It’s an unfortunate reality that we can’t escape.  The odds are likely that you’ll know someone who dies by suicide – even if you don’t know their death was suicide.  The truth is that we’ve had A Sadly Troubled History with suicide.  For centuries, we’ve grappled with our inability to predict who will die by suicide and who will not.  We’ve struggled to understand what drives some to suicide and others away from it even amidst anguish.  This 2009 book doesn’t offer clear answers, but it does provide more clues that will hopefully, one day, allow us to reduce the pain and suffering that leads to suicide and the grief in the aftermath.

Inside or Outside

There are two problems with detecting suicide.  The first one is outlined by Craig Bryan in Rethinking Suicide, which is that even the person themselves may not know about their suicidal desires.  The second one is whether the suicidal desire stays inside or whether it’s outwardly expressed.  In other words, do they keep it to themselves?  The answer is sometimes.  Despite Shneidman’s claims that 90% of suicidal people leave clues, we find that the number leaving clues is much smaller.  (See The Suicidal Mind.)

Sometimes, internal forces like loyalty to a country or others can decrease suicide, like in times of war.  Sometimes, persecution and the creation of an inner sense of worthlessness can lead to what amounts to little more than indirect murder.  That is, the reasonable outcome of the persecution is suicide.  We see these tragic results of bullying in the news all the time.

Careful with Causation

As humans we often confuse correlation – things that occur together – with causation.  (See Thinking, Fast and Slow, The Black Swan, Antifragile, Competing Against Luck, and The Signal and the Noise for more.)  One of the correlations that was discovered was that regions of France with high levels of literacy had high suicide rates; those with lower literacy rates had fewer suicides.  It sounds like teaching people to read is a bad idea – until you realize that the real cause may be hidden in things that are also correlated.  Higher literacy rates are associated with higher affluence – and perhaps that’s one of the driving factors, not literacy itself.

One of my biggest complaints about suicide research is that it often correlates non-changeable parameters with the suicide rate, offering us nothing in terms of what to do about it.  Being an older white male may statistically be correlated with higher rates of suicide, but there’s no explanation of what we’re supposed to do about it.

Instilling Fear is Insanity

Another early, frustrating, approach is the installation of fear in the mind of those who were considering suicide.  Instead of inquiring about their problems and attempting to help them solve them, fear is used.  In my review of The Anatomy of Suicide, I shared the burial at the crossroads and the penalties levied on the families of those deemed to die by suicide.  In my review of The Fifth Discipline Fieldbook, I explained why fear is a lousy motivator, but there’s more to the story.

Fear – and stress – are harmful to the body and the nervous system.  In Why Zebras Don’t Get Ulcers, Robert Sapolsky walks through both the physical and mental impacts.  What’s harder to understand is that there are many things that can cause people to appear to have mental illness when other factors are at play.  Certainly, fear causes people to respond in ways that reflect bounded reality.  That is, the behaviors only make sense from the point of view of the person who is fearful.  Their beliefs may not match other objective reality – but their decisions still make sense from their beliefs.

Recently, a good friend lost her husband, and she was over for dinner.  Our daughters, who have been taught cognitive assessments as a part of their work, were concerned.  They wondered if our friend had cognitive impairment.  The direct response to that is yes, but the implication that it’s a part of a long decline or that it’s permanent aren’t true.  The intense grief was causing her brain to function in a way that was abnormal for her.

Similarly, infections and low blood sugar often cause confusion.  There’s a belief that if someone has died by suicide, it’s because they have a mental illness or because they’re weak.  However, the answers can be simpler – or more complex.  It may be that the person didn’t know how to cope with grief or simply that their blood sugar was low.  It’s hard to really know what circumstances came together to create the tragedy.

Strength

When a person breaks their arm in an automobile accident, no one seems intent on blaming them for their lack of bone density.  No one is disappointed that their bones broke under the trauma caused by a rapid deceleration.  However, too often, we blame people who’ve died by suicide for not being strong enough.  We have a completely different view of psychological trauma than we do with physical trauma.

It used to be that women had “hysteria.”  It was believed that it was something about their physiology that made them uniquely susceptible to psychological trauma.  That was until 40% of the men being sent home from war were suffering from similar conditions.  For them, it was given the name “shell shock.”  (See Trauma and Recovery for more.)  It would be the 1980s before post-traumatic stress disorder was officially recognized, and we began to separate the sense of strength from the impact of psychological trauma.

Despite decades of professional recognition of the problems that unresolved trauma causes, the public still often blames people for their mental illnesses.

Suicide and Homicide

Suicide and homicide are not reciprocal.  They do not pull from one pool of violence and flip a cosmic coin to determine whether it will be suicide or murder.  Even Man Against Himself doesn’t make this claim.  We instead, must look at suicide and homicide as two separate – but tangentially related – phenomena.  In most cases, the cause of a suicide attempt isn’t an attempt of violence but, as Shneidman explains, an act of escape.

The Personal Significance of Trauma

One of the often overlooked aspects of trauma is that the degree to which someone experiences trauma from an event is the degree to which they’re connected to it and perceive it impacts them – or the degree to which they feel compelled to change their views of the world.  That’s why two people who experience the same event may perceive it very differently.  It can be that it doesn’t feel connected, personally impactful, nor changes one’s fundamental beliefs – or it can be the complete opposite.  (See Trauma and Recovery for more.)

It’s not that someone is stronger or weaker when it comes to experiencing events – it’s that one is more greatly impacted by the nature of the randomness of life.

Correcting Coroners

One of the challenges of historical records of suicide is that coroners don’t use the same standards as one another – or even between two cases.  Because suicides were historically shunned, there’s a not so subtle bias of coroners to not record something as a suicide when it probably should have been.

Assessing whether something is a suicide is difficult to be sure.  As it relies on intent, it’s hard to assess post-mortem.  Is that car accident the result of a slippery winter morning or a willful decision to smash into a tree?  There’s honestly no way of knowing for sure.

This variability in recording means that suicide statistics must be viewed with a degree of suspicion.  It must be assumed that the statistics are biased away from suicide.

Lagging Unemployment

While financial hardship is also associated with higher rates of suicide, it takes time for overall economic increases in unemployment to show their impacts in a suicide rate.  There are, likely, many causes of this, not the least of which is living on reserves and the charity of the community and friends.  Despite the lag, it’s clear that the financial pressure associated with unemployment has a negative impact on self-esteem and an unfortunately positive impact on suicide.

Own Worst Enemy

When it comes to suicide, we’re often our own worst enemy.  As Capture explains, we get into a negative spiral and have trouble seeing anything else.  We judge ourselves unfairly.  We believe we should get more done, be more important, and be more successful than is reasonable.  Instead of stopping to try to evaluate ourselves fairly, we get wrapped up into evaluations that lead us to believe that suicide is not only a viable option but the only viable option.

If we want to reduce suicide, we need to teach everyone to be fair with themselves and to accept that they have intrinsic and inherent value that makes the world a better place.

The true tragedy is that mostly we create our own challenges – we create A Sadly Troubled History in our own minds.