It has been my intention in this book to explore the ways in which literary reading can help people who are contemplating suicide decide to stay alive. I have also sought to demonstrate how literary reading can interact with theoretical perspectives from social psychology and philosophy to enhance our understanding of the suicidal experience.

Using evidence from epidemiological and literary sources, including the World Health Organisation and James Joyce, I have shown that suicidal thoughts and actions are common occurrences. I have discussed a range of sociological, psychological and anthropological theories explaining why people consider ending their lives, interweaving these together with the substantial literary testimonies of Leo Tolstoy, with particular focus on the characters of Anna Karenina and Konstantin Levin, and with the poetic insights of Gerard Manley Hopkins. I have linked these with my own experiences and those of patients whom it has been my privilege to encounter; all the while acknowledging, with Anna Karenina, my patient Charlie and David Foster Wallace, the unresolvable uncertainties around the inevitability or otherwise of the suicidal act.

With the help of Tolstoy and Hopkins, ably supported by Al Alvarez and Stevie Smith, I have explored direct personal experiences of facing the dilemma of existence and how ending one's life can appear to be the only viable option. And with Tolstoy's particular insights, I have imagined with Anna Karenina what the last few moments of life might actually be like.

I have reflected on the question of why people in the depths of despair might consider staying alive and found a wide variety of responses, ranging from Hamlet's fear that death may be even worse, through the conviction of Alvarez and Schopenhauer that suicide provides us with no answers, to the sense of compassion – for self and others – which (eventually) radiates through the poetics of Hopkins and emerges in the philosophy of Schopenhauer. I have noted how Hopkins’ determination to survive is reflected in the conatus of Spinoza and how even the deeply ambivalent Stevie Smith encourages us to keep on keeping on. I have shown how Peter Porter and Seamus Heaney have chosen to confront and challenge the seriousness of living and considered Matt Haig's literary and Galen Strawson's philosophical reflections on the infinite possibilities of existence.