Review of "How I Stayed Alive When My Brain Was Trying to Kill Me"

Part memoir and part survival guide, How I Stayed Alive When My Brain Was Trying to Kill Me aims to provide practical and immediate advice for those who are contemplating suicide but genuinely do not wish to die.  It offers a wealth of information, both for suicidal individuals and their loved ones, and should serve as a source of comfort and hope to all those affected by suicide.

Blauner has been plagued by major depression and borderline personality disorder for much of her adult life.  She confronted suicidal thoughts for eighteen years and made three "suicide gestures" in the 1990's.  Her understanding of suicide rests on five claims:

1. Most suicidal thinkers don't want to die; they just want their feelings to change or go away.  In Blauner's estimation, suicidal persons nearly always prefer life to death.  However, the sense of hopelessness that permeates their consciousness is so great that suicide seems the only solution to the misery and psychological hardship they face.  Suicide is neither the only strategy nor the best strategy for dealing with such anguish, an important reminder for those considering suicide.

2. Every single feeling we experience eventually does change -- with or without any help from us.  Suicidologists have repeatedly observed that suicidal thoughts and behaviors are frequently impulsive, rooted in essentially transient psychological states.  Suicidal individuals stand a much better chance of long-term survival if they can identify strategies to cope with these impulses.  Suicide remains a permanent solution to a temporary problem.

3. Feelings and thoughts are just electrochemical impulses in the brain.  Blauner's general position about the etiology of suicide is a sensible combination of nature and nurture: While genetic or environmental factors may predispose individuals to the risk factors associated with suicide, most notably depression and other mental illnesses, suicidal thoughts are simply short-lived brain events.

4.  It is possible to outthink the brain, actively changing feelings and eventually eliminating suicidal thoughts.  Blauner sees suicidal thoughts as a kind of habitual response to the feelings common to depression and other mental illnesses.  Once suicidal individuals recognize that these thoughts are a contingent response to such feelings, they can begin to adopt alternative non-lethal responses.

5. The reality of suicide is far different from the fantasy.  Most suicidal thinkers romanticize their death by suicide.  Blauner litters her book with anecdotes in which suicide attempts lead to embarrassment, humiliation, long-term hospitalization, disability, or organ damage.  Once disabused of the notion that their suicide attempts are risk-free gestures that will win others' attention or love, suicidal individuals ought to think twice about the ugly reality of life after suicide attempts.  And of course, it should go without saying that suicide is not a treatment for the conditions which often cause it: Attempting to kill oneself has never cured anyone of depression, to my knowledge.

Blauner offers far too many tips and strategies for suicide prevention to permit me to discuss any of them in detail here.  Nearly half of the book is devoted to describing these strategies and how to put them to use.  But as her five main claims would suggest, the overall orientation of these strategies is cognitive or behavioral, emphasizing suicidal individuals' self-understanding of their condition and the actions they take in response to that condition.  The majority of the strategies fall into one of four rough categories:

• Seeking the assistance or support of others. Blauner advocates creating a detailed phone list and a thorough "crisis plan" to be implemented when suicidal feelings are at their strongest.  She also credits her years in therapy for allowing her to develop the daily living skills, stress management techniques, and the sense of identity needed to survive her suicidal episodes.

• Description and documentation of feelings.  Central to Blauner's recovery was the careful description of her own suicidal feelings and the recognition of the gap between her feelings and the facts to which those feelings are reactions.  To this end, she explains how using personal journals served to express, and thereby diminish, her anxieties.  She also offers a comprehensive "feelings galore list" to help readers distinguish subtle emotional variations, and explains how "tracing feelings back" to their triggering causes keeps negative feelings in check.  Blauner also describes how to distinguish feelings ("I feel defeated and I'm never going to accomplish anything") from the corresponding facts ("I may have had a setback, but I am getting somewhere and this rough spot will pass").  These strategies are effective because they divorce us from our feelings so as to prevent our identifying ourselves with these feelings.  As Blauner observes, being sad is not the same as feeling sad.  Describing and documenting feelings in these ways reminds suicidal people that they are "only feelings" and distances them from feelings, which, Blauner reiterates , will inevitably change.

• Diversion and distraction.  Perhaps the most elementary of Blauner's recommendations is to stay busy, preferably with productive tasks likely to build self-esteem and establish routine.  These tasks can be mundane (fold laundry), whimsical (juggle), altruistic (volunteer at an animal shelter), or interactive (call a friend). (I liked her suggestion to draw unhappy faces on eggs and smack them with a baseball bat!)

• Attend to physical health.  Blauner notices that mental and physical well-being are interrelated; those suffering from depression or other mental illnesses often do not pay sufficient attention to their physical health, which in turn further exacerbates the symptoms of their mental discord.  She recommends consuming healthy "brain foods", exercising regularly, getting adequate sleep, and experimenting with sound and color to enhance physical health. 

Not that Blauner denies the utility of psychotropic medications such as Prozac ("vitamin P," she dubs it).  But these medications are no panacea; they provided what she calls a "safety net" enabling her to stabilize her feelings and put in place the long-term approaches necessary to overcome suicidal feelings.

The book also contains moving letters from Blauner's therapist and loved ones, characterizing their own feelings about her ordeal, and an extremely sensitive chapter for those trying to help suicidal people.  Nonetheless, her emphasis falls on self-help -- on the techniques suicidal persons need to survive day-to-day.  The book is packed with information, with literally dozens of phone numbers and resources for suicidal people to contact. 

How I Stayed Alive succeeds in its pragmatic objective.  But those expecting deep insights into the origins of suicidal behavior or the mechanisms of suicidal thought are likely to be disappointed.  As a theoretical treatise on suicide, the book has little to offer, and it suffers from the New Age-y fuzziheadedness common to the self-help genre. Suicidal persons are urged to practice a bland spirituality oriented around "God, Higher Power, HP, Goddess, Buddha, Great Spirit, Creator, Inner Light," etc.  And Blauner's carelessness with some diagnostic categories and concepts may bother some readers.  For instance, she repeatedly says that suicidal thought was an "addiction," her drug of choice for dealing with stress and conflict, and by seeing that suicidal thought was her chosen response to stress and conflict, she was able to circumvent her suicidal feelings.  Yet what is gained by calling suicidal thought an "addiction"?  Blauner seems to mean that suicidal thinking was her usual or automatic response to life's vicissitudes, part of her "brain style."  By admitting that suicidal thinking was a chosen response, she undermines her assertion that it acts like an addiction.  Apparently, Blauner thought that only by invoking the fashionable pop-psychological language of addiction could she encourage her readers to pursue alternative responses to stress and conflict.

Still, Blauner's book will prove a valuable resource.  Her story will undoubtedly resonate with suicidal people, and her own recovery can inspire them to begin extricate themselves from the knots of suicidal thinking.

 

© 2003 Michael J. Cholbi

 

Michael J. Cholbi, Assistant Professor of Philosophy, Brooklyn College, City University of New York