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Death & Dying

by Edwin S. Shneidman
Oxford University Press, 2004
Review by Matthew Pianalto on Jul 7th 2004

Autopsy of a Suicidal Mind

In any other discipline, a gathering of minds with only half the intellectual prowess and experience of the consultants brought together in Edwin Shneidman's Autopsy of a Suicidal Mind would give reason for a celebration. The very nature of suicidology must make even such a momentous reunion as occurs in this book a somber event. In Autopsy, Shneidman rejoins forces with seven suicide specialists, longtime colleague Norman L. Farberow, with whom Shneidman founded the Los Angeles Suicide Prevention Center (the first center of its kind), and Robert E. Litman, chief psychiatrist at the LASPC, Avery Weisman, John T. Maltsberger, David Rudd, Ronald Maris and Morton Silverman, who have share between them several turns as president of the American Association of Suicidology or editor of the AAS's journal Suicide and Life-Threatening Behavior, among their other academic and professional accomplishments. Shneidman himself founded suicidology as a scientific discipline, and at 86, has spent his entire mature life, the past fifty years, studying and writing about suicide. This book stands in the twilight of Shneidman's long life and career, and yet those who are familiar with Shneidman's work will readily see that his analytic powers as an interviewer, investigator, and a writer, shine as brightly as ever.

As Shneidman himself admits, Autopsy is a labor of love. At the conclusion of a talk, which Shneidman rarely gives nowadays, Hannah Zukin approached Shneidman and, pressing the eleven-page suicide note of her son Arthur into Shneidman's hands, asked to help her to understand her son's death. Shneidman impulsively agreed to help, and within months had conducted interviews with the mother, father, a sister, brother, pal, ex-wife, girlfriend, psychotherapist, and psychiatrist. These interviews, along with Arthur's suicide note, he passed along to his colleagues, entreating them to offer their own views on what happened, why it happened, and whether or not it could have been prevented. The interviews and analyses comprise Autopsy, which is a prime specimen of the psychological autopsy—another tool developed in large part by Shneidman.

Arthur, 33, summed up his predicament in the first sentence of his suicide note: "All I do is suffer each & every day." By the time of his death, Arthur had successfully completed both a law and a medical degree, and was working in medicine. At some point in his adolescence, he had overcome what was later identified as an auditory learning disability and change from a temperamental, slow-learning child, into a hard-working, successful student. By most accounts, Arthur could do whatever he decided he should do—except, it seems, to conquer the internal pain which accompanied him for most of his life—a mental pain Shneidman has conceptualized as "psycheache" (The Suicidal Mind, 1996, Suicide as Psycheache, ed., 1993). At the young age of seven, Arthur had told a friend, "One day I'll kill myself," and at fifteen, he made his first attempt, after returning from a wonderful camp experience. The joy he'd felt at camp, and the prospect of returning to his usual school days of isolation and depression were too much for him to deal with—the contrast between joy and pain too great.

As a small child, Arthur was susceptible to wild tantrums, which through psychotherapy were eventually brought under control, although it might be that as Arthur matured, his emotional sensitivity and violent reactivity were internalized. Competing with a bright and athletic older brother, Arthur developed perfectionistic tendencies and a narcissistic view of his own troubles. His parents divorced when he was eight, and his relationship with his parents is filled with inconsistency: he treats his mother with much ambivalence—he does not even mention her in his suicide note— and yet with more respect than his father, who was also a physician, and met regularly with Arthur in his adult life (although Arthur claimed to get very little out of these meetings). Nowhere in Autopsy are the interviewees able to nail down what exactly the effect of the divorce was on Arthur; nonetheless, it is added to the list of "failures" which must have weighed heavily on Arthur's sensitive mind.

With both ex-wife and girlfriend, Arthur established a pattern of catch and release: once he got the girl, he didn't want her any more, and when he sent her packing, he needed her back. His psychiatrist suggested that Arthur saw himself as "settling" in both of these relationships, and not getting what he ideally wanted, and thus in some sense failing.

As Maltsberger suggests, Arthur never seemed to be able to accept the flawed nature of human life, that suffering and imperfection were part and parcel of existence. Litman emphasizes the narcissistic side of Arthur's character, his sense that there was no other pain in the world as bad as or of a kind with his own. Despite his many successes, Arthur's mental anguish and the continual threat of its return in a major depressive episode shadowed, and eventually eclipsed, his entire life.

Could Arthur have been saved? This is a central suicidological question, and the majority answer appears to be no. Although there were many treatment possibilities which Arthur either discontinued (therapy, medication) or refused (electroconvulsive therapy was recommended as a possibility by a few of the consultants), it appeared that Arthur himself had become convinced that no treatment would ultimately 'beat' his pain. To the possibility of hospitalization, he told his sister that he knew, as a doctor, how to behave and answer in order to get out. In the end, Arthur represents a class of humans who, for one reason or another, are virtually untreatable. And as Ronald Maris points out, even if someone had saved Arthur by sheer interventionistic force, there arises a disturbing ethical question about what would justify such insistence on prolonging this life of suffering.

The success of Autopsy is certainly not that it provides an unequivocal analysis of Arthur's suicide. Such is the nature of 170 pages which offers eighteen different perspectives and hypotheses on the death and intentions of one man—two features of the human being which for others are virtually opaque. Although many of the interviewees and analysts emphasize the role biology played in constituting Arthur's character and his suffering, it remains clear that Arthur was a largely sane and rational human being—albeit, a human being with much pain inside him. As a student of philosophy, this reviewer found it remarkable that both the father and the brother, who both engaged in philosophical conversations with Arthur on "the meaning of it all" and "the point of things," both dismissed these dialogues as "abstract exercises." Father and brother both emphasized biology as the primary cause of Arthur's suffering and suicide, and thus excused his existential pessimism as symptomatic. Here was a man actively searching for a "meaning" which would give his pain sense. Then, perhaps, he could have better tolerated it. But it seems that Arthur concluded of his pain essentially the same as his father and brother concluded of their philosophical conversations with him—that, at bottom, it was all senseless, and thus, for Arthur, not worth living out.

What Autopsy teaches the reader is that suicide is the most slippery of topics. When not even the sagest professionals in the field can voice a harmonious explanation, or give a unanimously hopeful analysis, the student and the survivor will be reminded that suicide is a wellspring of confusion and complexity—not only emotionally, but intellectually, too. In cases such as Arthur's, where the interviewees are themselves impressively educated and articulate (all his family members hold advanced degrees), the psychological autopsy begins to reveal that each suicide is in many ways as nuanced, distinct, and original as those individuals who engage in the act. The diagnostic categories often help to map the general terrain of suicide, but they rarely provide the comfort, assurance, or clarity desired by those desperately seeking to discover what has gone wrong. For that, we have to defer to magnanimous human beings such as Edwin Shneidman, who will invest all the powers at his disposal to find something to say by way of comfort and explanation to the survivors, and who in some ways transcends his role as a scientist to put together this scrapbook of Arthur's life as a gift to his mother and the others. It is as thick with intrigue, discrepancy, discovery, and contradiction, as the troubled life which it examines. The ultimate question, Why?, is at once the most obvious and the most obscure of all the questions asked of not only Arthur's, but of any suicide.

 

© 2004 Matthew Pianalto

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Matthew Pianalto is a Ph.D. student in philosophy at the University of Arkansas, where he has also taught logic and introduction to philosophy. He holds a B.A. in English, and an M.A. in Philosophy. His master's thesis, "Suicide & The Self," attempts to reinvest in the philosophical nature of the problem of suicide. More info at his website: http://comp.uark.edu/~mpianal. (See "Suicide & Philosophy" link for resources on suicide.)