The Issue and Role of Suicide in Existential Psychotherapy

Suicide is a phenomenon that makes hearts race and faces flush with heightened emotions. It is ironic how the choice of ending life spurs sensations within our bodies that remind us what it feels like to be alive. Being someone who has contemplated suicide several times in my life and attempted to speak about it to people around me, I have seen first-hand the various reactions that it brings. It is an extremely powerful topic of discussion that invites everyone to examine our existence and understand what life means to us. And yet, reports and studies on suicide are almost always concerned with stating the rising rate of suicides in different parts of the world, the most common risk factors that lead to the act, raising awareness for suicide attempt surveillance and modeling techniques for suicide prevention. While these may be commendable ways of analyzing and responding to suicidal tendencies, it does not dive into the meaning of suicide to human experience.

In this essay, I would like to conduct an existential analysis of suicidal thoughts and actions through the four universal concerns of existence: death, freedom, isolation, and meaning(lessness) as described by Irvin D. Yalom in his book Existential Psychotherapy. I aim to highlight the therapeutic value of exploring suicidal tendencies to take a step towards lifting the stigma surrounding the issue.

Existential Concerns & Suicide

Death

Death is a certainty of human experience. There will come a point of time when our individual life will cease to exist. While we know this, the uncertainty in the ‘how’ and ‘when’ death will find us is a concern that constantly grinds at the back of our minds. Existentially, “death is a primordial source of anxiety” (Yalom, 1980: 29). And so, it may be natural that humans find a way to rid themselves of that angst. Suicide can be seen as an individual’s attempt to overcome their fear of the uncertainty surrounding death and choosing to gain control over the final steps of their existence. This is telling through the latest World Health Organization report stating that suicide rates are highest among the elderly (70+) in many regions of the world. Death can bring awareness to our natural vulnerability to our biology that makes us feel defenceless and weak. With this view, the act of suicide may be an active show of strength. It may also be possible that individuals who contemplate suicide perceive death as temporary based on their beliefs and understanding of life (Yalom, 1980). In these instances, it would be critical to spend time exploring their understanding of mind, body, and spirit to discover the goal they may be trying to achieve through the act of suicide.

Alternatively, close encounters with death may also intensify individuals will and purpose to live through a radical shift in their perspective. A study on palliative and hospice care professionals found that individuals found their work provided them an opportunity to explore the meaning of life and reflect on their own mortality helping them learn how to live in the present and stay curious about the continuity of life (Sinclair, 2011). This may also be evident in the stories of some suicide attempt survivors wherein their views on life have shifted positively following the experience of dying (Yalom, 1980).

Freedom

Paraphrasing translations of Schopenhauer and Sartre respectively, the universal concern of freedom can be succinctly stated as the dilemma between ‘Man can do what he wills but he cannot will what he wills’ and ‘Man is condemned to be free’. I believe these two quotes portray that although we have a freedom of choice regarding our actions and words; we are thrown into this existence subject to the natural laws of the universe that may be outside our comprehension. As we live with this ability to make our choices and are accountable for them, we are also grappled with the heavy weight of making meaning of our own experiences. This can be a rather overwhelming reality to accept leading to individuals feeling insecure or inadequately equipped to face life. Globally, suicide is reported to be the second leading cause of deaths among teenagers and young adults (15-29 years) according to the World Health Organisation (2014). This may be attributed to the fact that these are the stages of life when there are a large number of decisions to be made that would impact on and shape the rest of their lives.

The struggle with the concept of freedom may also be the reason for the highest number of suicides in Europe and South East Asia (World Health Organization, 2018). An existential exploration of freedom within the two cultures might draw out important differences in the two experiences of suicide. While the individualistic European society may put undue pressure on their citizens for creating their own meaning in life, the collectivist attitudes of South East Asian communities exert pressure by enforcing traditional values and structures on their people. Hence, to understand suicidal thoughts and tendencies it is important to dig through an individual’s experience of their existence rather than analyzing global or regional quantitative data sets to come to generalised conclusions.

Isolation

In the midst of difficult times, loneliness and isolation is something that is commonly experienced by everyone. However, existentially, the concept of isolation is concerned with the reality that an individual is confined to their embodied self: born alone, live alone and die alone. Even while being fully immersed in life and sustained by rewarding relationships with others around them, humans are bound by the fact that they alone are experiencing their existence and there will never be anyone around them that can have exactly the same experience as they do. As a human civilization, we constantly live as part of a group or family whether it is governed by our genetics, geography, profession, religious beliefs or even personal interests. This serves as a constant buffer over the sense of anxiety that overcomes us at the acknowledgment of existential isolation. And so, at times when this protective layer is shattered for any reason whatsoever, individuals may find themselves incapable of finding meaning in their existence without the definition of their group. This isolation can challenge their belief systems and suicide could be a way in which they attempt to protect the view they hold about themselves as part of something. In some instances, suicide could also be an attempt of calling attention to their existence for a fear of being forgotten or based on a belief that they could live through the consciousness of another merely by being remembered (Yalom, 1980).

The dilemmas brought on by the existential concerns of death and freedom may also lead to a sense of isolation for “dying is the most lonely human experience” and carrying the responsibility of one’s own existence can bring a deep loneliness when faced with difficult or sometimes trivial choices (Yalom, 1980: 356). Hence, the problem of isolation is multifaceted. Generally, it is usually regarded as a symptom or consequence of mental illnesses. While there are research and several studies on the impact of social anxiety and depression on suicidal thoughts that target the problems of loneliness in today’s world, there is a larger focus on interpersonal isolation that may be remedied through group support or fostering healthier relationships. An existential exploration of an individual’s understanding of loneliness could help garner a deeper connection with ones’ self.

Meaning(lessness)

The search for meaning in an existence which we are thrown into, one that we create for ourselves through the choices we are responsible for and could cease without our explicit control is a baffling ordeal. And this is the core of human experience – finding meaning without a universal goal in sight. Within the human world, an object derives its meaning at its conception. But when we do not know the intricate details that shaped the start of life, how do we know its meaning? Throughout history, humans have found several ways of making sense of their existence of which philosophy is part. Whether meaning is found through spirituality, objectivity and rationality, power and control or even through mere observation; humans use their lived experience to harness some meaning to the meaningless existence they are condemned to. Artists across centuries have attempted to make sense of life in unique ways and it is interesting to note that creative endeavours almost always challenge meanings created by those that came before them. In a way, suicide is much the same as it can be seen as a way to attach a concrete meaning to an individual’s life. Sometimes a person could have the strong belief that they have fulfilled the purpose of their existence and would like to preserve their lived experience as it is, so ending their lives would give them assurance that the meaning of their existence doesn’t not change through further experience. Other times, it could be the inverse, where a person questions the purpose of their life and finds no reason to stay alive.

Nietzsche was of the opinion that the contemplation of suicide is necessary for one to take life seriously (Yalom, 1980). In a translation of his work, Beyond Good and Evil (1998: 70), it is stated: “The thought of suicide is a powerful solace: by means of it one gets through many a bad night”. By this, I think he means that the ability to choose to end ones’ life can provide us with the strength to face the challenges that have the possibility of breaking us down. While for some it may serve as a reassurance that when all else fails they also hold the choice to end their lives; for others it could be a source of meaning to base the rest of their life. Suicidal thoughts can be used as a way to uncover what they value most so as to claim responsibility for their actions. I believe to contemplate the experience of non-existence involves a passionate comprehension of what it means to be alive.

Suicide: A Response to the Absurdity of Existence

An amalgamation of the four existential concerns: death, freedom, isolation and meaning(lessness) leads a philosophical thinker to consider the absurdity of human existence. In The Wisdom of Life, Schopenhauer (1902: 15) identifies a spectrum of reasons for suicidal tendencies that he believes could range from “morbid intensification of innate gloom” to “entirely objective grounds to put an end to [..] existence”. Both these extreme positions are held as a response to the anxieties of the lived experience caused by the paradoxes contained within the human experience as discussed above.

Albert Camus (1955: 3), in his introduction to The Myth of Sisyphus, states: “There is but one truly serious philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy.” What I believe is highlighted through Camus’ work is the fact that contemplating suicide is not unnatural or absurd. But it is the act of suicide that drags into it the absurdity. In his essay, Camus explores the relationship between the suicidal thought and the individual experiencing it drawing a distinction between the act and the thought itself. While a person may be seeking a sense of empowerment through suicidal thought, he points out that the act in itself reduces the experience to nothingness as the person would simply cease to exist and the meaning or control they aim for would be lost.

In Studies in Pessimism, Schopenhauer (1902: 404) concludes his chapter ‘On Suicide’ by likening it to “a clumsy experiment” involving “the destruction of the very consciousness which puts the question and awaits the answer”. This, I believe, is the key to unlocking the therapeutic value of exploring suicidal thoughts and attempts. It is this paradox held within the concept of suicide that plays the most important role in existential therapy. Suicide, much like every other aspect of existence, has an intrinsic dilemma within it that demands acknowledgment and acceptance. But more importantly, it isn’t suicided itself that requires discussion or intervention. An open, honest exploration of an individuals’ understanding of life and death would encourage individuals to philosophize on the perplexities of existence rather than committing suicide by succumbing to its anxieties. With this view, the issue of suicide isn’t one that requires a solution or a framework to help those with these tendencies but something that helps us embrace the reality of human experience.