Tuesday, 12 May 2015

Suicide

Abstract:
This essay explores into the topic of suicide using the following scenario: You are pastorally caring for a family in your Church whose 19 year old son recently committed suicide. They believe that he was a Christian, but his struggles with mental illness (including diagnosed paranoid schizophrenia) meant that his profession of faith occasionally took bizarre forms. Whilst they are dealing with their grief in healthy ways, they have become ‘stuck’ over the question of whether he is ‘in heaven’ and, if so, what that means for him. This essay looks at ways of pastoral, scriptural and theological guidance for the family. As there is a lack of scriptural passages condemning suicide and we do not know the state of mind of the person in his or her last moment, it is important not to be judgmental or jump into a conclusion about the eschatological end point of the person who committed suicide. Suicide is an ambivalent topic in Christianity. Pastorally it is more helpful to lead the family into the theology that “God has a purpose in my suffering”, that “God is in control of what is out of my hands”, and “life is a gift from God”.

Life as an endless cycle?
The Greek attitudes seem to be as follows: first, the course of life is filled with irreconcilable alternatives, a series of Hobson’s choices; second, tragic heroic man attempts to deal with this dilemma by hopelessly cycling through opposing alternatives; third, there is no way out of this trap, so the cycles become more helpless, hopeless, and suicidal. The assumptions underlying biblical and later Jewish thought are quite different: first, the world is not filled with irreconcilable conflicts; second, biblical and rabbinic man avoids the tragic-heroic trap; third, meaningful development is possible, and there is the potential to escape the dialectical-cyclical vacillation that leads nowhere. This sense of development is purposive, hopeful, and suicide-preventive.
Kaplan and Schwartz, A Psychology of Hope, 66.

Shneidman describes, “Currently in the Western world, suicide is a conscious act of self-induced annihilation, best understood as a multidimensional malaise in a needful individual who defines an issue for which the suicide is perceived as the best solution.”[1] This essay explores into the topic of suicide using the following scenario: You are pastorally caring for a family in your Church whose 19 year old son recently committed suicide. They believe that he was a Christian, but his struggles with mental illness (including diagnosed paranoid schizophrenia) meant that his profession of faith occasionally took bizarre forms. Whilst they are dealing with their grief in healthy ways, they have become ‘stuck’ over the question of whether he is ‘in heaven’ and, if so, what that means for him. As a pastoral carer for this family, I will need to stabilise the acute crisis and look into how I can guide their thinking on this matter theologically and biblically. I will point them towards portions of Scripture addressing the issue of suicide, then look into the historical as well as contemporary thoughts on suicide before guiding them to a conclusion.

As a pastoral carer, stabilising this acute crisis is the first priority. Townsend[2] explains that although suicide sets in motion a cascade of questions, in crisis intervention, de-escalation will most likely mean intensive pastoral presence and support, without trying to answer emotionally overpowering questions. Townsend’s four stages of pastoral presence can be helpful: Firstly, Listening in a nonjudgmental way with a caring presence that invites disclosure. Secondly, imagining, through the words and emotion expressed by the survivor, what it would be like in another person’s place. Imagining sets the stage for the third stage, empathy, which allows us to touch our own human vulnerability at a point of common humanity and enter into the fourth stage, the world of another’s experience. Pastoral connection is the result of the previous three stages, when survivors know they are heard, understood, and accompanied on a horrific journey. And if the suicide occurred at home, provide a temporary safe place if family members may not be able to return home before investigations are complete.[3]

Then when the timing is right, I can start pointing them toward scriptural passages on the topic of suicide. There are five clear passages of self-inflicted death in the Hebrew Bible. The first recorded suicide is found in Judges 9:53. Abimelech, ruler of the Northern Kingdom, was wounded seriously in battle by a millstone thrown down by a female defender. Rather than bear the disgrace of being killed by a woman, he instructs his armour bearer to kill him.[4] In Judges 16, Samson is humiliated and tormented by the Philistines. In vengeance, he prays for strength and pulls the roof down upon himself and the Philistines. King Saul’s death (1Samuel 31) is also suicide. Ahitophel (2Samuel 16-17), Zimri (1Kings 16) are further examples. Only one suicide occurs in the Christian New Testament: Judas Iscariot hangs himself from the branch of an olive tree after his betrayal of Jesus (Matthew 27:3-5).[5] Interestingly, Townsend[6] notes that observations were recorded but issues of suicide morality do not arise in the biblical text. There is no concern for the post-mortem welfare of the victim, no sense of punishment for taking one’s own life, or denial of burial.

Kaplan and Schwartz[7] observes that significantly, the Hebrew Bible also portrays some cases of suicide prevention, which involved individual who expressed suicidal wishes but were helped by God’s therapeutic intervention. For example, Elijah (1Kings 18-19) was in such despair that he wished to die. God gave him food and water.[8] There was no judgment about Elijah’s behaviour and he was given basic sustenance with intensive personal encouragement that leads towards reconnection with community.[9] Moses (Numbers 11) was offered help for his burden.[10] Other examples[11] include David (Psalm 22) with a renewal of faith, Job with a renewal of relationship, Jeremiah with the punishment of evil, Rebecca (Genesis 27-28) with appropriate matchmaking, and Jonah with protected withdrawal and guidance.

There are various historical views on suicide. Many contemporary suicidologists[12] have argued that there are no specific anti-suicide teachings in the Hebrew Bible. Kaplan and Schwartz[13] assert that suicide is completely alien to Jewish intellect, spirit, and law; it is portrayed as a damnable act of fools, cultists, and traitors. In fact, many Jewish suicides may have been carried out for Greco-Roman reasons. In Greco-Roman thought, the rash of philosophical suicides seems to have been associated with a generally pessimistic view of human existence.[14] The stoics saw fate as a powerful force capriciously controlling human destinies and they sought to escape it. In particular, they sought to escape the inevitability of death through the illusion of gaining control over death through suicide. The option of bringing about death seemed to give the Stoic an illusion of control by which he could prevent death from striking him by chance.[15]

In contrast, the rabbis accepted that God controls these matters of life and death. Birth and death are events beyond human understanding; God alone will handle them.[16] Ecclesiastes chapter 3 talks about how there is a timing for everything. According to the Oxford Bible Commentary[17], every action or event will come to pass, and God has made each ‘suitable for its time’. Kaplan and Schwartz[18] further elaborates that indeed, many things that come from God are beyond human reach, but humans do not need to feel helpless or doomed. Recognising mortal limitations and accepting divine omnipotence does not threaten the individual with annihilation. Koheleth faces a dilemma, but is not touched by suicidal doubts. Rather, since the world functions so well, he wonders what is left for humans to improve or create (Ecclesiastes 1:3-10). The Bible is not obsessed with the sense of heroism so endemic to the Greek world; nor is there the Greek dualism between the body and soul. The biblical God is a strong and nurturing parent, not a capricious deity. The highest goal of humans is thus to be obedient to God’s will rather than to liberate the soul from the body.[19],[20] There is no belief in doom, and there is always the possibility of prayer, repentance, atonement, and genuine change.[21]

In the early church, martyrdom was a major issue as Christians were persecuted for their faith.[22] Some scholars suggest that Christianity’s ambivalence about suicide rests in the central images of crucifixion.[23] A number of Christian thinkers have seen Jesus’ death as voluntary. How could it be otherwise if he was both divine and human?[24] Scripture affirms that Jesus chose the way of the cross: he willingly walked into a situation that he knew would kill him.[25] Aquinas offered three “objections” to the idea that Jesus was slain by another. First, he offers a quotation from John 10:18, “No man takes my life from me, but I lay it down of myself”.[26] Second he cites Augustine: “Those who were crucified were tormented with a lingering death.” This did not happen in the case of Jesus because, “crying out, with a loud voice, he yielded up the spirit” (Matthew 27:50).[27] Third he cites Augustine’s view that Jesus willed his soul to leave his body. At the same time, Aquinas points to a seemingly contradictory passage (Luke 18:33): “After they have scourged him, they will put him to death.” He attempts to resolve this seeming contradiction by distinguishing between direct and indirect causes. Jesus’ persecutors were a direct cause of his death; however, Jesus was himself an indirect cause of his death because he did not prevent it.[28]

Furthermore, this act is seen as representing the epitome of martyrdom: “Greater love has no one than this, that one lay down his life for his friends” (John 15:13).[29] Other examples of Christian ambivalence about life include suicide acted out in martyrs who threw themselves onto funeral pyres, who embraced the Roman soldiers who would kill them, or who drowned themselves rather than be defiled. Deep within our Christian heritage lie basic questions of the value of physical, earthly life. When is it better to die than to live? Under what circumstances is self-determined death part of the story of redemption, or conversely, a betrayal of God’s gift of life?[30]

In the fourth century, suicide was formally opposed by church doctrine as a pastoral concern. Augustine declared that, while Scripture did not prohibit suicide, neither did it make it lawful. To stop martyr suicides, he declared that the commandment against killing applied also to killing one’s self.[31] With the post-Constantinian success of Christianity, martyrdom was no longer an issue within the old Roman Empire.[32] Aquinas[33] expanded the church’s interpretation with the statement that established suicide is a sin that could not be forgiven. Despite his argument that Jesus was the voluntary indirect cause of his death, Aquinas[34] attempts to demolish pagan arguments for suicides. In addition to reiterating Augustine’s argument, Aquinas adds three arguments of his own. First, suicide is unnatural. Everyone bears an instinctive charity toward himself and should thus desire to do himself no harm. Second, an individual is a member of a social unit, and that suicide is antisocial. Third, life is a gift of God: though it is given, it remains God’s property; therefore, only God can pronounce the sentence of life and death (Deuteronomy 32:39).

Since the end of the eighteenth century the rabbinic maxim that “a suicide has no portion in the world-to-come” had become widespread.[35] Most of them recognize that it has no rabbinic source, and three approaches have developed: some totally reject its validity; some feel it is implicit in certain rabbinic passages; some believe that even though it is not found in rabbinic literature, simple logic dictates that a suicide has no portion in the world-to-come.[36] The Talmud[37] derives the prohibition against suicide from the Noahide laws in Genesis 9:5, which reads as follows: “And surely your blood of your lives will I require.” Upon this passage R. Eliezer takes it to mean “I will require your blood if shed by the hands of yourselves.” Epstein thinks it is obvious that just as one who kills is in turn killed (Gen. 9:6), so too one who commits suicide will be punished.[38] Not only this, but there are also prohibitions regarding self-mutilation, for example: “ye are the children of the Lord your God: Ye shall not cut yourselves, nor make any baldness between your eyes for the dead” (Deuteronomy 14:1).[39] However, according to the Oxford Bible Commentary[40], Genesis 9:5-6 is simply meant to forbid homicide, as mankind, in contrast to the animals, are created in the image of God. Kaldjian[41] contends that we alone are created in God's image, therefore human life is sacred. We have, accordingly, an obligation to God to live, gratefully accepting the gift of life.

The view of suicide as inherently sinful is also reflected in Protestant statements such as the Westminster Shorter Catechism (1647), which states that the sixth commandment “thou shall not kill” (Exodus 20:13) forbids suicide, and Dietrich Bonhoeffer’s Ethics, which asserts that suicide undermines God’s will.[42] Current Protestant thought on suicide tends to affirm that life is a gift of God and that God will not give a person more suffering than can be endured. To take one’s life is a failure of faith because it sets limits on how much suffering we think we can endure.[43] Though suffering may threaten to undo us, causing us even to doubt the goodness of our lives, God's providence and redemptive power invite us to believe that in all circumstances we may live in gratitude for the gift of life bestowed upon us and to trust that God's grace is sufficient for our need. Christ was forsaken on the cross for our sake, and because of his victory over sin and death, we may live in the bold confidence that God will never forsake us.[44] There are very few sins regarding which there is general acceptance that the perpetrator loses his portion in Paradise, and yet suicide seems to be viewed as such. However, there appears to be no reason why suicide should be included in this list, especially as there are no explicit biblical verses forbidding the practice.[45]

Next, I will lead the family into the contemporary insights on the topic of suicide. The medical definition of mental disorder in the DSM-5 manual[46] is “a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behaviour (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.”

In DSM-5, schizophrenia is “characterized by delusions, hallucinations, disorganized speech and behaviour, and other symptoms that cause social or occupational dysfunction. For a diagnosis, symptoms must have been present for six months and include at least one month of active symptoms”. Interestingly, these definitions are man-made and are different between different editions of the DSM manual.[47] It is, after all, impossible to confine the state of mind of any individual into a definition of a few sentences.[48] Adams assert that the Scriptures speak of both organically based problems and problems that stem from sinful attitudes and behaviour, but not anything that might approximate the modern concept of “mental illness”.[49] Adams[50] further argues that those labelled “schizophrenics” could not be considered “mentally ill” but have to be reclassified as “perceptually ill”: If perception is the problem, there is nothing wrong with the mental responses to what is perceived. The judgment has not been impaired. The problem is that a good judgment has been made on the basis of false data.

In fact, in my career as a medical doctor, I have seen quite a few people who are psychotic. For example, an elderly lady who thought she was Mary the mother of Jesus, and a teenage boy who thought there was a monkey inside him trying to control him. Compare this with elderly people with dementia: they are also not in a clear state of mind, so theologically can we say that those with dementia not saved? Or should we consider their beliefs at the time when their mind was in a clear state. Scenarios like these are always hard to assess. In fact, in the book ‘Turning points: an extraordinary journey into the suicidal mind’, De Leo[51] described many suicide survivors who encountered a dramatic shift in their thinking during their suicide attempts and they are happy to be alive, and the only reason we know of this change in mind set is because they survived.

For example, Sergio, one of the suicide attempters described by De Leo, described the following feeling as he was preparing to jump off his tallest silo, “Life has nothing to say and nothing to give to me anymore. I had no curiosity for anything, anymore. All I had was emptiness, darkness, and total disconnection.”[52] Then something incredible happened when he jumped off, “I immediately thought that I did not want to die… And then it came to my mind, all the energy and effort that I put into that property during my entire life… That property was everything to me and, honestly, was not bad at all. Maybe I could be useful again. In that precise moment I wanted live, with all of my being. But to die, I began my fall face down. Now I had to try to redirect my body. If I succeeded, I thought that, maybe by landing on my feet, I could eventually survive.”[53] So, it is impossible for us to know the state of mind people who did not survive their suicide attempt and therefore we cannot judge their individual eschatology endpoint. (more notes I made from De Leo's book can be found on: http://dryvonnewang.blogspot.com/2015/03/notes-from-book-turning-points.html)

Motivation to suicide is also very varied complicated. Alvarez[54] states, “No single theory will untangle an act as ambiguous and with such complex motives as suicide.” It could even be altruism, for example Mahatma Gandhi fasting to the point of death for the oppressed millions in India[55], and the physically ill people who are extremely fearful of being a burden to those around them[56]. It could be revenge, for example making an ex-lover feel guilty or even psychosis where one thinks they can fly. It could also be hopelessness, as high levels of hopelessness are directly related to suicidal action and may be more significant than high levels of depression[57], or simply to stop suffering, where one does not necessarily want to die but wants to escape from an unbearable situation[58].

Debriefing can often reassure and de-escalate the family’s cycle of guilt and failure. No one can fully know another’s mind or anticipate another’s action.[59] Rather than trying to guess the motivation of suicide, a more beneficial way of debriefing is to lead the family into benevolent religious reframing, interpreting negative events as contained in the care of a loving God. Uncontrollable negative events are not random or a form of punishment. “God has a purpose in my suffering” is not the best-formed theological statement. However, they do point to the fact that people who find redemptive religious meaning in their physical and psychological pain recover more quickly and are better protected from suicidal despair than those who cannot find such meaning. One pastoral task is to help people articulate “God is in control of what is out of my hands” in theologically beneficial ways.[60]

A funeral following suicide often marks the transition from crisis management to follow-up care. Funeral planning consolidates the reality of loss. These provide a window for further crisis resolution and opportunities for religious reflection. Primary family members must be included in decisions of how a victim’s life is honoured and the death is portrayed.[61] Once an immediate suicide crisis is managed, recovery is the focus of ongoing pastoral care.[62] Suicide sets in motion a cascade of questions, actions, and consequences that are unique in pastoral ministry. It is a choice that forever alters the future of those left behind[63], who are at increased risk of suicide themselves[64]. It is not unusual for a pastor, church members, friends, and family to be completely surprised by a suicide within the congregation.[65] Suicide will have a deep congregational impact and will demand theological response.[66] Personal and congregational narratives must be rewritten to incorporate a suicide into life’s story in a redemptive way.[67] Pastors must balance a family’s need for privacy with the congregation’s need for enough information to manage its own process of denial and acceptance.[68],[69]

In conclusion, suicide is an ambivalent topic in Christianity but there is a lack of scriptural passages condemning suicide and we do not know the state of mind of the person in his or her last moment. Furthermore, people tend to be reluctant to disclose their feelings for fear of judgment.[70] Therefore it is important not to be judgmental or jump into a conclusion about the eschatological end point of the person who committed suicide. Pastorally it is more helpful to lead the family into the theology that “God has a purpose in my suffering” and that “God is in control of what is out of my hands”.[71] At the same time, it is important to emphasise the theology of on the “sanctity of life as we are made in God’s image”, and “life as a gift from God” as those left behind are at increased risk of suicide themselves.


Bibliography:

Adams, Jay E. Competent to Counsel: Introduction to Nouthetic Counseling, Grand Rapids: Zondervan Publishing House, 1970.

Alvarez, Al. The Savage God: A Study of Suicide, New York: Random House, 1972.

Anderson, H. “A Protestant Perspective on Suicide,” In Comprehensive Textbook of Suicidology, edited by R. W. Maris, A.L. Berman, and M. M. Silverman, New York: Guilford Press, 2000.

Bockoven, J. Sanborn. “Community Psychiatry, A growing Source of Social Confusion,” Psychiatry Digest, 29 (1968): 51-60.

Clemons, James. What does the Bible say about suicide?, Minneapolis: Fortress Press, 1990.

Coleman, Diane. “Not Dead yet.” In The Case against assisted suicide, edited by K. Foley and H. Hendin, 213-37. Baltimore, MD: The Johns Hopkins University Press, 2002.

De Leo, Diego. Turning points: an extraordinary journey into the suicidal mind, Queensland: Australian Academic Press, 2010.

DSM-5. “American Psychiatric Association DSM-5 Development.” Accessed April 27, 2015. http://www.dsm5.org/

Kaldjian, Lauris C. “A Theological Response to Physician-Assisted Suicide.” Theology Today 56 (1999): 197-209.

Kaplan, Kalman J. and Schwartz, Matthew B. A Psychology of Hope: A Biblical Response to Tragedy and Suicide, Grand Rapids: William B. Eerdmans Publishing Company, 2008.

Maisel, Eric R. “The New Definition of a Mental Disorder: Is it an improvement or another brazen attempt to name a non-existing thing? Rethinking Psychology.” Psychology Today, July 23, 2013. Accessed April 27, 2015. https://www.psychologytoday.com/blog/rethinking-psychology/201307/the-new-definition-mental-disorder

Maris, Ronald. “Rational Suicide: an Impoverished Self-Transformation,” Suicide and Life-Threatening Behavior, 12 (1982): 4-16.

Oxford Biblical Studies Online. “Oxford Bible Commentary.” Accessed April 29, 2015. http://www.oxfordbiblicalstudies.com

Shapiro, Marc B. “Suicide and the world-to-come”, AJS Review, 18 (1993): 245-263.

Shepkaru, Shmuel. “From after death to afterlife: martyrdom and its recompense”, AJS Review, 24 (1999): 1-44.
                    
Shneidman, Edwin. Definition of Suicide, New York: John Wiley and Sons, 1985.

Smith, Wesley. “Better off dead?” The Weekly Standard, May 29, 2000.

Townsend, Loren. Suicide: Pastoral Responses, Nashville: Abingdon Press, 2006.

Wang, Ying-fan Yvonne. Dr Yvonne Wang’s Blabberings. Last modified May 12, 2015. http://dryvonnewang.blogspot.com.au.

Werth, James. Rational Suicide? Implications for Mental Health Professionals, Washington DC: Taylor & Francis, 1996.






[1] Edwin Shneidman, Definition of Suicide (New York: John Wiley and Sons, 1985), 203.
[2] Loren Townsend, Suicide: Pastoral Responses (Nashville: Abingdon Press, 2006), 112-113.
[3] Townsend, Suicide: Pastoral Responses, 116.
[4] Townsend, Suicide: Pastoral Responses, 13-14.
[5] Kalman J.Kaplan, and Matthew B. Schwartz, A Psychology of Hope: A Biblical Response to Tragedy and Suicide (Grand Rapids: William B. Eerdmans Publishing Company, 2008), 54.
[6] Townsend, Suicide: Pastoral Responses, 14.
[7] Kaplan and Schwartz, A Psychology of Hope, 47.
[8] Kaplan and Schwartz, A Psychology of Hope, 225.
[9] Townsend, Suicide: Pastoral Responses, 69.
[10] Kaplan and Schwartz, A Psychology of Hope, 225.
[11] Kaplan and Schwartz, A Psychology of Hope, 114.
[12] Kaplan and Schwartz, A Psychology of Hope, 35. e.g., Fedden 1938, 30; Alvarez 1970, 51; Shneidman 1985, 30
[13] Kaplan and Schwartz, A Psychology of Hope, 53.
[14] Kaplan and Schwartz, A Psychology of Hope, 24. The human being is not an exalted creation; and the gods are limited in power and not loving to man. Fear of the seemingly unavoidable changes in the cycle of life pushes people to destruction and oblivion, no matter how great their accomplishments are. There is a fatalistic preoccupation with the end of life in a hostile universe.
[15] Kaplan and Schwartz, A Psychology of Hope, 42.
[16] Kaplan and Schwartz, A Psychology of Hope, 42.
[17] “Oxford Bible Commentary,” Oxford Biblical Studies Online, accessed April 29, 2015, http://www.oxfordbiblicalstudies.com
[18] Kaplan and Schwartz, A Psychology of Hope, 70.
[19] Kaplan and Schwartz, A Psychology of Hope, 108.
[20] Lauris C. Kaldjian, “A Theological Response to Physician-Assisted Suicide,” Theology Today 56 (1999): 199. Though our bodies labour under the debilitating effects of sin, and groan with all creation in anticipation of our future liberation, to view death as the occasion of the soul's welcomed release from the body risks a dualism that degrades the value of embodied human life (Romans 8:18-23). Human persons form a physical-spiritual unity, reducible neither to pure body nor pure soul.
[21] Kaplan and Schwartz, A Psychology of Hope, 109.
[22] Kaplan and Schwartz, A Psychology of Hope, 58.
[23] Townsend, Suicide: Pastoral Responses, 15.
[24] Kaplan and Schwartz, A Psychology of Hope, 54.
[25] Townsend, Suicide: Pastoral Responses, 15.
[26] Kaplan and Schwartz, A Psychology of Hope, 54.
[27] Kaplan and Schwartz, A Psychology of Hope, 54-55.
[28] Kaplan and Schwartz, A Psychology of Hope, 55.
[29] Kaplan and Schwartz, A Psychology of Hope, 55.
[30] Townsend, Suicide: Pastoral Responses, 16.
[31] Townsend, Suicide: Pastoral Responses, 16. Augustine was responding to an incident of group suicide by women anticipating rape.
[32] Kaplan and Schwartz, A Psychology of Hope, 61.
[33] Townsend, Suicide: Pastoral Responses, 17.
[34] Kaplan and Schwartz, A Psychology of Hope, 61.
[35] Marc B. Shapiro, “Suicide and the world-to-come”, AJS Review, 18 (1993), 250-251.
[36] Shapiro, “Suicide and the world-to-come”, 251.
[37] Kaplan and Schwartz, A Psychology of Hope, 35.
[38] Shapiro, “Suicide and the world-to-come”, 258.
[39] Kaplan and Schwartz, A Psychology of Hope, 35.
[40] “Oxford Bible Commentary.”
[41] Lauris C. Kaldjian, “A Theological Response to Physician-Assisted Suicide,” Theology Today 56 (1999): 198-200. Death is an evil deprivation of life that human beings have received as punishment for wilful disobedience in Adam’s sin. Death remains an enemy, and as an enemy of life, death should never be welcomed as a good in itself (though God’s redeeming power can twist death to God’s purposes even as Christ’s own death has redounded to our benefit and God’s glory). The pattern of Christ's suffering on the cross reveals to us that the fundamental imperative of Christian love is not to minimize suffering, but to maximize love and care.
[42] Townsend, Suicide: Pastoral Responses, 17.
[43] H. Anderson, “A Protestant Perspective on Suicide,” In Comprehensive Textbook of Suicidology, edited by R. W. Maris, A.L. Berman, and M. M. Silverman, (New York: Guilford Press, 2000).
[44] Kaldjian, “Physician-Assisted Suicide,” 208.
[45] Shapiro, “Suicide and the world-to-come”, 245.
[46] “American Psychiatric Association DSM-5 Development,” DSM-5, accessed April 27, 2015, http://www.dsm5.org/
[47] Eric R Maisel, “The New Definition of a Mental Disorder: Is it an improvement or another brazen attempt to name a non-existing thing? Rethinking Psychology,” Psychology Today, July 23, 2013, accessed April 27, 2015, https://www.psychologytoday.com/blog/rethinking-psychology/201307/the-new-definition-mental-disorder
[48] J. Sanborn Bockoven, “Community Psychiatry, A growing Source of Social Confusion,” Psychiatry Digest, 29 (1968), 51. Bockoven speaks of “the indefinability of mental illness.”
[49] Jay E. Adams, Competent to Counsel: Introduction to Nouthetic Counseling, (Grand Rapids: Zondervan Publishing House, 1970), 29.
[50] Adams, Competent to Counsel, 39. For example if a book seems to be flying towards you (as your senses wrongly tell you it is), the right thing for the mind to do is to send signals to the arms to protect the head. Seemingly bizarre gestures, therefore, make sense when they are rightly interpreted as a protective response.
[51] Diego De Leo, Turning points: an extraordinary journey into the suicidal mind, (Queensland: Australian Academic Press, 2010), 88, 97, 116.
[52] De Leo, Turning points, 89.
[53] De Leo, Turning points, 94-95.
[54] Al Alvarez, The Savage God: A Study of Suicide, (New York: Random House, 1972), preface.
[55] James Clemons, What does the Bible say about suicide? (Minneapolis: Fortress Press, 1990), 102.
[56] Kaplan and Schwartz, A Psychology of Hope, 209. Studies conducted in Oregon by Foley and Hendin 2002, in the Netherlands by Hendin 2002, and in the northern territories of Australia by Kissane 2002; Street and Kissane 2000. We see in various studies that this fear arises as a leading reason given by people who prematurely ended their lives.
[57] Townsend, Suicide: Pastoral Responses, 25.
[58] De Leo, Turning points, 149.
[59] Townsend, Suicide: Pastoral Responses, 115.
[60] Townsend, Suicide: Pastoral Responses, 93.
[61] Townsend, Suicide: Pastoral Responses, 118.
[62] Townsend, Suicide: Pastoral Responses, 119.
[63] Townsend, Suicide: Pastoral Responses, 22.
[64] Townsend, Suicide: Pastoral Responses, 117.
[65] Townsend, Suicide: Pastoral Responses, 22.
[66] Townsend, Suicide: Pastoral Responses, 107.
[67] Townsend, Suicide: Pastoral Responses, 119.
[68] Townsend, Suicide: Pastoral Responses, 128.
[69] Townsend, Suicide: Pastoral Responses, 131-133. The tasks are as follows: 1) To state basic facts, 2) To define the purpose of intervening with the congregation, 3) To debrief the crisis, 4) To inform the participants about the nature of crisis, trauma, and recovery, 5) To respond to religious and theological myths or concerns, 6) To give people information about where to get further help if needed.
[70] Townsend, Suicide: Pastoral Responses, 22.
[71] Townsend, Suicide: Pastoral Responses, 93.

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