Why People Die By Suicide
Page 13
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