Book review: “Choosing to Live: How to Defeat Suicide Through Cognitive Therapy

This is my second book I’ve read on the topic of suicide after the tragic suicide attempt and later death of a BYU student at the Tanner building. Concerned about both my knowledge and my lack of understanding of those attempting suicide, I wanted to read up on the topic so I would be better prepared to help.

I first read the 1897 book On Suicide by Emily Durkheim, which was groundbreaking in its day. It provided a sociological framework for approaching suicide that examined the interplay of the individual and society as a factor in suicide. Many of its findings have stood the test of time, but others have had to be revisited. As a resource for someone seeking to help those who may be contemplating suicide, it may not be the first thing on your list: it takes a very impersonal and broad approach to the topic, and, well, it was 1897 when it was published. Nevertheless, it is a classic in its own right, and set a high bar for scientific literature in its own day.

While I was reading up on suicide, I did notice that the topic still causes a shudder to some: well, at least to everyone with whom I tried to discuss the book, including my wife and parents. Suicide is a topic that is off limits, even if you are trying to seek understanding or to be of help. And I don’t think that’s a good thing. In fact, this is how the book Choosing to Live begins: the first chapter is titled Suicide is an Ugly Word with the first subheading Job 1: Getting Rid of the Stigma.

No one seems to mind buying a book about how to have a healthy heart, read faster, or develop a winning personality, but in most cultures, suicide carries a stigma not seen with most other human problems. Take a look at your newspaper’s obituary section. It is known that 1.4 percent of all deaths are self-inflicted– more than the number of deaths caused by liver disease, kidney disease, or even homicide. But if your newspaper is like most, its policy is not to report suicide as a cause of death.

While this may be motivated by a well-meaning wish to protect the feelings of surviving family members, why is a death by suicide cause for shame or embarrassment any more than some other cause of death?…

You may ask, “Well, shouldn’t suicide and suicidal behavior be stigmatized? Isn’t it sinful, after all? Besides, we surely want to do everything we can to discourage self-destructive behavior.”

True, we want to do all we can to prevent suicide and suicidal behaviors, but it is unlikely that laying guilt trips on depressed people will be helpful. Aren’t depressed people already some of the guiltiest-feeling people around? If guilt were an effective strategy, we would expect depressed people rarely, if ever, to commit suicide. Most depressed people already feel bad about themselves. A threat of moral condemnation is unlikely to have a positive impact on someone who already believes he or she is bad.

This was an enlightening perspective for me, because this is the explanation I have always told myself regarding stigma towards suicide: if we don’t make it shameful, aren’t suicide rates going to rise? But it can have the exact opposite effect. I think we need to perhaps change the culture surrounding the discussion of suicide if we really want to make things better.

Choosing to Live is written like a self-help book for those entertaining suicidal thoughts, but it can be read by anyone really, and I would say can be especially helpful for those who have someone hoping to help a loved one who has contemplated suicide. I even found the book helpful for me, even though I’m not suicidal: the book teaches you how to use cognitive behavioral therapy (CBT), a way to combat negative thoughts. CBT was a central part of another book I read recently, The Coddling of the American Mind, in which the authors Greg Lukianoff and Jonathan Haidt suggest the use of CBT on college campuses to help address the rising mental health crisis. I think this is increasingly becoming an essential skillset.

The central idea of the book that I find absolutely profound is that the real solution to suicide is becoming a better problem solver. Take a look at this passage:

The ability to recognize a problem, define it clearly, and think through possible solutions is a valuable skill. There is no way to avoid life’s problems, so what separates those who are satisfied with their lives from those who are not often has to do with how well the person solves those problems.

But doesn’t that sound a bit, well, condescending? Are you implying that a suicidal person’s problems aren’t real, they just haven’t tried hard enough?

One of our clients, upon hearing that she might need to work on her problem-solving skills, reacted angrily: “Is that what you think– that my life is actually problem-free and that I just don’t know how to cope? Well, that is easy for you to say. You don’t have to deal with my hyperactive son, busted water pipes, and neighborhood drug dealers. Listen, my problems are real, and I resent you suggesting that they’re only in my head!”

If you notice yourself having thoughts like these, let us make one thing very clear: To suggest that you practice improving your problem-solving skills in no way implies that your problems are not real. Studies have shown that suicidal individuals actually do have more life stressors to deal with than people who are not suicidal. If you believe that you have more problems than the average human being, it is even more important for you to develop excellent problem-solving skills in order to address them.

I love this idea, but it is obvious that it could potentially be either mis-used or mis-understood if you were to suggest it to someone. The book itself is very sympathetic, it never minimizes the pain suicidal individuals are feeling, and it walks with them through problems. But it also helps individuals change.

After reading the book, I feel better prepared to help someone struggling with suicidal thoughts. I feel more sympathetic, but also more ready to help: not to try to play the role of therapist, but at least to give a boost and point them in the right direction, instead of feeling uncomfortable and reticent.

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