Review of "How I Stayed Alive When My Brain Was Trying to Kill Me"
By Susan Rose Blauner HarperCollins, 2002 Review by Michael J. Cholbi, Ph.D. on Jul 8th 2003
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
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
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.