Comment by pmoriarty | Hacker News Reader

Comment by pmoriarty | Hacker News Reader

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In "Why do people die by suicide", Dr Paul Thomlinson goes over the research on predicting suicide.[1]

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

Joiner's Model seems to exclude people who are candidates for assisted suicide. They often don't feel alone, don't feel like a burden, but are terminally ill, in constant pain, feel they've lived long enough, seeing significant mental/physical decline etc. You can shoehorn them into "IS PATH WARM" under hopelessness, trapped, or anger I guess.

Yeah, it's looking at mental illness suicide.

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.

I always wonder about a 3rd group. Those without mental illness or terminal illness who just want to die. Or is the assumption that someone who wants to die but isn’t terminally ill must be mentally ill?

That is the assumption. I don't agree with it - dying seems like a pretty rational choice for some people.

Like who? Of the people who can feel normal emotions like happiness without some great interference, and have reasonably functional bodies, (and aren't like a prisoner of war) what does a candidate for rationally wanting to die look like?

It seems like a matter of taste. When does a miserable life stop being worth the moments of happiness? What is a reasonably functional body? Where is that line and why are you the one who gets to draw it?

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.

Okay, I should have worded myself better. I was thinking of that kind of chronic pain as along the same lines of terminal illness, but I didn't make that clear.

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.

Will you give them that better environment to live in? Do you even know what that would be? Of course most people would benefit from a better environment, this is practically tautological at this point when you've excluded physical, mental, and now environmental factors, which covers just about everything. But a better environment is not a likely outcome for a lot of these people.

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.

1. But can you put any numbers on that?

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.

Honestly, me. I run ultra-marathons, I have a decent job, I have Type 1 diabetes (not terminal obviously), I’m about 40 years old.

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.

You don't think you could figure out a guaranteed painless suicide method if you had years of prep time?

I mean obviously I could with near (but not quite) 100% confidence. But it’s like saying couldn’t a weirdo rich guy from South Africa figure out self-driving if he had years of prep time. Even if he does, it’s going to be a little nerve wracking getting in the car.

Medical conditions can make life too unpleasant without being terminal.

Assisted suicide not being a thing in most places is an absurdity to me.

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.

Guns can be effective, but they are also very messy and plenty of people have attempted to kill themselves with a firearm and failed. The results of that are horrific and in some circumstances can leave a person unable to try again.

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.

Yea it’s a poor substitute, not least of which because it can ruin any open casket funeral, given that the best odds of not vegetating yourself calls for short barrel, high caliber hollow point.

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.

It's always interesting to find clinical observations for something you struggle with; you somewhat have to remove yourself from your own mind when learning why your brain is manifesting these types of thoughts and feelings.

"IS PATH WARM" really personifies the feelings.

interesting categorization, very much so, I find there's a duality in the lonely/self-hate group. So many people who feel like that are utterly normal, they just can't connect other realities than their own judgement.

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