The undiscovered country: Can suicide be predicted?
harpers.org
harpers.org
“The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom Its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who leap from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’, can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling.”
A 2001 University of Houston study of survivors of near lethal attempts showed that 70% of them had only decided to do it an hour or less before the attempt, and 24 percent had only spent 5 minutes before the attempt.
If when attempting it, they discover that their chosen method won't work for some reason, many will just give up on killing themselves rather than looking for an alternative measure.
This has been reliably seen many times. If a change is made such that one suicide method becomes unfeasible, the overall attempt rate drops. If one were committed to offing oneself it is almost impossible to stop them, as there are countless ways to do it. But the statistics are very clear that if some method is removed, alternatives are not always used.
The British had an issue with people killing themselves with oven fumes, back when the ovens used coal gas which created a lot of carbon monoxide, with this accounting for about 50% of suicide deaths. When things were changed to use natural gas where this approach does not work, suicides dropped by 30%. Obviously while that means a portion ending up using some other method, many others simply never killed themselves.
Of 515 people prevented by police from jumping off the Golden Gate Bridge between 1937 and 1971, by the end of the 70s only 6% of them had committed suicide by other means.
Weirdly even some of the non-impulsive cases where people had planned an attempt for days or weeks just give up if their plan is foiled, rather than coming up with some alternative method.
Now obviously not everybody is like this. Some people will continue to try over and over until they succeed. But the numbers suggest that those are very much a minority.
Can you elaborate? That sounds pretty much like the people in the analogy to me. They jump because the alternative they face right now is more terrifying for some reason. It makes sense that not all methods of suicide fulfill that criteria (being less terrifying than the alternative), even if they are all methods to end your life.
To go back to the analogy, it's as if they try to jump from the window, but there's a safety net that blocks them. They're stuck inside and the fire is mysteriously gone.
It holds even more true if we consider that a large part of suicides are not because someone wants to die - no - it's because someone does not want to live like in present situation anymore. Just like with the fire, the goal is not to die on a sidewalk - it's not dying in the fire. You attempt suicide as last resort - if you die, it's okay, it's final. If you don't, it perhaps changes something for the better.
This is human behaviour, and causality is really not as simple as wanking some stats around and making a bunch of super tenuous inference. 'fuck outta here with that reductionist bullshit.
You are responding to a thread of someone not like what you described, who exists in great numbers as well. The two examples you presented are wildly different: Britain's suicide rate dropped 30% and now they are at square zero again how to prevent all those suicides that keep happening!
The point of even talking about it is to show how useless telling someone "hey just call this phone number, because I care about you, well I don't actually know you but I avoid the topic of suicide" is just as useless as the people on the ground telling someone not to jump from a burning building.
Even if they don't jump (or do call the suicide prevention number), the fire is still there (the underlying problem is unresolved and still not reconcilable)
This detail is a little wrong or at least confusing. The coal gas (typically called "Town gas") was about 10-20% carbon monoxide, along with hydrogen, and other flammable gases. When set aflame in a ventilated room, the carbon monoxide burns - like the other gases - producing mostly carbon dioxide which is still slightly poisonous but since we breathe huge amounts of it already it's not near the top of your list of problems.
In this era British people (maybe 1000 per year or so) commit suicide by turning on the gas supply to an oven but not lighting it. The phrase "stick my head in the oven" signifies suicide for this reason, the implication is not that you would cook your head, but that you would deliberately breathe the poisonous carbon monoxide and die.
Perhaps much of that is because they got the help they needed following the incident. It probably also helps that they were a group made up of those who were able to be persuaded by police to not jump in the first place already showing at least some willingness to keep living.
I don't think the ones that are talked down are a remotely representative sample.
Lots of personal experience here (family). The suicidal 'mode' needs to be interrupted before death. Usually it lasts only an hour or two.
Helping one interrupt that mode is a learned skill that is very effective, and relatively easy to do.
This isn't universal of course, just my experience. If anyone reading this suspects someone is suicidal and they don't answer the phone at a time you know they are at risk, go see them asap. You might save a life.
So DFW rejected others ideas on the subject in favor of his own experience? Sounds a little narcissistic doesn't it?
Apparently it's one of the first weeks' side effects but I wasn't prepared... After 2 weeks it started to fade and the drug started doing its work. But I think it was a huge dopamine rush coming without a counteracting 'I want to live' that was the most revealing about chemical imbalance and how suicide might be sometimes uninterpretable as 'just' psychological.
First, he talks about a well supported model called Joiner's Model, based on research which shows that people who are most likely to commit suicide have all three of these factors:
- Thwarted belongingness ("I am alone")
- Perceived burdensomeness ("I am a burden")
- Ability to commit suicide ("I am not afraid to die")
Perceived burdensomeness has two components: Liability ("My death is worth more than my life to others") and self-hate ("I hate myself")
Thwarted belongingness also has two components: Loneliness ("I feel disconnected from others") and absence of reciprocal care ("I have no one to turn to and I don't support others")
And finally, capability to commit suicide is predicted by: Lowered fear of death, elevated physical pain tolerance, family history of suicide, clustering/exposure to suicidality, combat exposure, suicide attempts, childhood maltreatment
And another model with the acronym "IS PATH WARM" shows that people who are most likely to commit suicide are likely to have, feel or be:
- I = Ideation
- S = Substance Use
- P = Purposelessness
- A = Anxiety
- T = Trapped
- H = Hopelessness
- W = Withdrawal
- A = Anger
- R = Recklessness
- M = Mood Change
[1] - at about 25 minutes in to https://www.youtube.com/watch?v=Arywx88jMXw
The terminally ill ones are more like the people who jump from a burning building--life has legitimately become more painful than death. That's not something a psychiatrist can change.
If given a guaranteed to work and painless option of suicide, I’d plan to not work for a few years, drain my savings, and call it good.
Sure there are things I like and find happiness in. But what’s the point? I’ve had about enough.
Your current position sounds like no matter how miserable or how fleeting the moments of happiness are a person should just grin and bear it. They don't want to, but you want them to.
I agree there are clearly situations where a person only temporarily wants to die. These situations could be characterized as irrational.
For me personally, it's arthritis. I'm slowly losing functionality and interest in things I used to enjoy because the pain changes the calculus. It's not unbearable now but it's degenerative so it's only going to get worse.
So you just go into the "assisted suicide before illness gets too bad" bucket, not the people who "just want to die".
> Your current position sounds like no matter how miserable or how fleeting the moments of happiness are a person should just grin and bear it. They don't want to, but you want them to.
It's more like: if you exclude mental illness and intense suffering caused by physical illness, how many people still have lives so miserable they'd rationally want suicide, and how many of those would remain miserable if given a better environment to live in?
And you're reading too far into me having a position here. When I ask what that looks like, it's a legitimate question.
That can look like a thief or petty criminal being repeatedly incarcerated for most of their life, with perhaps brief gaps where they are released into the world with a criminal record to discover they have practically no opportunity and skill beyond crime.
That can look like an incel who yearns for connection but repeatedly and painfully fails; they have no social skills, no close friends to help, and no family who cares.
That can look like a minimum wage debt-ridden worker who does backbreaking labor day after day yet is never able to get ahead enough to make a life that gives them any relief.
That can look like a person who faces a life of never-ending secrecy and fear, never able to be who they want to be or say what they want to say because of taboo.
All of these people would benefit from a better environment as others are all too eager to remind them. Will you give them a rational reason to believe they will get one? Empty suggestions that "it could be fixed in the future!" are hardly compelling. Your severe cancer could disappear like the wind or someone invents a fantastic treatment in the future, yet no one would dare suggest that's a rational thing to look forward to.
2. None of the situations you listed are that hard to solve.
3. "I lack skills" doesn't sound like a good reason to die.
I can’t see the nobility in not having the option of going out cleanly on your own terms as your body reaches the final stage of terminal decline.
I suppose one could say that in the United States, the 2nd Amendment guarantees your right to an effective form of self-assisted suicide, as long as you use your 5th amendment right to keep quiet on why.
I don't think you were advocating for it as a replacement for medically assisted suicide, I'm only pointing out that it's a poor substitute for what we really need.
Just terrible that it can end up being the primary option when you get to the point where you don’t want to go through the last few months of suffering with no hope of recovery. Just terrible.
"IS PATH WARM" really personifies the feelings.
I think this explains suicide better: For most, it’s an irrational act done in the spur of the moment.
What I think is more interesting is when suicide is done as a rational act with planning, and consideration for others.
The mystery is what is going through the persons mind at the moment of self execution.
edit: I used the wrong word to describe a final act.
I think you may want "ultimate"? penultimate = second-to-last.
There's always a conversation over whether suicide is rational, but no one thinks to ask if living is rational.
I've never been suicidal, but I've always felt that strong anti-suicide advocates, while strongly well intentioned, might not be fully reasoning out their belief systems. I think I'd greatly prefer to go out on my own terms in old age, without need for qualifiers like pain or disability.
Recognizing the time for your conclusion is a tropey act for old characters in fiction, and implies deep wisdom. But in real life we assume anyone feeling similar has lost their mind.
https://gizmodo.com/the-agonizing-last-words-of-programmer-b...
https://ennyman.medium.com/a-lesson-from-29-golden-gate-suic...
Sure most suicide attempts aren’t done this way but I think statistics like this showcase how many suicides are irrational on some level. If it was rational then you’d think they wouldn’t immediately regret it (unless the regret is irrational I guess).
Source: "Where are they now?" by Richard Seiden
There could even be multiple mechanisms there: "turns out being that close to death is really scary," or "my survival means there is a higher power looking out for me," or "my life flashing before my eyes made me realize something about my life"...
"Nine out of ten people who attempt suicide and survive will not go on to die by suicide at a later date. This has been well-established in the suicidology literature. A literature review (Owens 2002) summarized 90 studies that have followed over time people who have made suicide attempts that resulted in medical care. Approximately 7% (range: 5-11%) of attempters eventually died by suicide, approximately 23% reattempted nonfatally, and 70% had no further attempts."
https://www.hsph.harvard.edu/means-matter/means-matter/survi...
I think we should be really careful about how we think & talk about this.
There are a few situations (like psychotic breaks) where people fully believe delusions that, in a short time, they will reject. We can cleanly call those experiences "irrational."
On the other hand, people who experience long term depression literally experience the world differently in a way that we frequently cannot 'correct'[1]. Those people are not irrationally convinced that the world is hard to be in - they have brains for which things feel worse than for neurotypical brains. We can agree on all objectively measurable qualities of the world and their experience of that world will still be subjectively and consistently worse.
The conversations from the right-to-die movement can be useful here, as chronic pain and disease offer a lens through which to understand. We have all experienced physical pain, but we have not all experienced serious depression.
All I mean to say is that in the same way that someone with any chronic illness should have some choice in when and how they die, people who have chronic mental conditions should have the same right. We do not want to make the mistake of thinking that a person in a more complicated situation is compromised in some way - just that their world is more complex and we should take care to attend to the specifics of it.
[1] It's not clear what way of seeing the world is 'right' but I will use correct here even with its implication that neurotypical people live in the real world.
In this way, I think they are clearly distinct from those with terminal illness or chronic pain.
I agree that people should have the right to choose death, independent of the rationality of their decision. Ultimately, people are the owner of their body and steward of their life, even if they are imperfect and irrational ones. Taking autonomy away turns individuals and their body into the property of someone else.
I think there is some room for temporary holds and crisis management, but all such activities should be finite in duration.
I don't think that that there is an ethical imperative to allow people to carry out irrational decisions. I was trying to say that, if someone with depression or another chronic mental illness decides they would rather be dead than alive, then after we determine that decision doesn't come from a passing[1] delusion, then we should give that desire the same weight we give to people with other chronic conditions. We all have the right to choose, after a time, that we do not want to live this way.
I also think that having a global standard for "rational" v.s. "irrational" is difficult enough that I think drawing strong lines tends to do more harm than good. So, in practice, I suppose I support people who "irrationally" wish to end their lives, but only due to the impossibility of determining what 'rational' means for each of our subjective perspectives.
[1] Whatever "passing" means - it is not an easy question.
This addresses the fact that a severely depressed person may not be able to make the same objective assessments of the world that the chronically I'll can.
A severely and chronically depressed person might think "I have no chance at happiness" when in reality, they actually do. If they base their decision on this premise, they would be following faulty logic. My point is that they have a fundamental right to act based on their conclusions, even if they are wrong.
100% agree!
Looking back on that version of me, I wouldn’t really trust myself to make decisions about life and death.
But on the flip side, I know not all circumstances are equal, and so all I can conclude is that this is incredibly complicated and I don’t have the answer.
America needs to get over itself that life needs to be lived until a natural death. Not everybody wants to further deal with the excessive burdens of life. Suicide, when not done in a spur of the moment decision, can be wholly rational. Wanting to live a garbage quality if life because society thinks it's weird to just end it to not suffer is some Catholic guilt being forced on everyone.
I don't think suicide is a rational response to that; I even think it's dangerous to frame it as any kind of 'rational' action to take in such a situation.
> I think this explains suicide better: For most, it’s an irrational act done in the spur of the moment.
Or it's rational, but we have some "irrational" mechanisms to prevent it that are best defeated by an impulsive act [1].
I don't actually believe that, but it's hard to argue against it under certain common sets of assumptions.
[1] e.g. from a rationalist/materialist perspective: suicide is to avoid/escape pain, and it also removes the pain of guilt for doing it and the pain of missing out on all future pleasures, etc. However, evolution has formed us to reproduce, no matter how painful the struggle is and how subjectively irrational it is to endure it.
A lot of bad things can happen to you in a lifetime, but death is the worst, without a doubt. To feel the need to inflict it upon yourself is therefore not rational at all, even if it is premeditated. What seems like one irrational spur of the moment decision is really one that in most cases had been considered well before. No one ends their own life before thinking about it beforehand.
I would say it's dedicated to keeping you alive long enough to raise children and help your children raise children. Which may be the same thing in practice, but more in line with how evolution works.
I personally believe humans derive their own meaning in life. Temporary chemical imbalances and runaway feedback loops of emotional harm can certainly lead to impairment of rational judgement concerning suicide, but that doesn't mean that if you accept the premise that humans derive their own value that there can be rational avenues to suicide.
For situations like accute depression and anxiety (of which I'm intimitely familiar) are situations where I would argue ones judgement is impaired when it comes to suicide, and I don't doubt that said impairment is extrapolable to many other situations.
>A lot of bad things can happen to you in a lifetime, but death is the worst, without a doubt.
I think that comes down to whether you believe that
A) Someone can experience a negative qualia
B) Someone can rationaly predict that said living situation is now a permenant state of affairs with a high enough degree of certainty
C) That death is a negative (negative only insofar as it can effect others) to neutral qualia that is still higher than and therefore preferable to an expected permenant negative qualia.
I'm not of the opinion that this is something that can typically be done independently, as humans are vulnerable to a host of conditions that can impair our ability to make judgement B, and I sure as hell hope that anyone wanting to make that decision trusts the people they ask to help them make it.
The protoypical example people tend to use is alzheimers victims, who are frequently (but not always) permenantly and irrecoverably (for now hopefully) distressed.
They're not dedicated to keeping people alive. They may play a role in keeping some people alive (or not, depending on a lot of factors).
You're imagining purpose for organs and cells which just exist and sometimes function or sometimes don't.
Even if they did have some purpose (which there's no evidence for), does that mean that humans should blindly submit to whatever that purpose is?
Why shouldn't a human be able to make their own decisions instead of giving over decision-making authority to their body?
On the contrary, I think every part of my body is dedicated to making sure my DNA propagates. But, being conscious, my cognition can overrule the evolutionary imperative. All the more easily if I've reproduced.
And death is not necessarily the worst thing that could happen to me. Search "locked in" illness. Or Alzheimer's. There are many illness states to which I'd find death preferable.
I personally think of suicide not as a decision to die but rather a decision not to live. No one wants to die but it is very conceivable that one could be in a situation that no longer is worth the effort to sustain. Side note, I do not feel this way now but when younger I certainly felt like being alive wasn't worth the trouble and had to go through a process of convincing myself it was.
They'd push it even sooner if no one they cared about depended on them.
A lot of people stay alive simply out of a sense of responsibility towards others.
That would be me. I don’t want to be a burden to people.
In my view, firearms are close enough to this level of technology, to shed doubt on the hypothesis. I don't think everybody with a gun tries to kill themselves.
What’s holding me up mainly is that this would probably freak out family and friends and I don’t want to be a burden to them. I also still have the hope that one day things will get better but that hope is diminishing.
I just watched somebody go through a serious cancer treatment and I am 100% sure that I wouldn’t have gone through the treatment but would have ended it. I don’t want to go through the hell of treatment only to end up back in a life that’s not much fun either.
Try to study philosophy, especially metaphysics, and confront any fears about life or death you might be having. It won't change your life situation (no windfall of cash) but it will change the way you see things and that can be huge.
As an example, take Jeffrey Epstein suicide (let's assume thats what happen). He might have sought that exit given his possible future perspectives. Had he been in Mexico (where I live) he may have had a different (more lenient) perspective of his future.
Suicides happen in tribal cultures - https://www.jstor.org/stable/658295
[0] https://en.m.wikipedia.org/wiki/Suicide_(Durkheim_book)
[1] https://www.firstthings.com/web-exclusives/2019/08/mass-shoo...
Let me present a scenario which might seem more relatable since it seems people understand physical pain but have no "scale" of what mental pain could be like.
You have a chronic pain (maybe one of wrists is broken in a way that there is no solution). No painkillers help. Every doctor you go to doesn't have a quick-fix. People around you keep telling you "you're imagining things", "be spiritual", "it isn't as bad as you think", "it'll go away". Nothing you try seems to help. You wake up every day feeling the pain and it keeps getting worse with no end in sight.
EDIT: Missed one crucial component. The pain is so much that you cannot have normal social interactions because 80% of your energy is spent trying to cover up the pain. You feel exhausted all the time due to this and don't have the energy or the motivation to do anything.
Image living this for even a year (where this is what life looks like for some people for the last 20 years or more) and then tell me you wouldn't say no to "anything to make the pain go away".
Sure, I think our rampant overdose problem and drug and alcohol over-use problem in general is a symptom of this. That's one of the reasons the war on drugs is so insidious, it punishes the people already suffering, which makes them suffer more, forcing a downward spiral that is almost impossible to get out of. All from a perceived moral failing.
The US is pretty cruel to its citizens. It's not overtly, in-your-face cruel like historical regimes, but still cruel, none the less.
There may be other reasons that affect it more, but I'd fully expect that to be enough to result in more self-medication, all else being equal.
He lost his eyes and face, had both of his hands amputated, and was forcibly given agonizing treatments for 14 months.
At his request a documentary video was made about him, which he titled "Please Let Me Die"[3]. It was shown to lawmakers and judges in hopes of allowing him to refuse medical treatment.
He was forced to endure the treatment against his express wishes, survived, and graduated law school to become an advocate of patient's rights. Still, he always maintained that he should have been allowed to end his life.
"No human being has the right to force another human being to undergo that kind of pain and to take away that person's right to self-determination."
[1] - https://en.wikipedia.org/wiki/Dax_Cowart
I feel the only reason we don't let people chose that path is to make ourselves feel good and feel "guilt-free".
I recently had a situation where someone in my family was diagnosed with a life threatening condition but the dilemma was that if you chose to undergo treatment their life will turn to shit. If you don't then they might suddenly die one day - albeit happy and normal.
I felt a lot of guilt trying to find reasons to convince people why the 2nd option was better. If you think rationally the only reason to pick the 1st option is selfishness. For the person who has undergo the treatment the 2nd option is hands down the better one.
Obviously this is just one of example of one random major religion and tells us mostly about how small many humans are and how it manifests across society. Feel free to apply this to much of evil caused by mankind, basically since we were humans.
Eye opening for me was when I met this fellow Texan guy in Nepal in 2008, great guy otherwise, who was telling me how all those arabs in Iraq and Afghanistan would make great christians. They just need to understand the right choice. He really believed it. If felt so surreal.
Interestingly, place like Switzerland which is highly religious has been for a long time bastion of self-assisted suicide, so that folks come here from all over the world to end their life peacefully. Tells you about how remarkably tolerant society this is (there are tons of other examples I can see every day around me, but that's for another topic).
To use your example, understand that most sects of Christianity teach that in order to gain entrance to heaven, one must accept Jesus as one's savior and at least try to follow the moral code promulgated by Christianity. People who do not will go to hell and suffer an eternity of torment. Understand, this is not a theoretical "what if" to them, they believe this to be true. Completely.
Thus, if you are a good person, would you not want to save others from eternal damnation? I mean, what kind of heartless human being would just let others go to hell without even trying a little? A good person, a kind person would therefore try to convert others to the path that would lead them to heaven.
Or similarly, if you believe a fetus is a human being then abortion is murder. Not the "termination of a fetus", but the literal equivalent of chopping up a newborn baby. If you understand that some people actually believe this, it is easy to understand why most pro-life arguments just seem facile to them. To them, those arguments are simply attempting to justifying the literal murder of innocent babies.
Putting yourself into the shoes of others and clearly understanding (not accepting as true, just accepting that they believe it is true) their underlying reasons is, IMO, critical to understanding what may, to you, be "crazy" or even "evil" positions.
I bet this was because doctors and surgeons saw him as challenge and a career/resume builder.
At least I can take a pill to get some relief on occasion. People understand.
Your description and analogy is dead on.
And yet polygraphs are known to be unreliable, to the point that they are generally not admissible in court. It would probably be better marketing if they don't imply that their product is comparable to an qn existing tech that is unreliable.
While they aren't used for it they can in certain circumstances produce results with an accuracy quite sufficient for the courtroom, and there isn't even any Fifth Amendment problems with the approach:
You need things which the criminal will know but which others will not--you have to keep a bunch of details out of the press. The suspect is not asked any questions, but rather asked to read a bunch of statements about the crime--"she was wearing a red blouse", "she was wearing a green blouse", "she was wearing a white blouse", "she was wearing a blue blouse", each statement is innocent and thus will not trigger a reaction in the person who doesn't know the details. There is a 1 in 4 chance that someone will show the strongest reaction to the true statement--but what happens when you do the same thing with a bunch of details? Show the strongest reaction to the true one on 20 such 4-choice questions and now what are the odds it's a random?
An innocent can't incriminate themselves because they don't know which are the sensitive answers. Note that you can't exonerate someone this way--someone who doesn't remember the details being asked about will look the same as someone who is innocent. However, if it fingers you to a sufficiently high degree of certainty guilt is assured.
Edit: looks like it varies by state, but most do not allow it.
https://www.brodenmickelsen.com/blog/why-polygraph-tests-are...
Ads for therapy are to stoke fears of people they may be mentally ill, and ads for dating sites are to make people feel isolated. They're just used as priming for selling you an additional something else to relieve the feelings the primers created.
If I wanted you to look at my ad, I'd present something you would look away from, and have my product ad right there waiting for where you will likely look to. Look at the difference between ads in the margin of pages, vs. those inline to the content.
I used to get a lot of dating and foreign-matchmaking ads stemming from the fact I like chess. Never mind that I have been off the market since before there was a www.
How would you know this?
Would your prediction cause it? avoid it? It was really about to happen? If you are "testing" it, stopping the people that is about to do it would mess with the test? And not stopping them would count as unintentional murder?
My objections are not about suicides, but about predictions in general and predictions that can affect human lives in particular.
People more readily mentally visualize somebody without a leg, somebody with open fractures. Not so much for mind stuff, it's not concrete enough to most until it turns physical (i.e. you're a bloodstain on the floor). That's why some comments go along the lines of "I can understand suicide for physical pain but not for mental one". I would suggest that a broken self hurts more than an open fracture, and lacking certain central abilities to stabilize the self leaves you much more legless than if you lost your physical legs.
Other comments point out the endless rational vs irrational discussion. I'd ask them: when you go get a drink at a café and you're about to order a cappuccino but you ask for a latte, how do you see the whole process? You've planned something rationally (going to get that cappuccino) and made a seemingly irrational choice at the end (getting the latte). Are you rational or not?
Furthermore, by what lens do you judge when the absence of rational decision is an illness? Typically people will reply either with a utilitarian point of view or a selfish one: either you are being counter-productive to society with your guts and bloods that need to be cleaned and the lack of your presence in the consumerist world, or I take it all backwards and call you ill first because that's what agrees with my worldview ("you're sick, you can't know what's good for you").
What I have done with myself and others is to acknowledge that those bits of perhaps-irrationality are not relevant to helping things, as we all have them in different places as we live and that's okay. It's also important to acknowledge that one can be right to feel like they're backed into a corner when a lot of evidence accrues towards that. BUT, the essential part is to show methodically that (1) there are levers of action that we are steering clear of due to cognitive distortions or lack of awareness, and (2) all suicidal people are fighting to be alive much more than even they might know, as they're still around even when making aimless steps due to the crushing pain. In short, tap into what wants to live to push back against what wants to die, and show that the realm of what is possible to advance is much larger than one might think when in the fog.
----
With that said, I have my own take on parts of the article itself.
> A reader of a late-nineteenth-century edition of Chambers’s Encyclopaedia would find committing suicide described as a “heinous crime,” for which the punishments included “an ignominious burial in the highway, with a stake driven through the body.” Today the National Institute of Mental Health cautions against saying that a person “committed” suicide at all; better to say that they “completed” it, to avoid the implication of an illicit or criminal act.
As if suicide wasn't still considered a vile and illegal thing. You can share your mental health struggles with a therapist just fine until you're a risk to yourself and they call people to, forcibly if needed, remove you and take you wherever they want. Your rights can be severely limited or removed entirely when a psychiatric emergency is considered - how is that any different from being treated like a criminal? Psychiatric intake can pragmatically be worse than prison intake, from someone who's seen both.
It's not seen as vile by everybody but there are still far too many people who frame the process with words of abandonment, with selfishness, with dismissal of all the inner work of the suffering through the singular use of irrationality as an absolute concept ("you're just irrational"), and so on. You're not considered as an equal to your peers when you're suicidal, and that's not something you get to argue against because that's just part of how you're defined by them. See the following paragraph for something related.
> When patients told Freud that their lives were hopeless or without purpose, he considered this an impressive display of self-awareness. “We can only wonder,” he wrote, “why a man must become ill before he can discover truth of this kind.”
That's Freud we're talking about so whatever.. but that train of thought still seems to exist quite a bit nowadays. The introspection and the ability to shatter illusions is put in the same box as the delusions that a "sick" person has, leading a lot of people with severe depression and other disorders to associate one with the other since society does it too. "My ability to dig deeper is part of why I am sick" is entirely the wrong message to send to a vulnerable person, and it is just incorrect. For it is not the power to see beyond the surface that is a problem, but the delusions one might hold or acquire about the process. CBT points it out with the terms of cognitive distortions, which is a start. It doesn't necessarily offer a wholly coherent narrative for the emergence of those distortions, nor does it offer a strong logical argument to disprove the utility of those distortions (i.e. somebody in pain could say "so what if I see everything in black and white? this is how I've managed to survive so far, so you better prove to me that what you're offering would help me survive better").
> (about Shneidman) “I am against suicide committed by other people,” he wrote, “but I want to reserve that option for myself.”
This holds meaning that most healthy people might not realize. People who commit suicide go to the last place where there is a semblance of effective control and ability to choose an option, have some agency, in a world that (objectively sometimes but not most of the time) presents no other option. Healthy people have the comfort of a grip on their existence, or at the very least the comfort of an illusion of a grip on it. Despite having their own beliefs and instabilities, they aren't mandatorily taught CBT and other such similar things - whereas it is expected of the "sick" to do more of the homework. It's like breaking your legs on a hike and then being asked to do leg workouts to keep up, when other people happen to be luckier and go without both things and wouldn't themselves be able to do the workout.
But this is a necessary thing for a person with mental illness to do nonetheless, and I'm not debating that point. What I am trying to point at however is that the world of people who are unaware of such struggles is filled with a violent hypocrisy that contributes to the reasons for very lacking mental health services and very lacking social support from peers, as it drives the ones who suffer away from everybody else. It would do well for any healthy person to acknowledge that they, too, could be cornered into helplessness if their need for control (or the illusion of it) shattered. That brings them closer to the person considered ill, and thus narrows the gap for bridges to be built - showing both kinds of people that there is a passage between the states. That's an application of empathy that would strengthen the vulnerable at no other cost. But the healthy too can have cognitive distortions and might actually fear that it weakens them.
This sort of disconnect between those who study the subject matter and those who experience is it nothing new, so it's funny to see that it surprises people who've worked on the subject for a while (as the article highlights about Brent and Shneidman)
> “One of the problems with suicide,” he said after a time, “is that the person who killed themselves takes a lot of the answers with them.”
And the people who failed are not being asked much of anything, but instead being told what to do. You'll be diagnosed this, given those meds, told to apply this and that method. Any question about mind and life are only there in order to give you a method, not to understand. Something diametrically opposed to the mind of the suffering in the first place, which seeks understanding of self and answers so much that it spirals and loses track of healthy methods to do so. Funnily enough, I think both sides are going at it kinda wrong, and we can do much better by weaving both approaches together and treading the middle line. Sometimes you need a practical tool, and sometimes you need to understand for the sake of understanding. Be both to yourself, be both to others.
100% agreed. People have felt physical pain of very wide ranges before so they have some "scale" on which they can measure it. e.g. stubbing toe to a fracture to a chronic pain. But people thankfully don't have similar breadth in the level of mental pain they have experienced. So they cannot imagine a "mental pain" ever being equivalent to getting your leg amputated without anesthesia.
I like how Mike Shinoda talks about it - if you woke up with a bad back tomorrow you might take some rest; if it was worse the next day then you take some painkillers and the next day you might visit a doctor. But we don't think similarly for mental health.
If you are not feeling good you may try to go through the day anyway; next day it's worse so you should think "I should take it easy today"; the next day you might visit the doctor.
Another issue which people cannot seem to understand is that someone not taking mental health seriously and saying things like "you are overthinking", "it's not as bad", "knock it off", "you're a downer" etc end up invalidating the other person's existence (since that's what life is like for them at the moment and people are essentially saying your life isn't real), make them feel like a burden, make them feel that the other person's life is worth more than their own, that they aren't useful and that nobody cares if they didn't exist anymore.
Imagine:
Your leg got crushed and I tell you "it's not that bad", "stop being a baby", "get over it", "you are making a big deal out of this". There is no solution for your leg so it hurts the same every day and I keep saying things like that every day. At some point you'll break. Combine the invalidation with the pain you are already feeling and you'll be like "no one understands me", "there's no one to support me", "i'm a burden" etc and maybe one day you'll be gone.
Suicide is notoriously difficult to predict. That meta-analysis is one example; once you account for base rates in realistic scenarios, you can do very little better than chance.
Some of this might have to do with the nature of predictors; maybe with deep learning and real-time data this might improve slightly, but I doubt it somewhat (there are significant ethical issues involved in such data regardless but that's a different issue).
One of the biggest problems in this area is that suicide is such a low base rate phenomenon that it's difficult to predict for that reason alone. Not only that, but many of the predictors are relatively high base rate by comparison, so there's a very very very low signal to noise ratio. Statistically speaking, it's like finding a needle in a needlestack.
I think adding to the complication is that it's not really that you want to know if someone eventually commits suicide, what you want to know is whether they do so within a certain actionable timeframe. That is, for most of the decisions such predictions are being clamored for, it doesn't really help to know that there's a 70% chance that someone will commit suicide eventually; what practitioners really want to know is "what are the odds someone will commit suicide if I make decision X right now." This is a significantly more difficult thing to study.
I personally believe that the approach to suicide in developed countries is horribly misguided and probably unethical, focused too much on the act and not prevention of the state (psychological, sociological, economic) that leads to it. It's unethical to leave someone in such a personal hell that they want to exit it by killing themselves; preventing themselves from doing so, without removing them from that state, only deprives them of a means of relief.
This has regulatory approval in the EU? Why is Harpers even writing about this?
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Don't forget the ALKALISK AAA batteries at the checkout.
#blackmirror
But no, that would mean one less entity to milk for labor and money.
Of course, 90% of the time that's because they see an opportunity to sell you on a new drug, religion, or ideology.
Cooperative systems like all sorts of communism don't work because people are by nature lazy and even worse greedy. Everyone maximizes their needs and minimizes their abilities.
Hence we are left with competitive systems like contemporary capitalism where pressure to perform and be better than the others directly leads to suffering as inevitably there will be losers. The winners also don't fare much better as well. It is often a Pyrrhic victory.
Cursed if you do. Cursed if you don't.
And in the end to feel better about ourselves, we the society, tell people it is worth living so they do their stressful job for a few more decades and enjoy a few weeks of free time a week to play Candy Crush on their iPhones they are still paying via installments.
But even if looked beyond politics and social organisation perfect prevention of suffering is impossible until medicine reaches some state of seamless merging with (bio)robotics. Ironically the competitive pressure might actually be the way we reach such a state of science. Ray Kurzweil is talking a bit about this in the book about the Singularity.
A very simplistic take. Human beings lived in cooperative communities for millennia. To a certain extent it wouldn't be unfair to say that our natural state is one of cooperation within a community. It's large scale civilization we haven't figured out how to deal with.
"Successful" people suicides are incredibly interesting because it forces us to ask the question "were they ever happy?" yet it is a question usually ignored in most post suicide bio films that seem to come out immediately after. There is this idea that suicide has to be treated with quiet respect, and whispers at funerals...we keep ignoring the actual issues and brush suicide off as a "mistake in the moment". Bullshit, anyone who commits suicide has been contemplating it most of their lives.