Then Merryl took a deep breath and looked up. There was a current calendar on her wall. She heard the hum of cars on the street outside and the sound of Nathan puttering in the next room. She was surrounded by the details of her new life. She opened the trunk. “As I picked up the picture, I looked into his eyes again, and it all began to recede. As I looked at him, I thought, ‘That was a different life, that was down another path.’ And I closed the picture up. ‘You suffered a lot, Carl,’ I told him. ‘But I have to put you away.’”
ACKNOWLEDGMENTS
IN 1980, JOHN BETHELL, then editor of Harvard Magazine, asked me to write an article about suicide. That article, which appeared in 1983 as “The Enigma of Suicide,” marked the beginning of my absorption in the subject. I thank John, Kit Reed, Jean Martin, and Gretchen Friesinger for their excellent editorial counsel.
Thanks also to Jim Silberman for seeing the germ of a book in the Harvard Magazine piece, and to Ileene Smith and Alane Mason for shepherding the manuscript to publication at Summit Books.
I am grateful to Nan Graham and Susan Moldow at Scribner for granting second life to this book, and to Sarah McGrath and Samantha Martin for smoothing its rebirthing process.
Special thanks to my agent, Amanda Urban, for her wise counsel and infectious enthusiasm throughout.
Among the many people in the field of suicide or suicide prevention who were of help, I am particularly beholden to Patrick Arbore, Karen Dunne-Maxim, Sam Heilig, Derek Humphry, Shirley Karnovsky, Joseph Lowenstein, Terry Maltsberger, Julie Perlman, Charlotte Ross, Ed Shneidman, Tom Welch, and the late Ann Wickett.
For translation, proofreading, typing, hospitality, and help of other varieties, I thank Susan Brenholts, David Breskin, Lisa Colt, Susannah Colt, Naomi Cutner, the late Phil Driscoll, the late Annalee Fadiman, the late Clifton Fadiman, Maureen Fitzpatrick, Campbell Geeslin, June Goldberg, Peter Gradjansky, Eliza Hale, Nina Hale, Douglas Heite, Rob Larsen, Laura Natkins, John Neary, Mark O’Donnell, Linda Pillsbury, Sam Pillsbury, Nancy Skinner, Rod Skinner, John Srygley, Jane Trask Rosen, and Lena Williams.
I cannot thank my parents and my brothers enough for their love and support throughout the years I have worked on this book.
I owe an enormous debt to my cousin and friend Henry Singer, who did the vast majority of the interviewing for part one, and whose sensitivity, emotional generosity, and unflagging energy made him one of the few people I felt I could trust with such a delicate, difficult task. These qualties have been everywhere evident in his subsequent career as a documentary filmmaker.
Several months before deciding to write the first edition of this book, I met Anne Fadiman, a writer who was herself in the midst of a long project on suicide, an examination of the right to die. We soon discovered that we had far more in common than our interest in self-destruction; during my work on this book, we married and became parents. Anne’s contributions to this book have been varied and immense. She has been a gentle and exacting in-house editor, showing as much care and enthusiasm for the last draft of the second edition as she did for the first draft of the first. In living with me, she also, in a sense, lived with the people who inhabit this book, and not once has she complained about their presence. Without her editorial skill, this book would be less readable; without her love, it would have been unwritable.
I have often been asked, “Isn’t it depressing to write a book on suicide?” The question never fails to surprise me, in large part because so many of the people I have met who have had first-hand experience with the subject—who have attempted suicide or have struggled to cope with a suicide in the family, or have worked to prevent the suicide of someone they loved—are so courageous and so admirable. Last and most important, I would like to thank those people whose voices and stories appear in this book1 who gave so generously of themselves, usually in the hope that by sharing their experiences, they might help someone else. I hope that I have not failed them.
RESOURCES
The following organizations will be of help to those who wish to learn more about suicide.
American Association of Suicidology
5221 Wisconsin Avenue, N.W.
Washington, DC 20015
(202) 237-2280
www.suicidology.org
American Foundation for Suicide Prevention
120 Wall Street, 22nd floor
New York, NY 10005
(888) 333-2377
www.afsp.org
Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
(800) 311-3435
www.cdc.gov
National Institute of Mental Health
6001 Executive Boulevard
Bethesda, MD 20892
(866) 615-6464
www.nimh.nih.gov
Suicide Prevention Action Network
1025 Vermont Avenue, N.W., Suite 1066
Washington, DC 20005
(202) 449-3600
www.spanusa.org
For those who need immediate help: National Hopeline 1-800-SUICIDE; National Suicide Prevention Lifeline 1-800-273-TALK.
ALSO BY GEORGE HOWE COLT
The Big House:
A Century in the Life of an American Summer Home
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NOTES
PART 1 Adolescent Suicide
Chapter II The Slot Machine
37 completed suicide: While most people speak of “committing” suicide, prevention groups encourage the use of the less judgmental word “completing” suicide.
38 third leading cause: Each year, about five children between the ages of five and nine kill themselves; for those aged ten to fourteen, the number grows to more than three hundred (a rate of 1.5 per 100,000—one-fifth that of the fifteen-to-nineteen-year-old age group). Suicidal intent is especially difficult to determine in children, however. Each year some twelve thousand children are hospitalized for deliberate self-destructive acts: stabbing, scalding, burning, jumping from high places, running into traffic. Some suicidal children may be motivated by an attempt to escape an intolerable home life, others by self-punishment, others to rejoin a lost loved one—often recently dead—or to gain attention from a neglectful parent. Many have been physically abused by a family member. In a study of 662 preadolescent children treated at the Neuropsychiatric Institute over a five-year period, UCLA psychiatrists found that 5 percent were suicidal or “seriously self-destructive.” Many came from families in which the concept of guilt was used to control the child’s behavior. Suicide became not only a way of escaping family problems but a form of self-punishment. The child often blamed himself for family problems and came to believe that he deserved to die.
38 Kay Jamison compared: Jamison, Night Falls Fast, 22–23.
39 19 percent of high school students: J. A Grunbaum et al., “Youth Risk Behavior Surveillance—United States, 2001,” Morbidity and Mortality Weekly Report, CDC Surveillance Summary 51 (SS4) (2002): 1–64.
39 No one knows: For a masterful review of recent adolescent suicide research, see Gould et al., “Youth Suicide Risk and Preventive Interventions.”
41 more than 90 percent: Y. Conwell et al., “Relationships of Age and Axis I Diagnosis in Victims of Completed Suicide: A Psychological Autopsy Study,” American Journal of Psychiatry 153 (8) (1996): 1001–8.
42 fifty-six hundred adolescents: Giffin and Felsenthal, Cry for Help, 218.
43 not the only answer: After a suicide one often hears family members say, “I don’t understand it. He had problems, but he was getting over them. Lately, he seemed so happy.” People commonly kill themselves just when they appear to be coming out of a depression. It m
ay be because they have made their decision to kill themselves, and their problems finally seem solved. Ironically, making the decision may help lift the depression—and give them the energy needed to carry out the act. If they have recently been prescribed antidepressant medication, the suicide may be made possible because the medication has taken effect and reduced their depression sufficiently that they are able to act on their self-destructive thoughts.
43 twenty-six depressed patients: Hendin et al., “Desperation and Other Affective States.”
43 “This is probably the most primordial”: G. Zilboorg, “Some Aspects of Suicide,” Suicide 5 (3) (1975): 135.
43 a “death trend”: Moss and Hamilton, “Psychotherapy of the Suicidal Patient.”
44 A University of Washington study: T. L. Dorpat et al., “Broken Homes and Attempted and Completed Suicide,” Archives of General Psychiatry 12 (1965): 213–16.
44 “Loss in all of its manifestations”: Styron, Darkness Visible, 56.
44 Comparing 505 children: Garfinkel et al., “Suicide Attempts in Children and Adolescents.”
44 120 young suicide victims: Gould et al., “Psychosocial Risk Factors.”
44 intense mood shifts: Pfeffer’s work is described in C. R. Pfeffer, The Suicidal Child (New York: Guilford Press, 1986).
45 one of mutual involvement: J. L. Rubenstein et al., “Suicidal Behavior in Adolescents: Stress and Protection in Different Family Contexts,” American Journal of Orthopsychiatry 68 (1998): 274–84; J. L. Rubenstein et al., “Suicidal Behavior in ‘Normal’ Adolescents: Risk and Protective Factors,” American Journal of Orthopsychiatry 59 (1989): 59–71.
45 childhood trauma: For an overview of the link between childhood trauma and suicidal behavior, see “Childhood Trauma” in Goldsmith et al., Reducing Suicide, 157–91.
45 at least two disorders: A. B. Silverman et al., “The Long-Term Sequelae of Child and Adolescent Abuse: A Longitudinal Community Study,” Child Abuse and Neglect 20 (8) (1996): 709–23.
45 9 to 20 percent: Goldsmith et al., Reducing Suicide, 183.
45 A review of twenty studies: E. E. Santa Mina and R. M. Gallop, “Childhood Sexual and Physical Abuse and Adult Self-Harm and Suicidal Behaviour: A Literature Review,” Canadian Journal of Psychiatry 43 (8) (1998): 793–800.
45 study of 159 adolescents: E. Y. Deykin et al., “A Pilot Study of the Effect of Exposure to Child Abuse or Neglect on Adolescent Suicidal Behavior,” American Journal of Psychiatry 142 (1985): 1299–1303.
46 five times more likely: D. A. Brent et al., “Alcohol, Firearms, and Suicide Among Youth: Temporal Trends in Allegheny County, Pennsylvania, 1960 to 1983,” Journal of the American Medical Association 257 (24) (1987): 3369–72.
46 drinking within three hours: Powell, “Alcohol Consumption.”
47 “A baby repeatedly left”: Giffin and Felsenthal, Cry for Help, 195.
47 “Nearly every suicidal child”: Ibid., 185, 215.
48 had physical fights: M. Peck, “Suicide in Late Adolescence and Young Adulthood,” in Hatton and Valente, Suicide: Assessment and Intervention, 222.
48 nearly four times more likely: “Suicide Attempts and Physical Fighting Among High School Students—United States, 2001,” Morbidity and Mortality Weekly Report 53 (22) (2004): 474.
48 psychiatrist David Shaffer found: D. Shaffer and M. Gould, “Study of Completed and Attempted Suicides in Adolescents,” Progress Report: National Institute of Mental Health (1987).
48 a recent disciplinary crisis: Gould et al., “Psychosocial Risk Factors.”
49 fewer than five minutes: T. R. Simon et al., “Characteristics of Impulsive Suicide Attempts and Attempters,” Suicide and Life-Threatening Behavior 32 (Supplement) (2001): 49–59.
49 “They are like a trivial border incident”: Alvarez, Savage God, 97.
49 “If youth is the season of hope”: G. Eliot, Middlemarch (Cambridge: Riverside Press, 1956), 398.
49 permanence of death: In a study of two hundred adolescents, one in five answered yes when asked if they could come back to life following a suicide. Such magical thinking is not limited to young people; some suicidal adults, too, describe death as a temporary state or believe that they will be able to observe the effect of their suicide on family and friends.
50 “I thought death would be”: Newsweek, August 15, 1983, 74.
50 “I wandered the streets”: K. Menninger, The Vital Balance (Harmondsworth, England: Penguin, 1977), 267.
52 frequency of moving: Potter et al., “Influence of Geographic Mobility.” Each year more than 14 percent of Americans relocate, compared with 8 percent of Britons and 4 percent of Germans.
52 A sixteen-year-old: Giffin and Felsenthal, Cry for Help, 125–27.
53 family had recently moved: San Mateo Times, February 11, 1983, 10.
54 “Television has brought”: J. Anderson, “An Extraordinary People,” New Yorker, November 12, 1984, 126.
54 more than a thousand studies: Senate Committee on the Judiciary, September 14, 1999, “Children, Violence, and the Media: A Report for Parents and Policy Makers,” http://judiciary.senate.gov/mediavio.
54 in video games: In 2005, the American Psychological Association called for a reduction in video game violence. Noting that 73 percent of violent acts in video games go unpunished, APA spokesperson Elizabeth Carll warned that “showing acts of violence without consequences teaches youth that violence is an effective means of resolving conflict.” (“APA Calls for Reduction of Violence in Interactive Media Used by Children and Adolescents,” www.apa.org/releases/videoviolence05.)
54 six prominent medical groups: Congressional Public Health Summit, July 26, 2000, www.aap.org/advocacy/releases/jstmtevc.htm.
57 therapists attribute the decrease: Columbia University researchers examined teenage suicide rates and use of antidepressants from 1990 to 2000 in 588 regions of the country and found an increase in antidepressant use was associated with a decrease in suicides. (M. Olfson et al., “Relationship Between Antidepressant Medication Treatment and Suicide in Adolescents,” Archives of General Psychiatry 60 (10) (2003): 978–82.)
Chapter III Brian
64 settled on a diagnosis: At the time, Brian was thought to be too young for manic depression, which was believed to manifest itself most commonly in the mid- to late twenties. It is now believed that the average age of onset is eighteen.
Chapter IV Something in the Air
79 “a contagious illness”: D. Bushman, “Cluster Suicides,” Reporter Dispatch (Gannett Westchester Newspapers), December 2, 1984, 1.
79 “sort of like punk rock”: Ibid., 16.
80 studied sixty-two patients: B. J. Rounsaville and M. M. Weissman, “A Note on Suicidal Behaviors Among Intimates,” Suicide and Life-Threatening Behavior 10 (1) (1980): 24–28.
81 columnist Ann Landers: Reporter Dispatch (Gannett Westchester Newspapers), April 2, 1985.
83 an article appeared: J. E. Brody, “‘Autoerotic Death’ of Youths Causes Widening Concern,” New York Times, March 27, 1984, C1.
83 “The most singular feature”: Winslow, Anatomy of Suicide, 108.
84 “In the year of Grace”: Coleman, Suicide Clusters, 17.
84 “Some threw themselves”: Fedden, Suicide, 150.
84 “Very few of those”: Cavan, Suicide, 69.
85 “A strange and terrible”: Fedden, Suicide, 299.
85 “vanity, if not sanity”: Alvarez, Savage God, 104.
85 “to abandon oneself”: A. Wynter, The Borderlands of Insanity (London: Henry Renshaw, 1877), 244–45.
85 “The East African societies”: Bohannan, African Homicide and Suicide, 263.
85 “A child is more open”: Friedman, On Suicide, 57.
86 “To all this may be added”: Mathews, “Civilization and Suicide,” 484.
86 “The sensational fashion”: Friedman, On Suicide, 137.
87 “One ‘new Werther’”: R. Friedenthal, Goethe: His Life and Times (Cleveland and New York: World Publishing Compan
y, 1965), 129–30.
87 “the mischievous influence”: Miller, Guilt, Folly, and Sources of Suicide.
87 “weakening the moral principles”: Winslow, Anatomy of Suicide, 87.
87 forty-three Russian roulette deaths: Coleman, Suicide Clusters, 126.
88 “When the mind is beginning”: Galt, Treatment of Insanity, 212.
88 “No fact is better established”: Phelps, “Neurotic Books and Newspapers.” This paper offers an extensive, if shrill, description of the controversy at the turn of the century.
88 “inducing morbid people”: J. A. Motto, “Suicide and Suggestibility: The Role of the Press,” American Journal of Psychiatry 124 (2) (1967): 157.
89 “literary chamber of horrors”: These examples are found in Phelps, “Neurotic Books,” 36.
89 found that suicides increase: Phillips, “Influence of Suggestion on Suicide.”
November of the Soul Page 80