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In Suicide Prevention, It's Method, Not Madness

San Francisco's Golden Gate Bridge. (Getty Images)

The rate of suicide in America is 11 victims per 100,000 people.

That's almost exactly the same as it was in 1965. In spite of the rise of anti-depressant drugs, crisis hotline centers, and better treatment of mental illness, we still haven't gotten much closer to understanding or preventing suicide.

The reason for that might be that prevention focuses more on the study of illness than it does on the actual ways people attempt to kill themselves, says Scott Anderson, the author of a New York Times Magazine article, "The Urge to End It All."

In effect, it's the method, not the madness.

Anderson says that suicide is an overwhelmingly impulsive act. He cites a study of survivors that said only 13 percent reported thinking about committing suicide for eight hours or longer; 70 percent said they thought about it for less than an hour; and a whopping 24 percent said the idea had occurred to them less than five minutes before their attempt.

If that's true, then suicide is highly opportunistic, and Anderson suggests that reducing the opportunities would reduce the incidence. He says that research and anecdotal evidence appear to bear this out. For example, he notes in his magazine piece that states in which gun ownership are highest have the highest rates of suicide by gun; in fact, the higher rates of gun ownership closely track the higher rates of gun suicides by state. Yet suicide rates by other means remain roughly similar.

Anderson points to another example where simply making a change in people's access to instruments of suicide dramatically lowered the suicide rate. In England, death by asphyxiation from breathing oven fumes had accounted for roughly half of all suicides up until the 1970s, when Britain began converting ovens from coal gas, which contains lots of carbon monoxide, to natural gas, which has almost none. During that time, suicides plummeted roughly 30 percent — and the numbers haven't changed since.

Anderson discovered that the personal stories of people who had attempted suicide appeared to support the statistical data, in sometimes very surprising ways. He cited one person who had picked out a place to jump off San Francisco's Golden Gate Bridge, but he never made it. His location meant that he would have had to cross six lanes of traffic, and he was afraid of getting hit by a car.

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Transcript

MIKE PESCA, host:

America's suicide rate is nearly 11 victims per 100,00 people. The New York Times says the rate is almost exactly the same as it was in 1965. In spite of the rise of the antidepressant drugs, crisis-hotline centers and better treatment of mental illness, we still haven't gotten much closer to preventing suicide. Scott Anderson reported on some of the fascinating paradoxes of suicide in this weekend's New York Times Magazine, in an article called "The Urge to End It." We're intrigued enough to ring up Scott for an interview, but respectful enough to credit him with this segment of...

(Soundbite of "Law & Order" theme)

PESCA: Ripped Off From the Headlines. Scott Anderson joins us. Hello, Scott.

Mr. SCOTT ANDERSON (Reporter, New York Times): Good morning.

PESCA: I think the big misconception about committing suicide rests in the word "commit." It makes it seem like people have a strong commitment to the act, but you document over and over that that's just not true.

Mr. ANDERSON: That's right, and probably the first thing that needs to be said is that there's really two broad types of suicide. One is suicide that's rather premeditated, that people have been planning for weeks or even months, and impulsive suicide. And with impulsive suicide, a majority of them think about it for less than eight hours, and something around 70 percent think about it for less than an hour before actually going through with it.

PESCA: Disturbingly, you quote mental health professionals who, maybe, don't even see that distinction as clearly as you do, because over and over again, they say after someone commits suicide, well, we know they were mentally unbalanced. That's called, I believe, in logic, a post-hoc rationalization.

Mr. ANDERSON: Yeah. I was very struck by that. As a layman coming to it, there seemed to be a sort of element of circular logic to the whole thing. Because while most of us think of suicide as an inherently irrational act, if someone commits suicide, they routinely perform something called psychological autopsies after the fact, and invariably, or over 90 percent of the time, they decide that mental illness is the culprit in suicide.

PESCA: Ovens, guns and bridges, those were three things you talk about, three methods of committing suicide where, in every case, just a wee bit more inconvenience between the person who, for a second, wants to commit suicide and actually committing suicide. Just a little more inconvenience, and the suicides drop drastically. You want to talk about any or all of those?

Mr. ANDERSON: Yeah, well, the first really dramatic example of how - it's called means restriction in public health school parlance - how means restriction can actually reduce suicide, and it came about completely inadvertently in Great Britain in the 1970s, when they - gas was switched from coal-derived gas, which was very high in carbon monoxide, to natural gas, which was virtually carbon-monoxide-free. And up until the 1970s, almost all of England was heated with coal gas.

And about 50 percent of all suicides in Britain were from people, quote, "sticking their heads in the oven." It was very easy to asphyxiate yourself with coal gas. With the switchover, it made it almost impossible to kill yourself that way. And over the space of about 10 years when the conversion was completed, the overall suicide rate in Britain dropped by about 30 percent, and it stayed at that level almost ever since. So, what it proved, really quite inadvertently, was that if you remove one means of people being able to kill themselves, the overall suicide rate would drop really drastically.

PESCA: And this proves itself over and over again, no matter the method. With bridges, you know, the Golden Gate Bridge is a magnet, and there's always that debate, if we put up some barriers against suicide, well, some advocates say it would help, but other people say, not only would it hurt the look of the bridge, oh, what's it matter, they say, if people want to kill themselves, people want to kill themselves.

But I think the statistic you quote was, they did a follow-up study, and of people who tried to commit suicide and have been thwarted, only six percent went on to kill themselves by another means. And over and over again, with bridges, it shows that just a little more inconvenience, a little higher barrier, and people will not jump off a bridge.

Mr. ANDERSON: That's right. It's a very deeply held notion that suicide is inevitable. But in fact, over and over again, with barriers being put up, it's shown not just that suicides are, you know, eliminated there, but that people don't go somewhere else to commit suicide. And there's really famous case of two bridges, virtually adjacent bridges, in Washington, D.C., where one was always the notorious suicide bridge in Washington, and finally in the 1980s, they put up a suicide barrier on it. And the opposition to it was, this other bridge is literally only 60 yards away, identical drop into this gorge, that people would just go there and do it. But in fact, people didn't, and that second bridge still doesn't have a suicide barrier up, and the numbers have never changed on that bridge.

PESCA: Your article ends with talking to this guy named Kevin Hines, who jumped off the Golden Gate Bridge, almost immediately regretted it. He was also in a documentary called "The Bridge," which was largely about people who have jumped off the Golden Gate Bridge. I have a clip of Kevin from that documentary.

(Soundbite of documentary "The Bridge")

Mr. KEVIN HINES (Sufferer, Bipolar Disorder; Attempted Suicide Survivor): The second when my hands left the bar, I said, I don't want to die. What am I going to do? This is it. I'm dead. So I said, well, maybe if I get feet first, maybe, maybe I'll live.

PESCA: He's a really effective spokesman. I've seen him do a lot of media appearances. I don't think, before people hear him, they realize that a lot of people regret it instantly.

Mr. ANDERSON: Yes. I actually talked to four people who attempted suicide who should have died. The odds were overwhelmingly against them, two who jumped off the Golden Gate Bridge, and two who shot themselves in the head. And all four of them said that they - the two people who went off the bridge, including Kevin, said the instant their hands came off the railing, they knew they'd made a mistake, and likewise with the two people that shot themselves. The moment they regained consciousness, or the moment they felt the impact of the bullet, they knew they'd made a horrible mistake.

PESCA: You never connect the dots, but one of the implications I got from the article was it was sort of an indictment of the mental health community, just as far as the suicide rights haven't budged. You talked to mental health professionals who said, oh, they were suicidal. They didn't even know about that gas-oven study or incident that you were talking about. Were you disappointed at the mental health community and its attitude toward suicide, or its effectiveness?

Mr. ANDERSON: A little bit. I think there is this element of myopia within the community of - I mean, I think they come from a standpoint of - like, looking at something from the standpoint that, well, of course, this is a crazy act. Therefore, the person has to be crazy. And I mean, I can understand why they, because of their training, they approach it from that angle.

My bigger problem with the mental health community is that the idea that everything is - almost all suicide is based in mental illness. It kind of raises the question, well, OK, where does that get you? Because even if you know somebody is depressed, somebody is bipolar, it doesn't give you any predictive power to figure out who is actually at risk to commit suicide.

PESCA: Scott Anderson, who wrote a piece in the New York Times called "The Urge to End It." Thanks, Scott.

Mr. ANDERSON: Thank you, Mike.

PESCA: We're back with the Bryant Park Project from NPR News. Transcript provided by NPR, Copyright NPR.

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