27 Jun Am I my Brother and Sister’s Keeper? Suicide and the mind/body problem
By Bart Magee, Ph.D.
A trial and a surprising verdict regarding a suicide created a media storm and sparked a heated debate last week. Michelle Carter, a 20 year old Massachusetts woman, was convicted of involuntary manslaughter in the suicide of her boyfriend Conrad Roy III. Much of the debate focused on the legal implications of a groundbreaking verdict, but there was little discussion of its profound social and psychological consequences. I will leave the legal experts to hash out the controversies related to law and ethics, while I address what this decision may mean for how we think collectively about suicide and related self-harming behaviors.
The decision rested on the extensive social media, text and phone conversations between Ms. Carter and her distressed boyfriend. Her early responses to his suicidal intentions were supportive, but by the end she was commanding him to follow through with his deadly plan. Speaking on the phone to him as he exited his carbon monoxide-filled vehicle, she reportedly responded to his expressing second thoughts about his action by commanding him to “get back in”.
For the first time another person was held legally responsible for another’s act of self-destruction. The verdict stunned many legal specialists because, according to the law, suicide is considered to result from a person’s free will. This is an important point both legally and psychologically. The concept of free will has not only formed a cornerstone for judicial thinking, but has cast a long shadow over psychology and has influenced how we think about the individual self, the mind and their various problems from depression, to substance abuse and eating disorders.
The concept of free-will in the individual subject has a long history in western thought. The concept first gained prominence among ancient Greek philosophers. More recently it was elevated through the wide acceptance of the concept of mind-body dualism first proposed by Rene Descartes. Under Cartesian dualism, the mind is made of a fundamentally different substance from the body, the two are split, and the mind, as the seat of rational thought, is responsible for the body’s actions. While extensive research in psychological, social, and brain science has largely recast the concept of dualism as more of an illusion than a reality, its cultural power remains forcefully intact. Because of this, the verdict of the Massachusetts court strikes so many as surprising.
We have ample evidence that minds cannot be separated from bodies, that the matters of perception, thought, emotion, experience and memory, are all bodily. For proof, we need to look no further than the phenomena of placebo effects, conversion symptoms (blindness, numbness, paralysis), and the physical, even genetic changes seen following psychological trauma. Spiritual practices like prayer and meditation change biological systems in marked and lasting ways. The more one recognizes the inseparability of mind from body the more difficult it becomes to ground such an abstraction as free-will. If the mind is not some kind of pure, rational substance governing a disordered, opaque body, but rather is inseparably tangled up in the total organism, one that is in constant interaction with its environment, the formerly hard concepts of “freedom” and “will” begin to soften and shift. With the shifting of these concepts, so shifts the phenomena of suicide as a self-determined act, and therefore how we hold the responsibility for such an act.
Another undeniable entanglement we face as embodied selves is the social. Mind-body selves are fundamentally social. There is no such thing as a person, being or mind as separate from other beings, persons or minds. We are all born dependent on the relationship to our mother or primary caregiver and born into culture, and culture (symbol, language, ritual, meaning, etc) is intertwined with physical, biological development. How this all unfolds is enormously complex and is the subject of extensive research and theorizing, the momentum of which continues to evolve toward an understanding of the human being and the elusive concept of the self as existing at the intersection of multiple realms: the social, biological, psychological, and spiritual.
So what does all of this mean about Michelle Carter, Conrad Roy and the court’s judgement?
Any reading of the court case will reveal that Carter and Roy involved in a deep and interconnected drama with each other. In an extensive conversation on Facebook he details his intentions and plans, drawing her in, and she responds variously by denying his idea, wondering if it’s her fault, declaring her love for him and accepting the outcome. It’s hard to tell whether he’s having a conversation with another person or himself.
It has taken time, but slowly we are catching up to the idea that suicide is complex phenomena that exists at that intersection between an individual, significant others and society at large. Therapists know this: suicidal thoughts, plans and actions are always bound up in relationships, real and imaginary. The internal suffering of the suicidal individual and the wished for relief through death is a renunciation of, or a giving up on, the expectation that suffering can be relieved through the caring response of another. Not surprisingly, studies have documented the presence of disordered (anxious, avoidant) attachment styles in suicidal behavior. Those with a secure feeling of attachment to others and to society in general are far less likely to seriously consider killing themselves. Social scientists have studied the effects of behavioral contagion on suicide and we know that the suicide of a friend or family member or close friend dramatically increases one’s suicide risk. (We recently saw another media frenzy around the Netflix series 13 Reasons Why and an ensuing debate about how much the producers of the show are responsible for inspiring copy-cat suicides.) We also know that suicide varies widely across cultures and countries ranging from as low as 0 to as high as 116 per 100,000 people per year.
How do we square this knowledge with an awareness of individual responsibility? Can one person cause or prevent another from killing themselves? Do we have a clear answer to these questions? Probably not, but that’s not necessarily a bad thing.
More and more we are seeing that behaviors once thought to be fixed within the individual are held within a social matrix. Think bullying for a moment. It used to be that bullying was just something that happened, a phenomena located within the individual. There were bullies, they bullied and if caught they were (maybe) punished. Today we recognize a much greater complexity, that the bully may also be bullied and that the bystanders have a role along with the social context. Restorative justice is now preferred to punishment. A similar shift has occurred around substance abuse, once seen as moral failing or a criminal act is now understood through a complex social, psychological, and biological frame.
From a mental health perspective, it’s helpful to view the trial of Michelle Carter through a similarly multifaceted lens. Remember, suicide is a huge problem in the US. According to the Centers for Disease Control suicide is the second leading cause of death for youth aged 10-24. These disastrous death rates are not going to change on their own. We are only going to bend this curve if we change our mind-set and think more collectively about the problem.
Our experience at Access Institute bears this out. Over the years, we have helped hundreds of suicidal people through serious crises utilizing a treatment approach that recognizes and listens to the deeper meanings communicated via suicidal thoughts, plans and gestures. We also utilize a fundamentally attachment-based methodology as we work to help the individual in crisis find safety in the relationship to the therapist and in key social connections.
With this in mind, I’ll end with a few well-validated responses to remember if a friend or family member begins to talk to you about suicide.
- Don’t ignore or play down or deny suicidal ideation. Listen and respond with empathy for their feelings, however irrational they may sound.
- Let them know you care and are concerned. Provide consistent support and try to think with them about how they can find safety with the support of others.
- Encourage them to seek professional help.