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Comment by mikeash | Hacker News Reader

While interesting, this article seems to ignore the possibility that most people simply have a very strong desire to live. It assumes that if someone is suffering, and death would end that suffering, then suicide makes sense, and something weird must be going on to make people keep going.

But this really doesn't make sense. The entire concept of suffering exists merely to keep us alive. We experience pain and despair and sadness not because it's some inherent part of being conscious, but because those sensations help us to avoid things which are detrimental to survival. When push comes to shove, the drive to survive is what's fundamental, and that will (usually) override the desire to avoid suffering.

As intelligent, conscious beings, we have the capability to understand when survival is no longer possible, making suffering a waste. Thus we can, sometimes, override our desire to live in the face of terminal illness. But what's weird is not the fact that we don't constantly kill ourselves at the first sign of trouble, what's weird is the fact that we do sometimes kill ourselves when things look completely hopeless. You might as well try to stay alive, after all.

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In addition to a desire to live, not everyone views suffering as the worst possible thing.

If I had to be in serious pain every day but could keep doing many things I would rather keep living with the pain. The loss in experience is worse than any level of pain.

For the obvious counterpoint: I say that from experience not naivete. I've had a nerve in my hand accidentally sliced lengthwise (for a significant length) by a surgeon. The pain was so excruciating they had to put me under before I had a heart attack (heart rate+blood pressure both went off the charts, 290bpm)

However, before that happened I was much more interested in what was going on and how unique this level of pain was. It was fascinating. Prior to that I didn't really know how much pain it was possible to feel.

Anyway the point is, not everyone is afraid of pain and suffering. Especially not to the point that suicide would even be considered.

Out of curiosity - was the pain fixed when you woke back up? Because brief, intense pain like that is one thing, but experiencing pain all day, everyday is a very different beast. Even if it's a tenth of the pain that you felt, that kind of thing really wears on you, especially after years and years and no help from doctors.

This, I think, is relevant to the idea that suicide is very strongly tied to exhaustion and hopelessness.

Pain and grief, even when they are absolutely horrible, don't appear to be strongly correlated with suicide. Inescapable problems, even when they are not so severe, absolutely do.

Broadly, people seem to turn to suicide either when their circumstances seem unimprovable (chronic pain, inescapable debt, irreparable loss) or when they lose the ability to imagine recovery (acute depression, various forms of psychosis). I think that when considering suicide, experiences like "I've been in that much pain" are basically irrelevant - the operant part is the permanence, not the severity.

I strongly agree! I think part of the reason I (and probably many others) don't see pain as something that would lead to suicide is because I would (and do) simply accept it as a fact and I no longer see it as a problem.

Kind of like being short, or not as smart as the next guy. It's just the way it is. No point worrying about it.

However, if you viewed it as a serious problem and when is it going to be fixed and then... never... yeah, that would be very different.

Notably, a lot of the people I know who report depression-inducing pain have distracting, breakthrough pain.

Even with chronic pain, it's probably not the end of the world when it's "an ache in my knee when I move in this direction" or even "a mild ache in my knee always". But if it's "at random, frequent times, my back hurts too badly to stand or function", that's super hard to ignore or get used to, and I can see being incredibly upset by it. Cluster headaches come to mind as following this sporadic + devastating pattern, and indeed they do cause a fair bit of suicide.

"Can't escape it" and "can't get used to it" are an ugly combination.

I've also torn three ligaments (complete separation) in my ankle and they hurt more than 1/10th of that every day. Honestly I really don't care about the pain. It bothers people around me much more that I limp severely than it bothers me that I hurt. It's not something I care to think about because when I do then I feel self-pity.

One additional note from my side: if you're able to think about anything else than the pain without the painkillers, then my post above does not relate to you at all.

Oh and to answer the direct question, I was given strict orders from the doctor to not go off of serious pain meds (something schedule 2, I don't remember what) for 2 weeks out of the heart attack danger. I took them for about a week before forgetting about it.

It was down to just like broken bone painful then so I decided to just deal with it so I could learn how to tolerate severe pain (I was 14 at the time), I figured it would be a useful skill. My parents were a little shocked that I decided to deal with it. I passed the time reading c++ books.

The pain did make me take a lot of breaks and sleep to bring my willpower back.

I still feel it now, but it's more like the feeling of a minor cut on your finger.

Honestly, I think I have the opposite problem. Pain hasn't been sufficient for me to avoid injury. I probably could have avoided many issues if I listened to it a little.

Chronic pain is an entirely different beast from acute pain.

Totally agreed. I woke up once with severe arthralgia throughout my entire body, went to the ER and was asked to rate my pain level. Despite being the worst pain I've ever felt (woke up in tears due to the weight of the blanket on my toes), I answered a 7/10. Acute pain – not really a big deal.

Unfortunately, whatever caused the arthralgia was (and still is) a complete mystery, and by day 5 of having top pediatricians explaining "nothing is out of the ordinary" I pragmatically, unemotionally contemplated suicide for the first time in my life. Somehow the ailment completely disappeared over the following weeks and hasn't returned, but it's quite something to feel that pain will truly and honestly never stop. It's not even that your brain goes into panic mode. It's a different mode of existence altogether – I can't even imagine people suffering through years of pain even 1/100th of the intensity of what I had.

I watched my father live with the pain caused by ankylosing spondylitis [0] for decades before he died. I myself live with the pain of psoriatic arthritis[1], and occasional uveitis [2], both related conditions I knew I was genetically predisposed to (HLA-B27 [3]).

It isn't easy. The pharmacological therapies I know would be most effective are too expensive. And so I have to choose how to avoid suffering from my pain, every day. I choose work, music, my family, antidepressant and anti-anxiety medication, and participating in communities (like this one) where I may find peers.

[0]: https://en.m.wikipedia.org/wiki/Ankylosing_spondylitis [1]: https://en.m.wikipedia.org/wiki/Psoriatic_arthritis [2]: https://en.m.wikipedia.org/wiki/Anterior_uveitis [3]: https://en.m.wikipedia.org/wiki/HLA-B27

I think we humans for some reason have ridiculously wide pain gauge. I can only theorize that we've got super pain sensitivity along with super brain.

Humans are very often disabled by pain alone, with neligible body damage. That's clearly evolutionary disadvantageous. Makes torture possible, etc.

Relevant xkcd: http://xkcd.com/883/

It's so you can taste ridiculously hot peppers ;)

For some reason I easily tolerate very spicy food but I have huge fear of pain.

> If I had to be in serious pain every day but could keep doing many things I would rather keep living with the pain.

Scratch that: ~~~No, you (most probably) wouldn't.~~~

EDIT: this post is about severe chronic pain. Think cancer, or a serious toothache which lasts for years. And it's not meant to discuss the specific situation of the parent! I'm talking in general. I also agree that not 100% patients with severe chronic pain will consider suicide, however the percentage of people considering suicide in such group is much higher than in the rest of the population.

You may believe so right now, but that's totally irrelevant: just as you were unable to imagine "how much pain it was possible to feel" before your experience, you are unable to imagine what a serious, chronic pain can do to you.

Chronic pain is a lot like depression: there's no relief, no hope, nothing you can do to ever feel any better. Assuming that you'd be able to do anything - and that doing that would even make you happy - is... well, very improbable, to say the least.

> Anyway the point is, not everyone is afraid of pain and suffering. Especially not to the point that suicide would even be considered.

Sure, it's easy to be brave in the face of the unknown. It's a lot harder to be brave once you see what "chronic pain" really means. And there is no notion of being brave (or not) once it actually happens to you - there's only despair and suffering. Really, only that. Nothing else, at all.

We have a lot of pain management methods at our disposal now and, in many cases, it's possible to reduce the symptoms and make the patient feel "well enough". Without such help, however, it's only a matter of time before (most of) the patient considers suicide - no matter how brave and "suffering accepting" he was before.

I heavily dislike such absolute statements, especially if they are unfounded.

It is merely your opinion that he wouldn't keep going with chronic pain, he has a different opinion.

There's no way for us to verify yours or his claim.

Sorry, but that patients with chronic pain are much more likely to consider suicide is an easily googlable fact. That chronic pain links with depression, which further reduces probability of "would rather keep living" is, too.

Also, the "(most probably)" part of that sentence in my previous comment is there specifically to show that I'm not making absolute statements...

The fact that given a population of people more of them will consider suicide with chronic pain does not mean ALL people will. Some of us won't.

True, of course. I edited my post above.

I've torn the ligaments in my ankle and I've been in chronic pain every day for the last 12 years. Honestly, it doesn't bother me. (I mean, it hurts a lot and given the choice to be alive AND have it gone, I would prefer it gone, but, meh)

It bothers people around me that I limp though. Oh well.

I gave the example of acute pain because that was more challenging to me than the chronic.

Interesting. This is a complex issue.

I have those types of issues too. Most of us do once we get old enough.

They don't really bother me. Like yours, I can overcome them. Almost everyone does.

I suspect if either of us had trained all our lives to be, and wanted to be professional runners, it would bother us greatly.

>I also agree that not 100% patients with severe chronic pain will consider suicide, however the percentage of people considering suicide in such group is much higher than in the rest of the population. You may believe so right now, but that's totally irrelevant

It doesn't matter if the "the percentage of people considering suicide in such group is much higher than in the rest of the population" if that percentage is still small within such a group.

E.g. if 1% kills themselves in the general population, while 2% or even 5% kill themselves in such a group, that's still 95%, an overwhelming majority, that do not.

In which case, what the parent thinks now is not "totally irrelevant" but mostly correct.

>And there is no notion of being brave (or not) once it actually happens to you - there's only despair and suffering. Really, only that. Nothing else, at all.

I've seen people with chronic pain (including long-term fatal cases) that are not just "despair and suffering". Including people who have dreams and follow them (creative work etc) despite the pain.

We're talking about considering suicide! Going through with it is a completely different matter, due to very many factors, some outlined in the OP, another sometimes being physically unable to do it...

> I've seen people with chronic pain (including long-term fatal cases) that are not just "despair and suffering". Including people who have dreams and follow them (creative work etc) despite the pain.

Without any kind of pain management? With severe, chronic pain?

Well, what I witnessed may have been outliers, but once you hear a person you care for begging to "please, just make it stop" every time she was able to actually articulate some words instead of screaming in pain... that leaves a mark.

What I'm saying is that there is - possibly very different for different people - a threshold of (pain-intensity times pain-time-length) above which everyone will be considering suicide. That the people you know are below such threshold doesn't mean it's not there. Having seen people way above it I really can't accept people telling me that they'd rather "live with the pain". What they mean is they'd rather live with bearable pain, which is OK; however, there is such a thing as an unbearable pain and I don't believe there is anyone who'd like to live with it.

>Well, what I witnessed may have been outliers, but once you hear a person you care for begging to "please, just make it stop" every time she was able to actually articulate some words instead of screaming in pain... that leaves a mark.

You seem to conflate chronic pain with "living in total agony", like some terminal patient.

People here are not talking about that. Maybe do some reading about what "chronic pain" means medically? It's not just a single thing like the one you described.

His example is dramatic. But it's not as far off as you might think. Have you ever had a migraine? "Chronic migraine" is a thing, and it's truely awful.

15 years ago I may have said something similar.

I'm going to try to shed a little light on how chronic pain and disability is a bit different than acute.

I've lived with chronic pain for over 10 years. As a registered person with disabilities, college resources helped me get by - but these did not exist in the real world for someone like me.

It prevented me from working in my field of study and preference and severely limited my freedom and willingness to take risks. I encouraged friends and peers to chase my dreams; they have succeeded where I could not.

On the spectrum of pain and disability I'm relatively lucky. My condition cannot kill me. At worst, it can only prevent me from doing what I want and deny my dreams. I have managed, and am somewhere in the top 20%. My old friends are in the top 5%. I burn my life doing irrelevant work because my employer has a good benefits package that has my back if I take a turn for the worse.

Now, with age, my body and mind is starting to deteriorate, and with it the dream of figuring a way to truly overcome my challenges rather than just get by.

I have it pretty good.

Anyway, I'm off to an experimental treatment where they'll stab me 20-30 times with a needle. Unfortunately my condition causes hypersensitivity. Acute pain doesn't really matter though. They claim to have improvement in 70% of patients but the published, controlled, literature is less encouraging. This is the best outlook and most hope I've had in years.

Maybe if I keep calm, remain positive, and make myself more susceptible to placebo I can get my life back. Or maybe I'll just be one of the lucky ones.

You nailed it.

Chronic pain can be really, really, debilitating.

Think about what you are going to do in a few hours. Maybe you'll hop on public transit to meetup with someone. Or maybe bike somewhere. Or take a shower. Or make a sandwich. Or make love.

Now imagine if you had a really bad joint (ankle, knee) or back. Suddenly, taking public transit has additional complexities, like does the station have a lot of stairs and a lengthy distance to the train? Will I be able to get a seat? Or if I'm biking, is my commute going to flare up my joint/back? If I take a shower, I can't stand too long lest a joint start to get painful. Besides, I have to 'save' my pain threshold for situations that are a bit less controlled like walking to the bank or returning an item.

Whereas most people can spend 100% concentration on their surroundings, I have to expend mental energy thinking "Where's the next seat? How long am I standing up for? Am I causing damage to myself?" When science and medicine can't do much, and quality of life drops dramatically, it's hard not to think about alternatives.

Death is permanent but it does have one advantage: it's silent. There's no more pain.

Chronic pain is very easily treatable.

In the US you only got the problem that the usually subscribed extended-release pain killer only works 2/3 of the period, but everywhere else this is a solved problem with its 4-6 hours cycle.

You're quite naive. My wife maxes out on prescription pain killers that her (really quite good) pain doc gives her. It means laying in bed doesn't cause constant pain, but everything else (including showering or sitting in a chair) is unbearable after a short time.

We know so much less about the human body than we think we do. When giving birth to our first son, she was given the maximum dose epideral and was told she wouldn't be able to walk for a few days because of intense numbness. Not only did she walk to the bathroom shortly after giving birth, but it didn't even lessen the pain.

Not everybody responds to and gets the benefits of modern medicine as we'd like. I'm grateful that medicine does work on me and my children though.

Good luck to you!

> However, before that happened I was much more interested in what was going on and how unique this level of pain was

your post brought back a memory of mine. i crushed my finger once while doing something mechanical. the bone was crushed into pieces.

it hurt so bad i started laughing. i had to be driven to the hospital because i couldn't even see straight.

that level of pain is something else, for sure. it hurts so bad, but you can detach yourself from it, somehow.

I get myself into interesting positions quite often by arguing this exact thing. Suffering is a bit of information about the state of your body/mind etc. I can imagine the best life possible, with the most contribution to society, being a huge source of pain and suffering.

Generally speaking, of course, that's not a safe bet. Suffering tends to be associated with damage and psychological stress, which are rarely good things. I'd take 8/10 pain every day for the next 40 years though over something like dimentia or advanced alzheimers.

That said, I'd also take pain over severe depression. That shit sucks.

Sounds like the importance of pleasure and enjoyment is greater than the importance of pain and suffering.

I wonder if you could model the "suicide critical point" as the point at which the importance of pain is greater than the importance of pleasure.

Somebody suffering and in pain but hopeful is not likely to commit suicide. Someone with a good, stable life and/or future but fixated on negative aspects or thinkings may be more inclined for suicide.

There is a big difference between pain you can reasonably expect to go away and pain you cannot reasonably expect to go away.

Suicidal ideation is due to the latter, not the former.

Or it's possible we're talking about differing amount of pain or different ways we experience pain.

My back gave out once and for about a week nearly every movement was excruciating. Getting out of bed was a 10 minute ordeal. Trying to sit down on the toilet or stand up was excruciating. Trying to sit down anywhere or lie back down on the a bed sent daggers of pain through my back. Turning in a chair or in the bed was just as bad. If a doctor had said "the rest of your life will be like this" I would have seriously considered ending it.

I've also had bad experience with bungled root canal and a resulting toothache that required 600-800mg of ibuprofen every 2.5 hours for 4 weeks while I waited for an appointment with the dentist to fix it. If the ibuprofen had not worked and had to live with that pain I would have unquestionably ended it.

Had a fingernail pulled out by a doctor once with no pain killers (well, he tried 3 injections of whatever over about 20 minutes but couldn't get the area around the nail to go numb). There's a reason denailing was used as torture. It causes extreme pain.

Whether others experience similar amounts of pain or I'm just a whimp I have no idea but of course I only have my experience to go on and I have a hard time believing if people experienced the same amount of pain every day they could truly live with it.

It seems very likely that this is a context issue or typical mind fallacy.

The View From Hell is written by an anti-natalist and, if I recall, 'nonpracticing suicide'. This, I think, is someone who has a radically different baseline for "desire to live" than a lot of the people responding to it.

And, on the flip side, a statement like "the drive to survive is what's fundamental" might well sound completely bizarre to the writer. The idea that despair and sadness are about avoiding things detrimental to survival is at best situationally true, as evidenced by all the times when people find those feelings themselves detrimental to survival.

But aside from all of that, I think this doesn't invalidate the basic claim that a lot of the things stopping somewhat-suicidal people are not the desire to live. At the point where someone is considering suicide, their "life drive" wiring is obviously not a whole answer - so it remains relevant to look at the large number of suicide ideators who are held back by fear, or motivation issues, or other indirect reservations.

I agree with your point at the end. The question of what keeps many suicidal people alive is quite interesting, and no doubt complex. I just feel like the introductory question of "Why do so few humans kill themselves?" is backwards: the basic strangeness of human suicide is why we do it at all. Beyond that, there is then the interesting sub-question of why some people feel a desire to do it, but refrain.

This is a fair summary. I suspect that the author might disagree about how strange the basic urge to suicide is, but I completely agree that the really interesting category is "internally suicidal but not acting on it".

> But what's weird is not the fact that we don't constantly kill ourselves at the first sign of trouble, what's weird is the fact that we do sometimes kill ourselves when things look completely hopeless.

I think hope plays a big part. We don't kill ourselves because we have hope. If we are suffering and have no hope, that's a recipe for suicide.

Being extremely depressed actually reduces short term risks of suicide because planning shuts down. It's the middle ground where things are bad, but people can still think that has the highest risks.*

*Excluding hospital assisted suicide where someone OD's on pain medication under end of life pain.

But "no hope" is not equivalent to "extremely depressed".

Think of people who commit suicide over inescapable scandals, chronic pain, or terminal illness. Extremely depressed comes with 'no hope', but that's cancelled out by 'decreased agency' (which is one theory for why antidepressants carry suicide risk). Not every form of hopelessness shares that loss of agency.

> While interesting, this article seems to ignore the possibility that most people simply have a very strong desire to live.

Alternatively: People can have goals related to the actual outside state of the world, rather than their own internal state. If you can only conceptualize goals in terms of your own internal state, then sure, you might kill yourself to avoid pain, or wirehead yourself at the first opportunity.

But if your actual goals are out there in the world, then it's essentially as you say above. Dying reduces your influence on the world. If you're not alive, it's much harder to steer the world to your desired state. Survival is a convergent instrumental goal, for people as much as for AIs.

Human evolution is very much a work in progress. Many things that hurt survival are around because other things are more important.

Evaluate these 50,000 options as pass fail. Change a few randomly, shuffle with another set. Repeat.

Sure, it works for minor things eventually. But, in the short term only the most major things have noticeable impact.

very strong desire to live.

Meh, I just fear hurting the ones I love.

So... a very store desire to live (so that you don't hurt the ones you love).

I guess the title caught me off guard. Suicide rates are low as compared to what, does any other animal on earth kill itself?

with regards to people I would not place on it on the desire to live, I figure it because there are so many distractions in life

It is said that pain is a fact, a by-product of life and the human condition. But suffering is a choice. Many simply choose not to suffer with their pain.

A depressed mind doesn't work like that.

For a depressed person, their brain is constantly torturing them, and the depressed point of view seems much more real. "You can choose to pretend you're happy like the rest, but you know how life really goes."

I think you missed the point, the way to "not suffer" is death.

In general every morning we make a decision on whether the expected future happiness is going to outweigh the expected future suffering. When that fails (and it does) we find reasons of duty to keep going, for the people we love etc. You're right, depressed people have a skewed vision of the future and it destroys their expectations of happiness.

I don't think that's obvious - spdustin could be speaking from a buddhist point of view: suffering is caused by desire, not pain. You can choose to remove desire and suffering from the mind through meditation.

What a terrifying sentiment. I'm astonished at how attracted people are to theories where problems are necessarily the fault of the person experiencing them. Hey, if you're suffering, there's an easy solution: just choose not to! Gee, why didn't I ever think of that.

I think I took something different from it than others are.

Many people choose not to suffer, because "suicide is an option". Or pills. Or therapy. Or, the lucky ones, they can switch it off.

Depression (noted in another comment) further limits the ways by which one can control the suffering brought on by pain. I know this well. Many of us do.

The strong will to live inherent in most humans means that suicide is typically not a choice people can make. That's kind of my whole point: the fact that anybody can ever make this choice is remarkable. But to take the possibility of suicide and thereby declare that suffering is a choice makes no sense to me. It may be for some, but not for most.

You did see that I listed other options, right?

Does it matter? There are plenty of people suffering from problems that can't be fixed by pills or therapy and who are not mentally capable of suicide. Suffering may be a choice for some, but it is not a choice for many.

I give up; you've checked out of the conversation and I don't believe I'm effectively choosing the words to match my feelings. Sorry if I caused any angst.

is it really that astonishing? it means that you're in complete control of your experience. quite a powerful statement. this isn't a blame game, no one's pointing fingers at anyone and saying, 'gee just think more positively man" or whatever. it's a personal strategy for managing one's own suffering, and a quite powerful one at that.

Pointing fingers and telling people to think more positively is a really common reaction to depression. I think that's why I reacted so strongly to it: it sounds so much like a common counterproductive refrain.

Agree, it is a definite common reaction, and completely counterproductive.

> The entire concept of suffering exists merely to keep us alive. We experience pain and despair and sadness not because it's some inherent part of being conscious, but because those sensations help us to avoid things which are detrimental to survival.

Emotions are often themselves detrimental to survival. They are there to make sure you survive and reproduce, not that you survive without issue.

Exactly. Our bodies go through great lengths reconstructing damaged flesh, holding together with the help of something as primitive as stitching, getting disinfected with something as common as ammonia that changes our perceptions of our bodies making survival a second nature and a habit to us.

I agree with most of the assumptions. They are assumptions, though. We don't really know what makes us feel and act the way we do.

> what's weird is the fact that we do sometimes kill ourselves when things look completely hopeless.

The hope is always there, just change the purpose.

Instead of a life without suffering one expects to end the pain.

That is the final hope that the suicidal people embrace.

For most of us, committing suicide is unimaginable.

Sometimes people find themselves in situations where the unimaginable is a better option than whatever it is they're facing. The act is equally horrific, but preferable to the alternative.

> At least 200 people are believed to have fallen or jumped to their deaths [from the World Trade Centre on 9/11] while other estimates say the number is half of that or fewer.

[...]

> The New York City medical examiner's office said it does not classify the people who fell to their deaths on September 11 as "jumpers": "A 'jumper' is somebody who goes to the office in the morning knowing that they will commit suicide. These people were forced out by the smoke and flames or blown out."

https://en.wikipedia.org/wiki/The_Falling_Man

I don't think the WTC jumpers are quite the same. They were faced with certain death or near certain death, and they naturally chose the latter. Falls from a great height are survivable, very very rarely. I see this an example of the human drive to survive: when faced with death, we'll try anything that offers any sort of hope, even just a slight delay.

> when faced with death, we'll try anything that offers any sort of hope, even just a slight delay

Many people opt-out of aggressive cancer treatments that may add months on to their lives, and increasingly euthanasia is a (legal) alternative to letting medical conditions run their course.

There are situations where ending things early can be one of the valid choices made available to you.

http://www.goodreads.com/quotes/200381-the-so-called-psychot...

That's true, but I think there's a big difference between a long-standing condition and a brief crisis. I love the quote you linked to and I think it does a great job at giving people some perspective on what suicidal people are thinking. I just think the analogy falls apart once you start digging into it. Jumping out of the towers was a last-ditch attempt to survive, not just a better way to die.

> Jumping out of the towers was a last-ditch attempt to survive

I'm not sure how it's possible to come to that conclusion.

(And to be clear: I wasn't originally trying to suggest that everyone that fell from the WTC made a decision to jump. I think it's probably fair to say almost everyone that fell was simply trying to get away from the smoke by leaning out of windows, etc. )

I'm not sure how it's not. Certain death in the smoke and fire versus a slim chance of survival if you jump, seems like the rational choice in horrible circumstances.

I don't think it was about survival chance. Death by heat sufficient to kill you would surely be extremely painful. Death by fall impact from high enough would at least be quick. As either option was clearly fatal, jumping wasn't a deliberate choice for death and hence wasn't suicide.

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