Mindfulness and the Transformation of

Despair Working with People at Risk of

Suicide 1st Edition J. Mark G. Williams
Et Al.
Visit to download the full and correct content document:
https://textbookfull.com/product/mindfulness-and-the-transformation-of-despair-workin
g-with-people-at-risk-of-suicide-1st-edition-j-mark-g-williams-et-al/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...

Mindfulness Diverse Perspectives on its Meaning Origins

and Applications J. Mark G. Williams

https://textbookfull.com/product/mindfulness-diverse-
perspectives-on-its-meaning-origins-and-applications-j-mark-g-
williams/

Mindfulness Diverse Perspectives on its Meaning Origins

and Applications 1 Reprint Edition J. Mark G. Williams

https://textbookfull.com/product/mindfulness-diverse-
perspectives-on-its-meaning-origins-and-applications-1-reprint-
edition-j-mark-g-williams/

Williams Manual of Hematology 9th Edition Marshall A.

Lichtman Et Al.

https://textbookfull.com/product/williams-manual-of-
hematology-9th-edition-marshall-a-lichtman-et-al/

We the People Benjamin Ginsberg Et Al.

https://textbookfull.com/product/we-the-people-benjamin-ginsberg-
et-al/
A Practical Guide to Mindfulness Based Compassionate
Living Living with Heart 1st Edition Mark Williams

https://textbookfull.com/product/a-practical-guide-to-
mindfulness-based-compassionate-living-living-with-heart-1st-
edition-mark-williams/

Williams Obstetrics 25th Edition F. Gary Cunningham Et

Al.

https://textbookfull.com/product/williams-obstetrics-25th-
edition-f-gary-cunningham-et-al/

Gabbe’s Obstetrics Essentials: Normal & Problem

Pregnancies Mark B Landon Et Al.

https://textbookfull.com/product/gabbes-obstetrics-essentials-
normal-problem-pregnancies-mark-b-landon-et-al/

Financing from Masses: Crowdfunding in China 1st

Edition Jiazhuo G. Wang Et Al. (Eds.)

https://textbookfull.com/product/financing-from-masses-
crowdfunding-in-china-1st-edition-jiazhuo-g-wang-et-al-eds/

Harrison's Principles of Internal Medicine, Twentieth

Edition (Vol.1 & Vol.2) J. Larry Jameson Et Al.

https://textbookfull.com/product/harrisons-principles-of-
internal-medicine-twentieth-edition-vol-1-vol-2-j-larry-jameson-
et-al/
 ebook
THE GUILFORD PRESS
 Mindfulness and
the Transformation of Despair
 Also Available

For Professionals

Mindfulness-­Based Cognitive Therapy for Depression,

Second Edition
Zindel Segal, Mark Williams,
and John Teasdale

For General Readers

The Mindful Way through Depression:

Freeing Yourself from Chronic Unhappiness
Mark Williams, John Teasdale, Zindel Segal,
and Jon Kabat-Zinn

The Mindful Way Workbook:

An 8-Week Program to Free Yourself
from Depression and Emotional Distress
John Teasdale, Mark Williams,
and Zindel Segal
 Mindfulness
and the
Transformation
of Despair
Working with people at risk
of suicide

Mark Williams
Melanie Fennell
Thorsten Barnhofer
Rebecca Crane
Sarah Silverton
with Accompanying Audio by
Zindel Segal, Mark Williams, and John Teasdale

THE GUILFORD PRESS

New York London
© 2015 The Guilford Press
A Division of Guilford Publications, Inc.
370 Seventh Avenue, Suite 1200, New York, NY 10001
www.guilford.com

All rights reserved

No part of this book may be reproduced, translated, stored in a retrieval

system, or transmitted, in any form or by any means, electronic,
mechanical, photocopying, microfilming, recording, or otherwise, without
written permission from the publisher.

See p. 334 for terms of use for audio files.

Printed in the United States of America

This book is printed on acid-free paper.

Last digit is print number: 9 8 7 6 5 4 3 2 1

The authors have checked with sources believed to be reliable in their

efforts to provide information that is complete and generally in accord
with the standards of practice that are accepted at the time of publication.
However, in view of the possibility of human error or changes in
behavioral, mental health, or medical sciences, neither the authors, nor
the editor and publisher, nor any other party who has been involved in
the preparation or publication of this work warrants that the information
contained herein is in every respect accurate or complete, and they are not
responsible for any errors or omissions or the results obtained from the use
of such information. Readers are encouraged to confirm the information
contained in this book with other sources.

Library of Congress Cataloging-­in-­Publication Data

Williams, J. Mark G.
Mindfulness and the transformation of despair : working with people at
risk of suicide / J. Mark G. Williams [and four others].
  pages cm
Includes bibliographical references and index.
ISBN 978-1-4625-2182-1 (hardback : acid-free paper)
1. Suicidal behavior—Treatment. 2. Mindfulness-based cognitive
therapy. 3. Psychotherapist and patient.
RC569.W55 2015
616.85′84450651—dc23
2015015978
 About the Authors

Mark Williams, DPhil, is Emeritus Professor of Clinical Psychology at the

University of Oxford, where he was Wellcome Principal Research Fellow
from 2003 to 2012. He collaborated with John T ­ easdale and Zindel Segal
in developing mindfulness-­based cognitive therapy (MBCT) to prevent
relapse and recurrence in major depression; together, they coauthored
Mindfulness-­Based Cognitive Therapy for Depression (now in its second edi-
tion), The Mindful Way Workbook, and (with Jon Kabat-Zinn) The Mindful
Way through Depression. Dr. Williams is a Fellow of the Academy of Medi-
cal Sciences and the British Academy. Now retired, he continues to train
mindfulness teachers around the world.

Melanie Fennell, PhD, is a Founding Fellow of the Oxford Cognitive

Therapy Centre, where she is now an Associate Trainer. She is also an
Associate Trainer at the Oxford Mindfulness Centre. As a research clini-
cian in the University of Oxford Department of Psychiatry, she contrib-
uted to the development of evidence-­based treatments for depression and
anxiety disorders, including MBCT. She developed and led the Oxford
Diploma in Cognitive Therapy, the Oxford Diploma/MSc in Advanced
Cognitive Therapy Studies, and (with Mark Williams) the Oxford Master
of Studies Program in Mindfulness-­Based Cognitive Therapy. Dr. Fennell
is an Honorary Fellow of the British Association of Behavioural and Cog-
nitive Psychotherapies (BABCP) and was voted “Most Influential Female
UK Cognitive Therapist” by the BABCP’s membership in 2002.

v
vi About the Authors

Thorsten Barnhofer, PhD, is a Heisenberg Fellow at Charité, the joint

medical faculty of the Free University of Berlin and Humboldt University,
where he investigates the neural mechanisms of mindfulness training in
the treatment and prevention of depression. Previously, he worked in Pro-
fessor Williams’s group at the Oxford Department of Psychiatry, where he
was involved in research on MBCT for suicidal and chronic depression. A
cognitive-­behavioral therapist and yoga teacher, Dr. Barnhofer regularly
teaches MBCT training workshops and retreats for mental health profes-
sionals.

Rebecca Crane, PhD, MA, DipCot, is Director of the Centre for Mind-
fulness Research and Practice at Bangor University in Wales. She previ-
ously worked in the mental health field as an occupational therapist and
an integrative counselor. Dr. Crane teaches and trains internationally in
both MBCT and mindfulness-­based stress reduction (MBSR), and is a cer-
tified MBSR teacher with the Center for Mindfulness in Medicine, Health
Care, and Society at the University of Massachusetts Medical School.

Sarah Silverton, DipCot, MEd, teaches at the Centre for Mindfulness

Research and Practice at Bangor University, Wales. She has extensive
experience as an occupational therapist, counselor, and mindfulness
teacher and trainer. She is the author of The Mindfulness Breakthrough.

Zindel Segal, PhD, is Distinguished Professor of Psychology in Mood Dis-

orders at the University of Toronto–­Scarborough. His research focuses
on vulnerability to and prevention of mood disorders, and he has pub-
lished more than 10 books and 150 scientific publications. Dr. Segal is a
founding Fellow of the Academy of Cognitive Therapy and advocates for
the relevance of mindfulness-­based clinical care in psychiatry and mental
health.

John Teasdale, PhD, held a Special Scientific Appointment with the

United Kingdom Medical Research Council’s Cognition and Brain Sci-
ences Unit in Cambridge. Dr. Teasdale is a founding Fellow of the Acad-
emy of Cognitive Therapy and a Fellow of the British Academy and the
Academy of Medical Sciences. He also is a recipient of the Distinguished
Scientist Award from Division 12 (Society of Clinical Psychology) of the
American Psychological Association. Since retiring, Dr. Teasdale has
taught insight meditation internationally.
 Acknowledgments

There are numerous people who contributed to the making of this

book.
We are deeply grateful for the long collaboration and friendship
with John Teasdale and Zindel Segal, whose work on the psychological
theory underlying mindfulness practice has provided a much-­needed
bridge between ancient wisdom and modern science, an understand-
ing that led to mindfulness-­based cognitive therapy (MBCT), which
remains the foundation for the work we report in this book.
We are continually grateful for the seminal work undertaken by
Jon Kabat-Zinn in originating mindfulness-­ based stress reduction
(MBSR), and for the teaching team at the Center for Mindfulness in
Medicine, Health Care, and Society at the University of Massachu-
setts Medical School, who have graciously and generously supported
the development of MBCT—particular appreciation goes to Ferris
Urbanowski, Pamela Erdmann, Melissa Blacker, Saki Santorelli, Elana
Rosenbaum, and Florence Meleo-Meyer.
Our colleagues Catherine Crane and Keith Hawton have been
particularly crucial anchors throughout the research reported in the
book. We thank others in the research team—Kate Brennan, ­Caroline
Creasey, Danielle Duggan, Catrin Eames, Mariel Jones, Kate Muse, Ann
Hackmann, Adele Krusche, Sholto Radford, Isabelle Rudolf Von Rohr,
Ian and Daphne Russell, Dhruvi Shah, Wendy Swift, ­Yongzhong Sun,
Shirley Thomas, Elaine Weatherley-­Jones, and Christopher Whitaker.

vii
viii Acknowledgments

Colleagues within the Centre for Mindfulness Research and Prac-

tice in Bangor, Wales, gave important support to us during the trial.
Jody Mardula took over the leadership of the center at this time to
enable the research. Judith Soulsby, Eluned Gold, Sharon Hadley, and
David Shannon were also generous in their support of this work.
The research was supported by Grant No. GR067797 from the
Wellcome Trust to Mark Williams and Ian Russell, and we are particu-
larly grateful to Candace Hassall, Louise Williams, and John W ­ illiams
of Wellcome for their generous guidance and support over many
years. Our personal and technical support came from the University
of Oxford and Bangor University.
We are grateful for the warm hospitality we received in the beauti-
ful setting of Hawkstone Hall in Shropshire, where most of the book
was written.
We thank our families, who gave us the space to write.
Most importantly, we thank our participants for taking the cou-
rageous step to join an MBCT group. We are grateful to them for
allowing us to reflect their experiences in this book. Many expressed
a wish to join the research to support personal learning, but also to
contribute to collective learning so that in the future people who are
experiencing despair can receive the best support possible. We are
glad of their generosity, and are also delighted that for many the work
has been transformational.
 Contents

1. Introduction 1

Part I. Theoretical and Research Background

2. The Origins of Despair: An Evolutionary Perspective 11

3. Why the Idea of Suicide Won’t Let Go 31
4. How Could Mindfulness Help?: Doing and Being 47

Part II. MBCT for Those at Risk of Suicide

5. Assessing Vulnerability to Depression and Suicidality 69

6. Developing the Preclass Interview: 95
Encouraging Vulnerable Participants to Engage in
and Persist with Mindfulness Meditation
7. Session 1: Awareness and Automatic Pilot 120
8. Session 2: Living in Our Heads 135
9. Session 3: Gathering the Scattered Mind 145
10. Session 4: Recognizing Aversion 155

ix
x Contents

11. Session 5: Allowing/Letting Be 165

12. Session 6: Thoughts Are Not Facts 183
13. Session 7: How Can I Best Take Care of Myself? 192
14. Session 8: Maintaining and Extending New Learning 199
15. How Does MBCT Enable Transformation?: Jane’s Story 204

Part III. Training Teachers and Defining Competence

16. MBCT Teaching Integrity: 237

Assessing Mindfulness‑Based Teaching Skills
17. The Experience of Being an MBCT Teacher 257

Part IV. MBCT—The Results

18. Mindfulness on Trial: Does MBCT Help People at Risk of Suicide? 285

Further Reading and Resources 307

References 313
Index 323
List of Audio Files 334

Purchasers can download audio files for this book

at www.guilford.com/williams6-materials.
 chapter 1

Introduction

It is one of the most difficult and painful conversations that takes place
between a person seeking help for his or her psychological difficulties
and the therapist, counselor, or teacher to whom he or she has come to
see. For when questions about their life history have been asked, about
their family and work, about what brings them here, about signs and
symptoms of the depression, hopelessness, and mental pain that can
accompany any physical or psychological problem, there needs to be a
question about suicide: “Have things ever got to the point that you’ve
considered ending it all; that life just wasn’t worth living anymore;
that even suicide would be better than carrying on like this?” He or
she may have told no one, and yet feel a huge burden of guilt about
harboring such thoughts.
There are many different ways of asking, but eventually the issue
has to be addressed, especially if the person is or has been clinically
depressed. Half of those who become depressed will have recurrent
thoughts of death or suicide, but while any psychological problem
increases the risk of suicide—anxiety or panic, bipolar disorder, posttrau-
matic stress disorder (PTSD), schizophrenia—it is the sense of depression
and helplessness that comes with these problems that exacerbates the
risk that someone may take his or her own life. Depression and hopeless-
ness form the “final common pathway” for suicidal feelings and behav-
ior, and it is suicidal depression and hopelessness that this book is about.
The approach to those at risk of suicide described in this book
arose from a larger quest to help those suffering from depression in

1
2 Introduction

general. Depression is consistently ranked in the top four disorders in

terms of global disease burden and has been described as a significant
global challenge for the 21st century (Collins et al., 2011). Twenty per-
cent of the population will be seriously depressed at some point in their
lives—over a billion people across the globe—and it blights the lives of
people whether they live in high-, middle-, or low-­income countries
(World Health Organization, 2008). Wherever it strikes, depression
erodes the well-being and quality of life of sufferers and their families
and profoundly impairs people’s ability to function in their day-to-day
personal, social, and working lives. But it is a hidden scar—few people
talk about it as openly as they would about other causes of disability.
In 1993, Zindel Segal, John Teasdale and Mark Williams set out
to find a way of understanding the factors that increase risk of depres-
sion and then how that risk might be reduced. Originally they had
intended to base their preventative approach on cognitive therapy, but
their own personal experience and new scientific findings about what
processes underlie the maintenance of high risk in depression con-
vinced them that there was more to be discovered than was contained
in their existing cognitive theories and therapies. Learning from
Marsha Linehan’s use of mindfulness (a key feature of her dialectical
behavior therapy for people with a diagnosis of borderline personal-
ity disorder), and Jon Kabat-Zinn’s pioneering work at UMass Medical
Center on mindfulness-­based stress reduction (MBSR), they proposed
a psychological model to explain why mindfulness training, with its
emphasis on changing modes of mind, might be helpful for people who
repeatedly get stuck in recurrent and toxic patterns of mind.
But what is “mindfulness”? The word “mindfulness” is a transla-
tion of an ancient Pali word, originally meaning memory or nonfor-
getfulness. In the Buddhist writings it came to mean “lucid awareness”
(Bodhi, 2011). In its more common usage in recent clinical literature,
it has come to mean the awareness that emerges as a by-­product of
cultivating three related skills: (1) intentionally paying attention to
moment-­by-­moment events as they unfold in the internal and external
world; (2) noticing habitual reactions to such events, often character-
ized by aversion or attachment (commonly resulting in rumination
and avoidance); and (3) cultivating the ability to respond to events,
and to reactions to them, with an attitude of open curiosity and com-
passion. Mindfulness is traditionally cultivated by meditation in which
 Introduction 3

people learn to pay attention in each moment with full intentionality

and with friendly interest. When people practice such meditation for
any length of time, a number of qualities of their experience change.
People say they feel more aware or awake, feel calmer and are more
able to see clearly and gain freedom from their own emotional pat-
terns and habits, free to be more compassionate to themselves and
to others. The early research trials conducted by Kabat-Zinn and his
colleagues had shown that this approach could be highly effective for
patients who suffered long-term physical health conditions that had
been destroying the quality of their lives (Kabat-Zinn, 2013).
Segal, Williams, and Teasdale recognized that mindfulness train-
ing might be the key to preventing depression. The research trial they
carried out at the University of Cambridge (England), the University
of Toronto (Canada), and Bangor University (Wales) showed that for
those who had suffered three or more previous episodes of depres-
sion, mindfulness-­based cognitive therapy (MBCT) reduced the rates
of relapse by between 40 and 50% (Teasdale et al., 2000).
At that time, they were cautiously optimistic that mindfulness could
pay a role in the reduction of risk of depression, but believed that such
an approach might be of interest to a minority of clinicians. In 2002,
they published a book that told the story of their research, their false
starts and reversals, and what they eventually discovered. To their sur-
prise, the book, Mindfulness-­Based Cognitive Therapy for Depression: A New
Approach to Preventing Relapse (Segal et al., 2002), was widely read and
became highly influential. It transformed the whole landscape of clinical
practice, changing both the way people understood depression and how
best to prevent it, and then went on to have a wide impact on the field
of evidence-­based approaches to other serious psychological conditions.

Mindfulness and Suicidality

But there were gnawing questions being asked again and again: Can
mindfulness be used for the most vulnerable people, that is, for those
who have a history of severe adversity? What if people get more upset
because mindfulness has made them more aware of their difficulties?
What if they have a risk for suicide? Wouldn’t it be unethical to encour-
age people to do a practice that might end up with them becoming
4 Introduction

more aware of suicidal thoughts and feelings? Williams had long been
concerned about those people who become so depressed that they
consider suicide as their only option. His colleagues and coworkers in
the International Association for Suicide Prevention had shown that
across the globe each year, around one million people commit suicide.
Suicide claims more lives than war. There was an urgent need to help,
but few clues about how best to do so.
In January 2003 Williams moved from Bangor University to the
University of Oxford to begin a 10-year research program as a Wellcome
Trust Principal Research Fellow, setting up a team that would be able
to investigate whether the psychological processes underlying mindful-
ness, that enable it to help prevent recurrence in depression, could also
apply to those who suffered depression so severely that they became
suicidal. Oxford was the center of choice since this is where Keith Haw-
ton had been working for many years at the forefront of research into
suicide and suicidal behavior. Here was an opportunity to deepen our
understanding of the particular vulnerabilities of people who had suf-
fered so much throughout their lives that they were persistently think-
ing of ending it all. Could mindfulness help them? Ultimately, the team
would have to carry out a research trial to see whether and for whom
mindfulness might be helpful. But before that, there was a lot of work to
be done to clarify exactly what made some people suicidal. Only if they
could understand the factors that trigger and maintain suicidal think-
ing and behavior could they begin to see what might help.
This book is the story of what they discovered, and about the
impact these new understandings had on their approach to MBCT. It
would affect their view of how to train new therapists in MBCT, and
how to assess competence in teaching it. But most importantly, the
research would show them how best to offer MBCT to those suffering
not only from suicidal depression but also from other difficulties that
have chronic histories and persistent symptoms.

Overview of This Book

We have divided the chapters in this book into four parts. In Part I, we
cover the research and theoretical background. Chapter 2 describes the
“cry of pain” model of suicidality, and how hopelessness and despair
 Introduction 5

can be switched on very suddenly under certain circumstances—­when

a person feels defeated and believes deeply that he or she has no escape
route. Chapter 3 goes into more detail about what we found when we
tested these theories in the laboratory. We see the science behind sui-
cide risk—­examining the difficulty that some people have in bringing
to mind positive images of the future and then the way people differ,
one from another, in how reactive they are to small changes in mood.
Reactivity not only encompasses negative themes but also rumination
and avoidance. More specifically, in those at risk of suicide, reactiv-
ity includes graphic images of suicide that, while being intrusive and
disturbing for some sufferers, are comforting for a few. Finally we see
how subtle changes in the way people recall their personal past (auto-
biographical memory) affects their reactivity to the present.
If we hope that the mindfulness approach will be taken seriously
by those who are most vulnerable, we have to explain to them why
mindfulness training might be appropriate for them to try. Chapter 4
offers a framework a clinician can use for answering the patient’s ques-
tion “Will it work for me . . . and how can it help?”
Part II moves from the laboratory and into the clinic, describing
the practical application of the Part I research. Chapter 5 examines
how we can best assess suicidal vulnerability in order to ensure that
we know as much as we can about the risks, and do not do harm. In
Chapter 6, we tell the story of how a pilot clinical trial to test our ideas
revealed important factors about who drops out before the end of a
MBCT course, and describe how we elaborated the preclass interview
so as to enhance engagement in the program. We take the learning
from this into Chapters 7–14, in which we describe, session by session,
the specific changes we made to the original MBCT for depression
protocol, and how our participants experienced these changes. These
chapters go into detail about the way MBCT can be offered to those
in whom strong suicidal thoughts and actions can be easily activated.
If it is true that transformation can come only by our “turning toward
difficulties,” how can this be done in a way that provides a place of
genuine safety for participants in the class?
Chapter 15 summarizes the MBCT program by “listening” to the
dialogues that take place in the class between teacher and a single
participant. It is out of this dialogue following each meditation (often
called “inquiry”) that much or most learning takes place.
6 Introduction

Part III moves into considering the crucial role of the teacher. In
Chapter 16, we turn to the controversial question of how we assess
the quality of teaching in mindfulness-­based interventions. For any
evidence-­based therapy, it is important to know that what is taught
week by week is faithful to the intentions of the approach—­that the
teaching covers the curriculum, and is taught at a certain level of com-
petence. These issues are not confined to research trial contexts. If we
want to disseminate mindfulness teaching to trainees, we need to have
a clear understanding of the skills and processes we are conveying
as a framework for training and supervision. So the question arises:
How can we consistently and reliably assess competence and adher-
ence (the “integrity” of the teaching)? The answer to this question is
not simple, because the process of teaching and learning within any
mindfulness-­based intervention is subtle, and in a large part arises
implicitly through the process rather than by covering an explicit cur-
riculum. So assessment of teaching has also to address the “hidden
curriculum,” that is, how teachers embody the learning in their own
way of being. This chapter considers the issues of mindfulness-­based
teaching integrity, what it is, how it develops over time, and how it
can be assessed. Chapter 17 approaches teaching from a different and
complementary angle, focusing on the experience of the teacher “from
the inside.” How can teachers best remain true to the curriculum and
intentions of the approach when working with the most vulnerable
patients? In particular, the chapter explores the challenges of teach-
ing a manualized, protocol-­based program, and the need to balance
adherence to the particular, defined curriculum of MBCT, on the one
hand, with flexibility and responsiveness to participants, on the other.
Finally, we move to Part IV. In Chapter 18, we summarize the pre-
vious chapters, and reveal what we found when we tested MBCT in a
large randomized controlled trial—and what the results show us about
how to treat the most vulnerable patients, including the best approach
to dealing skillfully with reactions of extreme suicidal despair. We
place our findings in the context of trials of MBCT that have been
published more recently and that inform our view of how to move
forward with this evidence-­based approach. In sum, by the end of the
book, we shall have identified the practical implications for mindful-
ness teachers, in terms of how they can assess would-be participants’
suitability for MBCT, and how to shape its planning and delivery,
 Introduction 7

remaining faithful to the protocol without undue rigidity or fear, as

well as drawing out the implications for teachers for sustaining their
own practice and continuing their own training.

How to Use This Book

No single book on mindfulness stands alone. Each one work contrib-

utes its own piece to a long-­standing and worldwide body of knowl-
edge, understanding, and practice. This book is no exception: it is
intended to complement the standard MBCT manual of Segal, Wil-
liams, and Teasdale (2013) both in terms of describing its adapta-
tion for highly vulnerable patients, and also in providing additional
information on recent general developments that are relevant from a
broader perspective, such as the definition and assessment of teacher
competency. The book is not a “manual,” and we would caution against
any teacher or therapist imagining that mindfulness alone will “cure”
suicidal thoughts and behavior. Segal and colleagues are very clear
about knowing the limits of our competence when any of us are work-
ing with trauma and serious mental distress, and we endorse their
advice about the training required to work in this field (Segal et al.,
2013, pp. 420–421).
The book follows an inherent logic, and it would be best to read it
in the sequence presented. In this way, the modifications to the MBCT
program and its delivery become understandable from a background
of research findings, and the advice on how to implement the program
week by week is informed by our best current knowledge. We often rec-
ommend that teachers reread the relevant chapter in the book before
teaching a particular session, not only in order to remind themselves
of the structure of the session, but also to reacquaint themselves with
its broader theme and the characteristic responses that may recur.
Being prepared in terms of the “hidden curriculum” may be particu-
larly important when working with highly vulnerable patients, so we
have laid out key issues in Part II (Chapters 7–14), session by session.
To support the implementation of the MBCT program, we have made
available audio recordings of practice exercises from the second edi-
tion of Mindfulness-­Based Cognitive Therapy for Depression (Segal et al.,
2013), which can be streamed directly from the Web or downloaded
8 Introduction

in MP3 format. Participants find the recordings helpful, especially

when they are getting started in practicing mindfulness. Teachers can
access these tracks at www.guilford.com/williams6-materials. Finally, in
the later chapters focusing on the experience of the teacher, we intend
to convey a sense of what is important psychologically in helping teach-
ers to respond with understanding, compassion, and care to suicidal-
ity and despair in MBCT and in other settings.
We hope the book will serve as a helpful resource not only for
those teaching MBCT to highly vulnerable patients but also for those
who might not be involved in teaching mindfulness in a mental health
setting but nonetheless find that they, or those who come to them for
help, struggle with suicidality, and despair.
Suicide is a tragedy that affects many of us, families, friends and
colleagues of those who have taken their lives, leaving behind feel-
ings of shame, anger, loneliness, and sorrow. As therapists, clinicians,
counselors, or mindfulness teachers, we need to deepen and extend
our understanding of the field in general and our vulnerable clients
or participants in particular. We dedicate this book to all those whose
lives have been touched by such a tragedy. May it bring fresh perspec-
tives, courage, and wisdom for those working with people at risk of
suicide.
 pa r t i

THEORETICAL AND
RESEARCH BACKGROUND
 chapter 2

The Origins of Despair

An Evolutionary Perspective

Cathy did not really understand how she ended up in the hospital.
Well, of course, she knew that she’d had a huge argument with a close
friend, that she’d gone home by herself and started to drink, and
not gone to another friend’s wedding on the weekend, making some
excuse about the illness that was going round the office. But that had
been 4 days ago . . . she’d been at work since and got on with her life.
Then old feelings of loneliness and the sheer pointlessness of life had
begun to overwhelm her in the evenings. Here she was, in her 30s,
with no real friends, living alone, a job she didn’t really enjoy, and a
past that was blighted by a recurring sense of failure. She had always
wondered how other people really “did” life . . . how did they “make
themselves happy” when, to her, there never seemed to be anything
to be happy about. She never seemed to be on the same wavelength
as other people. Worse than this, she seemed to make everyone else
around her unhappy.
That Thursday, when it happened, she had come home from
work as usual, with a crushing headache, and gone to the cupboard
to get some painkillers. She opened the cupboard and saw the pills,
and also the antidepressants she’d been prescribed last year but never
taken, and the very strong painkillers her mother had left by mistake
last year when she’d stayed. Suddenly it occurred to her, like a light
going on somewhere in her head—she didn’t have to put up with this.
If she removed herself from the world, everyone else would be better
off. She’d stop being a burden to others, and stop the pain she was
finding unbearable.

11
12 THEORETICAL AND RESEARCH BACKGROUND

Everything that happened after that was a blur. Here she was, in
the hospital with a drip in her arm, with her parents sitting by her bed-
side looking completely defeated, some flowers from her recently mar-
ried friend on the table beside her, and a constant voice in her head
telling her how stupid she’d been—she couldn’t even succeed at taking
her own life. The ER physician said she had been close to death, very
close indeed. It was a miracle she was alive, he’d said. Cathy did not
agree. She’d wanted to die, and now did not know what she wanted.

The Challenge for Therapists

Cathy’s story is repeated thousands of times a day across the world.

How can we understand how to prevent episodes like these? Suicide
and suicidal behavior are complex phenomena—­understandable at the
level of sociology, psychology, and biology. Understanding who is most
at risk and whether people can be helped to live a life that is worth liv-
ing, so that such overwhelming feelings can be handled in a way that
is not so destructive, is a huge challenge.
Let us first make clear how we see the issue from an ethical point
of view. It could be argued that suicide is a free act, that no one else
should interfere with a person’s right to end his or her own life. Here
are some views that we have heard expressed by clinicians, any or all
of which would undermine our motivation to help:

• The causes of suicide have nothing to do with mental illness: it

is an illness of society.
• Suicide is a matter that should be left for the individual to decide.
• Suicide is too rare for us to predict.
• Suicidal individuals rarely contact professional services. Even if
they do contact us, they do not talk about their suicidal intent.
• Patients who talk about suicide rarely go on to do it.
• Focusing on suicide in the clinical interview only increases risk.

Contrast these attitudes with some alternatives:

• Those at risk of suicide come to us in our professional capacity

to get help.
• Even though they have thought about or even planned suicide
 The Origins of Despair 13

for many weeks, months or years, they are still alive—something

is keeping them from dying.
• Most people, even when very hopeless, are usually ambivalent
about suicide, and we have a responsibility to encourage the
wish to live.
• Suicidal clients have already talked with relatives and friends,
and we may well be their last port of call.
• Most people who attempt suicide, and who die by suicide, are
depressed at the time they do it. Depression involves a style of
thinking that makes suicide seem the only option.
• Things can improve in a most unexpected way even in the case
of people facing enormous adverse odds.
• It is for us to assume that change for the better is always possible.

We agree with this latter stance. By whatever route a person has come
to us, here he or she is—still alive despite everything. We are commit-
ted to offering this person, right now, a way in which he or she can
come to see for him- or herself that life may surprise him or her with
its possibilities even when all seems to point to despair.
Systematic reviews of the research (National Institute for Health
and Clinical Excellence, 2011) show that, although there remains uncer-
tainty about which treatments are most effective, those that include
clarification of the patterns that underlie interpersonal difficulties
in order to improve the availability of problem-­solving options carry
some promise. Yet there is general agreement that there is much we do
not know. For treatments to progress further, we need to understand
clearly and precisely the psychological processes that underlie both
long-term vulnerability, what factors from time to time activate these
processes, and how activation can be followed by a swift downturn
in mood, exacerbated by reawakened negative thinking patterns, and
culminating for some in a spiral into suicidal despair. Our approach
is based on the observation that most suicidal thinking and behavior
occur in the context of hopelessness and despair about the future. Sui-
cidal feelings can come about very rapidly, but most often they occur
in the context of an episode of depression, even if the depression has
been successfully hidden from the view of family or friends.
In the book Cry of Pain, Williams (1997, 2014) describes the way
in which we might best understand suicidal feeling and behavior. The
14 THEORETICAL AND RESEARCH BACKGROUND

title was chosen deliberately as an attempt to answer those who tend

to dismiss suicidal behavior (often now called deliberate self-harm)
as a “cry for help.” The expression “cry for help” had been coined by,
amongst others, Erwin Stengel (1964) in his book Suicide and Attempted
Suicide. He had talked about the “appeal function” of such behavior,
but this description was widely misunderstood, as if he meant that
suicidal behavior is only a cry for help. Even now, many suicidal acts
are dismissed as “mere” cries for help, as if a communication motive
was incompatible with a serious attempt to end life, and as if the self-­
damaging act did not represent a deeper anguish that needs to be
taken very seriously indeed. In fact, Stengel was drawing attention to
the fact that a suicidal act shares with physical illness the characteristic
of drawing out from others a wish to come to the aid of the person in
need.
The “cry of pain” perspective was intended instead to capture the
way in which any behavior can have a communication outcome with-
out communication being the main motive. An animal caught in a
trap cries with pain. The cry is brought about by the pain, but may
also communicate distress in a way that will affect the behavior of
other animals. Suicidal behavior may be overtly communicative in a
minority of cases, but mainly it is “elicited” by the pain of a situation
with which the person cannot cope—a cry of pain first, and only then
a cry for help.
The “cry for help” idea had another unintended consequence.
Because it was limited to nonfatal suicide attempts, it contributed to
a widening of the gap between how people thought about nonfatal
suicide attempts and suicide. As pointed out in Cry of Pain (Williams,
1997, 2014), attempted suicide and completed suicide are very closely
related. Both affect the more socially disadvantaged, and the motives
for both completed and attempted suicide share many features. For
example, anger and communication issues can be found both in sui-
cide and in acts of self-harm that do not have a fatal outcome, and even
relatively low-risk “suicidal ideas” (which often do not lead to suicidal
behavior) may be dominated by the theme of escape and death rather
than communicating feelings with another person.
You can see this mixture of feelings in Cathy’s experience—­and
she might have easily ended up as one of the 38,000 people a year who
kill themselves in the United States (www.cdc.gov/nchs/fastats/suicide.
 The Origins of Despair 15

htm)—contributing to 800,000 suicide deaths worldwide each year

(www.who.int/mental_health/prevention/suicide). The number of people
who harm themselves intentionally but who do not die is staggering.
A recent population-­based study showed that almost 19% of 16- to
17-year-olds had engaged in some self-harm on at least one occasion
(Kidger, Heron, Lewis, Evans, & Gunnell, 2012). Most of this behavior
is without clear suicide intent, but if there is history of suicidal behav-
ior in close friends or family, then the behavior is more likely to have a
wish to die in its mix of motives (Hargus, Hawton, & Rodham, 2009).
Although this behavior seems to describe extreme reactions to
stress, we suggest that such moments arise in all our lives, whether
externally or internally generated. We all live on a spectrum in which
helplessness and loss, illness and death, are never far away. Human
minds have myriad ways in which we can find ourselves trapped, feel-
ing momentarily paralyzed. For some, such moments of despair can
lead to a sense of wanting to exit the world, to escape from the self.
Those who feel despairing and suicidal often live (or have lived) in
very difficult circumstances, or have come to understand their world
in ways that make them feel helpless and confused. Some may encoun-
ter these mind-­states because they have a genetic disposition toward
large and unpredictable mood swings. But whatever factors contribute
to these periods of deep despair, the cry of pain view suggests that all
of them will ultimately have their effects on people through a final
common pathway: the feeling of being totally defeated combined with
the feeling that there is no escape.

Can Existing Psychological Treatment Help?

Despite a great deal of research on suicidal ideas, planning, and behav-

ior, identifying ways to help such patients in order to reduce risk of
repetition has proven difficult. As we have mentioned, the recent
systematic review of the research studies to date showed that there
remains considerable uncertainty about which approaches are most
effective (National Institute for Health and Care Excellence [NICE],
2011). This uncertainty arises from the fact that even the best cogni-
tive or problem-­based approaches either report only modest success or
have not been replicated. Even in the case of cognitive therapy (CT),
16 THEORETICAL AND RESEARCH BACKGROUND

there is a paucity of studies showing effectiveness. Brown et al. stud-

ied participants who were highly socially vulnerable; over 40% had
an income of $8,000 or less, and 66% were unemployed or disabled
(Brown et al., 2005). They found that many people failed to turn up for
appointments or turned up at the wrong time and could not be seen
in the usual clinic, where the therapists were engaged in other clinical
duties. So they radically changed what they were doing, introducing
case managers for every patient in the study, who became responsible
for keeping in touch with clients, giving out bus tokens, conducting
home visits, picking up some patients in cars, arranging community
voicemail facilities, using the Philadelphia Homeless Database to track
patients, and identifying at the outset some contact people who would
be likely to know where the patient was at any time. The study found
a drop from 38% to 20% in repeated suicidal behavior in the period
following the CT intervention. However, there are no more studies
of this type, so we cannot know if it could be replicated by others.
Attempts to use day-­patient treatment (Bateman & Fonagy, 2008) and
CT (Davidson, Tyrer, Norrie, Palmer, & Tyrer, 2010) for reducing sui-
cidal behavior in patients with a diagnosis of personality disorder have
proven moderately successful, but need replicating.
Linehan’s (1993) dialectical behavior therapy (DBT) for those
with borderline personality disorder is an exception. DBT combines
weekly individual and weekly group therapy over a 1-year period. It
uses treatment strategies from behavioral, cognitive, and supportive
psychotherapies. A behavioral/problem-­ solving component focuses
on enhancing capability, generating alternative ways of coping, and
clarifying and managing contingencies—­a ll with the emphasis on the
“here-and-now.” The “dialectical” of its title lies in its emphasis on bal-
ancing acceptance of (seeing clearly) the stresses that exist in the envi-
ronment, on the one hand, with the need to change how to approach
them, on the other. The theme is encouraging clients to really grasp
how things are (“grasp” or “take in” is the root meaning of the word
accept). Once a person has understood things clearly and deeply as
they really are, they are more able to step back from them temporarily
to see what things may be changed.
The individual therapy prioritizes themes related to suicidal
behavior. Linehan believes this is a critical part of the therapy. She
asserts that newly trained therapists too easily avoid explicit discussion
 The Origins of Despair 17

of suicidal thoughts, urges, and behavior. The client needs to learn

that help for other problems can only be discussed when the self-harm
behavior has been faced directly and then brought under control.
Weekly group skills training, which lasts for 2½ hours a session,
focuses on themes of interpersonal problem solving, distress tolerance,
mindfulness, and emotional regulation.
Studies to assess the effectiveness of DBT have been encouraging.*
Altogether, they constitute impressive evidence that this approach pro-
vides a major source of hope for many people with some of the most
intractable social and emotional problems.
But apart from the extensive research by Linehan on those with
serious personality disorder, there are no treatment approaches that
have been found to be effective in reducing suicidal behavior and then
been replicated in further studies. Knowing how best to understand
and help with suicidal feelings that arise in the context of serious recur-
rent depression has not been addressed systematically. There is simply
not sufficient research on how best to understand and treat suicidal ide-
ation, planning, and behavior to be sure that we have done our best for
those who come to us for help. Treatments have evolved as pragmatic
approaches, but until recent research on the cognitive mechanisms
underlying problem-­solving deficits, these treatments proceeded in the
absence of any understanding of the psychology of despair and what
happens to the capacity to problem-­solve in its presence.

The Cry of Pain

In the light of the paucity of theory and evidence to guide our efforts
in developing new understandings and treatment approaches, we
returned to the research of evolutionary psychologists, who have
important insights to give on the circumstances in which all living
beings give up and become helpless in the face of stressors. We are
deeply indebted to Gilbert’s (1989) Human Nature and Suffering for the
following way of looking at depression and powerlessness in general,
and suicidal feelings in particular.

* Ten studies have evaluated the efficacy of DBT for suicidal patients with BPD—nine
of which are discussed in the U.K. NICE (2009) guidelines for BPD.
Another random document with
no related content on Scribd:
moment, listening; everything was quiet. I eased it open and stepped
onto the ramp inside the building. In the gloom, polished mahogany
and chrome-work threw back muted highlights. I circled, slipped the
mooring rope, and was about to step into the cockpit when I heard
the bolt of a rifle snick home. I whirled, threw myself flat. The
deafening bam of a 30 calibre fired at close quarters laid a pattern of
fine ripples on the black water. I rolled, hit with a splash that drowned
a second shot, and dove deep. Three strokes took me under the
door, out into the green gloom of open water. I hugged the yellowish
sand of the bottom, angled off to the right, and kept going.
I had to get out of my jacket, and somehow I managed it, almost
without losing a stroke. And there went all the goodies I'd stashed
away in the pockets, down to the bottom of the drink. I still had the
memory-trace in my slacks. I managed thirty strokes before having to
surface. I got half a gulp of fresh air before the shot slapped spray
into my face and echoed off across the water. I sank like a stone,
kicked off, and made another twenty-five yards before I had to come
up. The rifleman was faster this time. The bullet creased my shoulder
like a hot iron, and I was under water again. My kick-work was weak
now; the strength was draining from my arms fast. I had to have air.
My chest was on fire and there was a whirling blackness all around
me. I felt consciousness fading....
As from a distance I observed the clumsy efforts of the swimmer,
watched the flounderings of the poor, untrained creature.... It was
apparent that an override of the autonomic system was required. With
dispatch I activated cortical area omicron, rerouted the blood supply,
drew an emergency oxygen source from stored fats, diverting the
necessary energy to break the molecular bonds.
Now, with the body drawing on internal sources, ample for six
hundred seconds at maximum demand, I stimulated areas upsilon
and mu. I channeled full survival-level energy to the muscle
complexes involved, increased power output to full skeletal tolerance,
eliminated waste motion.
The body drove through the water with the fluid grace of a sea-
denizen....

I floated on my back, breathing in great surges of cool air and blinking

at the crimson sky. I had been under water, a few yards from shore,
drowning. Then there was an awareness, like a voice, telling me what
to do. From out of the mass of Vallonian knowledge I had acquired, I
had drawn what I needed. And now I was here, half a mile from the
beach, winded but intact. I felt beat and hungry, but I had to keep my
mind on the problem of getting to the mainland. It was a fifteen-mile
swim, but if the boys on shore could keep each other occupied, I
ought to be able to make it. The full moon would make steering easy.
And the first thing I would do when I got out of this would be to order
the biggest, rarest steak in South America.

CHAPTER XI
I sat at the kitchen table in Margareta's Lima apartment and gnawed
the last few shreds off the stripped T-bone, while she poured me
another cup of coffee.
"Now tell me about it," she said. "You say they burned your house,
but why? And how did you get here?"
"They got so interested in the fight, they lost their heads," I said.
"That's the only explanation I can think of. I figured they'd go to some
pains to avoid damaging me. I guessed wrong."
"But your own people...."
"Maybe they were right: they couldn't afford to let the Russkis get
me."
"But how did you get covered with mud? And the blood stains on your
back?"
"I had a nice long swim: five hours' worth. Then another hour getting
through a mangrove swamp. Lucky I had a moon. Then a three-hour
hike...."
"You'd better get some sleep," said Margareta. "What do you want me
to do?"
"Get me some clothes," I said. "A grey suit, white shirt, black tie and
shoes. And go to my bank and draw some money, say five thousand.
Oh yeah, see if there's anything in the papers. If you see anybody
hanging around the lobby when you come back, don't come up; give
me a call and I'll meet you."
She stood up. "This is really awful," she said. "Can't your embassy—"
"Didn't I mention it? A Mr. Pruffy, of the embassy, came along to hold
Smale's hand ... not to mention a Colonel Sanchez. I wouldn't be
surprised if the local cops weren't in the act by now...."
"Where will you go?"
"I'll get to the airport and play it by ear. I don't think they've alerted
everybody. It was a hush-hush deal, until it went sour; now they're still
picking up the pieces."
"The bank won't be open for hours yet," said Margareta. "Go to sleep
and don't worry. I'll take care of everything."
I knew I wasn't alone as soon as I opened my eyes. I hadn't heard
anything, but I could feel someone in the room. I sat up slowly, looked
around.
He was sitting in the embroidered chair by the window: an ordinary-
looking fellow in a tan tropical suit, with an unlighted cigarette in his
mouth and no particular expression on his face.
"Go ahead, light up," I said. "Don't mind me."
"Thanks," he said, in a thin voice. He took a lighter from an inner
pocket, flipped it, held it to the cigarette.
I stood up. There was a blur of motion from my visitor, and the lighter
was gone and a short-nosed revolver was in its place.
"You've got the wrong scoop, mister," I said. "I don't bite."
"I'd rather you wouldn't move suddenly, Mr. Legion."
"Which side are you working for?" I asked. "And can I put my shoes
on?"
He rested the pistol on his knee. "Get completely dressed, Mr.
Legion."
"Sorry," I said. "No can do. No clothes."
He frowned slightly. "My jacket will be a little small for you," he said.
"But I think you can manage."
"How come you didn't figure I was dead?" I asked.
"We checked the house," he said. "No body."
"Why, you incompetent asses. You were supposed to think I
drowned."
"That possibility was considered. But we made the routine checks
anyway."
"Nice of you to let me sleep it out. How long have you been here?"
"Only a few minutes," he said. He glanced at his watch. "We'll have to
be going in another fifteen."
"What do you want with me?" I said. "You blew up everything you
were interested in."
"The Department wants to ask you a few questions."
I looked at the pistol. "I wonder if you'd really shoot me," I mused.
"I'll try to make the position clear," he said. "Just to avoid any
unfortunate misunderstanding. My instructions are to bring you in,
alive—if possible. If it appears that you may evade arrest ... or fall into
the wrong hands, I'll be forced to use the gun."

I pulled my shoes on, thinking it over. My best chance to make a

break was now, while there was only one watch dog. But I had a
feeling he was telling the truth about shooting me. I had already seen
the boys in action at the house.
He got up. "Let's step into the living room, Mr. Legion," he said. I
moved past him through the door. In the living room the clock on the
mantle said eleven. I'd been asleep for five or six hours. Margareta
ought to be getting back any minute....
"Put this on," he said. I took the light jacket and wedged myself into it.
The telephone rang.
I looked at my watchdog. He shook his head. We stood and listened
to it ring. After a while it stopped.
"We'd better be going now," he said. "Walk ahead of me, please. We'll
take the elevator to the basement and leave by the service entrance
—"
He stopped talking, eyes on the door. There was the rattle of a key.
The gun came up.
"Hold it," I snapped. "It's the girl who owns the apartment." I moved to
face him, my back to the door.
"That was foolish of you, Legion," he said. "Don't move again."
I watched the door in the big mirror on the opposite wall. The knob
turned, the door swung in ... and a thin brown man in white shirt and
white pants slipped into the room. As he pushed the door back he
transferred a small automatic to his left hand. My keeper threw a
lever on the revolver that was aimed at my belt buckle.
"Stand absolutely still, Legion," he said. "If you have a chance, that's
it." He moved aside slightly, looked past me to the newcomer. I
watched in the mirror as the man in white behind me swiveled to keep
both of us covered.
"This is a fail-safe weapon," said my first owner to the new man. "I
think you know about them. We leaked the information to you. I'm
holding the trigger back; if my hand relaxes, it fires, so I'd be a little
careful about shooting, if I were you."
The thin man swallowed. He didn't say anything. He was having to
make some tough decisions. His instructions would be the same as
my other friend's: to bring me in alive, if possible.
"Who does this bird represent?" I asked my man.
"He's a Soviet agent."
I looked in the mirror at the man again. "Nuts," I said. "He looks like a
waiter in a chile joint. He probably came up to take our order."
"You talk too much," said my keeper between his teeth. He held the
gun on me steadily. I watched his trigger finger to see if it looked like
relaxing.
"I'd say it's a stalemate," I said. "Let's take it once more from the top.
Both of you go—"
"Shut up, Legion." My man licked his lips, glanced at my face. "I'm
sorry. It looks as though—"
"You don't want to shoot me," I blurted out, loudly. In the mirror I had
seen the door, which was standing ajar, ease open an inch, two
inches. "You'll spoil this nice coat...." I kept on talking: "And anyway it
would be a big mistake, because everybody knows Russian agents
are stubby men with wide cheekbones and tight hats—"
Silently Margareta slipped into the room, took two quick steps, and
slammed a heavy handbag down on the slicked-back pompadour that
went with the Adam's apple. The man in white stumbled and fired a
round into the rug. The automatic dropped from his hand, and my pal
in tan stepped to him and hit him hard on the back of the head with
his pistol. He whirled toward me, hissed "Play it smart" just loud
enough for me to hear, then turned to Margareta. He slipped the gun
in his pocket, but I knew he could get it out again in a hurry.
"Very nicely done, Miss," he said. "I'll have this person removed from
your apartment. Mr. Legion and I were just going."
Margareta looked at me. I didn't want to see her get hurt—or
involved.
"It's okay, honey," I said. "This is Mr. Jones ... of our Embassy. We're
old friends." I stepped past her, headed for the door. My hand was on
the knob when I heard a solid thunk behind me. I whirled in time to
clip the FBI on the jaw as he fell forward. Margareta looked at me,
wide-eyed.
"That handbag packs a wallop," I said. "Nice work, Maggie." I knelt,
pulled off the fellow's belt, and cinched his hands behind his back
with it. Margareta got the idea, did the same for the other man, who
was beginning to groan now.
"Who are these men?" she asked.
"I'll tell you all about it later. Right now, I have to get to some people I
know, get this story on the wires, out in the open. State'll be a little
shy about gunning me down or locking me up without trial, if I give the
show enough publicity." I reached in my pocket, handed her the
black-&-gold-marked cylinder. "Mail this to—Joe Dugan—at Itzenca,
general delivery."
"All right," Margareta said. "And I have your things." She stepped into
the hall, came back with a shopping bag and a suit carton. She took a
wad of bills from her handbag and handed it to me.
I went to her and put my arms around her. "Listen, honey: as soon as
I leave go to the bank and draw fifty grand. Get out of the country.
They haven't got anything on you except that you beaned a couple of
intruders in your apartment, but it'll be better if you disappear. Leave
an address care of Poste Restante, Basle, Switzerland. I'll get in
touch when I can."
Twenty minutes later I was pushing through the big glass doors onto
the sidewalk, clean-shaven, dressed to the teeth, with five grand on
one hip and a .32 on the other. I'd had a good meal and a fair sleep,
and against me the secret services of two or three countries didn't
have a chance.
I got as far as the corner before they nailed me.

CHAPTER XII
"You have a great deal to lose," General Smale was saying, "and
nothing to gain by your stubbornness. You're a young man, vigorous
and, I'm sure, intelligent. You have a fortune of some million and a
quarter dollars, which I assure you you'll be permitted to keep. As
against that prospect, so long as you refuse to co-operate, we must
regard you as no better than a traitorous criminal—and deal with you
accordingly."
"What have you been feeding me?" I said. "My mouth tastes like
somebody's old gym shoes and my arm's purple to the elbow. Don't
you know it's illegal to administer drugs without a license?"
"The nation's security is at stake," snapped Smale.
"The funny thing is, it must not have worked, or you wouldn't be
begging me to tell all. I thought that scopolamine or whatever you're
using was the real goods."
"We've gotten nothing but gibberish," Smale said, "most of it in an
incomprehensible language. Who the devil are you, Legion? Where
do you come from?"
"You know everything," I said. "You told me so yourself. I'm a guy
named Legion, from Mount Sterling, Illinois, population: one thousand
eight hundred and ninety-two."
Smale had gone white. "I'm in a position to inflict agonies on you, you
insolent rotter," he grated. "I've refrained from doing so. I'm a soldier; I
know my duty. I'm prepared to give my life; if need be, my honor, to
obtain for my government the information you're withholding."
"Turn me loose; then ask me in a nice way. As far as I know, I haven't
got anything of military significance to tell you, but if I were treated as
a free citizen I might be inclined to let you be the judge of that."
"Tell us now; then you'll go free."
"Sure," I said. "I invented a combination rocket ship and time
machine. I travelled around the solar system and made a few short
trips back into history. In my spare time I invented other gadgets. I'm
planning to take out patents, so naturally I don't intend to spill any
secrets. Can I go now?"
Smale got to his feet. "Until we can safely move you, you'll remain in
this room. You're on the sixty-third floor of the Yordano Building. The
windows are of unbreakable glass, in case you contemplate a
particularly untidy suicide. Your person has been stripped of all
potentially dangerous items. The door is of heavy construction and
securely locked. The furniture has been removed so you can't
dismantle it for use as a weapon. It's rather a drab room to spend
your future in, but until you decide to co-operate this will be your
world."

I didn't say anything. I sat on the floor and watched him leave. I
caught a glimpse of two uniformed men outside the door. No doubt
they'd take turns looking through the peephole. I'd have solitude
without privacy.
I stretched out on the floor, which was padded with a nice thick rug,
presumably so that I wouldn't beat my brains out against it just to
spite them. I was way behind on my sleep: being interrogated while
unconscious wasn't a very restful procedure. I wasn't too worried. In
spite of what Smale said, they couldn't keep me here forever. Maybe
Margareta had gotten clear and told the story to some newsmen; this
kind of thing couldn't stay hidden forever. Or could it?
I thought about what Smale had said about my talking gibberish
under the narcotics. That was an odd one....
Quite suddenly I got it. By means of the drugs they must have tapped
a level where the Vallonian background briefing was stored: they'd
been firing questions at a set of memories that didn't speak English. I
grinned, then laughed out loud. Luck was still in the saddle with me.

The glass was in double panels, set in aluminum frames and sealed
with a plastic strip. The space between the two panels of glass was
evacuated of air, creating an insulating barrier against the heat of the
sun. I ran a finger over the aluminum. It was dural: good tough stuff. If
I had something to pry with, I might possibly lever the metal away
from the glass far enough to take a crack at the edge, the weak point
of armor-glass ... if I had something to hit it with.
Smale had done a good job of stripping the room—and me. I had my
shirt and pants and shoes, but no tie or belt. I still had my wallet—
empty, a pack of cigarettes with two wilted weeds in it, and a box of
matches. Smale had missed a bet: I might set fire to my hair and burn
to the ground. I might also stuff a sock down my throat and strangle,
or hang myself with a shoe lace—but I wasn't going to.
I looked at the window some more. The door was too tough to tackle,
and the heavies outside were probably hoping for an excuse to work
me over. They wouldn't expect me to go after the glass; after all, I
was still sixty-three stories up. What would I do if I did make it to the
window sill? But we could worry about that later, after I had smelled
the fresh air.
My forefinger found an irregularity in the smooth metal: a short
groove. I looked closer, saw a screw-head set flush with the
aluminum surface. Maybe if the frame was bolted together—
No such luck; the screw I had found was the only one. What was it
for? Maybe if I removed it I'd find out. But I'd wait until dark to try it.
Smale hadn't left a light fixture in the room. After sundown I'd be able
to work unobserved.

A couple of hours went by and no one came to disturb my solitude,

not even to feed me. I had a short scrap of metal I'd worked loose
from my wallet. It was mild steel, flimsy stuff, only about an inch long,
but I was hoping the screw might not be set too tight. Aluminum
threads strip pretty easily, so it probably wasn't cinched up too hard.
There was no point in theorizing. It was dark now; I'd give it a try. I
went to the window, fitted the edge of metal into the slotted screw-
head, and twisted. It turned, just like that. I backed it off ten turns,
twenty; it was a thick bolt with fine threads. It came free and air
whooshed into the hole. The screw apparently sealed the panel after
the air was evacuated.
I thought it over. If I could fill the space between the panels with water
and let it freeze ... quite a trick in the tropics. I might as well plan to fill
it with gin and set it on fire.
I was going in circles. Every idea I got started with "if". I needed
something I could manage with the materials at hand: cloth, a box of
matches, a few bits of paper.
I got out a cigarette, lit up, and while the match was burning
examined the hole from which I'd removed the plug. It was about
three sixteenths of an inch in diameter and an inch deep, and there
was a hole near the bottom communicating with the air space
between the glass panels. It was an old-fashioned method of
manufacture but it seemed to have worked all right: the air was
pumped out and the hole sealed with the screw. It had at any rate the
advantage of being easy to service if the panel leaked. Now with
some way of pumping air in, I could blow out the panels....
There was no pump on the premises but I did have some chemicals:
the match heads. They were old style too, like a lot of things in Peru:
the strike-once-and-throw-away kind.
I sat on the floor and started to work, chipping the heads off the
matchsticks, collecting the dry, purplish material on a scrap of paper.
Thirty-eight matches gave me a respectable sample. I packed it
together, rolled it in the paper, and crimped the ends. Then I tucked
the makeshift firecracker into the hole the screw had come from.
Using the metal scrap I scraped at the threads of the screw, blurring
them. Then I started it in the hole, half a dozen turns, until it came up
against the match-heads.
The shoes Margareta had bought me had built-up leather heels: hell
on the feet, but just the thing to pound with.

I took the shoe by the toe and hefted it: the flexible sole gave it a
good action, like a well-made sap. There were still a couple of "if's" in
the equation, but a healthy crack on the screw ought to drive it
against the packed match-heads hard enough to detonate them, and
the expanding gasses from the explosion ought to exert enough
pressure against the glass panels to break them. I'd know in a
second.
I flattened myself against the wall, brought the shoe up, and laid it on
the screw-head.
There was a deafening boom, a blast of hot air, and a chemical stink,
then a gust of cool night wind—and I was on the sill, my back to the
street six hundred feet below, my fingers groping for a hold on the
ledge above the window. I found a grip, pulled up, reached higher, got
my feet on the muntin strip, paused to rest for three seconds, reached
again....
I pulled my feet above the window level and heard shouts in the room
below:
"—fool killed himself!"
"Get a light in here!"
I clung, breathing deep, and murmured thanks to the architect who
had stressed a strong horizontal element in his facade and arranged
the strip windows in bays set twelve inches from the face of the
structure. Now, if the boys below would keep their eyes on the street
underneath long enough for me to get to the roof—
I looked up, to get an idea how far I'd have to go—and gripped the
ledge convulsively as the whole building leaned out, tilting me back....
Cold sweat ran into my eyes. I squeezed the stone until my knuckles
creaked, and held on. I laid my cheek against the rough plaster,
listened to my heart thump. Adrenalin and high hopes had gotten me
this far ... and now it had all drained out and left me, a frail ground-
loving animal, flattened against the cruel face of a tower like a fly on a
ceiling, with nothing between me and the unyielding concrete below
but the feeble grip of fingers and toes. I started to yell for help, and
the words stuck in my dry throat. I breathed in shallow gasps, feeling
my muscles tightening, until I hung, rigid as a board, afraid even to
roll my eyeballs for fear of dislodging myself. I closed my eyes, felt
my hands going numb, and tried again to yell: only a thin croak.
A minute earlier I had had only one worry: that they'd look up and see
me. Now my worst fear was that they wouldn't.
This was the end. I'd been close before, but not like this. My fingers
could take the strain for maybe another minute, maybe even two;
then I'd let go, and the wind would whip at me for a few timeless
seconds, before I hit.

Down inside of me a small defiance flickered, found a foot-hold,

burned brighter. I would die ... but Hell, that would solve a lot of
problems. And if I had to die, at least I could die trying.
My mind moved in to take over from my body. It was the body that
was wasting my last strength on a precarious illusion of safety,
numbing my senses, paralyzing me. It was a tyranny I wouldn't
accept. I needed a cool head and a steady hand and an unimpaired
sense of balance; and if the imbecile boy wouldn't co-operate the
mind would damn well force it. First: loosen the grip—Yes! if it killed
me: bend those fingers!
I was standing a little looser now, my hands resting flat, my legs
taking the load. I had a good wide ledge to stand on: nearly a foot,
and in a minute I was going to reach up and get a new hold and lift
one foot at a time ... and if I slipped, at least I'd have done it my way.
I let go, and the building leaned out, and to hell with it....
I felt for the next ledge, gripped it, pulled up, found a toe-hold.
Sure, I was dead. It was a long way to the top, and there was a fancy
cornice I'd never get over, but when the moment came and I started
the long ride down I'd thumb my nose at the old hag, Instinct, who
hadn't been as tough as she thought she was....

I was under the cornice now, hanging on for a breather and listening
to the hooting and hollering from the window far below. A couple of
heads had popped out and taken a look, but it was dark up where I
was and all the attention was centered down where the crowd had
gathered and lights were playing, looking for the mess. Pretty soon
now they'd begin to get the drift—so I'd better be going.
I looked up at the overhang ... and felt the old urge to clutch and hang
on. So I leaned outward a little further, just to show me who was
boss. It was a long reach, and I'd have to risk it all on one lunge
because, if I missed, there wasn't any net, and my fingers knew it; I
heard my nails rasp on the plaster. I grated my teeth together and
unhooked one hand: it was like a claw carved from wood. I took a
half-breath, bent my knees slightly; they were as responsive as a
couple of bumper-jacks bolted on at the hip. Tough; but it was now or
never....
I let go with both hands and stretched, leaning back....
My wooden hands bumped the edge, scrabbled, hooked on, as my
legs swung free, and I was hanging like an old-time sailor strung up
by the thumbs. A wind off the roof whipped at my face and now I was
a tissue-paper doll, fluttering in the breeze.

I had to pull now, pull hard, heave myself up and over the edge, but I
was tired, too tired, and a dark curtain was falling over me....
Then from the darkness a voice was speaking in a strange language:
a confusion of strange thought symbols, but through them an ever
more insistent call:
... dilate the secondary vascular complex, shunt full conductivity to
the upsilon neuro-channel. Now, stripping oxygen ions from fatty cell
masses, pour in electro-chemical energy to the sinews....
With a smooth surge of power I pulled myself up, fell forward, rolled
onto my back, and lay on the flat roof, the beautiful flat roof, still warm
from the day's sun.
I was here, looking at the stars, safe, and later on when I had more
time I'd stop to think about it. But now I had to move, before they'd
had time to organize themselves, cordon off the building, and start a
door-to-door search.
Staggering a bit from the exertion of the long climb I got to my feet,
went to the shed housing the entry to the service stair. A short flight of
steps led down to a storeroom. There were dusty boards, dried-up
paint cans, odd tools. I picked up a five-foot length of two-by-four and
a hammer with one claw missing, and stepped out into the hall. The
street was a long way down and I didn't feel like wasting time with
stairs. I found the elevator, got in and pushed the button for the foyer.

In a few seconds it stopped and the doors opened. I glanced out,

tightened my grip on the hammer, and stepped out. I could see the
lights in the street out front and in the distance there was the wail of a
siren, but nobody in the lobby looked my way. I headed across toward
the side exit, dumped the board at the door, tucked the hammer in the
waist band of my pants, and stepped out onto the pavement. There
were a lot of people hurrying past but this was Lima: they didn't waste
a glance on a bare-footed carpenter.
I moved off, not hurrying. There was a lot of rough country between
me and Itzenca, the little town near which the life boat was hidden in
a cañon, but I aimed to cover it in a week. Some time between now
and tomorrow I'd have to figure out a way to equip myself with a few
necessities, but I wasn't worried. A man who had successfully taken
up human-fly work in middle life wouldn't have any trouble stealing a
pair of boots.
Foster had shoved off for home three years ago, local time, although
to him, aboard the ship, only a few weeks might have passed. My
lifeboat was a midge compared to the mother ship he rode, but it had
plenty of speed. Once aboard the lugger ... and maybe I could put a
little space between me and the big boys.
I had used the best camouflage I knew of on the boat. The near-
savage native bearers who had done my unloading and carried my
Vallonian treasures across the desert to the nearest railhead were not
the gossipy type. If General Smale's boys had heard about the boat,
they hadn't mentioned it. And if they had: well, I'd solve that one when
I got to it. There were still quite a few 'if's' in the equation, but my
arithmetic was getting better all the time.

CHAPTER XIII
I took the precaution of sneaking up on the lifeboat in the dead of
night, but I could have saved myself a crawl. Except for the fact that
the camouflage nets had rotted away to shreds, the ship was just as I
had left it, doors sealed. Why Smale's team hadn't found it, I didn't
know; I'd think that one over when I was well away from Earth.
I went into the post office at Itzenca to pick up the parcel Margareta
had mailed me with Foster's memory-trace in it. While I was checking
to see whether Uncle Sam's minions had intercepted the package
and substituted a carrot, I felt something rubbing against my shin. I
glanced down and saw a grey and white cat, reasonably clean and
obviously hungry. I don't know whether I'd ploughed through a field of
wild catnip the night before or if it was my way with a finger behind
the furry ears, but kitty followed me out of Itzenca and right into the
bush. She kept pace with me, leading most of the time, as far as the
space boat, and was the first one aboard.
I didn't waste time with formalities. I had once audited a briefing rod
on the boat's operation—not that I had ever expected to use the
information for a take-off. Once aboard, I hit the controls and cut a
swathe through the atmosphere that must have sent fingers jumping
for panic buttons from Washington to Moscow.
I didn't know how many weeks or months of unsullied leisure
stretched ahead of me now. There would be time to spare for
exploring the boat, working out a daily routine, chewing over the
details of both my memories, and laying plans for my arrival on
Foster's world, Vallon. But first I wanted to catch a show that was
making a one-night stand for me only: the awe-inspiring spectacle of
the retreating Earth.

I dropped into a seat opposite the screen and flipped into a view of
the big luminous ball of wool that was my home planet. I'd been
hoping to get a last look at my island, but I couldn't see it. The whole
sphere was blanketed in cloud: a thin worn blanket in places but still
intact. But the moon was a sight! An undipped Edam cheese with the
markings of Roquefort. For a quarter of an hour I watched it grow until
it filled my screen. It was too close for comfort. I dumped the tabby
out of my lap and adjusted a dial. The dead world swept past, and I
had a brief glimpse of blue burst bubbles of craters that became the
eyes and mouth and pock marks of a face on a head that swung
away from me in disdain and then the sibling planets dwindled and
were gone forever.
The life boat was completely equipped, and I found comfortable
quarters. An ample food supply was available by the touch of a panel
on the table in the screen-room. That was a trick my predecessor with
the dental jewellery hadn't discovered, I guessed. During the course
of my first journey earthward and on my visits to the boat for saleable
playthings while she lay in dry-dock, I had discovered most of the
available amenities aboard. Now I luxuriated in a steaming bath of
recycled water, sponged down with disposable towels packed in
scented alcohol, fed the cat and myself, and lay down to sleep for
about two weeks.
By the third week I was reasonably refreshed and rested. The cat
was a godsend, I began to realize. I named her Itzenca, after the
village where she adopted me, and I talked to her by the hour.
"Say, Itz," said I, "where would you like your sand-box situated? Right
there in front of the TV screen?"
No, said Itzenca by a flirt of her tail. And she walked over behind a
crate that had never been unloaded on earth.
I pulled out a box of junk and slid the sand-box in its place. Itzenca
promptly lost interest and instead jumped up on the junk box which
fell off the bench and scattered small objects of khaff and metal in all
directions.
"Come back here, blast you," I said, "and help me pick up this stuff."
Itz bounded after a dull-gleaming silver object that was still rolling. I
was there almost as quick as she was and grabbed up the cylinder.
Suddenly horsing around was over. This thing was somebody's
memory.

I dropped onto a bench to examine it, my Vallonian-inspired pulse

pounding. Itz jumped up into my lap and nosed the cylinder. I was
trying to hark back to those days three years before when I had
loaded the lifeboat with all the loot it would carry, for the trip back to
Earth.
"Listen, Itz, we've got to do some tall remembering. Let's see: there
was a whole rack of blanks in the memory-recharging section of the
room where we found the three skeletons. Yeah, now I remember: I
pulled this one out of the recorder set. I showed it to Foster when he
was hunting his own trace. He didn't realize I'd pulled it out of the
machine and he thought it was an empty. But I'll bet you somebody
had his mind taped, and then left in a hurry, before the trace could be
color-coded and filed.
"On the other hand, maybe it's a blank that had just been inserted
when somebody broke up the play-house.... But wasn't there
something Foster said ... about when he woke up, way back when,
with a pile of fresh corpses around him? He gave somebody
emergency treatment and to a Vallonian that would include a
complete memory-transcription.... Do you realize what I've got here in
my hand, Itz?"
She looked up at me inquiringly.
"This is what's left of the guy that Foster buried: his pal, Ammaerln, I
think he called him. What's inside his cylinder used to be tucked away
in the skull of the Ancient Sinner. The guy's not so dead after all. I'll
bet his family will pay plenty for this trace, and be grateful besides.
That'll be an ace in the hole in case I get too hungry on Vallon."
I got up, crossed the apartment and dropped the trace in a drawer
beside Foster's own memory.
"Wonder how Foster's making out without his past, Itz? He claimed
the one I've got here could only be a copy of the original stored at
Okk-Hamiloth, but my briefing didn't say anything about copying
memories. He must be somebody pretty important to rate that
service."
Suddenly my eyes were rivetted to the markings on Foster's trace
lying in the drawer. "Zblood! The royal colors!" I sat down on the bed
with a lurch. "Itzenca, old gal, it looks like we'll be entering Vallonian