Monday, June 3, 2013
The Suicide Epidemic
Excellent article from, of all places, Newsweek, on suicide epidemiology and featuring the work of psychologist Thomas Joiner.
This year, America is likely to reach a grim milestone: the 40,000th death by suicide, the highest annual total on record, and one reached years ahead of what would be expected by population growth alone. We blew past an even bigger milestone revealed in November, when a study lead by Ian Rockett, an epidemiologist at West Virginia University, showed that suicide had become the leading cause of “injury death” in America. As the CDC noted again this spring, suicide outpaces the rate of death on the road—and for that matter anywhere else people accidentally harm themselves.
Throughout the developed world, for example, self-harm is now the leading cause of death for people 15 to 49, surpassing all cancers and heart disease. That’s a dizzying change, a milestone that shows just how effective we are at fighting disease, and just how haunted we remain at the same time. Around the world, in 2010 self-harm took more lives than war, murder, and natural disasters combined, stealing more than 36 million years of healthy life across all ages.
And this assumes we can even rely on the official data. Many researchers believe it’s a dramatic undercount, a function of fewer autopsies and more deaths by poison and pills, where intention is hard to detect. Ian Rockett of West Virginia University thinks the true rate is at least 30 percent higher, which would make suicide three times more common than murder. Last fall the World Health Organization estimated that “global rates” of suicide are up 60 percent since World War II. And none of this includes the pestilence of suicidal behavior, the thoughts and plans that slowly eat away at people, the corrosive social cost of 25 attempts for every one official death.
The suicide rate for Americans 45 to 64 has jumped more than 30 percent in the last decade, according to the new CDC report, and it’s possible to slice the data even more finely than they did. Among white, middle-aged men, the rate has jumped by more than 50 percent, according to a Newsweek analysis of the public data. If these guys were to create a breakaway territory, it would have the highest suicide rate in the world. In wealthy countries, suicide is the leading cause of death for men in their 40s
Spring is the start of suicide season, the time when the average daily death toll begins its climb to a mid-summer peak, before tapering through fall and winter. This is one of the strongest findings in the field, a 200-year debunking of Herman Melville’s damp, drizzly November of the soul. One respected 19th-century French researcher actually calculated a boiling point for suicidal desire. It’s 82 degrees, basically paradise.
After hundreds of hours of sitting with patients, poring over research, and pounding his own memory, Joiner got a shoulder touch of inspiration: a seven-word explanation of everything. Why do people die by suicide? Because they want to. Because they can. Dozens of risk factors banged down to a formula he shared with me in his office: “People will die by suicide when they have both the desire to die and the ability to die.” When he broke down “the desire” and “the ability,” he found what he believes is the one true pathway to suicide.
It’s a “clearly delineated danger zone,” a set of three overlapping conditions that combine to create a dark alley of the soul. The conditions are tightly defined, and they overlap rarely enough to explain the relatively rare act of suicide. But what’s alarming is that each condition itself isn’t extreme or unusual, and the combined suicidal state of mind is not unfathomably psychotic. On the contrary, suicide’s Venn diagram is composed of circles we all routinely step in, or near, never realizing we are in the deadly center until it’s too late. Joiner’s conditions of suicide are the conditions of everyday life.
Joiner is a reporter's dream because of his life story -- his father died by suicide while Joiner was completing his clinical psychology doctoral program. A "hook" doesn't get any better than that. (It is very interesting to note how often what a psychologist studies seems determined by who they are, e.g., Marsha Linehan.) I will leave it to you to consider how subjectivity may have influenced the development of Joiner's theory.
For those who are interested, the long, scholarly version of the Interpersonal Theory of Suicide is essential reading: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3130348/.
For my money, the best book ever written on suicide is Edwin Shneidman's The Suicidal Mind. He thought that among the best books ever written on suicide were Anna Karenia, Madame Bovary, and The Sorrows of Young Werther.