One

This is the first is a series of posts on suicide. I have so much to say that I've been trying to figure out where to start and still put together something coherent. So I'll start with the most common question ask about suicide: Why?

There seems to be this idea that suicide is rare and only affects those with mental illness; thus, it is impossible to understand.

Not So Rare

In 2014 the total population of the US was 319 million and 7 billion worldwide. That year there were 42,733 deaths by suicide in the US and an estimated 1 million suicides worldwide. By comparison there were about 12,000 homicides in the US in 2014 and about 437,00 worldwide in 2012 (2014 numbers not currently available). The war in Afghanistan: between 47,000 and 62,000 in 13 years. The current civil war in Syria: about 470,000 over the last 5.5 years.

For every suicide in the US there are an estimated 20 to 25 attempts; that's between 850,000 and 1.1 million people in the US attempting to take their own lives in 2014. In addition, for every adult (age 18+) attempting suicide, there is one planning how to kill themselves, and an additional six to seven adults have serious thoughts of suicide. That's 9 to 10 million adults thinking about, planning to, and attempting to kill themselves. That does not include everyone under the age of 18 or the 42,733 who died by suicide. If we use 10 million as a low estimate and easy number for dividing, that is 3 percent of the US population thinking about, planning for, or attempting to end their own life.

If that still seems rare or at least uncommon, consider this. I have thought about killing myself more than once. I know at least 2 people who have seriously contemplated suicide; 3 who attempted; and 2 who died. I know 15 people in addition to those 7 who know a combined 19 others who ended their own lives, and over 40 others who have tried or who have thought about or are thinking about it. Thinking in terms of degrees of separation, that means, if you know me and you are not one of those people and you know none of those people, then you are 3 degrees away from 21 suicides, over 24 suicide attempts, and another 24 or more people who have seriously considered it. That is just the ones that I know and the ones that they know; actual numbers are certainly higher.

Circular Logic

In fact, there is research that shows 90 percent of people who died by suicide were suffering from a mental illness at the time of their death. I'll go into the details of the research in another post, but the basics are as follows. The 90 percent figure comes from a couple of studies that use psychological autopsies conducted on suicide deaths in western countries.

I'm a data person, and my first instinct is to question the 90 percent purely on the basis of it being 90. First, data analysis that results in tidy numbers gives me pause, especially if there are a lot of them. We seem to like numbers than end in 0 or 5. Perhaps they seem more solid. Second, what about the other 10 percent? Those closer you get to 100 of anything being absolutely unequivocally linked to something, the better the explanation needs to be for the remaining percent that are not. So if you are going to tie 90 percent of suicides to mental illness, I'm going to need a really good reason for those other 10 percent not to be. The only explanation I've come across so far is that it is actually 100 percent and that the evidence for it was just missed. It is a bit of circular logic: You'd have to be mentally ill to kill yourself; therefore, everyone who kills themselves is mentally ill.

Beyond the number itself, rates of suicide overall, by gender, and by age vary from country to country, so research showing that 90 percent of people who died by suicide in western (wealthier) countries cannot be blindly applied to poorer countries.

There's also the issue that in the US men are 3 to 4 times as likely to die by suicide than women, but women are 50 percent more likely to have a mental illness. Men 65 and older have the highest rate of suicide in the US, but rates of mental illness are lower among those 50 and older.

Mental illness is certainly a factor in some percentage of suicides, but not everyone who is suicidal is mentally ill.

Impossible to Understand

We can't exactly ask those who have died why they did it or what they were thinking at that moment. But there have been some very public discussions in recent years about people with terminal illnesses who are fighting for right to die and death with dignity laws that would allow doctors to prescribe lethal doses of drugs. Whether you agree with assisted suicide or not, it should not be impossible to see how someone in that situation could come to the decision to end their life. (Someone who, by the way, is not mentally ill.) Obviously not every who kills themselves in terminally ill, but if you can understand why someone who is terminally ill would want to end their life, then suicide is not impossible to understand; you've just understood a small part of it.

There are also millions of other people we can ask. We can ask everyone who has attempted, planned, or thought seriously about it. But in general we're not asking, and they're not talking. So I'll talk.

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