The Final Leap (30 page)

Whenever someone dies by suicide, loved ones and friends invariably ask the same question: Why? Why did he or she do it? There's no satisfactory answer because it's almost impossible for anyone who hasn't seriously contemplated suicide to assume the frame of mind of someone who dies that way. At the simplest and most basic level, there's the explanation of Nick Adams's father in Ernest Hemingway's short story, “Indian Camp.” The elder Adams is a doctor who delivers a woman's baby at the same time that her husband, who's also in the room, slashes his throat. Nick witnesses the horror and asks his father why the Indian killed himself. “I don't know, Nick,” the father replies. “He couldn't stand things, I guess.”

It's reasonable to think that a suicide note provides telltale clues; however, this is rarely the case. First off, only 20 percent of suicide victims leave any kind of note. Most don't. Few members of the general public have ever seen a suicide note. Second, there aren't any rules about what one should include in the note or even who it should be addressed to. Does one ask for forgiveness from loved ones, cite reasons of rejection and isolation in order to hurt others, or provide general instructions about money and insurance or the disposal of the deceased's remains? Third, among the relatively small number of people who do leave a note, the contents tend to be so meager that they lack the passion and desperation usually associated with suicide. In many instances, the note appears to be an afterthought.

This is the case with notes left by Golden Gate Bridge jumpers. In 1969, a doctoral student at the University of California at Berkeley, Ronald Tauber, working with Dr. Richard Seiden, compared authentic notes left by ninety-seven jumpers from three Bay Area bridges, the majority from the Golden Gate, with notes that were hoaxes (i.e., made to appear real but in fact weren't connected with a real jump). The biggest difference he found was that the fabricated notes contained more content and feeling than the authentic notes. Indeed, of the authentic notes Tauber said, “It is as if some of the suicides were, in a psychological sense, dead when they penned the note.” Here are a few samples:

“My darling, I cannot ask for forgiveness but I can say that I've loved you with all my heart. Please try and make a new life which you so richly deserve.”

“Dear Mother, everything I have done has been a lie. Everything Dad did was a lie. I am going to do away with myself before I do further harm to people.”

“Honey, I know that anything I have done or do is all on myself. Something was and is wrong with my makeup and there is not anything that anyone can do about it. I love you. Goodbye.”

“Spent all day yesterday walking around San Francisco deciding what to do. This is the only thing I could do with all the trouble I have caused. Please remember I loved you very much. Take the insurance money and settle the bills.”

Because there are rarely clear answers to the question of why someone decides to die by suicide—after all, suicidal behavior is complex, and usually precipitated by multiple causes—it's often left to researchers to explain. The challenge is that while suicide is a universal phenomenon, affecting all ages starting as young as ten, all ethnicities, all cultures, and all socioeconomic groups, the incidence of suicide varies considerably between nationalities, races, religions, and professions, as well as between men and women. Suicide rates around the world are highest for the elderly, for example, and in every country except China elderly men are at greatest risk. In China, elderly women have the highest suicide rate. In the United States, elderly white men have the highest rate, especially those living in western states. Seniors of other races, as well as those living in the East, have lower rates. Among youths, Native Americans are most at risk, gay and lesbian teens have elevated rates, and girls attempt suicide three times more often than boys, although more boys die by suicide than girls. How does one explain the differences?

Physicians and prostitutes have high rates of suicide, but why? Suicides increase during times of economic crisis and decrease during times of national crisis, but why? It's a fact that far fewer people died by suicide in the United States on February 22, 1980—the date of the Olympic hockey team's “Miracle on Ice” victory—than on any February 22 in the preceding 20 years or the following 20 years, but why?

How is it possible to understand mass suicides in cults? Why is suicide associated more frequently with anorexia than with bulimia? Why is self-injury by cutting or piercing a gateway to suicide even though it's rarely intended as a suicidal act?

It's like trying to put together a puzzle when some of the pieces missing. One may think that he or she knows what the puzzle is supposed to look like, but with empty spaces it's hard to know for sure.

In 1897, a French sociologist named Emile Durkheim published the first empirical study of suicide. Citing a variety of statistics, Durkheim concluded that: (1) suicide is more common among men than women, although women make more suicide attempts, (2) the elderly are more likely to die by suicide than younger adults or youths, (3) individuals who are divorced have higher rates of suicide than those who are married, and (4) adults who are childless kill themselves more often than adults who are parents.

Durkheim discounted the influence of mental disorders and psychological distress in explaining suicide. Instead, he believed that suicide rates were related to social factors, in particular to social integration. Simply put, when people feel part of a larger group they're less likely to attempt suicide, and when people lack social bonds the likelihood of suicide increases. Working people are more integrated than those who are jobless, Durkheim reasoned, which explains why suicide rates are lower during boom times when unemployment is low and higher during recessions when unemployment is high. Married people, as a rule, are more socially connected than those who are single, divorced, or widowed, Durkheim said; therefore, they're more protected against suicide. Parents with children are even more protected because they tend to be more integrated. Durkheim cautioned, however, that married people living in societies where divorce is common are less protected than those living in societies where divorce is rare.

Geographic mobility is a factor, too. Durkheim observed that starting in the latter half of the nineteenth century people were moving farther away from home in order to pursue educational opportunities, employment, and a better way of life. Once on the go, they continued to move, resulting in the disruption of social networks and kin support, which are especially needed during times of crisis. In 2001, the national Centers for Disease Control and Prevention reported that frequent moves are one of the more significant predictors of suicide.

From the vantage point of current research, there's a lot to critique in Durkheim's work. For one thing, Durkheim considered suicide to be predictable and regular when it's neither. Suicides do occur with predictable regularity, and some populations are at greater risk; however, even in instances where a group such as elderly white men has a high rate, the vast majority of people in the group never attempt suicide. Moreover, we know now that individuals who have seriously considered killing themselves and even may have made an attempt don't think about suicide every waking moment of the day. The desire to die, to be free of suffering, comes and goes. In addition, suicidal feelings vary in intensity depending on a variety of factors—they're not static. Thus, it's difficult to predict when or if an attempt will occur.

Attributing suicide entirely or even primarily to social factors also is flawed. While some external circumstances such as divorce, job loss, death of a loved one, or failure in school can precipitate a suicide attempt, they're considered triggers rather than causes. Instead, mental disorders—in particular severe depression that's untreated—play a major role, especially when combined with alcoholism. According to the National Institute of Mental Health, up to 90 percent of the people who die by suicide suffer from major depression, schizophrenia, or bipolar disorder. Not everyone who's mentally ill is a suicide risk, however. The majority of people with mental disorders don't kill themselves. At the same time, mental illness substantially increases the risk.

Durkheim's definition of
suicide
—when a person consciously does something or avoids doing something that leads to his or her death—also is debatable. It includes heroic sacrifice, for instance, and excludes madmen when today it's the reverse; heroic sacrifice usually isn't viewed as suicide and the death of a madman—a lone gunman or suicide bomber—is. In addition, Durkheim failed to acknowledge the moral reasons and material interests (such as life insurance benefits) that lead suicide to be underreported. Also, in explaining the disparity between suicide rates by age, Durkheim didn't note that questionable deaths of youths are less likely to be declared suicides because youth suicide carries the greatest shame, while seniors not only have fewer people left to care about them but they also may have no one around to hide the cause of death.

That said, Durkheim's work still represents a milestone. It demonstrated the value of statistics and methodology, laying the groundwork for future research. Indeed, the June 2008 issue of
Suicide and Life-Threatening Behavior
, a publication of the American Association of Suicidology and the principal journal in the United States for suicide studies, noted that Durkheim's book, published 111 years earlier, was cited forty-four times in academic articles from 1997 to 2001, ranking it eighteenth among 8,004 reference sources.

In 1918, a year after Emile Durkheim died in Paris, Edwin Shneidman was born in Pennsylvania. The juxtaposition of Durkheim's death and Shneidman's birth wasn't exactly a passing of the torch. Shneidman, a psychologist who was educated in southern California, was more interested in individual behaviors than social behavior. He made the study of death—thanatology— and in particular suicide the focus of his professional life when, early in his career, he was asked to write condolence letters to the widows of two veterans who had died by suicide. In researching their cases, he discovered a vault at the Los Angeles County Coroner's office that contained all of the suicide notes that the office had collected over the years. There was so much data, unmined at that point, that Shneidman felt as if he had struck gold.

In the next fifty-plus years, Shneidman published twenty books and hundreds of articles on suicide. He wrote the entry for
suicide
in the
Encyclopedia Britannica
, a book he read in its entirety in high school. He founded the Suicide Prevention Center in Los Angeles, which in 1958 launched the country's first suicide hotline. Six years later he founded the American Association of Suicidology, which today is the preeminent suicide research institute in the United States. During a three-year stint as the head of suicide prevention studies at the National Institute for Mental Health, he traveled to forty states sharing his views as a clinician and researcher of the unbearable psychological pain that leads people to contemplate suicide. This pain, for which he coined the word “psychache,” is the key to understanding suicidal behavior, Shneidman maintained. Social statistics and physiological factors have a place, but suicide is the desperate action of individuals in extreme emotional duress who can't see other options for relief. Backed into a corner psychologically, they resort to the one option that's available to them and offers a guaranteed end to their pain.

Shneidman said that the only way to explain suicide is to delve into people's private history, to learn their personal stories and glimpse the emotional circumstances behind their desire to die. When one does this, conducting what Shneidman called a “psychological autopsy” to determine a person's intentions, the most perplexing of all human behaviors starts to make sense.

He had little regard for research that studies physiological factors. “You don't understand psychopathic murder by slicing [Jeffrey] Dahmer's brain,” Shneidman said in a
Los Angeles Times
interview in 2004, “and you won't get E = MC
²
by slicing Einstein's brain. Unfortunately, it's in the mind. And the mind is not a structure. It is an ephemeral concept.”

There's growing evidence, however, that decreased levels of serotonin in the brain contribute to feelings of depression and, thus, influence suicidal behavior. Serotonin is a neurotransmitter and sometimes is referred to as one of the “feel-good” hormones. Decreased amounts have been found in patients who are depressed and have a history of suicide attempts, as well as in the postmortem brains of suicide victims (drugs such as Prozac, Paxil, and Zoloft often are prescribed to reduce depression because they increase serotonin levels). Additionally, researchers at Johns Hopkins and elsewhere are beginning to study potential links between chromosomal genes and suicidal behavior, indicating that some people may be genetically predisposed to suicide.

In treating individuals, Shneidman was emphatic in his support for people whose loved ones died by suicide, recognizing that they were at heightened risk.

“The person who commits suicide,” he said, “puts his psychological skeletons in the survivor's emotional closet.”

Shneidman died in 2009 at age 91, after battling a variety of ailments. To the end, he maintained that in dealing with suicidal people the only two questions any helper needs answers to are “Where do you hurt?” and “How may I help you?” He also continued to write, publishing his last book,
A Commonsense Book of Death
, at age 90. In it he wrote:

Death is not your ordinary garden-variety topic. There is a whiff of sulfur about it. Death has a Brueghel-like and Hobein-like quality.… It is associated with dread and tears. It has a scary, taboo aura. We don't like to think about it or talk about it. But death—the dying patient, the suicidal person, the grieving survivor—has been my life's topic. Being a professor of thanatology, I could rather be objective about it, until recently. Now, at 90, widowed and existentially alone, death has a definite personal bite to it.