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Why People Die By Suicide

Page 13

by Thomas Joiner


  in his fifties.

  The desire for life—life-sustaining desire—can’t be about faith

  and religion only, or else Steve and my dad would be alive. What is it

  about, then? Career success does not really constitute a satisfying an-

  swer either. For one thing, plenty of people who do not have particu-

  larly satisfying careers never consider suicide; for another, a lot of

  people who die by suicide appear to have had successful careers. Six

  weeks before my dad’s death, he made a very large amount of money

  in a stock deal. A child of the 1930s, my dad had worked toward a

  deal like that most of his life. He might have said that that was his life’s desire, along with his faith and family; his death six weeks later

  shows that somehow he was mistaken.

  How was he mistaken, though? Many prominent psychologists

  and others have considered psychological needs as a way to under-

  stand human motivation and human nature. Several lists of needs

  exist, and a premise associated with them is that people are highly

  motivated to meet these needs. When they do, the theory goes, well-

  being and health are achieved. Of course, the flipside to this is that

  frustrated needs can lead to an array of problems.

  Perhaps the most famous work on this topic is that of Henry

  Murray,1 who identified twenty such needs, including autonomy, nur-

  turance, play, understanding, dominance, and achievement, among

  others. Shneidman, heavily influenced by Murray, highlights these

  needs as well, postulating that the thwarting of them leads to psychache

  and thus to suicidality.2 These theorists might have guessed that

  though my dad belonged to a church and had career success, some-

  thing was still missing—some of his fundamental needs were still not

  being met.

  96 ● WHY PEOPLE DIE BY SUICIDE

  But which needs? Exactly how many are there, and are some more

  important than others? Models including as many as twenty needs

  pose a problem for a model of suicide based on needs. Given that

  there are so many needs and thus so many people with one or more

  thwarted needs, how to understand that very, very few of these peo-

  ple attempt suicide, and fewer still die by suicide?

  Murray was aware of this problem. He wrote, “In many cases the

  succorance drive is subsidiary to the need for affiliation (a basic tendency, whose aim is to establish and maintain friendly relationships

  with others).”3 I am intrigued that Murray believed the need for af-

  filiation was a superordinate need, because as I have noted already

  and will expand on in this chapter, I do too, and more to the point, I

  believe that the thwarting of this need is a main component of the

  desire for death.

  Shneidman, writing specifically of suicide, stated, “For practical

  purposes, most suicides tend to fall into one of five clusters of psy-

  chological needs. They reflect different kinds of psychological pain.”4

  The five are thwarted love, ruptured relationships, assaulted self-im-

  age, fractured control, and excessive anger related to frustrated needs

  for dominance.

  My solution to this problem is to assert two bedrock needs, the

  fulfillment of which satisfies most others and can compensate for

  frustration of other needs. The thwarting of both of these needs

  constitutes the desire for death. Shneidman’s five failed needs are im-

  portant, but they are collapsible into the two major categories of

  thwarted belongingness (i.e., thwarted love, ruptured relationships)

  and perceived burdensomeness (assaulted self-image, fractured con-

  trol, anger related to frustrated dominance).

  Regarding the first bedrock need, belongingness, the need to be-

  long involves a “combination of frequent interaction plus persistent

  caring.”5 Thus, there are two components of a fully satisfied need to

  belong: interactions with others and a feeling of being cared about.

  In order to meet the need to belong, the interactions an individual

  The Desire for Death ● 97

  has must be frequent and positive. Interactions within a stable rela-

  tionship will more fully satisfy the need to belong than interactions

  with a changing cast of relationship partners (i.e., higher levels of

  stability). The need to belong will be only partially met if an individ-

  ual feels cared about but does not have face-to-face interactions with

  the relationship partner (i.e., greater proximity). The model of sui-

  cidal behavior developed here asserts that an unmet need to belong is

  a contributor to suicidal desire: suicidal individuals may experience

  interactions that do not satisfy their need to belong (e.g., relation-

  ships that are unpleasant, unstable, infrequent, or without proxim-

  ity) or may not feel connected to others and cared about.

  I would argue that the other bedrock need is effectiveness or a

  sense of competence. When this need is thwarted, when one per-

  ceives oneself as ineffective, it is painful indeed. To perceive oneself as so ineffective that loved ones are threatened and burdened is even

  worse, so much so that the desire for death could be generated. The

  perspective taken here proposes that feelings of ineffectiveness con-

  tribute to the desire for suicide, and moreover, that feeling ineffective

  to the degree that others are burdened is among the strongest sources

  of all for the desire for suicide.

  Those who view themselves as a burden on others have a negative

  self-image, feel out of control of their lives, and possess a range of

  negative emotions stemming from the sense that their incapacity

  spills over to affect others besides themselves.

  Thwarted Effectiveness: The Sense that One Is a Burden

  If you let yourself down, the experience is not pleasant, but it is con-

  tained—it affects just you. If you let your group down, you experi-

  ence all the negative aspects of letting yourself down (because you

  are part of the group), but you also experience the sense that your in-

  effectiveness is not contained, that it negatively affects others.

  To take a relatively trivial example, I returned to playing soccer re-

  98 ● WHY PEOPLE DIE BY SUICIDE

  cently, after a layoff of a couple of weeks because of injury and travel

  commitments. I didn’t play very well. I was tentative because I was a

  little concerned about re-injury, and I was not energetic, because I

  was out of shape after the layoff. I was disappointed in myself and

  had the sense that my teammates felt that way about me too. Not

  pleasant.

  So why didn’t I just quit? And why didn’t my teammates want me

  to quit? The main reason, I think, is that my teammates and I re-

  member that I have a track record of holding my own, of contribut-

  ing to the team. Relatedly, everyone understands or at least hopes

  that my injury-related tentativeness and my layoff-induced lack of

  stamina are remediable—I can recover from both with time and

  training.

  But what if I judged that my failings were not remediable, that I

  was a burden to my team and would be permanently? And what if I

  thought my teammates felt the
same way? Under such conditions, I

  might very well quit the team. In this scenario, I have perceived my-

  self to be a burden on others and, lacking the remedy of time and

  training, am left with quitting the team as my only solution.

  I believe this example, though trivial, is analogous to the non-

  trivial, life-and-death psychological processes of people seriously con-

  templating suicide. They perceive themselves to be ineffective or

  incompetent, but it’s not just that. They also perceive that their inef-

  fectiveness affects others, too. Finally, they perceive that this ineffec-

  tiveness that negatively affects everyone is stable and permanent,

  forcing a choice between continued perceptions of burdening others

  and escalating feelings of shame, on the one hand, or death on the

  other hand.

  When I refer to “perceived burdensomeness,” I would like to em-

  phasize the term perceived. People who are contemplating suicide

  perceive themselves a burden, and perceive that this state is permanent and stable, with death as a solution to the problem. It is very

  The Desire for Death ● 99

  important to point out that their perceptions are mistaken. Indeed,

  that their perceptions are mistaken is the basis for the psycho-

  therapeutic treatment of suicidal symptoms. Any perception, mis-

  taken or not, can influence behavior. My contention is that perceived

  burdensomeness, though mistaken, influences suicidal behavior.

  The idea that how others see us and how we see ourselves is a life-

  or-death matter is not hard to fathom. For example, duels to the

  death were a common feature of society in Europe from the Renais-

  sance to the First World War. Duelling claimed the lives of hundreds

  of thousands of Europeans. Often, the disputes leading up to duels

  were very petty (e.g., a duel in 1678 in Paris occurred because one

  man said another’s apartment was tasteless; another duel was over

  ownership of an Angora cat).6 The causes may have been petty, but

  the duels themselves were serious, not only in the obvious sense of

  the possibility of death, but also regarding standing in one’s own and others’ eyes. In some societies, to have won a duel was to establish

  oneself as a man. To have fled one was a dishonor worse than death.

  But surely we have left to the past such things as duels? Appar-

  ently not. R. E. Nisbett, D. Cohen, and colleagues have conducted

  fascinating research on cultures of honor. In the United States, “the

  South and West have developed ‘cultures of honor,’ in which insults

  and threats to reputation, self, home, or family are taken quite seri-

  ously and are often met with violence.”7 These researchers have doc-

  umented that the U.S. South and West do in fact have more of cer-

  tain forms of violence (e.g., murder in reaction to a threat) than

  other areas of the United States. People in these regions who perceive

  themselves as dishonored may be especially prone to suicide. Is sui-

  cide more common in culture-of-honor states?

  Interestingly, excluding Alaska (which is ranked sixth, and which

  has a distinct cultural heritage), all fifteen of the states with the high-

  est suicide rates are culture-of-honor states—specifically, New Mex-

  ico, Montana, Nevada, Wyoming, Colorado, West Virginia, Idaho,

  100 ● WHY PEOPLE DIE BY SUICIDE

  Oklahoma, Oregon, Arizona, Arkansas, Florida, Utah, South Dakota,

  and Delaware. The association of suicide rates with culture-of-honor

  states is even higher than the association of murder with “culture of

  honor” states—eleven of fifteen culture-of-honor states are in the

  top fifteen with regard to murder rates; the four non-South and non-

  West exceptions in the top fifteen are Illinois, Indiana, Michigan, and

  Missouri.

  Our sense of effectiveness—the view that we are not burdens but

  rather contributors—can be sustaining. By contrast, feeling ineffec-

  tive and helpless can be life-draining. “Learned helplessness” experi-

  ments on animals illustrate this point. In these experiments, some

  animals learn helplessness by being exposed to noxious stimuli (e.g.,

  shock) from which they cannot escape; other animals are also ex-

  posed to the aversive stimuli but have the ability to escape and thus

  do not develop helplessness. It appears that helplessness suppressed

  animals’ will to live, as evidenced by passivity and appetite suppres-

  sion, for example.8 In fact, Seligman made this connection in his de-

  scription of rats who had not learned helplessness and swam for days

  to avoid drowning, as compared to those who had learned helpless-

  ness and drowned almost immediately.9 Also germane to the will to

  live, self-efficacy—the opposite of perceived burdensomeness—was a

  significant predictor of survival in a study of patients with chronic

  obstructive pulmonary disease.10 Relatedly, it has also been found

  that people with positive perceptions of aging, measured as much as

  twenty-three years earlier, lived an average of 7.5 years longer than

  those with less positive self-perceptions of aging, even accounting for

  variables like age, gender, socioeconomic status, loneliness, and func-

  tional health.11 Feeling effective, like a contributor instead of a bur-

  den, can be life-saving.

  The specific role of perceived burdensomeness in suicidal behavior

  is clear in some cultures. There have been reports that among the

  The Desire for Death ● 101

  Yuit Eskimos of St. Lawrence Island, for example, those who become

  too sick, infirm, or old may threaten the group’s survival; in the past,

  the explicit and socially sanctioned solution to this problem was rit-

  ual suicide. Reportedly, the ritual was graphic, often involving the

  family members’ participation in the shooting or hanging of the vic-

  tim.12 There is some question as to the veracity of this specific exam-

  ple, but the general pattern has been noted many times in Eskimo

  cultures.13 Arguably, this represents an example of anecdotal evi-

  dence being quite persuasive—cultures have sanctioned ritual sui-

  cide specifically in response to burdensomeness. Another example is

  ancient Ceos, where the law obliged all inhabitants over sixty years of

  age to die by drinking hemlock to make room for the next generation

  (a law that apparently was enforced only in times of famine).14

  Similarly, among the ancient Scythians, it was a great honor to

  die by suicide when one was too old to continue in and contribute

  to their nomadic lifestyle. Quintus Curtius, who described the

  Scythians, said: “Among them exists a sort of wild and bestial men to

  whom they give the name of sages. The anticipation of the time of

  death is a glory in their eyes, and they have themselves burned alive

  as soon as age or sickness begins to trouble them.”15

  In 2004, as reported on the news website Ananova.com, an elderly

  Malaysian couple died by suicide by jumping from the fifteenth floor

  of their apartment building specifically because they did not want to

  be a burden on their family. Their suicide note read, “If we had

  waited for our
death due to sickness, we would have caused much

  inconvenience to all of you.” Ritual murder of widows among the

  Lusi people in New Guinea has been described as essentially suicidal:

  “A Lusi widow would rather die than be dependent on her children;

  Lusi widowers are not viewed as a burden on their kin and are not

  ritually killed by their kin.”16

  Examples like this illustrate that perceived burdensomeness could

  102 ● WHY PEOPLE DIE BY SUICIDE

  play a role in suicidal behavior and also shows the link, mentioned in

  Chapter 1, between perceived burdensomeness and Durkheim’s con-

  cept of altruistic suicide. For Durkheim, altruistic suicides occur

  when people are so integrated into social groups that individuality

  fades, and they become willing to sacrifice themselves to the group’s

  interests. My account also emphasizes self-sacrifice in context of the

  perception that others will benefit, but I do not think this usually oc-

  curs when people are especially connected to a group—in fact quite

  the contrary, as will be expanded on in the next section on failed

  belongingness.

  Returning for now to the concept of perceived burdensomeness,

  some material from suicide notes also illustrates its potential role in

  suicidal behavior. A seventy-year-old man wrote “Survival of the

  fittest. Adios—unfit.”17 The closing line from musician Kurt Cobain’s

  suicide note (addressed to his wife Courtney regarding their daugh-

  ter Frances) provides anecdotal evidence that perceived burden-

  someness is implicated in suicide: “Please keep going Courtney for

  Frances for her life which will be so much happier without me.” A

  suicide note left by a teenage girl who died by electrocution read, “I

  have just been a very bad person, but now you are all rid of me.”

  Shneidman summarized several other examples from suicide notes:

  “Life is unmanageable. I’m like a helpless 12 year old” (from a 74-

  year-old widowed woman who died by self-cutting); “The failures

  and frustrations overwhelm me” (from a 49-year-old married man

  who died by self-inflicted gunshot wound).18

  Perhaps the clearest example cited by Shneidman is from a

  woman’s suicide notes to her ex-husband and her daughters. To her

  ex-husband, she writes, “[the girls] need two happy people, not a

  sick, mixed-up mother. There will be a little money to help with the

 

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