Rethinking Suicide

Why Prevention Fails, and How We Can Do Better

By: Craig J. Bryan

Narrated by: Mark Torres

An examination of how suicide prevention efforts largely fail due to the mistaken assumption that greater mental health awareness is the key to saving lives.

Rethinking Suicide is a critical examination of what we think we know about suicide, with particular focus on the assumed role of mental illness. Craig J. Bryan, a leading expert on suicide prevention, argues that most prevention efforts have failed because they disproportionately emphasize mental health-focused solutions such as access to treatment and crisis services. Instead of classifying suicide as a mental health issue, careful analysis of research findings suggest it should instead be seen as a highly complex problem with many risk factors—from personal decision-making styles, to the availability of lethal means, to financial uncertainty. As such suicide rates will not be curtailed by conventional solution-oriented thinking; rather, we need process-based thinking that may, in some cases, defy or contradict many of our long-held assumptions about suicide. Rethinking Suicide interweaves the author's firsthand experiences with explanations of scientific findings to reveal the limitations of widely-used practices and to introduce new perspectives that may trigger a paradigm shift in how we understand and prevent suicide.

©2022 Oxford University Press (P)2022 Tantor

Solid book slightly undermined by a smug narrator

Craig Bryan takes an admirably pragmatic, empirical approach to suicide prevention, debunking some myths about suicide causes and providing a light overview of the scientific data on the subject. It was especially fascinating to hear about the statistical errors and confirmation bias which hamper conventional suicide prevention efforts.

That said, as an intermittently suicidal person myself, there's something cold and dehumanising about being boiled down to a statistic, with the whole rationale behind helping me (and people like me) essentially amounting to "make death numbers go down". Nothing is said about the philosophy of suicide, or the more specific reasons one may hold overwhelmingly negative views about themselves or the world. Every motivation for suicide is flattened into a "risk factor"; the whole issue is treated like a mathematical probability problem.

The final chapter, "Creating Lives Worth Living", rings especially hollow. While Bryan makes a passing attempt to address the social causes of suicide (mentioning air pollution, minimum wages, lack of affordable health insurance, lack of support from friends and family, etc.), which I certainly appreciate, most of his focus is on local, individual contexts. Perhaps it's beyond the scope of his research, but no mention is made of young people's rising anxiety about wider political problems, such as climate change, plastic waste and economic exploitation of third world countries. A lot of the suicide prevention methods endorsed in this final chapter (keeping reminders of reasons for living, focusing on positive experiences, etc.) feel very akin to the typical platitudes and mantras of conventional self-help and psychotherapy, which I thought the book was criticising. Yes, we may learn mechanisms to cope with the stress of life, but is it worth living in a world where we produce tonnes and tonnes of plastic waste everyday, while children in the Congo are forced to mine coltan for our smartphones? The anxiety caused by these pervasive, international issues cannot be fixed by raising the minimum wage or giving people access to parks.

Even so, the book is solid; I don't consider the above omission to be a serious problem, as it doesn't undermine Bryan's thesis and arguments about the inadequacies of conventional suicide prevention. What actually ruined the book for me (specifically the audiobook) was the narrator, Mark Torres! The way he constantly pauses to emphasize individual words and his rising intonation makes it feel as if he treats every single statement like the most surprising, revelatory thing in the world. He always sounds like he's on the cusp of saying "wow, isn't that interesting?" or "who would have thought it?". This kind of prosody might be appropriate for truly unexpected or unusual conclusions, but this is how he delivers EVERY point, even very simple and obvious ones.

The result is this condescending tone, as if the narrator expects me to be in perpetual awe at the insightfulness of each statement. To be fair, Bryan's heavy reliance on visual metaphors and analogies, even when it's arguably unnecessary (I don't need an illustrative example to grasp that practical medical experience beats textbook education, it's a very simple concept), somewhat contributes to this feeling of being talked down to, like a child. Not fun. It was still possible to appreciate the quality of the writing, but it was a struggle.

Overall, good book, well worth reading, but I didn't like the narration.

Find Some Hope

Dr Bryan did a fantastic job of shifting the narrative to find hope in a positive and holistic way. I hope more of the suicide prevention community adopts this approach as we advance care.

Love the objectivity in writing style

I am a researcher and work in healthcare so I could understand the mathematical and statistical references in this book, but probably over the head for mainstream populations. However, the analogies and examples given are relatable and understandable to a majority of anyone reading the book. Since it’s on audible, I wasn’t given access to the tables and visual references given and would advice to include as part of the purchase in the future if teaching and education towards health professionals is the goal. My husband is a therapist and both of us would have benefitted substantially from a pdf copy to reference and utilize for the diagrams.