Better treatment and preventive measures can save lives.
Thomas Joiner was a graduate student in clinical psychology, studying depression, when he noticed that his father wasn’t himself. But Joiner had read about the kind of people who commit suicide — and his father, a gregarious successful businessman, didn’t fit the profile. A few weeks later, the police found his father in a parked van with a fatal knife wound in his heart and slashes on his wrist.
Joiner’s response was to fight back. “This thing killed my dad, and so it's a point of honor for me to try and kill it,” he says. “My weapon in this war is science.”
Joiner, the author of “Why People Die By Suicide” and “Myths about Suicide,” notes that there are some 200 risk factors for suicide — including genes, depression and other mental illness, and early life experiences. In the model he has developed, these factors contribute to three forces that lead to suicide attempts: a belief that you are a burden to others, a sense of alienation or isolation, and a learned fearlessness about death.
Suicide rates have increased by 60 percent worldwide in the last 45 years, the World Health Organization reports. In the United States, suicide rates dropped from 1986 to 2000, but then increased to reach the earlier level, accounting for about 14 deaths for every 100,000 people in the U.S.
As Joiner experienced, most of us haven’t heard accurate information about suicide. Better insight can help us respond appropriately to the bereaved and save lives.
Claim: Suicide is selfish. Response: People who commit suicide tend to think that they're relieving others of a burden, Joiner argues. In the grip of depression or other mental illness, killing themselves feels like the opposite of selfishness. Ordinary suicides share that misconception with suicide bombers, who are convinced they're doing a noble service.
Claim: Suicide is an impulsive act. Response: Suicide actually requires enormous courage, which develops over time. “To imagine that people would just, on a whim, on the spur of the moment, be able to engage in something that dramatic and that fearsome…completely misunderstands human nature,” Joiner says.
Claim: The signs are obvious. Response: Some people contemplating suicide seem to be functioning normally, while inwardly they’re miserable. Joiner notes that a team who filmed people walking on Golden Gate Bridge, a frequent site for suicidal jumps, thought they could spot the vulnerable people, and it turned out they were wrong.
If you do observe danger signs, do everything possible to steer the sufferer towards professional help. According to the American Foundation for Suicide Prevention (AFSP), you should take it seriously if you hear someone talk about killing themselves, having no reason to live, being a burden to others, feeling trapped, or experiencing unbearable pain. They may be reacting to a painful event by giving away possessions, visiting or calling people to say goodbye, withdrawing from activities, shutting out family and friends, or acting recklessly or aggressively. Heavy drinking is particularly dangerous: The AFSP reports that alcohol is estimated to be a factor in at least 25 to 30 percent of all suicides.
Claim: Anyone who really wants to die will succeed. Response: Even among people who have been hospitalized because they were suicidal, less than 9 percent actually die by suicide, according to one estimate. The AFSP reports various ways to save lives. Most research about barriers on bridges or restrictions on guns or pills have found declines in suicide rates. When suicidal people encounter a barrier on a bridge, they don’t all find another bridge or another method of suicide. When people who attempt suicide receive specific kinds of therapy they are less likely to make another attempt over the next 18 months. In another study, people who attempted suicide received letters every month for the first four months, every other month for the next eight months, and every three months for the next four years. Their rate of suicide was significantly lower than in comparison groups.
Claim: Since suicide is wrong, it's best to keep it a secret or not mention it. Response: Treat the bereaved as you would treat anyone who lost a loved one. “The memory of it, the pain of it, it'll lessen – for sure – with time, but it never really goes away. And all of that is just compounded by some of the – frankly appalling reactions that people have to the bereaved of suicide decedents. It's just such a stigmatized and misunderstood thing that the family members left behind have really, really quite a burden to carry,” Joiner says.
February 21, 2020
Christopher Nystuen, MD, MBA