Depression and Spiritual Growth

A. Therapy

2. The Problem of Suicide

Suicide is the greatest danger and worst possible outcome of a period of deep depression; it is a final, permanent, defeat. It is to be avoided by all means possible. As such it requires special consideration. It may seem ironic to include it among topics pertaining to "spiritual growth," because suicide obviously represents the end to all growth, spiritual or otherwise. The reason I have done so is that serious consideration of suicide by a deeply depressed person is certainly the sharpest existential moment he/she will ever have; and, if survived, this moment can spark spiritual growth. The trip to the edge of the deep black canyon of suicide is the darkest road anyone can travel in life; and if a person gets to the edge, and then decides not to go over, he/she may return to the rest of us with brilliant light of new insight. A threat of suicide, or a failed attempt, may actually represent an opportunity for profound spiritual growth for the victim, family, and friends, even though the process may be extremely frightening and very unpleasant. Suicide becomes tragedy only when it succeeds.

Let us first ask "Why do people suicide? Why do they want to die?" There have been many studies of this question. The clear answer that emerges is that people who suicide do not actually want to die, but rather have reached a point where their present life is unendurable, and they see no way to change it. Under these circumstances suicide is viewed as the lesser of two evils: a quick, clean, relatively painless death in the face of death by a slow, grim, grinding misery.

Of course, severe depression fits this description perfectly. If depression becomes severe enough, for long enough, there comes the day when anyone will think "I can't stand this any longer. And I'm not going to get over it. I'm a failure at everything. I'm a drag on my family and friends. There is only one sensible way out." If this line of thinking is followed to its logical conclusion it represents certain death. When a depressed person starts talking about suicide, he/she should be considered to be in a medical emergency, and medical intervention is urgent!

Sometimes, one reaches this crisis as a result of sliding, untreated, deeper and deeper into the black well of major depression; in such cases there is strong reason to hope that medication may bring prompt relief. Sometimes, one reaches the crisis after weeks or months of medical treatment that has not "worked". Here, one will need all the spiritual strength he/she can muster just to hang on, in hope that an effective treatment will still be found; this was the position in which I found myself in 1986. In contrast, in 1997, owing to remarkable medical progress in the intervening decade, particularly with the development of SSRIs (selective serotonin-reuptake inhibitors), the chances of effective treatment have gone up markedly.

People considering suicide often examine their life in agonizingly minute detail. In doing so, they are in a very negative frame of mind because of acute depression, thus they will almost invariably discount what is "good", and attach special importance to what is "bad". Skilled psychiatric intervention can play a beneficial role by helping the victim gain a more balanced picture, and reminding him/her constantly of the bias induced by the biochemical imbalance in his/her brain.

Sometimes this buys time while a more effective medical treatment mode is sought. But sometimes none of this works, and the victim moves on a smaller and smaller orbit around the black hole called suicide. At some point he/she may even become defensive about the desire to die. There may result a "Mexican standoff" with the victim resisting efforts to help him/her. At this point, he/she may ask baldly (or implicitly) "just whose life is it, anyway?!" The implication is that it is "my" life to dispose of, so "I" can/will "dispose of" it as I please. This is, to be sure, a very deep question. It can be, and has been, debated on many levels from many philosophical, legal, and religious points of view. The discussion given in Section D, using the Quaker principle of experiential knowledge of God, follows the route I took in arriving at a compelling answer to this question for myself when it arose during my own illness in 1986.

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