Suicide, a modern obsession
Suicide cannot be predicted, according to Derek Beattie and Patrick Devitt, in their book, Suicide, A Modern Obsession. In another section of the book, they take the World Health Organisation to task for suggesting that suicides are preventable.
Here, in an edited extract, they try to answer the question of why some people take their own lives…
After a person takes their own life, loved ones, health professionals, communities and even the media try to retrace that person’s thoughts and steps, to understand more about their death. They usually ask why the person did it. Knowledge about suicide has advanced significantly over the years, which means we can provide some partial answers. Work by clinicians and suicide researchers, as well as international data-collection efforts, also allows us to understand how the impact of suicide differs across the globe; some cultures and groups are more at risk than others.
That someone would really want to end his or her own life perplexes many of us. Life is usually seen by the religious and the secular alike as a precious gift, which a person should hold onto.
Explaining why someone has died by suicide is not straightforward. Usually, there will be multiple reasons or factors that lead to such a decision, with suicide the end result of interactions among multiple vulnerabilities. Such vulnerabilities can also be understood as risk factors and a large number can be identified that make it much more likely for certain people to kill themselves than the rest of the population.
Male gender is strongly associated with self-inflicted death, especially in developed countries where, typically, men are between two and four times more likely than women to kill themselves.
Hopelessness and personality traits such as impulsivity and aggressiveness make some people more prone to suicidal behaviour. Alcohol and drug abuse increase risk for individuals both in the short term, following intoxication or withdrawal, and in the long term, due to the ill effects of substance abuse over a sustained period. The World Health Organization has stated that more than one-fifth (22%) of global suicides would not occur if alcohol were not consumed.1 It is also estimated that 30-40% of those who die by suicide have some significant physical illness.
Suicide rates are especially high among people with terminal illnesses, including cancer and HIV/AIDS. Risk increases for those who have undergone traumatic experiences, particularly in early life, such as childhood physical or sexual abuse. People who are unemployed also have higher rates.
A previous suicide attempt is one of the strongest known predictors of subsequent suicide, as between 7% and 12% of those who make a suicide attempt will have ended their lives within ten years.
There are three significant risk factors: mental illness, family history of suicide and social isolation.
It is now well established that a diagnosis of mental illness elevates risk significantly. As many as one in every eight people with a diagnosis of schizophrenia will eventually end up killing themselves, and there are also high rates of suicide among those with depression and borderline personality disorder. This does not mean that all suicides are linked to mental illness; people choose voluntary death in the absence of mental illness, and independently of it.
In 2009, almost half a century after the celebrated poet and novelist Sylvia Plath ended her life, her son, Nicholas Hughes, hung himself. If a parent engages in suicidal behaviour, his or her children are six times more likely than the general population to carry out a suicidal act. Losing a close family member to suicide heightens risk in a number of different ways. Hughes, like his famous mother, had experienced depression. We know that there is a genetic component to mental illness. This makes it more likely for people to develop certain mental illnesses, including depression and schizophrenia, and, therefore, indirectly transmits a risk of suicide.
Genes do not tell the whole story. When a family member ends his life, it may also lead to a culture of permission within that family.
Dysfunctional family environments, in which physical or sexual abuse or drug and alcohol abuse are routine, which played a role in a relative’s suicide, will often remain dysfunctional after such a death. The exposure of other family members to further traumas means that they are at increased risk of ending their lives.
Social Isolation and Relationships
Rene Duignan is an Irish economist who has dedicated himself to fighting suicide in Japan, where he lives and works. He has drawn attention to the Japanese phenomenon of hikikomori, a disorder whereby people suffer from acute social withdrawal: they may never leave their homes. There are hundreds of thousands of Japanese with the disorder, which contributes significantly to the 30,000 annual suicides in Japan. Duignan contends that the influence of Japanese technology – and of the computer-gaming industry, in particular – creates an image of a trendy country and promotes the apparent benefits of people getting lost in computer games. He maintains, however, that the reality of a society obsessed with technology can be much bleaker, allowing many Japanese people to function without ever leaving their apartments.
Acute social isolation typifies the lives of many who kill themselves. A long period of loneliness in the year prior to suicide was reported for 46% of a sample of 190 suicides that occurred in Cork between 2008 and 2011, for example.
Towards a More Complete Understanding of Why
As well as individual vulnerabilities, there are societal and cultural traits that increase risk. Some cultures are more accepting of suicide, as is the case in Japan, which has a rich history of suicide and has always had elevated rates.
Unemployment increases risk for individuals, but economic decline can also increase rates in a country as whole and make it more likely for people who retain their jobs to end their lives.
In most cases of voluntary death, the likelihood is that a myriad of risk factors and stressors were impinging upon individuals at the time of death. There is also likely to be significant overlap among many of these factors. So we know that childhood abuse may lead to the development of mental illness, which, in turn, is associated with poor physical health and personality traits such as oversensitivity and aggressiveness. This combination can be deadly when levels of distress reach such a point that suicide is seen as the only solution.
At the same time, we must not make the mistake of assuming that suicide is an inevitable outcome for anyone with multiple vulnerabilities.
The presence of meaningful relationships in our lives protects against social isolation and suicide. Consider the findings of Ireland-based researchers Paul Corcoran and Aaron Nager, who looked at suicide trends in Northern Ireland between 1996 and 2005. They found that no matter what your age, if you were a man who had never married, your risk automatically went up. Among women though, only young single women were at increased risk. While marriage offers protection against suicidal behaviour, divorce increases risk.
You can read more in Suicide: A Modern Obsession by Derek Beattie and Dr Patrick Devitt, published by Liberties Press and available in all good bookshops, priced €14.99.