By Kate LaForge.
In her brilliant book exploring suicidality among Inuit youth, Lisa Stevenson  writes:
It became evident to me that presuming the value of life, staging it as the ultimate good, could be as dangerous as negating it. If listening to the pain in the lives of suicidal youth is only a means to the end of keeping Inuit youth alive, one ceases to hear much of anything. Listening—when life is radically in question—meant taking very seriously uncertainty about life and death. (p. 10)
Stevenson calls on us to listen by setting aside the presumed inherent value of staying alive. I take up this call by exploring what it would mean to take “uncertainty about life and death” seriously in the context of suicide prevention hotlines.
Suicide prevention hotlines are an accessible form of help for those who want it. In 2020, the U.S. Suicide Prevention Lifeline received 2.3 million calls  and the Crisis Text Line (currently available in the U.S., Canada, U.K., and Ireland) received 1.4 million texts . Many other local, national, and global suicide prevention hotlines exist. Suicide prevention hotlines are anonymous, typically staffed by volunteers, and provide brief crisis interventions that are free of charge.
As a counselor on the Crisis Text Line, where I have volunteered for the past 18 months, I often engage in conversations about suicide where uncertainty around life and death arise. “Texters,” as we call them, are typically facing material, relational, and personal hardship, and often struggle to identify reasons for staying alive. Counselors like me are trained to move the conversation forward using the Five Stages Philosophy, which includes the following stages: 1) Build rapport, 2) Explore, 3) Identify the goal, 4) Discover the next steps, and 5) End the conversation. The Five Stage Philosophy was developed, tested, and refined within the Crisis Text Line organization using user data and counselor expertise. While moving texters through the Counselors are taught to withhold personal opinions, even in the face of explicit requests for an answer to the often-asked question, “Why should I stay alive?” This question, which typically arises during the “Explore” phase, is tremendously important to the texter because they are grappling with uncertainty around life and death. From the crisis intervention training, my next moves are clear – I would explore this question by mirroring (“That’s an important question, but I can’t answer that for you, what do you think?”), then move towards supporting the texter to identify a goal (“What would you like to get out of our conversation?”)
In practice, the approach taken by Crisis Text Line outlined above is often at odds to Stevenson’s approach. Moving the conversation towards goals, and steps to reach goals, does not take seriously uncertainty around life and death. And yet, it is clear to counselors that their primary objective is to merely move the texter forward through conversational stages instead of engaging in meaningful conversation with a texter.
Would it be possible, or even desirable, for volunteer counselors to take seriously uncertainty about life and death? And if so, what would this look like? All crisis text conversations are unique as are each texter. Incorporating an approach which acknowledges uncertainty around life and death would mean the freedom to engage with a texter about the value of life or death, rather than linearly moving the conversation forward through prescribed steps. It would involve a radical form of listening which abstains from infusing the conversation with the assumption that remaining alive has inherent value.
Some texters, of course, would not be interested in this. Some would. Either way, the point is that a willingness to take this uncertainty seriously, if present, means letting the texter decide what ideological space the conversation occupies. This approach would mean going beyond a simple written acknowledgment that uncertainty around life and death is legitimate to spending time within the ambiguous space this question creates. This time may be strange – it may require the volunteer to remain existentially adrift, circling alongside the texter with enormous, unanswerable questions. It would mean occupying the question the texter is desperately trying to answer, even if the volunteer cannot provide an answer.
Would this style of conversation be neglectful? Or would it be honest? It depends on what we, as suicide prevention volunteers, are trying to do. Are we trying to help? To keep the texter alive? Or all of the above? And importantly, are volunteer counselors even qualified to explore these questions with texters?
I don’t claim to have answers to these questions. Each suicide prevention hotline, volunteer, and texter is unique and the confluence of these actors presents an endless number of situations, needs, and conversations. It is worth mentioning that suicide prevention hotlines, like Crisis Text Line, provide an invaluable resource for hundreds of thousands of people. As a volunteer worker on the Crisis Text Line, I am constantly humbled by the gratitude shown by texters for the Crisis Text Line and the volunteers who staff it. These hotlines absolutely have an impact that should not be understated. However, I am willing to argue that as suicide prevention hotlines continue to proliferate, we must think carefully about the assumptions we bring to these conversations and the values embodied within our assumptions.
Stevenson (2014) helpfully concludes:
Only when I was able to hold life as a value in abeyance could the outlines of a more indistinct, darker perhaps, and more uncertain way of thinking and caring come to the surface (p. 10).
In acknowledging and remaining within ambiguity, we may open ourselves up to a richer and more honest form of care. In neglecting these questions, in favor of ideologically directed actionable steps, we may cease to hear anything at all.
- Stevenson, L. (2014). Life beside itself. University of California Press.
- Suicide Prevention Lifeline. (2021). By the Numbers. Retrieved from: https://suicidepreventionlifeline.org/by-the-numbers/
- Crisis Text Line. (2021). Everybody Hurts: The State of Mental Health in America. Retrieved from: https://www.crisistextline.org/everybody-hurts/
Kate LaForge (@kate_laforge) is a PhD student in Medical Sociology at the University of California, San Francisco, United States. Learn more about her work at https://kate-laforge.squarespace.com/. Email: Kate.email@example.com.