Last Words
January 8, 2014 10:18 PM   Subscribe


 
Powerful stuff and hopefully it makes a difference. And it's too bad that site design is like staring into the sun while on mushrooms.
posted by pwally at 10:43 PM on January 8, 2014


But if you think that reading 1,400 suicide notes would be a profoundly illuminating journey into the human psyche, you would be wrong.

“Some of the people who annotated the notes were disappointed that they didn’t reveal more,” says Michelle Linn-Gust, past president of the American Association of Suicidology, who worked with Pestian to recruit volunteers for the project. “People think these notes are going to be confessional. Most are not. It’s ‘My jewelry goes to so-and-so.’ They’ve already checked out.”


I dunno. It seems kinda comforting to know that even in life's most desperate moment the banalities of life take high priority.
posted by three blind mice at 12:48 AM on January 9, 2014 [2 favorites]


Probably if people could articulate their reasons in a way that would enable help, they would be less likely to have reached the point of killing themselves. In a way it would be depressing if the one time they were finally able to get it all clearly into the open was the one time when it was too late.
posted by Segundus at 12:56 AM on January 9, 2014 [11 favorites]


I don't know, this kind of reminds me of the old 60s attempt at creating an AI psychotherapist otherwise known as Eliza. It's not that I think we shouldn't try, I am just skeptical of a computer's ability to take into account things like intonation, facial expressions and body language, etc. Mind you, if all you have to go on is the written word, I guess humans aren't much better.

And some weird paranoid part of me is envisioning in the not-too-distant future, a team of suicide-prevention cops breaking down the door of some teen who's just been joking around with a bunch of friends on whatever the equivalent of Twitter is then. I guess it's worth it if it saves someone's life, but there's still something creepy about it.
posted by Athanassiel at 1:22 AM on January 9, 2014 [2 favorites]


I wondered about the accuracy of using suicide notes from as far back as the '50s. I wonder whether the way people, particularly young people, use the language has changed enough that those subtle differences are lost.
posted by dg at 1:37 AM on January 9, 2014 [2 favorites]


"Have you ever been with someone who is dying?" he says. “We have a natural will to live; we kick ass to live"

Except that's not universally true. My elderly grandmother decided to forego cancer treatment almost entirely. Aging people often understand that there are limits to how long quality of life can be maintained and that there are points where what you have to go through to live isn't worth it. And yet we don't have a concept of palliative care for mental health. Not that I'm saying we should let anybody die, exactly the opposite--if you can maintain quality of life, you aren't going to be in a rush to make an exit. But it's hard to get society behind the idea that people are entitled to live lives free of physical suffering insofar as is possible, so I don't know how much traction there's going to be for saying the same of emotional suffering.

I also am not exactly sure that getting people to talk to computers instead of real humans who care about them is a great step forward towards the easing of that kind of pain.
posted by Sequence at 2:35 AM on January 9, 2014 [9 favorites]


"It seems kinda comforting to know that even in life's most desperate moment the banalities of life take high priority."

I've been suicidal, have had a couple of aborted attempts, and have spent large periods of time with suicidal ideation. And my own personal experience is that there's two quite different kinds of mental states I've been in when I've been close to suicide.

The first is the intensely painful crisis moment, generally when something traumatic has happened and there's that acute pain and that plunging "this is the end of the world" feeling. During that period, suicide can be very possible and is more likely to be impulsive. I can't recall if I've ever written a note in that state (partly I can't recall this because I pretty much don't experience this kind of depressive crisis any more; it was more common in my youth), but if I did, that's when I would be most likely to just spew my inner state onto the page. I don't know if there'd be that many answers, but if I were to express them, that's when I'd have done it.

The other kind of near-suicide depression is different. It's not an acute crisis pain, it's a chronic, grinding, deep aching pain that just has gone on and on and on. It erodes my ability to imagine that I could ever be happy again. Or not "happy", but even just not so soul-crushingly miserable. When I've experienced this, on a day by day basis it's like my will, my ability to continue is eroded just that much more. Long ago, I learned that I can survive if I just wait it out. And that's true. But as time passes in this extremely deep state of despairing depression, it just smears out into something that, eventually, I've become less and less sure that I can, in fact, outlast. I get so, so tired. In a way, that's what it comes down to. Just feeling so very tired of feeling so very bad.

In that state, there's not really any drama. There's not any deep insights. There's not really much to explain. All the people close to me know enough to know what I've gone through, what I'm feeling. When I've felt very close to suicide in this state — and I think I need to be clear that my sense of danger, of being really and truly close to killing myself, has been much stronger in this state than it has been in the crisis state (though there's no completely accounting for what someone might impulsively do in a crisis) — my concerns have been all very mundane. Concern about minimizing the trauma of someone finding me. My cat. My worries and sorrow about the people who love me. In the end, my concerns about the people who love me, that they'd be terribly hurt were I to kill myself, have always strongly acted as a brake on it. And, ultimately, I think I don't want to not exist (I don't believe in an afterlife).

But the point is that were I to write a note in this state, that's what it would be. Some housekeeping stuff, some mundane stuff, some saying obvious things to people just because I know they need to be said and maybe it will help limit how much my suicide would hurt them. That sort of thing. Nothing revelatory. What is there to reveal, really?

And so, honestly, if I were regularly dealing with people who might be suicidal, I'd be sensitive to trying to discern if someone was in one of these two states. And the first is going to be pretty obvious, right? What you'd want to do is notice the second, because they can sort of appear to be normal. Not normal, but ... calm? I'd definitely think there'd be quite a few distinct warning signs, in the things they talk about and such.

"And some weird paranoid part of me is envisioning in the not-too-distant future, a team of suicide-prevention cops breaking down the door of some teen who's just been joking around with a bunch of friends on whatever the equivalent of Twitter is then. I guess it's worth it if it saves someone's life, but there's still something creepy about it."

It's funny that you mention this because in another thread there's been some argument with someone who's certain that it's possible to automate monitoring on Twitter and the like for sexual harassment and such. And some of us have been trying to explain that this is a much harder thing to do, because of false-positives and people actively trying to avoid automated detection, to solve this problem truly requires a significant level of something acting quite a bit like real comprehension, real comprehension of natural language. And that's the strong AI problem, and we're not even remotely close to solving that problem.

But on the other hand, throwing huge amounts of data at processing that does a whole bunch of correlation can solve what seem like difficult problems, and what this is talking about is more that kind of problem. It's not as difficult a problem because it doesn't require comprehension, just a lot of number crunching. Google's translation is so much better than the automated translation that came before it, but it's not even in any remote sense understanding what it's translating; it's faking it by cheating with huge amounts of data.

You're basically just building a model that calculates some quantified risk on the basis of the kind of language used, life situation, demographics, and some evaluation of affect and such. Even then they'd not be expecting the tool to be some robotic, automated thing that, as you say, causes cops to break down some teen's door. What would actually happen is that the model would point to individuals that should be investigated further, or watched more carefully, by an actual person.

This kind of thing is good in medicine. People often don't like it because medicine is so subjective. And it is. That's the problem. When you have gifted practitioners, they do the mysterious stuff they do and consistently make the right diagnosis. But not all practitioners are so gifted. And the inconsistencies between practitioners, above and beyond that some miss things that others wouldn't have, cause problems. So standardizing diagnostic tools is good and helpful. In the end, it doesn't substitute for a practitioner's subjective judgment. What it does is augment it.
posted by Ivan Fyodorovich at 2:37 AM on January 9, 2014 [74 favorites]


That's a really cogent and coherent description of depression, Ivan-- sometimes the two states can be really difficult to explain to people.

Reading this made me really want to talk to the AI Sim.
posted by NoraReed at 2:47 AM on January 9, 2014


Only 25 to 30 percent of suicides are going to leave any kind of note. Most of the time it is an impulsive act.

I wondered about the accuracy of using suicide notes from as far back as the '50s.

That's a good point. A fair number of notes today are emails or text messages and the grammar in many notes would make an English teacher quite perturbed.
posted by Renoroc at 3:53 AM on January 9, 2014


Sometimes I wonder why we have to wait for someone to become suicidal to try and communicate with them. It feels to me like failed communication except for trivialities is the norm in society and we don't really want to mess with that unless there's no other choice.

The idea of suicide attempt as a cry for help is what you get when a non-suicidal cry for help just annoys others.
posted by Obscure Reference at 4:39 AM on January 9, 2014 [4 favorites]


Only 25 to 30 percent of suicides are going to leave any kind of note. Most of the time it is an impulsive act.

Cite? The suicide prevention training I've received says otherwise, but that statistic could have been doctored to give trainees the impression that they have more power in preventing suicides than is truly the case.
posted by chaiminda at 4:55 AM on January 9, 2014


The idea of suicide attempt as a cry for help is what you get when a non-suicidal cry for help just annoys others.

Many people don't even see it as a cry for help, but more like a cry for attention. They still think it is like some kind of social cheating, proof instead that someone is beyond help, and therefore someone else's problem. It's the ultimate coloring outside the lines, upsetting people unfairly, the biggest social gaffe. What a selfish imposition upon others! Can't they just suffer quietly in their box, discharging their social obligations until they die naturally, like the rest of us?

The space between, "I don't need to help this person", and "I can't help this person," can be arbitrarily small.
posted by bleep-blop at 5:29 AM on January 9, 2014 [8 favorites]


The space between, "I don't need to help this person", and "I can't help this person," can be arbitrarily small.

So true from what I've seen among my cohort.

Reading a few of these were weirdly familiar. I've never written a suicide note, but I've redone my wills several times (generally as I prepared for the three major surgeries in my life). A lot of the general stuff was easy and redundant - a reminder that monies first go to my spouse, then to my children and their guardians should my spouse also kick it. Then there were bits about who got my second-hand guitar* and other little thises and thatses.

*the original owner
posted by tilde at 5:54 AM on January 9, 2014


I wish there were some way of persuading potentially suicidal people that death does not, in fact, bring relief or escape (to experience those you need to be alive) without inappropriately sending the same message to the terminally ill.

YMMV.
posted by Segundus at 6:08 AM on January 9, 2014


This would be less creepy if it was even just like "here's a list of some questions, could we record a video of you talking about your thoughts regarding them?" I think if I was actually suicidal, being interviewed by a virtual psychologist who pretends to care while judging me based on someones crappy ML code would pretty much drive me over the edge. I'm imagining someone spilling out their life's darkest depths, and then getting the "WHAT ELSE COMES TO MIND WHEN YOU THINK OF YOUR FATHER" response.
posted by crayz at 6:42 AM on January 9, 2014 [2 favorites]


“We call them ubiquitous questions,” she says. “They’re not specific to suicide. You can ask them of someone who comes in with a broken arm or a sore throat.”

That would quite a weird doctor's visit.
posted by surplus at 6:46 AM on January 9, 2014


I dunno, when I had a recent flareup of suicidal ideation, I honestly thought my bad feelings weren't bad enough to talk openly about. I didn't want to bum anyone out or waste anyone's time.
I had the suicide hotline saved in my phone. If I thought a robot would answer and could verify the badness of my feelings before I would bother any person, I would have called. Maybe that's just me.
posted by MsDaniB at 7:05 AM on January 9, 2014


Seems to me it'd be more effective to focus on preventative treatment. Maybe if we focused on making peoples lives suck less and providing access to assistance when it was needed we'd have fewer suicidal people? This is harder to do than writing a computer program.

Also, I'd like to point out that 1) something is lost (humanism?) if/when we replace human interaction with machine interaction and 2) we should be very wary of creating algorithms that could be used to control our lives (see cops breaking down doors, NSA, etc.)
posted by nowhere man at 7:06 AM on January 9, 2014


My sister killed herself 15 years ago, and to this day I'm kind of haunted that she didn't leave a note. There was no goodbye, no explanation, nothing. Just....gone.

I'm glad you posted this, but I really don't think I'm going to RTFA.
posted by nevercalm at 7:08 AM on January 9, 2014 [1 favorite]


I wish there were some way of persuading potentially suicidal people that death does not, in fact, bring relief or escape (to experience those you need to be alive) without inappropriately sending the same message to the terminally ill.

I can't speak for every suicide because everyone is different. But during the times I've been acutely suicidal*, I wasn't looking for relief or escape. I was looking to die because every alternative was unbearable. It's not a running-to, it's a running-from. Whatever might come next (including nothing) was irrelevant. It didn't matter that I wouldn't be around to experience relief or escape - that was the entire point of the exercise.


* Most recently, last summer - coincidentally, following shortly on the heels of the last time Metafilter discussed this topic. Ended up in hospital for two months while they fried my brain with electricity.
posted by talitha_kumi at 7:22 AM on January 9, 2014 [3 favorites]


Interesting post. It reminded me of this story (possible trigger warning) on the Moth, about a man working at a suicide prevention hotline. It might be exceedingly obvious to some, but I found it compelling.
posted by likeatoaster at 7:33 AM on January 9, 2014 [1 favorite]


Probably if people could articulate their reasons in a way that would enable help, they would be less likely to have reached the point of killing themselves.

Not necessarily. When I have been suicidal (basically every day of my life since I was about thirteen, humming along in the background like a vicious whisper, occasionally spiking up into attempts, and this year turning into a total breakdown) I have been perfectly capable of articulating my problems in a way that would enable help.

The problem is, getting that help isn't a relief. In fact, unpacking the reasons for why you feel so bad is in many ways more painful: you have to confront everything head on.

I wish there were some way of persuading potentially suicidal people that death does not, in fact, bring relief or escape (to experience those you need to be alive) without inappropriately sending the same message to the terminally ill.

What on earth is 'inappropriate' about sending that message to the terminally ill? You do understand that terminally means you are going to die, right? And with most terminal illnesses that means dying slowly and in great pain?

Every human being has the absolute right to end their lives when and how they see fit. In some ways, how we die is truly the only free choice we have. Death is an escape. You no longer feel your pain because there is no longer a you to feel it. It's like getting to sleep, finally, after taking double your sleeping meds because nothing will stop that chaotic swirl of hatred in your brain, and feeling that blessed oblivion settle in for a few hours. Knowing that you're going to spend 6-8 hours without your pain is a wonderful feeling, tempered by the fact that you know you're going to wake up and it's all going to come crashing back.

Suicide is just making sure you don't have to wake up and suffer again.



I'm not going to be reading this article. I may be getting better--slowly, in fits and starts--but I'm nowhere near there yet.

My suicide notes (I wrote several; one for everyone, and a few specific notes for specific people) are still sitting as drafts in my email. I don't have much in the way of material possessions, everything really boiled down to "I can't anymore, XYZ is why, I am so sorry, please don't be sad."

Beyond that, I don't think I have much to add that I haven't said already.
posted by feckless fecal fear mongering at 7:50 AM on January 9, 2014 [5 favorites]


What on earth is 'inappropriate' about sending that message to the terminally ill? You do understand that terminally means you are going to die, right? And with most terminal illnesses that means dying slowly and in great pain?

Yes, I mean I wouldn't want to tell people dying in pain that death brings no relief. I think one of us is probably misreading the other, and if it's me, my apologies.
posted by Segundus at 8:35 AM on January 9, 2014


Ahhhhh. I think I have your point.

The problem is that your premises are wrong. For those of us living with chronic, severe depression, death is absolutely and totally an escape, a release from pain. I will no longer exist, therefore I will no longer feel pain, therefore please let me die.
posted by feckless fecal fear mongering at 8:46 AM on January 9, 2014 [1 favorite]


The title reminded me of the excellent Dead Like Me episode "Vacation" where the gang has some down time and use it to file some paperwork - the final thoughts of the reaped.
posted by maryr at 8:59 AM on January 9, 2014


Is there a place where one can read these notes?
posted by I-baLL at 9:18 AM on January 9, 2014 [1 favorite]


I have no idea if one can, but... I dunno. I don't think reading the suicide notes of people you don't know will give you much of an insight into, well, anything really.

There's that old line about all sad families being sad in their own way. Suicide's kinda the same. I mean it's all the same for all of us who are suicidal, but it's also intensely personal and different. I don't think, for example, you'd glean much about me from my drafted notes because they refer to inside jokes and knowledge; you'd have no context for understanding what is going on in my head. YMMV.
posted by feckless fecal fear mongering at 9:30 AM on January 9, 2014


"I don't think reading the suicide notes of people you don't know will give you much of an insight into, well, anything really."

I don't know either which is why I want to read them and find out if they will.
posted by I-baLL at 9:32 AM on January 9, 2014


I didn't say I don't know, I was slightly hedging my true opinion, which is: you will not get any meaningful insights from reading the suicide notes of others.

There's a fine line between wanting to understand, and tragedy-porn. Maybe I'm too close to the issue, but I think at the end of the day suicide notes should be left for the consumption of the people to whom they are addressed, and no others.
posted by feckless fecal fear mongering at 9:40 AM on January 9, 2014


I find it disheartening that we have to go to a SIM for suicide prevention. If we could only open up people's minds in understanding what depression is and what it feels like for those who are in it. But it still won't help 'cure it'. For example, there are days when my depression gets so bad that I truly need a break from life. No work, detox myself from connections, etc. But there are bills to be paid and no one can go to work and say "oh yea by the way, I have chronic depression so I need to take off of work for X amount of days." ADA, FMLA and disability aside, it still isn't enough to guarangee a job, get paid and get well. It's a temp fix where the constant worry is still in the back of someone's mind as they try to heal. I've been going back and forth reading advice papers on whether or not to tell a job that you' have depression (and may need some accomodations). Ninety percent of the advice said to say "medical issues" in general. It's really sad that no one can be honest and say exactly what is going on. Because if they do, the stigma will spin out of control and their job status as well as their personal status will change immediately.

It would perhaps be more beneficial to know what a deeply depressed person wants and how to deliver that to them. When the usual services of therapy and meds are of no use, what else is of benefit to them? For me, honestly, sunshine during the winter. I'm not asking for a window office....just to get some light my way. For three years straight my therapist and I noticed that every winter, I drop into a deep displair and even blood records show that my vitamin D levels drop to extremely low amounts even with suppliments. When I had a near window cube--I was doing ok or at least better.

But then everyone would be called a special snowflake and you can't be productive with special snowflakes.
posted by stormpooper at 9:48 AM on January 9, 2014 [1 favorite]


Sometimes I wonder why we have to wait for someone to become suicidal to try and communicate with them. It feels to me like failed communication except for trivialities is the norm in society and we don't really want to mess with that unless there's no other choice.
Bingo. I deal with chronic lifelong suicidal ideation, and it's not so much that people don't care as it is most people are so profoundly uncomfortable knowing and discussing emotions that they'd rather everything just get buried. Nothing will get dealt with that way, but nobody will have to deal with anything, either. Which seems a rather misanthropic (or more accurately mis-21stcenturyUSculture-ic) insight, but there you go. In Allie Brosh's wonderful depression comics, there's this one moment where she starts talking about her depression and suicidal ideation with someone else and then has to struggle to comfort that person because they freak out.

That's pretty much a huge reason why we fail, as a society, on these things. We're uncomfortable with them. We send people who have to deal with mental health things this very loud social message of, "there is no place for you here, you have no hope to function in OUR society, you are a burden and an utterly worthless waste of my air," then try to talk them off a ledge with stale hope when they hit a crisis point. Uh. Maybe alternatives to that first part might help more? People need meaningful ways of living. We all need to feel valued; there often just aren't paths there at all in our culture for people whose mental health and cognitive/emotional experiences stray from the norm.

and now I feel guilty for talking about things and shut up forever again
posted by byanyothername at 9:51 AM on January 9, 2014 [8 favorites]


For example, there are days when my depression gets so bad that I truly need a break from life. No work, detox myself from connections, etc.

I am insanely lucky that I can actually do that with my (part time, it's all I can handle right now, but have no choice b/c disability doesn't cover quite enough) job. After a meltdown in October, I just called my boss/owner and was like "I can't. I need a week. Sorry." (un)Fortunately, she has a family member in very similar circumstances, so understands where I'm coming from.

It would perhaps be more beneficial to know what a deeply depressed person wants and how to deliver that to them.

The first part is incredibly simple: we don't want to be depressed anymore. The second is the tricky bit.

For me, honestly, sunshine during the winter.

The expensive solution: light therapy. No idea what the machines currently cost but they're not cheap.

The cheaper solution: order some colour-correction gels from Lee or Rosco (theatrical/film lighting companies). They can filter any lightbulb or LED to provide the colour temperature of daylight, which if nothing else can be psychologically comforting.


there's this one moment where she starts talking about her depression and suicidal ideation with someone else and then has to struggle to comfort that person because they freak out.

Yeah. It's really, really hard to tell people in an honest way that there are mornings I can barely face even taking my medication, because that means opening my bathroom cupboard, and there's a lot of pharmaceuticals in there that could really hurt me, and some mornings...

They get really weirded out. And they make the mistake of thinking, e.g., that a hug makes them feel better when they're feeling a bit down, so hey! a really big hug will make you feel better right? No, not so much. I mean maybe, yes, sometimes, but depression is not the same as just being sad and I wish more people could understand that. The closest I've come to making one person near me understand is by drawing the difference between having a slightly upset stomach and having running-at-both-ends food poisoning. I think it's slowly sinking in.

Honestly, I've lost a bunch of friends in the past six months, because they just couldn't deal. I made a really conscious decision to be really open and upfront about my medical issues, partly to help combat the stigma, and partly just to help people understand what it's really like on the inside of my skull, and probably the inside of other skulls too.

We send people who have to deal with mental health things this very loud social message of, "there is no place for you here, you have no hope to function in OUR society, you are a burden and an utterly worthless waste of my air," then try to talk them off a ledge with stale hope when they hit a crisis point.

Honestly that's really an indictment of medical practice generally, not just mental health. As a culture, we don't place much emphasis on preventive medicine, we just react to problems. (Side note: I am convinced this is why societies with universal healthcare are healthier than those without; when you're not worried about the cost of visiting a doctor you're going to visit more often and nip things in the bud, leading to better long-term outcomes).

Mental care is no different; we give nobody healthy toolkits, and then we respond inadequately when crisis develops. Even here in Soviet Canuckistan I'm stuck on waiting lists with a bunch of crisis numbers to call if stuff gets bad while I'm waiting.

Frankly I think cognitive-behavioural therapy and mindfulness should be taught in every school everywhere from the age of about five. They are fantastically useful toolkits for everyone, even mentally healthy people, for dealing with stressful situations.
posted by feckless fecal fear mongering at 10:13 AM on January 9, 2014 [1 favorite]


Is there a place where one can read these notes?

I hate to start out like every recipe blog out there, but many years ago, in the years before Twitter, I came across a Sarah Silverman interview. It may have been in the old paper Onion's AV Club section in their SF edition, probably 10+ years ago. In it, she was asked if she was reading anything these days, or "what's that book in your hand," or something like that. She answered that she was, or had been, reading "Or Not To Be," and that it was amazing. I looked it up on Amazon back then and I believe it was out of print, but I'm happy to see that it is now in print, so you might pick up a copy. I'm pretty sure I will.

Frankly, I was surprised that the article didn't mention the book at all. I did the CTRL-F thing first up.
posted by rhizome at 10:19 AM on January 9, 2014 [2 favorites]


rhizome: Wow, thanks!
posted by I-baLL at 11:01 AM on January 9, 2014


I had the suicide hotline saved in my phone. If I thought a robot would answer and could verify the badness of my feelings before I would bother any person, I would have called.

I work at one of those; believe me, you aren't bothering us. We talk to people who are suicidal, we talk to people who aren't - basically, we talk to anyone who just needs someone to talk to about whatever is going on that has them feeling out of control, off balance, or unable to cope.

It's what we are for.

Picking up on feckless' comment above, mental health care is unfortunately inadequate and often not available for folks who need it when things are at their most acute; hence, organizations like mine where we provide a place for people to talk (or IM or text or email) about how they are feeling and plan on how to get through the next week or day or hour.
posted by nubs at 11:57 AM on January 9, 2014 [4 favorites]


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