Suicide is a mysterious enigma that challenges most people on many levels. One
of the biggest aspects of the challenge is that we can never ask the person who
died, "Why?" We can only infer from notes left behind, snippets of
last conversations, and changes in behavior.
The question of "why" often haunts the minds of those bereaved by
suicide. Frank Campbell once said that people who have lost a loved one to
suicide often fall into a "Canyon of Why"—an abyss that becomes
impossible to climb out of because the loved one is never there to answer the
question. While we can never really know all the reasons why people die of
suicide, there are some explanations that can help us fathom how individuals
might find themselves in such a state of despair.
Most people who kill themselves believe that suicide is the only solution to
their unbearable situation. Sometimes the analogy of what happened in New York
City on September 11, 2001, gives people a framework for empathy. When one
remembers September 11, some traumatic images etched in memories are the
pictures of people jumping out of the World Trade Center. These people did not
want to die. They were leaping to get away from the flames at their back.
In a similar manner, people who contemplate suicide are trying to escape
some type of peril in their own lives or unbelievable pain in their souls. Most
find it difficult to truly appreciate the flames that consume the minds of
people who contemplate suicide.
Experts who study suicide coined the term "psychache" to describe
the excruciating psychological pain that suicidal people experience, which
often blocks the ability to see other potential solutions to problems.
Psychache torments individuals who often do not want to die; they just cannot
escape. Even though a pervasive sense of hopelessness stifles the ability for
many to seek help, most suicidal people are very ambivalent about taking their
lives. Another common metaphor people use to describe suicidal pain is feeling
trapped in a completely darkened room with no way out.
A Model of Suicide Risk
In his book Why People Die by Suicide, Dr. Thomas Joiner explains
that those who kill themselves not only have a desire to die, they have also
learned to overcome the instinct for self-preservation. This theory goes beyond
previous theories of suicide that were adequate in describing psychological
risk factors but did little to explain why some people with those risk factors
died by suicide and others did not.
Used with permission.
The theory states that wanting death is composed of two psychological
experiences. The first is a perception of being a burden to others (perceived
burdensomeness). According to Dr. Joiner, when people are in this state, they
feel that their death is worth more to the people who love them than their life
is. The word "perceived" is emphasized because frequently these
thoughts are significantly distorted by depression or other mental disorders.
While conventional wisdom might believe that the suicidal person is selfish,
Dr. Joiner has found the opposite to be true.
Those who desire suicide often believe that they have become such a burden
on others, everyone will be better off if they are not around. In other words,
in the mind of the suicidal person, they are practicing ultimate selflessness.
When we combine this emotionally painful experience of being a burden with
isolation, suicidal despair often results.
Thus, the second common factor in the desire to die is a social
disconnection to something larger than oneself (thwarted belongingness). As
humans, we are hardwired to be in a relationship with others. For some people,
this means just a couple of very intense relationships; for others, it means
vast social networks.
When people lose key relationships with partners, children, colleagues, and
friends through death, divorce, separation, moves, layoffs, or conflict, they
can experience profound distress that can lead to a desire to die. Marked
social withdrawal is not temperamental shyness. Rather, it's a marked
change: the person used to be engaged with friends and family, and now they
withdraw into a bedroom or into their own head, and what you see is what Dr.
Joiner calls "an inward gaze of bemused resignation and
resolution."
Acquired Capacity for Suicide
Suicidal thoughts become more lethal, however, when people
have what Dr. Joiner has called an "Acquired Capacity for Suicide."
If suicide desire is the "I want to" part of the equation,
"acquired capacity" is the "I can" part.
Dr. Joiner puts conventional wisdom on its head once again by challenging
the notion that people who die of suicide are not cowardly—they are among our
most brave. He argues, with a lot of research behind him, that those who are
most likely to take lethal action on their suicidal thoughts are those who have
a fearlessness of death. The following three main contributing factors for
acquired capacity exist.
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You are born with it. Some people just come into the
world with a temperament for risk-taking. They do not seem to be afraid of
anything. Natural risk-takers in our society include law enforcement
personnel and military, skydivers, adventure explorers, race car drivers,
and emergency room doctors. These folks are not at risk for suicide unless
they have the first half of the diagram, "desire for suicide."
Should that desire ever develop, however, they have less distance to cross
to self-harm because the fear of death or pain is not as great as in other
people.
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You learn it. Other people may not be born with this
innate sense of courage, but they learn it over time by living through
painful and provocative experiences. By being exposed to violence and
life-and-death situations, people become more accustomed and less afraid.
For some people, this means a history of physical or sexual abuse. For
others, it is chronic injuries or illnesses that require adapting to high
levels of pain. For still others, it may be repeated suicidal thoughts or
attempts.
When Denver Bronco Kenny McKinley died by suicide, his death sent shock
waves through the nation. However, when we look at the National Football
League, we find a number of stories of suicide attempts and death,
especially among retired players. At first glance, this is inconceivable.
Our professional football players are national heroes. They have it all:
fame, money, and undeniable talent. But they also have fearlessness and
usually a history of powering through intense pain and debilitating
injuries. The vast majority do not experience suicidal crises, but when
they do, they have a shorter distance to go to reach a place of considering
suicide since they are not afraid of pain.
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You have access to and familiarity with lethal means.
For example, you might have at hand firearms, lethal medications, and
access to high places. The more comfortable a person is with the lethal
means of suicide, the more likely he or she will choose that method should
he or she find themselves wanting to die by suicide.
So, in Dr. Joiner's theory, we must have both conditions to have
increased risk for suicide. A desire for suicide is necessary but not
sufficient. As mentioned earlier, suicidal thoughts are relatively common
experiences, but suicide death is much less so. This is because most people who
have suicidal thoughts, thankfully, do not have the acquired capacity for
lethal self-harm.
Conclusion
As researchers ask questions to those most directly affected by the crisis
of suicide—both the suicidal and those left behind—the mystery of suicide
becomes less of an enigma and more of a significant preventable public health
problem.
Further Reading:
Thomas Joiner, Why People Die by Suicide (Cambridge, Massachusetts:
Harvard University Press, 2006).
William Styron, Darkness Visible: A Memoir of Madness (New York:
Vintage, 1992).
Philip Rodgers, Understanding Risk and Protective Factors
for Suicide: A Primer for Preventing Suicide, Suicide Prevention
Resource Center, 2011.