Suicide is one of those problems that a lot of smart minds have thought about, yet few answers satisfy. Instead, we rely on a patchwork of suicide prevention methods (like fences on bridges) and suicide hotlines, staffed by ordinary people trained in crisis interventions.
And while the number of people committing suicide over the past two decades has remained consistent (around 30,000 people a year commit suicide in the U.S.), the suicide rate has enjoyed a steady decline of approximately 0.7% per year (a 13% drop from 1985 to 2004)(Barber, 2004). The decline hasn’t been brought about by superior public health policy, government action, or even the Internet. It’s largely been brought about by the decline in firearm suicides, the leading method of suicide (followed by suffocation and then poison). Men are 3 1/2 times more likely to commit suicide than women.
Guns are a huge risk factor for a successful suicide, because they are one of the most lethal methods available. 90% of those who survive a nonfatal attempt do not go on to die by suicide, meaning that the impulsive, irrational act of a suicidal attempt is what we must try and stop. Hence the reason for the fences and suicide hotlines. If we can get most people past the crisis point, the vast majority of them will live.
But what about those people who are suicidal and make it to the emergency room after a failed attempt? Could we do something more to help the 10% of people who do end up successfully committing suicide?
A column in today’s Boston Globe Magazine today presents the poignant story of the writer, Peter Bebergal, who lost his brother to suicide, and how a group of researchers at Harvard are working to better identify people who are still suicidal when in a hospital:
What clinicians need is some other measure beyond external evidence that could assess whether someone like Eric is capable of suicide in the near future. Four years after my brother’s death, Harvard researchers at MGH are experimenting with a test they think could help clinicians determine just that. It focuses on a patient’s subconscious thoughts, and if it can be perfected, these researchers say it could give hospitals more of a legal basis for admitting suicidal patients.
Of course, I can’t help thinking about whether such a test could have saved my brother. But I also wonder: Would it have been ethically right – or even possible – to save him even if he didn’t want to save himself?
This missing piece in the suicidal puzzle is what prompted the innovative research study now in its final phase at MGH. The study, led by Dr. Matthew Nock, an associate professor in the psychology department at Harvard University, is called the Suicide Implicit Association Test. It’s a variation of the Implicit Association Test, or IAT, which was invented by Anthony Greenwald at the University of Washington and “co-developed” by Dr. Mahzarin Banaji, now a psychology professor at Harvard who works a few floors above Nock on campus. The premise is that test takers, by associating positive and negative words with certain images (or words) – for example, connecting the word “wonderful” with a grouping that contains the word “good” and a picture of a EuropeanAmerican – reveal their unconscious, or implicit, thoughts. The critical factor in the test is not the associations themselves, but the relative speed at which those connections are made.
The research is still ongoing, so we don’t know whether this type of psychological testing will actually work or not. But it’s intriguing to imagine that our unconscious minds might give away our “true” thoughts when it comes to something like suicide. It could become as valuable a test as the ones we use to assess whether someone had a stroke and is at greater risk for a future stroke.
The next step, Nock realized, was to use the test to determine, from a person’s implicit thoughts, whether someone who had prior suicidal behavior was likely to continue to be suicidal. It would give doctors a third component, along with self-reporting and clinician reporting, and result in a more complete picture of a patient. Nock doesn’t assume that a test like the IAT would be 100 percent accurate, but he believes it would have predictive ability.
I believe any tool that can be used to better predict future behavior is a potentially valuable one. Especially when that future behavior might be the taking of one’s own life.
Read the full article: On the Edge
Reference:
Barber, C. (2004). Trends in rates and methods of suicide: United States, 1985-2004 (PowerPoint presentation). Harvard Injury Control Research Center.
12 comments
Johnny, seriously, for the love of pearl, stop using the word “Irrational.”
In one sentence you claim that ‘few answers satisfy’ why suicide exists and in the next sentence you directly claim a reason for it.
You cannot have your cake and eat it too.
It’s interesting that the suicide rate has fallen in correlation to the increased use of pharmceuticals in the treatment of depression and bipolar disorders.
Sorry, I make no claim for the “reason” of suicide. It is and always has been an irrational, impulsive act done in a moment of crisis.
While it may seem perfectly rational to weigh one’s choices in life and choose to end it, I can’t think of a single recorded incident where someone who wasn’t suffering from depression made the same rational choice. Suicides exists exclusively within depression (or some other serious mental disorder).
I disagree with this totally. I lost a grandfather, an aunt and a mother to suicide. And I myself have attempted more times than I can count. Ironically my mother said I was too stupid to die.
Suicide prevention is an irrational act.
Most of the interventions we refer to as suicide prevention amount to little more than, “This is a rope; if you see a rope, cut it.” Tertiary interventions do little to affect change in the problems that underlie suicidal ideation, except to pathologize the victim and placate social guilt. I believe they are such primarily for political and economic “reasons” – additionally and sociologically, we are a society that rationally and compulsively distances itself from its own complicity in this problem, as it does with many other social ills.
There are many reasons for suicide and it is dangerously reductionistic to categorize all acts of suicide as “always” anything.
We do have the power to affect the problems that underlie such drastic actions, and to do so I believe we must change the way WE as a society view and treat each other – long before THEY reach the emergency room or the teetering chair.
James your comments on these blogs could be harmful to someone who is thinkimg of suicide. Please just stop. You made your point. If u must keep it up email dr. John. People who read these blogs sometimes are looking for a reason not to kill themselves. Some hope or a way out. When people say its not irrational blah blah blah it just feeds a very self destructive fire inside a person who is self destructive. OK? Please stop.
I found a bizarre method Korean companies use to prevent suicides: Fake your own death. I’d love to hear a psychologist’s take on this.
http://www.businesspundit.com/samsung-stops-suicides-through-well-dying-courses/
Most people are just wired to cling on pathetically to life, and simply cannot empathise with those of a different mindset.
I realize this comment is probably unnecessary at this point, but…
Steph, if calling something ‘irrational’ was the basis by which we stop certain behaviors, psychologists would be out of a job.
I am not condoning suicide. I am, however, against alienating an already depressive person even further by labeling their potential choices as ‘irrational.’
Calling someone irrational is just another blow to the already fragile sense of self. My purpose in not wanting to call suicide ‘irrational’ is to give people a better sense of self. To give them a sense of value in their beliefs (however consequential they might be). To give them a sense of responsibility and accountability for their actions and to give them a voice! People (it can be argued) spend their whole lives trying to be heard. And they commit suicide because they’re not. Suicide (perhaps) is that ACT of wanting to be heard, wanting to matter.
So, again, while I do not condone this choice of action, I am not going to sit here and take away a person’s last desperate act of wanting to matter by calling him/her ‘irrational.’
All they want (arguably) is to be heard and valued! And I feel that continually calling them (or THEIR actions) ‘irrational’ does away from that valuing and hearing!
We’ve essentially muted the muted with the word ‘irrational.’ And this is neither fair to the individuals who decided to commit suicide or to the individuals who are contemplating it.
I’d like to think we can come up with other reasons, motivations, labels, etc., to negate the act of suicide. And that was all I was (however, adolescent of me; my apologies for that John) pointing out…
James
James,
Thank you for understanding and specifically for being able to articulate that which I was not able to, even though I have struggled to not commit suicide for the last two years.
Yes, I want to be heard. Yes, I grasp how ridiculous the concept seems. Ok – you killed yourself, ok NOW we believe you were serious and not just trying to get out attention. Well, now you have our attention but you are dead. Oh well, life goes on (without you).
Did anybody learn anything? Do you think perhaps if you were to have the misfortune of crossing paths with yet another suicidal person you might LISTEN to that person now that you learned this valuable lesson at MY expense?
I’d sure like to think so.
Last month my next door neighbor hung himself. I was outside ten minutes after his nephew stopped by to check on him, found the door unlocked, found him hanging from the beam. I answered the policeman’s questions as we waited for the ME to arrive and clear the scene and determine signs of foul play. I was there the next day getting my mail when his best friend showed up, pounding on his door, yelling his name. I sat the friend down on the curb, and like ripping off a bandaid, I told him.
As my words registered, the pain exploded with such force, I felt it slam my chest as the man slammed him body backwards onto the grass. He curled on his side in the fetal position and while crying said all the usual things:
“why, oh why, we knew he was having financial problems, he’d been drinking a lot, I know he was upset because the family didn’t invite him over for the Holidays, but why didn’t he say something, why didn’t he reach out to any one, why!!?!?!”
I can answer that one – that’s an EASY one to answer.
For the last two years, every person I’ve known in the 30 years I have lived here has slowly distanced themselves from me, some abruptly broke contact with me. Why? Cause worrying about whether today was the day I would ‘do it’ caused them too much stress. It was said many different ways – but that was the common denominator.
On really hard days, I found myself being forcefully cheerful, so I did NOT stress out my friends. I was the one so depressed I was at the point that the pain was more than my resources to cope with the pain and here I was bending over backwards to accommodate THEIR mental health.
That is why we DON’T REACH OUT.
Before people started bailing on me, there was the trip to the hospital when one friend thought the best thing to do was call 911 and report me. My crime? I said the antidepressants my doctor has me on were making me obsessed with committing suicide and I wanted to kill myself so badly it was driving me insane and I needed to reach my Doctor today to see if she could give me some other medication to counteract this one until it left my blood stream.
“Blah blah I want to kill myself blah blah bah blah Kill myself blah blah blah”
That is all they heard, that is what they told the police, that is what the ER staff was told.
I spent ten hours handcuffed to a bed, otherwise ignored when not being treated like a drug overdose piece of shit. Finally the on call psych nurse interviewed me for ten minutes then told them to release me so I could go home.
That is why we do NOT reach out. YOU DO NOT LISTEN.
And let’s not forget the Boy Who Cried Wolf syndrome. We struggle with sever depression for years. We have good days rarely, and we have bad days often. Sometimes bad days become bad weeks, bad months, and we struggle every night to NOT lose the battle. When we reach the point where we don’t think we are going to win that battle one more time, we reach out. And that is when we receive the “oh here we go again….”, at times the person does not even bother to turn their head before they roll their eyes.
And how does this make me feel? I feel I should apologize that I have not just done it already. Gee, I am so sorry I bothering you with this annoying problem again, sorry to disrupt the family, sorry to stress out grandma, sorry, sorry, sorry. No, I fine, really, much better now, I guess I just was feeling a little down….. no really, I’ll be fine, please don’t worry about me. What, why did I say anything? uh oh, well, you are right, I guess I shouldn’t have said anything and got everyone all stirred up.
YES- we want to be heard. Each and every time we NEED to be heard.
At times I reach a point where I feel I HAVE TO COMMIT SUICIDE because I said I was going to and now if I don’t, well I was just faking all this time for attention.
Why do we NOT reach out? Why do we isolate ourselves. Because we stress you out. Because we inconvenience you. Because we let you down with our false alarms. Because when we need to feel safe more than anything, we know if we reach out and tell someone what we need, we risk losing yet another friend…. and we are already teetering on the brink, holding on by the slick of our teeth, wondering if tonight will be the night we lose the battle, we do not dare reach out, because all it might take is one more heavy sigh, one more rolling eyes, one more unanswered email or phone call and we won’t slide over the edge into the abyss – we will run and fling ourselves into it.
So, again James, THANK YOU for understanding. We just want to be heard. And if you won’t or can’t hear us talking — maybe our silence will be deafening.
……. to all my fellow warriors waging these nightmare battles, I wish you peace, where ever you find it — I hope you land in a loved one’s arms and are covered with sloppy wet kisses of every pet you have missed for so long……
Im under the impression that being terminal is better than suicidal. Where do you get your stats 10% success rate. How is that possible if everyones born invincible?
Yeah thank you that was really helpful. I’m trying to prevent the negative thoughts and the only thing you do on this article is to say the word 20 times. Peace…