THE preservation and enhancement of the quality of life is such a widely shared human objective that its opposite, self destruction, is hard to understand and to recognise, and this is one.of the reasons why we may miss the chance of saving a person who is in general danger of selfannihilation.
Yet the attempt to end life goes on continuously in our midst as the figures for suicide and attempted suicide show only too clearly. In 1974 there were 3,891 suicides in England and Wales and at least 100,000 attempted suicides.
Both these figures are probably conservative es timates because there is no way of knowing accurately the number of suicide attempts and suicides.
Unless the circumstances of death show unequivocally the intention of selfdestruction the verdicts of coroners tend to choose alternative and less harsh causes of death. Given all these mitigating factors, nonetheless the human suffering and carnage is considerable.
So what light can be thrown on this blatant repudiation of the widely shared value of life'? Psychiatry, in whose terrain lies this form of selfdestruction, has made many illuminating contributions.
But before discussing these it should be remembered that there are other forms of selfdestruction which, while not having the immediate dramatic poignancy of suicide, are equally dangerous to life in the long term.
For example, heavy smoking and alcohol consumption, intravenous use of addictive drugs, obesity, careless driving and driving under the influence of alcohol.
One of the remarkable experiences of my life is that while I have heard innumerable sermons on the dangers of sex, I have never heard a single one devoted exclusively to these subjects which must be some of the most prominent social sins of our day.
Suicide attempts, or parasuicides as some experts call them, have to be distinguished from successful suicide. This is not only for the obvious reason that unsuccessful attempts to end life give an opportunity to
render help to the person, but because a great deal of research suggests that the motive for attempted suicide is not to destroy life but rather to draw attention to a desperate plight.
The "call for help" phrase has virtually passed into everyday language as a general gesture of men and women who have reached' the end of their resources and feel they are drowning in a situation too painful to contain or control.
Attempted suicides may take place in any age group, but are usually the activity of the young — more often women than men — and take the form of an overdose of tablets or a self-inflicted bodily injury which calls for medical attention.
Several features, however, are associated with suicide attempts. First of all the amount of drug taken is not excessive, nor is the selfinflicted injury serious. The circumstances are also such that help is not too far away and the arrival of 'someone who will witness the action and intervene in' time is often part of the general picture.
Frequently the person seeks help soon after the attempt. This means that the overwhelming majority of suicide attempts are interrupted in time and the intention of the person, which is to draw attention to their plight without endangering their life, is achieved.
Death may ensue rarely from a miscalculation of a suicide attempt, but it is more often deliberate, premeditated and therefore planned accordingly. The amount of drug taken is excessive: dangerous combinations of drugs are used, the activity is carried out in isolation and so discovery is intentionally delayed until after the person is unconscious.
Finally, instead of taking an overdose, the people may kill themselves by some physical violence such as drowning, hanging, throwing themselves in front of a moving vehicle or train. The intended suicide may occur at any time in life, but is usually an act of older persons and involves more men than women.
A suicide attempt is not merely a gesture to draw attention with the maximum dramatic impact. This is rarely the presenting picture although it may seem so. Very often the act is a desperate attempt to draw attention to a plight of feeling overwhelmed by a situation.
Adolescents feeling trapped within the home with authoritarian parents, longing for their independence but afraid to take the plunge and start life on their own, reach a point of hostile frustration to punish the unyielding and uncomprehending parents by taking a handful of tablets.
The young men or women unable to reach a decision about their future in work or a personal relationship, feeling a failure repeatedly through rejection, experience a sense of meaninglessness creating an ever-growing void inside them which is too powerful to bear.
The broken engagement, the deserted or trapped spouse, the failed exam or business venture, public or private disgrace, in other words an escalation of lack of self-esteem, feeling of impotence or rejection and hostility gradually drain personal meaning and replace it with a sense of futility and badness.
The determined attempt to end life arises from the conviction that life holds little prospect of any further value .or significance. Undoubtedly the commonest state associated with such a feeling is that of depression — particularly severe depression, which is a frequent background to suicide.
Older people who have lost their spouse, are living alone or in isolation (deafness plays an important part here), suffering from chronic painful disease or an incurable condition or, as a result of drinking, have finally lost all contact with relatives and friends, are likely victims for suicide.
So is the person just recovering from a depressive illness, perhaps afraid of a recurrence or just sufficiently recovered but not enough to have willpower to end the continuing misery.
Apart from these specific reasons which psychiatric research has drawn to our attention, are there any other clearly delineated ones?
Here we enter the world of speculation in which industrialisation and urbanisation, with the breakdown of supportive family systems, the social and ethical norms which exercised restraint on the individual, undoubtedly play a part but are not ones that can be easily defined.
The growing secularisation and loss of the sense of God have reduced the powerful impact of the presence of a Being Who loves us personally. inspires with hope and gives a powerful example in Christ of how to transform suffering meaningfully.
All these are undoubtedly contributory reasons as communal support and love have been gradually replaced by alienation and in
Christians believe that life is derived from God and is precious, and await the divine call to return to His loving presence. Suicide is therefore a breach of this loving relationship and a specific denial of hope.
Nevertheless, Christianity has moved on from using threats, condemnation and fear as the main weapons of deterring self-destruction. This reduction of deterrence through fear, has yet to be matched by widespread positive action.
Such action is the prerogative and duty of everyone who responds sensitively and with care to the plight of their intimate neighbour.
Thus, anyone who mentions seriously or repeatedly the idea of suicide must be taken seriously, and so must the lonely, the recently bereaved, those who are depressed, the isolated alcoholic, the chronically physically ill, particularly if they give any hint of feeling self-destructive, Having recognised that such a person is in danger, what should we do?
First of all we must not be afraid to confront them with their intention. Such a discussion clears the air and helps to clarify the situation. If the risk is gauged to be serious or when in doubt, we need to bring in the help of the medical profession, the priest, social worker or any available professional person.
If the situation becomes desperate and we feel personally suicidal with no one to turn to we can call the Samaritans, who provide in most areas a 24-hour service for those in need.
'The Samaritans organisation is a national, indeed now international, voluntary movementset up by Chad Varah, a Christian minister, to provide a practical, confidential and immediate service to those in distress. Its members are men and women of all faiths and none, committed to offer themselves in a caring response to those in need in these desperate circumstances.
It is a modern movement worthy of the attention of all men and women who care for their neighbour and should receive serious consideration by anyone who has a little time to spare and wishes to respond to this particular apostolate.
But ultimately the
apostolate involves everyone with whom we come into contact, for the potential suicide can be our father, mother, husband, wife, brother, sister, son or daughter, friend or neighbour, at work or at home, and we may he their only hope of sustaining them and directing them to a source of help.
Dr J. Dominian