"Autopsy" presents a man defined not only by himself but also by his family and friends, and in this context suggests a message hidden in the connections we create with one another, in the meaning of love, of anger, hope and disappointment.
Disconnection is vulnerability, says contributor and psychiatrist Jerome Motto. Its treatment can be quite simple. "I've often just hypothesized that there is more suicide prevention that goes on over the back fence, talking to a neighbor, than goes on in physicians' offices," he says.
Motto tells the story of a suicide note left by a young man who jumped off the Golden Gate Bridge. It simply read, "I'm walking to the bridge. If one person smiles at me on the way, I will not jump."
When people talk about suicide prevention nowadays, the conversation often turns to the work being done at the New York State Psychiatric Institute in Manhattan, one of the premier research facilities in the country.
In the offices and laboratories of the Department of Neuroscience on the second floor, researchers take slices of human brains and pore over their cellular structure in an attempt to discover a difference between those who have committed suicide and those who haven't.
Although they concede that suicide is not entirely a biological phenomenon, they devote their time and resources to studying the role of serotonin, a neurotransmitter associated with depression, aggression and impulse control, and charting the skein of biochemical reactions that occur at times of stress and stimulation. It is a study that they hope might lead one day to biological tests and genetic screens for suicidal dispositions.
Shneidman acknowledges their work but believes it will provide only part of the answer. "You don't understand psychopathic murder by slicing [Jeffrey] Dahmer's brain, and you won't get E=MC2 by slicing Einstein's brain," he says. "Unfortunately, it's in the mind. And the mind is not a structure. It is an ephemeral concept."
Two years before his death, Arthur had been taking Effexor (100 milligrams). Later, it was Prozac (10 to 40 milligrams), and a year before his death, Wellbutrin (300 milligrams), Effexor again (75 to 150 milligrams), Eskalith (450 milligrams) and Celexa (40 milligrams). "I have gone through literally countless years of therapy & now over 2 years of antidepressant medications," he wrote. "Why is it that I should believe that one day I will be 'happy.' "
Yet it is a regimen that is widely accepted.
For depression and social anxiety today, there is less consideration of private histories and more prescriptions of Zoloft and Paxil, now advertised on television as if they were cold medicines.
Although most contributors to "Autopsy" believe that drug therapy treats only symptoms, none argues against it. Treating an ephemeral concept -- to borrow Shneidman's phrase -- is a difficult proposition, made more difficult by numbers (nearly 30,000 people commit suicide in the country each year), institutions and culture.
"We want quick fixes. Pop a pill and it will take care of your problems," says contributor and psychiatrist Morton Silverman. "The message you get when you watch ads in the newspapers or the television is that there is a fix for everything, that you're not supposed to suffer. You're not supposed to struggle. You're not supposed to learn from adversity."
In addition, we live in an age of celebrity and superlatives, which can often create unhealthy expectations. "Part of the problem in fixing people is not to make them better but to make their expectations lower," says Maris. The goal is to help them understand that their lives -- their spouses, their children, their careers, their income -- are good enough.
Bucking the zeitgeist is difficult, but it is at the heart of Shneidman's work, especially as he has watched, in the last 25 years, the mental health pendulum swing from left to right, from clinics to laboratories, from social to pharmaceutical agendas.
At one point in the 1960s, Shneidman was the head of the Center for the Study of Suicide Prevention at the National Institute of Mental Health. Today, he is, as he acknowledges, "a footnote in the history of suicidology. I'm not in the mainstream at all. I am peripheral."
Beyond the Biological
The sun has left Shneidman's back porch. The wind vane on top of the garage -- a whale, instead of a rooster, in tribute to his literary mentor, Herman Melville -- catches the last rays. His beloved statute of Venus Genetrix and the street sign -- "Griffin Ave.," where he grew up in Lincoln Heights -- stand in the shade. A bonsai pine, a gift from the eminent social psychiatrist Fritz Redlich, is dead.
"If I were to do it all over again," Shneidman says, "I would probably study love."
Shneidman's mysticism is precisely his appeal. Suicide does not lend itself to anything else. It strikes at the essence of humanity. It requires a deep understanding of the issues of life and death.
It asks us, as Silverman says, to "incorporate concepts that have to do with the self, with one's religiosity, with one's concepts of family community, issues which go far beyond just a purely biological approach."
"Autopsy" may be a biased book, but all of its contributors, Maris said, are the people you'd want sitting at your bedside if you were thinking of killing yourself. Such moments are not just about neurochemistry, he said. "It is also a matter of whether you care if the person in front of you lives or dies and if you can strike a rapport or an empathetic alliance with the person."
Could this gift have been offered to Arthur?
Shneidman wishes he'd had the opportunity. "No one has to die, absolutely no one," he says. "It will be done for you."