Grief and Failure
Abstract
The motivations discussed in this chapter represent a very small proportion of individuals in our sample. One group (60 people) committed suicide because of grief issues (31 people), while others felt like a failure in life (22 people). We examined specific patterns that can be seen within both the bereavement and failure categories, which can provide information about risk and protective factors.
Keywords
Bereavement; grief; failure; altruism; alienation
Joyce struggled with depression for most of her adult life and had been under the care of a psychiatrist for years. Now she was in her fifties and had developed a number of physical conditions, including high blood pressure, high cholesterol, and a heart arrhythmia. Joyce had one daughter, Carolyn, who spoke with her every day on the phone and visited on weekends. Joyce had never expressed any suicidal ideation until Carolyn was killed by her husband. She had suspected Carolyn was being abused by her husband, but Carolyn would not discuss it with her. Joyce attended the funeral and almost immediately began talking about suicide. She told her brother she was going to kill “some people” and then kill herself. Two weeks after the murder, she began calling her psychiatrist and leaving what he called “desperate” voicemails. Although he returned the calls within an hour, Joyce did not answer the phone. He requested a welfare check and when the police entered her residence, they found Joyce dead from a gunshot wound to the head. On the end table near her chair were pictures of her daughter, her grandchildren, and a newspaper clipping about her daughter’s murder which indicated that Carolyn’s husband would be charged with murder.
The vast majority of cases we examined were motivated by interpersonal issues or were individuals trying to escape painful circumstances, as described in the previous two chapters. However, there was a small group (60 people or 5%) who committed suicide for other reasons. Most of these people were either dealing with grief issues (31 people) or felt like a failure in life (22 people). There were also some people who spoke of feeling guilty (4) or alienated (2). Finally, there was one person who believed suicide would make someone else’s life easier (altruism). Joyce provides a representative example of someone who killed herself out of grief.
Distinguishing Uncomplicated and Complicated Grief
Grief is a term used to describe emotional, cognitive, functional, and behavioral responses to a loss, such as a death (Zisook & Shear, 2009). Following the loss of a loved one, most people experience normal or uncomplicated grief. Uncomplicated grief usually begins with an acute phase and proceeds to integrated or abiding grief. The acute phase is characterized by intense sadness, preoccupation with thoughts of the deceased, and difficulty concentrating (Zisook & Shear, 2009). There may be “shock, anguish, loss, anger, guilt, regret, anxiety, fear, loneliness, unhappiness, depression, intrusive images, depersonalization, and the feeling of being overwhelmed” (p. 68), which may be intermingled with positive feelings about the deceased. The length of acute grief can vary based on many things including the individual, the significance of the loss, and whether the loss was expected. In the acute grief phase, daily routines are often disrupted. Most individuals begin to shift to integrated grief within 6 months. In this phase, there may still be sadness related to the deceased, but the preoccupation has lessened. There is also healing, adaptation, rebalancing, and a reengagement into life’s activities. It is not that the deceased is forgotten, but the loss becomes integrated into the individual’s new worldview. Grief may at times become more prominent, e.g., on the anniversary of a death, but it is not as pronounced as it was during the acute phase. Most people experience uncomplicated grief while others (7–20%) develop complicated grief (Carmassi, Shear, Socci, Corsi, & Dell’osso, 2013).
When someone remains in acute grief for a prolonged period, without shifting to integrated grief, complicated grief generally results. Complicated grief is also known as traumatic or unresolved grief. Complicated grief is intense grief that is associated with impairments in work, health, and social functioning (Zisook & Shear, 2009). A yearning for the deceased is often experienced, as well as anger, bitterness, shock, and/or a continuing disbelief that the person has died. Individuals experiencing complicated grief may be preoccupied with thoughts of the deceased and avoid reengaging in life. They may also feel that by moving on with life, they are being disloyal to the deceased. Feelings of excessive loneliness, purposelessness, and emotional detachment from others can also be present (Latham & Prigerson, 2004). Prolonged complicated grief can lead to negative physical outcomes such as high blood pressure or heart problems. Not surprisingly, individuals suffering from complicated grief have higher rates of suicidal ideation than do bereaved people experiencing uncomplicated grief (Szanto et al., 2006).
Quintessential Case of Bereavement
Bill and Linda were high school sweethearts and married shortly after they graduated. They were unable to have children and chose not to adopt, but they were very active in their community and their church. Bill worked as a police officer, and Linda worked for the police department. They were virtually inseparable. When they retired, they bought a home in Florida and spent summer months in Ohio. They were enjoying life. Shortly after they celebrated their fifty-fifth wedding anniversary, Linda was diagnosed with ovarian cancer. Linda fought the cancer with every treatment that was available, but after 18 months she died. Bill was devastated and for two months told friends and neighbors how depressed he was feeling. One morning a neighbor saw Bill leave his house carrying a long object. When Bill had not returned by late afternoon, she called police requesting a welfare check. On the dining room table in Bill’s home the police found his will, power of attorney, and the names of next of kin. They also found a piece of paper with “Bird Island” written on it. Bird Island was not accessible by car but the police boated out to it where they found Bill, dead from a shotgun blast to the head. He did not leave a note, but near his body there was a picture pinned to the tree. In the picture, Bill and Linda were smiling, enjoying a vacation together.
When one considers who would kill himself or herself out of bereavement, Bill and Linda represent the quintessential case. It had only been 2 months since Linda died, so Bill was still in an acute phase of grief, but it seems he could not integrate the death into his new worldview. In other words, he could not envision a life without Linda. Zisook and Shear (2009) found that when a bereaved spouse was older than 50, over half (57%) with complicated grief had suicidal ideation. To a certain extent, this is supported by our findings. The age range of those killing themselves because of grief was 23 to 85, but approximately two-thirds were over 46 and the average age was 57 years old. Ten were grieving the loss of a wife, and four had lost a husband. However, there were more people who had lost someone other than a spouse than those who had lost a spouse. Eight had lost a parent, evenly split between mothers and fathers. Eight had also lost a child, six sons and two daughters. One had lost a sister and one had lost a brother, while three had lost a friend. Finally, one person lost his guide dog. Some people had lost more than one person. Interestingly, two people had lost a loved one to suicide.
Similar to our overall sample and every subgroup, the victims were mostly men (68%) and Caucasian (94%). Although two women used knives to kill themselves, most used guns (39%), asphyxia (26%), or overdose (26%). No one committed murder–suicide and only two people killed themselves in front of someone, one by jumping from the top of a building. Most were home when they killed themselves (74%).
By and large, these were not people who were experiencing other life problems. Legal or financial problems or domestic violence were not mentioned in any case. This does not mean that no one had these problems, but rather that they were not significant enough for an investigator to mention. Aside from dealing with the loss of a loved one, only two people were identified as having interpersonal issues. A few people had physical illnesses (23%) but almost everyone was identified as dealing with mental health issues, mostly related to their loss.
The death of a loved one can trigger or worsen mental disorders (Carmassi et al., 2013). Mental health concerns were identified by investigators in 28 out of 31 people and for the other three people mental health status was not addressed. In only six cases did the investigator identify that the mental illness was present before the death of a loved one. Since the mental illness frequently arose from the loss, it is not surprising that 25 people were depressed. In addition, one person was diagnosed with bipolar disorder; one person with multiple disorders; and one person with dementia. At least 19% had a history of drug or alcohol abuse, and the same percentage were drinking or using drugs prior to their suicides. Twenty-three percent had previously attempted suicide, 27% had made threats, and 24% had expressed suicidal ideation.
The highest risk period for suicide due to bereavement is in the 2 years following the loss but the risk remains elevated for 5 years after the loss (Szanto et al., 2006). It was impossible to determine how long it had been since the loss for 35% of our cases, because the investigator’s report simply said “recent death” or did not mention a time frame. For three (10%) it had been less than a month, for seven (23%) it had been one to six months, for two (6%) it had been seven months to a year and for eight people (26%), it had been more than a year. One woman killed herself on the anniversary of her husband’s suicide, which he had committed on her birthday.
For our sample, almost half of the suicides (48%) occurred during the summer months (June, July, and August), particularly June (23%). Many memories are made during the summer as families and couples go on vacations and relax together. Perhaps the idea of spending a summer without their loved ones was just too overwhelming. Additionally, almost half killed themselves on Sunday (23%) or Monday (26%). Sunday and Monday can be difficult days for many people as they face the challenges of a new week. Frequently weekends are spent with friends or loved ones but the week can be long and lonely. Oftentimes it is the routines of the week that become too difficult to face alone. The loss of a partner/spouse means an individual may be facing life ostensibly alone, but for some the loss of other family and friends creates just as significant a void. As the victims struggled to cope with the loss of the person they loved, they often gave clear signals of their peril and distress.
The day after Memorial Day, Scott drove to the cemetery with Tina, his girlfriend, to visit his mother’s grave. His mother had recently succumbed to pancreatic cancer. Scott felt that, at 58, she was too young to die, and that she had died too fast. Diagnosed in October, his mother died in January. In the months after she died Scott was depressed and had been talking continually about suicide. During one suicide attempt, his gun was confiscated by the police.
On this visit to the cemetery, Scott left his girlfriend in the car and grabbed a cold beer from a cooler in the trunk. He walked over to the grave, where he sat down. Ten minutes later Tina saw him rise, then heard a muffled sound, and watched Scott collapse. When she arrived at the grave, she found Scott unresponsive and bleeding from the chest. Although she called for help, Scott was dead on arrival at the hospital.
The relationship between the griever and their loved one may affect the severity of grief symptoms. Approximately half of our sample lost someone other than a spouse. These included siblings, friends, and a guide dog. Yet, the biggest groups were those who had lost a child or a parent. Only one person in our sample left a note. In the note, he talked about being reunited with his son and said to his wife, “I tride to be a good man for you but wen I lost my son it changed.”
It is common for parents to experience many of the symptoms of complicated grief following the loss of a child (Zetumer et al., 2015). These may include shock, disbelief, anger, and guilt. Zetumer et al. compared parents with complicated grief to nonparents with complicated grief. Parents experienced significantly more yearning, preoccupation, anger, bitterness, shock, and disbelief than nonparents. In addition, they experienced more caregiver self-blame and were significantly more likely to indicate that they felt they should have done something to prevent or ease the death than nonparents. Finally, parents were more likely than nonparents to have suicidal ideation, such as a wish to be dead, and engage in more indirect suicidal behavior following the loss.
Losing a child, even an adult child, can be devastating to parents. In general, parents are the primary caregivers to children and establish their first attachment patterns (Bowlby, 1969). For most parents and children, attachment is lifelong. It continues to dictate the parent–child relationship, but also becomes a template for other relationships. Part of the responsibilities of a healthy parent–child attachment includes protecting the child from harm. There is also a societal expectation, especially for young children, that parents will protect their child from harm. Even children themselves look to their parents to protect them from harm. When a child has died, parents often feel they have not fulfilled their parenting responsibilities. Whether the death was accidental or medical, parents may feel responsible for it or for the death process. Most parents expect their children will outlive them and when they do not, the grief becomes complicated.
Losing anyone with whom one has had a deeply satisfying relationship is a risk factor for complicated grief (Zisook & Shear, 2009). Other risk factors include a history of mood or anxiety disorders, poor health, multiple important losses, adverse life events, concurrent stress and a lack of social support. Even the quality of care that a loved one receives at the end of life is related to caregiver suicidal ideation. Abbott, Prigerson, and Maciejewski (2014) found that if caregivers perceive that the quality of care their loved ones received at the end of life was poor, there is an elevated risk of suicidal ideation in bereavement. That hypothesis was especially true for those who had a spousal relationship with the deceased and for those who had suicidal ideation before the death. Most caregivers want to feel as if they did all that they could, and poor quality of life at the end of life may leave them with lingering doubts and guilt.
The process of grief, like coping, is very personal. Someone with no risk factors, such as Bill, can develop complicated grief, while others who have all the risk factors may not. Just as there are identified risk factors, there are also identified protective factors that attenuate depression. Prigerson, Frank, Reynolds, George, and Kupfer (1993) found that older individuals who had lost a spouse were less likely to develop depression, or developed a less severe depression, if they received social support and mastered life events. Given the pivotal role of social support, it was not surprising to see investigators’ reports which referred to conditions suggesting a lack of social support. Victims were clearly telling people they were in distress, yet often their signals, and even threats, were ignored. This is not an attempt to disparage the people who did not respond to these signals and threats. It is impossible to know how worn down these people were from their own grief and from possibly responding to the victim’s repeated suicide attempts, threats or ideation. Still, victims may have viewed this lack of response as representing the absence of social support.
Prevention and Intervention
In most of the cases of suicide that were precipitated by bereavement and complicated grief, the individuals were not experiencing other life problems. Overall, the loss itself created an imbalance and made life unbearable. Consider the case of Joyce from the beginning of the chapter. Although Joyce had some physical and psychological challenges, she was not considering suicide. Domestic violence had led to Carolyn’s death, and Joyce was unable to protect her child from harm. Joyce was clearly angry, as she told her brother she was going to kill some people, but there was more than anger. Her psychiatrist referred to her messages as “desperate.” There is no doubt that she was despairing and likely distressed. Joyce had a very close relationship with her daughter, and she likely missed her calls and her company. Her previous mood disorder, the loss of social support, physical illness, and her guilt over not being able to prevent her daughter’s murder put her at risk for suicide. Like many individuals discussed in this section, Joyce did reach out, but she was too distraught to continue on or even wait for help.
There are ways to assess whether someone who has experienced a loss is at risk for suicide. One way is to assess them on the risk factors outlined previously. For example, if someone has struggled with mental illness throughout his/her life, the risk for complicated grief is heightened. However, in addition to assessing for the risk factors outlined, an Inventory of Complicated Grief was developed to identify those individuals who may be suffering from pathological grief (Prigerson et al., 1995). This would not likely have helped Joyce, since she killed herself so quickly after Carolyn’s death. However, had Bill or Scott been assessed, their results would have indicated that intervention was needed. Funeral directors, who are often the first point of contact for a bereaved person, are sometimes prepared to offer grief counseling or recommend programs in the community. Larger funeral homes sometimes employ grief counselors (Worden, 2008). While they may come too early in the process to identify complicated grief, they may be able to prevent it from occurring by routinely recommending assessment to their clients.
Suicide among bereaved caregivers must also be addressed. Enhancing the quality of palliative care would reduce the risk of suicide among caregivers, although this would not have affected every case. Hospital-based care models have traditionally been focused on cost and are not patient centered. New models, such as community-based, nonhospice, palliative medicine programs have addressed symptoms, psychosocial and emotional wellbeing, and caregiver and patient satisfaction. As palliative care continues to evolve, the focus on the individual’s quality of life at the end of life may be enhanced. In the meantime, assessing caregiver satisfaction may provide important information about caregiver risk for suicide.
It may seem that the suicides precipitated by grief fit better in the interpersonal motivations for suicides section, but they were qualitatively different. As opposed to many of the interpersonal cases, no longstanding conflicts or rejection issues in the relationships were identified. In fact, the individuals who died were generally beloved. Also, no history of unrequited love was present. The deceased and the suicide victim usually had a mutually loving relationship. It was the death, not the relationship, that caused the suicide. Therefore, the goal of intervention becomes trying to find ways to rebalance an individual’s life after the loss. This may involve establishing or reestablishing positive social support and encouraging them to focus on the things that enhance their sense of self-sufficiency or mastery (Prigerson et al., 1993). It may also mean helping individuals to create a worldview that both includes their memories of their loved ones but allows for their own personal evolution to continue beyond their deaths.
Failure
Nick was a junior in college when he wrote, “I HATE MYSELF. I CAN’T ACCOMPLISH WHAT I WANT TO DO…I DON’T EVEN KNOW WHAT I WANT OR WHAT I WANT TO DO…I AM LOST. I HAVE NO VALUE TO THIS WORLD. I AM EXPENDABLE. ANYTHING THAT I CAN DO, SO MANY OTHER PEOPLE CAN DO TOO…I FEEL LIKE A CARD HOUSE BUILT OF FAILURE. NOT PUBLIC FAILURE BUT PERSONAL FAILURE. I AM FAT, LAZY, ENJOY ONLY THINGS THAT BENEFIT ME.”
Nick had struggled with depression during his life. Recently, he had shared his suicidal ideation with his therapist who had him sign a “suicide contract.” The contract explicitly stated what Nick would do if he felt suicidal, such as calling his therapist. Nick lived off campus in a fraternity. One night he and his roommates were watching movies and drinking. He went up to his room about midnight and two hours later his roommate found him hanging in a closet. Nick had also taken an overdose of sleeping pills. There were small amounts of cocaine and marijuana in the room.
On the desk was a suicide note, which was written on the back of Nick’s suicide contract. There was also a journal. In the note he said, “I HATE MYSELF…..STEPPED OUT OF REALITY. STEPPED INTO A DREAM. —BYE— NICK. 100 TYLENOL PM +31 CVP SLEEP TABLETS. GOODNIGHT. I AM A DISAPPOINTMENT.” The last lines in his journal were, “WHY SHOULD I HANG AROUND AND CONTINUE TO MAKE MYSELF MISERABLE? I HATE MYSELF. FUCK IT I’M OUT.”
Nick is an example of someone who killed himself because he felt like a failure. In our study, we counted failure as a motivation for suicide only in cases in which the deceased left a note where it was explicitly mentioned or where details from the investigator’s report made it clear the person felt like a failure. For example, the investigator’s report detailed the results of interviews with family members who indicated the deceased had always felt like a failure or described some aspect of the scene or body that made it clear the person felt like a failure. One woman wrote words or phrases all over her body such as “Worthless,” “Trash,” and “Big Ugly,” and then hanged herself from a rafter in the living room.
Another investigator’s report referred to a notepad with what appeared to be scribbles and doodles. The scribbles sounded like a to-do list and read, “Death, Kill Yourself, Suicide Edicius, Cash Check, Make Resume, WP, Shut up, Less talk is better, Talk is cheap, Trying is the first step toward the failer, Can’t be afraid to fail, if you don’t want to succeed, Get By Liven or get busy dien. Why, no friends, no job, no part of society, better off, Don’t want to go on Another 40 years. Nobody likes you.” Edicius (suicide spelled backwards) is a popular term on certain websites. Numerous poems have the title “Edicius,” too many to list. It is also the name of an Indie Rock group and a French death metal group. Some of the lines were from popular culture: The Simpson’s hapless father figure, Homer Simpson (“Trying is the first step toward failure”) and The Shawshank Redemption (“Get busy living or get busy dying”). Also, a drawing showed a person hanging by a noose from a rafter and the words “Brooks was here” were carved into the wood. That phrase was also a reference to The Shawshank Redemption and the character, Brooks, who killed himself shortly after getting released from prison. Brooks was unable to adjust to the outside. Alone and out of place, he hanged himself from the wooden beam in his shabby hotel room after carving his name for posterity. Not surprisingly, this person killed himself by hanging.
At first, it was difficult to discern the difference between failure and escape. After careful examination, it became clear that the tone of the “failure” notes was different, as were the circumstances of the person’s life and death. For those who killed themselves because they felt like a failure, the source of the failure was internal, whereas with escape it was external. For example, some note writers explicitly stated that they had failed at everything in life. Nick wrote, “I have been a failure in my own eyes my entire life.” People in the escape category may have failed at something specific and external, such as their finances, but they did not necessarily see themselves as failures. They might state, “I can’t take this anymore,” but it referred to specific circumstances. People who were trying to escape felt helpless, but people who felt like failures felt hopeless. They had a sense of doom, an inability to see a light at the end of the tunnel. They weren’t just trying to escape specific circumstances; they were trying to escape life altogether.
Although a precipitant was present for everyone, the significance of it was different for those who were attempting to escape versus those who felt like a failure. Those who were attempting to escape felt they had lost control of the situation, and their decision to kill themselves was often impulsive. Those who felt like a failure had thought about suicide for a long time, and the precipitant was simply the final straw. Nick talked about the multiple failures in his life, including relationships (“I suck @ them”) and school (“I have always been picked on in school. It is a cruel place.”) When he spoke about suicide, it was almost as if he found it comforting. He said, “It is the one consistency in my everyday activities. I think about it all the time. You know how men think about sex like every minute, or something like that?, well I think of suicide and killing myself the same way.”
When people viewed themselves as failures, it was a long-term assessment, so it was not surprising to see that many (65%) were and had been depressed for a long time. They saw themselves as alone in their suffering. Similar to every other category, this group had mostly men (86%) and they ranged in age from 20 to 52 with the average age 35 years old. Out of 22 people, 18 left notes (81%). This high percentage may be due to the fact that, as mentioned earlier, a note was generally the only way to identify someone who committed suicide due to feeling like a failure. In their notes they referred to feeling like a failure (84%), worthless (28%), shame (28%), guilt (17%), hopeless (11%), or that life was not worth living (11%). Virtually every note contained some statement referring to the person’s failure or lack of self-worth. It may be of some significance that 11 of the suicides in this group (50%) occurred in 2008 and 2009, during the greatest economic downturn since the Great Depression of the 1930s. As we have no information about the economic circumstances of most of the victims, we cannot be sure of any causation or relationship.
Donny was 45 years old and lived by himself in an apartment in a white, middle class, suburban neighborhood near Dayton, Ohio. He had a history of depression and had just lost his job in December. He had attempted suicide before, but this time he knew he would follow through. “Well, I’m surprised I didn’t do this sooner,” he wrote. “I had the lowest self-esteem in the world.” He died in his bed of an overdose in mid-January. His sister told police he had become increasingly withdrawn.
Sonya also died of an overdose. She was recently divorced but still having phone contact with her ex-husband. It was one day after a conversation with him that her mother discovered Sonya’s lifeless body in bed. Next to her were pill bottles and a note. “It is not anyone’s fault,” her note began. “I’ve been fucked up from the beginning. I’ve never been OK, I’ve never been good enough. I’ve never been normal… It’s definitely no one’s fault. just I’ve had all I can bear. I’m done I’m done I’m done,” she wrote, with no period after “done.” She loathed herself. “I feel disgusting. I hate myself. I don’t know how to change and I’ll never ever be OK. Or normal. Or just acceptable.” She pleaded for them to understand. “It’s an immature decision,” she reflected, “but I really am doing all that I can and its never good enough. I’m so so tired of feeling like a reject. I’m just fucked up. I hurt so much and I hurt all the time. It’s no one’s fault. It’s no one’s fault.”
Alone, depressed, not without loved ones but nevertheless withdrawn from others, Donny and Sonya were typical of one quarter of those who died feeling like failures.
Letting others down was a predominant theme in several notes. “Sorry I couldn’t make you proud,” wrote one 21-year-old man. He left many notes to several family members, and then shot himself while in his apartment. One woman in her late fifties was found clutching a crucifix with both hands, having taken an overdose of pills. In her note, she told her husband she loved him and apologized for her action. In a P.S., she wrote, “I’m sorry I failed you.” A white man in his early thirties hanged himself in a wooded area. He sent his mom a message before he killed himself, warning her about his intentions. “I am such a disappointment to you and everyone else so I’m sorry and I love you.” Then to his father he wrote, “I know you have tried to be there for me and I sorry to let you down.” A 40-year-old man who hanged himself wrote to his wife, “I have let you down; I have done this in such a way that I can’t even look at myself in the mirror. I didn’t do my job taking care of you—and for that I am so very very sorry.”
These notes demonstrate three dimensions to “failure suicide” which were identified in an earlier study: self-perception of competence/failure, another’s support (succorance) of the individual’s efforts, and the individual’s perception of what others think of his competence/failure. In some of these cases, the individual’s aspirations may have exceeded the individual’s capability. The aspirations or expectations may have been the individual’s own or those imposed by others. It’s possible a dysfunctional cycle developed in which high expectations were followed by a lack of success, then followed by a lack of support (or perceived lack of support). The individual then may have believed that in the eyes of the person whose approval was desired, the individual was a failure (Folse & Peck, 1994). This culminated in the suicidal act, very much as Durkheim (1897, 2006) predicted.
Others cast themselves very specifically as losers who were unable to face themselves. In addition to believing he let his wife down, the previously discussed 40-year-old hanging victim added, “I also didn’t want to be such a big loser—but that isn’t the case. I am a loser, I have lost the most precious things in life. I have lost my family, I have lost my pride, I have lost my own dignity.” One 31-year-old man hanged himself in a motel room from the shower curtain rod. He said, “I’ve done to many bad things in my life and I can’t look at myself. You will understand one day.” Sonya expressed her exasperation at repeated failure: “I’m just so tired of trying my best and things here working out never being good enough.” Another man who hanged himself from a water pipe in the basement of his apartment pleaded, “Please beleive that I love you all so so much And that I’m sorry I was such a shitty dad and lover.” The idea of being a loser demonstrates the adoption of an identity that can affect behavior. The person who believes himself or herself to be a loser differs from the aspiring person who does not succeed. The “loser” engages in a thought process that may lead to apathy and a perceived inability to act differently.
Those who let others down and those who believe themselves to be losers are small subsets of those who feel like failures. Another subset is those who were “screw-ups,” who could not do anything right. Their notes demonstrated a sense of fatal inevitability. “I just can’t take be 47, broken down, and nothing to show for my life anymore.” They felt predestined to be where they were. “I wish I could go Back and Change everything We All Know I Cant So I am sorry to bring pain to everyone. My life has no meaning any more all I do is drag everyone around me down.” Sometimes that sense of predestination haunted the future. “Please don’t let our boys F-up & turn out like we did.” They also lacked an ability to cope. “I just can’t deal with all the mistakes I’ve made.” Moreover, they often expressed themselves in broad, general terms. “I’ve screwed up my life I don’t need to screw his up too.” Others also believed they had no ability to help or change the pattern. “You have been so good to me and I allways fuck up.”
Many people who felt like failures had myriad problems. One middle-aged man who had numerous health problems was depressed because of a recent divorce. He called his ex-wife to tell her he was going to kill himself. She called his parents, who called 911. He shot himself, and left a note that read, “Sorry that I did this to everybody but I candle handle feeling like shit everyday and being a disappointment to everyone.”
Outward appearances could belie internal identifications with failure. One man in his late twenties worked in law enforcement for the state. What he felt inside was that he “let down” those he cared about and “the more anyone tried to help, the more guilt I felt when I kept failing.” He shot himself while on patrol just after being in touch with a dispatcher.
The pain these victims felt was palpable. “This is what I feel is best. A world without me in it,” wrote a man who killed himself with carbon monoxide poisoning. He had a job, but had broken up with a girlfriend the week before his death. “I noe this hurts to bear. I’m tired as always be labeled a failure…I tried so hard to hold onto my life, but this time I cant do it. No more. I’ve only failed everyone and for that I’m sry. All I wanted was to make everyone happy, but I can’t.” He had an alcohol and drug abuse problem linked to chronic back pain, but when his girlfriend broke up with him because of the substance abuse, it engendered feelings of failure so great that he locked himself in his car in his garage and turned on the engine.
In their notes, some individuals referred to the pain they felt, whether it was unspecified (22%) or psychological (17%). Sonya, discussed previously, was a college graduate who worked in healthcare and was still attending school for additional certification. She had long been depressed and was recently divorced. The divorce proceedings were contentious, and her ex-husband was awarded custody of their 5-year-old daughter. Although Sonya had visitation rights, these visits were marked by bickering between the parents. One weekend when her daughter was with her ex-husband, Sonya decided to end her life. She had stockpiled an array of medications and ingested dozens of pills while drinking beer. She left a journal and a suicide note detailing her thoughts and her experience of pain. She said, “It just never seems to leave. I’m always in such pain. Something is definitely wrong in my brain. I’m ready to be done here. I don’t know what awaits me, if anything, but I’ve had all I can bear and I want the pain to stop….I was so tired of feeling down. I am hoping to go peacefully asleep. I’ve suffered enough.” Other than pain, people talked about feeling love for others (83%), ambivalent (17%), loved (17%), apathetic (11%), angry (11%), lonely (11%), and tired (11%). No one talked about feeling joy, sadness, or relief. One person felt like a burden.
In all of the notes, the victim’s thoughts were organized and most provided a justification for what they were doing (83%). For example, one man wrote to his son, “Please try to understand that this has nothing to do with you. Daddy has a lot of problems.” Only two (11%) mentioned the precipitant cause. In some notes there was constriction or dichotomous thinking (33%). The most frequent stressor mentioned was interpersonal problems (50%). They did not mention a lot of other problems although two mentioned financial issues, one mentioned legal issues and one person mentioned school problems. No one mentioned job problems or abuse.
When most people mentioned blame, it was both to blame (28%) and to absolve people from blame (33%). Over half (61%) wrote a personal apology to someone specific, and many wrote a general apology (44%). One-third (33%) asked for forgiveness and another 11% asked that someone else be forgiven. When they talked about forgiveness, oftentimes it was to ask God for forgiveness. When they talked about the afterlife, there were equal percentages of positive, negative, and uncertain terms. Two people (12%) talked about watching over their loved ones, two talked about looking forward to being reunited in the afterlife and one person talked about being reunited with a deceased relative.
Most people left only one note (78%) with 50% under 150 words. The others were 151–300 words (17%) or over 300 words (33%). In their notes they mentioned parents most often (56%), followed by other family members (50%), children (44%), siblings (28%), partners (22%), and friends (17%). When they left instructions, these related to managing property (39%) or affairs (22%), and caring for someone or something (22%). They (44%) provided general advice or life lessons such as, “Be the man I know you can be,” or “Try to forgive her (Mom) she messed up. She loves you.” There was no use of humor or quotation in any note.
This group of people was unusual in several other ways, the most striking of which was the method of death. Aside from the escape legal group, where some had restricted access to means, this group had the largest percentage (41%) who chose to kill themselves by asphyxiation, and all but one of these was via hanging. In many other countries, but not in the United States, hanging is one of the most frequently used methods of suicide (Ajdacic-Gross et al., 2008). For example, in England, 55.2% of men and 35.9% of women commit suicide by hanging. It is possible that these individuals viewed hanging as more painful and felt they were so worthless that they deserved pain. However, much debate is ongoing about whether hanging is more or less painful or quick than other means. Additionally, in their notes not one person spoke of feeling a need to be punished, but rather they talked about needing to stop the long-term pain. In other words, they had been punished enough. It is also possible that hanging is symbolic of how they felt, unable to speak or articulate their pain.
British researchers conducted interviews with 12 men and 10 women who had survived a near-fatal suicide attempt, 8 of whom had attempted hanging (Biddle et al., 2010). Those 8 all concurred that they had expected that hanging would be certain, rapid and painless with little awareness of dying. They believed hanging would not damage their bodies and that it would be less horrifying for others. Materials for hanging were easy to obtain. The majority saw hanging as easy to accomplish, with no need for special knowledge. The interviewees who did not choose hanging believed that it was not foolproof and could be both messy and difficult (Biddle et al., 2010). For people in the United States, it is not clear how much information about hanging they possess. However, hanging is, with firearms and drowning, one of the most lethal forms of suicide (Spicer & Miller, 2000).
In almost any room of the house, numerous materials can be used to construct a noose, from electrical cords to curtains. For someone who is depressed and lacking energy, hanging is relatively effortless. Since materials are so accessible, and because it is a relatively silent death, hanging is very difficult to prevent. It also has a comparatively high success rate. Interestingly, it may be that individuals who feel like a failure use a method where they are virtually assured success.
No one in this group committed murder–suicide and no one killed him/herself in front of another person. In addition to being depressed (65%), two were diagnosed as bipolar (10%), one had multiple diagnoses, and three were diagnosed but their disorder was not specified. At least 41% had problems with drug or alcohol abuse and a few had physical illnesses as well (23%). Twenty-three percent were using substances when they killed themselves. Some had expressed suicidal ideation (14%) or threats (18%). Many of the people who felt like failures experienced multiple layers of pain that added to their inability to bear their perceived failures.
Failure is in some ways a state of mind, but it is also situational and circumstantial. When a person loses a job, or repeatedly loses multiple jobs, or does poorly in college, failure is not just a perception. It is happening, even if those to whom it is happening cannot figure out why. With failure comes a loss of self-esteem, but failure can spread its tentacles beyond the self, and it can cause the loss of relationships and prevent new ones from forming. Most of the time the people in the “failure” group saw the failure coming. Some even felt rather used to it, though it still hurt. But in some situations failure sneaks up; a successful person suddenly finds himself or herself abused, intimidated, undermined, sabotaged, or exploited in an unexpected way. It’s called bullying.
People who commit suicide as a result of bullying may at first appear to want to escape pain. Those who were escaping pain, however, did not feel like failures, but rather wanted to escape specific circumstances, as we discussed previously. Targets of bullying internalized what was happening to them and blamed themselves. They believed they had failed and felt a sense of doom.
In bullying situations, failure can result from an interpersonal relationship conflict between the bully and the bullied; it can also then cause other relationships to fail. Failure creeps into the bullied person’s life in insidious ways. Nick, the college student, bemoaned in his journal how he was bullied at school. Years later he could not shake the way it made him feel. Others in our study had problems at work; at least one was bullied at work. It is worth a look at the problem of bullying and why suicide could be a result.
Workplace Bullying: An Example of Complex Failure
The temperature that autumn had averaged around 55 degrees, not bad for October. But it had poured rain, a total of five inches for the month. It only rained relentlessly like that every few years. Roberta held the handgun to her chest. It was nearly three o’clock in the afternoon on a Monday, and the children would be getting home from school soon. She felt terrible that they would find her, that in addition to everything else, the kids would remember her like this. She signed her note “Mom” and pulled the trigger of the gun.
“Hold onto this paper. Don’t let anyone know about it or see it,” Roberta instructed her eldest daughter. Concerned that the autopsy might reveal drugs in her system, she informed her girls that the only drug she had taken was valium and the only chemical she had been exposed to was a pesticide fogger. “If there is anything else then I have inadvertently taken it—without my knowledge. Remember what I have told you about the department last year and this year. Leaving my Mountain Dews unattended at my desk and in booking may have been how other drugs have gotten into my system if there are any present.”
In her note, she expressed regret about lost relationships, including her nine-year failed marriage to their father, and her loss of trust in other people. “Trust…is a hard thing to live without in life.” She told her children how much she regretted having to commit suicide, but she simply had no choice. “[A]s it has been pointed out in so many ways, by so many people I’m not good at anything…” Although Roberta never used the term, and perhaps had no words to express what was happening to her, she was being mobbed, and she had come to believe her colleagues were trying to poison her. Mobbing is a form of workplace bullying, when more than one person targets another. Roberta felt she had been in a “battle” in which she was the only one fighting on her side. She was surrendering.
Bullying is a subject that has been much in the news. The suicides of 15-year-old Phoebe Prince at a Massachusetts high school and Tyler Clemente, a university freshman at Rutgers whose private love affair with a man was filmed and circulated by his roommate, gained national attention, because they showed the vulnerability of young people who are subjected to bullying (Associated Press, 2011). Bullying in schools has been the subject of legislation in some states. The public, though, generally considers bullying a “school” problem. In the last decade, the media have reported on suicides as a result of workplace bullying or cyberbullying of adults, and legislation has been introduced in 31 states and territories of the United States to make it illegal. In some western countries and Australia, it is already illegal. Australia took the dramatic step of criminalizing workplace bullying (Yamada, 2004).
Workplace bullying, whether in person or online, includes behavior that is intimidating or abusive, results in work sabotage, or exploits a known psychological or physical disability in an attempt to harm the person who is targeted. In the United States bullying is distinguished from illegal discrimination or harassment in the workplace, because those are defined by federal and state laws and protect people based on their status, such as race, religion, and sex. Bullied targets are not chosen because of their status, and the abuse they suffer is not the traditional quid pro quo or disparate treatment of discrimination or harassment law. Since much of the bullying behavior includes psychological abuse, it often does not fall under state workplace violence statutes either. Because employment is often essential to all aspects of a person’s life, from financial security to friendships to internal self-esteem, workplace bullying can be completely devastating and leave its targets feeling, like Roberta, as if they have failed in all aspects of life (Yamada, 2000).
Between 2003 and 2010 in the United States, 1719 employees committed suicide in their workplaces, but no study has been conducted on the reasons for those deaths (Nielsen, Einarsen, Notelaers, & Nielsen, 2016). A 2012 poll of 516 self-identified targets of workplace bullying conducted by the Workplace Bullying Institute revealed that targets had contemplated suicide (29%) and some planned how to commit it (16%; Namie & Namie, 2012). It isn’t known what percentage of targets who completed the survey, if any, eventually committed suicide. The Namies compared the results of the 2012 poll with results from a scientific survey they had done in 2003 and found they aligned, but the 2012 poll had asked more detailed health questions. Half (49%) of targets reported being diagnosed with clinical depression, and nearly one-third (30%) with posttraumatic stress disorder (PTSD), though few reported using addictive substances. What came to the fore was their attitudes and ways of thinking. Many (41%) said they could understand how a person could be driven to hurting or killing those who had bullied them, though the number of those who had formulated a plan to hurt or kill others was about the same percentage (14%) as those who had planned suicide. The vast majority of bullied targets said they felt betrayed by coworkers (74%) and were now distrustful of institutions (63%). More than half (59%) experienced hypervigilance and 50% had intrusive thoughts, but the top negative effect of the bullying was the anticipation of the next negative event.
Negative events often do occur for targets in the aftermath of their bullying, such as losing friends, housing, future job opportunities and so on. Yet sometimes the anticipation of negative events, even without any actual occurrences, was enough to cause overwhelming anxiety and thoughts of suicide among bullied individuals. A recent study (Nielsen et al., 2016) matches some of the Namies’ findings. They found that suicidal ideation was clearly present in targets of bullying after they had been bullied. The odds for having suicidal ideation were 2.05 times higher among bullied people than among those not bullied.
Annette Prada was a state employee in New Mexico. After experiencing bullying at work for years, in the form of verbal abuse, intimidating emails, and finally demotion, Annette killed herself. Her colleagues testified that she was the most competent worker in their division. She had even been promoted to bureau chief. When the next opportunity for promotion came up, Annette was passed over because she had asked for more money. That’s when the bullying began. Annette’s daughter said that her mother was “only two years away from retirement. She tried to stay strong.” Annette also had health problems. As older workers face the possible loss of employment which may affect their housing and ability to retire, it can feel like a failure, especially if the employment had been long, as with Annette, who was a 22-year veteran in her office (Matlock, 2012).
In the wake of a suicide, families and friends also frequently say they did not understand the severity of what the person was telling them. They often responded that the person should just retire, if that were an option, or that he or she should find a new job, not realizing that by that point, the target had almost certainly formed a belief that he or she would never work again or have a future (Namie & Namie, 2009). Suicide because of workplace bullying also elicits some harsh responses from those who read stories about it. When stories appear in newspapers or in online forums, it is not uncommon to see comments that disparage the deceased target as weak, incompetent or crazy. The comments often cite the writers’ own terrible job situations and seem to be a way they can distance themselves from the suicide victim through ridicule.
Online commentary has indeed become its own form of bullying known as cyberbullying. Targets can be any age. Indeed, the targets themselves do not even need to have an online presence. Social media sites like Facebook, Twitter, and Instagram and newspaper sites do have reporting systems for cyberbullying, but other platforms such as chat rooms may have fewer or no controls. In all instances, though, the sites do not intervene unless the posts are reported. Sometimes, the sites themselves can become the forum for cyberbullying, not in comment sections, but in pages set up for the express purpose of bullying someone.
Thirty-one-year-old Nicole Mittendorf was a stunningly beautiful woman, a fact noticed by coworkers and, as it turned out, people on the internet whom she did not even know. She worked as a firefighter in Virginia, a traditionally male job. Nicole’s body was found one Thursday in April in a national park after she had been missing for six days. A suicide note was found in her car. Nicole was the victim of vicious comments on a forum set up ostensibly for discussing firefighter and emergency personnel issues, but which in reality was used for disparaging women in those professions. Comments about women’s promiscuity and discussions of their bodies, looks, and sex lives abounded (Hensley, 2016).
What makes cyberbullying so pernicious is its public nature on the one hand and the anonymity of the commentators on the other. A single comment or incident can suddenly become hundreds of texts, posts, and comments that “go viral” and spread even to strangers. Those who are young may be especially vulnerable to suicide, but no one is immune from the shame and humiliation that such bullying inflicts upon the target. Targets then often isolate themselves, exacerbating the effects of being shunned. As with workplace bullying, the target’s entire social network can crumble quickly. Feelings of failure are multiplied, and it can become impossible for the target to see a way out (Kowalski, Limber, & Agatston, 2012). It is clear that intervention for this group needs to involve treatment or support for the emotional and cognitive effects of bullying.
Intervention
In our overall findings, and throughout all categories, the psychological diagnosis most associated with suicide was depression. For individuals who felt like a failure, this was often a condition they had struggled with for most of their lives. Unlike other individuals who were responding to a death and were bereaved or were trying to escape circumstances, such as physical pain, individuals who felt like a failure had been struggling for years. Their pain and agony are evident in their notes. Most specifically said that they felt like a failure, but others referred to worthlessness, shame, guilt, hopelessness, or simply said that life was not worth living. Bolton, Belik, Enns, Cox, and Sareen (2008) found that “the depressive symptom most strongly associated with a history of suicide attempts in both men and women was feelings of worthlessness” (p. 1139). In addition, chronic symptoms of depression (over 13 months) increases the risk of suicide (Spijker, de Graaf, ten Have, Nolen, & Speckens, 2010). Not surprisingly, Spijker et al. also found that suicide was associated with feelings of hopelessness. Feelings of hopelessness likely develop and worsen over the chronic course of depression when no relief is found from the symptoms and pain.
It is difficult to point to a specific intervention or prevention for people who kill themselves because they believe they are failures. It is generally a chronic condition and therefore often difficult to identify something pivotal that tips the balance for them. They simply reach a point where they are sick of feeling this way and things have to change. Carrie Fisher, the actress best known for her portrayal of Princess Leia in the Star Wars series, has documented her long struggles with addiction and mental illness in two autobiographies (Fisher, 2008, 2011). In Shockaholic, she poignantly discusses how she became so depressed after the death of a friend that she ultimately relapsed and turned to drugs to cope. She states, “You see, even after decades of therapy and workshops and retreats and twelve-steps and meditation and even experiencing a very weird session of rebirthings, even after rappelling down mountains and walking over hot coals and jumping out of airplanes…I remained pelted and plagued by feelings of uncertainty and despair” (Fisher, 2011, p. 4). Eventually, she decided to try electroconvulsive therapy (ECT). She describes the decision as follows:
I believed that this treatment was an extreme measure primarily administered as punishment to mental patients for being crazily uncooperative. But it turns out that if you’re in sufficiently agonizing shape, you—or maybe not you, but, for example, I—will finally sob, ‘Fuck it. Let’s say it even does turn out to be a punishment, which I doubt very much that it will, but if it did it couldn’t be much more horrifyingly harsh than what I’m barely able to endure now, so what are you waiting for?! Go on! Do it! Do it before you don’t have a mind to change (pp. 4–5).
This is the same reasoning that appears in the notes of those who killed themselves because they felt like a failure. The distinction is that Carrie Fisher opted for trying a new treatment approach as opposed to ending her life. She indicates that having a child served as a protective factor for her. Having a strong support system could make the difference between choosing alternative, and perhaps frightening, treatment options, and suicide.
It was not unusual to read a statement in the investigator’s report that indicates, “The decedent had a long history of depression and had threatened suicide to his wife, brother and sister.” In other words, for most of these victims, friends and/or relatives knew they were struggling with thoughts of suicide or mental health issues. However, simply suggesting that family or friends be more supportive and take these threats seriously is short-sighted. These support systems had usually been hearing suicidal ideation or threats for a long time. Loved ones can reach a point where they become numb to the threats and fatigued from numerous trips to emergency rooms and hospitals. Like Nick, many of these individuals were seeing mental health providers and family and friends had turned responsibility over to those people. In fact, mental health providers will tell family and friends not to try to handle someone who is suicidal but rather to get them into treatment. However, even providers may have difficulty detecting the subtle changes that indicate someone has become suicidal.
Perhaps the best prevention might be to educate friends and family about the warning signs of suicide, and even more importantly, how to build resilience and enhance protective factors to prevent suicide. These include helping the individual to stay connected with loved ones and aiding them in trying out new problem-solving approaches. This may mean considering new treatment options or adopting new ways of dealing with stress or conflict. It is also vital to provide support for family and friends who may become exhausted, frustrated and even bitter. They not only need help in dealing with the current circumstances, but they will need a well-established support system if they have to handle the suicide of a loved one.
If asked to envision the “type” of person who would commit suicide, many people would envision someone who has been described in this section: a person who feels like a failure. However, according to our findings, these individuals represent less than 1% of the sample. It could be that our numbers underestimate the actual prevalence, since many people do not leave notes and that is where feelings of failure are most often expressed. However, it could also be that our numbers are correct and this is, in fact, a small subset. Although Nick may seem to embody the quintessential suicide, this is likely illusory. This happens with other shocking and misunderstood behaviors. For example, people often associate postpartum depression with a mother killing a child but, in reality, that is rarely the case; it simply receives more media attention than other reasons mothers kill their children (Meyer & Oberman, 2001). We want to believe that a mother must be “mad” (or “bad”) to kill a child but, in fact, more mothers kill their children through neglect, by abuse or with intent. However, if they are mad or bad then we can convince ourselves that we would never do it. Connecting suicide to mental illness and feelings of failure may be the “safe” way to perceive it. It becomes distant then, something most people cannot envision themselves doing because they do not have a mental illness. However, our findings suggest suicide is more often in response to specific external stressors and that makes anyone a potential victim.
Other Categories That Were Not Well Supported
In total we derived 11 categories from preexisting literature and research. We have already discussed interpersonal relationships (see chapter: Suicide Motivated by Interpersonal Relationships), escape (see chapter: Escape as a Motivation for Suicide), bereavement (this chapter), and failure (this chapter). Approximately 95% of our cases fell into those categories. Some categories received no support and a few received weak support. No support was found for the idea of killing oneself for spiritual reasons or to end life in order to gain entry into an eternal life/existence. Also, no support was found for killing oneself because of feeling discriminated against or to leave an abusive situation. Some people had a history of being abused and spoke of it in their notes, but no one indicated that the motivation for his/her suicide was a current abusive situation. For example, two women met our definition of abuse, experiencing unwanted physical contact or being subjected to emotionally harmful intimidation, but the abuse occurred 30 years before the suicide. The precipitant for the suicide was to escape from current psychological pain which resurfaced when their daughters reached puberty and the perpetrators attempted to renew contact with the victims.
Similarly, although revenge/retaliation was a part of other suicides, the motivation was interwoven with relationships and the relationship was the driving force, not the revenge/retaliation. Those cases are discussed in the chapter on interpersonal relationships as motivations for suicide.
As for the other categories, only four people killed themselves out of guilt, two who committed suicide because they felt alienated, and one who killed herself for altruistic reasons. Each of these smaller categories will be briefly discussed here.
Guilt
Frank came from a large family. Although his dad and one sibling had already passed away, he had several siblings still living nearby, and his mother had worked in the community for years. He was 44 years old with a daughter from a previous relationship. He attended two evangelical churches, one of which identified itself as reforming and Jesus-centered. Holiness and unity were the themes of the church movement. He liked sports and even did a little coaching.
Frank and his girlfriend had been having relationship difficulties for months. While on the phone one night she suggested they spend some time apart, but Frank wanted to talk to her about this in person. He went to his girlfriend’s house, and they began to argue. Frank threw his girlfriend on the bed and raped her. The next day he wrote a brief note that said, “I’m sorry for my action’s! I can’t live with myself. Please forgive me. My insides are just full of guilt!” Then he hanged himself in his garage.
The motivation for Frank’s suicide was unambiguous. Everything else was stable in his life and the previous quotation represents most of his entire note. The other three individuals who killed themselves due to guilt were just as clear-cut. One man wrote a long note to his girlfriend which read, in part, “I just couldn’t believe I hurt someone I love as bad as I hurt you. I’m truly sorry. It was not me that did that. That is why I cannot live with myself. Because I know I could not hurt you & I still did.” In his note he never stated what he did to his girlfriend, but frequent passages similar to this one discuss how he felt about it.
Two other individuals were included in this category but neither of them left a note. They were both in their fifties when tragedy struck. One man was the driver in a fatal car crash which killed his wife. For 5 years he struggled with depression and guilt related to her loss, and then one day he shot himself in the temple. The last person had a long history of physical and mental health problems and suicide threats but no attempts. One weekend while she was babysitting her grandson, who was a toddler, he ingested a large quantity of her medications. He was taken to the hospital by the grandfather but the grandmother remained at home with a relative. According to the relative, the grandmother was very distraught about the accident. When the relative stepped out to go to the convenience store, the grandmother took all her remaining medications. Although she died, the child lived.
Not much can be extrapolated from only four individuals, especially since two did not leave notes. It is impossible to compare them to other categories. Half left notes and one note was very long, while the other was very short. In general, things appeared to be relatively stable in their lives. It was an event that was precipitated by their behavior, or lack of it, that sent them reeling. All of them had remorse over doing or failing to do something that led to the injury of another. Even if it was accidental, their remorse over the event triggered their suicides.
Research on guilt as a motivation for suicide is limited and much of what is available focuses on veterans. Kopacz, McCarten, Vance, and Connery (2015) examined sources of guilt in veterans who sought chaplaincy services. Approximately 12% of their sample reported they had experienced suicidal ideation sometime during the prior 2 years while the rest had not. They divided their sample into “ideators” and “nonideators.” They then determined how frequently each of the groups experienced guilt and the sources of that guilt. Participants were asked, “How often do you feel guilty over past behaviors?” Of those who were identified as “ideators,” almost 59% said they felt guilty very often as compared to approximately 22% of the “nonideators.” When asked the sources of the guilt, overall the four most common sources were life, God, family, and the military. Their research was designed to provide information about the frequency with which guilt is connected to suicidal ideation in a military population and the sources of guilt. Future research may identify exactly what is meant by the constructs they identified. For example, when participants felt guilt about “military,” what specifically were they referring to? It could be construed as survivor’s guilt or guilt over having to kill others. Perhaps most importantly, this research suggests that, although guilt as a motivation received very little support, it may warrant further consideration within a military population.
Alienation
Tom was a married man with one son, Tommy, Jr. After high school he served in the military and then returned home to settle down amidst the many relatives he had in the area. He had a good job in the building trades. His wife, Beverly, was a professional in the health care community. They belonged to a local black Christian church.
Tom and Beverly had experienced marital problems for years and although they had been in counseling many times to repair their relationship, it never worked. Finally, Beverly told Tom she was going to file for divorce. They had been living separately and their son was residing with Beverly. The night she told him she wanted a divorce, Tom became intoxicated and came to her house at four o’clock in the morning. When she left for work, he was passed out in the living room and she left him to “sleep it off.” That afternoon he called her and told her that he intended to kill himself. Beverly called the police and told them what Tom had said and that he did own a gun. When police entered the home they smelled gasoline but they did not find Tom. They called a SWAT team and an hour later the team found Tom sprawled on the garage floor dead from carbon monoxide poisoning. In the note he left for his son he said, “Oh! Tommy, I love you so much. Please forgive me, this hurts so much Tommy. I need you more than you need me. It sounds stupid, but it’s true, because all I love is you. I love you so much little buddy please forgive me, please. I’m so alone. I feel completely by myself.”
Tom was just one of two people whom we determined killed themselves due to feeling alienated, and they both left notes. The other person talked about how he had recovered from his addictions and yet still no one came to visit him. He indicated that this hurt and he was “going Home to heven.” Both note writers referred to feeling isolated from family, friends, intimate partners or society.
For the two individuals in this category, alienation was not just one more thing, but rather the motivation for their suicide. As with guilt, not much research has been done on alienation as a motivation for suicide. Basically, motivations for suicide are just not that simple. However, recent research published in Croatia which is titled, “Parental Alienation and Suicide in Men,” may offer some insight into Tom’s actions (Sher, 2015). Sher indicates that:
Parental alienation is defined as a mental state in which a child, usually one whose parents are engaged in a high-conflict separation or divorce, allies himself strongly with one parent (the preferred parent) and rejects a relationship with the other parent (the alienated parent) without legitimate justification. Parental alienation is anomalous, maladaptive behavior (refusal to have a relationship with a loving parent) that is driven by an abnormal emotional condition (the false belief that the rejected parent is evil, dangerous, or unworthy of love) (p. 1).
Sher suggests this alienation may be connected with suicidality, especially in men.
Similar to guilt, relatively no support exists for alienation as a lone motivation for suicide. However, it may be that certain populations are more at risk, such as recently separated parents. Even if it is not a motivation, alienation is a risk factor that frequently occurs in victims.
Altruism
It was right after her 66th birthday when Frances found that it was becoming difficult to find the right words to express herself during conversations with friends and family. She attributed this to menopause, but later found she became confused, disoriented and lost while driving. She decided to look up the symptoms of Alzheimer’s disease and found that out of ten early symptoms, she had nine. She also had a family history of Alzheimer’s disease and cared for her mother and grandmother as they died from it. Frances had always struggled with anxiety and depression, and she was paralyzed with fear over the possibility of having this disease. She would not even make an appointment with the physician to have any testing completed but instead relied on her self-diagnosis. She lived with her husband on a farm and after he went to work one day she wrote him a brief note that read, “Honey, Don’t grieve for me. I feel like I’m getting Alzheimers. I love you & don’t want to be a burden.” Then she shot herself in the chest with a handgun.
Durkheim (1897) referred to altruistic suicide as death as a duty or honor. We had no cases where someone killed themselves out of duty or honor. Durkheim associated this type of suicide with those in the military. One who serves may feel the need to kill himself, when his service is no longer of value or he cannot perform it ably. In civilian life, an analogous situation can occur, which Durkheim also labeled altruistic, when someone is motivated to kill herself to help others. Some people in our sample spoke of not wanting to be a burden in their notes, but it was a small part of the note and not the impetus for the suicide. Frances was the only case where the motivation for the suicide appeared to be to spare someone from having to deal with a burden. To us, this represented an unselfish concern for the welfare of others, an altruistic reason for the suicide.
According to Durkheim, altruistic suicides are perceived by the victim as supporting the social order and meeting with cultural approval. The military is an area in modern society in which these suicides persist. One may also find them in highly traditional societies. One reason altruistic suicides may not have appeared more often in our study is that they tend to occur in social groups where a low value is placed on the individual (Stack, 2004). The United States, and western culture as a whole, places a high value on the individual, but in rural, traditional farming communities, individualism may be less valued among women than in urban areas. Frances lived in a rural community and was of an older generation. In a traditional society, women, not men, are the caregivers, but Frances had no woman to look after her.
In our sample, although altruism may have played a small part in why some people committed suicide, especially those escaping physical or mental pain, the deciding factor was not related to a motivation to help others. It was not even one of the main considerations. People enduring physical pain killed themselves to escape the pain and relieving any burden to others was simply an added benefit.
Conclusions
All of the motivations discussed in this chapter represent a very small proportion of individuals in our sample. We include them because other theorists had suggested them as motivations for suicide. It is important to note that many suicide motivations are time and culture specific. While these motivations may have been more prevalent in another time or are more prevalent in another culture, at this point they are surpassed by other categories which are more robust. Still, we felt it was important to describe the specific patterns that can be seen within both the bereavement and failure categories, which can provide information about risk factors. More importantly, for individuals in both categories, social support may be the most important preventative factor.