Indefinite Postponement: A Case Study of Adolescent Suicidality

A young woman is insistent upon committing suicide despite the repeated attempts of others to thwart her. She is just 15 years old. Why does she want to die? Such is the story of Indefinite Postponement: A Case Study of Adolescent Suicidality. The slim volume, although ostensibly authored by psychiatrist John P. Williams, is in fact a creative collaboration between psychiatrist and patient and as such is unique in the field of not just psychiatry but nonfiction in general. Williams has conceived of the book as an instructional text for mental health care providers hoping to gain insight into those who consider suicide, as well as a book that may appeal to the general public. Divided into five sections and preceded by a forward by Judith Butler, it begins with an introduction to the demographics of suicide and then moves swiftly into a description of 15-year-old “Grace,” renamed for anonymity, who chronicled her struggle with suicidality in a diary. Grace eventually shared with Williams the journal she had been keeping during her treatment with prior providers, and he obtained permission from her to publish it. In between excerpts from the diary, Williams highlights various comments made by Grace and remarks on their potentially instructive quality for practitioners. In the penultimate section, Grace reflects on her diary during recovery; the final section provides a few “take-home lessons.”

In some ways, despite its overt instructional mission, the most captivating aspects of this book are the diary excerpts themselves and their inscrutability. Even when the significance of certain passages is explicated by Williams, much of the diary remains enigmatic. Despite Williams’s desire to draw concrete secular lessons from Grace’s words, considering her text independently as a reader feels more like performing an exegesis. Reading her words is bearing witness to a mind and body in anguish. Like Quentin besieged with suicidal feelings in Faulkner’s The Sound and the Fury, Grace’s syntax breaks apart, and her punctuation runs wild as her illness takes over. The reader observes what might at first be mistaken as a psychotic disintegration of language but is in fact a reflection of the fracturing of a mind in depressive torment. Her diary passages suggest there is no clear answer to either the cause of her depression or to her recovery. Even Williams points out that “only luck prevented her death” (p. 6), and luck is certainly not something that can be easily harnessed productively by those hoping to help others through suicidality.

Despite the journal’s opacity, Williams is certainly correct in finding within it much that was hidden and of edifying significance both to Grace and to readers. One of the most important “lessons” is the succor of human connection. Grace is painfully alone and self-aware and often comments on how she appears to others: it looks as if she is manufacturing her malcontent because in many ways she is extraordinarily put together. Her external and internal realities do not match. Grace’s inability to truly connect with others and have them see her for who she is isolates her further and sets her psyche at war with itself. Williams shows readers how she unfortunately does not seek refuge in her parents—like many children, she thinks more of wanting to protect them from her thoughts than of their helping her. Fortuitously, one friend stands out as a person to whom Grace reached out and was received, and thus was of vital consequence to her survival. The significance of Williams as a psychiatrist is implied throughout the book but never stated directly by Grace herself. The format of the book—alternating between Williams and Grace—is, however, a wonderful metaphor for the crucial nature of dyadic relationships and the collaborative nature of therapy and treatment. The book also highlights the possible therapeutic value of writing; Grace cites it as being of paramount importance to her process of recovery, and the book by Williams is written in the hope of postponing the suicides of others.

The title is also an important “lesson.” “Indefinite postponement” is taken from something Grace wrote regarding getting into college: “Still, I will not be bored there, and that will save me from my mind. It will make indefinite postponement possible” (p. 60). The thing being postponed, of course, is suicide. The euphemistic words underscore Grace’s ongoing and possibly lifelong struggle with depression and allow her to exert control over her intense emotions. Suicide to Grace is almost a legal contract; it remains an option for permanent escape from psychological pain and thus cannot be resolved but can only be postponed—fortunately, this can be done for eternity. Trying to convince Grace not to be suicidal, Williams points out, only drove her closer to it.

The most challenging facet of Williams’s book concerns the origin of Grace’s suicidality. Early on, Williams makes reference to multiple providers, including himself, who missed crucial clues that pointed to its root. The decision to use excerpts from her diary similarly constructs the question of her suicidality as a puzzle to be solved. The answer turns out to be early childhood sexual molestation barely remembered. The treatment thus becomes prolonged exposure therapy, applied by Williams with good effect. Although the riddle of Grace’s depression is solved, one wonders whether for others with chronic suicidality if such an answer can ever be found and whether the molestation episode was truly the fertile ground from which all of Grace’s problems grew, as her text often eludes efforts to pin her down. Overall, however, Williams’s Indefinite Postponement is a quick read that should be perused slowly as there is much to be learned from the words of those who struggle with a desire to end their lives.