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10 things I wish people understood about suicide

Like most secular people, and many religious ones, for most of my life I believed the dominant cultural idea about suicide: that it was everyone's private choice. That it was morally neutral. And that since we cannot presume to comprehend the pain that concludes in such an act, we should drop the subject. I no longer think any of that is true.

What caused me to change my mind? I lost two friends to suicide, within about a year and a half of each other. I, too, couldn't help but think about suicide sometimes. I'm a poet and a historian, and I've written a lot about the history of secular ideas, so I thought hard about what I was going through. I noticed it was strange that we all feel so alone in our suicidal suffering and yet how keenly we feel connection when someone we know dies by suicide. I started to think of the positive side of what that pain tells us. We are not as alone as we think, and we can make a huge contribution to society just by staying alive. I had often read that one suicide can lead to more suicides. That means even if you believe that are a terrible burden right now, your suicide would be a much bigger burden.

I came to these conclusions by writing first a poem, and then a blog post about suicide. Responses were moving and made me feel that I had to learn and write more. Thus began a period of deep research on suicide throughout history and today.

We are not as alone as we think, and we can make a huge contribution to society just by staying alive

What I learned is that, compared to ours, most societies have had stronger messages about rejecting suicide, because of what we mean to each other and because of what we owe to our future self. Socrates is often remembered as a suicide. But in the jail cell where he took the hemlock, Socrates told his students and friends that they must not kill themselves, unless they too are condemned to it in court; and Aristotle also spoke of suicide as wrong because "the just and the unjust always involve more than one person." We moderns have lost contact with this and other crucial ideas because of a turf war between religion and secularism. It was time to rethink the secular stance on suicide on its own terms. This research became my book, Stay: A History of Suicide and the Arguments Against It.

Let me clarify that I am not talking about end-of-life care, which I believe should include the right to die, especially in an age when people are medically kept alive for so long. I sometimes say that I am addressing "despair suicide." Loosely, I am talking about a person whose loved ones, or medical caretakers, would think needs to keep living.

After several years of thinking and writing, I've boiled down ten ideas for how we can think differently about suicide.

1) We don't have the right to suicide

Suicide hurts other people terribly. For some it is fatal: Throughout history people have noted that one suicide can lead to more suicides, in all sorts of groups. After the publication of Goethe's The Sorrows of Young Werther, some young men across Europe killed themselves dressed as Werther, or holding the book, and by many accounts there was a rise in suicide in countries where the book was available.

Now modern statistical studies repeatedly demonstrate the existence of suicide clusters, each representing a real rise in the suicide rate in certain high schools, colleges, regiments, and towns, age groups, and professions. You may remember headlines, over the past few decades, about suicides among farmers, policemen, among teens in the eighties; at certain colleges, or in a particular college dorm. Recently there have been major headlines about a shocking rise in suicide rates among baby boomers, military personnel, and Native Americans (especially the young).

There are a variety of indications of the significance of influence. In the 1970s researcher David Philips, now a sociology professor at University of California San Diego, followed the rise in suicides after the death of Marylyn Monroe and other celebrities and called it the Werther Effect. The rise is strongest for those of the same age and gender as the celebrity. Beyond celebrities, studies show a robust correlation between media reports about suicide and an increase in actual suicide in the area that hears about it, again especially among people of the same age and gender. Media influence on suicide seems especially potent with adolescents and young adults. There is even a dose response, such that more exposure to such news leads to more suicidal behavior.

Victor Hugo rejected suicide because, "As soon as it touches your neighbors, suicide is murder." And Jean Jacques Rousseau had a wise character tell a younger, suicidal friend that suicide must be rejected for many reasons, including that it might cause more suicide. Suicide is too harmful to be a right.

2) Staying alive is a life-saving social contribution

Because of the power of suicidal influence, staying alive through your dark night keeps other people alive. In a very careful and large study out of Johns Hopkins in 2010, researchers found that the suicide of a parent of a child under 18 triples the children's suicide rate, with different patterns of hospitalization and death depending on the child's age at the time of parent's suicide. A 2014 study shows that a parent's suicide attempt increases the likelihood that the child will make a suicide attempt fivefold, "even after adjusting for the familial transmission of mood disorder."

That means that if you don't kill yourself, your daughter is less likely to kill herself; and if you make it through, maybe she does too. An ex-Army Ranger quoted this idea from Stay in a personal essay on suicide for the Daily Beast and added: "If you want your Ranger buddy to survive, you have to accept help and fight through your own battles." I don't know why we cannot always see our own value, but when people realize that getting help and surviving will keep others alive, they feel less self-indulgent when they take steps to make it through the crisis. We save each other's lives when we look after ourselves. Society should express gratitude to those who stay alive for others, and I'm happy to start. Thank you. We are often telling people to get help, but we don't tell them why.

A suicide prevention sign on the Golden Gate bridge in San Francisco (Jamie McCaffrey)

3) We need to consider the rights of our future selves

Albert Camus, famous for announcing that we must all confront the question of suicide, is less famous for his powerful conclusion that we must reject suicide. He argued that more life is always better, even if it is not happy. Camus says that what you will learn from experience is unknowable until you get there, and very much worth the wait and struggle.

Just as our culture minimizes the interconnected nature of our selves, it also sees the self as an unchanging agent. We forget that we will change and grow in ways we cannot now imagine. Who are we going to become? We should make an effort to have respect for that person.

Many figures through history have reminded us that even when all seems lost, circumstances sometimes change abruptly. The Renaissance philosopher Michel de Montaigne offered many tales of suicides completed just before everything changed for the better, and other tales of the rejection of suicide leading to a wonderful and storied life. For we moderns, there might also be a new drug or other intervention, if we can wait for it.

There are certain people who need to give the "future self" idea particular thought. Up until age 25, the brain's prefrontal cortex isn't finished growing. Until then, you do not know how you will experience the world in a few years. The prefrontal cortex is the location of executive function: planning complex cognitive behavior, personality expression, decision-making, and moderating social behavior. You are about to get much better at getting what you want to get. For now, find a way to wait. For we who are older, if you are going through a period of life that is infamously taxing, remember that things may get better for you too, if you can trust your future self to know things you do not yet know.

4) Suicide is among the top ten killers of Americans

In 2000 the number of American suicides was 30,000, and it began rising. The last full count was in 2012, and it was up to 40,600. Suicide is the second leading cause of death for people between the ages of 15 and 24.  In a recent study of college students, suicide beat out alcohol as a cause of death.

Meanwhile, most suicides are older white men. Women attempt suicide more, but men die of it more. That's most likely because men have more access to guns; in 2010 suicide accounted for 61 percent of gun deaths in the US. Suicide kills more than murder.

When people try to kill themselves and survive, they overwhelmingly report being glad they lived

As for war, a 2012 study showed that more US military personnel died of suicide than of combat or transport accidents that year. (The numbers for 2013 just came out this week: while active military suicides are down, there has been a rise in suicide among reservists.) In the general population suicide recently out-killed car accidents.

The World Health Organization estimated that the global rate of suicide is up 60 percent since 1945. In 2010, in the developed world, suicide became the number-one killer of people ages 15 to 49. Except for the three worst years of the disease, it has killed more people annually than AIDS. Worldwide we are at a million suicides a year.

5) Suicide is often impulsive, such that if the impulse is thwarted, the person lives

When people try to kill themselves and survive, they overwhelmingly report being glad they lived, according to studies and observations by suicidologists. A follow-up on 25 years of people who tried to jump off the Golden Gate Bridge showed 96 percent alive or having died of other causes. We often think of suicide as the unavoidable end point of a life-long battle with agonizing depression, but it often isn't that, or isn't only that. Recent humiliation or loss is very often a determinant.

We think of military suicide as the result of PTSD and other direct results of the wars, but note that the study on military suicides in 2012 showed that a full third of the deceased had never been deployed, while more than half had recently suffered the loss of an important relationship, or a humiliation at work. A recent study of police suicides showed that 64 percent were described as "a surprise." There are news reports of popular and successful college students who gave little sign of depression suddenly ending their lives. If part of the problem is that in certain groups, at certain times, suicide seems like a popular option, it is useful to name that and to be ready to resist it. If you do not want to someday die of suicide, tell yourself now that you are on the lookout for such inclinations and that you are prepared to reject them.

A sign on the Aurora Bridge in Seattle (Justin Kraemer)

6) Physical barriers to suicide have been shown to work and so can conceptual ones

Studies show that when we put up a barrier fence on a bridge famous for suicides, the people who go there to jump do not go to another bridge. Bridge barriers lower the real, overall suicide rate. That is why we are finally putting up a barrier on the Golden Gate Bridge — as a chorus of experts in various fields explained, suicide barriers save lives. The act is so impulsive that most of the time people do not seem to plan ahead enough to find a backup bridge and make sure it is climbable and high enough to do the job.

In the 1990s the United Kingdom was seeing a lot of suicide by acetaminophen overdose, so they legislated that the drug had to be sold in smaller quantities. Deaths by acetaminophen overdose fell significantly. The number of overdoses stayed constant, but far fewer were fatal. People survived because the act is so impulsive that they only ingest what is in the house, so smaller bottles save lives.

In the US over half the gun deaths are suicides and over half the suicides involve guns. Having immediate means is bad. If you are looking after yourself, see that it would at least take you a few hours and a bit of effort and human interaction. I have heard from several men and women who store their guns in someone else's home for this reason.

The Austrian philosopher Ludwig Wittgenstein said suicide is always a rushing of one's defenses, and added that there is nothing worse than rushing your defenses. Wittgenstein felt suicidal off-and-on his whole life and three of his four brothers committed suicide, but he had worked out reasons suicide was wrong and he didn't do it. As a rule, we cannot usefully tell ourselves not to be depressed, but it seems that we can usefully tell ourselves not to commit suicide.

7) We can't always trust our moods, so we should train ourselves to override suicidal impulses

Ralph Waldo Emerson said, "Our moods do not believe in each other." Of the roughly 40,000 people who commit suicide a year in the US, surely some would not have predicted such a death for themselves. Some just got caught in a bad moment, with lethal means, and no solid ideas about not doing it. There is a part of many suicidal people that fiercely does not want to die; the part of us that calls hotlines, for instance. That part of us needs encouragement.

There are people reading this who do not see themselves as at risk for suicide but who will die that way, unless they take some mental action now. Inoculate yourself, as much as you can, by thinking some of this over in this new context. Don't let yourself be killed by the classic blind forgetfulness of misery. Practice remembering that depression casts an illusion of constancy whenever it arrives.

There is a part of many suicidal people that fiercely does not want to die. That part needs encouragement.

I received a letter from one man, a lawyer, who told me that my presentation of the numbers regarding the suicide of parents with children under 18 had settled the matter for him after decades of painful vacillation. It was a relief. He also gave me a great insight: he writes a note to himself when he is happy, because when he feels bad only his own handwriting can show that he ever felt happiness, or ever would again. Decide now not to let your worst mood kill off all the others.

8) If individuals knew how common suicidal thoughts are, they would be less frightened of their own

A lot of people think about suicide — my educated guess is well over half the population. A 2006 study of 26,000 college students (undergraduate and graduate) showed that over half had considered suicide at some point. Eighteen percent of undergraduates had thought seriously about it. Anecdotally, when I speak to adults, most of them confess to sometimes wanting to die. Thinking about it is not an indication that you should do it, or will do it. Take the thoughts seriously as an indication that all is not well, and find someone to talk to. But the thoughts are too common to be terrifying. If we all knew how many of us sometimes think about it, we would be less inclined to be pushed around by our ideation.

9) Our increasing suicide rate is a trend, and trends can be slowed or reversed

The suicide rate goes up and down. The mechanism that makes sense to me is that people copy each other's behavior ever more, until they reach a saturation point and begin to see that behavior as old-fashioned. When that feeling is forgotten, the cycle starts again.

Human societies have stopped trends in the past, even with very addictive drugs. There are social trends that were endemic for centuries, like foot binding, dueling, and the Atlantic slave trade, that were stopped by a re-examination of what is good and a rejection of something that is causing suffering and waste. Perhaps we can change this, too.

I am sure the conditions of one's life matter tremendously to people's moods, but whether or not suicide is on the table as a response to that pain is often based on things that trend, like how many suicides you have heard of, by people similar to you. We can make a point of not dying by trend. Of course, the part of our suicidal thoughts that come from trauma, neglect, and bad chemistry needs to be taken care of, and the part of our suicidal ideation that comes from economics, politics, war, and the loss of the natural world ought to be a spur to action. But sometimes what makes the difference is whether suicide seems like a viable response to suffering for a person like you, and we can be on guard against that.

Anti-suicide graffiti (Daniel Lobo)

10) If we manage to lower the suicide rate and keep it low, people in the future will look back at our age and see a massacre

What would you think if I told you about a civilization where 40,000 men, women, and children took their lives every year? How is this not a kind of blood sacrifice? Suicide notes are full of people explaining that they are a burden. How did they get that idea? Our culture told them that it is up to them to decide if life is worth living. They have been told it is up to them to weigh their contributions and deficits, joy and anguish. What a cruel and wrong-headed thing to tell people.

I believe that community and culture make meaning and it is not up to any one of us to sustain meaning all the time. Imagine that tomorrow morning you wake up alone on the planet. Would you do anything the same? We make life and meaning together, in the context of others. Can you imagine trying to know about meerkats by grabbing one specimen and looking it over in the lab? We are what we are together and we should say so. Or don't say anything about it, but stop saying it is morally neutral to kill yourself, and stop saying it is everyone's choice. If this society is in any way complicit in making us hate ourselves, I don't think we should listen to it invite the miserable to die and get out of the way. For many of us who think about suicide, part of the appeal is to shove life back in life's face. I think the better rebellion is to stay alive.

Lead image: Shutterstock

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