Monday, June 20, 2016

Excellent article on suicide

Here's an exc one on suicide:

Little wonder, then, that most of us have come to regard suicide with an element of resignation, even as a particularly brutal form of social Darwinism: perhaps through luck or medication or family intervention some suicidal individuals can be identified and saved, but in the larger scheme of things, there will always be those driven to take their own lives, and there's really not much that we can do about it. The sheer numbers would seem to support this idea: in 2005, approximately 32,000 Americans committed suicide, or nearly twice the number of those killed by homicide.

But part of this sense of futility may stem from a peculiar element of myopia in the way we as a society have traditionally viewed and attempted to combat suicide. Just as with homicide, researchers have long recognized a premeditation-versus-passion dichotomy in suicide. There are those who display the classic symptoms of so-called suicidal behavior, who build up to their act over time or who choose methods that require careful planning. And then there are those whose act appears born of an immediate crisis, with little or no forethought involved. Just as with homicide, those in the "passion" category of suicide are much more likely to turn to whatever means are immediately available, those that are easy and quick.

Yet even mental-health experts have tended to regard these very different types of suicide in much the same way. I was struck by this upon meeting with two doctors who are among the most often-cited experts on suicide — and specifically on suicide by jumping. Both readily acknowledged the high degree of impulsivity associated with that method, but also considered that impulsivity as simply another symptom of mental illness. "Of all the hundreds of jumping suicides I've looked at," one told me, "I've yet to come across a case where a mentally healthy person was walking across a bridge one day and just went over the side. It just doesn't happen. There's almost always the presence of mental illness somewhere." It seemed to me there was an element of circular logic here: that the act proved the intent that proved the illness.

The bigger problem with this mental-illness rubric is that it puts emphasis on the less-knowable aspect of the act, the psychological "why," and tends to obscure any examination of the more pedestrian "how," the basic mechanics involved. But if we want to unravel posthumously the thought processes of the lost with an eye to saving lives in the future, the "how" may be the best place to look.

To turn the equation around: if the impulsive suicide attempter tends to reach for whatever means are easy or quick, is it possible that the availability of means can actually spur the act? In looking at suicide's close cousin, murder, the answer seems obvious. If a man shoots his wife amid a heated argument, we recognize the crucial role played by the gun's availability. We don't automatically think, Well, if the gun hadn't been there, he surely would have strangled her. When it comes to suicide, however, most of us make no such allowance. The very fact that someone kills himself we regard as proof of intent — and of mental illness; the actual method used, we assume, is of minor importance.

But is it?

As it turns out, one of the most remarkable discoveries about suicide and how to reduce it occurred utterly by chance. It came about not through some breakthrough in pharmacology or the treatment of mental illness but rather through an energy-conversion scheme carried out in Britain in the 1960s and '70s. Among those familiar with the account, it is often referred to simply as "the British coal-gas story."

…Beyond sheer lethality, however, what makes gun suicide attempts so resistant to traditional psychological suicide-prevention protocols is the high degree of impulsivity that often accompanies them. In a 1985 study of 30 people who had survived self-inflicted gunshot wounds, more than half reported having had suicidal thoughts for less than 24 hours, and none of the 30 had written suicide notes. This tendency toward impulsivity is especially common among young people — and not only with gun suicides. In a 2001 University of Houston study of 153 survivors of nearly lethal attempts between the ages of 13 and 34, only 13 percent reported having contemplated their act for eight hours or longer. To the contrary, 70 percent set the interval between deciding to kill themselves and acting at less than an hour, including an astonishing 24 percent who pegged the interval at less than five minutes.

The element of impulsivity in firearm suicide means that it is a method in which mechanical intervention — or "means restriction" — might work to great effect. As to how, Dr. Matthew Miller, the associate director of the Injury Control Research Center, outlined for me a number of very basic steps. Storing a gun in a lockbox, for example, slows down the decision-making process and puts that gun off-limits to everyone but the possessor of the key. Similarly, studies have shown that merely keeping a gun unloaded and storing its ammunition in a different room significantly reduces the odds of that gun being used in a suicide.

"The goal is to put more time between the person and his ability to act," Miller said. "If he has to go down to the basement to get his ammunition or rummage around in his dresser for the key to the gun safe, you're injecting time and effort into the equation — maybe just a couple of minutes, but in a lot of cases that may be enough."

It reminded me of what Richard Seiden said about people thwarted from jumping off the Golden Gate Bridge. When I mentioned this to Miller, he smiled. "It's very much the same," he said. "The more obstacles you can throw up, the more you move it away from being an impulsive act. And once you've done that, you take a lot of people out of the game. If you look at how people get into trouble, it's usually because they're acting impulsively, they haven't thought things through. And that's just as true with suicides as it is with traffic accidents."

The Urge to End It All

 Subscribe in a reader