The Final Leap (31 page)

Aaron T. Beck, a psychiatrist, sees the problem of suicide somewhat differently. In the 1980s he created the Beck Hopelessness Scale and Beck Depression Inventory to rate degrees of hopelessness and depression in psychiatric patients as a predictor of suicide. In these models, the more one perceives life events as overwhelming, the more despairing he or she becomes. When events such as the ending of a relationship, death of a loved one, legal problems from being arrested, job loss, financial crises, or medical illness exceed a person's coping abilities and capacity for tolerance, suicidal thoughts and behaviors can develop.

Obviously, people deal with stress in different ways. Moreover, what's unbearable for one person isn't necessarily unbearable for another. Nevertheless, Beck believes, the extent to which a person has developed effective skills to deal with adversity can mitigate feelings of hopelessness. He studied 207 hospital patients who had been admitted five to ten years earlier because of suicide ideation, not for a recent attempt. Before learning what happened to them, he used his hopelessness scale to correctly identify 91 percent of those who ended up dying by suicide. A subsequent study of 2,000 outpatients yielded similar results, with Beck correctly identifying 94 percent of the patients who eventually killed themselves.

Today, experts agree that psychological pain and extreme hopelessness are important pieces of the puzzle, as is social connectedness. At the same time, a key question that virtually no one addressed until fairly recently was this: How do people acquire the ability to kill themselves? Wanting to die is one thing, but acting on it is altogether different. After all, self-preservation is the strongest of all human urges. Voltaire called it “the most powerful instinct of nature.” How, one asks, is it possible for some people to voluntarily end their existence before—sometimes way before— age or illness do it for them? Is this a sign of weakness, wanting to escape life, or an indication of fearlessness, being unafraid to die? It's not unusual for anyone who looks down from a great height to imagine what it would be like to fall. Common sense and good judgment stop most of us from doing anything more than imagining it, though, and if there isn't a solid guardrail, we're careful not to get too close to the edge. In the same way, many individuals who want to die can't bring themselves to jump from the precipice, pull the trigger, swallow poison, cut themselves, or otherwise inflict self harm. Yet a smaller number of people have this capacity and, moreover, follow through on it. What makes them different?

Thomas Joiner is the author of numerous books and studies on suicide. Suicide is both a professional interest of his and a personal one because when Joiner was in graduate school, his father drove to an office park a mile from home and killed himself in the back of a van.

Joiner believes that capacity combined with desire is the key to understanding suicide. People not only have to want to die, they have to overcome the natural instinct for self-preservation. How? Through practice and repeated exposure to pain and death. He uses rock star Kurt Cobain's suicide as an example.

As a young man, Cobain was afraid of needles and heights. Eventually, though, by continually challenging himself to surmount these fears, he became a self-injecting drug user and someone who scaled thirty-foot platforms during concerts. Cobain also abhorred guns, and when a friend invited him to go shooting, Cobain wouldn't get out of the car. On later excursions Cobain got out of the car, but wouldn't touch a gun. Still later, he let his friend teach him how to aim and fire. Cobain died in 1994 of a self-inflicted gunshot wound at age twenty-seven. Through continued exposure, he conquered his fear of needles, heights, and guns. In so doing, Cobain “worked up” to the act of suicide, Joiner says, by becoming accustomed to pain and danger.

In much the same way, nonlethal self injury such as cutting yourself with a razor blade, knife, or piece of glass, as well as self-induced starvation (anorexia), is a gateway to suicide, Joiner believes. Though the intent rarely is lethal, cumulative and escalating experiences prepare a person to be less afraid of dying. Similarly, body piercings, tattoos, and cosmetic surgery can increase someone's pain threshold the more he or she has them, progressing to the point where even extreme acts, such as dousing yourself with gasoline and setting your body on fire, no longer seem terrifying.

Past suicide attempts also lead to increased capacity, of course, even if an attempt didn't seem serious to others at the time. Individuals who are, in essence, “trying out” suicide, working it through in their minds in order to decide on a means and perhaps a location, may make some sort of “test run” such as consuming a large but nonlethal dose of medication or visiting a jump site like the Golden Gate Bridge multiple times. This can place them at much greater risk the next time they test because the danger is less threatening to them. While family members and friends may consider these acts as calls for attention rather than genuine attempts, they contribute to a person's ability to overcome the natural instinct for self preservation.

“Some people think that those who commit suicide are weak,” Joiner says. “It's actually about fearlessness. You cannot do it unless you are fearless, and this is behavior that is learned.”

A person doesn't have to experience pain and injury personally, however, in order to develop the capacity to kill oneself. Joiner believes that repeated witnessing of pain, violence, or injury is sufficient. This explains why physicians and prostitutes have high suicide rates. Every day, through their work, they're exposed to pain and suffering and gradually they become inured to it. The same is true for police officers and servicemen, with an added risk. While physicians and prostitutes have access to drugs that can be lethal depending on how much is consumed, cops and soldiers have even easier access to firearms, which are far more deadly. Oftentimes this access continues long after they've retired because people in these professions tend to keep guns around them.

In this light, it's not surprising that veterans account for 20 percent of all U.S. suicides. While considerable attention has been paid in recent years to the number of suicides among active personnel serving one or more tours of duty, as well as those recently discharged, what's overlooked are the number of suicides by veterans. More than 150,000 Vietnam veterans have died by suicide— three times the number of soldiers whose names are engraved on the Vietnam Memorial. Veterans are twice as likely to die by suicide as non-vets, giving new meaning to the phrase “collateral damage.” Once used to refer to civilian deaths that occurred during war, it's being used more frequently now to refer to a high rate of military suicides, both on the battlefield and at home. It's not coincidental that the first confirmed suicide from the Golden Gate Bridge was a veteran.

The capacity to kill yourself isn't enough, however. One must also have the desire, which Joiner says derives either from a perception that a person is a burden to others or to a feeling that he or she doesn't belong. Joiner trained a group of people to evaluate real suicide notes according to the concept of perceived burden-someness, as well for hopelessness and general emotional pain. What the raters didn't know was that half the notes were written by people who had killed themselves and half were written by people who survived their suicide attempt. The result was that perceived burdensomeness was more prevalent in the notes of those who died than those who survived. The former made more lethal attempts because their desire to die and leave others better off was stronger. There was no statistical difference when the notes were evaluated for hopelessness or emotional pain. These findings support an earlier study in which people who survived a serious suicide attempt characterized their desire to die as a way to relieve others of the burden of caring for them, while people who engaged in self-injurious behavior that wasn't suicidal (primarily cutting) characterized their behavior as an expression of anger or a desire to punish themselves.

Lack of social connectedness—what Joiner calls thwarted belongingness—parallels Durkheim's theory of suicide. In a Norwegian study, one million women were tracked over fifteen years. Those with six or more children had suicide rates five times lower than other women. A Danish study in 2003 compared 18,000 people who died by suicide with 370,000 others who were randomly selected. It concluded that having children—especially young children—is a buffer against suicide. Another study the same year found that twins have lower rates of suicide regardless of their gender, even though there's evidence that suggests twins may be slightly more likely to develop mental disorders than non-twins, which in other circumstances would increase their risk of suicide.

“One of the more interesting facets of the possible association between thwarted belongingness and suicide,” Joiner says, “is the ‘pulling together' effect at times of national tragedy.” When it seems as if people should be most depressed because a calamity has befallen the country, in fact they experience the greatest sense of social connectedness. The shared experience of a crisis increases an individual's feelings of belonging. For instance, suicide rates in the United States declined during World War I and World War II, then increased immediately afterward. They also declined following the assassination of President John F. Kennedy; in fact, a study of twenty-nine U.S. cities found that there wasn't a single reported suicide for eight days after Kennedy's death, from November 22 to November 30, 1963, even though there had been suicides between November 22 and November 30 in the years before and after. Similar data emerged following the 1986 explosion of the Challenger space craft and the 9/11 terrorist attacks. Even people who were physically isolated during these events felt socially connected, as if they weren't alone because people all around them were experiencing the same sense of loss. The country was united in its grief, and individual feelings of depression and despair were counterbalanced by the thought that this was normal, what everyone else was feeling.

For the same reason, suicides rarely occur in concentration camps even though a person's desire to live would seem to be at its lowest point. Despite starvation, cold, torture, and separation from or loss of loved ones, people don't kill themselves (if they survive the death camps, though, they may die by suicide later as noted Italian writer Primo Levi did).

Joiner was able to combine his professional study of suicide with his personal love of sports to demonstrate that the camaraderie and sense of pulling together that result from being a fan provide another form of connectedness. When a city's football, baseball, basketball, or hockey teams—professional or collegiate—win a national championship, there's a temporary decline in the suicide rate. Conversely, after a loss the rate goes up. People literally live and die with the success and failure of their team. The U.S. Olympic hockey team's 1980 victory over the Soviet Union—the so-called Miracle on Ice—came at a time when the Iran hostage crisis had gone on 111 days and Russia's invasion of Afghanistan was a month old. Millions of people in America had never seen a hockey game, didn't know the rules or the names of any of the players, yet were glued to their TV sets and radios rooting the home team to victory. It's not surprising, Joiner says, that the suicide rate in the United States was unusually low that day, February 22, 1980, compared with February 22 twenty years before and twenty years after. (It may have been unusually high in Russia, although there's no data available to verify this.)

Joiner's theory that people die by suicide because they've developed the capacity to kill themselves and have the desire to do so can be applied to mass suicides as well, he maintains. In 1978, in the jungles of Guyana, Jim Jones induced 914 of his Peoples Temple followers to drink grape-flavored Kool-Aid laced with cyanide. In 1997, in Los Angeles, Marshall Applewhite coerced thirty-nine of his Heaven's Gate brethren to ingest a lethal mixture of Phenobarbital and vodka. In both instances, prior to the fateful day there were discussions and explicit rehearsals for suicide, designed to overcome people's fear of dying. On multiple occasions, Jones tested the loyalty of his followers by giving them a drink that he said contained poison (it didn't) and telling them to swallow it. In Jonestown, people worked long hours in oppressive heat farming and constructing buildings, receiving little food— another way that they became accustomed to suffering. In Heaven's Gate, eight of the eighteen men who died had undergone voluntary castrations.

It's possible to argue that a sense of belongingness exists in cults. After all, people work side by side, eat together, worship together, cohabitate, sometimes share sex partners, and often engage in communal child rearing. Outsiders are demonized, adding to the cult's solidarity, and dissidents are expelled. In fact, though, the connection of followers to one another is minimal. Crises are invented to keep the focus on the leader, and close relationships are disrupted so that alternative forms of authority don't develop. As a result, followers don't belong to a group—they belong to the leader, who's not interested in developing community bonds. His interest (cult leaders almost always are male) is exerting and maintaining power.

Understanding why people die by suicide is critical in preventing it. At the same time, no two individuals—even identical twins—are exactly alike. While circumstances may push one person to the brink, causing him or her to consider suicide, the same circumstances can result in different choices for others. It doesn't help that the only person potentially capable of explaining his or her suicidal intentions may not be alive to do so; nevertheless, even people who attempt suicide and survive can't always articulate their motives. If one's judgment is impaired because of a mental disorder, alcohol, drugs, or intense psychological pain, being able to describe accurately what he or she was thinking or feeling at the moment of an attempt isn't necessarily possible. Moreover, it assumes that a person
was
thinking when, in fact, some suicide attempts—especially by adolescents—appear to be impulsive.