New article about suicide

From today's NY Times magazine, very worthy of discussion here!

[INDENT] July 6, 2008
The Urge to End It All

By SCOTT ANDERSON
"There is but one truly serious philosophical problem," Albert Camus wrote, "and that is suicide." How to explain why, among the only species capable of pondering its own demise, whose desperate attempts to forestall mortality have spawned both armies and branches of medicine in a perpetual search for the Fountain of Youth, there are those who, by their own hand, would choose death over life? Our contradictory reactions to the act speak to the conflicted hold it has on our imaginations: revulsion mixed with fascination, scorn leavened with pity. It is a cardinal sin - but change the packaging a little, and suicide assumes the guise of heroism or high passion, the stuff of literature and art.

Beyond the philosophical paradox are the bewilderingly complex dynamics of the act itself. While a universal phenomenon, the incidence of suicide varies so immensely across different population groups - among nations and cultures, ages and gender, race and religion - that any overarching theory about its root cause is rendered useless. Even identifying those subgroups that are particularly suicide-prone is of very limited help in addressing the issue. In the United States, for example, both elderly men living in Western states and white male adolescents from divorced families are at elevated risk, but since the overwhelming majority in both these groups never attempt suicide, how can we identify the truly at risk among them?

Then there is the most disheartening aspect of the riddle. The National Institute of Mental Health says that 90 percent of all suicide "completers" display some form of diagnosable mental disorder. But if so, why have advances in the treatment of mental illness had so little effect? In the past 40 years, whole new generations of antidepressant drugs have been developed; crisis hotline centers have been established in most every American city; and yet today the nation's suicide rate (11 victims per 100,000 inhabitants) is almost precisely what it was in 1965.

Little wonder, then, that most of us have come to regard suicide with an element of resignation, even as a particularly brutal form of social Darwinism: perhaps through luck or medication or family intervention some suicidal individuals can be identified and saved, but in the larger scheme of things, there will always be those driven to take their own lives, and there's really not much that we can do about it. The sheer numbers would seem to support this idea: in 2005, approximately 32,000 Americans committed suicide, or nearly twice the number of those killed by homicide.

But part of this sense of futility may stem from a peculiar element of myopia in the way we as a society have traditionally viewed and attempted to combat suicide. Just as with homicide, researchers have long recognized a premeditation-versus-passion dichotomy in suicide. There are those who display the classic symptoms of so-called suicidal behavior, who build up to their act over time or who choose methods that require careful planning. And then there are those whose act appears born of an immediate crisis, with little or no forethought involved. Just as with homicide, those in the "passion" category of suicide are much more likely to turn to whatever means are immediately available, those that are easy and quick.

Yet even mental-health experts have tended to regard these very different types of suicide in much the same way. I was struck by this upon meeting with two doctors who are among the most often-cited experts on suicide - and specifically on suicide by jumping. Both readily acknowledged the high degree of impulsivity associated with that method, but also considered that impulsivity as simply another symptom of mental illness. "Of all the hundreds of jumping suicides I've looked at," one told me, "I've yet to come across a case where a mentally healthy person was walking across a bridge one day and just went over the side. It just doesn't happen. There's almost always the presence of mental illness somewhere." It seemed to me there was an element of circular logic here: that the act proved the intent that proved the illness.

The bigger problem with this mental-illness rubric is that it puts emphasis on the less-knowable aspect of the act, the psychological "why," and tends to obscure any examination of the more pedestrian "how," the basic mechanics involved. But if we want to unravel posthumously the thought processes of the lost with an eye to saving lives in the future, the "how" may be the best place to look.

To turn the equation around: if the impulsive suicide attempter tends to reach for whatever means are easy or quick, is it possible that the availability of means can actually spur the act? In looking at suicide's close cousin, murder, the answer seems obvious. If a man shoots his wife amid a heated argument, we recognize the crucial role played by the gun's availability. We don't automatically think, Well, if the gun hadn't been there, he surely would have strangled her. When it comes to suicide, however, most of us make no such allowance. The very fact that someone kills himself we regard as proof of intent - and of mental illness; the actual method used, we assume, is of minor importance.
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