The Best Way To Save People From Suicide

[Laird]

I know that members of this forum have been affected by this issue. This article, I think, really lives up to its title.

The Best Way To Save People From Suicide

Months later, Whiteside met with her therapist to discuss how she could handle these feelings of powerlessness. Whiteside brought up the work of a long-retired psychiatrist and suicide researcher named Jerome Motto. He wasn’t well-known. But Whiteside’s mentor Marsha Linehan was enamored of him because he was the only American to devise an experiment that dramatically reduced suicide deaths. His technique didn’t involve a complicated thousand-page manual to follow or $1 billion in pharmaceutical research and development. All he did was send occasional letters to those at risk.

Right there in therapy, Whiteside found herself spouting out everything she knew about Motto’s approach and career. She began to cry. “Oh my God,” she said. “What if this is what we should be doing? What if it’s that simple?”

All around him, Motto saw suicidal patients being made to feel alone. In 1965, he chanced upon a collection of papers by a German psychoanalyst named Hellmuth Kaiser. Kaiser argued that the most disturbed patients could be helped if they felt a sense of connection, even on a subconscious level. This got Motto thinking about Marilyn Ryan and how her letters had gotten him through the war, her sincerity dispensed as steadily as an intravenous drip.

“My own experience—it didn’t prove anything, of course,” Motto told me years later. But he wondered if the simple act of showing people that he was there for them—and expected nothing in return—would make suicidal patients feel less isolated, less in conflict with themselves.

It seemed so ridiculous: letters that could pull a person out of an abyss that deep. Not personal messages, but form letters typed out on one of the office’s IBM Selectrics. Motto wanted them to be simple and direct, with no clinical jargon or ass-covering fine print. Most importantly, they had to demand nothing. “No expressions like ‘you really should try to resume therapy’ or ‘would you fill out this depressive scale so we can determine what your status is?’” he said. It ought to convey a genuine sense of kinship—“simply what one might say to a friend.”

Motto didn’t take long to write the first letter a patient would receive. He knew what he wanted to say, hitting upon two sentences—37 words—that felt just right: “It has been some time since you were here at the hospital, and we hope things are going well for you. If you wish to drop us a note we would be glad to hear from you.”


With each letter they sent out, the research team’s secretaries enclosed a self-addressed envelope. Motto insisted that it not include a stamp. “That’s important,” he later explained, “because some of these persons were so sensitive that putting the stamp on the envelope would be pressure, that they’d feel obligated that we wouldn’t waste our stamp.”

Motto recalled receiving letters that thanked him and his team for remembering them, while one replied, “You will never know what your little notes mean to me.” Even when the subject matter was dark—“Please call I don’t care what time it is. I love my kids but I need a rest because I think I am having a nervous breakdown,” a woman wrote in 1973—there was a sense of intimacy there.

The most pivotal response was sent to Douglas Kreider, one of Motto’s researchers, by a study participant who lived in an apartment in San Francisco’s Haight-Ashbury district. The man, who 18 months earlier had written a “kiss-off” letter, now described himself as a broken vase held together by his own hands. His letter spanned five single-spaced typed pages and read as if it had taken days to write. Forty years later, Motto could remember the first sentence: “You are the most persistent son-of-a-bitch I’ve ever encountered, so you must really be sincere in your interest in me.” There it was, a perfect encapsulation of the study’s aims. Motto called it “the bingo letter.”

Ursula Whiteside is, above all else, a bad pun and cat-based humor kind of person. She seems never to have met a GIF of a penguin, or of Beyoncé, she didn’t like. And her therapeutic practice draws heavily on these cornball ways. One of her clients had trouble getting out of bed in the morning, so Whiteside regularly texted her things like: “Here comes the magical wake up goat to make this day less baaahhh.” And the next morning: “The rabbit needs feeding! Only you can make this happen by hopping out of bed.” When that same client went on vacation last year, Whiteside sent a text urging her to feel “FREEEEEEEE!” accompanied by a cartoon of a dog sticking his head out the window. (These texts, like all others in the piece, were provided not by Whiteside, but by the patients.)

Paul Appelbaum, a professor of psychiatry, medicine and law at Columbia University, believes that texts are dangerous because they can be “the first step to the crossing of other boundaries.” He mused: “Is this once a day? Every hour? Can you have a drink even if that means you might not be as sharp? Can you enjoy a family wedding without retreating to a corner to answer text messages?”

At least one study cuts against these concerns. In 2004, researchers found that the more open therapists were to receiving calls from clients in between sessions, the fewer they ended up taking. Stacey Freedenthal, a clinical social worker and associate professor at the University of Denver, believes that one way to manage the boundary problem is for all mental health care workers to have a better understanding of risk.

“Some therapists stand in the light and call out to the person in the darkness, ‘Come out, there’s light here, there’s hope here,’” she says. “But sometimes what the suicidal person needs is for the therapist to join them in the darkness and show them a way out.”