Values Can Be an Antidote to Suicide
By Norman Cotterell, PhD
Clinical Coordinator, Beck Institute
James was a 53-year old firefighter debilitated by depression who saw suicide as a way out. Prior to his first episode of depression, he was able to work full time, support his wife and family, and fulfill his obligations. This episode was physically and emotionally devastating, resulting in both the loss of his job and his will to live. A series of electroconvulsive therapy (ECT) treatments eliminated the urgency of the suicidal thoughts but compromised his confidence in his memory, reaction time, and attention. He felt more willing to live but less able to work. As a result, the suicidal thoughts crept back in. Waking up in the morning, he saw pain and suffering. James thought, “I’m not able to be productive, to participate, to create. I’m a burden to my family.” And life? “It’s hard to see the purpose. It’s exhausting to deal with this. I want to run away from my thoughts. With death, all this ends. All this pain and suffering ends.”
These are automatic thoughts, anchored to a place and time, but they reflect what James regards as the disadvantages of life. Marsha Linehan, the developer of Dialectical Behavior Therapy, has saved countless lives, yet she has likened suicide to an exit door in a burning room.
We save people by understanding that room, making sense of that room. As Judith Beck has stated, “The way people act always makes sense when we know what they are thinking.” From such a perspective, suicide is an option that makes sense. There are reasons, powerful reasons, that make it appear to be the only option.
But these reasons also reflect what our clients value in life. Instead of a life of pain and suffering, James wanted a life of comfort and joy. These feelings were not just worth dying for, they were feelings worth living for. And even his suicidal thoughts deeply reflected his values, principles, needs, and desires. The dialogue below illustrates how I elicited his values and asked him to reflect on their importance.
Dr. C: It sounds like not being productive is extremely painful for you, and the depth of that pain really tells me how important it is for you to be productive. How important is that for you, on a scale from 1 to 10?
James: It’s a 10. If I’m not able to work, not able to support my wife, what use am I?
Dr. C: And you see yourself as useless. But participating is also important. How do you participate with your family?
James: By showing up. Coming down for dinner. Not backing out of family birthdays and so on.
Dr. C: How important is participating for you, on a 1 to 10 scale?
James: That’s also a 10.
In this way, James and I were able to identify the values associated with the problems in his life. Each “reason to die” pointed to a “reason to live“: a value, hope, desire, or dream that was worth living for.
|Reason to die||Value of life||Rating|
|“I’m not able to be productive,||Productivity||10|
|to participate,||Participation with family||10|
|I’m a burden to my family.”||Being supportive to family||10|
|“It’s hard to see the purpose.||Having a purpose||10|
|It is exhausting to deal with this.||Having more energy||9|
|I want to run away from my thoughts.||Engaging in life||10|
Each reason to die corresponded to a value, a desire, an aspiration: I can be productive. I can participate in life. I can be creative. I can be of benefit to my family, providing love and support. If the lack of such qualities is important enough to die for, the presence of such qualities is important enough to live for. And from this list, we generated more:
- My family cares about me.
- My friends care about me.
- I care about and love my family.
- I can learn ways to overcome depression.
- I can live a life.
- I can contribute to family.
- Staying alive is the better decision, given how much I love and care for my children.
These reasons to live formed an essential part of James’s Safety Plan, a list which included warning signs, activities to engage in, coping strategies, support people, and professionals enlisted to help him weather his emotional storms. His struggle is far from finished. He still has rough days, but the desires listed above describe a direction for his life. Below, I encourage him to live a life in service of his values, despite his struggles, addressing key automatic thoughts that might stand in the way:
Dr. C: As part of your safety plan, I’d like you to live these values. Do what you would do if you were not depressed.
James: I don’t know if I can.
Dr. C: What could stop you?
James: I don’t know if it will make me feel any better.
Dr. C: It won’t. Not initially; in fact, I can almost guarantee that you will not feel better initially. It may even take a couple of months to kick in. So, accept whatever judgmental thoughts float through your mind and just do it.
James: What do I do?
Dr. C: You can make plans with your friends, spend time with your family, do simple repairs, do household shopping, home projects, games, or anything else that you did on weekends or vacation when you felt okay.
James: What if I don’t feel like doing it? What if I don’t see it as good enough?
Dr. C: You won’t at first. So, give yourself credit for doing it anyway. Give yourself extra credit for doing it without motivation. And really give yourself credit if you do it with these judgmental thoughts!
Judith Beck likens doing what you know you need to do as strengthening a muscle. Our clients are strengthening the “getting better” muscle. And they have many opportunities to do so. Individuals with depression are not burdens. They are carrying a burden — a heavy burden. Doing anything constructively while dealing with depression is a sign of strength, because carrying such a burden builds muscle. The greater the difficulty, the greater the accomplishment. And such accomplishment may lead to a recognition of worth, an ability to love, a desire to share, and a passion for life.
CBT for Depression and Suicide
May 6-8, 2019