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As someone who has struggle with suicidal ideation his entire life, whenever the subject comes up I try to educate people by quoting author David Foster Wallace (who commited suicide) with the best explanation:
“The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom Its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who leap from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’, can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling.”
One flaw with the analogy is that a pretty significant portion of suicides (successful or attempts) are impulsive. Many people who attempt it have literally no idea they will when they wake up that morning.
A 2001 University of Houston study of survivors of near lethal attempts showed that 70% of them had only decided to do it an hour or less before the attempt, and 24 percent had only spent 5 minutes before the attempt.
If when attempting it, they discover that their chosen method won't work for some reason, many will just give up on killing themselves rather than looking for an alternative measure.
This has been reliably seen many times. If a change is made such that one suicide method becomes unfeasible, the overall attempt rate drops. If one were committed to offing oneself it is almost impossible to stop them, as there are countless ways to do it. But the statistics are very clear that if some method is removed, alternatives are not always used.
The British had an issue with people killing themselves with oven fumes, back when the ovens used coal gas which created a lot of carbon monoxide, with this accounting for about 50% of suicide deaths. When things were changed to use natural gas where this approach does not work, suicides dropped by 30%. Obviously while that means a portion ending up using some other method, many others simply never killed themselves.
Of 515 people prevented by police from jumping off the Golden Gate Bridge between 1937 and 1971, by the end of the 70s only 6% of them had committed suicide by other means.
Weirdly even some of the non-impulsive cases where people had planned an attempt for days or weeks just give up if their plan is foiled, rather than coming up with some alternative method.
Now obviously not everybody is like this. Some people will continue to try over and over until they succeed. But the numbers suggest that those are very much a minority.
As usual DFW's writing is striking. I've had very strange experiences when starting antidepressants. For 2 or 3 weeks I'd have sudden urges to 'jump': incoming train at the station, walking over a bridge with fast cars under, walking on the pavements next to fast traffic. I'd see a truck coming and I'd feel such a rush to jump, to end it all. I had never felt so strongly about it, and usually had suicidal ideation at other moments, but never such urgent calls to action. I avoided any triggering situation and started listening to myself a lot more.
Apparently it's one of the first weeks' side effects but I wasn't prepared... After 2 weeks it started to fade and the drug started doing its work. But I think it was a huge dopamine rush coming without a counteracting 'I want to live' that was the most revealing about chemical imbalance and how suicide might be sometimes uninterpretable as 'just' psychological.
Also some levels of pain completely fuzz the upper layers of the brain in ways that are hard to describe.
This is an amazing explanation, thank you for sharing this.
I can agree with DFW on that because it sounds reasonable and consistent with people I've known. The error is in thinking there is a single train of thought leading to the end. "Hopelessness" may not be sufficient, but Demoralization is probably an indicator. I would also posit that excessive or increased rumination (possibly leading to an increased sense of demoralization) is also an indicator. It is apparently also a thing that Borderline patients are at increased risk, though I have no idea what goes through their mind in that moment.
So DFW rejected others ideas on the subject in favor of his own experience? Sounds a little narcissistic doesn't it?
In "Why do people die by suicide", Dr Paul Thomlinson goes over the research on predicting suicide.[1]
First, he talks about a well supported model called Joiner's Model, based on research which shows that people who are most likely to commit suicide have all three of these factors:
- Thwarted belongingness ("I am alone")
- Perceived burdensomeness ("I am a burden")
- Ability to commit suicide ("I am not afraid to die")
Perceived burdensomeness has two components: Liability ("My death is worth more than my life to others") and self-hate ("I hate myself")
Thwarted belongingness also has two components: Loneliness ("I feel disconnected from others") and absence of reciprocal care ("I have no one to turn to and I don't support others")
And finally, capability to commit suicide is predicted by: Lowered fear of death, elevated physical pain tolerance, family history of suicide, clustering/exposure to suicidality, combat exposure, suicide attempts, childhood maltreatment
And another model with the acronym "IS PATH WARM" shows that people who are most likely to commit suicide are likely to have, feel or be:
- I = Ideation
- S = Substance Use
- P = Purposelessness
- A = Anxiety
- T = Trapped
- H = Hopelessness
- W = Withdrawal
- A = Anger
- R = Recklessness
- M = Mood Change
[1] - at about 25 minutes in to https://www.youtube.com/watch?v=Arywx88jMXw
Joiner's Model seems to exclude people who are candidates for assisted suicide. They often don't feel alone, don't feel like a burden, but are terminally ill, in constant pain, feel they've lived long enough, seeing significant mental/physical decline etc. You can shoehorn them into "IS PATH WARM" under hopelessness, trapped, or anger I guess.
It's always interesting to find clinical observations for something you struggle with; you somewhat have to remove yourself from your own mind when learning why your brain is manifesting these types of thoughts and feelings.
"IS PATH WARM" really personifies the feelings.
interesting categorization, very much so, I find there's a duality in the lonely/self-hate group. So many people who feel like that are utterly normal, they just can't connect other realities than their own judgement.
Robert Lowell once said that if humans had access to a button that would kill us instantly and painlessly, we would all press it sooner or later.
I think this explains suicide better: For most, it’s an irrational act done in the spur of the moment.
What I think is more interesting is when suicide is done as a rational act with planning, and consideration for others.
>> Robert Lowell once said that if humans had access to a button that would kill us instantly and painlessly, we would all press it sooner or later.
> I think this explains suicide better: For most, it’s an irrational act done in the spur of the moment.
Or it's rational, but we have some "irrational" mechanisms to prevent it that are best defeated by an impulsive act [1].
I don't actually believe that, but it's hard to argue against it under certain common sets of assumptions.
[1] e.g. from a rationalist/materialist perspective: suicide is to avoid/escape pain, and it also removes the pain of guilt for doing it and the pain of missing out on all future pleasures, etc. However, evolution has formed us to reproduce, no matter how painful the struggle is and how subjectively irrational it is to endure it.
"Robert Lowell once said that if humans had access to a button that would kill us instantly and painlessly, we would all press it sooner or later."
They'd push it even sooner if no one they cared about depended on them.
A lot of people stay alive simply out of a sense of responsibility towards others.
One major challenge is that careful premeditation does not necessarily mean suicide is rational. There is a big crossover between people who consider suicide and people with disorders negatively impacting their cognition and decision making.
Someone can think about killing themselves for months or years before actually doing it.. are you suggesting that is irrational because there wasn't a plan or consideration of others?
>>>> Robert Lowell once said that if humans had access to a button that would kill us instantly and painlessly, we would all press it sooner or later.
In my view, firearms are close enough to this level of technology, to shed doubt on the hypothesis. I don't think everybody with a gun tries to kill themselves.
Suicide is not irrational in of itself. Facing 25-Life? Perfectly rational. Lost all your money and have no retirement? Still very rational. All you friends left you and you are completely alone to fend for yourself? Still rational.
America needs to get over itself that life needs to be lived until a natural death. Not everybody wants to further deal with the excessive burdens of life. Suicide, when not done in a spur of the moment decision, can be wholly rational. Wanting to live a garbage quality if life because society thinks it's weird to just end it to not suffer is some Catholic guilt being forced on everyone.
I'm not convinced there's anything rational in suicide by definition. Every organ, vessel, and part of your body, especially your brain, is dedicated to keeping you alive for as long as possible. If it makes you feel the need to end your life, by definition it is not working.
A lot of bad things can happen to you in a lifetime, but death is the worst, without a doubt. To feel the need to inflict it upon yourself is therefore not rational at all, even if it is premeditated. What seems like one irrational spur of the moment decision is really one that in most cases had been considered well before. No one ends their own life before thinking about it beforehand.
If there was a simple and dignified way to end my life I think I would have done it multiple times already. My whole life so far has been a struggle with feeling that I am not fitting in, with social anxiety, depression and other stuff. There have also been good times but it seems whenever I start to believe that life is good, something happens, and the happiness is taken away. The older I get the more tired I get and I really don’t feel anymore like fighting to find a place in life where I feel ok.
What’s holding me up mainly is that this would probably freak out family and friends and I don’t want to be a burden to them. I also still have the hope that one day things will get better but that hope is diminishing.
I just watched somebody go through a serious cancer treatment and I am 100% sure that I wouldn’t have gone through the treatment but would have ended it. I don’t want to go through the hell of treatment only to end up back in a life that’s not much fun either.
> The older I get the more tired I get and I really don’t feel anymore like fighting to find a place in life where I feel ok.
Try to study philosophy, especially metaphysics, and confront any fears about life or death you might be having. It won't change your life situation (no windfall of cash) but it will change the way you see things and that can be huge.
What are your concerns about fitting in?
It's impossible to measure, but I wonder what % of suicides happens because of the culture that we live in. A lot of times when you read about someone commiting suicide it's blamed on that individual or their mental health - but is that really the root issue? How many of the suicides wouldn't happen if society was set up in a different way?
I think the culture is extremely relevant. If you look at this map on the right: https://en.wikipedia.org/wiki/Gender_differences_in_suicide You'll see China is a significant outlier, being the only country with a higher suicide rate for women than men. All of the western nations have rates between 3.5 and 4 as many men commit suicide as women, a shockingly high difference.
The is basically Durkheims conclusion: suicide is the outcome of sociological, rather than psychological, forces. [0] There is an argument that a lot of the mass shootings are actually better classified as a type of suicide under this model as well [1]
[0] https://en.m.wikipedia.org/wiki/Suicide_(Durkheim_book)
[1] https://www.firstthings.com/web-exclusives/2019/08/mass-shoo...
I think you are onto something. An example for me would be, someone committing suicide in the USA due to the perception of having to confront some incredible stressful event in the future; whereas the exact same situation in another country (with different culture) would not yield the same weight to that person.
As an example, take Jeffrey Epstein suicide (let's assume thats what happen). He might have sought that exit given his possible future perspectives. Had he been in Mexico (where I live) he may have had a different (more lenient) perspective of his future.
I think it's part of who we are.
Suicides happen in tribal cultures - https://www.jstor.org/stable/658295
This is it. It would be quite the sight to see people with real money/power (Jeff Bezos, for instance) discuss that.
The lack of empathy in the comments is scary. No wonder the situation is so bad.
Let me present a scenario which might seem more relatable since it seems people understand physical pain but have no "scale" of what mental pain could be like.
You have a chronic pain (maybe one of wrists is broken in a way that there is no solution). No painkillers help. Every doctor you go to doesn't have a quick-fix. People around you keep telling you "you're imagining things", "be spiritual", "it isn't as bad as you think", "it'll go away". Nothing you try seems to help. You wake up every day feeling the pain and it keeps getting worse with no end in sight.
EDIT: Missed one crucial component. The pain is so much that you cannot have normal social interactions because 80% of your energy is spent trying to cover up the pain. You feel exhausted all the time due to this and don't have the energy or the motivation to do anything.
Image living this for even a year (where this is what life looks like for some people for the last 20 years or more) and then tell me you wouldn't say no to "anything to make the pain go away".
This reminds me of the case of Dax Cowart[1][2], who as a young man suffered tremendous burns from an accident which he survived but which killed his father who was with him.
He lost his eyes and face, had both of his hands amputated, and was forcibly given agonizing treatments for 14 months.
At his request a documentary video was made about him, which he titled "Please Let Me Die"[3]. It was shown to lawmakers and judges in hopes of allowing him to refuse medical treatment.
He was forced to endure the treatment against his express wishes, survived, and graduated law school to become an advocate of patient's rights. Still, he always maintained that he should have been allowed to end his life.
"No human being has the right to force another human being to undergo that kind of pain and to take away that person's right to self-determination."
[1] - https://en.wikipedia.org/wiki/Dax_Cowart
>"anything to make the pain go away"
Sure, I think our rampant overdose problem and drug and alcohol over-use problem in general is a symptom of this. That's one of the reasons the war on drugs is so insidious, it punishes the people already suffering, which makes them suffer more, forcing a downward spiral that is almost impossible to get out of. All from a perceived moral failing.
The US is pretty cruel to its citizens. It's not overtly, in-your-face cruel like historical regimes, but still cruel, none the less.
As someone who now does suffer from chronic pain due to abdominal adhesions post-pancreatic trauma and having had issues with depression in the past, I'll take the adhesions.
At least I can take a pill to get some relief on occasion. People understand.
Your description and analogy is dead on.
'Poté explained that the basic mechanism is comparable to the process “used in lie-detector tests, like you see in the movies.”'
And yet polygraphs are known to be unreliable, to the point that they are generally not admissible in court. It would probably be better marketing if they don't imply that their product is comparable to an qn existing tech that is unreliable.
The basic problem with lie detectors is that if you know what you're doing you can trick the machine. Also, people tend to react to the sensitive questions, producing false positives.
While they aren't used for it they can in certain circumstances produce results with an accuracy quite sufficient for the courtroom, and there isn't even any Fifth Amendment problems with the approach:
You need things which the criminal will know but which others will not--you have to keep a bunch of details out of the press. The suspect is not asked any questions, but rather asked to read a bunch of statements about the crime--"she was wearing a red blouse", "she was wearing a green blouse", "she was wearing a white blouse", "she was wearing a blue blouse", each statement is innocent and thus will not trigger a reaction in the person who doesn't know the details. There is a 1 in 4 chance that someone will show the strongest reaction to the true statement--but what happens when you do the same thing with a bunch of details? Show the strongest reaction to the true one on 20 such 4-choice questions and now what are the odds it's a random?
An innocent can't incriminate themselves because they don't know which are the sensitive answers. Note that you can't exonerate someone this way--someone who doesn't remember the details being asked about will look the same as someone who is innocent. However, if it fingers you to a sufficiently high degree of certainty guilt is assured.
Better marketting can and probably should include honest implications of a product's limitations.
I would tend to assume suicide is fairly predictable with high sensitivity and the data many corporations have from surveillance of customers tbh.
Wrong science fiction reference, it should be The Minority Report.
Would your prediction cause it? avoid it? It was really about to happen? If you are "testing" it, stopping the people that is about to do it would mess with the test? And not stopping them would count as unintentional murder?
My objections are not about suicides, but about predictions in general and predictions that can affect human lives in particular.
At points in my journey I've thought that the one genuinely good thing that I could maybe end up doing for others is to end my own life so that the way mental health patients are treated receives another impetus for change so that others can get the help I didn't get while desperately reaching for it.
In order to predict suicide you'd need real-time data of wide variety of aspects of a human being (levels of pain, hopelessness, connectedness, capability for suicide, etc) in a way that is impossible to achieve at the moment (insufficient measures and insufficient data gathering techniques).
I like the article for the most part. I've noticed many comments here are lacking the empathy that is so fundamentally needed in this world to help those who suffer alleviate the pain, so as a fellow struggling one I figured I could throw my words to the wind.
People more readily mentally visualize somebody without a leg, somebody with open fractures. Not so much for mind stuff, it's not concrete enough to most until it turns physical (i.e. you're a bloodstain on the floor). That's why some comments go along the lines of "I can understand suicide for physical pain but not for mental one". I would suggest that a broken self hurts more than an open fracture, and lacking certain central abilities to stabilize the self leaves you much more legless than if you lost your physical legs.
Other comments point out the endless rational vs irrational discussion. I'd ask them: when you go get a drink at a café and you're about to order a cappuccino but you ask for a latte, how do you see the whole process? You've planned something rationally (going to get that cappuccino) and made a seemingly irrational choice at the end (getting the latte). Are you rational or not?
Furthermore, by what lens do you judge when the absence of rational decision is an illness? Typically people will reply either with a utilitarian point of view or a selfish one: either you are being counter-productive to society with your guts and bloods that need to be cleaned and the lack of your presence in the consumerist world, or I take it all backwards and call you ill first because that's what agrees with my worldview ("you're sick, you can't know what's good for you").
What I have done with myself and others is to acknowledge that those bits of perhaps-irrationality are not relevant to helping things, as we all have them in different places as we live and that's okay. It's also important to acknowledge that one can be right to feel like they're backed into a corner when a lot of evidence accrues towards that. BUT, the essential part is to show methodically that (1) there are levers of action that we are steering clear of due to cognitive distortions or lack of awareness, and (2) all suicidal people are fighting to be alive much more than even they might know, as they're still around even when making aimless steps due to the crushing pain. In short, tap into what wants to live to push back against what wants to die, and show that the realm of what is possible to advance is much larger than one might think when in the fog.
----
With that said, I have my own take on parts of the article itself.
> A reader of a late-nineteenth-century edition of Chambers’s Encyclopaedia would find committing suicide described as a “heinous crime,” for which the punishments included “an ignominious burial in the highway, with a stake driven through the body.” Today the National Institute of Mental Health cautions against saying that a person “committed” suicide at all; better to say that they “completed” it, to avoid the implication of an illicit or criminal act.
As if suicide wasn't still considered a vile and illegal thing. You can share your mental health struggles with a therapist just fine until you're a risk to yourself and they call people to, forcibly if needed, remove you and take you wherever they want. Your rights can be severely limited or removed entirely when a psychiatric emergency is considered - how is that any different from being treated like a criminal? Psychiatric intake can pragmatically be worse than prison intake, from someone who's seen both.
It's not seen as vile by everybody but there are still far too many people who frame the process with words of abandonment, with selfishness, with dismissal of all the inner work of the suffering through the singular use of irrationality as an absolute concept ("you're just irrational"), and so on. You're not considered as an equal to your peers when you're suicidal, and that's not something you get to argue against because that's just part of how you're defined by them. See the following paragraph for something related.
> When patients told Freud that their lives were hopeless or without purpose, he considered this an impressive display of self-awareness. “We can only wonder,” he wrote, “why a man must become ill before he can discover truth of this kind.”
That's Freud we're talking about so whatever.. but that train of thought still seems to exist quite a bit nowadays. The introspection and the ability to shatter illusions is put in the same box as the delusions that a "sick" person has, leading a lot of people with severe depression and other disorders to associate one with the other since society does it too. "My ability to dig deeper is part of why I am sick" is entirely the wrong message to send to a vulnerable person, and it is just incorrect. For it is not the power to see beyond the surface that is a problem, but the delusions one might hold or acquire about the process. CBT points it out with the terms of cognitive distortions, which is a start. It doesn't necessarily offer a wholly coherent narrative for the emergence of those distortions, nor does it offer a strong logical argument to disprove the utility of those distortions (i.e. somebody in pain could say "so what if I see everything in black and white? this is how I've managed to survive so far, so you better prove to me that what you're offering would help me survive better").
> (about Shneidman) “I am against suicide committed by other people,” he wrote, “but I want to reserve that option for myself.”
This holds meaning that most healthy people might not realize. People who commit suicide go to the last place where there is a semblance of effective control and ability to choose an option, have some agency, in a world that (objectively sometimes but not most of the time) presents no other option. Healthy people have the comfort of a grip on their existence, or at the very least the comfort of an illusion of a grip on it. Despite having their own beliefs and instabilities, they aren't mandatorily taught CBT and other such similar things - whereas it is expected of the "sick" to do more of the homework. It's like breaking your legs on a hike and then being asked to do leg workouts to keep up, when other people happen to be luckier and go without both things and wouldn't themselves be able to do the workout.
But this is a necessary thing for a person with mental illness to do nonetheless, and I'm not debating that point. What I am trying to point at however is that the world of people who are unaware of such struggles is filled with a violent hypocrisy that contributes to the reasons for very lacking mental health services and very lacking social support from peers, as it drives the ones who suffer away from everybody else. It would do well for any healthy person to acknowledge that they, too, could be cornered into helplessness if their need for control (or the illusion of it) shattered. That brings them closer to the person considered ill, and thus narrows the gap for bridges to be built - showing both kinds of people that there is a passage between the states. That's an application of empathy that would strengthen the vulnerable at no other cost. But the healthy too can have cognitive distortions and might actually fear that it weakens them.
This sort of disconnect between those who study the subject matter and those who experience is it nothing new, so it's funny to see that it surprises people who've worked on the subject for a while (as the article highlights about Brent and Shneidman)
> “One of the problems with suicide,” he said after a time, “is that the person who killed themselves takes a lot of the answers with them.”
And the people who failed are not being asked much of anything, but instead being told what to do. You'll be diagnosed this, given those meds, told to apply this and that method. Any question about mind and life are only there in order to give you a method, not to understand. Something diametrically opposed to the mind of the suffering in the first place, which seeks understanding of self and answers so much that it spirals and loses track of healthy methods to do so. Funnily enough, I think both sides are going at it kinda wrong, and we can do much better by weaving both approaches together and treading the middle line. Sometimes you need a practical tool, and sometimes you need to understand for the sake of understanding. Be both to yourself, be both to others.
I feel like the article didn't deliver on its promise. The author never got to try out the device that's supposed to predict suicide. I was most curious about that because I find myself skeptical such a thing could work.
>It measured for what Emotra called “electrodermal hyporeactivity” by running a weak current over the skin as the sweat glands open and close. The association with suicide had been advertised by an experimental psychiatrist named Lars-Håkan Thorell, Emotra’s founder,
This has regulatory approval in the EU? Why is Harpers even writing about this?
> The Swedish device, which is called the EDOR and is manufactured by a company called Emotra
Pick up EDOR in the self-serve warehouse: isle 19, bin 5. SKU 700.593.23.
Don't forget the ALKALISK AAA batteries at the checkout.
Two words: Means Matter https://www.hsph.harvard.edu/means-matter/
...and assuming it is, can algorithms push people away or towards suicide?
#blackmirror
Well that's an interesting way to fight ad blockers. Hiding the whole content.
Just allow people the basic freedom to leave the fuck out of this world if they really want to.
But no, that would mean one less entity to milk for labor and money.
If suicide can be predicted then I would why not homicide? And then perhaps all crime.