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In light of the recent tragic death of Robin Williams (and of course many others who have also died by suicide who are not famous enough to make headlines), I decided to post a portion of the chapter on suicide that will be published in my next book, On Edge: Mental Illness in the Christian Context, that will be available in September. The following is an excerpt from the book:

“As a mental health professional committed to serving the church, I have sat with many Christians who struggle with concepts of “joy” and “peace.” A desire to escape or find some sense of relief overwhelms rational thought — the pain is too great to bear. Unfortunately, the church has typically been a place where those with thoughts of suicide feel out of place and misunderstood. How can you be a Christian and at the same time want to put an end to your life?

In order to understand suicidal thinking, we must first differentiate between self-harm and suicide. Self-harm involves acts such as cutting or burning oneself. While these actions are risky and should not be taken lightly, they are typically done without the intent to die. I have heard many people describe the relief they feel when they cut their skin — the shock of visually seeing the blood as well as the body’s physical responses to the wound provoke a chemical change within the body that can act as a temporary release from anxiety or depression. Control is also a key factor in self-harm, as those who have been abused and harmed by others gain a sense of power over their own pain by causing it themselves. Often, however, this risky method of finding relief actually causes the person to be out of control, and the result is often nerve damage or other significant injury. Some who have no intent to die end up accidentally killing themselves.

Others struggling with depression, anxiety, Bipolar Disorder, schizophrenia, and other severe mental illnesses do face symptoms of suicidal thinking in which a desire to end one’s own life is prominent and recurrent. It is important to note that suicidal thinking is a symptom of various mental illnesses. Because of our misguided belief that people “should” be able to control their emotions, it is often hard to think of an emotion or thought pattern as a physical symptom of an illness. Without proper treatment, a mental illness can be fatal. The untreated symptoms of the illness take over one’s mind and can lead to death by suicide.

Christians often struggle with the idea that an action such as suicide could be a symptom of an illness rather than a conscious choice. If a person dies from cancer or complications of a physical disorder, they most likely did not want to die. Thus fatality of mental illness seems to some to be an excuse for bad Christian behavior. It is difficult for anyone, Christian or not, to find the line between choosing to end your own life and having your ability to choose compromised by a mental illness.

Understanding identity is critical in wrestling with the concept of choice in suicide. Ideas about personality as well as capacity are central in defining one’s identity. In my work with people who suffer from severe and persistent mental illness, I have personally seen untreated symptoms cause a person to act and think in ways that are not only abnormal compared to the rest of society but are also abnormal for the person himself. When stabilized with medications and counseling, someone who has suffered a psychotic break or deep, intense depression often cannot believe they came so close to death by suicide. In these cases, how are we to understand where the conscious, choosing person ends and the out-of-control symptoms begin?

Spiritual language plays a role as well, especially for Christians struggling with a mental illness. Ideas such as  “…to die is gain” or “this world is not our home…” are often taken out of context and embedded in minds that are already searching for every possible negative pathway that could give them a way out of living. Again, this tendency towards turning everything meant to be positive into a negative thought is a clear, observable symptom of the fact that something is going wrong in the brain.

While there are these severe cases in which some slip so far into a mentally ill state that they lose their ability to choose, there are many struggling with less severe symptoms who do maintain a capacity to decide for or against suicide. This road is a painful and treacherous one, in which the suffering Christian must battle daily to choose life. If we as Christians are to continually surrender our lives to God, this means we cannot take our own lives back. The very act of staying alive is a visible sign of surrender, and it is an admirable act for those who struggle with wishing for death.

Proper treatment is essential for Christians who are engaging in self-harm or have suicidal thoughts. Anyone who has a specific suicide plan should immediately call 9-1-1 or go to the nearest emergency room. Others who do not have a plan or present intention to harm themselves need ongoing treatment to decrease these symptoms. For these severe symptoms, medication is almost certainly needed in addition to counseling. A psychiatrist can help fine-tune medications that can target your symptoms, and a professional Christian counselor can work with you to uncover possible root issues contributing to your desire to die.

Perhaps the most tragic aspect of suicide is that those who die by their own hands do not truly want to die. I have seen many people suffering from severe symptoms and who have had numerous hospitalizations become well again through treatment and recovery maintenance. When in this state, with a desire for suicide removed, they are able to say, “I don’t really want to kill myself, even though life is hard and I sometimes wish I could escape.” Certainly we must recognize the hand of Satan in this and all types of illness, as his kingdom of destruction wreaks havoc on our world. Death is his ultimate “victory,” and as Christians we must recognize that the enemy we fight is not ourselves, but the one who seeks to devour. Suicide is his invention, and every step we take to prevent this tragedy is an attack on his designs.”