least agree to let the counselor do so. If the caller refuses to give his address, the counselor will try to keep him on the line long enough to trace the call (which can take several hours) and dispatch emergency help.
More often, however, a counselor will maneuver behind the scenes. Beverly Kalasardo was on the line when a fifteen-year-old girl in tears called from her high school. Her boyfriend had just received his grades and realized he was going to fail. Making her promise not to tell anyone, he told the girl he had a shotgun and was going to kill himself. Kalasardo calmed the girl as they tried to find a solution. They couldn’t talk to the boy’s parents; his father was an abusive alcoholic, and his mother wouldn’t have cared. They couldn’t talk to her parents; they didn’t like the boy either. Kalasardo asked the girl if she would feel comfortable talking to the school counselor. The girl said no. “I asked her if I could, and she said yes,” recalls Kalasardo. “So I called the counselor and explained the problem. Meanwhile, the girl talked to their friends, who walked the boy from class to class. The counselor called the boy in, and without letting him know he knew about his plans for suicide, told him he had been looking at his grades, and while it was a shame that they were low, he could go to summer school and pull them up without hurting his record. The boy hadn’t thought of this option and was relieved. He told the girl. She called me. Later, she wrote me a nice thank-you letter.”
Endings are not always so happy. The SPC has estimated that between 1 and 2 percent of its callers eventually commit suicide. Although they don’t make a point of reading the obituaries, the staff members occasionally find out. When this happens, they meet to share their grief and to talk about how the caller had been handled, what might have been done differently, and what might be done in the future. One of the most disturbing deaths occurred when a shy, young, unemployed accountant who had worked as a volunteer on the lines became depressed and suicidal. One day he called and told a volunteer he was going to kill himself. He asked the volunteer to call the police because he was terrified that his body might lie undiscovered for a long time. Keeping the young man on the line, the volunteer had another volunteer call the police. While the volunteer was still on the phone, the man shot himself the moment he heard the police knock on the door.
Such incidents explain why SPC staffers stress the importance of recognizing one’s limits. “A lot of you came here thinking, ‘I’m going to give these people something magic,’ “ Kalasardo used to tell each new class of trainees. “I know I did. And it was a rude awakening to realize I couldn’t. Please understand your limitations. You’re going to want to take them by the hand and lead them to a new life. But you can’t. There is no special magic that will give a caller a new life or that will keep a caller from committing suicide if he really wants to. All you can do is listen, really listen. That’s what people need when they’re hurting. You may think that listening’s not very much, but you may be the first person to ever listen to them. And you may be the last.”
It was past eleven. As the city of Los Angeles began to fall asleep, the volunteers at the center were trying to put people to bed, like air traffic controllers trying to talk pilots down through heavy storms for a safe landing. But some did not want to come down and ended up circling, circling. As the call continued, Pat leaned still lower over the desk and held the phone even tighter against her ear, as if by sheer will she might be able to squeeze across Los Angeles to some unknown room and sit beside this nineteen-year-old girl. They had been talking for more than an hour. Pat could feel the girl, like a fish on a line, pull away, then come closer, then pull away again. Pat was trying different approaches, her voice now a little softer, now probing, nudging, but never losing its concern. She asked fewer questions and offered more suggestions. Although the girl had opened up a little, her voice was still a small, thin monotone, and she kept coming back to the Percodan and whether nine would be enough.
“Are you determined to take those nine Percodan?” Pat asked. “I can’t stop you. I hope you don’t do that. . . . I think you’re making a mistake. . . . It’s going to take a little more strength to choose a different option.” Her voice became firmer. “No, you haven’t. You have not tried everything. . . . I suspect you’re stronger than you sound. . . . I think you deny your strength.” Pat sensed the girl retreating. “I can’t give you anything you don’t already have. But I don’t want you to hurt yourself. I don’t want you to kill yourself. Do you think you can get through tonight?” Pat paused. “You may be moving into a place where you are going to have to grow, and that may feel very threatening to you. But you need to share this with your therapist. Will you call her tomorrow? . . . Would you let me call her tomorrow? . . . Have you thought about changing your therapist? . . . Why don’t you ask your psychology teacher to suggest a therapist? . . . Why would it embarrass you? . . . But you’re not crazy.” Pat was silent for a moment. “Go to that teacher and ask for a therapist.” Pat listened. “One more thing: If you’re thinking of killing yourself at any point again, will you call us first? . . . Will you? . . .” As the girl apologized for taking up so much of Pat’s time and thanked her for listening, Pat imperceptibly shook her head, then said softly, “Thank you for calling.”
After the girl hung up, Pat held the phone in midair, staring at it as if more words or tears might still pour out. Then she gently set it in its cradle. She let out a deep sigh. “Oh, mercy,” she said. It was 11:20, and she had been on the phone for eighty minutes. “I think she’s going to kill herself,” she said, “or at least make an attempt.” For the first time since she’d taken the call, she sounded tired and a bit defeated. “I told her I can’t keep her from killing herself, but also you have to remember you can’t make her kill herself.” She shrugged. “You have to hold on to that, working here.” Pat nodded her head slowly, sadly. “She hung up crying, and when I picked up the call, she was crying.”
Another counselor who had also just finished a call walked in and plopped down on the couch. The SPC stresses the importance of talking over each call afterward to give oneself time to recover before the next and to help forestall burnout. (The average volunteer works on the lines for about two years.) “I really felt I took it as far as I could,” Pat said to her colleague, “that if we went any further, we’d get redundant.” She began to write up the call, then looked away. “She was the most fragile caller I’ve ever had,” she said. “It was like trying to hold water in your hands. It just keeps slipping through.” Pat was quiet. For eighty minutes she had been aware only of the girl, of the sound of their voices meeting in the phone. Now the world began to come back. The sound of traffic spilling through the venetian blinds was softer now, almost soothing. It was 11:30. The phone rang. Pat put on her glasses, picked up the receiver, and in a warm, gentle voice said, “Hello, can I help you?”
II
SUICIDOLOGY
SUICIDE PREVENTION is not a new idea, but the use of kindness, care, and patience, as demonstrated by Pat and the SPC, is by and large a twentieth-century development. The first recorded instance of suicide prevention occurred in 600 BC when Roman soldiers, forced to cut drains and sewers, considered the work beneath a war
rior’s dignity and threw themselves off the Capitoline Rock. The epidemic abated only when the king, Tarquinius Priscus, ruled that soldiers who killed themselves would be crucified in public and abandoned to the birds and beasts of prey. For the next two millennia desecration of the corpse, confiscation of property, exorcism, and sermons enumerating the tortures of hell were what passed for suicide prevention. Although an occasional clergyman earned a reputation for his ability to rid suicidal people of their demons, or an asylum director gained renown for the efficacy of his “moral treatment,” the notion that suicidal people should be helped rather than terrorized didn’t take root until 1906, when Henry Marsh Warren founded the National Save-A-Life League.
Warren was a thirty-nine-year-old Baptist minister who left his New Hampshire parish to go to New York City, where he became pastor at the Central Park Baptist Church. He also held regular services in hotel lobbies around the city for what he called The Parish of All Strangers. One evening a twenty-year-old girl staying at a Broadway hotel called the manager and asked to speak to a minister. The manager was unable to reach Warren that night. The following morning a maid found the woman unconscious, an empty bottle marked POISON nearby. She was rushed to Bellevue Hospital, where Warren went to her bedside. The girl told Warren she was from a small West Coast town, had been jilted by her boyfriend, and had come to New York, where nobody knew her, to kill herself. She had wanted to talk to a minister first, she said, but had been too miserable to wait. “I think maybe if I had talked to someone like you,” she told Warren, “I wouldn’t have done it.” Not long afterward she died.
If in its many retellings over the years the story of the young woman and the minister has gained a suspiciously smooth veneer, the result of their meeting is indisputable. In his next sermon to The Parish of All Strangers, the shaken Warren described the girl and cried, “I wish that all who believed that death is the only solution to their problems would give me a chance to prove them wrong.” He placed an ad in the newspaper urging anyone considering suicide to call on him. In the following week eleven people appeared. All of them admitted they had decided to kill themselves, yet all were eager to pour out their despair. Warren listened. All eleven eventually abandoned their plans. Warren gave up his pastorate, set up an office in his home on Washington Square, and devoted himself to what he called the National Save-A-Life League.
The idea that someone might welcome dealing with suicidal people was novel, and ministers, doctors, and social workers were delighted to send these troublesome people to the league. (At the turn of the century many physicians, in fact, refused to treat suicidal people, who were believed to be insane or doomed to suicide by heredity; suicide was a crime and a sin, and the medical profession did not wish to contaminate itself with such cases. Suicidal people were scorned, ignored, or locked up in mental hospitals.) Newspaper stories and word of mouth drew others, and soon about eight people a day were arriving at the league’s offices, where they were treated with what Warren described as “human sympathy and understanding,” by himself or one of several volunteers. While one-third of the cases required more than that and were referred to psychiatrists, Warren found that merely by giving troubled people a chance to talk confidentially to a stranger, he could help them get through a crisis. Although Warren believed “the one sure remedy lies in Paul’s message to his Philippian jailer, ‘Believe in the Lord Jesus Christ and thou shalt be saved,’” he did not proselytize and in a pinch was quick to offer more earthly aid: money to tide them over, a square meal, a train ticket home, or an invitation to rest at his twenty-one-room home in Hastings-on-Hudson, ten miles north of the city.
Warren didn’t wait for would-be suicides to come to him. He arranged with churches, hospitals, and the police to interview attempted suicides and scanned the newspapers for stories about suicide and suicide attempts. Local attempters were visited by a league fieldworker. Out-of-towners received letters advising them against the futility of their act and, where possible, referring them to a league volunteer in their city. (Eventually, the league had representatives in thirty-five cities and received two thousand letters a year asking for help.) Families of New York City suicides were visited as soon after the death as possible, to be comforted, counseled, and, if necessary, helped financially. Children of suicides were sent to summer camp for a week at the league’s expense, to help them “forget.” At one time the league, which did not charge for its services and was funded by private donations, sponsored its own Saturday-morning radio show in which it presented dramatizations of its cases and invited public support. In 1932, league volunteers interviewed 2,816 would-be suicides or their friends at its offices and visited 1,084 families in which suicides had occurred and 2,168 homes where suicide had been attempted. According to Warren, the National Save-A-Life League more than lived up to its name; he claimed the league saved one thousand people a year. By 1940, when Warren died and his son Harry Warren Jr. took over the operation, the league, by its own estimation, had saved thirty-four thousand lives.
By then several other suicide prevention organizations were in operation. In 1906, the same year in which the league began, the Salvation Army founded the London Anti-Suicide Bureau, offering free consultation, sympathy, and advice. During its first year, 1,125 men and 90 women applied to the London Bureau, more than half of whom, according to Salvation Army founder General William Booth, had been driven to the brink of suicide by financial problems. Branches were established in Berlin, New York, Chicago, and Melbourne. Elsewhere, Zurich established its Anti-Suicide League, and Berlin a Suicides’ Aid Society. In Budapest, after a wave of 150 suicides by drowning in April and May 1928, a “suicide flotilla” patrolled the Danube and managed to save nine of ten would-be suicides. In Odessa an antisuicide museum displayed firearms, knives, and poison bottles left by people who had killed themselves, as well as grateful letters from those dissuaded from their plans.
Vienna offered the would-be suicide a smorgasbord of services. All suicide attempts that came to police attention were reported to the welfare department. A written summons was issued to the attempter, and if it was ignored, a social worker made a house call. The social workers helped the attempters find housing, employment, and financial assistance. The Ethical Society Agency for Suicidal Persons, founded in 1927, tried to reach the despairing before they made an attempt. From six to eight each evening, lay volunteers and social workers were available to listen and provide advice, referrals, and occasionally financial aid to troubled people. Trained workers interviewed relatives, friends, and employers and acted as mediators in family disputes and housing squabbles. To promote an esprit de corps among its clients, the center organized an annual banquet at which leading Viennese stage performers provided entertainment. To help prevent adolescent suicide, Vienna opened a youth counseling service in 1928, in which about thirty lawyers, teachers, physicians, social workers, and priests offered advice in their own homes. Unfortunately, these organizations disbanded when their leaders were forced to flee during the Nazi occupation.
One suicide prevention agency still going strong traces its roots to 1935, when a recently ordained twenty-four-year-old Anglican minister named Chad Varah officiated at the funeral of a thirteen-year-old girl who, menstruating for the first time, didn’t understand, had no one to ask, and killed herself. Her death made a deep impression on Varah, who had always been more interested in counseling than in other kinds of parochial work. In 1953, in response to a magazine article he had written on “the new morality,” he received fourteen letters from people who said their problems had driven them to the verge of suicide. “They didn’t need professional help,” Varah recalls. “They needed someone to talk to, someone to listen. They needed a friend.” Varah read that there were three suicides a day in London. He imagined them “dying miserably in lonely hotel rooms.” Varah took out a newspaper ad that invited people contemplating suicide to telephone or visit him, and on November 2, 1953, he set up shop in the crypt of his church, St. Stephen
, Walbrook, in London’s business district. A newspaper article later gave Varah’s service its name—the Samaritans.
In the beginning Varah and his secretary manned the telephone, but soon so many people were calling and coming in to talk to him that volunteers were recruited to make tea for the troubled as they waited in line. By the time they reached Varah, many didn’t need to see him—they already felt better after talking to the volunteers. Varah decided to use the volunteers to talk to the clients and found that caring contact between two people reduced the client’s loneliness and despair. The concept of “befriending,” as Varah called it, had been born. Befriending might mean a volunteer and a client talking on the phone, meeting for tea, or visiting at the Samaritan office or in the client’s home. Befriending was not counseling or therapy; volunteer and client met on equal ground. The recruiting slogan for volunteers was “Are you ordinary enough to be a Samaritan?”
Befriending was not intended to obviate professional help, but Varah’s hunch that fear kept many people from seeking that help was justified. The Samaritans befriended one hundred clients that first year; today, there are 203 Samaritan branches in the United Kingdom, staffed by eighteen thousand volunteers, that receive nearly 5 million calls each year. Troubled people can call Samaritans in fifty countries, including Armenia, Egypt, Israel, Russia, the United States, and Zimbabwe. Despite their extraordinary expansion—they have become a veritable McDonald’s of suicide prevention—the Samaritans have retained their intimacy and efficacy by clinging to their original formula. Over the years, erudite researchers have made many attempts to analyze the essence of befriending, but as one Samaritan volunteer put it, “In its purest form, befriending is love.”
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