Answering the Real Question

I recently received an extremely moving email on the topic of suicide from a lurker. It turns out that my words, wrung from the pain of the deaths of two children, brought solace; truly a miracle of our times and the internet. Fat Doctor also had a post several weeks ago about how to answer the question, "Give me one good reason not to kill myself." (Back off, Grammar Nazis; the actual sentiment in the form of a question would be, "Why shouldn't I kill myself?")

My answer to that is to address the real question.

First of all, let me point out that it can take some skill NOT to answer what appears to be a question. It's not really hard to do, though it can take some practice. Here are some questions that are routinely not answered:

• How yoo doin'?
• Is the doctor there?
• Why do I have to go to bed?

The first statement, of course, isn't meant as a question at all. It's Philly-speak for "Hello." The second is answered, Jewish-style, with another question: "Can I help you with something?" The third, usually asked by a pre-schooler, also isn't a question. What the kid is really saying is, "I don't want to go to bed." The wise parent learns this -- sometimes the hard way -- and responds with a non-answer like, "Because." But a mark of skillful parenting is learning to address "the real question," which is that the child wants to stay up because he doesn't want to miss interesting things (he perceives) going on without him. Of course he needs to sleep in order to be alert for much more interesting things the next day, and the wise parent learns to address this lovingly and explicitly.

"Why shouldn't I kill myself?" is, in my opinion, not really a question at all. It is an expression of despair so deep that the questioner cannot believe it will ever get better. In the case of a terminal illness with physical suffering, it is a statement that symptoms are not adequately controlled, and should prompt efforts to better manage them. This is also the case in the psychiatric version, but because the suffering is the belief itself, it is by definition resistant to intellectual logic.

The problem is that trying to answer these non-questions enters into a tacit agreement that an issue is open to debate. If you start trying to explain to a kid why he needs to go to bed, what happens if he makes a better argument than you can? Are you going to let him stay up? (Perhaps; but stay with me here.) Similarly, if you can't manage to come up with "one good reason" not to commit suicide, are you going to agree that the patient ought to kill himself? The flaw in the logic is that a suicidal person is unable to comprehend such a reason, just as a non-suicidal person doesn't need one.

Anyone who has contemplated suicide but not gone through with it eventually comes to realize that it was not a good idea, and that they were not thinking clearly at the time. What sense does it make to enter into a highly intellectual debate about life and death with someone unable to think rationally? I believe a better approach to the question, "Why shouldn't I kill myself?" is to recognize that what has really been said is, "I am in pain, and I am desperate." Expressions of empathy for the pain and reassurances that things will get better -- even (especially) if the patient doesn't understand or believe it -- strike me as a more honest approach than trying to come up with an "answer" to the wrong question.

And to my lurker: You cannot begin to imagine how deeply your words moved me. I can't even fathom the courage it took to write them, much less the courage it took to step back from that abyss. Please be assured that whatever my words did for you, you have returned the favor hundred-fold. Peace.