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Key points
- We can learn many lessons about living from studying those who consider suicide.
- The question of what makes life worth living is an eternal and important question worthy of our consideration.
- Living intentionally, with meaningful plans, goals, and hope for the future is critical to fulfillment.
- Meaningful work, love, and play can become an important "mission" to fully realizing a life worth living.
“Okay Doc, I got it… my new mission is to not kill myself! But honestly, I still have a big problem: I don’t exactly know how to live?”
So said “Sam” to his clinical provider as the dyad met within a 12-session course of suicide-focused care, having now met operational criteria for resolving his suicidal risk. As a 23-year-old U.S. Army Infantry Soldier, Sam was a patient-participant in a randomized controlled trial (RCT) of the Collaborative Assessment and Management of Suicidality (CAMS), which is an evidence-based suicide-focused clinical intervention (Jobes, 2023).
Within the Suicide Prevention Lab (SPL) that I direct at The Catholic University of America, we are engaged in large RCTs of CAMS across different clinical settings and with different clinical populations of patients who are actively suicidal. Within our research, SPL members watch dozens of videos each week across various RCTs to evaluate providers’ adherence to CAMS and ascertain overall treatment fidelity. As I personally watched this resolution session of CAMS with Sam, I felt a mixture of relief and a lingering concern.
To be honest, when Sam was first engaged in CAMS, he was extremely worrisome. There were nights when I literally lay awake in bed worrying about the prospect of Sam ending his life and the potential threat to his commander and members for whom he harbored serious homicidal feelings.
Sam had been deployed several times to Afghanistan and Iraq where he had engaged in fierce tours of combat. His two closest friends had been killed adjacent to him and he had been involved in countless bloody firefights. Returning from his last deployment, Sam was enraged at his commander and resented members of his unit that he felt did not have his back in combat.
Fortunately, as we see with such patients so engaged in CAMS, Sam made steady progress on his self-identified suicidal “drivers” (CAMS parlance for what causes suicidal risk). Sam’s drivers centered on acute symptoms of PTSD and the prospect of losing custody of his two young children in a divorce battle with his estranged wife.
In relatively short order, Sam’s intense emotions became more regulated as he responded to prolonged exposure for PTSD. In addition, spiritual direction from an Army chaplain also helped him deal with an emerging sense of moral injury. Sam’s CAMS provider also helped engage an Army JAG attorney to represent him in the custody litigation. Contacts made with the VA also set the stage for Sam to leave the Army and transition back into civilian life.
In his resolution session, Sam still had some lingering suicidal ideation. But he had become quite skilled at managing his suicidal thoughts and feelings and realizing behavioral stability. As I watched, I was pleased with Sam’s clinical resolution, but I nevertheless had a nagging concern related to Sam’s statement that he did not know how to live.
My treatment research mentor, Dr. Marsha Linehan (the developer of dialectical behavior therapy, or DBT) famously espoused the importance of developing a life worth living. Within the CAMS framework, we fully embrace this notion—particularly as treatment draws to a close, when the importance of reasons for living, and the development of plans, goals, and hope for the future (i.e., a life worth living) are emphasized.
Nonetheless, as I watched Sam’s resolution session in the lab, I knew that he had no guidebook for knowing how to live. Sam had been born into a broken and dysfunctional family. Sam’s father was an abusive alcoholic who was killed in a bar fight when Sam was a teenager. He had no positive role models and he never gave much thought to his future during his teen years.
When his high school girlfriend got pregnant, they quickly got married and Sam promptly enlisted in the Army at age 18 to support his young family; he did not know what else to do. Sam was soon deployed after basic training and his shaky marriage was never stable, yet they conceived a second unplanned child between his deployments. Sam clearly took pride in the successful resolution of CAMS—but while suicide may have been clinically averted, how indeed would he ever know how to develop and live a life worth living?
In the ensuing years, I have become engrossed with the “psychology of life” and what makes life worth living. I have studied philosophers, theologians, and research of various psychologists. As for the latter, I have long admired the work of Carol Dweck (2016) who developed and then investigated the construct of mindsets that can be either “fixed” or “growth” oriented. In turn, Angela Duckworth’s (2016) work on grit has been interesting as she studied the importance of perseverance and passion for a greater good in the world.
British novelist Matt Haig (2020) came perilously close to taking his own life, but he recovered and has written best sellers, including The Midnight Library, which is the extraordinary journey of a talented and yet hapless woman who lives a life defined by regret for having failed to make decisive choices. After overdosing Nora (the protagonist) finds herself in a magical midnight library where every book is a different story of a possible life she might live.
From a scholarly perspective, Emily Esfahani Smith (2017) writes in The Power of Meaning that we endlessly and fruitlessly seek happiness when having a sense of meaning is what makes life worth living. Sam the soldier had sparked in me an earnest desire to better understand what makes life worth living brimming with purpose and meaning.
Ironically, after 40+ years in suicidology, I have come to know a bit about life by studying those who feel compelled to end it. What we know from our investigations is that people who are suicidal usually are existentially struggling with a few key topics: relationship issues, vocations (what they do in life), and their sense of self (e.g., self-hate). Problems related to these domains are invariably implicated within our assessment and driver-oriented treatment research.
When we pull together all these various considerations, we can begin to operationally define what seems to make life worth living. The accumulated takeaway thus far? There is value in living life with conscious intent, pursuing one’s self-defined plans and goals, and discovering meaningful work, love, and play. While I have neither personally nor professionally figured it all out, I believe that the pursuit of a life worth living can become both a compelling and worthwhile mission for us all.
If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 in the U.S., dial 988 for the National Suicide Prevention Lifeline or reach out to the Crisis Text Line by texting TALK to 741741. Outside of the U.S., visit our International Resources page for suicide hotlines in your country. To find a therapist near you, visit the Psychology Today Therapy Directory.
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References
Duckworth, A. (2016). Grit: The Power of Passion and Perseverance. Scribner.
Dweck, C. S. (2016). Mindset: The New Psychology of Success. Ballantine.
Haig, M. (2020). The Midnight Library. Canongate.
Esfahani-Smith, E. (2017). The Power of Meaning. Broadway Books.
Jobes, D. A. (2023). Managing Suicidal Risk: A Collaborative Approach 3rd edition. The Guilford Press.
Note: The case of Sam is an amalgamation of several soldiers in the RCT.
