EP. 91: INSIDE A SUICIDAL MIND

WITH CLANCY MARTIN

Dec 5

WITH CLANCY MARTIN

A philosopher and survivor of more than 10 suicide attempts explores the suicidal mind and shares advice on finding hope amid life’s bleakest moments.

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Episode Summary

Since childhood, Clancy Martin has been preoccupied with, and even addicted to, the idea of suicide. A survivor of more than ten suicide attempts. Clancy has spent his life wrestling with questions like: where do these impulses come from? Why am I haunted by them? Why do I feel so much guilt? Can I be helped?

Clancy is a professor of philosophy at the University of Missouri — Kansas City, where he teaches existentialism, moral psychology, philosophy of the mind, and ethics. He is a Guggenheim Fellow and the author of more than ten books, most recently 2023’s How Not to Kill Yourself: A Portrait of the Suicidal Mind, in which he chronicles his struggles with suffering, substance use, and an obsession with self-destruction. At the same time, the book is a prescription of hope and an eloquent reminder of the interconnectedness of our lives. These are the issues we grapple with in this episode.

Content warning: Due to the sensitive nature of the topic of suicide, this episode might be distressing for some listeners. If you or someone you know is struggling with thoughts of suicide, in the United States, you can contact the National Suicide Prevention Lifeline by texting or calling 988, available 24 hours a day, seven days a week. For our international listeners, please refer to local resources in your country for support.

Clancy Martin is professor of philosophy at the University of Missouri — Kansas City. His research covers the ethics of social and behavioral health, especially in the areas of suicide prevention and the treatment of addiction, and the use of storytelling as part of the therapeutic process. He has published more than 10 books on a variety of subjects, mostly philosophical, including two novels, and his writing has appeared in The New Yorker, The New York Times, The Wall Street Journal, Ethics, Journal of the History of Philosophy, Harper’s (where he is a contributing editor), Vice (where he is a contributing editor), and dozens of other magazines, journals and newspapers. His work has been optioned for movies and television and has been translated into more than 30 languages, and he has won a Guggenheim Fellowship among other fellowships and awards.
In this episode, you will hear about:
• 3:53 - The importance of “speaking honorably” about suicide and removing the taboo surrounding the topic
• 9:23 - Applying the biopsychosocial model of illness to suicide
• 13:29 - Clancy’s lifelong experience with suicidal ideation
• 22:58 - Moving past our tendency to see suicidal ideation as a personal sin or failure.
• 27:07 - Understanding the different reasons why a person would consider suicide
• 35:54 - In Clancy’s view, what lies on the other side when one moves beyond a suicidal mindset
• 44:42 - Clancy’s advice for how to cope if you are currently vulnerable to suicidal thoughts
Henry Bair: [00:00:01] Hi. I'm Henry Bair.
Tyler Johnson: [00:00:02] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to The Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build healthcare institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across healthcare, from doctors and nurses to patients and health care executives those who have collected a career's worth of hard earned wisdom probing the moral heart that beats at the core of medicine. We will hear stories that are by turns heartbreaking, amusing, inspiring, challenging, and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.
Henry Bair: [00:01:03] Since childhood, Clancy Martin has been preoccupied with and even addicted to the idea of suicide. A survivor of more than ten suicide attempts. Clancy has spent his life wrestling with questions like where do these impulses come from? Why am I haunted by them? Why do I feel so much guilt? Can I be helped? Clancy is a professor of philosophy at the University of Missouri, Kansas City, where he teaches existentialism, moral psychology, philosophy of the mind, and Ethics. He is a Guggenheim Fellow and the author of more than ten books, most recently 2023 How Not to Kill Yourself A portrait of the Suicidal Mind, in which he chronicles his struggles with suffering, substance use, and an obsession with self destruction. At the same time, the book is a prescription of hope, an eloquent reminder of the interconnectedness of our lives and an affirmation that help is always, always available. Says Clancy of his book, "If you're going to write a book about suicide, you have to be willing to say the true things, the scary things, the humiliating things." And as you'll hear, he brings this raw intimacy and honesty to our conversation.
Henry Bair: [00:02:15] Before we begin this episode, I want to make a few points that address the sensitive nature of the topic of suicide, which might be distressing for some listeners. We will be delving into the thoughts and feelings that led Clancy to the darkest moments of his life. So first, we recognize that some listeners may themselves be struggling with these or similar thoughts and feelings. If that is the case, we invite you to defer this episode for now and revisit it at a later time. Second, if you are dealing with these thoughts and feelings before we talk about anything else, we want to remind you that there are myriad places to get help, whether it's from those who know and love you, or whether it's from a mental health professional. In the United States, you can contact the National Suicide Prevention Lifeline by texting or calling 988. Available 24 hours a day, seven days a week. For our international listeners, please refer to local resources in your country for support. And third, our conversation will be structured as follows. While we will initially be talking candidly about the frame of heart and mind that might lead someone to think about ending their own life, we will then take the conversation beyond that darkest, narrowest part to where we open to a more expansive space filled with light. So if you find the first half somewhat heavy, you may want to stay with us as we seek some measure of resolution and work our way eventually towards the hope that is on the other side.
Tyler Johnson: [00:03:41] With all of that as preamble. Clancy, we want to thank you so much for being willing to come on and talk with us on the program.
Clancy Martin: [00:03:49] Oh, it's certainly my honor and pleasure. Thank you so much for having me.
Tyler Johnson: [00:03:52] Of course.
Henry Bair: [00:03:53] Well, to start us off very early on in your book, you write, we don't speak of suicide 'honorably' because at some point we don't really sympathize with the person who kills herself. But I want to try here to speak honorably, respectfully, and sympathetically of people who have killed themselves or tried to kill themselves, including myself. Can you share with us what you meant by speaking honorably about suicide?
Clancy Martin: [00:04:20] Yeah, this is a big one and a very important one. You know, the World Health Organization estimates that something like 10% of the world population suffers from suicidal ideation, maybe even chronic suicidal ideation. And so we're talking about 700, 800 million people who are struggling with this kind of thinking, who are in danger of making an attempt or have made an attempt. And then they go on and they say that the number one obstacle to helping what is, you know, really a pandemic, you know, it's almost suicide is almost always listed in the top ten causes of death of human beings worldwide. The number one obstacle is shame and taboo. And how do we perpetuate shame and taboo? It's through, basically the view that suicide, there's something dishonorable about suicide, that there's something shameful about suicide, that there's something extremely selfish or morally blameworthy, something even sinful about suicide. Suicide is still to attempt suicide or to die by suicide is still a criminal act in many countries around the world. And of course, quite recently, it was a criminal act in our own country here in the United States. So we have a whole lot of work to do. And still, even as more open as we have become. And when it comes to thinking and talking about suicide, still, I constantly speak with people who have had a suicide in their family, and they they don't want to talk about it, they don't want to admit it. And there is this kind of cloud of shame and secrecy that often surrounds an attempt, particularly if it's a repeat attempt, and also the death in a family of a loved one by suicide.
Clancy Martin: [00:06:07] So how do we get past this? We have to change our thinking, and we have to change the way we talk about the issue.And we have to start recognizing that there is nothing shameful about thinking in this way, that it's just one way of thinking, like there are many, many different ways that we think we're allowed to think all of these different things, including thinking about taking our own lives. There's nothing inherently shameful or blameworthy about that, and that the way that we have tended to talk about suicide. In the past, at least since Saint Augustine was trying to discourage all these first century Christians from taking their own lives so that they could get to heaven faster, has been loaded with all this extraordinarily unhelpful moral and religious baggage, and that we need to liberate ourselves from. And this is, you know, it's as recently as the 1970s that people were ashamed to talk about cancer in our society, and that Betty Ford made great strides in being willing to talk about cancer. And then we're still making progress. And the question of talking about addiction and all of the shame around that subject. But where we are the furthest behind, I think, is on this question of suicide. So it should be a goal of all for all of us, especially those of us who are in the health professions to learn how to speak honorably about suicide, suicidal thinking, people who've made suicide attempts, people who've lost loved ones to suicide. And it's hard because it involves death. And we do a terrible job, as you guys both know better than I do. We do a terrible job of talking about death in this culture. I mean, we we're really incompetent at it. So it's an ambitious thing to learn how to talk about suicide, but we've got to do it because it's the only way we're going to save lives.
Tyler Johnson: [00:08:01] Yeah. You know, I remember when I was 17 or 18, there was a very popular, well-liked, energetic, one of the most popular guys at school, at the high school where I grew up, who died by suicide. And this came as a shock for multiple reasons. One was because this was not something that our community, at least intimate community, had had ever dealt with before. But also, I think precisely because he was the picture of gregarious youth. Right? He was anything but the, you know, sort of I am a rock. I am an island person shut away in his bedroom, who I think we sort of stereotypically picture. And one thing that I remember is that at that time, I think almost universally, the rhetoric around this was still about people committing suicide. Right. And to your point, just the shift from committing the term, committing suicide to die by suicide is large, right? Because it is to move from the idea that your last dying act was to commit a sin. That's why that verb is that way, right? To saying that this is a person, the way that a person died. And I think it is really important to recognize, I'm going to use a term here in a second that I recognize can be loaded with its own stigma in a way. But let me just explain it for a moment.
Tyler Johnson: [00:09:23] So as a doctor, you know, we often admit people to the hospital with heart failure or kidney failure or liver failure, right? And yes, there are times, admittedly, when maybe a person would look at that and say, well, you know, that person, that thing happened to them because they made decisions ABC, X, Y, Z. But for the most part, that's not really how we think about that at least anymore. Right? Like if someone's heart is failing, it's just that an organ in their body is not working anymore. And that's not their fault anymore than whatever their DNA is or what have you. And so I think that one, to your point now, speaking as a doctor, one thing that has been helpful to me is to think of the conditions that lead a person to be contemplating taking their own life as a sort of a brain failure or a psychological failure, not in terms of a personal failure on their part, but as a doctor, just in the same way that any other organ in the body can stop working, the brain or the psychological apparatus writ large can just stop working. Right. And that can... And often in medical circles, we talk about the biopsychosocial model of disease. Right. And I think it's important to think that all of those elements, a biological element which does even include your DNA and a psychological element, which includes all of the complicated nexus of stuff behind our own personal psychology and a social element. Right. We talk a lot now about deaths of despair and other things along those lines. I think it's just important to open up the fact that the brain is an organ, like the other parts of the body are organs, and that when things go amiss, that can be every bit as dangerous or even fatal as having a heart attack or cirrhosis or whatever other problem. Does that sort of resonate?
Clancy Martin: [00:11:08] Yeah, I was going to say I wish we'd had this conversation before I wrote the book, because I would have loved to use this language of a biopsychosocial model of suicide. The analogy is perfect, just as we need to open our minds when we are thinking about what we had commonly thought of as as much more sort of physical or material conditions, we need to open our minds to see the larger contexts of the psychological and the social, and how those physical conditions come to manifest themselves. Similarly, we need to open our minds when it comes to the biological and the organic and the material. When we're thinking about suicide and recognize that these are maybe not only analogous, but they might actually be fundamentally similar. You know that it might be the case that having a heart attack is fundamentally medically, more or less the same sort of thing as making a suicide attempt. And if we could get to that position, my God, how much progress we would make, because then these suicide attempters would realize, look, this is not my fault.
Clancy Martin: [00:12:21] And so much of what creates a second suicide attempt or a third suicide attempt is all the stigma, shame, and taboo that went with the first suicide attempt. You know? And so much of what leads to a first attempt also is this. I mean, nobody documents this better than David Foster Wallace and his short story Good Old Neon, which should come with a trigger warning for anybody who's feeling vulnerable right now. It's not the right story to read if you're feeling vulnerable right now, but so thoroughly details the kind of self accusation that goes into the suicidal mindset, where you're actually reproaching yourself for not having yet taken your own life despite your ardent desire to do it, and that itself informing the desire to do it, bolstering the desire to do it. Proving to yourself that you're not a fraud because you are actually making the attempt. I mean, this is the horrible paradox of suicidal thinking, but it is driven by this deep confusion about responsibility, guilt, and could be so well opposed by the kind of rethink you're suggesting.
Henry Bair: [00:13:29] I love the way we have started this conversation. I think it's an honest and ultimately healthy framing of this difficult discussion. One of the most striking things about your book is that you actually start early on by describing your relationship with suicidal thinking, going back into your childhood. To me, that was quite shocking. And as you actually point this out, we don't normally conceive of young children as even really capable of thinking about death. But that was the case for you. Can you share with us what you recall of how you thought about death when you were a child, and how that thinking has evolved since then?
Clancy Martin: [00:14:05] Yeah, I think this is also a tremendously important. Among my earliest memories, my very earliest memories. I remember feeling the carpet and noticing the color of the carpet. And this would have been because we moved homes. So I know which carpet this was. This would have been when I was around two and a half or three years old. And with that memory there is the memory of. Equally as strong as the carpet. The desire to die and all of my earliest memories are infused with this desire to die. And as a child, I always wanted to kill myself. All day, every day, all day long. I mean, it was always there. And when I was a teenager and I started talking to friends and realizing that not everybody that yeah, they admitted that now and then, they had thought of killing themselves, but realizing that they didn't feel this way all the time, or this wasn't the dominant mode of their mental life, you know, as it was for me, initially, I thought they were just lying to me. Or they may be best case scenario, they were lying to themselves. I was convinced that everybody felt this way. I thought it was just in the human, the nature of human experience.
Clancy Martin: [00:15:16] And still sometimes when I'm talking to someone on a podcast or for a newspaper interview and meet someone, this has happened a couple of times since this book has come out. Who claims never to have thought of taking their own life? I have trouble accepting this. It sounds fantastically implausible to me now as far as the way my thought has evolved, I would say that it did go in three big stages for me. The first big stage was this kind of constant desire to kill myself and just feeling afraid of the violence of it. And, you know, I made several attempts during that stage, but I was always very much looking for the least painful way, as one tends to do, not unreasonably, and the way that you thought if you did survive, you weren't going to have done irreparable damage to your physical body in some way. And that lasted until I was about 30 or so. And then I entered into my, like, real hardcore suicidal phase. People say, when you're talking to suicidal people, one of the first things if someone's reaching out to you and they're in trouble, you should say, well, look, are you planning to make an attempt? And it is an important question to ask. You should be sensitive about when you ask it. Otherwise you might you might sort of close them off by asking that question too soon. The main thing if someone comes to you in crisis is just keep them talking and ideally get them walking. Ideally get them out of the physical space they're in and moving around.
Clancy Martin: [00:16:48] But anyway, at that point, I was just constantly planning, constantly thinking of different ways of doing it. And that was the worst period of my life as a suicidal person. It was just always a part of my daily agenda and sometimes making attempts, practicing was part of my daily routine. And in the suicide literature, you see, you see other people who get into this like routine of practicing killing themselves. Donald Antrim and his wonderful book on suicide writes about this, Margo Jefferson and her her memoir Negroland writes about this practicing suicide. It's not uncommon among people who are suicidally inclined. And then in the last ten years or so of my life, my suicidal thinking has shifted so that it became much less active, much more of a passive thing. But the really dramatic change came a few months before this book came out. And since this book has come out and now I find myself in this place where whole days go by and I don't think of killing myself. And, you know, I want to knock on wood as I say it, because it may go back again, but it's it's a relief, like you can't even imagine. I mean, it's just been it's just been wonderful. Like I never expected it. I never expected I would look back on yesterday and think, you know, yesterday, I never one time, even once thought of killing myself yesterday. It's still hard for me to believe that it's changed so dramatically and I'm just grateful for it.
Tyler Johnson: [00:18:15] This may sound like I'm sort of returning to the point that we were discussing before, and I hope, Clancy, that this doesn't come across as objectifying you or patient-ifying you. But but I think it's a really important observation as we listen to your both your written and your spoken words to just draw this out. I think that most people, if they were to think about bad things that befall humans, right. There's this kind of like a spectrum, right? And on one end of the spectrum are things that almost everybody recognizes. You just have no role in the thing, right? It just is a thing that happens to you. Right? If if a pedestrian is crossing the street and is at the crosswalk and the whole nine yards, and a car just runs a red light and runs into them, nobody looks at that and thinks, well, that was your fault and what a bad person you are for doing that, right? Like nobody thinks that, right? So you have things that are way over on that side of the spectrum, and then there's a lot of stuff in the middle, but then you sort of move towards this part of the spectrum where even if we don't say it out loud again, back to the point about committing suicide, right? There's this kind of intuitive sense that like, well, yeah, but that was either an act of choice or at least it was a sort of a, you know, a passive allowance of, you know, making this bad decision.
Tyler Johnson: [00:19:34] You slipped into this, whatever. So the reason that I want to sort of have people picture this spectrum in the light of the remarks that you were just making, right, is that I think it's both painful and weighs on me. And also important to recognize that a three year old or a four year old who is thinking already of taking their own life, no reasonable person could come up with a way of saying that that is their responsibility or their fault, that it's a sin or irresponsible or whatever, right? And whether that has again, back to the bio psychosocial thing, like whether that has to do with not just with you personally, but with anybody, right? It has to do with circumstances at home or your own biological wiring or your own psychological loops that you get into or whatever. The thing is. Right? There is just no reasonable way to think about that and think that this is the person's fault, let alone that this is the person being, I don't know, a bad person or what have you. Right? And so I just think that it's important to draw out to the point that you were getting out, that you then can add on top of all of the weight that a person considering taking their own life is already feeling. Then you add the burden of guilt and shame to everything else that they're already feeling, right?
Tyler Johnson: [00:20:52] I think it's just important. Sometimes it's easier to see that in another person than it is in yourself, right? And I think it's important to be willing to question your own assumptions about your own thinking that if you think of four year old Clancy and you think, well, clearly that's nothing that Clancy has anything to do with, it can help to uncover the fact that, okay, if someone listening is really suffering right now and is really trapped in sort of this loop of self recrimination, that you can look at that and say, oh, okay, so maybe this is not me being defective. Maybe this is a thing that is happening to me or happening inside of me in the same way that a stroke or a heart attack or liver cirrhosis or whatever might. And it is not me being a bad person, and that's why I'm here.
Clancy Martin: [00:21:37] Yeah, exactly. I think that's really, really helpful. And then rather than feeling like you're fighting to kill yourself and it's this is something that you ought to do, and it's proven by the fact that you are ashamed that you haven't done it, or that ashamed that you've tried or ashamed that you feel like you're so selfish a person that you would even consider this. You could actually conceive of fighting against that, thinking like you would fight against your cancer, or you would fight against your heart disease, or you would fight against whatever medical condition that had, you know, unfortunately and maybe unjustly, you'd been afflicted with, you know. Yeah, since this book has come out, I've talked to so many people and many psychiatrists who report children under the age of six who've been either. I've talked to these people who've attempted taking their own lives under the age of six, the age when I first made my own first attempt, or psychiatrists who treated kids, who made their first attempt when they were under the age of six. And I agree with you entirely. If you can't see well, we just have to be able to see that a child of that age clearly is not just doing something selfish or morally blameworthy or there's something wrong. No, this is just something has gone wrong and their brain that we need to help them with. Yeah.
Tyler Johnson: [00:22:58] And, you know, it's striking to me too. So I want to say two things about this that I think both of them are important. The first one is that it is so striking. I'm a cancer doctor by training, and it's so striking to me how many people are sitting in my office dealing with this life altering, sometimes life threatening cancer diagnosis. And with this absolutely pained look on their face, they ask some version of the question, what did I do to deserve this? Or why did this happen to me? Right now, we know enough about the pathogenesis of cancer to know that in the vast majority of cases, cancer happens because the susceptibility to cancer is written into the very mechanisms of life that allow DNA to be replicated, that allow any human to grow in the first place. Right? It just is. Part of the way that DNA replication is wired also, unfortunately, gives rise to cancer, which is to say that in the vast majority of the cases, the answer is - you did nothing. This is just part of the human experience. I mentioned that to say that there is this seemingly human tendency in all bad things to look for. Why do I deserve this? Even if I can't intuit a way that I do? There is this almost. I don't want to call it a need, but there's this intuitive sense that I should be looking for that. That's number one. The other thing is that on this program, we talk often about religion and religious subjects, and we have spoken about the fact that we feel like spirituality, let's say a spiritual sense of the world, at least for many people, is important in intuiting a sense of meaning in the way that the universe works and our role in it, and the meaning of our own lives and everything else.
Tyler Johnson: [00:24:39] The reason I want to surface this at this moment is to say the following: I think that sometimes we make the mistake of thinking that a spiritual or religious worldview somehow necessitates this idea of every bad thing that has happened is my fault, or someone's fault, or is, you know, punishment or some version of that. And I think that there is. Instead, I just want to make sure that we don't pass by this without mentioning the fact that that is not necessarily required in order to have a spiritual or religious outlook in life. Right? There is a way to look at human woundedness and human suffering, that is, as a compassionate response to that suffering. Rather than framing the suffering in a way that posits that all suffering is a punishment for something. Right. And in fact, I would say that a spiritual, religious approach to life can actually largely be employing ourselves in the compassionate response to the suffering that we see around us, rather than trying to identify people or things that we feel are culpable for that suffering.
Clancy Martin: [00:25:41] Yeah, I think that's a really important distinction. It is true that the way the Abrahamic tradition has been sort of received and even revised, we have this tendency to blame ourselves for a whole host of things that go wrong in our lives and think that this, that we are guilty and that this is a consequence of our sin in some way. And even within the Abrahamic tradition, there are so many great thinkers, leaders and philosophers who will tell you, no, that's not the right way to think about it. You can have an ought to have a disposition towards your religion, towards your spiritual experience, such that it is there precisely to help you with those most difficult challenges, with places where you encounter obstacles, precisely the place where you would like to blame yourself is the place where you should be. You know, applying spirituality as a medicine, you know, to help you accept yourself, nurture yourself, take care of yourself. So I think that is a really important distinction. Unfortunately, the Abrahamic tradition has been particularly bad on this question of suicide. And there were times in the history of the Abrahamic religion where suicide was actually viewed as a worse sin than murder, that it was morally blameworthy to take your own life than it was to take the life of another human being. That's how confused we have gotten on this issue in this particular tradition.
Henry Bair: [00:27:07] The next question really pertains to our efforts to try to get a better understanding of the mind of somebody who thinks about these issues. You know, we've been talking a lot about blame and fault and trying to think openly about this. And your book does a great job of presenting the reasons why someone would even try to kill themselves. And I think what's fascinating is that it's really easy to think of it as well, they don't want to live anymore. But actually, as your book illustrates, there are a lot more nuances. There is a difference between a desire for self-destruction and the desire to simply not exist, or a desire to escape the harshness of reality and of life. And I think you flesh this out quite a bit, so I'd love to hear a little bit about, based on your own experiences, based on your conversations and research, what are some of the reasons that people even attempt suicide?
Clancy Martin: [00:28:00] Right now, we should say it's important to note there are as many different reasons as there are for being human, for how how it is that we are disposed towards being human. There are different reasons for suicide. So when we look at the literature, you know, we find hundreds of different reasons. And, you know, not all of the suicides that we see throughout history have been motivated by despair or anxiety or depression or shame, self-loathing, the reasons we commonly associate with suicide, you know, among the ancient Messalians who live in Marseille, France, the Roman traveler Valerius Maximus and the second AD reports that they had a council there. And you could go to this council and you could request the poison they kept on hand to end your own life. And people would go to this council sometimes because they were bankrupt, sometimes because they were broken hearted, sometimes because they were suffering from terrible depression or anxiety, sometimes because they're suffering from a terrible disease, sometimes because they were at the peak of their powers, they're at the absolute peak of their happiness. And they thought, well, it's never going to get better than this. So now is an appropriate time to end my life, because it can only get worse from here. And this was a common reason cited for taking one's own life in the ancient period, generally among the Greeks and Romans. Also quite common reason given in the ancient Japanese literature on suicide. Whereas particularly often young people in love when they were at the absolute peak of their love would say, okay, love cannot get any better than this. And so this is an appropriate time for us to take our own lives because we're at the peak.
Clancy Martin: [00:29:48] So we should say that first of all, about suicide, just to be intellectually responsible. Now, when we're speaking about suicide as a cultural phenomenon or a worldwide phenomenon and a problem that we would like to address as mental health professionals or people like me who are just trying to help, the vast majority of suicides we're talking about are suicides that are motivated by, you know, anxiety, despair, depression, self-loathing, these kinds of feelings. And. What I try to argue in this book of mine is that those feelings manifest themselves in our lives in all different kinds of ways, and we have all different kinds of responses to them. So when we try to distract ourselves from our troubles by, you know, addictive shopping or web browsing or whatever it is, this is a little attempt to escape from the self. When we get deeper and deeper into various kinds of drugs that are useful for medicating away the feeling of being yourself. This is similar to the kind of impulse that informs the suicide, and someone who makes a suicide attempt. I think attempting suicide is just a particularly extreme form of those same kinds of addictive behaviors we find in so many different ways we have of trying to escape ourselves. There's this wonderful conversation that takes place between Martin Luther King Jr and Tich Nhat Hanh during the Vietnam War, and Martin Luther King Jr is confused by these monks who are burning themselves alive in protest of the Vietnam War. And he says to Tich Nhat Hanh, he says, "you know, from our Christian perspective, they shouldn't be doing this because suicide is a sin." And Tich Nhat Hanh writes back to him and he says, "No, you are confused about what they are doing. Suicide is defined as the attempt to exterminate oneself. That's the goal, is to eliminate oneself. These monks do not suppose that by burning themselves alive, they are exterminating themselves or extinguishing themselves. They know that their minds will continue after they die. They even know, although they might be working on the goal of eventually eliminating the self, they even know that their selves will persist after they die. What they are doing is taking their own lives in this way, to try to get the world's attention to the horrors of war that are going on in Vietnam, to the genocide of a people that's taking place in Vietnam, but they are not seeking self extermination."
Clancy Martin: [00:32:28] And one of the reasons I love this exchange is that Nhat Hanh is so clear on what is actually motivating the vast majority of suicides, which is just this, you know, for me, the aroma of Clancy, the smell of Clancy, the stink of Clancy would just become unbearable. And it had been unbearable for 18 years. Totally unbearable until I discovered alcohol. And then when I started to drink, I was like, my God, at last, bill w when he discusses it, he says, lo, the miracle, two beers and finally the weight of Clancy. All this Clancy, Clancy, Clancy removed from my shoulders, you know, and and 17 beers and then Clancy's gone altogether, you know, he's just completely extinguished. And that worked for a while. Although, you know, my suicidal thinking was still very much there. It was a medicine in its way. But then ultimately, of course, it wound up making it much worse, as any addictive pattern will over time. If a person is already predisposed toward suicidal thinking, other addictions are only going to wind up eventually exacerbating that suicidal thinking. But I do want anyone who feels this way just to notice. The problem is that you're trying to escape from yourself. And as Wittgenstein wrote when he wrote, you know, Wittgenstein was suicidal all of his life. The great Austrian philosopher, probably the greatest philosopher of the 20th century, who lost several of his siblings to suicide and was suicidal all his life. He said, look, suicide doesn't end despair. It makes despair eternal. And what he really means is that there's a deep confusion in the notion that suicide is going to eliminate yourself. It's rather it's some kind of bizarre, ultimate confirmation of yourself as it is. And that's exactly the opposite of what you want. There are ways to be less oppressed by your sense of yourself, but suicide is not one of them.
Tyler Johnson: [00:34:40] So, in line with what you've just been discussing, I want to read a passage from the essay, which I understand to have been the sort of the precursor to your book. 'I'm Still Here', and then I want to take you through some thinking that we discussed a year or so ago with one of our other guests, which I'll explain and then get to what I think is if I had to choose only one question that we could get to ask you, I think this question that I'm building to here in a second would be that one. So let me first start. This is from your essay. You write... So you're writing about your sort of in a in or being transferred into a psychiatric hospital after attempting to take your own life. And you write, "This is how I thought at that time. Everything was one second to the next. I truly couldn't conceive of tomorrow. Things were just happening and they were either good or bad, and I wanted to get away from the bad things and find the good things. Or if there were no good things to find, kill myself to get away altogether. It was basically the opposite of what William Blake and Soren Kierkegaard might have been talking about when they wrote about the bliss of immediacy in mystical experience. I had an immediacy of despair, I suppose, or I just couldn't bear to think more than a few minutes ahead because I knew what was coming."
Tyler Johnson: [00:35:54] So you have been talking about the how there is a sort of a thread of thought or feeling or both, that unites the suicidal mindset with the addictive mindset. Right? And a year or so ago we had this discussion where we talked with Anna Lemke, who is one of the psychiatry or physician world experts on addiction. So she explained to us that one of the difficulties of modern life and actually, in her mind, one of the drivers of the uptick in depression and anxiety and whatever over the last 10 or 15 years is the ubiquity of addictive substances, which she considers very broadly right, everything from social media to TikTok to calorie dense foods to online pornography to, yes, alcohol and heroin and cocaine and whatever. All of it is addictive. And, you know, all you need is a smartphone. And addictive stimulants considered broadly are available to you all the time, all day, every day, wherever you go. Part of what she talked about in that podcast is how, because addictive stimulants are available ubiquitously, much of what she ends up doing in her practice in her private psychiatry practice, including with people who seem to be young and successful high fliers, right. Stanford students or whatever. Much of what she ends up doing with these people who are desperately depressed is first to help them, to wean themselves off of all of their addictive stimulants, whether that's, you know, their social media presence or their, you know, junk food or their pornography or whatever it is. And then because as you were sort of explaining a moment ago, right at the end of the day, all of those things, yes, they are stimulants, but they're empty, right? They don't really fill the hole that they purport to fill. They feel like they do for a time. But then you need more of them and more of them, and then eventually things come crashing down.
Tyler Johnson: [00:37:52] So then she talked about that process of weaning yourself off of addiction. And then we said, well, okay, but let's say you're working with a person and they have done that. They've successfully weaned themselves off of all of those things. And then they say to you, okay, but now what? Right. We've taken away all of the fillers, but now we're left with this, this sort of empty space. And what goes in there. Right. And I have never forgotten that in that discussion she said, well, that's when you have to enter into what she called the great quiet push past the suffering that is inherent in human experience to find the deeper meaning on the other side.
Tyler Johnson: [00:38:33] And so when I hear the entire arc of your story, and again, I want to be very careful, I do not mean to suggest that you just sort of woke up one morning and chose to put on your happy pants, and now you're in a better place, right? Like, clearly that goes against everything that we've been discussing. But nonetheless, you give this arc of just in the last whatever months, few years you have arrived at a place where finally you are not constantly, every day obsessed with thoughts of how you might take your own life. And so this, in light of a history of many serious addictions from what you describe, and also, of course, all of the suicidal thoughts and attempts. So I guess my question to you is the same as the one that we posed to Anna Lemke, as you try to escape from addictive loops and from the sort of gravitational pull of thoughts of your own destruction, what do you. More meaningfully, more substantively, fill your life with like, what does the light on the other side of the darkness look like?
Clancy Martin: [00:39:41] Yeah. Well, first, I want to applaud you and Anna Lemke for bringing this to all of our attention because I couldn't agree with it more. It totally accords with my own experience. And, you know, frankly, much to the irritation of my publisher, I should say I have no social media presence. Because for this very reason that I know this about myself. I mean, I tried Instagram and I tried Facebook. I could feel them poisoning me, you know, I could feel them having a bad effect on my mental well-being. So I was like, okay, I've got to get off. I can't do this. And so I just don't, you know, I can't. It's not because I think there's something necessarily something wrong with them, although maybe I'm willing to have that conversation too. But for me, they just are bad news. You know? I can't do them. I have been in the process of progressively weaning myself for quite a number of years now, from a whole host of my addictions.
Clancy Martin: [00:40:44] But, you know, addiction is insidious. It can creep up in all kinds of different places. So you have you do have to be watchful. But that said, what is on the other side, you know, what I found is that really what is on the other side of that great quiet and I love that expression is other people. That's what's on the other side of that great quiet is other people. You know, Rebecca has this wonderful line when he says to love is when two solitudes meet and greet and respect each other. It's not that solitude isn't a crucial, important of that great quiet it is. And discovering and coming to peace with your own solitude is a crucial part of this, I think.
Clancy Martin: [00:41:30] But even more than that is this kind of meeting and greeting and respecting. You will find once you start being a little, just a little tiny bit liberated from the your addictive patterns of thinking that suddenly you are able to hear other people better than you were able to hear them before. You're able to connect with them better than you were able to connect with them before, and you are able to care for them better than you were able to care for them before. And suddenly then you realize that you have been being cared for much more than than you knew, you know, and that you had been being loved and needed much more than you knew. And suddenly you will feel as realize as Derek Parfit, another great philosopher of the 20th century, realized when he thought about death and realized that he would never actually die and death disappeared for him. He realized this because he realized the only way in which he actually existed at all was in his connections with other people. And he said when he realized that that his connections with other people were his personality, that's just what it was to be Derek Parfit. He said this tunnel that was leading towards death suddenly opened up this vast expanse, and he realized that in some sense, there just is no death, because those relationships he had with other human beings never disappear. You know, he's always going to be in the ongoing minds of those relationships, which were what constituted him in the first place. Similarly, on the other side of that great quiet, there's just all these other human beings to talk to, to listen to, to care about and to be cared for by that you didn't really fully see, understand or appreciate before because you were too trapped in your addictions, you know, and I always say about myself.
Clancy Martin: [00:43:24] I don't want to extend this to anyone else, but I always want to say about me that the opposite of self-loathing is self-aggrandizement. And as much as I was every time in which I was increasingly like elaborating all of these fantasies about Clancy Martin, that at the same time, all of the self-loathing, all of the shame, all of my aggression against Clancy Martin was, was amplifying at the same time. But once I could let go of both the self-aggrandizement and the self loathing and start to think, you know, that Clancy Martin guy, he doesn't really matter so much as I thought he did. I don't have to be so focused on myself, which means I don't have to be so focused on distracting myself from myself, which is all that I'm doing with my addictions is trying to distract myself from myself. But if I would just make the simpler shift, which is not be so very worried about myself at all, then suddenly, oh, this great burden falls off of your shoulders and you realize, oh, everybody's all just in it together. And we're all struggling together. And you know, we can smile at each other. We can talk to each other. We can care. About each other. There really wasn't anything to be afraid of in the first place, you know? That's what's on the other side of that great quiet for me.
Henry Bair: [00:44:42] That was so powerful. I thank you for articulating that in such a thoughtful, personal, thought provoking way. You have been sharing a lot about your perspectives for in a larger and more metaphysical spiritual sense, like what is on the other side of that great quiet. Your book, How Not to Kill Yourself has a very, very prescriptive title. It's one of the Bluntest titles. It gets right to the point. And in fact, the end of your book, the concluding paragraphs and the appendix of the book offers extremely concrete advice for people who are going through the worst of it right now, what they can do. I think in your preface, you actually say, if you're struggling right now, go to the end of the book, because I have tools that can help. So I think that that would be something I would love to explore more. For those who are currently struggling with suicidal thoughts, who come to you and say, you know, in your book you talk about students who've done this exact thing, they come to you and say, I'm really, really struggling with this right now. What are some immediate things you can offer them to help make it through the worst of it?
Clancy Martin: [00:45:46] Sure. Thank you for asking. Well, the first thing I want to say is that if you can and maybe you can't, but if you can reach out to anyone, do. And I'm not saying you have to call nine, eight, eight or I'm not saying you have to text your mom or, you know, text your lover or something like that. You know, the last time I was having a really rough time, which was a few years ago, I was having a really rough time, and I texted my roofer because he seemed like he seemed like kind of a cool, sympathetic person. And I just texted him and I said, "man, I'm having a lousy day. How's your day going?" And he said, "oh, it's funny that you're right. I'm kind of having a lousy day, too." And we texted back and forth a little bit and it really helped. It doesn't matter who you reach out to, reach out to anybody. And if that person doesn't text back, reach out to somebody else. That's number one.
Clancy Martin: [00:46:39] Number two, the physical your environment in right now is bad news for you. So you got to get out of that physical environment and just please get up, take a little walk, get out of your space or, you know, however you need to get out of your space. If you need to wheel out of your space, wheel out of your space, get out of that physical space that you're in right now. Get your body moving a little bit if you possibly can. Most of the time it is going to help if you do those two simple things. Similarly, if someone reaches out to you, you're thinking, okay, I think this person might be in crisis. You know, get them walking. If you can get them out of that physical space. The physical space is dangerous for them right now. Get them talking and keep them talking, and don't try to solve their problems.
Clancy Martin: [00:47:24] There's a book I'm reading to my five year old recently, and there's a little girl in the book and she's making this puzzle. The puzzle falls apart and she's very upset, and a lion comes to visit her and he says, I know what we can do with this problem. We can attack the problem. And he roars. Problem doesn't go away. And then a bear comes and he says, we can scare the problem. And he growls, problem doesn't go away. And Beaver comes and he says, we can fix the problem, and the problem doesn't go away. And a mouse comes and says, we can run away from the problem, and the problem doesn't go away. And then a rabbit comes and it just sits with the little girl and. The problem starts to lessen. And then the rabbit says, you want to talk about the problem, and the problem starts to lessen some more. And then they get to talking, and then the problem dissipates. And if someone reaches out to you, that's the mindset you need to go into it with. Don't try to fix their problems. Don't try to tell them they're not having a problem. Don't try to scare the problem away. Just be a rabbit. Just be with them. Stay with them. Comfort them until they can get talking, you know?
Clancy Martin: [00:48:28] And the Micmac tribe of indigenous Canadians, this is back from the 17th century when they were feeling suicidal. The tribe would partner them up with someone and they'd say, okay, you two are going to go into the forest, and now all you're going to do is the person who's feeling suicidal is going to sing sad songs, and you're going to stay in the forest singing sad songs together until you're ready to come back out of the forest again. And that's what you need to do. And if you need to sing some sad songs, good.
Clancy Martin: [00:48:58] Now, from Edwin Shneidman three basic recommendations. You've got to ease the pressure. You've got to lessen the pain, and you've got to open the blinders. You know how to do these things. Ease the pressure. In short, do anything that might help a little bit with the pressure you're experiencing right now.
Clancy Martin: [00:49:17] My friend, the great Suicidologist John Draper, one of the guys behind 988, says that what feels like a boulder is actually a big pile of rocks. Sometimes taking one rock off, like sending one email that you didn't want to send, actually will ease the pressure a little bit. If that eases the pressure a little bit, do it. If, like me going on a walk eases the pressure, do it whatever it is. Listen, you're thinking of taking your own life, so whatever you have to do, it's cool, you know, because it's better than the alternative, which is taking your own life. Then if you are going out for a walk, here's something that can be really helpful. Smile at somebody who wasn't expecting a smile. And when you do that, suddenly you'll see that you've done a little good thing for that person. They suddenly got this unexpected smile, and they don't know why. They don't know if they if it's because you think they're cool looking, or if you're just a friendly person or whatever it is, but suddenly you've lifted their day a little bit. A little bit of good is suddenly in the world because of you that wasn't there before. And if you can recognize that, then you recognize that you are good. You can contribute goodness to the world. You're supposed to be here. You can help. So that will help a lot.
Clancy Martin: [00:50:32] You should have a list of things that lessen the pain for you. So like my friend Desiree Stage, a wonderful Suicidologist, has a great website called LiveThroughthis.org that I recommend to everyone. For Desiree, it was going and getting a Starbucks Frappuccino when she was right on the edge. She'd go get a Frappuccino and that frappuccino would save her life. She also has a list of movies that'll save her life. I think one of them is Love Actually, which also would be on my list of Movies That Could Save Your Life. For me, it was a 99 cent McDonald's ice cream cone. If I went, and sometimes I'd go through that drive the drive through line to get a 99 cent ice cream cone three times and they'd laugh at me. They're like, wait a second, that's your third cone. How many of these are you planning on eating? And I'd be like, if I need to get seven of them, I'll keep coming. The reason? My record, but anyway.
Clancy Martin: [00:51:24] Yeah, anything. Anything at all that eases the pain. And then if you lessen the pressure and you ease the pain a little bit, the blinders will start to open up a bit by themselves. And you realize you do have other options. And one of those other options that I can't recommend strongly enough. Recommended by the Stoics, recommended by the great Romanian philosopher Cioran is wait until tomorrow. You could still do it tomorrow. You know tomorrow will still be there. If you really, really want to do it, you can do it tomorrow. Just wait one day. And if you just wait one day, you will see you've got a free day on the planet. And now you can do whatever you damn well please. You just gave yourself a day. You know it's a vacation day for you. Because otherwise, Clancy, you are going to be dead. So do whatever you damn well please. It's whatever you do. It's going to be better than what you were thinking of doing. And just like in the old maxim, I'll take a drink tomorrow. If you can get in the habit of saying, I'll wait until tomorrow, I'll wait until tomorrow. I can always do it tomorrow. Then you might start to stack up some days and you realize, huh? I don't have to do this. You know, this isn't as necessary as I thought it was. There are other alternatives. So that's just like a real quick rundown of some things that I know have worked for me and have worked with people that I have tried to help. And, you know, every day I'm in communication with people. And these are techniques I recommend to people every day, and they do work.
Henry Bair: [00:52:57] Well with that. We want to thank you so much for your time, for your stories. This is a deeply important conversation. This is a deeply important book. Thank you so much for your valuable advice. It is, and it will be so valuable to anyone who comes across the book or this conversation. So from the bottom of our hearts, we want to thank you again for being so open about this very difficult and all important topic. Thank you so much.
Clancy Martin: [00:53:21] Thank you guys so much. You know, as you know, there's this thing called the Papageno effect, which is that whenever you have in the media a rich conversation about suicide. Suicide rates go down. All of us, just from having had this conversation, are less likely to suffer from suicidal ideation and less likely to die by suicide. Everyone we care about. Just as a consequence of this conversation, their rates just went down. This is statistically proven, and anyone who listens to this podcast, their likelihood of dying by suicide or making an attempt also has gone down. So the work you're doing is invaluable and I can't thank you enough.
Tyler Johnson: [00:54:00] Thank you so much, Clancy. We really, really appreciate your your time and the hard won truths and experience that you bring. We really, really appreciate it.
Henry Bair: [00:54:13] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program notes and transcripts of all episodes at www.theDoctorsArt.com. If you enjoyed the episode, please subscribe, rate and review our show available for free on Spotify, Apple Podcasts or wherever you get your podcasts.
Tyler Johnson: [00:54:32] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments.
Henry Bair: [00:54:46] I'm Henry Bair
Tyler Johnson: [00:54:47] and I'm Tyler Johnson. We hope you can join us next time. Until then, be well.