________________________________________________________________ VOLUME 2, ISSUE 6 THE INTERPSYCH NEWSLETTER JULY, 1995 ________________________________________________________________ SECTION D: RESEARCH *SPECIAL ARTICLE* VIRTUAL SUICIDE: A FIVE PAGE HISTORY By Fred Cutter, Ph.D. email@example.com Virtual suicide refers to transmissions on the internet that describe suicidal ideation; descriptions of the wish to die, methods of self injury, accounts of past suicidal attempts, and future plans for lethal degrees of self injury. To date, no one has been reported to have committed suicide while connected to the internet. There exists within the various support newsgroups a body of communications reflecting a meta level of discussion about suicide. These are transmissions by mental health profession- als, volunteers, and victims (survivors of prior attempts, planners, family members and significant others). In both groups there are large, but unknown numbers of lurkers. These are people who read the transmissions, but make no com- ments. We know they exist, since some of them come forward eventually and self identify. We also know from our personal "lurking". Organizations are not represented, except for a regular posting by Samaritans. Hemlock has been discussed in an IRC conference held in Jan 1995 (see below). The Interna- tional Association for Suicide Prevention (IASP), The American Association for Suicidology (AAS), and similar organizations in other parts of the world have not posted to any aspect of the internet as far as this writer knows. The source of my observa- tions are USENET support groups, various discussion lists, e- mail. TELNET, and FTP have not been used. GOPHER has identified publications, print media both public and professional with suicide as a subject. ARCHIE has not identified computer programs dealing with suicide, although this writer has reported 10 such program activities in 1989 at an AAS meeting in San Diego, CA. In 1990, this list was expanded to 12 at a paper presentation for the Deutsche Gesellschaft Fur Suizidpraeven- tion. Subsequently this list was expanded to 14. A table of relevant information for all programs is available from the author at the above e-mail address. Actual suicidal deaths have not occurred because of obvious physical limitations. Events, such as homicide or suicide on TV talk shows, have not been reported. While common sense would argue that this is just not feasible, there is no limit to the human imagination, especially when desperate. Within the above boundaries, this article will summarize events observed on the internet that focused on transmissions dealing with suicidal behavior, as defined in my opening paragraph. The most well known, and most accessed newsnet group dealing with virtual suicide is ALT.SUICIDE.HOLIDAY or ASH. This was appar- ently started by Michael Marsden. He dropped out, for lack of internet access. Leadership was assumed by Calle Dybedahl (firstname.lastname@example.org) from Sweden. These facts are described in the Monthly Suicide Methods post, which she continues with var- ious additions. The content is a repeat listing of methods to achieve a suicidal death, with new additions. The content on ASH can perhaps be characterized as the pornogra- phy of suicide, meaning that all the socially unacceptable atti- tudes about suicide (in civilized countries with internet access) are expressed here. The feelings are sincere. The intentions and the ability to act are more occult. The carthartic effects for the posters is positive, at least for the immediate effort. Some bonding is apparent between posters, and some concern when long intervals occur without posting. This is followed by apolo- gies when the absent poster returns. This seems to represent some kind of group cohesion, if not plain affection. Others stop posting and are not heard from again. Whether this be a passing phase in their lives or due to death is not known. The groups right to exist, post, and take whatever positions they do are not in question by anyone. Their effect on other casual viewers is offensive, and to potential victims often traumatic. I was first drawn to virtual suicide by a fax from a lady with a history of suicide attempts who had viewed ASH, and subsequently gone on to make another attempt. A few months later she contact- ed me with data suggesting that I, others, or AAS should take a proactive stance, and at least post on the suicide prevention side. Since that time, and largely with the help of Graham Stoney, and others mentioned in this article some things have happened which can be reported here. The first of these I noticed was the FAQ on suicide written by Stoney (Greyham@research,canon,oz.au) for Australians. He has been a volunteer on a hotline, and was familiar with the myths of suicide material originally published by Shneidman and Farberow. This material has been debated at AAS meetings, and some items have been rejected or modified. Sad to say there is some contro- versy here among some suicidologists. The basic disagreement is that mental illness is or is not a factor in the causation of suicidal behavior. The data says yes. The others trying to minimize the stigma of "crazy" have said no. Its a case of mixed intentions: objective truth, or help for the victim. I leave the choice to the reader. Stoney went on to host and start the suicide-Prevention (@re- search.canon.oz.au) discussion list, and again along with others this went on to the companion list of suicide-support (@research,canon,oz.au). The reason for the two is obvious, yet we came to it through slow, careful exchanges about what should be on the list. The initial groups were largely helpers. Those people seeking some kind of aid were few, far between, and not typical of those who called ASH. Both discussion lists occur, with volunteers from the prevention list monitoring calls for assistance on the help list. The activity is a shadow of what is found on the various support groups. However it does continue. Steve Harris (email@example.com) has been a vigorous participant on both lists. He is an active Samaritan designat- ed by them to coordinate e-mail activities on the internet. He is offering his assistance to the discussion lists with calls for providing more support, and especially respecting confi- dentiality. Samaritans have been posting announcements of avail- ability for befriending since mid 1994. The caller is invited to post a request to Jo@samaritan.com with volunteers taking turns responding to the calls. Samaritans have at least a 30 year history of successful support to callers with distress. They have also tried offering letter support in the far reaches of Scotland going back 20 years that I can recall. The internet effort is within the last year, and they use the same service approach within the limits of the electronic media. Their current e mail address is Samaritans@cix.compulink.co.uk. The reader can obtain more infor- mation at either address (Jo or Samaritans). Steve Harris has also prepared a list of support groups, by topic, which has impressed me as a useful and a relevant way of accessing the newsgroup that might be called in place of, or in addition to ASH. Grohol (@alpha.acast.nova.edu) has published a proactive piece on professional interventions in suicide prevention. He refers to the task of accepting the duty of providing help to any one who requests this, doing so on the internet, and essentially abandon- ing the usual face to face professional commitments. He is opposed by Robert D Canning (firstname.lastname@example.org) who argues for the traditional, cautious approach with careful attention to confi- dentiality, accountability, and the client's commitment to the task. This controversy, has not yielded any agreed approach that resolves the conflict. Some limitations to the debate reflecting the internet are 1) all activities are verbal, 2) the affect is not observable unless reported and then not always what it is labeled 3) the continuity seems less present than face to face 4) the commitment is tenuous, no money changes hands. These unsolved issues soften hard edges of the contro- versy. An additional dimension to the good Samaritan approach, is that it like charity, has more demand when witnessed live. A physi- cian who observes a news event depicting suicide in progress, does not have to do anything about it, even if it occurs in the same city. In contrast, a person attempting to kill him or her self in the same room requires intervention of some sort. Fail- ure to act can be a basis for the loss of ones health profession license. Does a discussion or newsnet group on the internet constitute physical presence? It is different enough where the traditional principle of intervention may simply be inappropri- ate. This brings us back to the issue of virtual suicide and its difference from actual suicide. In clinical practice, competent professionals often overreact to the threat of suicide, rather than attending to the psychodynam- ics of unconscious motivation, or the adjustment in psychotropic medications. Suicidal ideation is often influenced by secondary gain, and ambivalence about life. Why should its manifestation on the internet be any different than in behavioral health care practice? I am suggesting suicide on the internet has the same complications, as in clinical practice. Within the limits speci- fied in this article, efforts to "help" may not always be appro- priate or effective, due to misunderstandings of the "call for help". The Hemlock Society's presence on the internet was noted through an IRC forum Scheduled for Jan 5 1995 0300 GMT. This was taken from ALT.IRC. Included was a WEB page, a gopher address and an e-mail address. The mission statement of Hemlock is: "terminally ill people should have the right to self- determination for all end-of-life decisions... dying people must be able to retain their dignity, integrity and self- respect. We encourage, through a program of education and re- search, public acceptance of voluntary physician aid-in-dying for the terminally ill. The Hemlock Society USA does not encourage suicide -- for emo- tional, traumatic, or financial reasons -- in the absence of terminal illness. We support the work of those involved in suicide prevention programs. ...the final decision to terminate life is ultimately the individual's. This action, and most of all its timing, is an extremely personal decision, taken in concert with family, close friends, and an individual's personal physician when possible. " In the context of terminal illness, the clinical condition where death is near, I would argue for personal and professional neu- trality; neither rush the death nor delay it. I assume the patient can be kept comfortable while waiting. Back to virtual suicide, irrational or affectively motivated self injury behavior is a proper focus for prevention efforts whether by mental health professional or volunteers. Discussions of suicide as a solution for terminal illness belongs on talk.euthanasia; unless the underlying motivations are more irrational. The American Association of Suicidology, computer committee is exploring ways to develop, a web page and cooperate with other support groups in fostering a suicide prevention presence on the internet. The committee is developing an e mail directory of AAS members. Contact the author at the address above for more infor- mation. Graham Stoney is also formulating a WEB page for suicide preven- tion that embodies, the topics below in a draft shared with the writer. The opening statement is reproduced: "Welcome to the Suicide Prevention World Wide Web page, a collec- tion of Internet crisis resources. If you are aware of any other Internet resources that could be included here, or have any other comments or criticisms, please feel free to let me know via E- mail to: email@example.com" Items to click on are: -General Information about suicide and suicide prevention (FAQ) -A list of Internet and National suicide-prevention and crisis resources for various countries: -A layman's article about Suicide Prevention on the Internet: Suicide Prevention on the Information Superhighway -The suicide-survivors mailing list an electronic support group for people who have had a close friend or family member die by suicide. -The suicide-prevention mailing list for discussions relating to suicide prevention. The following other relevant resources are also available on the Internet at the indicated addresses. alt.support/Psychology_&_Support_Groups_Newsgroup_Pointer") "ftp://rtfm.mit.edu/pub/usenet/alt.support/ Psychology and Support Mailing Lists available via E-mail. John M. Grohol's http://www1.mhv.net/~grohol)Mental Health Page "ftp://ftp.hawaii.edu/outgoing/lady/chronix")chronix(/A) contains the files chronix.1 through chronix.12, comprising a set of notes on suicide prevention written by firstname.lastname@example.org.Hawaii.Edu" Lee Lady (at the end of a three-year period as a telephone volun- teer) for the Honolulu Suicide & Crisis Center. ---------------------------------------------------------------- Stoney's web page proposal looks good to me, however any one accessing it will always be looking for something else which is not addressed. This reflects the complexity of suicide and the variety of professions responding. I would recommend as many options as we can identify. In addition to Stoney's suggestions I would add, 1. Chat options for fellow victims 2. Organizations with directories of health professionals 3. Support groups 4. Published suicide rates by demographics 5. Self help computer programs, especially those oriented to suicide (I count 12). 6. Helpers, professionals and volunteers postings. 7. other (the list administrator or designee could respond selec- tively to any request. Summary This review of virtual suicide, activities on the internet, addresses the wish to die, the acts of self injury, past and future suicide attempts, methods, but not episodes that end in death, while connected. The article surveys activities the author has observed, tries to describe them, and makes additions where appropriate. Internet addresses are provided for further informaton.