Covert and Slow Suicide

Suicide may be a long-term option in dealing with life impasses. Suicide doesn't always have to take the form of a sudden, dramatic event, such as shooting or hanging oneself. It can be a slow and deliberate, barely conscious plan carried out over a period of years. In this latter form it's very hard or even impossible to identify.

Here's a sample scenario: A 40-year-old woman in an impossible and abusive marriage has strong religious beliefs that make the deliberate taking of her own life intolerable. The same beliefs absolutely preclude divorce as an option. She believes she cannot bear the thought of living as she has for the rest of her life. So she begins doing things that will clearly shorten her life span, but will not kill her immediately. She smokes more heavily, eats a lot of fast food and gains weight. Her blood pressure gets fairly high. She is advised to exercise and lose weight, but she doesn't do that. Her physical condition continues to slowly deteriorate. She sleeps and naps a lot, complaining of "being tired". She drinks too much and sometimes (not often, perhaps) drives while slightly intoxicated. Her fights with her husband intensify, and she may be assaulted by him, but never follows through with a complaint. She knows he has a gun, but she does nothing to get rid of it.

She's not directly killing herself, but she knows as a fact that her life expectancy is pretty limited. If her husband doesn't kill her, her health will continue to deteriorate fairly rapidly. The stress of her life style increases the likelihood that she may die of a stroke or heart attack, or even in a car wreck. However, such a death doesn't count as a suicide either in her mind or in the collective mind of the family, her religious community and authorities. Nonetheless, her life is deliberately limited, even though she may never put this intention into words. She has found a way of acceptably solving her problem. If you asked her how long she might live, given her current life style, she would laugh and avoid the question, or answer it in a way that makes it a joke not to be taken seriously (gallows humor) or she may become defensively angry.

Another scenario: A middle-aged man hates his job, doesn't get along with his wife and fights with his grown children. He fantasizes about changing his life, moving away, even getting a divorce, but knows he will never do it. The thought of such major changes provokes a lot of anxiety. He begins to drink more, and his smoking becomes heavy, as much as 2 packs a day. He talks about trying to stop smoking, but nothing seems to work. He spends more and more hours per week at work in a fairly demanding and high-stress job. He gains a lot of weight and signs up for a gym, but never seems to have time to go there. He gets anti-depressant medication from his family doctor but seems to get little benefit from it.

We are all making choices regularly that will impact on our life span. Some choices are simply short-sighted; some choices make our lives better and others may shorten our lives. People carrying out a covert suicide, however, consistently make choices that are known to lead to an early death. They get angry or laugh it off when asked or confronted, because the whole intent is to get away with suicide without being forced to recognize the truth of what they are doing. Much of the time the decision to slowly shorten one's life is not verbalized or even a consciously thought. It's a passive way of dealing with difficult problems and is congruent with people who use passive-aggressive defenses.

While people in the covert suicide category can be treated successfully in therapy, they are not likely to be willing to deal directly with this issue, since a key part of its usefulness lies in its easy concealment/denial. They may ask for help in "getting over being depressed" and will be readily compliant with anti-depressant medication. However, they invariably misidentify their unhappiness as depression, and so anti-depressants don't work very well. What they don't want to do is to be faced with the underlying issue of a miserably unhappy and "trapped" life. The anger and denial they express when confronted is a give-away. They have found a solution for an impossible situation (as they see it) for which they cannot be blamed and which cannot be prevented.