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What’s Really Behind America’s Suicide Epidemic?

• February 17, 2014 • 10:00 AM

(Photo: Axstokes/Shutterstock)

The means—prescription drugs, access to firearms, bridges without prevention methods—play a much bigger role than any emotions or thought processes.

In the 19th-century, French researcher Emile Durkheim calculated the ideal temperature for suicide: 82 degrees Fahrenheit. It was his compatriot Albert Camus who, a half-century later, then asked not under what conditions people kill themselves, but why. “There is but one truly serious philosophical problem,” he said. “And that is suicide.”

While the science behind suicide research has certainly improved since Durkheim and Camus’ times, the quest to understand the phenomenon is still two-pronged, a question of both how and why.

What must go so wrong that someone would fight against every survival instinct, every ounce of biological drive to end their life? Why did 40,000 Americans kill themselves last year, the most in recorded history? How has—as a new study published in January by JAMA Psychiatry revealed—suicide become not only the leading cause of “injury” death in America but also the leading cause of death for people between the ages of 15 and 49, now surpassing even cancer?

Suicide stems from four feelings that coalesce to make a deadly cocktail, according to a new theory by Thomas Joiner, a professor at Florida State University, as presented in a comprehensive article in The Daily Beast last year. The equation is made up of Thwarted Belongingness (“I am alone”), Capability (“I am not afraid to die”), Perceived Burdensomeness (“I am a burden”), and Desire, according to Joiner.

While the myth prevails that most suicides are pre-meditated, nearly half of suicide attempt patients reported that the time elapsed from their first thought of suicide to the actual attempt was a mere 10 minutes.

Under this theory, suicides can be explained entirely by a person’s emotions and thought processes. If you are lonely, fearless, and have a feeling of social meaninglessness, then there’s a high probability that if you want to die, you’ll find a way.

Joiner’s theory is understandably popular because it points to mental illness and emotional instability as the exclusive culprits for suicide. When we consider David Foster Wallace or Sylvia Plath or Virginia Woolf or Alexander McQueen or any of the other “famous” suicides victims, it’s easy to draw the conclusion that suicides are based solely on feelings, that it’s possible for one to be, somehow, too emotionally fragile.

And yet, this theory fails to account for something rather simple: the means. Not everyone is suicidal. In fact, most are not. Most suicides are “impulsive”—a gun to the head, a jump from a bridge—and were there not, say, loaded firearms around or bridges without suicide guards, tens of thousands of lives could be saved.

The story of British coal gas goes a long way in helping to explain how, in the case of suicide, means can trump both feelings and mental illness. For a long time, the majority of people living in Britain fueled their stoves and heated their homes with coal gas. It was cheap and never in short supply. But it was also lethal. Coal released dangerously high levels of poisonous carbon monoxide; a leaky valve could wipe out an entire household. If you wanted to kill yourself, you could simply open a valve and be asphyxiated (similar, today, to stuffing your car’s tailpipe and closing the garage door). By the 1950s, “sticking your head in the oven” accounted for about half of the country’s total suicide deaths.

In 1958, natural gas—essentially free of carbon monoxide—was introduced into Britain, and, by 1971, accounted for 69 percent of all gas used in British households. As a contemporary study showed, total suicides in Britain dramatically decreased by one-third.

While the myth prevails that most suicides are pre-meditated (only 29 percent of people believe suicides most often happen without previous warning), nearly half (48 percent) of suicide attempt patients reported that the time elapsed from their first thought of suicide to the actual attempt was a mere 10 minutes. Make following through just a little bit harder, and many people will have the time to think twice. In fact, if you take away the means for suicide just once, most people will never try again.

Around the same time that Britain moved away from using coal gas, Richard Seiden, a professor emeritus and clinical psychologist at University of California-Berkley, was studying “suicidal inevitability” across the Atlantic. What he wondered was whether failed “impulse” suicide attempts led to later suicides. Being in northern California, he obtained a police department list of “failed” jumpers from the Golden Gate Bridge over a 34-year period. There had been 515 thwarted suicide attempts off the bridge, but only 31 people—or six percent—actually killed themselves later through a different means. In fact, one person Seiden interviewed decided against jumping off the bridge because he was afraid he would be hit by a car on his way across the street.

Seiden’s conclusion was that many suicides are the result of impulsive thoughts—“I want to jump off that bridge”—and if you can stop that one action, you can save potential victims from suicide for the rest of their lives. People do not become inherently “suicidal;” they have times where they feel suicidal.

And yet, since 1999, there has been a consistent annual increase in suicides all the way up to the end of 2013—and there’s no sign of slowing. What’s different now?

As a recent CDC report showed, almost the entire rise in suicides is attributable to the 45- to 64-year-old demographic. Baby Boomers are ending their lives in record numbers, and they’re almost single-handedly raising the national suicide average. As for why, the answer lies in a sort of Revolutionary Road, white-picket-fence malaise: a feeling of suburban entrapment and existential claustrophobia.

In the 1960s, the great sociologist Lewis Mumford noted, “The suburb served as an asylum for the preservation of illusion.” Although members of the American middle class are often told they are free, suburbia tends to take away independence with its social rules and emphasis on homogeneity.

As the world has become increasingly developed, people are dying not because they cannot feed themselves or because they contract an illness for which there is no treatment. As Julie Phillips, a Rutgers University sociologist, and much of her academic cohort have suggested, Baby Boomers are dying due to the rise of the number of people living alone (loneliness), higher bankruptcy rates, higher health care costs, and a shaky economy that has led to long-term unemployment. Like Richard Yates’ April Wheeler or Jeffrey Eugenides’ Lisbon sisters, a majority of people are killing themselves because they’ve become trapped in a social system, the very same system that they or their families believed would give them stability and therefore set them free.

Yet even in these instances, the highest cause of suicide is prescription pill overdose, which, with more comprehensive mental health screenings by doctors, could be curtailed. Minimizing the means for suicide isn’t just relevant to bridge jumpers and mid-20th-century Britons; prevention cuts across all demographics.

That said, we should remember that there are also the rare instances of premeditated suicide, where the victim will ultimately prevail. These deaths rest outside the most typical definitions of mental illness, and taking away “the means” might make them slightly more difficult to accomplish, but, eventually, won’t matter.

I spoke with a friend whose father killed himself after struggling with guilt and depression over his own sexual addiction. His death took three attempts, but one evening his daughter found him motionless on his bed, an empty pill bottle on the floor.

“Without his will to live, there was no saving him,” she says. “With each failed attempt, I knew we were getting closer to an inevitable end.”

No matter what we do as a society, people will likely continue to kill themselves, and there will almost certainly always be feelings of loneliness and guilt and depression that even the best treatments cannot solve. Yet, we can better understand the difference between impulse suicides and pre-meditated ones. We can realize that making it more difficult to buy a firearm or get prescription pills, that putting up suicide guards on bridges, that recognizing impulsive behavior before it manifests into a suicide attempt, will make a significant difference. And even if we can’t entirely solve Camus’ philosophical dilemma of why people desire their own death, embracing our understanding of how people kill themselves (and then taking away those means) would surely make Durkheim proud.

Cody Delistraty
Cody Delistraty is a writer, researcher, and historian. Most recently he has worked at the Council on Foreign Relations, UNESCO, and NBC News. Follow him on Twitter @delistraty.

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