259 nearly twice as likely: “Youth Risk Behavior Surveillance—United States, 2000,” Morbidity and Mortality Weekly Report, CDC Surveillance Summary 49 (SS05) (2000): 1–96.
259 “After they were confined”: L. H. Dizmang, “Suicide Among the Cheyenne Indians,” Bulletin of Suicidology, July 1967, 9.
260 new ways to vent aggression: The Native American death rate from cirrhosis of the liver is far higher than for any other race, especially among the young. The rates of homicide and violent accidents are also high, although there is evidence that they have decreased somewhat over the past few decades.
260 the causes were numerous: “Suicide Among Aboriginal People,” Royal Commission Report, February 23, 1995, prepared by Nancy Miller Chenier, Political and Social Affairs Division, Canadian Parliament.
261 “Inuit culture is rooted”: “Tragedy of Inuit Suicides Must End: New Measures Needed on World Suicide Prevention Day,” press release issued September 7, 2004, by Stephen Hendrie, director of communications, Inuit Tapiriit Kanatami.
261 “Prior to the development”: Rofes, “I Thought People,” 25. My discussion of gay and lesbian suicide owes much to this pioneering work.
261 “Homosexuality used to be”: Ibid., 11.
262 “The homosexual act in itself”: Meerloo, Suicide and Mass Suicide, 72. Among the eminent psychiatrists who believed homosexuality to be inherently suicidal were Karl Menninger and Gregory Zilboorg. Zilboorg, in fact, suggested that male suicide was invariably connected to homosexuality. Pointing out that far more men than women kill themselves, Zilboorg suggested that “man’s suicide has more to do with the inner struggles created by passivity and feminine strivings, i.e., by homosexuality. This would perhaps explain why more men shoot themselves than women, shooting having obviously something to do (symbolically) with passive homosexual wishes.” Zilboorg, “Considerations on Suicide,” 25.
262 “Have lesbians and gay men”: Rofes, “I Thought People,” 14.
262 survey of 3,648 men: Cochran and Mays, “Lifetime Prevalence of Suicide Symptoms.”
262 1986 study concluded: C. L. Rich et al., “San Diego Study I: Young vs. Old Subjects,” Archives of General Psychiatry, 43 (6) (1986): 577–82.
262 A study of male twins: Herrel et al., “Sexual Orientation and Suicidality.”
262 A 1978 Kinsey report, for instance: A. P. Bell, and M. S. Weinberg, Homosexualities: A Study of Diversity Among Men and Women (New York: Simon and Schuster, 1978).
262 A gay suicidologist likened this: www.virtualcity.com/youthsuicide/sltb.
263 One frequently cited paper: D. Shaffer et al., “Sexual Orientation in Adolescents Who Commit Suicide,” Suicide and Life-Threatening Behavior 25 (Supplement 4) (1995): 64–71.
263 “Less than two months ago”: J. Nelson, “Documentation Regarding Some Relationships Between Adolescent Suicide and Homosexuality” (unpublished paper, March 1987).
263 one of the first systematic studies: New York Times, March 4, 1988. See P. Marzuk et al., “Increased Risk of Suicide in Persons with AIDS,” Journal of the American Medical Association 259 (1988): 1333–37.
264 has been linked to increased anxiety: “You and AIDS: The HIV/AIDS Portal for Asia Pacific,” www.youandaids.org.
264 “exchange formulas for suicide”: R. Shilts, “Talking AIDS to Death,” in J. Kaplan, ed., The Best American Essays 1990 (New York: Ticknor & Fields, 1990), 243.
264 survey of 113 men: S. C. Kalichman et al., “Depression and Thoughts of Suicide Among Middle-Aged and Older Persons Living with HIV-AIDS,” Psychiatric Services 51 (7) (2000): 903–7.
264 survey of 3,365 students: Garofolo et al., “Sexual Orientation and Risk.”
264 survey of nearly forty thousand: Remafedi et al., “Relationship Between Suicide Risk.”
264 “All of the problems”: This and other Gibson quotes are from P. Gibson, “Gay Male and Lesbian Youth Suicide” (paper presented at a joint meeting of the American Association of Suicidology and the International Association for Suicide Prevention, San Francisco, May 25–30, 1987). For a critique of this paper, see P. LaBarbera, “The Gay Youth Suicide Myth,” www.leaderu.com/jhs/labarbera.
265 study by the Los Angeles Suicide Prevention Center: S. Schneider et al., “Suicidal Behavior in Adolescent and Young Adult Gay Men” (paper presented at a joint meeting of the American Association of Suicidology and the International Association for Suicide Prevention, San Francisco, May 25–30, 1987).
266 “He wanted to be normal”: The material on Jim Wheeler was taken from several Web sites, including www.jimwheeler.org.
Chapter V Backing into the Grave
267 survey of the etymology: Daube, “Linguistics of Suicide.” For much of the material in these first three paragraphs I am indebted to this fascinating paper.
268 Alvarez cites an earlier usage: Alvarez, Savage God, 48.
268 “One barbarous word”: Fedden, Suicide, 29.
269 “eating to gluttony”: Ibid., 184.
269 “the daredevil”: Durkheim, Suicide, 45–46.
269 “I have now learnt” and “When a member of my family”: S. Freud, The Psychopathology of Everyday Life (1901), in Strachey, Works, 6: 178–82.
270 “in the end each man”: Menninger, Man Against Himself, vii.
270 two armies at war: Meerloo, Suicide and Mass Suicide, 92.
270 “The development of symptoms”: K. Menninger, “Expression and Punishment,” in Shneidman, On the Nature of Suicide, 71.
271 self-mutilation: In Man Against Himself, Menninger offers an extensive analysis of self-mutilation. For a brief but comprehensive summary of the syndrome, see M. A. Simpson, “Self-Mutilation and Suicide,” in Shneidman, Suicidology, 281–315. See also A. R. Favazza, “Self-Mutilation,” in Jacobs, Harvard Medical School Guide, 125–45.
272 about 3 percent: G. E. Murphy et al., “The Lifetime Risk of Suicide in Alcoholism,” Archives of General Psychiatry 47 (1990): 383–92.
272 115 times that: G. E. Murphy, Suicide in Alcoholism (New York: Oxford University Press, 1992). As cited in Goldsmith et al., Reducing Suicide, 84.
272 “a form of self-destruction”: Menninger, Man Against Himself, 161.
272 147 suicidal male alcoholics: Hendin, Suicide in America, 127.
272 one-third of alcoholic suicides: Murphy et al., “Suicide and Alcoholism.”
273 “I didn’t think I was worth anything”: Giffin and Felsenthal, Cry for Help, 53.
273 review of more than thirty studies: A. Gardner and C. Rich, “Eating Disorders and Suicide,” in R. Yufit, ed., Proceedings of the 21st Annual Meeting of the American Association of Suicidology (Denver: American Association of Suicidology, 1999), 171–72.
274 Melvin Selzer has demonstrated: Selzer and Payne, “Automobile Accidents.”
274 In a subsequent study: New York Times, April 1, 1968, 35.
274 “lifelong war against boredom”: Greene describes playing Russian roulette and making several adolescent suicide attempts in G. Greene, A Sort of Life (New York: Touchstone, 1971), 73–88, 128–33.
274 “They use risk-taking behavior”: The quote and a description of the study are taken from Washington Post, June 9, 1987, Health Section, 5.
275 “I would describe myself”: M. Begley, “Risky Business,” Backpacker, May 1986, 38. Yukio Mishima compared athletes who sought such extreme experience to kamikaze pilots. But most rock climbers, skydivers, and so on are not, of course, suicidal. “Generally speaking, all dangerous activities (for example, auto racing, mountain climbing, acrobatics, etc.) could reflect suicidal tendencies,” writes Jean Baechler. “There is no question of considering all race-car drivers as suicidal but simply of having available a form of suicidal behavior that is revealed in taking risks.” Baechler, Suicides, 19. Some, however, may be attracted to such risky endeavors partially because of their self-destructive possibilities. The British climber Menlove Edwards was famous for his risky expeditions and bold routes. The feats that in public won hi
m medals had a pathetic parallel in his private life. A homosexual who never found lasting love, he was tormented by depression. When depressed, he liked to row far out into the open sea in a battered boat, then ride huge waves to shore, scrambling to safety as they crashed on the rocks. At age thirty-four he suffered a breakdown and made three suicide attempts. He lived the last fourteen years of his life as a recluse, cared for by his sister, although he continued to climb. In 1958 he completed suicide by swallowing potassium cyanide.
275 “Life is impoverished”: Alvarez, Savage God, 253.
275 “Many soldiers have the fantasy”: Meerloo, Suicide and Mass Suicide, 75.
275 In his 1950s study of murder: M. E. Wolfgang, “Suicide by Means of Victim-Precipitated Homicide,” in H. L. P. Resnik, ed., Suicidal Behaviors (Boston: Little, Brown, 1968), 90–104.
275 a forty-three-year-old German man: M. Landler, “German Court Convicts Internet Cannibal of Manslaughter,” New York Times, January 31, 2004.
276 A twenty-two-year-old babysitter: Quite the opposite of people who use murder as a means of suicide are those political prisoners who are murdered and are called “suicides.” During the 1930s when the National Socialists imprisoned and killed many of their opponents and insisted they were suicides, the French revived the caustic phrase être suicidé—“to be suicided.” In the 1980s and early 1990s, this occurred among antiapartheid prisoners in South Africa who were said to have killed themselves while in detention.
276 creativity: On the other hand, some artists make art of self-destruction, an aesthetic of asceticism. Like a contemporary St. Simeon Stylites, one New York performance artist spent five days and nights in a two-by-three-foot locker without food. Another sat on a shelf in an art gallery for twenty-two days. Then there was the man who lived in a cage for a year.
276 “Most people are no longer alive”: Meerloo, Suicide and Mass Suicide, 19.
277 “backing into the grave”: Pretzel, “Philosophical and Ethical Considerations,” 32.
277 examples of self-destruction: Steincrohn, How to Stop Killing Yourself.
277 “One must be careful”: Baechler, Suicides, 18.
277 “There is a little murder”: K. Menninger, Sparks, ed. L. Freeman (New York: Thomas Y. Crowell Company, 1973), 142.
277 “A thousand people”: J. Carroll, The Winter Name of God (Kansas City: Sheed and Ward, 1975), 87–88.
PART 4 Prevention
Chapter II Suicidology
291 until 1906: There were a few exceptions. During the Enlightenment, when there was great interest in using scientific advances to extend the human life span, societies were formed in which physicians, clergy, and laymen essentially acted as eighteenth-century paramedics. The members of one such group, London’s Royal Humane Society, founded in 1774, were trained to restore life “to the drowned, those suspended by the cord, or otherwise suffocated: likewise in cases of intense cold; the aweful and tremendous stroke of lightning; and other premature, accidental or sudden deaths.” Members were paid four guineas for each successful revival; unsuccessful attempts earned two. While preventing suicide was not its primary goal, the society came in contact with many attempted suicides. “By the Annual Reports of this society it appears, that since its first institution not fewer than five hundred cases of suicide have fallen under its cognizance,” observed the Reverend G. Gregory in 1797, “in about three hundred and fifty of which its interposition has been providential enough to restore the despairing culprit to himself, to his friends, and to society; and to rescue the soul of the sinner from the overwhelming pressure of despondency, and, perhaps from the danger of everlasting condemnation.”
Although the society considered suicide a “horrid crime,” its members were among the first to realize that suicidal people can and should be helped. They also recognized a characteristic of suicidal people that would be crucial to subsequent prevention efforts: ambivalence. After describing the rescue and rehabilitation of a homeless woman who attempted suicide in 1778, one member wrote, “This happy issue must give pleasure to every reflecting mind. It proves that there is no life so miserable but it may be worthy of our endeavours to save it; and it is an additional argument, to the many others Our Society has afforded, against a prevailing sentiment, that all attempts to save a suicide are in vain; for, they will repeat the act. A sentiment this, neither founded in the knowledge of human nature, nor justified by experience.” In 1797, a year in which, according to society records, eleven would-be suicides were saved and “all of them were reconciled to life,” the RHS held an anniversary celebration. The evening’s highlight was “the Procession of the Persons restored to Life by the efforts of the Humane Society, and its Medical Assistants.” Odes “To Sympathy” and “To Science” were recited, which seems appropriate considering that the society’s good works were inspired as much by the spirit of scientific inquiry as by sympathy for the suicidal. (Material on the Royal Humane Society from G. Gregory, A Sermon on Suicide (London: J. Nichols, 1797).)
In the nineteenth century, there were a few organized prevention efforts. Like the Royal Humane Society, the Lemberg Volunteer Rescue Society (with a branch office in Budapest) was an emergency paramedical service whose cases included suicides and suicide attempts. According to a 1906 German newspaper article the society had attended to 720 suicides and suicide attempts since its founding in 1893. Fedden reports that toward the end of the century an association was formed in Foochow, China, to keep four boats patrolling the Foochow Bridge to save would-be suicides from drowning.
295 “Prior to the 1950s”: Frederick, “Current Trends,” 172.
296 broke the key: E. S. Shneidman and N. L. Farberow, “Some Comparisons Between Genuine and Simulated Suicide Notes,” Journal of General Psychology 56 (1957): 251–56.
300 “Both of those have given way”: A. B. Tulipan and S. Feldman, eds., Psychiatric Clinics in Transition (New York: Brunner-Mazel, 1969), 128.
304 “The goal of the NIMH Center”: E. S. Shneidman, “The NIMH Center for Studies of Suicide Prevention,” Bulletin of Suicidology, July 1967, 2.
304 coined by Shneidman: Shneidman subsequently learned that the word suicidologie had been used in 1929 by Dutch professor W. A. Bonger.
304 “massive public education”: E. S. Shneidman, “A Comprehensive NIMH Suicide Prevention Program” (1966) (a thirty-six-page memorandum to Stanley Yolles, then director of NIMH), 14.
304 “The ‘early signs’ of suicide”: Ibid., 2.
305 “Just as there are fire stations”: Ibid., 7.
305 The suicide prevention movement: Psychiatrist Erwin Ringel, who in 1947 founded Vienna’s Lebensmuedenfuersorge (Society for the Care of People Who Are Tired of Life), frequently expressed his belief in the efficacy of such centers by maintaining that “if Romeo had had a crisis intervention clinic handy, neither he nor Juliet would have died.” (Washington Post, January 21, 1973, C5.)
305 “How to Set Up a Suicide Prevention Center”: N. Allen, “How to Set Up a Suicide Prevention Center,” California’s Health, January 1970.
305 wide variations: Much of the information on prevention centers in these paragraphs is drawn from Fisher, Suicide Prevention and/or Crisis Services.
306 Shneidman even pointed out: Shneidman, “Comprehensive NIMH Suicide Prevention Program,” 29.
306 “One of the problems”: D. Lester, “Spiritualism and Suicide,” Omega 12 (1) (1981): 45–49.
306 A 1972 summary: D. Lester, Why People Kill Themselves (Springfield, Ill.: Charles C. Thomas, 1972).
306 psychologist Richard McGee: R. K. McGee et al., “A Survey of Telephone Answering Services in Suicide Prevention and Crisis Intervention Agencies,” Life-Threatening Behavior 2 (1) (1972): 42–47.
307 CSSP-sponsored task force: H. L. P. Resnik and B. C. Hathorne, eds., Suicide Prevention in the 70’s (Washington, D.C.: U.S. Government Printing Office, 1973), 3.
307 When a 1968 study: C. Bagley, “The Evaluation of a Suicide Prevention Scheme by an Ec
ological Method,” Social Science and Medicine 2 (1968): 1–14; and R. Fox, “The Recent Decline of Suicide in Britain: The Role of the Samaritan Suicide Prevention Movement,” in Shneidman, Sucidology, 499–524.
307 more carefully controlled study: C. Jennings et al., “Have the Samaritans Lowered the Suicide Rate? A Controlled Study,” Psychological Medicine 8 (1978): 413–22.
307 compared eight cities: D. Lester, “Effect of Suicide Prevention Centers on Suicide Rates in the United States,” Health Services Reports 89 (1974): 37–39.
307 institute’s top priority: At the same time, the federal government was at the height of its commitment to community mental health centers. Emphasis shifted from research to direct services. The government’s goal was to reach more people for less money. With the move toward crisis intervention and youth problems, suicide research received decreasing support, and the suicide prevention center per se was swallowed up in the extraordinary growth of hotlines of all varieties. By 1974 there were almost seven hundred hotlines in the United States; St. Louis alone was alleged to have ninety-three. There were hotline newsletters and hotline conventions. National magazines and TV melodramas offered histrionic accounts of tearful calls and heroic rescues. “At this very moment, thousands of hotlines are ringing,” began a book describing the hotline phenomenon. “People are calling for help about problems that deal with pregnancy, illegal drugs, boy-girl problems, family hassles, alcohol abuse, suicide, loneliness, child abuse, runaways, rape, and more.” The book, which included instructions on how to start a hotline, described the LASPC as “the grandfather of all hotlines.” Its progeny now included Rap Shop, Some Body Loves You Baby, Awakening Peace, Fort Help, Mother, Need, The Way Out, Listening Post, Pulse, Inc., Oz, Yell Inc., Sunshine Line, and Tele-Mom (M. O. Hyde, Hotline! [New York: McGraw-Hill, 1976]). In a 1972 issue of Romaine Edwards’s Hotline Newsletter, the author, who claimed to have founded fifteen hotlines, captured the hotline fever: “The word got around quickly: You didn’t need a battalion of degreed headshrinkers to start helping local folk with their big and little problems. . . . All you needed were a couple of phone numbers, a few friends, and a little publicity, and presto!”
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