The Suicide Epidemic 3

It’s a “clearly delineated danger zone,” a set of three overlapping conditions that combine to create a dark alley of the soul. The conditions are tightly defined, and they overlap rarely enough to explain the relatively rare act of suicide. But what’s alarming is that each condition itself isn’t extreme or unusual, and the combined suicidal state of mind is not unfathomably psychotic. On the contrary, suicide’s Venn diagram is composed of circles we all routinely step in, or near, never realizing we are in the deadly center until it’s too late. Joiner’s conditions of suicide are the conditions of everyday life.
Male Australian redbacks sacrifice their lives for sex. The females often devour the males after they mate. But there’s an evolutionary upside: a greater chance the male passes along his genes.
He calls the first “low belonging,” and it’s the most intuitive idea in his formula. Joiner argues that “the desire to die” begins with loneliness, a thwarted need for inclusion and connection. That explains why suicide rates rise by a third on the continuum from married to never been married. It also accords with the fact that divorced people suffer the greatest suicide risk, while twins have reduced risk and mothers of small children have close to the lowest risk. A mother of six has six times the protection of her childless counterpart, according to one study. She may die of work and worry, but not of self-harm.
The need to belong is so strong, Joiner says, that it sometimes expresses itself even in death. “I’m walking to the bridge,” begins a Golden Gate Bridge suicide note he cites. “If one person smiles at me on the way, I will not jump.” The writer jumped. He was alone, and so are more of the rest of us. Unattached is the new fancy-free, a strategy for success that translates to later marriages, easier divorces, fewer kids, and a tendency to keep running toward the next horizon, skipping family dinner in the process.
Twelve years and a tech revolution after Robert Putnam wrote Bowling Alone, his treatise on the decline in American community, the institutions that used to bind America together have, if anything, crumbled even further. People tell surveyors that the world has become less helpful, trustworthy, and fair. It’s a place where you work longer at more deadening jobs for less pay, your life pulsing away with each new email, or worse, each additional hour on your feet. What’s deadly about all this is the loss of what Joiner calls “reciprocal care.” When people have no shoulder to lean on, they feel more isolated, and that isolation can be lethal.
Maybe Facebook is not “making us lonely,” as Stephen Marche argued in an Atlantic cover story last spring. But Facebook doesn’t help. “The greater the proportion of online interactions, the lonelier you are,” John Cacioppo, a professor at the University of Chicago and the world’s foremost expert on loneliness, told Marche. The opposite is also true: more face time, less loneliness. But as you might expect, the trend lines in our relationships are all in one direction.

The life-saving power of belonging may explain why, in America, Hispanics and African-Americans have lower suicide rates than whites.

For her 2011 book, Alone Together, MIT psychologist Sherry Turkle interviewed more than 450 people, most of them in their teens and 20s, about their lives online. She’s the author of two prior tech-positive books, but this time she discovered a sadder, more antiseptic world, a place where people turn to their machines more than each other. She even identified a long-term trend toward sex with robots, a future where we’ll prefer mechanical company over the mess of human interaction. (And here you thought it was hard enough to live up to our current crop of battery-powered lovers: the flicker of Internet porn, the hum of a bedside power tool). After a decade of decline in face-to-face gatherings, Mark Silva, CEO of Great Unions, one of the nation’s largest reunion-planning companies, launched a new marketing pitch: “Unplug for a night.” He might now be justified to add: “Or else.”
The life-saving power of belonging may help explain why, in America, blacks and Hispanics have long had much lower suicide rates than white people. They are more likely to be lashed together by poverty, and more enduringly tied by the bonds of faith and family. In the last decade, as suicide rates have surged among middle-aged whites, the risk for blacks and Hispanics of the same age has increased less than a point—although they suffer worse health by almost every other measure. There’s an old joke in the black community, a nod to the curious powers of poverty and oppression to keep suicide rates low. It’s simple, really: you can’t die by jumping from a basement window.
Lions: Adult males will charge into a battle against another lion pride, even if outnumbered, and expose their throats to attacking lions to give family members a chance to escape.
Joiner calls his second condition “burdensomeness,” and it may be as emotionally intuitive as loneliness. When people see themselves as effective—as providers for their families, resources for their friends, contributors to the world—they maintain the will to live. When they lose that view of themselves, when it curdles into a feeling of liability, the desire to die takes root. We need each other, but if we feel we are failing those we need, the choice is clear. We’d rather be dead.
This explains why suicides rise with unemployment, and also with the number of days a person has been on bed rest. Just the experience of needing and receiving help from friends—rather than doing for oneself and others—can make a person pine for death. We’re a gregarious species, but also a gallant one, so fond of playing the savior that we’d rather die than switch roles with the saved. In this way suicide isn’t the ultimate act of selfishness or a bid for revenge, two of the more common cultural barbs. It’s closer to mistaken heroism.
If suicide has an evolutionary component, as Joiner believes it might, this is where it manifests itself. Humans are not the only animals that commit suicide. Bumblebees kill themselves as a defense against parasites, abandoning the nest to save it. Pea aphids do something similar. They use a kind of suicide bomb that maims ladybugs, their biggest predator, to save their own kind. Higher up in the animal kingdom, male lions sacrifice themselves on the savannas: they expose their throats to attacking clans in an effort to give other family members a chance to escape. A similar instinct may still linger in our DNA, colliding uncomfortably with the frailties and banalities of modern life.
Honeybees: In what is literally sex to-die for, male honeybees perish after mating. Bumblebees, a close relative, will also abandon their nest if infested with a parasite.
Has there ever been a society that does more than our own to make people feel like ineffective animals? Whole neighborhoods are caught in federal catch nets, incarcerated or snared in a cycle of government benefits. Millions more are poor or near poor, most likely stuck that way. And never have Americans been heavier, or sicker. One in five people in middle age suffers multiple chronic diseases, double the rate of a decade earlier. If Joiner is right, all these developments are as hard on the mind as on the body. As one of the suicide notes Joiner quotes puts it: “Survival of the fittest. Adios. Unfit.”
The recession can’t explain the new trends in suicide, but longer-term structural changes in the economy may undergird many of them. Only recently have economists begun to focus on the psychological impact of income inequality, tying the wealth and happiness of all to the risk of suicide for some. If you make 10 percent less than your neighbor, for example, you are 4.5 percent more likely to die by suicide, according to a paper led by Mary C. Daly, who works for the Federal Reserve Bank in San Francisco. In an earlier study, she and colleagues found that suicide rates generally rise with measures of national “happiness,” a fact that accords nicely with Joiner’s ideas about alienation and burdensomeness. It’s hard to be sad and alone, and even harder if others seem too happy to disturb.
If Joiner is right about the suicidal peril of feeling useless, then long-term changes in the economy can also help explain the new demographics of suicide. As the U.S. workforce has transitioned from brawn to brain over the past three decades, women have matched or overtaken men as a percentage of all job holders. In doing so, however, they seem to acquire some of the traditional male risk for suicide when their performance in those roles falters. That could be why the suicide shift is stark among middle-aged educated women, according to forthcoming research by Hyeyoung Woo, a sociologist at Portland State University. They are the rare group where more school is associated with more opportunity—but also more self-harm.
Among their middle-aged male counterparts, the opposite is true: those with less education have a greater suicide risk. The states with the highest suicide rates tend to be clustered in the South and the Mountain West, areas with a lot of white men and guns, a historically bad combination for self-harm. This suicide belt is also defined by what psychologists have dubbed a “culture of honor.” As Joiner has discovered, that means higher murder rates but even more-exaggerated suicide rates, a fact he attributes to millennia of old masculine codes meeting a disappearance of blue-collar jobs unlikely to reverse itself. Give me honor, or give me death was a safer personal motto when honor could still be readily found.
Aphids: Aphids past the age of reproduction release a waxy substance on predatory ladybugs approaching their habitats, harming the ladybugs and killing themselves in the process.
Even people in their teens and earlier 20s may discover the lethal effects of unemployment. Krysia Mossakowski, a sociologist at the University of Hawaii, has found that people unemployed for long stretches during their young years are far more likely to show signs of depression and alcoholism as they approach middle age. This finding held regardless of psychological history, and it was unshakable even among those young people who went on to flourish in the workforce. In Japan, meanwhile, most mental-health-related disability claims are filed by people who entered the labor force during the economically “lost decade” of the 1990s. They’re in their 30s now, and increasingly depressed.
But then again so is everyone. The trends in suicide in both America and abroad are mirrored by devastating changes in behavior and mental health. In the last two decades, for example, there’s been a 37 percent increase in the years of life lost to clinical depression, anxiety, alcohol and drug abuse, and other disorders of the mind, according to the batch of previously unpublished GBD data provided to Newsweek. As a group, these disorders are the leading cause of disability in the world, vexing developing countries in particular, and the United States most of all. In the land that commercialized positive thinking and put pill bottles in every drawer, depression has emerged as the most debilitating condition we face.
Joiner calls his final condition for suicide “fearlessness,” and all that really means is “the ability to die,” an ability he says people have to develop over time. That’s because it’s hard to kill yourself. This should be obvious. The human body is built to endure, the mind rigged to flee from death, which is why so many people flinch. They apply the brakes, pull up at the railing, beg someone to pump their stomach, lever themselves off the tracks, or just pass out before they can inflict the damage they intend.

Athletes, doctors, prostitutes, and bulimics all share a heightened risk of suicide. All have a history of tamping down the instinct to scream. 

In this way, suicide isn’t about cowardice. It’s not painless or easy, like pulling the fire alarm to get out of math class. It takes “a kind of courage,” says Joiner, “a fearless endurance” that’s not laudable, but certainly not weak or impulsive. On the contrary, he says, suicide takes a slow habituation to pain, a numbness to violence. He points to that heightened suicide risk shared by athletes, doctors, prostitutes, and bulimics, among others—anybody with a history of tamping down the body’s instinct to scream, which goes a long way to unlocking the riddle of military suicides.
For the population at large, it might seem mildly reassuring at first. After all, most of us don’t fall into these categories. But Joiner believes there may be a side door to fearlessness: exposure to violence in media. Remember this debate? Well, it’s basically over. “The strength of the association between media violence and aggressive behavior,” the American Academy of Pediatrics concluded in 2009, “is greater than the association between calcium intake and bone mass, lead ingestion and lower IQ, and condom nonuse and sexually acquired HIV infection, and is nearly as strong as the association between cigarette smoking and lung cancer.” In one of the studies reviewed, a social psychologist showed students pictures of a man shoving a gun down another man’s throat, among other images. The people who had been exposed to more violent media didn’t respond. They were numb.
Joiner first sketched his theory about a decade ago, which isn’t all that different from yesterday in the science world, a place where evolution is still just a theory. But his ideas have already survived direct challenges, and he has defended them before ballrooms of academics and long tables lined with government officials. The Guggenheim and Rockefeller foundations have forked over cash, as have the National Institutes of Health and the Pentagon, which recently tapped him to co-direct its Military Suicide Research Consortium. In two books—Why People Die by Suicide (2005) and Myths About Suicide (2010), both published by Harvard University Press—and hundreds of articles, he has built a testable model. It’s “elegant” in the words of Aaron Beck, a University of Pennsylvania psychiatrist, known as the father of cognitive therapy. It’s “insightful” and “effective,” added the American Psychological Association, which published a $60 volume of Joiner’s work to help guide clinicians suffering their own Galveston crossroads.
As we discussed suicide in his office, the Florida sun blazing through a picture window, Joiner gently bounced side to side in a swivel chair. He wore blue jeans and a short-sleeve button-down in the buff color of a cartoon desert. He spoke in careful, complete sentences. But it was hard to concentrate once I noticed the trophy-size silver fish and coiled snake mounted near his computer. “That’s a piranha,” he explained, “and that’s a rattlesnake.” He keeps both as reminders of this principle that killing your own kind, let alone yourself, is hard to do. “The piranha won’t do it. They’ll kill us, but they won’t kill each other,” he says. “Same with rattlesnakes. They have venom and fangs and everything, but they don’t use those. They wrestle. It’s a rule of nature, not a hard fact, but a rule of thumb: you don’t kill your own.”
Joiner explains how his theory applies to singer Kurt Cobain.
And yet his father did. He grew lonely, letting old friendships die as he built his career. He formed an identity through work, one that left him rudderless when he entered semi-retirement. Here was his sense of not belonging, a feeling so acute he tried to join an African-American church, apparently lured by the community and the possibility of connection. The sense of burdensomeness came later, as his dark moods prevented him from being the pillar he had been within his family. That gave rise to the desire to die, according to Joiner’s theory.
But the ability to die took root earlier and grew much more slowly. Joiner’s father had a lifetime of painful physical experiences—freak accidents, sporting injuries. He was also a fisherman, a man who knew how to use a knife and was comfortable with blood on his hands. Joiner recalls one fishing trip in particular, father and son unzipping the sea in a boat that felt like a 25-foot piece of driftwood in the heaving Atlantic. When a sudden storm developed, Joiner watched his father wrestle the waves, trying to keep the tiny yacht from capsizing. He gripped the wheel until it snapped off, at which point he steered using all that remained, a shattered column, his hands slashed and bleeding.
This, in the end, is what killed him, Joiner says: the fact that his father was strong enough, in a perverted way, to fall on his own knife. This, and the fact that he found himself in the center of the three circles of risk. After decades of walking in and out of them, much as we all do, he walked into the middle.
These days, Joiner’s thoughts have shifted toward prevention. If he’s right about suicide, the ability to foil one of the three variables is the ability to save a life. Smart clinicians can do it, but it’s not easy to get people into treatment. There’s the cost, for one thing, but more than that, there’s the shame and the stigma. Suicide is the rare killer that fails to inspire celebrity PSAs, 5K fun runs, and shiny new university centers for study and treatment. That has to change, says Joiner. “We need to get it in our heads that suicide is not easy, painless, cowardly, selfish, vengeful, self-masterful, or rash,” he says. “And once we get all that in our heads at last, we need to let it lead our hearts.”
Need help? In the U.S. call 1-800-273-8255 for the National Suicide Prevention Lifeline.