Abstract
This article proposes that suicide can be viewed as a staged performance in which suicidal individuals create a dramatic event by the choices that they make for their suicidal act, such as which method to use, which location, what to wear, and what communications to leave for others. The choices that they make have psychodynamic significance and may, in some cases, provide clues to their impending act.
Shakespeare, in his play As You Like It, said that “All the world's a stage, and all the men and women merely players.” Nikolai Evreinov (1927), a Russian playwright and essayist, formalized this notion by arguing that we are theatrical beings and that everything that we do in our daily lives is a drama staged by ourselves—in his words, a monodrama. If Evreinhov was correct, and everything in life is theatrical, why should dying be anything less?
On September 18, 2010, Mitchell Heisman, age 35 yr., dressed himself in a white tuxedo, white tie, white shoes, and white socks. He went to Harvard Yard, a green area on the Harvard University campus, and shot himself in the head with a silver revolver on the steps of the Memorial Church in front of a group of tourists. He left a 1, 500-page suicide note online, with copies mailed to friends and family. 2
At 5 a.m. on August 15, 2013, Martin Manley, age 60 yr., went to the parking lot of his local police station, called the officers inside, and told them where he was and that he intended to shoot himself. He then shot himself. Manley had spent the last 18 mo. creating a website outlining his life and the reasons for his decision to die by suicide. He chose the setting for his death in order to spare his landlord and siblings from having to discover his body. 3
Not every suicidal death is as dramatic as these two examples, but it can be argued that every suicidal person stages their suicidal action. They make choices as to whether to leave a note, what method of suicide to use, what to wear, where to die, and whether they want witnesses to their action. Many of these decisions have personal meaning, but there are also gender and cultural scripts that affect people's choices. It is well documented that many suicides have made previous non-fatal suicidal acts and, in the present context, these non-fatal acts can be viewed as rehearsals for their later fatal action.
Dramatic performances typically involve a script, rehearsals, wardrobe, venue, audience, and the actual performance. Although dramatic performances often have a written script and an audience and take place in a theater, these elements are not necessary. For example, dramatic performances can be improvised and, therefore, lack a script. Dramatic performances construct a meaning through the selection of actions and arrangements. Most dramatic performances require a director, choreographer, lighting designer, sound designer, costume designer, and set designer, but these roles may be played by one person. 4
Rubenstein (2015) noted that the writings of Erving Goffman (1959) presented a dramaturgical model of social life, and the role playing by the suicidal actor reminds us that individuals choosing suicide do so in relation to an audience. In the performance, a social message is conveyed. Whether the actor is aware of it or not, impression management is occurring, and the audience attributes meaning to the act. There is a setting with scenery, props, and location that are central to the performance. The protagonist is playing a role, and we can consider whether the performance is consistent with what we know about the actor. Inconsistent performances require a more complex reading of the script.
The present article will discuss briefly these choices made by suicidal individuals when planning the staging of their suicidal act, what these choices tell us about these individuals, and what research needs to be done to help us better understand these choices.
The Suicide Note
A good proportion of suicides leave a suicide note, and this gives individuals an opportunity to present themselves to their significant others. For example, Haines, Williams, and Lester (2011) found that 347 of 1, 051 consecutive suicides in Tasmania left a suicide note (33%). Yang and Lester (2011) argued that, contrary to the belief of suicidologists who conduct research on the suicidal mind by studying suicide notes, studies of suicide notes may not provide clues into the mind of the suicide since this social self which is presented to others may hide (or mask) the real self or true self.
As noted above, not all suicides leave a note. Why do some suicides leave notes while others do not? Some suicides notes read like last wills, and they give instructions to their significant others. Other suicide notes present reasons for the decision to die by suicide, and their significant others may find this helpful in resolving their grief. In contrast, the friends and relatives of those who do not leave a suicide notes often are obsessed with the question of why the individual chose to die by suicide. The suicide note can express anger toward the significant others. These choices made by the suicide have an effect on the significant others, and this effect may be chosen intentionally by the suicide.
The body can also be a “suicide note.” If suicides die in such a way that significant others will find their body, they have left a “communication” in choosing this particular death scene. Finding the body leaves a lasting image in the minds of the significant others which increases the traumatic effect of the event, and this may have been the intent of the suicide. In rare cases, suicide notes have been written on the skin of the suicide (Austin & Byard, 2013). These may indicate loneliness and a lack of significant others or a lack of preparation and forethought.
These days, suicide notes may appear in social media. The 1, 500 page suicide note of Mitchell Heisman and the website created by Martin Manley were mentioned above. One 15-yr.-old girl in Canada posted a video on YouTube in which she silently displayed a sequence of flash cards detailing a history of bullying (Lester, 2015). She posted the video on September 2 and died by suicide on October 10. The video received 1.6 million views, but, according to newspaper reports, no one intervened during that period.
An 18-yr.-old girl in Texas died by suicide after sending 145 tweets in the 24 hr. prior to her death, detailing her experience of sexual abuse by her father and previous suicide attempts. During the series of tweets, there were two breaks (of 139 min. and 21 min.), yet no one intervened to stop her death. Interestingly, she made many of her tweets rhyme so that the tweets read like poems (Gunn & Lester, 2012).
Suicide notes using social media provide ample opportunity for intervention, but it is not known what proportion of suicides are prevented. We hear, instead, of those suicides where no one intervened.
What to Wear
People have to make a choice as to what to wear when they die by suicide. The members of the Heaven's Gate cult, who died as a group in California in March 1997, all dressed exactly alike. They used phenobarbital dissolved in vodka and applesauce, and pulled plastic bags over their heads. Their heads were shaved clean, and each had a five dollar bill and three quarters in a pocket. They wore black shirts, sweat pants and Nike Decades athletic shoes. All had their face and torso covered with a square piece of black cloth. This uniformity of dress symbolized their membership in the group action.
Some suicides die naked (Simon, 2008), perhaps to symbolize rebirth and cleansing, to shock those who discover them, to be tidy or exhibitionistic, or simply because the method chosen for suicide demanded nakedness (such as drowning in a bathtub).
The mode of dress can be used to detect potential suicides. Gaylord and Lester (1994) noted that the Hong Kong subway system has surveillance cameras, and staff have identified clues that potential suicides show, including putting bags down as the train approaches the station (whereas regular passengers pick up their bags), standing by the wall where the train enters, hiding their faces with hats or scarves, and their choice of clothes. Prostitutes usually dress in an ornate red silk dress, while elderly Chinese wear traditional ethnic clothes. The staff who observe these clues are trained to approach the person and engage them in conversation, hoping to avert the suicide.
Which Method to Use
Each suicide must choose a method for their action. Clarke and Lester (2013) listed 20 possible influences for this choice:
Availability (e.g., owning a car)
Familiarity with the method (e.g., car exhaust gases)
Technical skills needed (e.g., hanging or gassing)
Planning necessary (e.g., buy a gun, save up drugs)
Likely pain (e.g., cutting wrists)
Courage needed (e.g., high building or train)
Consequences of failure (e.g., disability or publicity)
Disfigurement after death (hanging vs overdose)
Danger and inconvenience to others (e.g., car crash or subway leap)
Messiness and bloodiness (e.g., wrist cutting)
Discovery of body (by loved ones or strangers)
Contamination of nest (i.e., avoid home)
Scope for concealing or publicizing death-shame, insurance (e.g., car crash, drowning, or subway leap)
Certainty of death (perceived or actual)
Time taken to die while conscious (e.g., poisons or wrist cutting)
Scope for second thoughts (e.g., swim back to shore, switch off gas versus gunshot)
Chances of intervention (e.g., “fate,” estranged lover)
Symbolism (e.g., cleansing by fire, seppuku)
Masculine/feminine (e.g., guns)
Dramatic impact (e.g., lover's leap vs overdose)
The most common explanation for the choice of method for suicide is convenience and accessibility of the method, and, as a result, one tactic for preventing suicide has been to propose restricting access to lethal methods for suicide (Clarke & Lester, 2013), such as placing fences on the bridges from which people jump and detoxifying the gas used in homes for heating and cooking.
There has been some research on simple personal characteristics that are associated with choice of method. For example, women generally choose less violent methods than do men. There are also ethnic differences with, for example, Asians and Asian-Americans choosing fire (self-immolation) more than other ethnic groups. However, what is perhaps more important is to identify the psychodynamic reasons for the choice of method. For example, Grumet (1989) reported the case of a male registered nurse, 35 yr. old and married, who took an overdose of imipramine and then connected a defibrillator to his head and released the electric charge through his brain. The man was a perfectionist and viewed himself as a failure. He frequently experienced guilt and depression. He also feared having a heart attack after suffering a mild one at the age of 31 yr. Grumet saw the choice of electricity as a symbolic way of execution for his sins (akin to convicted prisoners dying in the electric chair) and as a symbolic way of curing himself (akin to electroconvulsive therapy). Thus, the choice of method for suicide for this man had a very personal meaning.
Where to Die
Suicides must make a choice of where to die: at home or away from home; in the presence of others or when isolated; if away from home, where (a hotel room, a national park); if home, in which room, etc. Suicide when others are present provides an opportunity for bystanders (friends, relatives, or strangers) to intervene. Steer, Beck, Garrison, and Lester (1988) found that those attempted suicides who were interrupted during the act were much more likely to eventually die by suicide than were attempted suicides who attempted alone (14.6 vs 4.8%), and they died sooner (after 32 vs 54 mo.). Bystanders do not always intervene to prevent the suicide from occurring. Cases have been reported of strangers observing a potential suicide (such as an individual standing on a ledge about to jump) who baited the individual and urged him to jump (Mann, 1981).
Suicide in public also shocks those witnessing the event. Bud Dwyer shot himself during a press conference in January 1987. He was the Treasurer for the state of Pennsylvania and about to be sentenced for bribery. Some reporters in the room ran for help, others tried to approach him, while others simply screamed and cursed. Several televisions stations showed the complete sequence. In July 1974, Christine Chubbuck, a television news reporter, shot herself on live television during the news broadcast. She said on camera: “In keeping with Channel 40's policy of bringing you the latest in blood and guns and in living color, you are going to see another first—attempted suicide.” She then shot herself in the head and died. She had a history of depression, a recent romantic rejection, and had just been informed by her physician that she would have difficulty ever having a baby.
Stack (2015c) has explored the characteristics of those who choose to die in hotel rooms rather than at home, and those who choose a natural area (such as the Grand Canyon). In his study of those who travel away from home and who use a firearm, which Stack (2015a) called the Paladin pattern after the television series Have Gun, Will Travel) Stack found that men were twice as likely as women to follow this pattern, married individuals more likely than single individuals, and whites more than those of other ethnicities. The Paladin pattern was more common in those with a history of violence, but less common in those with psychiatric problems. The pattern was more common if the suicidal individual had used marijuana, but less common in opiate users and alcoholics.
Recently, Dogan, Demirci, and Deniz (2015) examined 20 suicides in Konya, Turkey, who hung themselves from trees. These suicides comprised 11% of all the suicides by hanging and occurred primarily in the garden of the suicide's house (9 cases) and in woodlands (7 cases). All of these suicides lived in rural or small communities, and this method was used primarily by men (16 cases). Ten of the suicides (50%) occurred at night, and these all chose the garden of their home (9 cases) or the hospital in which they resided (1 case). The suicides during the daytime were more likely to travel to woodlands (by motorcycle or by foot), and Dogan, et al. suggested that this was to prevent intervention by others. (They noted one earlier case of a suicide by hanging in the woods that was found only after 29 years.) Dogan, et al. also suggested that although the choice of method and location may be affected by convenience and access, the choice may also have symbolic meaning, noting that Judas Iscariot hung himself on a tree after betraying Jesus. One of the suicides tied his hands together, presumably to prevent him changing his mind and attempting to abort the suicidal act.
Attempting Suicide as a Rehearsal
The single best predictor of subsequent suicide is a previous suicide attempt (Mann, 2002). Gunn (2015) cast attempted suicide as a rehearsal. His review of research found that, in general, those who used violent methods for the suicide attempt were more likely to repeat their suicidal behavior, both attempted suicide and completed suicide. It is interesting that some suicides stay with one method, whereas others switch methods. There has been no research on the psychological differences between those who stay and those who switch.
Gunn noted that attempting suicide as a predictor for subsequent fatal suicidal behavior fits neatly into Joiner's (2005) Interpersonal Psychological Theory of Suicide, which proposes that an acquired capability for suicide is a prerequisite for suicide. Attempting suicide is one of the many experiences (such as combat experience or experience of physical and sexual abuse) that seems to develop this capability.
Cultural Scripts
There are cultural (and subcultural) scripts for suicidal acts, such as seppuku in Japan and sati in India. Culture can determine the location of the act and the method chosen. For example, in Tikopia in the South Pacific Ocean, the preferred methods are swimming out to sea and also strangling oneself by tying a rope around one's neck, securing it on a hook, and then running at high speed through the house (Firth, 1961). Interestingly, in this latter case, it is customary for the individuals to fast beforehand so that they do not soil themselves if they lose control of their bowels.
Among the subcultural scripts are suicidal acts such as victim-precipitated homicide, in which individuals provoke others into killing them, making the act seem to be one of murder rather than suicide, a method that Wolfgang (1958) found in Philadelphia to be more common among African Americans than among European Americans. The assumption is that, for these individuals, suicide is morally unacceptable whereas being killed by another is morally acceptable. A variant of this is suicide-by-cop (Lindsay & Lester, 2004), in which individuals provoke police officers into killing them. Lindsay and Lester presented a series of clues that police officers might use to identify a potential suicide-by-cop incident.
Incident initiated by subject
Subject creates an event to ensure police response
Subject forces confrontation
Subject initiates aggressive action
Presence of a deadly weapon
Subject advances toward officer
Subject refuses to drop weapon
Retreat by officers
Injured officer or citizen
Subject threatens officer with a weapon
These clues constitute a script for this type of suicidal act.
Discussion
Not every suicidal act is as dramatic as that of Mitchell Heisman mentioned in the Introduction to this article. But every suicide has to make choices for the staging of the suicidal act. In making these choices, the suicides are deciding how they want to be viewed by others and how they want to be evaluated and remembered after their death. The choices that they make are determined, in part, by their psychodynamics and how they want to present themselves to others.
The Need for Qualitative Research
There have been studies of some simple personal characteristics that are associated with the choices made by suicides, such as age, sex, and ethnicity, but what is needed to further understanding of these aspects of the suicidal act is qualitative research that explores the reasons behind the choices that suicides make. Of course, suicides are deceased and cannot be interviewed, but those who make near-fatal attempts at suicide, with strong suicidal intent, can be interviewed by psychodynamically oriented clinicians. Qualitative research is not easy to carry out and even more difficult to publish in scholarly journals, but it would advance our understanding more than simplistic quantitative research. A recent excellent example of this type of research appeared from De Leo (2010) who interviewed serious suicide attempters about their state of mind leading up to and immediately prior to their attempt. What was most interesting in their accounts was the presence of anxiety immediately prior to their attempt, a feature that has not received much attention in past research (Lester, 2014b).
Impulsive Suicides
Some suicides appear to be impulsive, and, for these suicides, the staging of the suicidal act may be minimal and the proposals made by the present paper may be less applicable. For example, Cheah, Schmitt, and Pridmore (2008) reported the case of a young man who had misappropriated some money and lost it while gambling. He was crossing a bridge and one-third of the way across began to worry about being found out. He decided to kill himself and jumped from a height of 49 m, but survived. The psychiatrist who examined him afterward found no evidence of Axis I or Axis II psychiatric disorders. The decision process for this young man, therefore, lasted only a few seconds. Studies of attempted suicides have reported that, for many, the decision process was brief. Simon, Swan, Powell, Potter, Kresnow, and O'Carroll (2001) found that 24% of attempted suicides took less than 5 min. between the decision to die by suicide and the actual act, and 5% just 1 sec. Williams, Davidson, and Montgomery (1980) reported that impulsive attempters were more often in the presence of others, thought that they would survive, were less depressed than non-impulsive attempters, and experienced reduced tension as a result of the attempt. It is unknown what proportion of completed suicides is impulsive, although it is probably much less than the proportion of attempted suicides that is impulsive.
Gender, Social, and Cultural Scripts
This perspective of suicide as a dramatic act draws attention to the role of gender, social, and cultural factors in the staging of suicide. It is well known that the methods used for suicide vary greatly from one society to another (Lester, 1990), but the staging of suicidal actions also varies greatly from one society to another, varying in such variables as location and clothes worn. Societies vary greatly in the role of conformity versus individualism (Konsky, Eguchi, Blue, & Kapoor, 1990) Triandis, 1993), and members of the more conforming societies may have more similar scripts for their suicidal acts.
Furthermore, research has consistently shown that there are sex differences in the rate of suicide, the methods chosen, and other decisions, such as the location for the suicide. Stack (2015b) found that women in the USA in 2003–2006 were more likely to die by suicide at home than were men. Women are also more likely to attempt suicide and survive than are men, while men die more often than do women (Lester, Gunn, & Quinnett, 2014). The scripts chosen for suicidal acts may differ, therefore, for women and men.
The Decision-making Process
Although there is research on problem-solving behavior and decision-making choices in general in attempted suicides, the research utilizes tests of general problem solving and has not explored the problem solving and decision making relevant to suicide. For example, Liu, Vassileva, Gonzalez, and Martin (2012) compared attempted suicides and controls for whether they would accept $5 now versus $10 one week from now (a choice known as delay-discounting). The suicide attempters were more likely to choose the immediate reward. But this is not a study of the decision-making process involved in staging one's suicide.
The ideas presented in this paper indicate that two decisions have to be made by the potential suicide. First, the individual has to decide to die by suicide and then decide how to arrange this act. There is no research on these decisions, only clinical guesses by psychotherapists who have treated a particular suicidal individual and presented in case study reports their speculations about the psychodynamics of the suicide. For example, in the case of Mitchell Heisman mentioned in the beginning there were no clues in the newspaper reports of his suicide or in his 1, 500 page suicide note as to why he dressed in white, why he chose a silver gun, and why he chose the location of Harvard Yard.
Lester (1988a) reported a study that provides an example of the type of research that is needed. Lester studied the choice of method for suicide in a non-clinical population of 72 undergraduate students enrolled in a psychology course (and, therefore, most likely not suicidal). He asked them to consider if they were going to die by suicide, would they use an overdose of pills or a gun. Nineteen chose a gun, and 53 an overdose of pills. Those who choose pills rather than guns saw the use of pills as less quick, less painful, less planned, and less “bad” (the term presented to the participants). In a second study (of 429 undergraduates), Lester (1988b) found that women rated pain, disfigurement, and the availability of the method as more important reasons for choosing a method for suicide than did men. These judgments about the methods of suicide most likely affect the method chosen by a suicidal individual.
These studies presented subjects with dimensions (quick-slow, painful-painless) decided upon by the researcher. A better technique would be to let the participants choose their own dimensions with which to rate the methods for suicide using a technique similar to the Role Construct Repertory Grid technique devised by George Kelly (1955) for having participants describe the significant others in their life. Of course, the research needs to be conducted on those who made serious attempts to die by suicide, but who survived, rather than on non-suicidal undergraduates.
Final Comment
Viewing suicide as a dramatic performance, in which individuals make conscious (or unconscious) choices as to how to stage their suicidal action, raises interesting questions about the psychodynamic reasons behind these choices. Viewing suicide from this perspective may also provide clues for the impending suicidal act, as in the cases of suicide-by-cop in the United States and suicide in ethnic Chinese individuals in the Hong Kong subway noted earlier. If elements of cultural and subcultural scripts are observed by onlookers, intervention is possible. In addition, the choices (of location, methods, whether alcohol is consumed, dress, etc.) made by those who make attempts at suicide may have predictive value for future, fatal suicidal behavior. For example, Runeson, Tidemalm, Dahlin, Lichtenstein, and Långström (2010) found that those choosing hanging for their suicide attempt had the greatest likelihood of later dying by suicide.
Finally, our understanding of the staging of suicidal acts may be advanced more by qualitative case studies rather than by quantitative research, which tends to focus on distal variables rather than the psychodynamic factors affecting people's behavior.
For a discussion of this suicide note, see Lester (2015).
For a discussion of Manley's death and website, see Lester (2014a).