But perhaps the most concerning part of these developments, according to Harvey Whiteford, head of the GBD’s mental and behavioral health group, is that the changes behind them are likely to intensify amid the galloping progress of developing nations. Where people lack basic services, they live unsanitary, impoverished lives, and death comes to visit long before it’s invited. Where conditions improve, life expectancy does too, and somewhere in this transition there is a tipping point, a Rubicon beyond which death is no longer a bone-fingered stranger but the man in the mirror.
That’s scary in a world of constant (and welcome) improvement, but there’s an even bigger reason to fear the burden of suicide in the new millennium: it’s a charge being led by people in middle age. In America in the last decade, the suicide rate has declined among teens and people in their early 20s, and it’s also down or stable for the elderly. Almost the entire rise—as both the new CDC and GBD numbers show—is driven by changes in a single band of people, a demographic once living a happy life atop the human ziggurat: men and women 45 to 64, essentially baby boomers and their international peers in the developed world.
The suicide rate for Americans 45 to 64 has jumped more than 30 percent in the last decade, according to the new CDC report, and it’s possible to slice the data even more finely than they did. Among white, middle-aged men, the rate has jumped by more than 50 percent, according to a Newsweek analysis of the public data. If these guys were to create a breakaway territory, it would have the highest suicide rate in the world. In wealthy countries, suicide is the leading cause of death for men in their 40s, a top-five killer of men in their 50s, and the burden of suicide has increased by double digits in both groups since 1990.
The situation is even more dramatic for white, middle-aged women, who experienced a 60 percent rise in suicide in that same period, a shift accompanied by a comparable increase in emergency-room visits for drug-related (usually prescription-drug-related) attempts to die. In a sad twist, they often make a bid for death using the same medicine that was supposed to turn them back toward life. And the picture is equally grim for women in high-income countries, where self-harm trails only breast cancer as a killer of women in their early 40s—and has become the leading killer of women in their 30s. “In the middle of the journey of our life / I found myself in a dark wood,” begins Dante’s epic tour of hell. He wouldn’t have to change the line today.
Baby boomers have the highest suicide rate right now, but everyone born after 1945 shows a higher rate than expected.
In the United States, Julie Phillips, a sociologist at Rutgers
University, was among the first researchers to frisk these middle-age
suicides for deeper meaning. In 2010 she and a colleague declared the
age range a new danger zone for self-harm. Many commentators took this
as another fun fact about the boomers, not a cause for general alarm.
But earlier this month, Phillips presented the results of a second
paper, an attempt to settle the question of whether the boomers were
especially suicidal. She sifted through eight decades of U.S. suicide
data, wrenching it to separate the influence of absolute age, peer
effects, and the events of the moment, and she found something shocking:
the boomers have the highest suicide rate right now, but everyone born
after 1945 shows a higher suicide risk than expected—and everyone is on
pace for a higher rate than the boomers.That means that the last decade isn’t just a statistical blip, a function of a bad recession, unlocked gun cases, or an aging counterculture. It’s much darker, and deeper than all that. This is the “new epidemiology of suicide,” as Phillips puts it, one where the tectonic changes of the last decade—socially, culturally, economically—have created a heavy burden of suicide, growing heavier by the year. “The baby-boomer generation,” Phillips writes in her new paper on boomers, “may be the tip of the iceberg.”
When teen suicide was on the rise in the 1970s and 1980s, society was stung by the conclusion that something must be wrong with the way we live, because our children don’t want to join us. The question today is different, but just as unsettling. With people relinquishing life at its supposed peak, what does that say about the prize itself? What’s gone so rotten in the modern world? In her next bundle of research, Phillips hopes to pinpoint the massive, steam-rolling social change that matters most for self-harm. She has a good list of suspects: the astounding rise in people living alone, or else feeling alone; the rise in the number of people living in sickness and pain; the fact that church involvement no longer increases with age, while bankruptcy rates, health-care costs, and long-term unemployment certainly do.
Sociologists in general believe that when society robs people of self-control, individual dignity, or a connection to something larger than themselves, suicide rates rise. They are all descendants of Emile Durkheim, who helped found the field in the late-19th century, choosing to study suicide so he could prove that “social facts” explain even this “most personal act.” But when someone’s son dies by suicide and the family cries out for an answer, “social facts” don’t begin to assuage the pain or solve the mystery. When a government health official considers how he might slow down the suicide problem, “society” is a phantom he can’t fight without another kind of theory entirely.
In 2010 worldwide deaths from suicide outnumbered deaths from war (17,670), natural disasters (196,018), and murder (456,268).
I MET Thomas Joiner in Tallahassee one sunny day in March, the kind of day that gives people hope and moves others to die. Spring is the start of suicide season, the time when the average daily death toll begins its climb to a mid-summer peak, before tapering through fall and winter. This is one of the strongest findings in the field, a 200-year debunking of Herman Melville’s damp, drizzly November of the soul. One respected 19th-century French researcher actually calculated a boiling point for suicidal desire. It’s 82 degrees, basically paradise.
But why? What is it about cherry blossoms that crowds the throat with sorrow? For years after his father’s death, Joiner amassed such odd facts about suicide, a bewildering catalog on a condition as old as society. For centuries there hadn’t been much to collect, and what there was, was often insulting. In the first half of the 20th century, suicide research got Freudian. Suicide was attributed to murderous rage turned inward, a death wish topped with a dollop of autoerotic desire. Was Thomas Joiner Sr. a man lost in a deadly spiral of masturbation and guilt? Somehow his son couldn’t see it.
By the time Joiner got his Ph.D. in 1993, the literature was full of facts about self-harm, but most were as perplexing as the notion of a spring suicide season. If four out of five suicide attempts are by women, why are four out of five suicides by men? If big cities and beautiful architecture are magnets for suicide, why are natural wonders and public parks as well? Prostitutes, athletes, and bulimics have an above-average risk for suicide, but what else do they have in common? Why are African-American people relatively safe? And twins?
Joiner had no idea when he took his first job at the University of Texas Medical Branch at Galveston. It was the first time since his father’s death that he got to regularly look suicidal people in the eye, only this time he did so knowingly, as a therapist, and with a decision to make: which of these people were risks to themselves? Under Texas law he was allowed to lock people up if they were, but space in the ward was tight, and he needed a way to sort the imminent threats from the not so imminent. He needed something that let him sleep at night. But how could he tell one from another?
Diane Arbus in 1968. She would kill herself four years later.
The theories out there didn’t offer an answer. Neither did the lists of more than 100 known “risk factors,” which were too broadly defined, and most patients suffered from more than one: family conflict, combat experience, childhood abuse, poor sleep, drug and alcohol use, access to the means to die, witnessing suicide, previously attempting suicide, feeling alone, feeling angry, feeling purposeless—the list went on for pages. Single people, gay people, the newly widowed, the suddenly unemployed, the terminally ill, and the lonely were all found to be at an increased risk for suicide. But which of these factors could help differentiate people who want to live from those who want to die, and then again from those who ultimately do kill themselves? This was a huge hole in the field. On the journey from suicidal thought to metal gurney, 99.5 percent of people stray. What is it about the other 0.5 percent?
After hundreds of hours of sitting with patients, poring over research, and pounding his own memory, Joiner got a shoulder touch of inspiration: a seven-word explanation of everything. Why do people die by suicide? Because they want to. Because they can. Dozens of risk factors banged down to a formula he shared with me in his office: “People will die by suicide when they have both the desire to die and the ability to die.” When he broke down “the desire” and “the ability,” he found what he believes is the one true pathway to suicide.
Source: Kimberly A. Van Orden et al., "The Interpersonal Theory of Suicide," Psychol Rev. 117(2) (2010): 575
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