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United States: Suicide Tourism Destination?

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The United States has relatively liberal gun laws compared to first-world countries, and allows the public to access shooting ranges where real guns may be rented for target practice. Many Americans have taken advantage of this quick access to guns in order to commit suicide (and sometimes homicide-suicide).

On November 15, 29-year-old Australian twin sisters in the United States on tourist visas attempted to commit suicide at a public shooting range in Colorado. One died; the other “was rushed to a nearby hospital where she was in a critical but stable condition after undergoing surgery.” As of November 18, police have not yet determined which sister died.

Free access to guns makes the United States attractive as a suicide tourism destination; however, as this case illustrates, the de facto suicide prohibition makes gunshot suicide in the United States a risky proposition. But apparently it’s better than the options in Australia.

Australians have previously taken advantage of the availability of barbiturates in Mexico. One can only conclude that the suicide prohibition is even worse in Australia than it is in the United States:

Another Australian who purchased the drug in Mexico, Caren Jenning, was convicted in June of accessory to manslaughter because a friend, Graeme Wylie, who had advanced Alzheimer’s disease and had long expressed a desire to end his life, used it to commit suicide two years ago.


Written by Sister Y

November 17, 2010 at 3:44 pm

A Siblicide-Suicide

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Followers of The View from Hell know a great deal about murder-suicide – characteristics of the typical shooter, the typical relationship between shooter and victim, etc. Enough to recognize how very, very strange this case of murder suicide is:

Pa. brother, sister die in apparent murder-suicide

YORK, Pa. – Police are investigating an apparent murder-suicide of a brother and sister in south-central Pennsylvania.

Sgt. Rod Varner of the York Area Regional Police says the man was in his 50s and the woman in her 40s. Their names have not been released.

The bodies were found inside an apartment around 9:30 a.m. Tuesday. The woman didn’t show up for work at York Hospital, so a co-worker stopped by to check on her. The co-worker found the back door unlocked, discovered the bodies and called 911.

York County Coroner Barry Bloss says the deaths appear to be a murder-suicide , the two appear to have died of gunshot wounds sometime Sunday evening.

Bloss says there were no signs of a struggle inside the home. A gun has been recovered.

While filicide-suicide is fairly common, as is uxoricide-suicide and various combinations of the two, siblicide-suicide is nearly unheard of (thought it is almost certainly more common than stranger homicide-suicide). A murder-suicide happening at all in south-central Pennsylvania must be a very rare occurrence. But do the police in south-central Pennsylvania realize how very strange this particular murder-suicide is?

More details about the incident reveal that the situation of the shooter resembled a maternal filicide-suicide or paternal familicide-suicide in many ways, however:

David Stoner loved his sister, Kathy.

He protected and looked after his sister, who was mentally challenged. He made sure she made it to her job in food services at York Hospital.

But, according to neighbors, David Stoner was sliding deep into depression. He was angry and unhappy after losing his job as a mechanic about a year ago. He became more beaten down each day he could not find work.

The shooter’s caretaking role toward his sister, coupled with the loss of his job, closely resemble the failed belonging/burdensomeness perceived by a suicide, and his relationship with his younger, disabled sister seems to be one that would clearly be a candidate for the proprietariness expressed by familicide-suicides.

Written by Sister Y

June 23, 2009 at 9:50 pm

With a .22

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I. Fourteen Shots

He shot himself fourteen times with a squirrel rifle. “It is probably the most incredible kind of suicide I have ever seen,” says P. Boxho, reporting the case in the Journal of Forensic Science (“Fourteen shots for a suicide,” 101:1:71-77, 1999).

The man, a 56-year-old Belgian, used such a low-energy weapon (.22 LR cartridges in a 22 mm rifle) that he had to shoot himself fourteen times in the chest in order to effect his end – and, even after fourteen shots, his death was slow. He had to operate the bolt of his rifle between shots, and, most incredibly, he had to reload after the first seven shots. According to Boxho,

The last bullet was certainly the one that went through his left arm for, with a humerus fracture and the fatigue generated by developing hypovolemia, it was getting impossible for him to reload the gun and to keep shooting.

So he had to lie down in the position in which he was found and to wait for death to come.

That death was certainly very slow for, considering their trajectories, the projectiles could only go through his lung, maybe skim past his heart, causing a slow haemorrhage, responsible for death by a hypovolemical shock.

II. Christmas Money

Mychal Bell, best known as one of the Jena Six, shot himself with a .22 pistol. Bell became despondent after being charged with shoplifting, he says.

Police say surveillance video appears to show Bell stuffing merchandise into a bag in a Dillard’s store while another male seems to serve as a lookout.

Bell walked out with the bag without paying, officials said, and a security guard approached and took it from him. Police said Bell and the other male fled, and guards chased Bell because he’d had the bag. Authorities say it contained $370 worth of clothes.

Bell hid under a car in the parking lot, and as a store security officer tried to pull Bell out, he hit the guard in the face with his elbow, police said. Bell, who was charged with shoplifting, simple battery and resisting arrest, was released on bail, according to authorities.

Investigators don’t know who the other male was, and Bell “admitted to everything” to a detective, Lt. Jeff Harris said.

He decided to use his Christmas money to buy a gun, and eventually obtained the .22-caliber handgun. And then he “went awry” at his grandmother’s house, he said.

He aimed it at his head and pulled the trigger, he said, but the gun misfired. Then he pointed the gun at his chest and fired. The bullet clipped his lung, and he was taken to the hospital and treated. It is not clear who found him, or whether he was alone in the house at the time of the shooting.

Does someone who shoots himself in the chest with a .22 really mean to die? It seems that our Belgian man did. However, given the limited availability of reliable means of suicide, I think it is best not to make a hasty judgment that someone did not want to die, and was merely seeking attention and sympathy, based only on the choice of an ineffective method. Perhaps an ineffective method is all the potential suicide could access.

III. Low-Energy Weapons

The term “multiple gunshot wound suicide” is often used sarcastically – a joke, meaning that the alleged suicide was really a homicide, but was (poorly) made to look like a suicide. However, about 1% of gunshot suicides involve multiple wounds. The majority of these multiple gunshot wound suicides involve those aforementioned squirrel guns (or plinkers) – .22 caliber handguns. A .22 is such a low-energy weapon that a single shot may not be enough to bring about death.

IV. Suicide Black Widow

Terry Cottle shot himself behind his right ear with a .22-caliber handgun in 1995. His wife, Cheryl, was present at the time of his death.

Initially, Cheryl told sheriff’s investigators she heard 10-year-old Christopher shouting that Cottle had shot himself. She said she ran into the bathroom and found him on the floor with the revolver still in his hand.

In a second version attached to a coroner’s report, Cheryl said she was eating oatmeal when one of her boys yelled, “Mom, Dad has a gun!” She said she ran toward the bathroom “and saw Terry standing up and looking at her” with the gun in his hand.

“She said that she yelled something like, `Terry, wait!’, and this was at about the same time as she pushed on the door to try to get into the bathroom and at the same time she heard a shot,” the report says.

Cottle was taken to the hospital, but was removed from life support and his organs donated. 57-year-old Sonny Graham received Cottle’s heart.

What makes the story, though, is that a few husbands later, Cottle’s widow Cheryl married Sonny Graham.

Then Graham shot himself.

If your mind weren’t poisoned with Cheryl’s sordid history and strange behavior, you might be tempted to romantically contemplate “cellular memory” or something. But the story seems darker. There were other gun incidents involving her other three husbands. And there’s this shocking failure of proper feminine decorum and chastity:

On her MySpace account – now deactivated – her photo changed from a sweetly smiling portrait to pictures of her on a lake or drinking beer with friends. Her screen name changed, too, from simply “Cheryl” to “PrEttY LAdy,” then “BeaUtiFuL MeSs.”

Family members monitoring the account noticed that shortly after Graham’s death, she posted a man’s photo identifying him as her “new boyfriend.” A flirtatious message on the man’s Web page, from her account, was dated March 26 – six days before Graham’s death.

I find this story remarkable because it is the first time I’ve ever seen a mainstream news outlet imply that a suicide was caused by another person – rather than by, say, mental illness. “Implied” may be too soft a word:

As far as [Cottle’s sister] was concerned, Graham’s death was less about her brother’s heart than about Cheryl – the woman with whom both men had chosen to share it.

Written by Sister Y

May 13, 2009 at 1:09 am

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 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

More Than Half of Gun Deaths Are Suicides

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In 2005, according to CDC statistics, 55% of gun deaths were suicides. Apparently, suicides have outnumbered homicides and accidental deaths by gun for 20 of the past 25 years. An interesting and surprising statistic. But what’s missing from this article by Mike Stobbe, released in the wake of the United States Supreme Court decision interpreting the Second Amendment as a personal right to bear arms?

First, and most importantly, it’s missing any hint that a perspective might exist recognizing a right to suicide. Second, it fails to provide a single reason justifying the paternalism underlying gun bans enacted to prevent suicide in particular (“You can’t have a gun because you might use it to kill yourself”). And, third, there’s something glaringly missing from the recital of success rates for different suicide methods:

More than 90 percent of suicide attempts using guns are successful, while the success rate for jumping from high places was 34 percent. The success rate for drug overdose was 2 percent, the brief said, citing studies.

“Other methods are not as lethal,” said Jon Vernick, co-director of the Johns Hopkins Center for Gun Policy and Research in Baltimore.

That’s right – no mention of hanging, which has a lethality rate of up to 70%. Mention of this fact might have undermined the political point Stobbe was trying to make. (The article also fails to address the paradoxically high suicide rate in gun-free Japan – over twice that of the United States.)

As I have previously written, there is some evidence that reducing guns correlates to reducing suicides. What I object to is taking the “more guns means more suicide” statistic as license to argue in favor of coercive suicide prevention policies, such as gun bans, without examining in the slightest the philosophical basis for such a policy.

Written by Sister Y

June 30, 2008 at 9:52 pm

Suicide Trends: Antidepressants, They Do Nothing

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Suicide trends in the United States: this is what they look like, in case you’re confused.

One question often asked, in reference to whether antidepressants are effective, is whether suicide rates have declined in response to widespread antidepressant use. Many authors have attempted to answer this question. One study attempted to demonstrate a time correlation between antidepressant use and declining suicides. Why did these authors cut off the data for the 1950s, and begin their analysis with data for the 1960s? Including the suicide rate data (very low, especially among women) for the 1950s would reduce confidence in the authors’ conclusion that antidepressant use is time-correlated with a drop in suicides. (The 1950 data occurred long before SSRIs were available, but undercut the authors’ claim that the 1960-1988 data represented the baseline condition from which suicide rates dropped.)

More importantly, given the data that antidepressant use is not associated with a drop in suicidal behavior, such as suicidal ideation and suicide attempts, even if time correlation were properly demonstrated, the effectiveness of antidepressants is not supported. It is difficult to imagine any way in which antidepressant medications could reduce suicides while having no effect on suicidal ideation, behavior, and attempts, especially given that the JAMA study found that “cry for help” insincere suicide gestures decreased slightly between the 1990-1992 and 2001-2003 studies.

Actually, there is a way that antidepressants could reduce completed suicides but not suicidal behavior or ideation: if they interfere with cognitive ability in general, rendering suicides clumsier or more poorly planned.

But the more likely explanation, given all the data, including the February study that the commonly prescribed antidepressants don’t work better than placebo, is that some factor other than antidepressant use is responsible for any drop in suicides. The obvious answer is that, to the extent that there has been a drop in suicide rates, it’s due to the drop in gun ownership over the past few decades. (Here’s a graphic.) As I have previously noted, gun ownership is highly correlated with suicide. Reduction in gun ownership, in addition to reduction in availability of other reliably lethal methods of suicide, such as lethal pesticides (frequently used for suicide by men and women in poor countries) and barbiturate sleeping pills, is much more likely to be responsible for the drop in suicides than increased antidepressant use. These factors – what might be termed coercive suicide prevention methods – would easily explain a drop in suicide not associated with a drop in suicidal ideation or behavior.

Thanks to Overcoming Bias poster Peter McCluskey for the pointer to the PLoS article.

Edit: Cognitive behavioral therapy (CBT), much hyped for depression, apparently doesn’t work either. From the study:

Stravynski and Greenberg suggested that all models of psychotherapy, including cognitive behavior therapy, may be “equally unsound scientifically but they energize the therapists and provide useful fictions to activate the patients to lead somewhat more satisfactory lives.” [Citations omitted.]

Written by Sister Y

June 12, 2008 at 11:30 pm

Suicide, Gun Ownership, and the Ethics of Suicide Prevention

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A 2002 study in Injury Prevention positively links regional rates of gun ownership with regional rates of gun suicide, and with regional rates of overall suicide. This study stands for the proposition that people who own guns are more likely to kill themselves at some point, not merely for the trivial proposition that one must possess a gun, at least for a brief period of time, in order to commit suicide with a gun. (People who bought guns specifically to kill themselves, and then immediately killed themselves, would not be reflected in the regional rates of gun ownership in this study.)

There are two other less intuitive conclusions of the study: regional rates of major depression are completely uncorrelated (r=-0.10) with gun ownership; and – much more shockingly – regional rates of major depression are completely uncorrelated with regional suicide rates (r=0.00!). The latter conclusion, of course, casts doubt on the commonly-held belief that suicide is a symptom of a disease – depression – or the end-point of a disease process, rather than a rationally and freely chosen action. Interestingly, and again supportive of the suicide-as-decision hypothesis, regional rates of suicidal thoughts are correlated with suicide – though suicidal thoughts do not correlate with gun ownership.

You can read the study, “Association of rates of household handgun ownership, lifetime major depression, and serious suicidal thoughts with rates of suicide across US census regions,” by D. Hemenway and M. Miller (Inj Prev 2002;8:313-316), if you have library or school access to Injury Prevention, but if you don’t, I think it’s important to give an idea of how careful and well-planned this study is. On why they chose to do a regional study with data averaged over ten years:

Because the stock of guns in the United States is so high (over 200 million guns in civilian hands) and because guns are highly durable goods, year-to-year variations in survey estimates of firearm ownership rates are as likely to reflect measurement error rather than actual fluctuations in firearm ownership levels. Handgun ownership data are, therefore, averaged over the 10 year study period to obtain more reliable estimates of regional handgun ownership rates.

On the limitations of studies comparing regional variables:

This study has various limitations. First, as in any ecological study, a concern is that the association found at the aggregate level does not exist at the individual level. For example, from our data, even if there is a regional level association between alcohol and suicide, we do not know if the individuals who are alcohol consumers are the ones more likely to commit suicide. However, from other studies we know that guns are the prime method of suicide in the United States, most people who use guns to commit suicide use family guns, and a gun in the home is a risk factor for firearm suicide.[footnote omitted] We thus have somewhat less reason to be concerned about the “ecological fallacy” with respect to the gun prevalence-suicide connection.

In short, the study is the wet dream of those who would like to restrict handguns in order to prevent suicide. Gun advocates disfavor this sort of logic when it means restrictions on handgun use for the general population, because they see a value to gun ownership; however, gun advocates such as the NRA are all too willing to sell out and cheer on this sort of logic when applied to people diagnosed with some sort of mental illness. No one seems to be considering the possibility that banning guns to reduce suicides is wrong because the right to commit suicide is valuable. Mark Daigle, writing (ironically) in Accident Analysis & Prevention (Volume 37, Issue 4, July 2005, Pages 625-632), typifies this assumption in the public health field:

The effectiveness of restricting access to certain means of committing suicide has been demonstrated, at least as regards toxic domestic gas, firearms, drugs and bridges. At the individual level, studies tend to indicate that many persons have a preference for a given means, which would limit the possibility of substitution or displacement towards another method. Similarly, the fact that suicidal crisis are very often short-lived (and, what is more, influenced by ambivalence or impulsiveness) suggests that an individual with restricted access to a given means would not put off his plans to later or turn to alternative methods. [“Suicide prevention through means restriction: Assessing the risk of substitution (A critical review and synthesis)”]

Restricting access to gun, toxic gas, drugs, and bridges reduces suicide, says Daigle – and that’s good, right? If a “suicidal crisis” might be “short-lived,” and if it might be characterized by “ambivalence or impulsiveness,” isn’t it good to prevent the suicide – for the suicide’s own good?

I think we need to take seriously a very real alternate possibility – that thousands of people suffer so desperately that they often wish to kill themselves, and that if a suffering person chooses death, death is what is for his own good. Methods for “suicide prevention” that merely remove access to what Daigle calls preferred means is not good, but cruel – it actually increases the amount of suffering in the world, and does so by forcing suffering on a segment of the population. They do nothing to reduce the need for suicide – only to reduce the occurrence of suicide. This sort of “suicide prevention” is a form of masking the suffering of a population.

It is only good to prevent suicide in people who wish to commit suicide – who want to die – if life itself is good despite suffering, and if it is proper to force this value onto others who do not accept it. Only if suicide is inherently wrong – if dying is inherently worse than living – is it proper to use force, such as legal restrictions, to reduce the suicide rate. It is my firm commitment that life is not inherently good, and that dying is not inherently worse than living.

Banning tattoo needles, for instance, would probably reduce the rate of tattoos, just as banning guns might reduce the rate of suicide. But despite the impulsiveness and ambivalence that might characterize the decision to get a tattoo, the short-lived nature of the desire, and the permanence of the tattoo (n.b.: especially colored ink), most people support the right to get a tattoo. The fact that many people who were prevented from getting a tattoo are later glad to have been prevented from making the decision would not remove the repugnance of a tattoo ban. Advocates of suicide prevention through force and restriction must explain why dying, when freely chosen, is necessarily worse than getting a tattoo. A tattoo you may regret for your entire life – but suicide will result in no regrets, and no conscious suffering at all. This view is consistent with the idea that life may be assigned value by an individual living person – i.e., killing a person who wishes to live is still a wrong to that person, even if he feels nothing. But prohibiting suicide forces this view of life-as-necessarily-more-important-than-your-suffering on those who adamantly reject it.

Written by Sister Y

June 4, 2008 at 9:15 pm