The Suicide Epidemic

Self-harm now takes more lives than war, murder and natural causes combined.  Why are we killing ourselves and how can we stop it?  By Tony Dokoupil

WHEN THOMAS Joiner was 25 years old, his father—whose name was also Thomas Joiner and who could do anything—disappeared from the family’s home. At the time, Joiner was a graduate student at the University of Texas, studying clinical psychology. His focus was depression, and it was obvious to him that his father was depressed. Six weeks earlier, on a family trip to the Georgia coast, the gregarious 56-year-old—the kind of guy who was forever talking and laughing and bending people his way—was sullen and withdrawn, spending days in bed, not sick or hungover, not really sleeping.
Joiner knew enough not to worry. He knew that the desire for death—the easy way out, the only relief—was a symptom of depression, and although at least 2 percent of those diagnosed make suicide their final chart line, his father didn’t match the suicidal types he had learned about in school. He wasn’t weak or impulsive. He wasn’t a brittle person with bad genes and big problems. Suicide was understood to be for losers, basically, the exact opposite of men like Thomas Joiner Sr.—a successful businessman, a former Marine, tough even by Southern standards.


But Dad had left an unmade bed in a spare room, and an empty spot where his van usually went. By nightfall he hadn’t been heard from, and the following morning Joiner’s mother called him at school. The police had found the van. It was parked in an office lot about a mile from the house, the engine cold. Inside, in the back, the police found Joiner’s father dead, covered in blood. He had been stabbed through the heart.
The investigators found slash marks on his father’s wrists and a note on a yellow sticky pad by the driver’s seat. “Is this the answer?” it read, in his father’s shaky scrawl. They ruled it a suicide, death by “puncture wound,” an impossibly grisly way to go, which made it all the more difficult for Joiner to understand. This didn’t seem like the easy way out.
Back home for the funeral, Joiner’s pain and confusion were compounded by ancient taboos. For centuries suicide was considered an act against God, a violation of law, and a stain on the community. He overheard one relative advise another to call it a heart attack. His girlfriend fretted about his tainted DNA. Even some of his peers and professors—highly trained, doctoral-level clinicians—failed to offer a simple “my condolences.” It was as though the Joiner family had failed dear old Dad, killed him somehow, just as surely as if they had stabbed him themselves. To Joiner, however, the only real failing was from his field, which clearly had a shaky understanding of suicide.
Survivors of a suicide are haunted by the same whys and hows, the what-ifs that can never be answered. Joiner was no different. He wanted to know why people die at their own hands: What makes them desire death in the first place? When exactly do they decide to end their lives? How do they build up the nerve to do it? But unlike most other survivors of suicide, for the last two decades he has been developing answers.
Joiner is 47 now, and a chaired professor at Florida State University, in Tallahassee. Physically, he is an imposing figure, 6-foot-3 with a lantern jaw and a head shaved clean with a razor. He wears an off-and-on beard, which grows in as heavy as iron filings. The look fits his work, which is dedicated to interrogating suicide as hard as anyone ever has, to finally understand it as a matter of public good and personal duty. He hopes to honor his father, by combating what killed him and by making his death a stepping stone to better treatment. “Because,” as he says, “no one should have to die alone in a mess in a hotel bathroom, in the back of a van, or on a park bench, thinking incorrectly that the world will be better off.”
He is the author of the first comprehensive theory of suicide, an explanation, as he told me, “for all suicides at all times in all cultures across all conditions.” He also has much more than a theory: he has a moment. This spring, suicide news paraded down America’s front pages and social-media feeds, led by a report from the Centers for Disease Control and Prevention, which called self-harm “an increasing public health concern.” Although the CDC revealed grabby figures—like the fact that there are more deaths by suicide than by road accident—the effort prompted only a tired spasm of talk about aging baby boomers and life in a recession. The CDC itself, in an editorial note, suggested that the party would rock on once the economy rebounded and our Dennis Hopper–cohort rode its hog into the sunset.
The world has lost many beloved public figures to suicide. Writer Virginia Woolf (d. March 28, 1941).
Writer David Foster Wallace (d. September 12, 2008).
Singer Mindy McCready (d. February 17, 2013).
Artist Mark Rothko (d. February 25, 1970).
But suicide is not an economic problem or a generational tic. It’s not a secondary concern, a sideline that will solve itself with new jobs, less access to guns, or a more tolerant society, although all would be welcome. It’s a problem with a broad base and terrible momentum, a result of seismic changes in the way we live and a corresponding shift in the way we die—not only in America but around the world.
We know, thanks to a growing body of research on suicide and the conditions that accompany it, that more and more of us are living through a time of seamless black: a period of mounting clinical depression, blossoming thoughts of oblivion and an abiding wish to get there by the nonscenic route. Every year since 1999, more Americans have killed themselves than the year before, making suicide the nation’s greatest untamed cause of death. In much of the world, it’s among the only major threats to get significantly worse in this century than in the last.
The result is an accelerating paradox. Over the last five decades, millions of lives have been remade for the better. Yet within this brighter tomorrow, we suffer unprecedented despair. In a time defined by ever more social progress and astounding innovations, we have never been more burdened by sadness or more consumed by self-harm. And this may be only the beginning. If Joiner and others are right—and a landmark collection of studies suggests they are—we’ve reached the end of one order of human history and are at the beginning of a new order entirely, one beset by a whole lot of self-inflicted bloodshed, and a whole lot more to come.
THE RISE of suicide in the U.S. has been slow enough to sneak up on people. I realized this just the other day, on the phone with Catherine Barber, who directs the Means Matter Campaign, a suicide-prevention program at Harvard. A decade ago, she led the team that designed the National Violent Death Reporting System, a key source of federal data on premature exits. Because she’s now focused on education and prevention, not data mining, it had been a few years since she looked at national numbers, so we logged on together.
We selected suicide from a drop-down menu of violent injuries that also included accidents, murder, and war, and we clicked send. Our screens blinked—hers in Boston, mine in New York—and up popped a simple black-and-white chart. The world’s most depressing spreadsheet. There are as many intentional ways to die as there are people to imagine them, and we saw more of all of them: an almost 20 percent rise in the annual suicide rate, a 30 percent jump in the sheer number of people who died, at least 400,000 casualties in a decade—about the same toll as World War II and Korea combined.
We saw more jumping and shooting, poisoning and stabbing, drowning, and strangulation. We even saw more death by “unspecified means,” a catch-all column for the most inventive forms of self-destruction—the swan dives into lava, the encounters with farm equipment. As she scrolled through the woe, Barber began to mutter to herself: “Oh, shoot ... yeah, that’s no good ... the increase is across all methods ... dang.”
This year, America is likely to reach a grim milestone: the 40,000th death by suicide, the highest annual total on record, and one reached years ahead of what would be expected by population growth alone. We blew past an even bigger milestone revealed in November, when a study lead by Ian Rockett, an epidemiologist at West Virginia University, showed that suicide had become the leading cause of “injury death” in America. As the CDC noted again this spring, suicide outpaces the rate of death on the road—and for that matter anywhere else people accidentally harm themselves. Somewhere Ralph Nader is smiling, but the takeaway is darkly profound: we’ve become our own greatest danger.
This development evades simple explanation. The shift in suicides began long before the recession, for example, and although the changes accelerated after 2007, when the unemployment rate began to rise, no more than a quarter of those new suicides have been tied to joblessness, according to researchers. Guns aren’t all to blame either, since the suicide rate has grown even as the portion of suicides by firearm has remained stable.
The fact is, self-harm has become a worldwide concern. This emerged in the new Global Burden of Disease report, published in The Lancet this past December. It’s the largest ever effort to document what ails, injures, and exterminates the species. But allow me to save you the reading. Humankind’s biggest health problem is humankind.
The coordinating center for the GBD, the Institute for Health Metrics and Evaluation, provided Newsweek with custom data that bears this out in dramatic fashion. At first glance, the numbers seem to be uniformly good news. The suicide rate—the number of people per 100,000 who killed themselves each year—dropped in developed countries between 1990 to 2010 and grew only slightly overall. But these age-adjusted good tidings mask considerable trauma in the population at large.
In the developed world, suicide became the leading cause of death in 2010 for people ages 15-49.
Throughout the developed world, for example, self-harm is now the leading cause of death for people 15 to 49, surpassing all cancers and heart disease. That’s a dizzying change, a milestone that shows just how effective we are at fighting disease, and just how haunted we remain at the same time. Around the world, in 2010 self-harm took more lives than war, murder, and natural disasters combined, stealing more than 36 million years of healthy life across all ages. In more advanced countries, only three diseases on the planet do more harm.