I have heard about and read about the movie The Bridge for years, but until recently I had not watched it entirely myself. Since I teach frequently about suicide and have actually made reference to the movie, I thought I should see it and review it for a blog entry. I believe it certainly has relevance to military mental health given the rise in military suicides and relevance to mental health in general since suicide is one of the most frightening client outcomes that we encounter or worry about as mental health professionals.
Some sources state that the Golden Gate Bridge in San Francisco is the most common site for suicide in the world. At the very least, it is a common place for people to attempt suicide—so common that there have been signs posted up on the bridge to discourage people from jumping, offering them a phone number for a suicide hotline, and warning them that the outcome of jumping is almost always death. Signs such as this exist elsewhere too, as a public health suicide prevention effort.
The director of The Bridge, Eric Steele, placed cameras near the Golden Gate Bridge in 2004 to film and capture actual suicidal behaviors--people contemplating, attempting, and completing suicide from that location. Then, he interviewed family, friends, and witnesses (and one jumper who survived) to try to offer some explanation as to “why” these people were determined to end their lives. Hearing their stories was difficult at times because of the tragic outcome of most of them, but it also provided a real-life backdrop to material that we frequently only think about in a theoretical sense. Therefore, I think that a helpful way to discuss the movie is to do so within the context of concepts outlined in the suicide literature: risk factors, warning signs, protective factors, and theories of suicide.
Although the movie did not attempt to educate the viewer on “what risk factors are,” close attention to the interviews revealed risk factors and warning signs that we as mental health professionals assess routinely in our clients. In hearing about the individuals’ lives in The Bridge, I learned of these aspects of their situations that made them more likely to attempt to kill themselves. Just to clarify, risk factors and warning signs are similar in that their presence raises the likelihood of future suicidal behavior. They differ in that risk factors are more distal and static in nature. Risk factors also may or may not be modifiable. There are hundreds of risk factors in the literature, but two examples of risk factors are: being male (generally a static risk factor) and poor coping skills (modifiable).
On the other hand, warning signs are more fluid and subject to respond to situational factors. In addition, warning signs suggest that suicidal behavior is more imminent. Examples of warning signs are: making statements that suggest the desire for death and engaging in preparatory behavior (e.g., practicing noose-tying). In hearing from the family and friends of the suicide completers in The Bridge, the viewer learns real life stories of these risk factors and warning signs. Gene’s friends describe him as depressed (risk factor) throughout much of his life. He had a history of talking about suicide, to the point that some of his friends “blew it off” when he did so in the final weeks of his life (warning sign). He also had experienced losses (risk factor) in the year prior when his mother died of cancer and when a romantic relationship ended. He and his mother had been especially close (protective factor) throughout his life and he had promised her that he would not kill himself while she was alive. David’s friends described him as a person who seemed to have a “joy for life” but in the months prior to dying by suicide, he emailed about twenty-four friends to say he was considering suicide (warning sign). Ruby’s sister had killed herself (risk factor), and Ruby also had a history of depression (risk factor). Ruby had told a friend a couple of months before his suicide that he could not get over the losses he had experienced (risk factor), was more depressed than ever (risk factor), and was only sleeping two or so hours per night (risk factor). He also wanted medication to address his symptoms, but did not have insurance, so felt he that he did not have access to mental health care (risk factor). One of Ruby’s friends had a conversation with him a few weeks prior to his suicide, and he divulged various plans he had been considering (warning sign).
While it is easy to identify these risk factors and warning signs in retrospect, it is important to note that they are not always readily apparent to family and friends in real time, although sometimes they are. Ruby’s friend, in particular, had significant regrets and guilt about not acting on some of the warning signs Ruby had displayed. In a heartbreaking part of the interview, she said, “Never again will I not intrude. I could have done something.”
Lisa, one of the few females featured in the documentary, was “normal” according to her family until the age of fourteen when her father died. Over the next several years, she became more withdrawn, depressed, and bizarre and was eventually diagnosed with paranoid schizophrenia (all risk factors). She was in and out of mental health treatment (protective and risk factor) and ultimately resided in a group home in the local community. She struggled financially and was in poor health (risk factors) according to her mother. The night of her death, she left her mother’s home abruptly after dinner and went to the bridge. She was seen by a family who observed that she was laughing in her last moments before she jumped. This incongruent affect likely was indicative of symptoms of paranoid schizophrenia, one of the diagnoses most at risk for suicide.
A fascinating part of The Bridge was hearing from Kevin, a young man who actually survived a jump from the Golden Gate Bridge, and his father. Kevin said that he had had suicidal thoughts for years (risk factor), and his father said that he began to have severe mood swings in high school—later he was diagnosed with bipolar disorder, another diagnosis with relatively greater suicide risk. He also had symptoms of paranoia (risk factor), had begun writing suicide notes (warning sign) and having sleep problems (risk factor) before his attempt. The most amazing aspect of Kevin’s recollection of his suicide attempt was the memory that he had when his “hands left the rail” of the bridge. He said that he “hurdled over” instead of climbing so he would not have a chance to change his mind, but when he began falling toward the water, he realized that he was probably going to die and then immediately thought of a way to try and survive the fall. He said that if he landed feet first he might make it, so he moved his body in space and indeed landed on his feet. Although he plummeted about forty feet into the water and experienced significant physical injuries, he was able to swim back up to the surface. This immediate regret of jumping reflects ambivalence about dying that many suicidal individuals express, yet some are not aware of in the midst of severe depression. A witness to a nameless young woman who was sitting on the edge of the bridge said this: “She must have wanted to live a little or else she would’ve jumped right away.” This story ended with the witness forcibly pulling the young woman back from the edge and calling 911. As the police officers took her away, presumably to a psychiatric hospital, she looked back and met the witness’ eyes. He continues to wonder if she felt gratitude toward him or anger since he had interrupted her attempt.
In the individuals above, it is noteworthy that protective factors could be identified for each. Gene had several close friends, some of whom he had known for years. All of the individuals had families that expressed love and concern for them, although the suicide completers may have not have perceived this to be the case. Most of them had been in mental health care as well, which certainly can be protective. However, hearing the family and friends recollect about these individuals’ certainly suggested that the risk factors outweighed any protective factors. As Lisa’s mother said in an attempt to explain her daughter’s suicide, “I think it was a relief. She knew she had the mental illness, probably knew she wouldn’t be physically well again. There were just too many things.”
In addition to watching this film and automatically hearing risk factors, warning signs, and protective factors in the individuals’ stories, I found myself understanding their suicide attempts through the lens of Joiner’s Interpersonal Theory of Suicide. Recall that Joiner proposes that three conditions must be present for someone to attempt suicide: thwarted belongingness (real or perceived), a sense of burdensomeness (real or perceived), and the ability to make an attempt. The first two reflect the desire for death, and when combined with the ability to make an attempt (through a loss of fear of death or acquired increased tolerance for pain), the likelihood of suicide is great according to Joiner. In thinking about thwarted belongingness, it seemed that most of the individuals in the film had the support of important people in their lives. Gene’s friends described their social group as a circle of “tight friends” who had known each other for years. On the other hand, they also said that he was always looking for love and took romantic losses hard. While it appears that he did not experience thwarted belongingness, his story reminds us that perceived levels of belongingness may be more important than actual levels of support. Burdensomeness was not a theme I detected in the stories in this documentary. Recall that Joiner proposes that when an individual perceives their death to be more helpful than their life to those around him/her, that individual is experiencing the perception of burdensomeness. Lots of examples of this can be called to mind such as a person with physical disabilities feeling like they “weigh the family” down with caretaking and extra expenses. Sometimes people may feel that through dying, they help alleviate financial problems if there is a life insurance benefit to be gained. It is hard to know if any of the people in The Bridge felt like a burden but this is an important piece of Joiner’s theory that I have heard reflected many times in my career among people experiencing suicidal ideation.
Acquired ability to attempt suicide was certainly reflected in The Bridge. Lisa’s sister said it best when she said that a person has to “have a lot of guts to do that” because when [you] look over that rail [at the bridge], it’s really scary. Indeed, most people get a nervous feeling and instinctively stand back or hold on when in that situation, but those who climb over and jump have had to overcome that fear. That’s what Joiner’s concept of acquired ability is about. Those who attempt suicide, no matter what the means, have acquired the ability to enact a possibly painful and fatal behavior toward themselves. Many of the individuals in the The Bridge had attempted suicide before, and certainly this contributes to acquired ability in that previous attempts can be conceptualized as “practice.” This is why previous preparatory behavior is such a significant warning sign.
In summary, watching The Bridge was not easy and it certainly is not a “feel good” movie. However, it is a rare account of factors associated with the suicides of real people as told by surviving family, friends, and witnesses, (and by one attempter himself). I certainly appreciate and respect the individuals who shared the personal details of such a tragic life circumstance. While the movie was probably not made with mental health professionals as the intended audience, I appreciated being able to watch it. I experienced it like an extended case study with rich and real details to which I could apply some of the suicide-relevant knowledge from our field.
The Bridge. Directed by Eric Steele
Regina Shillinglaw, P.hD., is a Deployment Behavioral Health Psychologist with the Center for Deployment Psychology at Wright-Patterson Medical Center in Ohio. Dr. Shillinglaw is the chief of Mental Health Outreach there.