It has long been suggested that one person’s suicide is destructive for other people and that suicides sometimes come in clusters. Recall, for instance, that the young women of Miletus suddenly started killing themselves at an alarming rate several hundred years before Plutarch wrote about the story in the first century B.C.E. These suicides have commonly been understood as a chain of influence.
A few early attempts to examine suicidal influence in scientific terms came in the nineteenth century. In 1845 Amariah Brigham, the first editor of the American Journal of Insanity, approvingly cited the medical statistician William Farr’s finding that imitation is often a source of suicide. Farr put it in the dramatic terms that “a single paragraph may suggest suicide to twenty persons.”1 As he explained it, the act, as well as its particular details, seizes the imaginations of those who learn of them, and who, in a moment of distress, are powerfully drawn to repeat it. A later editor of the same journal also wrote of suicidal influence and explained that some of this imitation occurs because one victim uses the fact of an earlier suicide to justify his own.2
Some observers even tried to warn their communities against publicizing a suicide. In 1837 the physician Isaac Parrish wrote of a suicide cluster. He told of an adolescent woman who killed herself a few months after the young woman had witnessed the male head of her household, called J.S., attempt suicide. Closer to her own death she had read a newspaper report of a man’s death by the intentional swallowing of arsenic. This was the method of suicide by which she herself died. Nine months later, J.S. killed himself as well. Jacob Heckstor, who lived five blocks from J.S., killed himself soon after. In the same year Albert Davis, who also lived five blocks from J.S., took his own life as well. Parrish concluded that these deaths were connected and that the newspaper reports of them were a powerful force behind the cluster. He presented his findings to the American medical profession, along with cautions against newspaper reports of suicide, but his suggestions were not heeded.3
Also in the nineteenth century, we find evidence of coroners refusing to return an object used in a suicide to the victim’s family, fearing that the gun, cup, or razor might take on a pernicious fascination and be used for the same purpose again. Likewise, coroners counseled against broadcasting any unusual method or place of suicide lest it enact a dangerous attraction upon others. Some even wrote of “emotional contagion,” while others simply spoke of imitation.4
Today’s sophisticated statistical research bears out these intuitions. Sociological studies have found evidence that a person taking his or her own life increases the likelihood of another person doing so. Parent suicides are easily the most dramatic and damaging influence, but there are examples in other communities, such as workplace, school, and neighborhood, as well as suicide clusters centered on popular culture. Media reporting on suicide can also result in suicides. One insight from this research is that “like affects like.” Suicide influence is strongest on those who are close to the victim in some way, or like them, in all meanings of that word. It has been repeatedly demonstrated that the report of suicide results in a rise in suicides of those similar to the victim in age and gender. Beyond the sociological and epidemiological studies, the notion of suicide influence is a common truth of clinical psychology. Counselors consider it a risk factor for suicide when a person reports having known someone who died this way. The sociological fact that suicide influences suicide leads to a philosophical idea: that it is morally wrong to kill oneself. A key predictor of suicide is knowing a suicide, and that means that in killing yourself you are likely to be killing someone else too, by influence. This claim can be shown to be valid in poetic as well as scientific terms, but here we are concerned with what we can measure.
The first step in demonstrating suicidal influence is to look at the fatal harm a parent’s suicide often causes. A 2010 study from Johns Hopkins University in the May 2010 issue of the Journal of the American Academy of Child and Adolescent Psychiatry showed that children (eighteen years old or younger) of suicide victims are three times as likely to commit suicide at some future point, compared with people who reach eighteen with neither parent having committed suicide.5 The study looked at the whole Swedish population over thirty years. Investigators in Sweden and the United States examined suicides, psychiatric hospitalizations, and violent crime convictions in more than 500,000 Swedish children, teens, and adults under the age of twenty-five who had lost a parent to suicide, accident, or disease compared with nearly four million children, teens, and young adults with living parents. A suicide by a parent while a child was under the age of eighteen tripled the likelihood that that child would commit suicide. Children under thirteen who lost a parent to illness had no increased risk for suicide when compared with children with living parents. The study also found that children who lost parents to suicide were almost twice as likely to be hospitalized for depression as those with living parents; those who lost parents to accidents had a 30 percent higher risk for hospitalization for depression, and for those who lost parents by illness the risk was 40 percent higher.
To be sure, the case of parents is complicated. Being left voluntarily by a parent causes anguish no matter how the parent goes; mental illness can have a genetic component; and parents displaying tortured behavior can traumatize a young person such that the child becomes suicidal. Any of these factors might suggest that what happens to the child is not necessarily due to knowing that the parent took his or her own life. Yet the numbers overpower these objections. When a parent leaves, or dies unintentionally, or displays emotional torment, it may cause a lot of sadness, but it doesn’t triple the children’s suicide rate. From this numerical relationship alone we can see that suicide’s influence to cause suicide is enormous. We have seen that children of a suicide have reported feeling haunted by thoughts of that parent and his or her fatal final act. Friends of someone who has committed suicide have reported experiencing a similar obsession. This study of parents and children, however, shows that the experience of suicide in this relationship is the most cataclysmic. As further evidence that the biological inheritance factor was not dominant, the researchers did not include children with psychiatric or developmental disorders who were treated before the parent’s death; thus the influence of parental suicide may be even more marked than the study suggests.
It is hard not to think of Sylvia Plath killing herself in her kitchen in England, while her children slept, and some forty-six years later and half a world away, her son Nicholas Hughes taking his own life, too.
Researchers have found that women with dependent children often feel inhibited from committing suicide, except for those who have been victims of incest.6 More generally, women who have been raped are thirteen times as likely to attempt suicide as those who have not.7 But the aspect of being an incest survivor seems to be particularly life-threatening, and it is striking to see that even having young children offers little protection against a suicidal impulse. This contrast, though, is important to note. It means that both the past and present circumstances of people’s lives—their psychic scars as well as the obligations of the parent of young children—contribute to their assessment of the permissibility of suicide. It also reconfirms that the concept that we need one another is already in place, though perhaps too localized, restricted to children needing mothers, when in fact it is all of us needing one another.
Another measure of suicide influence is the phenomenon of suicide clusters. These spikes in the suicide rate of a local population are well documented. The consensus of many studies is that, through often quite remote influence, the early suicides in a cluster partially cause the later ones. We will consider the phenomenon of adult clusters before moving on to the much more heavily documented cases of suicide clusters influencing young adults.
In sociological or epidemiological literature it is often said that suicide clusters are largely exclusive to teens and young adults. They certainly appear to be, as we mostly notice them in high schools and colleges. However, suicide clusters of a sort may also happen with adults, just less visibly. The meaningful relationships of people past the age of thirty may be too geographically spread out to allow us to notice that a feeling of connection to a person who has committed suicide has influenced other people to commit suicide.
Among adults, geography camouflages our spheres of influence. Finding out that your old friend killed himself can be painful. Even if you had not seen one another for a long time; even if the last time you spoke, you were annoyed with each other. Different work-related communities have different levels of personal interaction, but all groups that have blogs, websites, and listserves, as well as actual hangouts and annual conferences, are social fields that can be sensitive indeed to what happens to one of their own. We cannot know how many people feel an acute loss when someone commits suicide. There is also the factor of a sense of permission, that if suicide was a route out of problems for one person, it might be considered by the second person as an acceptable route out of her own problems. By full adulthood, we have met so many people, studied with so many, worked with so many, and lived in so many communities, that each of us may belong to a multitude of distinct groups touched by suicide. We can measure the impact only by asking people whether they have been emotionally distressed by having known, or known of, someone who killed himself. In my canvassing of the literature and of survivors, the answer is that suicide strikes most people with crushing force. Close friends report grievous suffering over many years. Casual friends report an increase in suicidal thoughts, also for years. It must be recognized that staying alive though suicidal is an act of radiant generosity, a way in which we can save each other.
In his book Suicide Clusters, Loren Coleman points out the suicide clusters in adult professions.8 One of his examples is what Coleman called “town fathers.” In the period of 1973 and 1974 the town of Dueren experienced a wave of suicides among prominent town members. One of the best-known doctors was the first, shooting himself in the head. Next was a notary who used a noose. Then a chief doctor in the local hospital took poison, and in the next month a local official hanged himself. The victims all knew each other. Another cluster Coleman cites occurred among policemen. In one week in 1986 three Boston policemen died at their own hands by gunshot. In the next month, a private detective working in the same area also shot himself. Another police suicide cluster occurred in New York City, with seven police suicides in the same year, and yet another early the next year in nearby Suffolk County.
Coleman notes that generally such phenomena are interpreted as related to the stress of the job, but that behavior contagion seems to be an important factor that should not be overlooked. He also notes suicide clusters in the 1970s and 1980s involving gay men, particularly those diagnosed with AIDS. The phenomenon was severe enough to register with some researchers as a suicide epidemic. Finally, Coleman speaks of a cluster of suicides by farmers. In 1985 an indebted farmer shot himself, and in the aftermath the country experienced an increase in farmer suicides. The chief of statistics at the Minnesota Department of Health reported that between thirty and fifty of the state’s four hundred suicides each year were from farm families. As with the other clusters there were intense pressures acting on the group as a whole, in this case the crisis in agriculture, but there is also an implication of cultural scripting or contagion. One person in a given situation deals with his problems by committing suicide and others are both struck by the loss and influenced to see suicide as a way out of their own difficulties.
A quarter of a century after Coleman’s book was published, the staggering losses to suicide in the military constitute one of the worst suicide clusters in history. The number of suicides in the U.S. Army set records in 2007, 2008, and 2009 (hitting 162 in 2009). In June 2010 alone, the branch had 32 suspected suicides. There may have been even more, as is explained in an article in Harvard magazine: “If accidental death through risky behavior—such as drinking and driving, or drug overdose—is included, more soldiers now die by their own hands than die in combat.”9
Shocking new Pentagon data showed U.S. troops were killing themselves at the rate of nearly one a day in 2012; the final count for the year was 349—more than died in combat. The army lost 182 soldiers to suicide, as compared with the 176 members lost to Operation Enduring Freedom. Overall, since the war in Afghanistan began more members of the U.S. military have taken their own lives than have died in the fighting there. Across the United States military suicides were up 16 percent from 2011.10 This is all the more striking since historically the civilian population always had a significantly higher suicide rate than the military. The reason for the shift is not well established, but repeated tours of duty have given rise to a higher rate of posttraumatic stress disorder, which in turn generates an increase in suicide attempts. But there are limits to this explanation. An article in Time magazine’s July 2012 issue entitled “One a Day” makes the important point that nearly a third of the suicides in the five years from 2005 to 2010 were among troops who had never deployed, 43 percent among those who had deployed only once, and only 8.5 percent among those who had deployed three or four times.11 This Time article does not mention suicide influence on other suicide but an online Time article on the subject (by one of the same authors) mentions that issue: “There is a sense, some service members say, that suicide—or at least suicide attempts—can be contagious.” A study released in June of 2013 showed that in the years from 2008 through 2011 a full 52 percent of military suicides were people who had never been deployed. These numbers suggest that the military suicides are a result not of individuals being exposed to horror but of a community that has now experienced so many suicides that voluntary death has become part of the culture.12
Looking specifically at soldiers, a study by Russell B. Carr showed the profound and devastating impact on both comrades and caregivers. In his commentary on Carr’s paper, suicide expert Matthew K. Nock writes that recent research offers better prediction of who is in danger, through genetic and behavioral inquiry.13 There is some evidence for the benefit of prevention programs employing physician educators, training “gate-keepers,” and restricting suicidal opportunities.14
In another look at adult cases suicidal influence has been understood as “cultural scripting.” A study of suicide in the U.S. Mountain West found that older American and European men were apt to kill themselves after being diagnosed with a serious illness, and concluded that these men had a cultural script of defending one’s masculinity by responding to illness with suicide.15 The authors held that suicide is culturally patterned and that each man who enacts this script keeps it potent for the other men around him.
In the past suicide has been most prevalent among the young and in elderly men, but lately there has been a rise in the rates of suicide among middle-aged Caucasians, especially middle-aged white women. The category is broad, but it is worth asking whether some aspect of suicide clusters or cultural scripting is contributing to the phenomenon. According to a study from Johns Hopkins University, from 1999 to 2005 the overall suicide rate rose 0.7 percent, while the rate for white men aged forty to sixty-four rose 2.7 percent and the rate for middle-aged white women rose a full 3.9 percent.16 Another way of looking at this is that baby boomers killed themselves at a relatively high rate as adolescents, and they continue to do so in middle age. Sociologist Ellen Idler of Emory University has posited that the earlier suicides contribute to the current rise. She cites clinical studies that have shown that knowing a suicide makes one more prone to suicide and concludes that the higher rate of teen suicides a few decades ago may be having a reverberating effect now.17
The example of celebrities can give us further insights into the likelihood of suicide influence among adults. When celebrities die by their own hand, there is a rise in suicide nationally. The sociologist David Phillips first began writing about this phenomenon in 1974. In the month following Marilyn Monroe’s overdose, there was a 12 percent increase in suicides in America, with 197 more cases than usual. Phillips called it the “Werther Effect,” alluding to Goethe’s novel. Phillips’s “Werther Effect” was met with some skepticism at first, but gradually became the sociological consensus on the subject.
Phillips’s research showed a strong relationship between the age and gender of the particular famous person who died by his or her own hand and the age and gender of the population whose suicide rate then spikes. This relationship, too, has held up under scrutiny. A famous young female suicide yields a rise in young female suicides. It works for older women and for older men too. When Phillips couldn’t find a significant rise in suicides in young males after a suicide by a famous young male, he found, instead, that one-person fatal car accidents involving young males did increase—enough to close the gap.18
We do not always know whether suicides in a certain demographic were well known to others in that demographic, but we do have studies of close communities in which a suicide was known to all. The authors of one study report an epidemic of six inpatient suicides in a psychiatric hospital in Finland.19 They found that the timing and the methods of the suicides were influenced by suggestion and identification. The authors report that an increase in inpatient suicide rates has been reported from many countries, and the Werther effect is thus likely to be of considerable importance in psychiatric hospitals. People who are already severely depressed and/or anxious are particularly susceptible to suicidal influence, so psychiatric hospitals are likely to be particularly vulnerable to suicide clusters. Furthermore, members of small communities may have unusually strong influence on one another, and for this reason too, psychiatric hospitals may find it important to offer a robust response to patients in the wake of a suicide. That might take different forms in different circumstances, but in general, directly discussing the problem seems to be beneficial, as does giving patients additional contact with their psychiatric caregivers.
Some researchers have been able to isolate particular aspects of suicidal influence. The authors of a 1998 article reported that within the population studied in Manitoba it is common after a suicide for people to experience dreams of the suicide victim beckoning them to follow the victim into death.20 This phenomenon of dreaming that a suicide victim is waiting for the dreamer in the afterlife and encouraging the dreamer to join him or her has been noted by other researchers. In the Manitoba First Nations community discussed in this article, there were six suicides in a population of fewer than fifteen hundred in three months, and several other suicide attempts occurred in the same time frame. The community was notably isolated. First Nations communities are particularly hard hit by suicide clusters, and studies of the phenomenon reach back several decades. One such article, from 1977, reveals that suicides were brought on by various specific stressors, including a loss of extended family and lack of a sustaining social life, but the authors conclude that the influence of knowing a previous suicide acted as a kind of “last straw” factor.21
Exceedingly careful theorists still caution against assuming that every suicide cluster is due to contagion; after all, in some cases similar stressors acted on each victim independently. Furthermore, some studies have found no rise in suicide due to media reporting, for instance. (Still, there are many more articles supporting suicide contagion than arguing against it.) The theory still has some skeptics, but even challengers often find the evidence troubling.22
It is also true that sometimes when scientists report that a cluster is not specifically due to contagion from the first victim to the next ones, they are merely acknowledging that rather than strict imitation, the first person’s suicide saddened the next person, whose depression then led its own course toward suicide.23 Both these definitions fit under other researchers’ definition of contagion, and both are included in what we are trying to establish here: that a suicide can contribute fatal harm to others. On this point there is a great deal of agreement.
We have touched on a number of themes already, but the main point up to now has been to highlight suicide imitation in adults or groups containing adults. We now turn to the more plentiful literature arguing that suicidal influence is real and powerful among younger people.
Some studies concerning suicide in and around the teenage years highlight personal contagion, while other studies look at media contagion. Both often also discuss “post-vention,” the term researchers and psychologists use for action taken to prevent a suicidal cluster from occurring after an initial case. Though research often combines personal contagion and media contagion, we will largely examine personal contagion first. In looking at media contagion, adult suicide clusters are also often discussed alongside those of young people, so there will be some overlap here as well.
On the subject of personal contagion in young people, consider, for instance, the findings of a 2001 study of high school suicide contagion.24 Focusing on several secondary schools that had each experienced at least one student death in this manner, the researchers examined whether a suicide at a school predicted more suicides. They were able to show that after the first event, indeed, the number of additional suicides at the school increased markedly beyond chance. However, schools that provided “talk-throughs and psychological debriefing” by a mental health professional saw no new suicides. The study examined crisis intervention in three secondary schools following the suicides of five students, focusing on the relation between suicide contagion and crisis intervention. The contagion hypothesis was supported. There is agreement among experts that intervention in a community can be very effective. Influence is real and it works in both directions, toward death or toward life.
A group of researchers from Sweden studied two suicide clusters.25 In the first cluster, three teenagers who knew one another committed suicide by hanging within an eleven-month period. Two lived in the same industrial community adjacent to a city where the third victim lived. The first case was a seventeen-year-old boy who regularly attended a church to which the parents of the third suicide victim belonged. His parents perceived him as being “depressed” the last few months before the suicide. He never received psychiatric treatment. Eight months later, a seventeen-year-old girl committed suicide. She lived and worked close to where the first young man lived. She did not exhibit problems at school and had many friends. Eleven months after the first victim, the third teenager, a fourteen-year-old girl, committed suicide. She had known the young man as a friend. Almost from the day he committed suicide she expressed suicidal thoughts. The parents contacted a child and adolescent psychiatric clinic and attended several sessions with a psychologist.
In the second cluster, three teenagers committed suicide by jumping from a tower and by hanging within a seventeen-month period. They lived on the same block in the same city and they knew each other. The first case was an eighteen-year-old boy who had a history of problems with schoolmates. He spent more time at home than usual before the suicide and was described by his parents as reserved. Some time before the suicide he disappeared from home, and his concerned parents found him near the tower from which he later leaped. A seventeen-year-old boy was the second victim fourteen months later. He was uneasy at school, and his parents had noticed that he had been quieter the last few days before the suicide. He told them that he was going to visit a friend, but instead he went to the same tower from which the first boy had jumped, left a suicide note there, and leaped to his death. Three months later the third case, a sixteen-year-old girl, committed suicide. She identified the second victim by name in her suicide note, saying that she was now going to talk to him. During her last year, she had an intense interest in suicide-related information, such as newspaper articles about suicide and music by artists who had committed suicide.
Frank J. Zenere, the author of another article that considers personal suicidal contagion, was called in as a consultant on several suicides. He was asked to determine whether the events were, indeed, a cluster.26 What he found was that over a thirteen-month period, six violent deaths of teenagers were reported, five clearly suicides and the other suspected to be so. All the victims were male; four went to the same school, the two others to a school nearby. The rate of suicide exceeded that which would be normally expected. One victim survived for a brief period before dying, and a large number of young people kept a bedside vigil, including some of the teens who eventually killed themselves as well. One victim was a pallbearer at the previous victim’s funeral. The day before the fourth victim’s suicide, the third victim’s mother gave him some of the clothing of her deceased son; the fourth victim used that clothing to hang himself. The fifth victim lived four houses away from the fourth. Victim six was a friend or classmate of victims one and three and attended their funerals. All six had been diagnosed with forms of depression or showed signs of mood disorders. Based on these facts Zenere concluded that these tragic events were, with a high probability, eventuated by a strong imitative contagion. He also noted that school psychologists can do much in identifying the factors that promote contagion, and that suicide is a public health problem that should be addressed with a public health solution.
This thesis is reiterated in David Miller’s Child and Adolescent Suicidal Behavior: “A primary purpose of postvention procedures is to prevent any further instances of suicidal behavior, a phenomenon known as suicidal contagion.”27 Knowing someone who commits suicide is here identified as a more potent factor than media influence, but both were shown to be significant.
School bullying of gay and lesbian students today is considered a clear danger for suicide. The author of a recent article shows that as a result of bullying and suicidal influence, a school district’s young people experienced an increase in suicides, attempted suicides, and calls to crisis centers regarding suicide.28
The authors of another study point out that the evidence suggests that it is not the closest friends of the suicide who are most at risk but rather peers who have psychiatric vulnerabilities.29 It is important to recognize that subsequent victims do not need to have been close to the previous victims. There are times when suicide contagion is brought on when a person desperately misses a person who has committed suicide, but other times it is more about the example set by the previous victim.
There also has been extensive study on the effect of media on suicide. Media depictions of suicide are dangerous to susceptible people in all age groups but seem to be particularly so to young people. We might begin by quoting the surgeon general of the United States, writing in 1999 that “evidence has accumulated that supports the observation that suicide can be facilitated in vulnerable teens by exposure to real or fictional accounts of suicide.” That was based on a great many studies, and these studies have continued to appear.
An article by A. Schmidtke and H. Hafner reviewed the evidence from several studies.30 In a West German study researchers looked at the suicide rates after a twice-broadcast television program featuring a suicide. In this study, it was possible to prove the Werther effect in suicides that occurred after the victims had watched fictional models. The program was a fictional miniseries called Death of a Student showing the railway suicide of a nineteen-year-old male student; it was broadcast once in 1981, and once in 1982. The researchers found such striking confirmation of suicide influence that their analysis has affected broadcast standards. What the researchers called “imitation effects” were most clearly observable in the groups whose age and sex were closest to those of the model. The effect lasted a couple of months. In the seventy days after the first time the show was broadcast, the number of railway suicides among fifteen-to-nineteen-year-old males went from an average of 33.25 for a period that length to 62, up 175 percent. For girls of the same age there was a rise of six suicides, and for other age groups there was smaller increase, and for this population the effect faded much faster.
Researchers found that increases observed after the first and second broadcast for men younger than thirty closely corresponded with the respective audience figures for the two showings. After the second showing the result was smaller but still significant on males, up seventeen, or 54 percent, and for young women, the increase was nine. During this time suicide by other methods did not decline, and the rate for all suicides stayed higher than average throughout the year. This strongly suggests that the suicides were not simply happening sooner rather than later or by different means because of the broadcast, but rather the broadcast was influencing people who would not otherwise have killed themselves.
Schmidtke and Hafner also report the results of another study concerning the airing of an episode of the British soap opera The Eastenders in which a woman takes an overdose of pills.31 In the following weeks, twenty-two overdosed patients came into the emergency room where the authors worked, compared with a weekly average of 6.9 for the previous ten months and 6.7 the previous ten years.
In a letter published in 1992 in the New England Journal of Medicine, researchers Elmar Etzersdorfer, Gernot Son-neck, and Sibylle Nagel-Kuess reported on the possible effect of the print media’s coverage of Vienna’s subway suicides.32 Since opening in 1978, the Viennese subway repeatedly has been used as a method of attempted and completed suicide. Though the number of suicides was low in the early years, suicides and suicide attempts began to increase in 1984. Dramatic reports on these suicides in the major Austrian newspapers raised concern about the effects of imitation in suicidal behavior. The Austrian Association for Suicide Prevention created media guidelines and requested the press to follow them beginning in June 1987. After these guidelines were released, the character of reporting on suicides changed considerably. Sensational articles ceased and the papers either printed only short reports, frequently on inside pages, or refrained from reporting the suicides at all. The number of suicides in the subway decreased abruptly from the first to the second half of 1987, and the rates remained low in the years examined. The overall suicide rate in Vienna decreased steadily (by 13 percent) from 1987 to 1990. The authors found that the striking relation between the change in reporting by the media and the number of subway suicides in Vienna supports the hypothesis that press reports of suicides may trigger further suicides.
In the United States studies of suicide contagion have increased awareness of the phenomenon and influenced the way the media tell us about suicide.33 One study shows what the researchers call a “dose-response” correlation between the amount of media attention a particular suicide drew and the increase of suicide in the general population.34 The U.S. government has for decades issued recommendations for reporting suicide, based on the findings of such studies, in the hope of minimizing the contagion.35 Many news outlets adopt the government guidelines or establish standards of their own to minimize any negative effects of their reporting. Typical print guidelines include omitting from the headline the fact of suicide, or at least its method, announcing instead merely that the person has died. The text of the article often informs readers that the death was a suicide, but journalists are frequently requested not to mention the method of suicide. Reporters are cautioned against sensationalizing any account of suicide, and often are advised, to that effect, to refer to suicide as a public health issue, not a crime. For the same reason many editors decline to print photographs of the victim in death, or pictures of grieving survivors, or of the funeral, instead showing an image of the person in life. If there is a suicide note, an account might mention that fact without quoting from the document. And instead of using such common phrases as “unsuccessful suicide attempt” and “successful suicide attempt,” articles often describe suicide attempts as either “completed” or not. Many editors believe that articles should not suggest that a suicide was brought on by a particular event or disappointment, in order to avoid the implication that suicide is an appropriate response to a setback. Instead of quoting from first responders to this particular suicide, journalists are often encouraged to consult with and quote suicide experts. Finally, some media outlets make it a policy to include in any such article information to help the reader find guidance if she or someone she knows seems to be at risk for suicide.
Adoption of guidelines like these appears to be beneficial. A study by Madelyn Gould, a psychology professor at Columbia University, and Patrick Jamieson and Daniel Romer, researchers at the University of Pennsylvania, suggests that suicidal influence from media is real and can be mitigated.36 The authors find abundant evidence from the literature on suicide clusters and the impact of the media to support the hypothesis that suicide is contagious. This contagion can be understood within the larger context of behavioral contagion: the rapid spread of any distinct behavior through a group. Another way of understanding contagion is through social learning theory.37 Citing a wide variety of research sources, the authors state that young people, in particular, are susceptible to the influence of reports and portrayals of suicide in the media. They found the evidence strong for the influence of news reports on suicide, citing several studies that have found dramatic correlation between televised portrayals and increased rates of suicide and suicide attempts using the same methods displayed in the shows. While acknowledging dissenting voices, the authors conclude that suicidal contagion should no longer be in doubt.
Fictional portrayals of suicide can have powerful negative effects, too. Studies in the 1980s found after the showing of a TV movie that included a suicide, there was an increase in hospitalization of adolescents who had attempted suicide.38 All of those interviewed reported having seen the program. Still, because there is less evidence that exposure to fictional suicides leads to more actual suicide, fewer guidelines exist for these portrayals. Gould, Jamieson, and Romer have argued that the influence of fictional suicides in popular media is considerable and that we ought to have better guidelines for it. They suggest reducing the harmful effects of both factual reporting and fictional portrayals by educating journalists and media programmers about ways to present suicide so that imitation will be minimized, and by encouraging media outlets to urge troubled viewers or readers to seek help.39
It is worth noting that television programmers focus more on murder than suicide. Considering that in America and across the world, more people die every year by suicide than by homicide, it is particularly surprising to note how many more murders than suicides are shown on television. According to Gould, Jamieson, and Romer, however, the number of suicides in movies has been increasing exponentially in recent years.
A recent study by Frank J. Zenere sums up the prevailing literature in an interesting way.40 He writes that there are three contagion vectors that influence people in the wake of a suicide. The first is “geographical proximity,” which extends from those who are eyewitnesses to the event or those exposed to the immediate aftermath of the suicide, all the way to those who are simply in the same community.41 The second is “psychological proximity,” which has to do with how closely the person in question identified with the suicide victim, taking into account such cultural commonalities as both being “victims of bullying, team members, classmates,” as well as other common characteristics.42 Finally there is “social proximity,” the closeness of the relationship that the person had with the deceased. Those at risk along this vector are family, friends, romantic partners, and others of the same social circle. As Madelyn Gould and others have shown, a victim of a suicide cluster generally is acquainted with the first suicide but not a close friend.43 A person who is implicated in more than one of these vectors is at the highest risk, especially if he also has a history of mental illness or traumatic experience. A further factor that increases contagion is a sense of responsibility and helplessness for having failed the first victim by missing signs of his or her intentions.
Alex Mesoudi, a London researcher, designed computer programs that highlighted similar sets of factors and found that the mass media play an important role in either encouraging or discouraging copycat suicides: “The computer simulations strongly support the proposed link between the mass reporting of a prestigious celebrity’s suicide and an increase in national suicide figures.”44 Mesoudi distinguishes “point clusters,” defined as people actually around the suicide victim, from “mass clusters,” which have more to do with those hearing about the event through mass media. The simulations suggested that social learning did generate point clusters: some people who knew the victim of a suicide imitated the behavior. On the other hand, in some cases of suicides among a group of people, the reason might not strictly be imitation but an affinity among friends initially drawn together because of their common depression or other mental health issues. In mass clusters Mesouidi demonstrates that prestige and identification are also factors in the influence that occurs after a celebrity suicide. Essentially the more famous and respected the first victim was, the more copying of the behavior occurs, and the closer the resemblance—especially in age and gender—between the celebrity victim and potential copycats, the more that population would be at risk.
Researchers have assessed the aftermath of the Seattle musician Kurt Cobain’s suicide in 1994.45 Cobain’s death raised immediate concerns among suicidologists about the need to pre-empt suicide influence and copycat suicides. Data collected from the Seattle Medical Examiner’s Office and from the Seattle Crisis Center suggested that there was no significant rise in completed suicides but that there was a significant increase in suicide crisis calls following his death. The authors hypothesized that the lack of an apparent copycat effect in Seattle might be due to various aspects of the media coverage, and to the impact of the crisis center and community outreach interventions.46 The marked increase in phone calls to the suicide crisis center suggests that influence is very real, that one person’s suicide can inspire or increase suicidal feelings in many other people. The apparent success of local intervention is encouraging.
Just as caring and realistic discussion of suicide can help curtail suicide influence, sensitive, informed depictions of suicide in media can do the population good rather than harm. In one study of three television movies including a suicide, suicide increased after two, both of which concentrated their attention on the suicide victim. The one that was not associated with a rise in the suicide rate concentrated on the grieving parents.47
All the caveats about suicidal influence are points to be considered. My argument that suicide harms the community as it fatally harms its immediate victims seems clearly confirmed by the research. Imitation or contagion may be insignificant among those who are psychologically healthy, but those with a history of depression seem to be highly influenced. If nothing else, the example of primary suicide may increase the sense in those with some risk factors that suicide is a reasonable way to deal with their problems.
People in the counseling professions are very much aware of suicidal influence. Psychologists assessing people’s suicide risk ask whether the troubled person has lost someone to suicide. It is one of the most important risk factors that mental health professionals consider. The common suicidal risk factors, here quoted from the physician and medical writer Matthew Hoffman on the respected health website WebMD, are as follows:
One or more prior suicide attempts
Family history of mental disorder or substance abuse
Family history of suicide
Family violence
Physical or sexual abuse
Keeping firearms in the home
Incarceration
Exposure to the suicidal behavior of others.48
I especially want to stress the third and the final items, but we should note the high-risk company they keep, such as family violence, past sexual abuse, and nearby guns.
It is worth thinking about the effects of using the term “contagion.” Obviously it is a metaphor, since the term refers to a phenomenon that involves pathogens passing from one host to another, and there is, technically considered, no pathogen here. What is contagious is an idea. Suicide begins as an idea. Remaining alive after one has contemplated suicide also begins as an idea. It may be possible to encourage antisuicide contagion.
For each suicide, there are many who are profoundly affected. Suicide researcher Edwin Shneidman argued in 1973 that each suicide affects six people. The website USA Suicide: 2009 Official Final Data estimates, “If there is a suicide every 14.2 minutes, then there are 6 new survivors every 14.2 minutes as well.”49 According to suicide expert Alan L. Berman, empirical study of the question suggests that the number of survivors for each suicide is between six and thirty-two.50 Beyond those people considered survivors, many more also feel connected to the loss. Researchers randomly called people and asked each whether he or she knew someone who had committed suicide in the past year, thereby discovering that about 425 people are connected to each suicide. This broader category of people touched by suicide makes up 7 percent of the population of the United States.51
Some poignant recent suicides have been people who had lost a friend to suicide. In 2010 the fashion designer Alexander McQueen killed himself after his close friend and supporter Isabella Blow had killed herself a few years earlier. In July of 2011 the Olympic skier Jeret “Speedy” Peterson took his own life, and among several tragedies in his history, he too had a friend who had died this way. Indeed, the friend shot himself in front of Peterson, and years later Peterson used the same method. It is heartbreaking but important to note that he got his nickname because he wore an oversized helmet that made him look like the cartoon character Speed Racer, but the helmet was considered more protective than others. He stood out for trying to take care of himself until such a time as he became his own worst enemy. The biggest threat was what was in his head, not assaults from without. It is a keen parallel with what happened with the ancient hero Ajax and his longed-for armor: he ended up dying because of his inner distress, not because of his body’s weakness.
I ask for soldiers and veterans in despair to think of other soldiers and veterans and the influence they have on them, and to try to stay alive for their sake as well as their own. Young people might be convinced to have the same concerns. A middle-aged woman must think of other middle-aged women struggling with mental and emotional anguish, especially women she has known. She might consider it a pact of a sort to stay alive to spare the other. Some pacts fail, but some succeed. An older man must consider his place and influence among older men. College students in despair need to consider the influence they have on one another and commit to the rather heroic act of keeping one another alive. High school students must meditate on the other high school students who feel agonized and think nothing will get better. They have to encourage one another, if only by refusing suicide for themselves. Rejecting suicide is a huge act within a community. I also think it changes the universe. Either the universe is a cold dead place with a little growth of sentient but atomized beings each all by him- or herself trying to generate meaning, or we are in a universe that is alive with a growth of sentient beings whose members have made a pact with each other to persevere.