Overview

Throughout the world, about 2000 people kill themselves each day. That's about 80 per hour, three quarters of a million a year. In the U.S., there are more than 80 deaths from suicide every day, 30,000 every year. This is the equivalent of a fully loaded jumbo jet crash every fifth day. From another perspective, you are more likely to kill yourself than be killed by someone else.

Another estimated 300,000 (or more) Americans a year survive a suicide attempt. A majority have injuries minor enough to need no more than emergency room treatment. However, about 116,000 are hospitalized, of whom 110,000 are eventually discharged alive. Their average hospital stay is 10 days; the average cost is $15,000.

"...without knowledge of proper dosages and methods, suicide attempts are often bungled, leaving the victim worse off than before. Many intended suicides by gunshot leave the person alive but brain-damaged; drug overdoses that are not fatal may have the same effect. One eighty-three-year-old woman obtained an insufficient number of pills and lost consciousness but did not die; her daughter ended up smothering her with a plastic bag."

Seventeen percent, some 19,000, of these people are permanently disabled, restricted in their ability to work, each year, at a cost of $127,000 per person. Such injury is tragic, either if someone were trying to kill herself and failed, or, perhaps even sadder, if the suicide attempt was intended as a "cry for help".

About 1.4% of Americans end their lives by suicide. This is the eighth leading cause of death in the U.S., and ranks fourth in years of lost life. The largest increase in the last 30 years has been among people between 15-24 years old, but the highest rates are still among the elderly. Men kill themselves at about four times the rate for women (19.8/100,000 vs 4.5/100,000 in 1994). Around 3% of adults make one or more suicide attempts.

There are more suicides than the official numbers show, but there is no general agreement as to how many more. Estimates of under-reporting range from around 1% to 300%. Reasons for under-reporting include:

(1) families or family physicians may hide evidence due to the stigma of suicide. For example, "Physicians and surviving relatives have told me in confidence of many deaths which were suicides, but which had been certified as natural or accidental deaths by a physician, either through error, misinformation, or deliberate falsehood....My own estimate is that there were an additional 10,000 deaths yearly [in the U.S.] which would have been certified as suicides if there had been complete and impartial investigations."

(2) the determination of cause-of-death is judged by local standards, which vary widely. In one egregious instance, a coroner would cite suicide only in deaths where a suicide note was found, and suicide notes are only found in around one quarter of known suicides.

(3) there are lots of ambiguous situations, some of which are suicides, but which almost always end up classified as "accidental" or "undetermined" the single-car "accident"(24f) with no skid marks; the "fall" off the night ferry; the "stumble" in front of the train; the "inadvertent" overdose; the gun-cleaning "mishap".

(4) compared to the "accidental" or "undetermined" motive categories, there is a much larger number of deaths officially classified as "ill-defined and unknown causes of mortality," where even the actual cause of death is uncertain, and some of which are undoubtedly suicides.

(5) the frequency of physician-assisted suicide for the terminally ill is unknown, but, based on anecdotal evidence, is probably both substantial and increasing. More on this in "Assisted Suicide and Terminal Illness".

On the other side of the ledger, some doubtful cases are classified as suicides. These usually occur in institutions, such as prisons, hospitals, religious orders, and the military, which control their populations more-or-less completely.

For such institutions a verdict of suicide is likely to be the least embarrassing (after "natural") cause of death: homicides must be investigated and a murderer sought; accidents may be the basis of negligence lawsuits.

The number of suicide attempts is also subject to dispute. Based on a range of studies, there are probably between 10-20 attempts for every suicide, or roughly 300,000-600,000 attempts per year in the U.S. Yet more than half of suiciders kill themselves on their first try.

The overall 3-or-4-to-1 male-to-female suicide ratio in the U.S. is reversed for suicide attempts. Between 70% and 90% (studies differ) of suicide attempts are by medicine/drug overdoses, roughly 15% by wrist cuts.

For adolescents, the attempt-to-fatality ratio may be 50:1; but this average masks the fact that the death rate for boys is a hundred times higher than for girls: around 10 percent and 0.1 percent, respectively. About 11% of high school students have made at least one suicide attempt. Ninety percent of adolescents' suicide attempts occur at home, and parents are home 70% of the time.

What Is Suicide?

The numbers above refer to acts formally classified as suicides, but the more one thinks about it, the less clear the boundaries become. Should we include refusing medical treatment in a terminal illness? What about a suicidal gesture gone awry? How about martyrdom? And what of the "little suicides": the high-speed drag race, the drunk drive, the picking of a quarrel in a bar? Among adolescents the combination of reckless (and inexperienced) driving with alcohol/drug use may be more dangerous than overt suicide attempts.

In Man Against Himself, Karl Menninger compiled some 400 pages of self-destructive behavior, ranging from war to nail-biting. He divided these into three groups: "chronic" suicide includes alcoholism, martyrdom, psychiatric illness, and antisocial actions; "focal" suicide targets specific parts of the body, as in self-mutilation, or deliberate "accidents"; and "organic" suicide, where people supposedly lose their will to live and die of illness and disease that they would otherwise overcome. His list, and subsequent additions to it, has been called "slow suicide" or "suicide on the installment plan".

And there is the daily suicide of depression and apathy:

"A thousand people are `officially' dead of suicide every day, but they are not the only ones who are faced with the constant choice between life and death. We all are....We might lack the nerve to commit the final act, and we might not recognize our `sinful' tendencies for what they are, but day in and day out we confront the problem of our innate attraction to self-destruction.

We live in a world that encourages the small daily acts of negation that prepare us for the great one. There are meanings of suicide that neither the courts nor the dictionaries admit, but that make it impossible for us to regard those thousand people a day who do themselves in as very different from us.

They are not necessarily `sick' or `sinners', but simply our sisters and brothers. And who are we? We are the resigned housewives, the compulsive playboys, the despairing priests, the addicted teenagers, the reckless drivers, the bored bureaucrats, the lonely salesmen, the smiling stewardesses, the restless drifters, the walking wounded....It may be nothing more than the steadfast commitment to sameness.

The simplest form of suicide is the act of refusing the adventures and challenges that offer themselves to us every day. `No, thanks,' we say. `I prefer not to,' we murmur, like Melville's Bartleby, preferring to stare at the wall outside the window. Preferring, as I do on especially bad days, to stay in bed." --James Carroll.

If you play Russian roulette with a six-shooter, your odds of dying are one in six; if you climb Mt. Everest they're also about one in six. The former is a generally-condemned form of suicide; what, then, is the latter?

Yet, "Life is impoverished, it loses in interest, when the highest stake in the game of living, life itself, may not be risked. It becomes as shallow and empty as, let us say, an American flirtation." --Sigmund Freud.

As you can see, the topic of suicide is almost boundless.

Why People Commit Suicide

Thousands of books have tried to answer the question of why people kill themselves. To summarize them in three words: to stop pain. Sometimes this pain is physical, as in chronic or terminal illness; more often it is emotional, caused by a myriad of problems. In any case, suicide is not a random or senseless act, but an effective, if extreme, solution.

A slightly more elaborate list of some reasons people commit or attempt suicide follows. The categories are arbitrary and overlap to some degree. However, this is just an outline, and there is no lack of books that discuss suicidal motivation in much more detail and from many different perspectives.

(1) Altruistic/Heroic suicide. This is where someone (more-or-less) voluntarily dies for the good of the group. Examples include the Greeks at Thermopolae; the Japanese Kamikaze pilots at the end of WWII; the Buddhist monks and others who, starting in 1963, burned themselves to death trying to stop the Viet-Nam war; elderly Inuit (Eskimos) killing themselves to leave more food for their families; some Communists who confessed to invented (and often impossible) crimes during the Purge Trials of the late 1930s and early 1950s. Gandhi's tactic of hunger strikes, called "satyagraha" or "soul force", would have fallen into this category, had the British authorities failed to respond to his demands.

(2) Philosophical suicide. Various philosophical schools, such as stoics and existentialists, have advocated suicide under some circumstances.

(3) Religious suicide. There is a long history of religious suicide, usually in the form of martyrdom. This was widespread in the early years of Christianity and was also commonly seen in the various "heresies" uprooted before and during the Reformation, Counter-Reformation, and Inquisition. More recent examples may include members of the Solar Temple in Switzerland, France, and Canada, the San Diego Hale-Boppers in March, 1997, the Branch Davidians in Waco, Texas, and some of the people at Jonestown, Guyana.

(4) Escape from an unbearable situation. This may be persecution, a terminal illness, or chronic misery. There is no lack of historical examples:

Epidemics of suicide were frequent among Jews in medieval Europe; (sometimes they were given a choice between converting to Christianity and death). Later, both Indian and black slaves in the New World committed mass suicide to escape brutal treatment. One slave owner supposedly stopped such desertion among his slaves by threatening to kill himself and follow them into the next world, and impose worse repression there.

There were large numbers of suicides during times of pestilence in medieval Europe. More recently, AIDS has generated a similar response among many of its victims.

There was also a wave of suicides among priests and their wives around 1075, after Pope Gregory VII imposed celibacy on the clergy, who had previously been allowed to marry. Marriage had been only slightly more popular than damnation with the Church ("It is better to marry than to burn."), but had been accepted for its first thousand years.

A significant number of killers commit suicide. Four percent of 621 consecutive murderers later killed themselves; and about 1.5 percent of suicides follow murders.

All of these situations can be readily seen as more-or-less "unbearable". However, sometimes "unbearable" means failing an exam, or missing a free throw in the big game. As George Colt notes, "Most adolescent depression is caused by a reaction to an event, a poor grade, the loss of a relationship, rather than a biochemical imbalance....Feeling blue after not getting into one's first-choice college is as appropriate as feeling happy after scoring a winning touchdown. But many adolescents who experience depression for the first time don't realize that it won't last forever."

Or, as an anonymous teenager said, "It sounds crazy, but I think it's true, kids end up committing suicide to get out of taking their finals."

(5) Excess alcohol and other drug use. The observed high correspondence between alcohol and suicide can be explained in several ways, including: (a) Alcoholism can cause loss of friends, family, and job, leading to social isolation. (This may be a chicken-and-egg question; it's equally plausible that family or job problems induce the excess alcohol use. In its later stages, the fact and consequences of alcoholism dominate the picture and are often blamed for everything.); (b) Alcohol and suicide may both be attempts to deal with depression and misery; (c) Alcohol will increase the effects of other sedative drugs, frequently used in suicide attempts; (d) Alcohol may increase impulsive actions.

The significance of the last two points is emphasized by findings that alcoholic suicide attempters who used highly lethal methods scored relatively low on suicidal-intent tests. The correlation between lethal intent and method was found only among non-alcoholics.

Thus, to claim that alcoholism "causes" suicide is simplistic; while the association of alcohol excess with suicide is clear, a causal relationship is not. Both alcoholism and suicide may be responses to the same pain. "A man may drown his sorrows in alcohol for years before he decides to drown himself."

(6) Romantic suicide. "My life is not worth living without him". This is most celebrated among the young, as in Romeo & Juliet, but is probably most frequent among people who have lived together for many years, when one of them dies.

Suicide pacts (dual suicide) constitute about 1% of suicides in western Europe. Most often, their participants are over 51 years old, except in Japan, where 75% of dual suicides are "lovers' pacts."

(7) "Anniversary" suicide is characterized by use of the same method or date as a dead loved one, usually a family member. "Imitative" suicide is similar to anniversary suicide in its focus on the dead, but uses a different date and method.

(8) "Contagion" suicide. This is where one suicide seems to be the trigger for others, and includes "cluster" and "copycat" suicides, most often among adolescents. For example, on April 8, 1986, Yukiko Okada, 18, jumped to her death from the seventh floor of her recording studio. She had recently received an award as Japan's best new singer. Media attention was intense. 33 young people, one nine years old, killed themselves in the next 16 days, 21 by jumping from buildings.

There are comparable examples from many parts of the world. The highly publicized suicide of a Hungarian beauty queen was followed by a epidemic of suicides by young women who used the same method.

Similarly, there was a spate of ethylene glycol (automobile antifreeze) intentional poisonings in Sweden following two accidental fatalities and "spectacular attention in the Swedish mass media."

In the U.S. there have been clusters of suicides, most often (or most often reported) among high school students, but not necessarily using identical methods. Even fictional accounts may be enough, as in a claimed spurt of "Russian roulette" deaths shortly after the release of the film The Deer Hunter, with its powerful and nihilistic Russian roulette scene.

On the other hand, other studies found no linkage between most newspaper reports and suicides. Nor do copy-cat suicides occur consistently. For example, the 1994 death of Nirvana lead singer Kurt Cobain was not followed by a cluster of suicides. In the seven weeks following his death there were 24 other suicides in the Seattle area, compared with 31 in the corresponding weeks of the previous year.

(9) An attempt to manipulate others. "If you don't do what I want, I'll kill myself," is the basic theme here. However, the word "manipulative" does not "...imply that a suicide attempt is not serious....fatal suicide attempts are often made by people who are hoping to influence or manipulate the feelings of other people even though they will not be around to witness the success or failure of their efforts." Nevertheless, while people sometimes die or are maimed from their attempts, the intention in this case is to generate guilt in the other person, and the practitioner generally intends a non-fatal result.

(10) Seek help or send a distress signal. This is similar to "manipulative" suicide except that there may be no specific thing being explicitly sought; it's the expression of too much pain and misery. This may occur at any age, but it is more frequent in the young. However, "Parents may minimize or deny the attempt. One study found that only 38 percent of treatment referrals after an adolescent attempt were acted on. Another found only 41 percent of families came for further therapy following an initial session. `It's often difficult to get parents to acknowledge the problem because they are the problem,' says Peter Saltzman, a child psychiatrist."

(11) "Magical thinking" and punishment. This is associated with a feeling of power and complete control. It's a "You'll be sorry when I'm dead" fantasy. An illustration is the old Japanese custom of killing oneself on the doorstep of someone who has caused insult or humiliation. This is similar to "manipulative suicide", but a fatal result is intended. It's sometimes called "aggressive suicide." In a power struggle, if you can't win you can at least get in the last word by killing yourself.

(12) Cultural approval. Japanese (like Roman) society has traditionally accepted or encouraged suicide where matters of honor were concerned. Thus, the president of a Japanese company whose food product had accidentally poisoned some people killed himself as an acknowledgment of responsibility for his company's mistake.

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from suicide and attempted suicide by geo stone.