The View from Hell

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Archive for the ‘female suicides’ Category

An Interview With Me

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Chip Smith of The Hoover Hog recently conducted an interview with me. The resulting document is an excellent synthesis of, and introduction to, my strange ideas.

Jumping From Heights: More on Gender Imbalance, and on Suicide Contagion

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In a story related to model Ruslana Korshunova’s suicide, Emily Friedman interviews Adam Kaplin, an assistant professor of Psychiatry at Johns Hopkins, who has this to say about jumping from heights as a suicide method:

“When people don’t have access to firearms and get it into their head that they don’t think pills are going to work, they think there is something about the finality of [jumping] and think ‘If I just do this it will be over,'” said Kaplin, who told ABCNEWS.com that while men and women are equally likely to attempt suicide by jumping, women are less likely to die after the fall because of their lighter body weight. [Emphasis mine.]

It’s interesting and unusual to see a non-psychological reason posited to explain the difference between the success rates of men and women who attempt suicide. According to this story, suicide by jumping from heights accounts for only a small proportion of total suicides. But the high (perceived and actual) lethality of the method, coupled with similar rates of attempt and a plausible physical explanation for differential lethality, must make us a bit more skeptical about psychological explanations for the difference in gender rates of suicide success. I feel this lends some support to my hypothesis that women may attempt suicide more, but succeed less, because they have less access to and familiarity with guns.

And, later in the story, “clinical psychologist and suicide expert” Madelyn Gould challenges the idea that suicide contagion affects people who aren’t really suicidal:

“[44-year-old New York attending physician Douglas Meyer, who committed suicide by jumping from heights shortly after Korshunova] could think that the model definitely accomplished what she was trying to accomplish and then that method could be seen as an option for him, even if he hadn’t readily thought about it before,” said Gould, who said this sort of copycat syndrome isn’t seen in people who are not already severely depressed or contemplating suicide, and usually only affects those who have already mapped out a plan for their death. [Emphasis mine.]

Of course, this sort of statement, backed up by precisely no evidence, should be taken with a grain of salt, but it’s interesting and rare to see any sort of statement challenging the idea that suicide contagion causes people to kill themselves who are not already inclined to do so.

Written by Sister Y

July 2, 2008 at 8:09 pm

When It’s Permissible To Force Someone To Stay Alive For His Own Good

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I think the question of when, if ever, it’s morally permissible to force someone to stay alive against his will, for his own good, is one of the most difficult questions to appropriately answer. While I argue in favor of an institutional right to effective, comfortable suicide, the opponent that I feel has the most interesting standing to challenge me is the reformed suicide: someone who attempted suicide, or came close to attempting suicide, but was “rescued” from his intentions, and now believes that rescue to have been in his best interests.

First, I would like to demonstrate that it is sometimes permissible to stop a person from killing himself. The example I find most persuasive is that of a person in an acute confusional state (delirium) secondary to a physical illness, such as diabetes. If a person in an acute confusional state walks out into traffic or engages in other self-harming behaviors, I would feel completely justified in intervening and basically forcing the person to stay alive. But why?

In previous posts, I’ve examined a non-paternalistic explanation of how the right to die might be said to harm some people (though, as I pointed out, this only applies to suicide rights for the terminally ill or catastrophically disabled). It is my view that stopping a person in an acute confusional state from harming himself is also allowed on non-paternalistic grounds, whereas stopping the suicide of a non-delirious person has only paternalistic justifications.

Paternalism obtains when individuals or the state wish to substitute their judgment for that of another, on the grounds that the affected person will make a poor decision. There is a real risk that paternalistic interventions will prevent people from being best off according to their own values. But guiding the deranged diabetic out of traffic is, I argue, not paternalistic, because the action of walking out into traffic, in this limited case, is not based on judgment at all. Put another way, the “person” deciding to walk out into traffic is not really a person at all – the circumstance is not attributable to anyone’s will or decision, so intervening with our own will or decision is not paternalistic. George didn’t decide to walk out into traffic – his delirium “made” him, and when George gets his insulin shot and comes back to us, “he” will be grateful to us for saving “him” from his illness.

The problem, of course, is how far to apply this idea of a suicide being the result of circumstance, delirium, and illness, rather than the result of a choice by the suicide. Many people seem willing to take the incident of a suicide attempt itself as probative evidence that the person is not in his right mind, that is, acting under something other than his will. The extreme medicalization of depression has allowed society, including the mental health industry, to take the view that suicide is always a sign of illness. (Revealingly, a suicide attempt, in and of itself, is not valid diagnostic criteria even for a major depressive episode under the DSM-IV, though of course, in practice, the elastic criteria for diagnosing depression are often fudged.) These people argue that intervening in an attempted suicide is always permissible – and, perhaps, never paternalistic – because suicide, in this view, is never truly a willed act, and always the result of something outside the person, such as (vaguely defined) illness.

We have to draw a line as to when it’s morally permissible to intervene in a suicide attempt, or to withhold the means for suicide from a person. Some, as I have explained, would draw the line at “always.” Hopefully my writings of the past two months might give a tiny bit of pause to those folks. At any rate, I don’t think the line should be drawn at “always,” which leaves me the task of explaining where the line should be drawn.

I am comfortable with preventing suicide in the case that it is attributable to a circumstance that is clearly outside the suicide’s will – such as an attack of delirium, or an accident. But in any case where the suicide’s will is invoked – where, we might say, the suicide is acting on reasons for ending his life – I am much less open to intervention. This is true even if the suicidal person is culturally defined as having a medical illness, such as depression, and even including many cases where the suicide has a thought disorder or otherwise may be thought to be “incompetent.” A person with a mental illness may make a will, for example, as long as he understands the extent of his property, knows who his relatives are, and understands that he is making a will. I am comfortable allowing suicide in situations where a person understands what death is, can articulate his desire for death, and can give non-delusional reasons for his desire. Intervening in a case like this must be seen as at least paternalistic, and must require a much greater justification than intervening in the case of the delirious diabetic. The more an illness is short-term, well understood to be biological in nature, and seems to obliterate the person’s will, the more comfortable I am with intervention against suicide. The more an “illness” is long-term, poorly understood, and leaves the person’s will apparently intact, the more justification I would require for an intervention.

An interesting point is that many people, under our current system, might attempt suicide as a “cry for help” without actually desiring to die. The data indicates that women in particular are much more likely to make an unsuccessful suicide attempt; many authors infer that women have motivations other than dying when attempting suicide, such as getting more attention or support from those around them. Dena S. Davis responds, in her essay “Why Suicide is Like Contraception,” that this is not much of an objection to legalizing suicide, and that the legalization of suicide might encourage people to act authentically:

. . . if assisted suicide became open and legal, perhaps women who otherwise would use a suicide attempt as a “cry for help,” will be forced to confront and articulate their real needs. To continue to play a societal game in which women “attempt” suicides they don’t really intend, perpetuates a situation in which women are rewarded for communicating one thing and meaning another. This makes it more difficult for women to command respect for their real beliefs and wishes . . . . I make a similar argument with respect to Jehovah’s Witnesses and refusal of life-saving treatment in “Does ‘No’ Mean ‘Yes’? The Continuing Problem of Jehovah’s Witnesses and Refusal of Blood Products,” Second Opinion 19: 35-43 (1994).

Written by Sister Y

May 31, 2008 at 4:07 am

Men, Women, Suicide, and Guns

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The generally accepted figure is that American women attempt suicide about twice as often as men, but men actually commit suicide about four times as often as women. The disparity between male and female suicides is often explained in terms of psychological sex differences:

“Women process their experiences with friends. They discuss their feelings, seek feedback and take advice,” Murphy says. “They are much more likely to tell a physician how they feel and cooperate in the prescribed treatment. As a result, women get better treatment for their depression.”

And the usual story to explain the disparity between female suicide attempt and female suicide success goes something like this:

“An attempted suicide is not really an attempt at suicide in about 95 percent of cases. It is a different phenomenon. It’s most often an effort to bring someone’s attention, dramatically, to a problem that the individual feels needs to be solved. Suicide contains a solution in itself,” he says.

In attempted suicide, both men and women tend to use methods that allow for second thoughts or rescue. Murphy says that when people intend to survive, they choose a slowly effective, or ineffective, means such as an overdose of sleeping pills. That contrasts to the all-or-nothing means like gunshots or hanging used by actual suicides.

Those are the numbers, and that is the traditional story: more men want to kill themselves, so they choose more lethal methods. More women are just being dramatic, so they choose pills.

Now consider the data from my previous post. When lethal methods are more known and available to women (physicians, chemists, veterinarians), they commit suicide more often (as do men, but not as much). And consider the most lethal, most frequently used method of all for suicides: the gunshot. Couldn’t the fact that women successfully commit suicide less frequently than men be explained by the fact that women, by and large, own fewer guns?

How big is the disparity in gun ownership? Based on Gallup polls and census data, a man is about three times as likely as a woman to own a gun. Women are, of course, not prohibited from gun ownership as a group, but they are much less likely than men to be exposed to guns and learn how to use a gun. A factor of three difference in gun ownership may go a long way to explaining the disparity in suicide success compared to attempt, rendering the psychological explanation largely unnecessary. Of course, women who choose gunshot as a method of suicide frequently succeed; but we should not be so quick to claim that those who choose other methods that don’t succeed just don’t really want to die. Perhaps large numbers of them do not know enough about gun acquisition and use to feel comfortable choosing this method.

This brings up another issue, which is how we tell when a suicide or attempted suicide “really wanted” to commit suicide. Just because someone refuses to use a method available to him, should not in and of itself make us suspect that he “doesn’t really want” to kill himself, any more than someone’s rejection of a particularly nasty medical intervention should tell us that person “doesn’t really want” to live. Suicides face different barriers, legal and practical, in achieving their ends. It’s ridiculous to use willingness to overcome one particular society’s set of barriers as the litmus test for whether someone wants to die enough. Many people do not wish to die by gunshot wound, but definitely wish to die, and would gladly die if better means were available – easier to accomplish, more comfortable, more certain, less ghastly for discoverers, and less likely to result in sequelae. Just because someone will not, or cannot, shoot himself in the head or slit his jugular vein should not entitle us to presume that he does not really want to die.

Edit: In Bangalore, India, more women commit suicide than men. The most common method is to use the extremely lethal industrial poisons available in India but not in the United States. This casts doubt on the theory that fewer women commit suicide because fewer women want to, and inclines one to think about the alternative hypothesis that women and men prefer different means, which are differentially available in the United States.

Cultural factors are, of course, not ruled out, but neither are they ruled out in the case of fewer female suicides in the United States.

Written by Sister Y

April 13, 2008 at 3:28 am