Questions of intent can’t get to the real roots of suicidal experience
Some suicides are akin to manslaughter. I don’t mean that they are criminal. I mean simply that some suicide belongs in that liminal category between the accidental and the intentional. An attempt is made on a life without premeditation, messy and unmeticulous. It is impossible to answer definitively, “did they mean to do it?”
These are those anguished leaps for oblivion, which—not for want of medical and psychiatric pathology—remain mysterious. These acts stand in stark contrast to the deliberated acts of suicide, either assisted or solo, in which an individual determines that their life is better ended. When 29-year-old Brittany Maynard moved to Oregon—where it is legal to die with a physician-prescribed lethal dose of barbiturates—she asserted sovereignty over her own life. Facing swift and terminal brain degeneration from cancer, the young woman took to YouTube before her scheduled November death to publicize her case and argue that others, like her, should be permitted to Die With Dignity. Cases need not be as clean cut or imminently terminal as Maynard’s to be defensible. I see no moral ill in deciding to die; players should be able to fairly choose how many hours to strut and fret upon this stage.
Had any of my attempted suicides been successful, I believe they would have been equally morally defensible. But it would not have been death with dignity, nor deliberation. “Crime of Passion, Your Honor,” I’d tell the judge, “it was manslaughter.”
I’ve tried to kill myself twice. I feel a twinge of disingenuousness even writing that, because those are uncompromising words, “I tried to kill myself.” The sentence sits ill with me, though it is straightforwardly verifiable: Twice I have landed in a Brooklyn emergency room because I overdosed. Most recently it was fistfuls of Ibuprofen and Seroquel—an anti-psychotic medication, prescribed for bipolar disorder. (This gives some context, I suppose.) Just over a year before that, it was anything I could find in the disheveled bedroom I shared with the violent and broken man with whom I had planned to spend my life (there’s some more context for you)—painkillers, anti-depressants, Klonopin, some methadone a passing junkie had left behind.
All of which is to say, these were the sorts of concerted efforts which left me hooked up to IV fluids, Under Observation and shitting black activated charcoal for a week. And that gets called attempted suicide. In both instances, though, intent was a grey area. Distressed, unplanned, and, thankfully, unsuccessful, these were attempts at self-annihilation rooted in a transient despair. My overdoses are memory black spots. I don’t remember the ambulance or how my best friend knew to get there or when they swapped my clothes for the green gown that would make even a paragon of wellness appear sickly. I don’t remember deciding to take the pills or deciding that I wish I hadn’t. I do remember the way a handful of Ibuprofen felt in my palms, sweaty and melting red dye, though not in my mouth nor going down my throat. I do remember that I couldn’t form words when asked, “Did you intend to kill yourself?” or “What happened?” I was too out of it to speak and, in truth, I didn’t know. I still don’t.
I both did and did not intend to die. EMTs and ER staff, however, don’t barter in such equivocations. Risk assessments have to be made and patients must be sorted into the suicidal and the accidental. Psychiatry distinguishes between suicidal ideation, intent and risk. Ideation is common and, while a mark of certain depressions, is no consistent indication of intent or risk to self-harm or death. I’ve thought about the fact of suicide for as long as I can remember—but those familiar vertiginous fancies, arising, say, at the edge of a subway platform (“how strange, just one more step, such a small and common act, most simple, most difficult”)—are a world away from the implacable terror or dread-like sensation that preceded my suicidal acts. Though still overly simplistic, the differentiation between suicidal ideation, intent and material risk goes some way to acknowledge that our sovereign relations with our own mortality, our control over it, are fraught and complicated.
It is correct and unavoidable to point in cases like mine to mental illness and substance abuse, and wherein the two meet. It is also irredeemably circular. Un-premeditated suicide, manslaughter suicide, is understood as the act of an unsound mind. Pathology, bartering as it does in cause and effect, posits such suicide as an effect of mental illness and seeks causal explanation in the realm of mental illness. In his book Suicide: Foucault, History and Truth, Ian Marsh notes that “unequivocally” suicide is treated as “an issue to be categorized, managed, controlled and prevented, and solutions to the problem are pharmacological and psychotherapeutic.” As Marsh argues, pyschiatry has constructed a “regime of truth” that produces a “compulsory ontology of pathology in relation to suicide.” We can’t even think about impulsive suicidal acts without reference to mental illness. Like any regime of truth, suicide-as-pathology posits a particular world of subjects, objects and relations to make sense of suicide. Above all, it assumes that sense can be made.
But the pathologized suicidal subject is ontologically weird. “She killed herself”—the sentence’s subject and object are the same individual. It is no stranger than any other instance of apparent subject-object collapse—a perennial problem philosophy finds for itself. In David Hume’s troubled appendix to his Treatise on Human Nature, he expresses some despair that the self presents as no more than a contiguous series of mental states, but, this being so, the pesky “I” that experiences these states persists, evading reduction to empirical explanation. “When I turn my reflection on myself,” wrote Hume, “I never can perceive this self without some one or more perceptions; nor can I ever perceive any thing but the perceptions.” The self as object, this set of perceptions, cannot account for the phenomenon of the self as subject. Of this quandary, the Scottish philosopher wrote, “I find myself involved in such a labyrinth, that, I must confess, I neither know how to correct my former opinions, nor how to render them consistent.”
I find myself, the suicidal subject, irretrievably tangled in this dualism of self: both attempted killer and her would-be victim. I designate the former as unwell and monstrous, an Edward Hyde of my own making, my own being. Petrified that she might strike again, I try to obliterate her, first with medication, more sleep, and appointments in a psychiatrist’s office twelve floors above Union Square. The view from the window captures every Manhattan skyline landmark, like a snow globe. Philosophically, my split suicidal self is incoherent; therapeutically, the split provides some relief and refuge from the nagging question of whether I did or did not really mean to die. Placing the suicidal subject within the realm of the clinically pathological provides a story that makes sense of my attempted self-manslaughter. Yet, for reasons unclear and probably historical, the problem of intent lingers. It’s not a question I seek out, but one that haunts me: Did I mean to do it?
The need (or the feeling of need) for answers about intent emerges in part from the gravity of the matter at hand. When Hume, one of the key defenders of suicide in the Western philosophical canon, wrote in 1750, “I believe that no man ever threw away life while it was worth keeping. For such is our natural horror of death that small motives will never be able to reconcile us to it,” he gestured to the weightiness normally, or normatively, applied to considerations of mortality. If all suicides were of the deliberate and considered variety, like Brittany Maynard’s, Hume would have been quite right. His proposition that an individual is a correct judge of when to end her own life posits the suicidal subject as an ultimately rational actor.
Hume’s tract, “Of Suicide,” is an attempt to salvage suicide as defensible within a moral context that demanded an act neither abrogate duty to God nor the Laws of Nature to be considered justifiable. I am unburdened by religiosity and, without a metaphysical commitment to life’s inherent value, I’m not interested in a moral argument in defense of suicide. I simply suggest, contra Hume, that not all suicides or attempted suicides involve a suicidal subject reconciling herself with the “natural horror of death.” In my case, at least, the brute fact of having tried to die, and there is horror in that, only hit post hoc and remains unreconciled.
Any survey of suicidal intent is stymied by survivor bias; even the most diligent research can’t reach beyond the grave and ask those who take their own lives whether they had really “meant” to. Some leave notes, some don’t. But we must avoid the sort of tautological thinking that asserts that if a suicide attempt was successful, the actor had really intended to succeed in ending their lives. Even with a complete and coherent pathological explanation of a suicide attempt, intent can remain a gray area.
Attempts to attribute intent or complete lack thereof in suicide cases is understandable. Intent is dramatized in suicide narratives because the stakes are so very high. Grasping for understanding, we run the risk of ascribing complete and reasonable deliberation (such as in Maynard’s case) or a psychopathology in which any sort of intention is impossible. Suicide becomes the purview of the mad or the meaningful, and nothing in between. Speaking from little more than personal experience, I suggest that it might not be so. Despite all the answers psychiatry and pharmacology have to offer, none of them can resolve the haunting self-knowledge that in some sense, I tried to die, both meaningfully and without really meaning it. An explanation from mental illness feels necessary, but not sufficient. And I tentatively conclude that this is okay. While impulsive self-manslaughter attempts can be explained, the feeling of having committed the act will persist like a haunting and threat, unsettling and unsettled. Maybe I just haven’t come to terms with it yet, but something tells me the terms might just not be there. Like Hume, I find myself involved in the labyrinth trying to locate an “I,” which maybe I cannot.
Meanwhile, life continues. In the weeks—and it has only been some weeks—since my most recent overdose, my days have been surprisingly normal. I scared myself and have renewed commitments to better self care; I did that last time, too. Surviving my own attempted manslaughter brought no revelation. On a few fleeting instances I have paused for something like sentimentality, or appreciation. My best friend was sick one night, I sat with her, stroked her hair and watched her fall asleep; I was pleased to watch her feel better, and was pleased to be alive to watch her feel better. My lover’s body is always warm, remarkably warm. He feels like energy and I have, once or twice in the weeks since I didn’t die, pressed my face against his chest to appreciate heat and heartbeat. After writing that sentence, I rested two fingers against my throat to feel my own pulse.