suicide| \soo-ә-sīd |
noun
the act of taking one’s own life voluntarily and intentionally
It’s estimated that 85 percent of the people in the United States will eventually know at least one person who killed themselves. Right now you may have a brother, daughter, spouse, or parent who is displaying signs of mental health issues or having suicidal thoughts, right before your eyes. You yourself may have a genetic predisposition for suicide or have one or more stress factors that could put you on the road to self-harm. These signs are not always obvious. But if you do not see the signs that are there, you or someone close to you could needlessly take a step toward catastrophe.
What exactly is suicide? Thomas Joiner, PhD, is a clinical psychologist and researcher who studies the behavior and beliefs of people who die by suicide. He offers this on-the-nose definition of suicide and its aftermath: “Suicide is self-inflicted, purposeful death,” says Dr. Joiner. He adds, “Suicide is a catastrophe for families, and I don’t think ‘catastrophe’ is an exaggeration. It just shocks and stuns individuals and families. They are confused, feeling searing emotional pain for months if not years, sometimes even decades, and this reverberates throughout generations.”
The American Foundation for Suicide Prevention’s Christine Moutier, MD, says, “The CDC [Centers for Disease Control and Prevention] is approaching suicide as a public health crisis because the rate in the United States has been on the rise since about 1999.”
Crisis is a heavy-duty word in the world of public health, brought out for only the most serious problems. Epidemic has similar punch, and professionals don’t like to use it. It refers to “a sudden, widespread occurrence of a particular undesirable phenomenon,” usually a disease. In the US the rise of suicide has been widespread, but has it been sudden? Yes. Just since 2007 the suicide rate in the US has risen by one-third, to rates not seen since the end of the Second World War. Columbia University epidemiologist Madelyn Gould, PhD, says, “I don’t like to use the word ‘epidemic’ because I don’t want to have people get hysterical about the rates of suicide. Unfortunately, suicide can be considered an epidemic. The rates have been steadily increasing over the past couple of decades. Suicide is the tenth leading cause of death across all ages.”
On average, about 45,000 people in America die by suicide each year, or 124 every day, a death toll higher than car accidents or homicides. For every person who dies, there is an average of about ten attempts. And every day some 15 million Americans endure suicidal ideation: persistent, agonizing thoughts about taking their lives.
What does that have to do with you?
If someone you cared about were on the brink of having a stroke or a heart attack, wouldn’t you want to know before it happened? Suicide is no different. Like other health emergencies, its signs are often apparent if you know what to look for. And no one is immune, not even those who we assume are in the prime of life. Suicide is the second-largest killer of young people between the ages of ten and twenty-five. It’s the fourth-largest killer of men between thirty-five and sixty-four years of age; white men in that age group account for almost 70 percent of all suicides in America.
On average, women attempt suicide three times more frequently than men, but men kill themselves at four times the rate of women. That’s largely because men more often use firearms, which are involved in about 52 percent of suicides, more than all other methods combined. In the US each year, about four times as many people die from suicide by firearm than die from homicide by firearm.
The grim statistics around suicide belie a little-known fact: it is preventable. Generally speaking, each death by suicide and the agony it causes family, friends, and colleagues is unnecessary and can be avoided with timely, often low-cost interventions. That it is unnecessary is what makes suicide frightening and different from most other kinds of death. “Normal” deaths, caused by old age, illness, and even accidents, seem to be part and parcel of the natural order of things, jarring facts of life. Not suicide. Like homicide, it is usually unexpected and it is often violent. It has a terrible agency that most other deaths lack. It delivers an awful shock to the systems of the people around it, a shock some don’t survive. While we spend so much of our lives coaching ourselves and our children not to be crushed by cars, not to slip off icy roofs, not to be reckless with guns, the fact that some people willfully kill themselves challenges us to our core.
Many of us have grieved the “normal” deaths of loved ones; we follow grief’s familiar social script and generally emerge bowed but not broken. Grieving a suicide is a whole other kind of grief. On average, each suicide leaves six or more intimate survivors. Besides shock and disbelief, these survivors are accosted by the barbed question Why? Why did she do it? Why did she take her precious life? But the why is almost always unanswerable, because suicides usually occur at the confluence of many whys, which psychologists call risk factors, such as mental health disorders, alcohol abuse, romantic conflict, a family history of suicide, a previous suicide attempt, and many more. Survivors rarely unravel all the whys. Almost by definition the dead person is the only one who knows the full breadth of facts and feelings that led to the decision to end their life, and even they may not have been fully aware of the risk factors stacked against them. Into that vacuum of understanding rush the whys.
Death by suicide is also different because of blame. Usually when someone dies, we point our finger at the disease or the perpetrator, the heart that stopped working, the driver who was texting, the pharmaceutical company that flooded the town with opioids. But with suicide the victim is the perpetrator. Blaming him, who has suffered so much and has now lost everything, feels cruel, and it’s not rewarding. The dead will offer no contrition and suffer no punishment. Rarely do friends and family deserve blame for a suicide, but it attaches to them like barnacles to a ship. According to our need to rationalize catastrophes, largely in an effort to push them away, survivors believe they failed to see the signs of the suicide, which only in retrospect may seem obvious, or they failed to support the suicidal person, or they let the victim down in some undefinable way that grows in significance after the loss. In its emotionally tumultuous aftermath, suicide can shatter families in a multitude of ways, but none is as common as blaming oneself or one another. Upon learning that her brother Angelo killed himself, my friend Christina’s first words were “We weren’t there for him!” Unwrapped, Angelo’s story reveals that he suffered from depression, alcohol and drug abuse, chronic pain, failing health, and a failed marriage. Those who loved him had repeatedly urged him to seek professional help. Christina and her family had in fact been there for him as much as they could have been. Angelo’s unnecessary suicide was preventable, by Angelo himself.
Blame rarely fits, but it too can kill. Unless treated, some survivors may develop post-traumatic stress disorder (PTSD), and involuntarily relive the trauma. They are themselves at elevated risk for thinking about and planning suicide. It’s estimated that the suicide of a loved one increases the chances of survivors’ suicide by 60 percent.
There’s one more big distinction in deaths by suicide. Stigma. Since biblical times, death by suicide has borne intense social condemnation. Suicide can isolate survivors from their families, communities, and even from their religions, many of which consider suicide a mortal sin. In some twenty countries, attempting suicide is a criminal offense. In medieval Europe, survivors were often punished by death. Suicide victims were denied a Christian burial, and worse. Psychiatrist Eric D. Caine, MD, of the University of Rochester Medical Center told me, “A thousand years ago if you died by suicide in, say, Western Europe your body was drawn and quartered and hung by the roadside. Your family was stripped of all its resources and they carried the stain of your death for the rest of their lives. In some societies it’s still felt that way.”
Survivors may find themselves isolated because they’re not comfortable talking about their loved one’s suicide, or people in whom they could confide cannot handle the discomfort of talking about it. And isolating yourself is among the worst things you can do if you lose a loved one to suicide.
Survivors are often ashamed and friends rarely know what to say. In the minds of some neighbors, suicide equals crazy or weak. Survivors don’t speak honestly because of this stigma and because they don’t want to upset anyone. Frequently, a family denies that a suicide even occurred, and claims the victim died in their sleep or suffered a freak accident. Farmers and agriculture workers sometimes disguise their suicide attempts as farming or hunting accidents. Some survivors have to endure hurtful comments from their community or church or school. But keeping suicide a secret can lead to confusion, shame, and isolation that can last years, even generations.
This book, Facing Suicide, has three goals. The first is to show you the signs of suicide illustrated by real-life stories of people who killed themselves but, more to the point, people who survived or were stopped in their attempt by someone who saw the signs and intervened. My hope is that once you know the signs of the mental health issues surrounding a suicidal crisis, you may become attuned to them in the people around you, and in yourself. And once you have determined that someone may be suicidal, this book will show you what to do next, for your family member or colleague or for yourself.
Facing Suicide’s second goal is to give you a general background in the causes of suicide through true life stories and science. I hope that by doing so, I can help move suicide out of the shadows of its enduring stigma and into the light of public conversation. You probably already know suicide is a national emergency, and the source of untold pain. I hope that by learning more about suicide, you will be more inclined to discuss it as a public health crisis, like COVID or heart disease, and help bring it into the mainstream.
Gathering accurate information about suicide is no small feat, especially when each case is different and each has a distinct constellation of causes. And while the science of suicide has advanced rapidly over the last thirty or so years, much is still unknown. Suicide information is not available from research alone; new insights and theories arise yearly. To learn about suicide, I relied on the ideas and papers of many of the top US psychologists, psychiatrists, neuroscientists, therapists, and social workers, and people who professionally study suicide and provide therapy to people who are suicidal. In each case, early in their careers, they decided that their life’s work would be to stop as many people as possible from dying by suicide. For the better part of five years, it was my great pleasure to sit and walk and talk and correspond with these world-class suicidologists, listen to their stories, and pick their brains. I gained this access because I wrote and directed the ninety-minute documentary film Facing Suicide, which premiered on PBS in September 2022 and now streams online; many of the experts you’ll meet in this book are interviewed in that film.
While I gained the cooperation of the experts, I sought out people whose stories embody the messages of suicide and its prevention: people who had survived attempts to kill themselves, or those who had died and whose relatives and friends could describe the events that led to their deaths. Their experiences with suicide have many things in common, including one or more mental health issues, painful isolation, and a psychological tunnel vision that didn’t allow them to perceive alternatives to suicide. Their experiences are also distinct, and have much to do with the socioeconomic and cultural context of their lives. So a Native teenager living through a mass suicide in his region experiences different life stresses than a farmer enduring severe economic uncertainty. And both face life pressures different from those of a black woman living in an underserved community in the American South or a mentally ill white man from Denmark. The stories of their battles with thoughts of suicide contain important lessons. I hope you’ll find them illuminating and instructive.
Facing Suicide’s third goal is to spread hope. Suicide is a difficult, often dark, and polarizing subject—what role could possibly be played by hope? We learn about hope from happy endings, which, in the case of suicide, are endings in which the subject does not die and ultimately builds a life worth living. Through the extended hands of helpers, through recovery, and through healing, many survivors press on with life, and many thrive. One hundred percent of the survivors I’ve spoken with are glad they survived. They learned to live and to hope. And hope is powerful medicine.
Christine Moutier, MD, is the chief medical officer of the American Foundation for Suicide Prevention. She believes hope is the antidote to suicide’s seemingly intractable grip.
“I’m really filled with hope about not only what’s happening right now in the scientific field of suicide prevention and research, but about what’s happening in the world,” she says. “People are now talking about their experiences of distress, loneliness, hopelessness, when they become suicidal. And talking with others can reconnect them to their healthier selves, and to resources like mental health treatment and peer support and family support. So there are a lot of reasons to hope.”
Facing Suicide is a book about hope in the face of suicide.
If you are thinking about suicide or if you or someone you know is in emotional crisis, please call or text 988 at any time to reach the 988 Suicide and Crisis Lifeline for confidential, free crisis support.