Facing Suicide: Understanding Why People Kill Themselves and How We Can Stop Them

It started with a movie.  Facing Suicide: Understanding Why People Kill Themselves and How We Can Stop Them started with James Barrat’s film of the same name (without the subtitle).  The book is an expansion of the content in the video.  It’s a contemporary view of suicide in America and what the experts see as opportunities to change the outcomes.

Preventable

From the very start, there’s solid information about suicide – and there are fine points where the coverage requires clarification.  A big one is whether suicide is preventable.  It’s a myth I tackle on SuicideMyths.org.  At some level, it’s clear from works like Suicide: Inside and Out that there’s no stopping another person from suicide if their mind is set on it.  However, what Barrat is talking about isn’t others intervening.  He’s saying that people’s minds can be changed and that they can see life as a better option than death.  In that sense, he’s right.  Some suicides can be prevented.  The challenge is that not all of them can be.

Blame Barnacles

One of the challenges of being a suicide survivor – that is, being impacted by someone else’s suicide – is that you’ll be blamed for the suicide death.  Fathers weren’t loving enough.  Mothers must have ignored them.  Friends must have dismissed them.  In a vast number of the situations I’ve seen, it’s not that straightforward.

Mothers and fathers feel guilt from claims that there are always signs.  The implication is that the signs were there, and they failed to act.  (See Myth: Every Suicide Attempt Has Warning Signs.)  They may transition from guilt about what they did or didn’t do into a sense of shame.  That is, they may believe they’re bad people.  (See I Thought It Was Just Me (But It Isn’t) for more on guilt and shame.)

In most cases, they’re good people who didn’t see the signs.  They didn’t know that their loved one, friend, or neighbor was considering suicide.  One could argue that you should always be asking those you care for whether they’re considering suicide.  It won’t plant the idea.  (See Myth: Asking About Suicide Will Plant the Idea.)  Whether we should or not, it’s not the sort of thing that we normally ask.

Regardless of their innocence, many families and friends suffer by being shunned by others at the very moment they need them most.

Pride

There’s good reason for America’s farmers to be proud.  They feed the nation and to some degree the world.  They are – for the most part – hardworking, salt-of-the-Earth type people.  Many have had farming handed down from their fathers – who, in turn, received the farm from their father.  It’s more than a profession.  It’s a legacy.  Unfortunately, the desire to preserve that legacy for their children becomes a burden as they struggle against forces that are larger than so many farmers can bear.  Increasing production led to lower per bushel pricing.  Global trade wars changed tariffs and further reduced crop prices.  Interest rates climbing on the money borrowed to buy seed to plant made it impossible for many.

There became a sort of minimum number of acres you could farm to make it work.  You can’t afford to buy and maintain the equipment if you don’t have enough acreage to amortize the capital investments over.  That’s why we see farms that have thousands of acres instead of the original 40 acres granted to most during the westward expansion.

The pressure between the pride for the land and the realities of the economy made far too many decide that suicide was a better option.

Gun Storage

Sometimes, the narrative is more impressive than the research – and sometimes, it isn’t supported by research at all.  The data is clear that if you have guns, you should secure them.  This mostly means locking them, but could mean storing the ammunition and firearm separately.  The problem is that the data supporting these conclusions is weak.  To get enough statistical power, they had to combine all forms of “safe” storage.  That means we don’t really know if storing guns and ammunition separately matters much – or even at all.

People who sit on the gun control side of the issue have taken the research to mean that you must do everything.  The result is a recommendation to store guns and ammunition both locked and separate.  There is simply no research to support this approach.  Intuitively, it makes sense, but we’re found lots of things intuitively make sense that don’t really work that way.  Barrat falls into this trap and suggests storing guns and ammunition separately.

This is despite the fact that around 70% of all gun purchasers and gun owners say they have their gun to protect themselves (personal protection) or their home (inclusive of family).  If you tell them that they need to store the gun and the ammunition separately – as many do – they’ll simply stop listening.

We can say with clarity that guns should be locked up to prevent their theft, unauthorized use, and potential use in a suicide.  That’s acceptable to those who want it for protection.  It’s also often not done, because we continue to message in ways that invalidate the reasons that people buy guns in the first place.

When you message in a way that people will not accept, nothing changes – and you’ve wasted everyone’s time.

Connection is Prevention

“Thwarted belongingness,” a key component of Thomas Joiner’s Interpersonal Theory of Suicide, is, Joiner claims, a fancy way of saying loneliness.  (See Why People Die By Suicide for Joiner’s model).  Whether you prefer IPTS or something different, we know that loneliness increases the risk of suicide.  (See Loneliness and A Biography of Loneliness.)  When we consider suicide risk from the viewpoint of loneliness, we can see that the solution is to increase the degree to which people feel connected to others.

In The Anxious Generation, Jonathan Haidt explains how disconnected we are.  Robert Putnam expresses the relative concentration of importance on the individual in The Upswing (which could be seen, like Our Kids, as following up on the themes laid down in his landmark book, Bowling Alone).  Haidt builds a case that one of the causes is our increasingly technologically connected lives, particularly social media.  Sherry Turkle, in Alone Together, shared this sentiment over a decade ago.

Harried Learner in The Dance of Connection speaks to the delicate dance of staying connected to others, and Dr. Ruth Westheimer discusses practical tips in The Joy of Connections.  They stop short of claiming a cure for loneliness or suicide prevention, but there is good reason to believe that the more connected people are, the less likely they are to die by suicide.

Removing Stigma

Echoes of the ghosts that we shouldn’t talk about suicide lead to fear about removing all stigma from suicide for fear that it may elevate suicide rates.  After all, we don’t want others to think it’s a good idea.  The argument is that we know that there is a media “contagion” effect.  Glorification of deaths by suicide may set off a suicide cluster that will claim more lives.  (See Life Under Pressure.)

We’re in a scary place where we know that stigma is preventing people from getting the help they need – and it’s in some ways reducing suicides by preventing those who believe in the stigma.  Many people believe it’s morally wrong, and that’s enough to keep them from considering it.  We’ve got to find a careful path through making it okay to talk about suicide – and to think about it – without releasing the concerns about people acting on those thoughts.

A Roll of the Dice

There’s a problem with prediction in suicide prevention.  We can’t screen or assess in a way that reliably separates those who will and will not attempt suicide.  Craig Bryan makes this point clear in Rethinking Suicide.  Neither screening tools nor assessments are much better than a coin flip in identifying those who will make an attempt.  Despite this, we want to believe these tools are predictive.

Here’s the problem.  Suicide is too rare statistically and, tragically, too high societally.  If we had a screening tool that always said there was no need for enhanced services, we’d be right more than 99% of the time.  It would also be clinically unacceptable.  We’re struggling, because we’re trying to predict the unpredictable.

You Can Kill Yourself Later

The truth of the situation is that people can always kill themselves.  The goal is to get them to decide to do it later (and hopefully never).  A suicide death is permanent.  There’s no coming back from it and, as a result, it’s a good idea to defer that decision to the last possible moment.  If we did this more often – if we could be honest with people – we’d save lives.  Too frequently after hearing of suicidal ideation, clinicians rush to inpatient hospitalization.  What they don’t know is that there is no evidence that inpatient hospitalization works – much less that it is best.  There is, however, plenty of evidence that the highest possible risk is immediately after discharge from an inpatient setting.  Clinically, there is sometimes no choice but to hospitalize someone – but it should be the very last resort, because it’s necessarily a risky decision.

Far Transfer

In the language of education, it’s called “far transfer.”  It’s when the differences between the learning environment and the place that the skills must be used are large.  The difference can be physical environment, but it’s more frequently frame of mind.  If we’re learning emotional regulation in a safe classroom, it will be harder to recall that training in the midst of a difficult situation.

It’s one of the concerns about some of the recent research that teaches mindfulness to potentially suicidal individuals.  The results aren’t positive – and that may be because they’re unable to access these ideas from the point of considering suicide.

Drivers

Many people hear of the problem with veteran suicide – how more service members have died of suicide than of combat.  We fail to recognize that though military service increases risk, it does so regardless of battle experience.  It doesn’t seem to matter whether they were sitting at a desk in Texas, in a base in Afghanistan, or were in a firefight.  The driver seems to be service in any way.

Other, more pertinent, drivers seem to be problems with relationships, the law, or finances.  All these are possible factors for veterans – particularly those who suffer from some sort of PTSD.

The Strategy That Isn’t

At the time of Barrat’s writing, the latest national suicide strategy was published in 2012.  The problem is that most people who were working in suicide prevention in America weren’t even aware of the plan.  The 2024 refresh of the plan suffers from many of the same issues as its 2012 predecessor.

First, it’s not a strategy.  It’s a list of aspirational things that it hopes the states will implement.  Thus, when it was evaluated in 2017 almost no one had fully implemented the plan.  Second, the efficacy of the interventions was never measured, yet many of them are in the 2024 plan with slightly different wording.

Proponents will say that there is a federal action plan outlining what the federal government will be doing to support the strategy.  However, the federal action plan is a long list of activities – most of which have been ongoing.  There’s no measurement of change, just the appearance of trying to make it better.

Without a set of tools that states can use to implement the plan, we can wait another decade to realize we’ve not implemented the strategy and issue a new one with minimal changes.  It may be a cynical view, but it’s the one you develop when you see the gaping holes that never get addressed when Facing Suicide.