Dying to understand: How a collection of suicide notes is helping one psychologist unravel the mysteries behind suicide

 

“I see notes as a golden road to understanding suicide,” says Dr. Antoon Leenaars. He has a collection of more than 2,000 notes that he uses for his research.

Nick Brancaccio/Canwest News Service

“I see notes as a golden road to understanding suicide,” says Dr. Antoon Leenaars. He has a collection of more than 2,000 notes that he uses for his research.

Kathryn Blaze Carlson in Windsor,  National Post

Some are handwritten and erratic, some are typed and line-edited for grammar, and some are as banal as “Please return my library books.”

This collection of suicide notes, and there are more there than 2,000 originals and photocopies, are kept under lock in an undisclosed location somewhere in Windsor.

The precise whereabouts of the archive – the world’s largest collection of its kind – is known only to its custodian, a psychologist who has spent the past four decades studying the notes as if they were scientific clues to the suicidal mind.

“I see notes as a golden road to understanding suicide, a looking glass that reveals the worst kind of pain – the meta pain, an unbelievable pain, the pain of pain,” said Dr. Antoon Leenaars. “Suicide notes allow us to peer into the soul.”

Although Dr. Leenaars has safe-guarded and digitalized most of the collection, he has agreed to lug a six-inch thick pile of photocopied notes to his seventh-floor office on Ouellet Street, careful to avoid the day’s heavy rain.

His modest office overlooks a parking lot, and is lined with crammed bookshelves and framed prints by Vincent Van Gogh, the painter who famously died by suicide, and who, as it happens, was born near Dr. Leenaar’s hometown of Ulvenhout in the Netherlands.

On the floor near the bookshelf, in a bright blue tote, sits the stacked sample of notes. Dr. Leenaars, dressed in a navy suit and a turquoise Van Gogh tie, is seated in one of two pillowy sofa-chairs where his patients come to divulge their deepest thoughts.

Although much insight can be gleaned from these conversations, Dr. Leenaars said those who attempt are different from those who die by suicide – males, for example, kill themselves four times more often than females, but females attempt far more often than males.

And so, he said, the long-standing challenge in understanding suicide is the obvious one: The individual is no longer alive to explain their decision.

For Dr. Leenaars, the notes left behind are the next best avenue to predicting and preventing suicide, which he termed a “multidimensional malaise.”

In a fated combination of gutsy academic pursuit and personal intrigue, Dr. Leenaars was first introduced to the collection in the early 1970s by the man who would quickly become his mentor, the late Dr. Edwin Shneidman, who co-wrote the 1957 book Clues to Suicide and who is today regarded as the father of suicidology.

Some 70 years ago, Dr. Shneidman was investigating the suicides of two American soldiers and had visited the Los Angeles coroner’s office to obtain the relevant files. In one, he found a suicide note. In the other, he found no such document.

He mentioned this curious fact to the office secretary, who then proceeded to offer Dr. Shneidman her photocopied collection of 800 notes which she kept in a desk drawer out of what may have been somewhat of a natural compulsion, Dr. Leenaars explained.

“We’re all intrigued by life and death,” he said, adding that notes – some as brief as three poignant words or as verbose as 23 pages typed; some laden with coffee stains or evidence of tears – have since been collected from coroners offices and grieving families who want to assist his suicidology research. “Of course we want to know: Why did the person do it?”

That is precisely what Dr. Leenaars and his “academic father” sought to understand and, given that suicide is one of the leading causes of death among Canadian men and women from adolescence to middle age, any progress in that regard could prove life-saving.

“Suicide is not like copper or water, where all copper conducts electricity or all water freezes at zero degrees Celsius,” cautioned Dr. Leenaars, who, along with his psychologist daughter, recently returned from the American Association of Suicidology annual conference in, of all places, Walt Disney World.

Teenagers, Dr. Leenaars has learned, are not only less likely to leave notes in the first place – only eight in the sample of roughly 1,000 notes in the blue tote were written by teenagers – their minds are also more constricted. They tend to think in absolutes, often penning words such as “no one,” “everyone,” “only,” “always” and “never,” said Dr. Leenaars, a Brock University alumnus.

While suicide notes gathered from Canada and the United States are comparable, the epidemiology in these two countries is strikingly incomparable, especially when it comes to teenagers.

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“Canadians kill themselves more often than Americans, in fact teenaged males here kill themselves 50% more than their American counterparts,” said Dr. Leenaars, author of 13 books and dozens of articles on suicide.

Dr. Leenaars’ analysis also found that the elderly are far more decisive and clear-minded, at least in their writings. In fact, it was a note by an elderly woman that has resonated with Dr. Leenaars more than any other.

In search of the note, he carried the blue tote to an adjacent office and slipped the meticulously stacked pile onto his otherwise cluttered desk. Despite the chaotic array of file folders, papers, coffee mugs, stalled clocks, empty juice bottles and pictures of his three daughters, Dr. Leenaars was notably apprehensive to scatter the notes, instead collecting and then re-collecting the corners to straighten the edges.

He licked his index finger and parsed through the notes, stopping at the one written by the elderly woman: No. 58.

“Della, Im heartsick,” Dr. Leenaars read aloud, his Dutch accent slight but noticeable. “First grnma then Otto – then my home – my car – my eyesight – now my apartment. The last few days my sight is getting worse…. Alice & George: so long to two good friends. Mary.”

No. 58 was scored using the same methodology as the rest of the sample – not sentence-by-sentence, but rather concept-by-concept, Dr. Leenaars said.

There are a total of 35 concepts outlined in Dr. Leenaars’ Thematic Guide for Suicide Prediction which, since the late 1980s, has been used by upwards of 20 trained “judges” – psychologists and psychiatrists – who are working as researchers to advance the field of suicidology.

Among the numbered concepts in the Thematic Guide are No. 11, “S’s aggression has been turned inwards;” No. 7, “S reports a history of trauma;” and No. 6, “S is in a state of heightened disturbance (perturbation) and feels boxed in.”

Dr. Leenaars, who inherited and then expanded the global collection, tore a piece of lined paper and, with one finger tracing the list of concepts and the other bracing a black pen that struck monstrous commas, he scored Mary’s note: 2, 3, 4, 5, 6, 7, 9, 13, 14, 15, 20, 21, 33.

Concept #15 – “S exhibits a serious disorder in adjustment” – is particularly encompassing, and is among the concepts Dr. Leenaars used to score the suicide notes of Nirvana singer Kurt Cobain and Adolf Hitler.

The 15th concept has seven subsections denoting a different mental disorder, including schizophrenia, anxiety disorder, borderline personality disorder, depression and manic-depression. The latter, Dr. Leenaars said, can reveal itself quite obviously in a note.

“Those with bipolar disorder actually tend to kill themselves when they’re in a state of mania,” he said. “Their notes are like a flowing stream of consciousness, their speech moves faster and faster and faster.”

Although mental illness is a prevalent factor in suicide, Dr. Leenaars said it is a “suicide myth” that all people who kill themselves are depressed.

“The cognitive constriction is the lethal aspect,” said Dr. Leenaars, the first past-president of the Canadian Association for Suicide Prevention, and the only non-American to have served as president of the American Association of Suicidology. “It’s about the inability to cope with the unbearable pain.”

In fact, after a scientific “cluster” analysis based on the 35 concepts, Dr. Leenaars discovered that this “unbearable pain” is among the eight common traits that exist across suicide notes – no matter the gender, era or method used.

The other seven commonalities, in layman’s terms, are tunnel vision, ambiguities about life and death, psychological disorder, a weakened ego, a disturbance in a relationship or some other ideal like one’s health, rejection-aggression and a desire to escape.

“The study of the notes revealed that suicide has a complex history, ” said Dr. Leenaars, whose first experience with suicide came in Grade 11 when one of his classmates took his own life. “Oftentimes it’s a Romeo and Juliet issue where a person feels anguish over the loss of a loved one. A suicide can also be a murder in 180-degrees, a sort of ‘F— you.’ To write, ‘P.S.: Happy Father’s Day,’ or ‘Happy Birthday’ is certainly an act of aggression.”

Love, he went on, is among the most commonly used words.

His enumeration process might appear the work of a madman to all but him and his closest colleagues – of which there are only a handful in Canada – but his more recent work with suicide notes has revealed some important cross-cultural differences.

Dr. Leenaars and his co-researchers distinguish between “collective” and “individualistic” cultures, and have discovered that in collective countries, such as Turkey, there is more indirectness, hiding and lying in the suicide notes.

“In this culture, you are not allowed to be suicidal because it is an affront to Islam,” Dr. Leenaars said. “There are even greater taboos in collective cultures, so when we look at notes from these countries, there is much more ambivalence and secrecy.”

Analyses of notes from coroner’s offices in Russia or Lithuania reveal a tendency to direct anger at other people or the state, said Dr. Leenaars, who has collaborated with 150 colleagues in more than 35 countries.

Although his work has connected him with leading suicidologists around the world, his work in Canada can be quite lonely. Dr. Leenaars lamented that many Canadian stars in suicidology have left for countries such as the United States and Australia, or for other research fields altogether.

He said his research has never been funded by anyone in Canada, and pointed out that only 100 of the more than 2,000 notes come from Canadian coroner’s offices and families. Notes from the United States, meantime, account for upwards of half the collection.

“It’s a stigma even to study suicide,” Dr. Leenaars said. “It’s a sad statement, but it’s true. Suicidology in Canada is itself dying.”

National Post

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