Suicide Prevention Sheds a Longstanding Taboo: Talking About Attempts | Hacker News Reader

Suicide Prevention Sheds a Longstanding Taboo: Talking About Attempts

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Serious question: is someone who attempts suicide in the same group as someone who successfully commits suicide?

For instance, far more men commit suicide. But far more women attempt suicide:

http://en.wikipedia.org/wiki/Gender_differences_in_suicide

I'm sure there are other differences. To me, the questions are:

1. Why do people fail at suicide attempts?

2. Will information that dissuades a failed suicide attempt dissuade someone from making a successful suicide attempt?

A lot of people don't _actually_ want to commit suicide. Humans generally speaking do not want to die, but when you're there, it feels like the only option.

I distinctly remember feeling that my brain wanted me to die, but I personally was not of the same opinion at all. So what I did was call up a friend and basically said "You have an hour to convince me not to do this". It worked, I'm here.

But I feel that when trying to commit suicide, you will instinctively do everything in your power to botch the attempt. Because what you're looking for isn't death per se, it's clarity and resolution. Mostly you just want "it" to stop, any sort of traumatic experience can be surprisingly helpful with that.

It is not suicide attempt if you are not planning to die. For example drug overdose is not necessary suicide attempt.

Men in general are treated like a shit, so they kill themselfs. Most women are emotionally blackmailing their families.

This post consists of 1) an undocumented / unproven assertion, 2) a laughable generalization, and 3) an offensive generalization.

What part do you actually disagree with?

If you have two persons with the same body mass, both of them drink 1 liter of whiskey. I bet in one case it will be 'really bad hangover' and in second case it will be 'suicide attempt'.

I disagree with absurd stereotypes such as "men in general are treated like shit" and "most women are emotionally blackmailing their families".

OK. Let's do the stats.

Men are 95% of homeless, 90% of prisoners, 95% workplace deaths, 80% suicides...

In second case:

I went unnecessary offensive, call it "most women cry for help" whatever.

The fact is that people who are at risk of suicidal behavior are equally distributed between genders [1]. Also mental illnesses such as schizophrenia are equally distributed [wikipedia].

So I see two options why women have much higher suicidal attempt rate:

- it is a cry for help

- men suicide attempts are under reported

[1] www.ncbi.nlm.nih.gov/pubmed/9501750

Gender trolling is not welcome on Hacker News. Repeated, off-topic gender trolling is particularly unwelcome. Please do not do this again.

I would say it's all three combined.

I'm not saying what he said was valid, but I am saying that neither being offensive nor being a generalization needs to have a bearing on truth value.

Another: All else being equal, women get a lot of attention and praise, while men generally have to compete harder for such things.

> neither being offensive nor being a generalization needs to have a bearing on truth value.

Of course, but neither being offensive nor being a generalization (especially of that magnitude) belongs in a mature discussion, either.

> All else being equal, women get a lot of attention and praise, while men generally have to compete harder for such things.

All else, however, is not equal. Feel free to examine average salaries in the US, or perhaps simple human rights in many other countries.

1. Men are more "successful" because they tend to use more violent methods - guns, jumping off high places, etc. Women are more likely to use pills. Sometimes attempts are more of a call for help than ending one's life. 2. Your question is unclear to me, but most people who have attempted and failed to commit suicide regret that decision.

I suppose I meant: will the stories of suicide survivors help stop those who are planning to commit suicide, using a method that is likely to succeed?

But of course stopping suicide attempts (that are destined to fail) is a worthy goal too.

Apparently not so in China?

http://en.wikipedia.org/wiki/Gender_differences_in_suicide#C...

Perhaps china is tougher on their Women than their men?

>It has been found that suicide makes up for about 30% of deaths of women living in rural China.

Wow... that must be pretty bad for them living out there. Can you imagine living in a place where there was a 1 in 3 chance you'd off yourself before dying naturally? Wow... just wow.

> 2. Your question is unclear to me, but most people who have attempted and failed to commit suicide regret that decision.

Couldn't this thesis explained by selection bias? I mean if you don't regret your suicid decision, you'll probably try again (and again) until you succeed. This IMHO biases the survivers strongly towards those who regret it.

Committing suicide is actually very difficult. All humans have a strong will to survive, which is always present, even if you are suicidal. Additionally, a painless, nonviolent suicide needs a lot of preparation, which isn't exactly easy either if you are lethargic.

Well, in answer to 1., often suicide is attempted at times of extreme emotional volatility - in other words, when it's easy to make a mistake. Additionally, suicide is almost always linked to depression, which manifests itself in a whole host of ways. It's easy to say "just point a gun at your head and shoot, what's so hard about that?" Well it's terrifying, which is emotional. It costs money to acquire a gun, and money problems are highly associated with depression. It's a social activity, and social anxiety often is related to suicidal behavior, etc.

If it were a decision like "which toothpaste works better", and you could calmly evaluate evidence and act impartially, I imagine there would be fewer suicide attempts, fewer suicides, and a higher percentage of attempts would succeed. But this is a vastly different sort of thing, an intrinsically uninstinctual act. This is just speculation, but I would guess that the rare cases where the suicidal person is overwhelmingly justified by his or her decision (Goering killing himself painlessly rather than being tried and hanged), the success rate improves.

In response to 2., I have no idea - that is an empirical question. But it's an interesting question, and it's good to see the topic discussed in the media as it generally is quite taboo.

1. I'm surprised how often the simple matter of difficulty is skirted. I've been wholeheartedly and single-mindedly motivated to off myself in the past, and it is hard to do. I don't know how to get a gun, and if I had one, I wouldn't know what to do with it. Jumping from height requires enormous courage to override the instinctive refusal to do it. Hanging requires tremendous endurance of pain: hanging your whole body by your neck hurts!!!, and you do not go out right away. As far as the pills that would actually work, I would not know where to get them.

You could say if I was truly motivated, I would learn how to overcome one or more of these obstacles. Well that's a moving goalpost. I maintain that I was motivated to try whatever I had at my disposal, and I was not able to determine whether it was actually possible.

A friend of a friend of mine's experience answers your number 1 question:

He wasn't very good at aiming, apparently. When he shot the bullet into his head, probably in a drunken stupor, he missed his brain and lived... probably still wanting to shoot himself and succeed, but being physically unable to do so at this point he just lay there until someone found him.

By the time he recovered in hospital from the wound, he wanted to live! Albeit with a very disfigured face, which I thought would be a hinderence to an already depressed individual, but he sees it differently and we're all glad for it!

"...in the past few years, scores of them have come together on social media and in other forums to demand a bigger voice in prevention efforts."

Wha-?

I'm by no means a heartless person. However, I truly believe if you don't want to live any more, that it's your right and your responsibility.

I'm not in your head. I don't know what you're thinking. Most of the time, I won't even know that you're depressed. Many people mask it very well. Why is it my fault that you decided to kill yourself?

Prevention efforts could include ways to talk about your problems without being afraid that people would treat you differently or force you to do something you didn't want to do. There would have to be an absolute guarantee of privacy of course.

It's not your fault, like it's not your fault when children die of cancer. That doesn't mean we should find ways to prevent it. Most poeple who attempt or commit suicide don't want to die, but rather prefer death over life because they want to put an end to their suffering.

That said, I don't think talking about attempts will help someone who is suicidal in the slightest. If anything it leads to emulation suicides, also known as the Werther effect, see: https://en.wikipedia.org/wiki/Copycat_suicide

Copycat suicide is contested.

This has more detail:

http://thelastpsychiatrist.com/2006/10/werther_effect_copyca...

This podcast discusses the issue:

http://freakonomics.com/2011/08/31/new-freakonomics-radio-po...

Here's the thing though, depression is a treatable-ish illness. Suicide is a symptom.

Isn't the usual approach to at least treat symptoms, if you can't immediately cure the underlying illness?

I'm sorry, but as a long-time sufferer, I feel compelled to disagree with this viewpoint wherever I see it, to represent people like me. I've been suicidal and depressed on and off for about 20 years. From in here, it doesn't seem anything like an illness at all. The flu is an illness. This is having lived through an absurd number of absurd events, emotionally draining and also traumatic in the long-term. It's having been abused. It's having exhausted yourself pouring all the energy you have into being your best, excelling, achieving, pleasing everyone, but having one dream after another expectation shattered, and having to learn a new framework for living with it. It's cumulative rejection. It's guilt over things you can never undo. It's finding no pleasure in life, only monotony, the grind, suffering, disappointment, and loneliness. It's wondering what's wrong with you that everyone you know got married, have kids, own homes, advance in their careers, buy nicer cars, but your life is still just like a single college student's.

It's not quite my brain, and it's not quite my mind. It's my life, which in a sense is my mind. Which may or may not be my brain. I think that current psychiatry is confused about which level of abstraction is the one to target - not too surprising, since it's circular, almost strange-loopy. Also, people, even most professionals, don't really know what to do or say when the problem really is your life.

I know how you feel and I definitely would call myself only in remission from depression. It never really goes away, but you learn to live with it. Or at least I did.

If you need someone to talk to, contact info in my profile.

Actually, is it known how large proportion of suicides is caused by clinical depression?

I can imagine suicide cases brought on by real hardship such as a hopeless&painful disease; unescapeable debts in a poor society, or cases such as teenagers married to someone against their will with no chance of escape; these wouldn't be caused by an illness but it's hard to figure out on how to estimate the proportions.

The longstanding taboo I think is actually allowing people to commit suicide. This question rarely enters the debate.

Can you elaborate on this? I think it would be virtually impossible to prevent suicide, not to mention various things perhaps not treated as suicide but which are self-caused deaths (repeatedly engaging in very-very-high-risk activity, for example).

I mean that suicide is perceived as something to prevent, but I don't often see the conversation about _why_ we are preventing it. Clinical depression is a beast, and many people who pursue treatment seriously continue to struggle with it their whole lives. I think great minds like David Foster Wallace prove how persistent depression is. Suicide is a real escape from the incredible pain that depression can cause, yet we continue to culturally perpetuate the taboo of suicide. The question is; Why is it not okay for people to kill themselves?

One cause of suicide is emotional pain, and at times it is inflicted (accidentally or intentionally) by others in society. Not preventing suicide would mean we give up solving the actual problem of inflicted emotional pain. At the same time, IMHO, the focus is on suicide prevention rather than catering the emotional needs of individuals because there's a tendency for society in aggregate to only solve problems at the last minute. i.e. Society doesn't care about your health until you reach the emergency room. It doesn't care about your emotional pain until you attempt suicide. It doesn't care about your career until you become unemployed.

Why did it take "a great mind like DFW" to accept how persistent depression is? I doubt you meant it but I found the dfw bit to be offensive. You seem to deny the serious pain and suffering my friend experienced simply because he was not a celebrity and/or had an average IQ? The reason I say it is offensive (and that you did not intend it to be) is that it seems as if pre-DFW you assumed my friend was just not smart enough to out think depression, or that given his mediocore mind/life, depression would not need to be that powerful and persistent in order for him to realize the loss of his life was no big deal.

In my opinion the better question to ask would be "Why is it not okay for depressives to kill themselves?" The taboo is related to a very specific suicide. When an individual has brain cancer it is euthanasia, when the individual has depression it is suicide.

Sorry to cause offense, I understand what you're saying. The news of DFW death was popular here on HN, and I was using him as an appeal to authority.

I wanted to bring up the difference between suicide and euthanasia, I think it's critical to understanding the issue culturally.

I should have said "it could be offensive if I thought you recognized/intended." I have no reason to think you are a bad person, so no harm no foul. The fact that you are thinking about this and asking questions is evidence of a certain level of compassion and intelligence.

DFW wrote a lot of Infinite Jest three blocks south of me and across the street from the coop where I buy groceries. It is still kind of eerie walking by the house with a bag of groceries.

When it happens to a high-profile figure, people grapple with the issues in the public sphere. It raises awareness.

With the exception of people who commit suicide in terminal end-of-life situations (terminal cancer, or similar), folks who are attempt or commit suicide because of depression, aren't thinking straight. The depressed brain senses, feels and interprets things differently than the same brain not depressed. So the idea is that the person isn't well, and their decision making process isn't working right. The decision to commit suicide is the result of hopelessness brought on by the brain misinterpreting the person's situation and perceiving that the only way to escape the situation is death. The person doesn't want to die, per se. They just want the pain to end. With that in mind, to allow a depressed person to commit suicide is basically failing to treat a person's health problem, and them dying as a result of it.

I'm a proponent of allowing people to make that choice when they have the wherewithal do so. Someone who is dying of a painful terminal illness, etc, end of life is no one's choice but yours. But the suicidally depressed person can't make that decision rationally. It's like making any decision under the weight of extremely strong emotion, only it's an order of magnitude more powerful than what most people will experience in their lives. The suicidal person is ill, and needs help. It's the fact that they can't find help that brings them to suicide.

"folks" aren't thinking straight ? This sort of attitude is a huge part of the problem. This is why people don't seek mental help - dehumanization.

There are lots of cultural and legal forces that deter suicide. (hopefully you were not being pedantic with prevent/deter)

  * Cultural shame of surviving family.
  * Suicide is a sin in some religions.
  * Suicide voids most life insurance policies.

I think in most cases, suicide only voids life insurance policies for the first 2 years of having the policy. It makes sense, since it prevents people from buying life insurance when they plan to kill themselves.

This is stupid. And I can't believe it doesn't sound stupid to those who are the most likely to attempt suicide seriously.

Why doesn't anyone talk about "misery prevention" ?

There's a lot of academic literature that supports the claim that reports of suicide in the media lead to an increase in the number of suicides. This is often referred to as "copycat suicide" or "the Werther effect". As a result, journalists and academics are often very careful about they way they publicly discuss suicide attempts. More information can be found here:

http://en.wikipedia.org/wiki/Copycat_suicide

http://www.jstor.org/discover/10.2307/2094294?uid=3737536&ui...

http://bjp.rcpsych.org/content/197/3/234.abstract

The army officials who deny mental health care to soldiers who later completely unpredictably off themselves at a rate higher than combat casualties must have read some of the same literature.

I've contemplated suicide off-and-on since age 6. It's just a working part of my language. No successful attempts, or failed attempts, or whatever grammar is being built here.

It might partly be influenced by a Tourette's like underlying structure, which would here make it more publicly, or in terms of a biological profile, a symptom. Usually all we see are symptoms in the narration of science.

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