Cry of Pain: Understanding Suicide and Self-Harm
J. Mark G. Williams


My aim in writing "Cry of Pain" was to bring together the most recent research and scholarship on the subject of suicide and attempted suicide. It was written for those health professionals and volunteers who help people who are suicidal and despairing. As such, the book would, I hoped, be helpful to students in the health and social sciences and to those undergoing training as doctors, nurses and related professions. But I also wanted to write a book that might be found helpful to those who have been suicidal or been bereaved by suicide, and who want now to deepen their understanding of suicide. For there is much about suicide that presents a real and often tragic puzzle to be solved by family and friends, by physicians and other professionals involved with someone who has committed or attempted suicide. Why did they do it? Why did they not see that there was help available? At the larger level, will a biological, sociological or psychological explanation provide the best clue to suicidal behaviour? The book examines evidence from all of these fields to gain a better understanding of what drives people to take such drastic action. A central idea of the book is that suicide and attempted suicide are most often a cry of pain, like the cry of an animal caught in a trap. The suicidal person is rendered helpless by things that are happening around them and by their own mental anguish. Struggling to get free only seems to make matters worse. The book deliberately moves away from seeing suicidal behaviour as a cry for help, since such an explanation is so often used nowadays to dismiss such behaviour as unimportant. The book starts by placing suicide in its historical context, including suicide in antiquity, contrasting Greek and Roman stoic ideals of the freedom to kill oneself, with religious tradition of self-murder as sin. It then moves on to examine differences between countries and within countries over time, looking at the facts and figures to see how men and women of different nationalities, ethnic groupings, ages and social classes differ in suicide risk. (These statistics may seem dry and distant for those recently bereaved by suicide, and you should feel free to ignore them). It considers 'rational suicide', euthanasia and martyrdom, and how serious self-harm can occur either because there are too many reasons for dying, or because there are too few reasons for living. It looks at some of the factors that may reduce the barriers for suicide, how television and newspapers can cause an increase in such behaviour by showing or reporting suicide stories which vulnerable people then imitate. It examines how biological, social and psychological theories try to explain these phenomena. The 'Cry of Pain' idea draws things together, showing how suicidal behaviour results from feelings of being trapped. Such a feeling triggers further negative and self-destructive thinking that then lowers mood in a vicious downward spiral. Recent research shows that a person's memory plays a pivotal role in this vicious spiral. This is due to the huge influence that memory has on all aspects of personality. It is from memory that we get our sense of self, a sense of being the same person through time. Our memory provides us with all the information we ever have about ourselves, other people and how they see us. When biases and deficits occur in memory, the whole world can become distorted, affecting a person's mood, the ability to solve problems and to make plans for the future. This research has clear implications for how best to help those who are feeling hopeless and suicidal, and these are spelled out in the final part of the book.

Suicide is the most individual of acts, and as I wrote the book I realised how difficult it is to try and draw conclusions that are general across a number of situations. Many readers whose professional or personal lives have been touched by suicide or suicidal behaviour will, at many points, be able to think of exceptions to much of what is in the book. Yet if we are to understand and help people in the future, there will need to be a dialogue between the general rule and the individual circumstance. This book is offered as a contribution to that dialogue.

Chapter Titles:
1. Historical Perspective
2. Suicide: the Statistics
3. Psychiatric and Social Factors in Suicide
4. Attempted Suicide: the Statistics
5. The Causes of Attempted Suicide
6. Rational suicide, Euthanasia and Martyrdom
7. Psychodynamics, Biology and Genetics
8. The Effect of the Media
9. The Cry of Pain
10. Memory Traps
11. The Primary Prevention of Suicidal Behaviour
12. Secondary Prevention: Therapy for Suicidal Feelings and Behaviour
13. Final Thoughts

The Author, J. Mark G. Williams

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