Excessive drinking is one way to kill oneself; insufficient eating is another. An estimated one in every hundred females in this country, most of them young and white, suffer from anorexia nervosa. In a misguided attempt to conform to cultural norms of attractiveness, they may literally starve themselves into illness and even death. The underlying causes of anorexia—low self-esteem, feelings of self-hatred—are not dissimilar to the roots of suicide, and the disorder is often accompanied by traditional suicide attempts. “I didn’t think I was worth anything,” said one young girl, who dropped from 120 to 80 pounds. “I had no friends, no one to talk to. I was really depressed. I wanted to kill myself. I had thought of taking a knife or pills, but I couldn’t. That was suicide, and I knew suicide was a sin. So I just stopped eating.” Another young anorexic who was close to death says, “I would rather have died than eaten.” Many do. Fifteen percent of acute anorexics will die of what one psychiatrist calls “intestinal suicide.”
An even greater number of people in this country suffer from bulimia. Bulimics, who tend to be middle- or upper-middle-class women with high intelligence and high standards, endure recurrent episodes of compulsive eating followed by self-induced vomiting, fasting, or the abuse of laxatives or diuretics. Some bulimics vomit as many as six times a day or take as many as three hundred laxatives a week. Although the ostensible purpose is to develop a more beautiful figure, the effect is a litany of self-destruction not unlike that achieved by the early Christian martyrs. Bulimics may suffer from rotten teeth and receding gums (the result of being bathed in stomach acid each time they vomit), swollen salivary glands, sore throats, abrasions on the esophagus walls, numb or curling fingers and lips (from low potassium levels), and broken blood vessels in the eyes. In her attempts to vomit, one young woman repeatedly jammed her fingers down her throat so forcefully that years later she still has teeth marks on the back of her hand. Occasionally, bulimics die from a severe electrolyte imbalance or from rupture of the stomach or esophagus during a binge. But their self-destructive urges often take a more direct form; in one study one-third of bulimics had made at least one suicide attempt. Perhaps surprisingly, unless one agrees with Menninger that self-destructive behavior is often a way of avoiding true suicide, a recent review of more than thirty studies concluded that about 1 percent of people with eating disorders complete suicide, a figure far lower than that for those who suffer from depression.
Experts suspect that many single-passenger auto deaths may well be suicides in disguise. Some, like Willy Loman in Death of a Salesman, who kills himself by driving into a tree, are unequivocal suicides. For Loman “autocide” seemed to be a way of ending his life without forfeiting his insurance premium. Others are somewhat less obvious about their intentions, such as the man who, after an argument with his wife, wrote a note saying, “You’ll be sorry when I’m dead,” jumped into his car, and sped off down the highway. Two minutes later he had a fatal crash. The police report concluded, “It looked as if he pointed it into the tree.” But suicidal intent is difficult to prove, and such deaths are usually classified as accidents unless a note is found. When a young Massachusetts woman drove on the wrong side of the highway with her headlights off and was killed in a head-on collision, her death was ruled an accident. Researchers estimate, however, that as many as 15 percent of single-car crashes are suicides, and auto accidents have been linked to suicidal behavior in several studies. Psychiatrist Melvin Selzer has demonstrated that suicidal people have more than twice as many auto accidents as nonsuicidal people. In a subsequent study Selzer compared ninety-six drivers responsible for fatal crashes with a control group of drivers. Almost half of the fatal-crash drivers had exhibited depression, violent behavior, and suicidal thinking, compared to 16 percent of the control group. Drivers in crashes were at least four times more likely to have been under severe stress from alcoholism, job problems, or financial troubles. “I don’t think there are many overt suicides by auto,” Selzer has said, “but the driver may be increasingly depressed, angry, and frustrated until he reaches a state at which it is a matter of indifference to him whether he lives or dies.” Young men in particular may drive in careless, risk-taking ways, speeding, racing, driving with their eyes closed, or engaging in games of “chicken” like that played by James Dean in Rebel Without a Cause. Reckless driving is often combined with alcohol; in one study more than 50 percent of a group of accident-prone drivers were alcoholics.
The connection between suicide and risk-taking behavior is most dramatically apparent in Russian roulette deaths, which coroners usually classify as accidents. For some people, like Peter Newell, Russian roulette seems to offer a passive-aggressive approach to suicide. For novelist Graham Greene, who suffered from manic depression and toyed with suicidal thoughts throughout his life, Russian roulette seemed to be an attempt to shock himself from numbness. It was one of a number of risk-taking behaviors (drinking, dalliances with prostitutes, travel in war zones) he employed in what he called his “lifelong war against boredom.” A study of twenty Russian roulette victims, all but one of them men, found that they were young (many were students) and in good physical health. Half of them were known to have been depressed, however, and nearly 60 percent had a history of drug or alcohol abuse or psychiatric disturbances. “They use risk-taking behavior as a form of self-treatment for depression,” observed Dr. David Fishbain, the study’s lead author. Although the researchers were unable to conclude whether the victims were “true suicides” or not, the urge for death was clearly evident; more than half of the victims had fired the gun more than once, and 16 percent had loaded more than one bullet in the gun. All had played the “game” with other people present.
The person who plays Russian roulette has a one in six chance of dying; the person who climbs Mount Everest has a one in ten chance of dying. Is it suicidal to attempt that climb? The odds are not good for war correspondents, soldiers of fortune, skydivers, motorcycle racers, daredevils, glacier skiers, climbers who spurn ropes and protective hardware, and others who spend their lives in pursuit of extreme physical risk. Some call them adrenaline junkies and suggest that such people need a high concentration of the stress hormones that are released by fear or excitement. Impulsivity and sensation-seeking have been shown to be associated with the gene for a receptor of the brain chemical norepinephine, suggesting that thrill-seeking personalities are driven, in part, by biology to a life of living on the edge. Edge-livers themselves dismiss the suggestion that they might harbor a “death wish.” “I would describe myself as having a life wish,” Himalayan mountaineer Gordon Wiltsie has said. “When you do adventurous things, you get a real sense of being alive and enjoying being alive. Life gains value when you realize that it could be extinguished.” Freud said as much in a discussion of war: “Life is impoverished, it loses in interest, when the highest stake in the game of living, life itself, may not be risked. It becomes as shallow and empty as, let us say, an American flirtation.”
Some people complete suicide by getting someone else to kill them, becoming what Aldous Huxley called a “murderee.” Like the Christian martyrs who goaded the Romans into executing them or the angry young men who engage in “suicide by cop,” they provoke someone or something else into striking the final blow. Sometimes this strategy is invoked because of the stigma of suicide. Among the Malays, for whom suicide is a sin, if a man wished to die, he ran amok, killing people randomly until he himself was killed. In certain aboriginal tribes of Australia, if a native wanted to die but couldn’t get someone to kill him, he might expose himself to a venomous snake. To evade the divine decree against suicide, eighteenth-century Irish Catholic convicts facing torture in Australian prisons drew straws. The man holding the longest straw was killed, thus avoiding prolonged torture; the man who drew the second straw did the killing—whereupon he was executed by the authorities. In war, suicide may be disguised as heroism. “Many soldiers have the fantasy of throwing themselves into the turmoil of battle in order to die,” wro
te psychiatrist Joost Meerloo. “One of them, who was very courageous indeed, became very depressive after the war because God had not understood his magic gesture and had not used the enemy to kill him.” Some would call such men heroes; sociologist Marvin Wolfgang might call them examples of “victim-precipitated homicide.” In his 1950s study of murder in Philadelphia, Wolfgang stated that 150 of 588 consecutive homicides were cases of victim-precipitated homicide, many of them husbands who attacked their wives, provoking their wives into murdering them. One drunken man, for instance, beat his wife, then handed her a kitchen knife and dared her to use it on him. She said that if he hit her once more, she would. He slapped her in the face; she stabbed him to death. In a more recent, particularly horrific example, a forty-three-year-old German man responded to an Internet posting seeking someone willing to be “slaughtered,” whereupon he was stabbed to death, carved into pieces, and eaten, over a period of months, by a forty-two-year-old computer technician. After the rejection of a defense request that the defendant be found guilty only of “killing on request” (his lawyers pointed out that the victim had consented, even begged, to be killed) he was convicted of manslaughter and sentenced to eight and a half years in prison.
Many of these people may be unaware of their desire to die, or they may prefer to leave their fate to chance. They may have some magical belief that they cannot take their own life, or they may feel an intense need to be punished by others or to be killed by a symbolic parent. Psychiatrists believe that some people commit murder in the hope of invoking the death penalty. (There are mental health professionals who oppose capital punishment partly because it may encourage violent, suicidal persons to murder.) A twenty-two-year-old babysitter who murdered two small children in her care told police that although she had loved them, she killed them in the belief that if her crime was sufficiently odious, the death penalty would be invoked. She had attempted suicide many times and believed she was incapable of killing herself. (She did not get her wish.) Many death row inmates have tried to insist on their right to the death penalty. In 1977, convicted murderer Gary Gilmore, who demanded to be shot by a firing squad, fought several stays of execution and made two suicide attempts before being executed.
Some forms of suicide are metaphorical. Beset by rumors of marital infidelity, 1988 presidential candidate Gary Hart challenged the press to “put a tail” on him. That very weekend he canceled his campaign appearances to dally with a young model. In the ensuing scandal he resigned from the race, one in a long line of politicians to have committed “political suicide.” Such an unconscious need to fail had been recognized by Freud, who said that men who sabotaged their own success were commonly seen in psychoanalysis. In what has been called “pseudocide,” some people fake their own suicide, disappear, and start over again somewhere else under a new identity. This is one of many forms of social suicide in which one withdraws from contact with the outside world, essentially declaring the rest of the world dead. In Melville’s Moby-Dick, Ishmael settles for temporary withdrawal; rather than giving in to “pistol and ball,” he ships out for two years on the Pequod. Some suggest that various forms of nonaction are essentially suicidal, as in the renunciation of ambition or creativity. The poet Arthur Rimbaud stopped writing at nineteen although he lived almost two decades more. A long-term study of gifted young people found that some had been conspicuous failures in their adult lives, accepting what one psychologist called a sort of “partial death” in lieu of overt suicide. Joost Meerloo believed that such resignation is widespread: “Most people are no longer alive after their entrance into maturity,” he wrote. “They commit a partial and token suicide by stopping their growth and stopping the pleasure of expansion. They bury themselves in old accepted habits and customs, drowning their sense of curiosity regarding new inner and outer experiences. Contented apathy and the ending of inquisitive curiosity may be looked at as the early intrusion of death.” Ernest Hemingway referred to such behavior as “backing into the grave.” Hemingway himself went headfirst, shooting himself when he felt his creative powers had deserted him.
Some theorists seem to believe that almost every action we take—or don’t take—may represent some form of self-destructive behavior. In How to Stop Killing Yourself, a sort of layman’s version of Man Against Himself published in 1950, Dr. Peter Steincrohn found examples of self-destruction almost everywhere—“exercisitis” (exercising after age thirty), “vacationitis” (being too relaxed on vacation), and even “disbelief in the philosophy of self-destruction” (a refusal to recognize that we are all suicidal in some way). But not all behavior having possible self-destructive consequences is necessarily motivated by a desire for punishment or death. Merely getting into a car could be considered suicidal behavior, given current accident rates. Some psychiatrists call entering a convent a form of suicide; others call it enlightenment. “One must be careful and not fall into the trap that Menninger did,” writes French sociologist Jean Baechler. “Biting one’s nails is a form of self-mutilation so removed from total suicide that there is something arbitrary about keeping it in a study of suicide. As ever, it is a question of degree.”
Exploring the extent and variety of self-destructive behavior may, however, help us understand that within each of us there is the capacity for self-destruction that may emerge in various forms at various times. “There is a little murder and a little suicide dwelling in everybody’s heart,” wrote Menninger. “Give them a powerful weapon like a car, inflame their inhibitions or irritations or frustrations, and diminish their suppressive control by means of alcohol or fatigue, and the murder or suicide may get committed.” Although few of us pick up the gun, much less pull the trigger, we all engage in activities that have within them a germ of self-destruction.
Several writers on suicide propose that self-destruction is best conceptualized as a continuum of behavior ranging over a broad spectrum. On one end there is the person who puts a bullet through his brain, the completed suicide. On the other, the person who lives a full, healthy, loving, creative, positive life. Located along that continuum are various forms of self-destructive behavior, from suicide attempts to alcoholism to reckless driving to cigarette smoking to the tiny acts of self-sabotage we engage in daily. We all lie on that continuum somewhere between those two extremes, moving along the scale in either direction as circumstances change. In The Winter Name of God, author and priest James Carroll wrote:
A thousand people are “officially” dead of suicide every day, but they are not the only ones who are faced with the constant choice between life and death. We all are. . . . We might lack the nerve to commit the final act, and we may not recognize our “sinful” tendencies for what they are, but day in and day out we confront the problem of our innate attraction to self-destruction. We live in a world that encourages the small daily acts of negation that prepare us for the great one. There are meanings of suicide that neither the courts nor the dictionaries admit, but that make it impossible for us to regard those thousand people a day who do themselves in as very different from us. They are not necessarily “sick” or “sinners,” but simply our sisters and brothers. And who are we? We are the resigned housewives, the compulsive playboys, the despairing priests, the addicted teenagers, the reckless drivers, the bored bureaucrats, the lonely salesmen, the smiling stewardesses, the restless drifters, the walking wounded. . . . It may be nothing more than the steadfast commitment to sameness. The simplest form of suicide is the act of refusing the adventures and challenges that offer themselves to us every day. “No thanks,” we say. “I prefer not to,” we murmur, like Melville’s Bartleby, preferring to stare at the wall outside the window. Preferring, as I do on especially bad days, to stay in bed.
4
PREVENTION
I
CONNECTIONS
AT 10 P.M. ON A TUESDAY NIGHT in April, the phone rang in a small room in a one-story building in Los Angeles. Pat, a trim, forty-three-year-old woman wearing sneakers, jeans, and a sweatshirt, picked
up the receiver and, in a warm, gentle voice, said, “Hello, may I help you?” As she listened to the answer, she grew still. “Nine Percodans? I don’t know,” she said. “I’m not a doctor. . . . Did you take nine Percodans? Did someone you know take them?” After each question Pat listened intently before asking the next. “How old is your friend? . . . Nineteen? . . . Is she there with you? . . . No? How frightening.” Pat spoke slowly, her voice comforting but firm. “Your friend should get some help. Do you have anyone to call who can help you with this? . . . Maybe you should call the paramedics. Did you call her house? . . . She has roommates? . . . Might they know where she is? . . . Might she call you back? . . . No? . . . She just called you to say good-bye?”
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