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Reuters Refusing to Use Stupid Euphemisms

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(Reuters) – The body of a man who apparently committed suicide last week was found inside a car buried in snow on Tuesday, police said. [Emphasis mine.]

It’s not a particularly noteworthy suicide story, but I’m pleased that writer Aman Ali uses the natural phrase “committed suicide” instead of the unnatural euphemism “died by suicide,” preferred by self-appointed media censors. Ali also uses the construction “shot himself with a shotgun,” which is about as non-euphemistic as you can get without describing the entry wound.

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Written by Sister Y

February 1, 2011 at 7:33 pm

Censoring Murder-Suicide: What If Everything Is Contagious?

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Ecological studies suggest that highly publicized suicides cause more suicides. But what other behaviors are media-contagious – and why are we so slow to censor (or even study) them?


Idea Contagion

For good or ill, behaviors among humans pass not only by genes, but by language. A judgmental way to put this is that behaviors and ideas are “contagious.” Pathological homesickness, apotemnophilia,[4] multiple personality disorder, and even Ursuline convents in seventeenth-century France[6] have been posited to arise from contagion.

In particular, suicide is widely accepted as a contagious behavior. The posited contagion even has a name – the “Werther effect.” Belief in the media contagion of suicide is so strong and pervasive that “media guidelines” – a form of voluntary censorship – are widely observed in reporting on suicide.

There is evidence that many behaviors other than suicide are similarly “contagious,” however. Violence against others, in particular, is well-studied in its relation to media contagion. The harm of violence, especially homicidal violence like murder and murder-suicide, is much greater than that of suicide. And the evidence in favor of “violence contagion” is stronger than that of suicide contagion. Why, then, are reports of suicide voluntarily censored, while reports of violence are not?

Suicide Contagion: The Evidence

The evidence for suicide contagion through the media is almost entirely ecological. The studies that provide the basis for the phenomenon of suicide contagion are somewhat questionable.[7] Many suffer from lack of control for important variables; those that are controlled suffer from problems with the control groups or small sample size. Some ecological studies have indicated that the suicide contagion phenomenon is real;[2] others have contradicted those findings. Even among studies that find a correlation between suicide rate and media reports of suicides, the correlation is often much weaker than the correlation of the suicide rate with other factors, such as the unemployment rate.[9]

Of course, there is a more abstract critique of ecological-level data in general. A criticism[1] of David Phillips’ ecological data on suicide contagion and fatal aircraft incidents goes as follows:

Phillips asserts that the statistically significant increase in aircraft fatalities can be explained due to suicide, as well as a “consciously or unconsciously” induced motive on the part of the pilot to also murder some person or persons. What Phillips does, in effect, is impute suicidal motives to some deceased persons on the basis of the statistically significant increases in accidents. Such a jump is conceptually unwise because it is based on a tautology: the statistical increase is the basis for defining some cases as suicide, but these cases are also used to explain the increase. [Citations removed.]

At any rate, a major problem with suicide contagion research is a lack of empirical evidence at an individual level. The one case-controlled study that I am aware of[7] fails to demonstrate any link between hearing media reports of suicide and making a suicide attempt – and, in fact, demonstrates that hearing a media report of suicide has a significant protective effect against suicide attempts.

The study authors interviewed 153 people, ages 13-34, who were “victims” of nearly lethal suicide attempts and who had been treated at local emergency rooms in the Houston, Texas, area. A control group of 513 subjects was similarly interviewed. The conclusion? Not only did the study fail to demonstrate any sort of “suicide contagion,” but, as mentioned above, the authors note a statistically significant protective effect when a subject heard a news report of suicide within 30 days prior to the suicide attempt or had a friend or acquaintance make a suicide attempt. That is, the ER suicide-attempt group was actually less likely than the control group to be aware of a recent media report of a suicide, or to have experienced the suicidal behavior of an acquaintance! The suicide attempt of a parent or relative had no statistically significant effect on suicidal behavior, whereas the usual “suicide contagion” sources had a statistically significant protective effect – the opposite of what the suicide contagion model predicts.

Violence Contagion?

The evidence for violence contagion is much stronger than that for suicide contagion. But whereas suicide censorship is widely accepted, censorship of other-directed violence in media stories is rare.

Violence contagion is demonstrated by the same type of ecological study as suicide contagion.[8] In addition, unlike the suicide case, there is a body of laboratory evidence suggesting that exposure to violent stimuli increases aggressive behavior. However, despite both sources of evidence, the theory that media reports of violence “cause” real-life violence is not at all universally accepted.[5] And the idea that the media should voluntarily self-censor with regard to reports of violence is much less widely accepted than self-censorship of reports of suicide, despite greater evidence for a causal link in the former case.

Contagion and Moral Responsibility

I believe that the insistence that suicide is media-contagious, but violence is not, is not rational, but is a consequence of the differential attributions of moral responsibility in cases of suicide versus other-directed violence. Suicide is seen as an irrational act; the actor, as the story goes, is not in control of himself, certainly not sane, and is therefore vulnerable to external effects.

On the other hand, the idea that violent acts like homicides are attributable to media suggestion is generally seen as a pathetic excuse. Perpetrators of violence are perceived as much more morally responsible for their acts than suicides; despite evidence to the contrary, idea contagion is psychologically ruled out as a cause of violence, but not of suicides (though there are exceptions to this line of thinking[3]).

Is political corruption contagious? Adultery? Prostitution? Drug abuse? Such questions are rarely even studied. Obesity certainly appears to be contagious. If so, should we censor reports of these topics to avoid a contagion effect? To do so would seem ludicrous and counter-productive, not to mention contrary to our political ideals. But the censorship of suicide goes unchallenged.

Moral Responsibility and Willingness to Censor

The more an actor is seen as the agent of his actions, the less outside influences are seen as affecting his actions. Therefore, in cases where moral responsibility is strongly attributed to an actor, outside influences are unlikely to be taken seriously as a cause of his actions – and, therefore, it is not necessary to censor these “outside influences” (such as media reports).

It is my belief that the widespread voluntary censorship of reports of suicide – from use of politically correct language to pervasive norms of message content – are the result of the modern trend to exculpate suicides from moral responsibility and redefine suicide as an act of insanity. There is, however, little evidence that suicides are any less morally responsible for their actions than murderers. Certainly, many other behaviors are media-contagious – but they are not censored, nor are many of them even studied.

I think that one possible explanation is that, at a deep level, people understand that suicide is just not that bad compared to actual acts of violence – despite hysterical language describing suicide as “self-murder.” We want to exculpate people from acts to which we are sympathetic. While we often refuse to define acts outside of societal norms as “not wrong,” we may nonetheless refuse to attribute full moral responsibility to these acts. However, this sort of sympathy backfires in our society. People who are “not responsible for their actions” must be “protected,” often in painful and dehumanizing ways; and society is responsible for their “protection,” often to the detriment of freedom.

Think of the children.


On a largely unrelated note, could this be the stupidest news story about suicide of all time?


Works Cited

1. Altheide, David. “Airplane Accidents, Murder, and the Mass Media: Comment on Phillips.Social Forces 2:593-596 (Special Issue, 1981).

2. Bollen, Kenneth, and David Phillips. “Imitative Suicides: A National Study of the Effects of Television News Stories.American Sociological Review 47:802-09 (1982).

3. Coalition of Law Abiding Sporting Shooters. “Ideas Kill: Science Shines a Light on Port Arthur Deaths.” Retrieved from http://www.class.org.au/ideas-kill.htm on 04/06/2009.

4. Elliot, Carl. “A new way to be mad.The Atlantic, December 2000.

5. Gunter, Barrie. “Media Violence: Is There a Case for Causality?American Behavioral Scientist 51:1061 (2008).

6. Jones, Marshall, and Elizabeth Rapley. “Behavioral Contagion and the Rise of Convent Education in France.Journal of Interdisciplinary History 31.4:489-521 (2001).

7. Mercy, James, Marcie-jo Kresnow, Patrick W. O’Carroll, Roberta K. Lee, Kenneth E. Powell, Lloyd B. Potter, Alan C. Swann, Ralph F. Frankowski, and Timothy L. Bayer. “Is Suicide Contagious? A Study of the Relation between Exposure to the Suicidal Behavior of Others and Nearly Lethal Suicide Attempts.” (American Journal of Epidemiology 154:2 (2001).

8. Phillips, David. “The Impact of Mass Media Violence on U.S. Homicides.American Sociological Review 48:4:560-568 (1983).

9. Stack, Steven. “Divorce, Suicide, and the Mass Media: An Analysis of Differential Identification, 1948-1980.Journal of Marriage and the Family 2:553-560 (1990).

Written by Sister Y

April 9, 2009 at 6:58 pm

Suicide as a Religious Act

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In her laudably dangerous article, “Religious Suicide in an Investor’s World,” Rita Polevoy dares to take suicide seriously. Suicide, says Polevoy, is often a religious act – a conscious act, in protest against the evils of the world, and in preservation of a different kind of dignity than J. David Velleman has in mind in his papers on suicide.

Polevoy, identified as “a student at Loyola University Chicago,” writes:

Suicide, as historian of religion David Chidester reminds us in Salvation and Suicide, his seminal study of the People’s Temple, is frequently a religious act, invested with religious motivations and following a religiously understood logic. The Jewish zealots at Masada, for instance, facing death (or, worse, torture, rape, forced conversion, and slavery) at the hands of the Romans in 70 CE took their own lives as a way of escaping with their religious identity and dignity intact. Likewise, when the utopian community at Jonestown drank poison in 1978, a ruling interpretation among those who participating willingly was that this act of suicide was in protest of “the conditions of an inhumane world.” Suicide presented a means of remaining fully human in the face of a society defined by race, class, and gender divisions and, thus, intent on dehumanization. [Emphasis and links mine.]

In response to the suicide of Rene-Thierry Magon de la Villehuchet, we have seen the predictable, safe ruminations on selfishness and mental illness. And yet, with shocking boldness, de la Villehuchet’s brother, Bertrand, told the press that his brother’s suicide was an “act of honor.”

Advocates of suicide censorship abhor any consideration of the idea that suicide might sometimes be honorable or right. Douglas Faneuil, who claims to “work in the field of suicide prevention,” writes that “Praising a suicide as honorable may come with an extremely high price: namely, more suicides.” He encourages censorship (though you’re not supposed to call it censorship, he says, but rather “putting it in context”) of suicide coverage and justifies that by clinging to the idea of suicide contagion. (I have previously argued that there is clinical evidence that suicide contagion might not exist, and that even if it does, it does not justify censorship.)

But rather than failing to put suicide “in context,” Polevoy is merely describing a genuine aspect of many suicides, including de la Villehuchet’s. She writes,

Villehuchet’s suicide was a public act, an utterance aimed, surely, to resonate throughout the media and thus voice the outrage and despair of many anonymous investors, in the process focusing public attention on the very real ramifications of this white collar crime.

Not all suicides are idealistic, but certainly some are. Polevoy acknowledges a truth; to insist that all suicides are the product of mental illness, that there is never honor in suicide, is to sacrifice truth for the sake of political correctnessbullshit in the strict Frankfurt sense.

Update: An anonymous commenter points to a note by Nassim Nicholas Taleb (author of The Black Swan) on the suicide of his acquaintance, de la Villehuchet. Note 106, “On Killing Oneself,” reads in part:

This is an aristocratic act coming from an aristocratic character: you take your own life when you believe that you failed somewhere — and the solution is to inflict the ultimate penalty on yourself. It is not the money; but the embarrassment, the shame, the guilt that are hard to bear. Someone callous, indifferent to the harm done to others would have lived comfortably (“it is all about money”). A life of shame is not worth living. Christianity never allowed suicide; the stoics did –it allows a man to get the last word with fate.

Thierry, veuillez recevoir l’expression de mon respect le plus profond. [Emphasis in original.]

Written by Sister Y

January 16, 2009 at 9:13 pm

Censoring Suicide

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Well-meaning anti-suicide groups publish “media guidelines” that promote myths and increase the pain for survivors of suicide.


In London, Paul Day’s compelling, emotionally dense frieze was pulled from a rail station because it depicted a skeleton driving a train and a commuter “wobbling precariously” close to the tracks – alluding to suicide by train.

Pepsi apologized for, and retracted, ads (published in a German magazine) that depicted a “lonely single calorie” committing suicide. The self-appointed censor who received the apology indicated that electronic communication will help him carry out his inquisition into commercial art: “The lesson here is that social media has eyes everywhere and the network to make sure that advertisers can no longer hide stuff in niche markets,” said Chris Abraham.

Art, advertisements, and video games that deal with suicide – entry points for conversations about suicide among ordinary people – are unjustly criticized, censored, and destroyed. There is only one appropriate way to speak of suicide, one appropriate attitude toward it, and all others are quickly suppressed. This is not the case for other controversial topics – murder, race, gender, drug use – nor should it be. Suicide is tabooed in a unique and unfortunate way.

Joan Wickersham, author of The Suicide Index and daughter of a suicide, thinks that more conversation about suicide would be a good thing:

“I think there is a kind of shame and a kind of taboo attached to suicide,” she says. “We would prefer to think it doesn’t happen. I think we have to acknowledge it does happen. We have to acknowledge that it’s a mystery, that we don’t understand it very well. I just wanted to give a sense of what it is really like to go through this.”

Wickersham says there is a reluctance to talk about suicide, adding, “I would love to see more honest conversation about it.”[“World Suicide Prevention Day seeks to raise awareness,” Voice of America.]

Contrary to Wickersham’s goal, “honest conversation” about suicide is suppressed in the media when a suicide occurs, often based on well-intentioned but flawed “media guidelines” published by anti-suicide groups. In addition to the fact that these guidelines promote the ethical position that suicide is wrong, I see two major problems with these guidelines: one, they promote myths about suicide as if they were facts; two, they increase the guilt of survivors by portraying suicide as preventable.

The “Media Guidelines for Suicide” on suicide.org advise reporters as follows:

Emphasize the number one cause for suicide:

The number one cause for suicide is untreated depression.

And then indicate that depression is treatable, and thus anyone suffering from depression needs to receive IMMEDIATE help.

This is in contrast to the scientific studies, which show that depression only slightly increases the risk for suicide – a fact which in itself carries little weight, since suicidality is one of the possible criteria for diagnosing depression. According to Thomas Joiner (Why People Die by Suicide, p. 195-196), borderline personality disorder and anorexia nervosa are far more predictive of suicide than depression; BPD has a 10% lifetime risk of suicide and a 50% lifetime rate of at least one very severe suicide attempt.

Even given a slight correlation between depression and suicide, it’s overstating the case to say that depression causes suicide – even Thomas Joiner would not agree with that, as stated. It would be more accurate, but less satisfying, to say that the desire to die, coupled with the acquired ability to die, is the leading cause of suicide.

The suicide.org guidelines also recommend using the “fact” that “Over 90% of the people who die by suicide have clinical depression or a similar mental illness when they die.” I have extensively attempted to debunk this statistic, but the comfortable idea that suicide is caused by mental illness is hard to dislodge and unlikely to be questioned too closely.

Other “media guidelines” offered by suicide.org range from silly to intrusive to “whoa, thought police”:

Do not begin a television newscast with a suicide story.

Do not place suicide stories on the cover of newspapers or magazines.

Never portray suicides as heroic.

Never say that a suicide “ended pain” or “ended suffering.” Suicide CAUSES excruciating pain for suicide survivors.

Also, people need to be alive to feel relief from pain. Suicide CAUSES pain.

Do not use the terms “successful suicide” or “committed suicide.” Use the term “died by suicide” instead.

The term “committed suicide” is NOT accurate and is VERY hurtful to those who have attempted suicide and to suicide survivors. Say “died by suicide.”

The media guidelines proposed by suicide.org strictly fit the definition of politically correct bullshit I proposed in an earlier piece: they express majority opinion in a manner unconcerned with truth, and have the function of a moral taboo to protect an important cultural narrative from negation.

The guidelines promulgated by the National Institutes of Mental Health are much more harmful, however, in that they function to increase the pain and guilt experienced by people close to a person who committed suicide. The message promoted by the NIMH guidelines is that suicide is always preventable, and there are always warning signs. The guidelines advise reporters that

Studies of suicide based on in-depth interviews with those close to the victim indicate that, in their first, shocked reaction, friends and family members may find a loved one’s death by suicide inexplicable or they may deny that there were warning signs. Accounts based on these initial reactions are often unreliable.

That is, there are always warning signs; push family remembers until they “remember” the politically correct story. Reporters are advised to ask survivors questions such as

  • Had the victim ever received treatment for depression or any other mental disorder?
  • Did the victim have a problem with substance abuse?

The message is that there were warning signs that, had the family cared enough to look, would have revealed the suicide’s intentions so that the suicide could have been prevented. Unfortunately, this serves to increase the guilt of survivors, legitimize increasingly coercive suicide prevention tactics, and increase the survivors’ sense that the suicide was a tragedy because it was “preventable.”

The problems I identify – promoting false information and unnecessarily increasing survivors’ guilt and pain – are in addition to the harm to the marketplace of ideas that is done in the name of curbing the controversial phenomenon of suicide contagion. A single ethical idea is given precedence over all others, and false facts are repeated in the name of protecting it, and of protecting the institutions that depend on it (“Mention that Suicide.org is available 24 hours a day for anyone who is suicidal,” advises suicide.org).

Update: zarathustra at MentalNurse discusses media treatment of suicide in “How should the media report suicide?

Written by Sister Y

December 5, 2008 at 2:18 am

How People Die By Suicide

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A review of Why People Die By Suicide, by Thomas E. Joiner. Harvard University Press, Cambridge, 2005.

Thomas Joiner provides a robust descriptive model of suicide, but repeatedly refuses to consider the deeper “why” – the answer to which might be evolutionary adaptation in the Pleistocene.


In bathrooms at Disneyland, signs over the sinks offer what are described as “hand washing tips.” The alleged “tips” are:

  • Wet hands and apply soap.
  • Scrub hands and rinse.
  • Dry hands thoroughly using paper towels.

People find this sign amusing from an epistemological standpoint: it’s not so much a set of hand washing tips as it is a (humorously unnecessary) phenomenological description of the act of hand washing. It is funny because it purports to have normative content, but fails to contain anything but description.

Similarly, Thomas Joiner’s Why People Die By Suicide promises, in its title and its project, to provide an explanatory model for suicide. Joiner does provide a useful descriptive model of suicide, but he fails to live up to his title’s promise of an explanation of suicide. In fact, he explicitly rejects, on what are essentially aesthetic grounds, the most promising candidate for a genuine explanatory model of suicide – that is, evolutionary psychology.

Joiner’s Model

According to Joiner, three factors cause suicide: competence, or the ability to carry out a suicide; the feeling of being a burden; and social failure to belong. The first factor, competence, includes the physical ability, knowledge, and pain tolerance required to carry out a suicide, as well having lost or overcome the fear of death. The second and third factors, burdensomeness and failed belonging, join together to create the desire for death. Both the desire for death and the capability to achieve death must coexist in order for a person to commit suicide; that much is obvious. Joiner’s main contributions are setting this up in a clear formulation, and positing the two specific factors that constitute the desire for death.

Importantly, while maintaining that mental illness is relevant to suicide, Joiner does not implicate mental illness in causing suicide – rather, his model explains the elevated suicide levels in people with disorders like Bipolar I and II and Borderline Personality Disorder by the fact that such disorders (a) facilitate comfort with increasingly lethal self-harm, (b) increase feelings of (and perhaps actual) burdensomeness, and (c) decrease the ability to belong.

Joiner’s model is clear, helpful, and well-supported by studies. The problem with Joiner’s model is that, while it describes who commits suicide and how they manage to do it, it fails to explain why those people commit suicide. Why should people care about being a burden to others? Why should people care about social belonging? Why should they care about these things, but not other things, enough that death is preferable to the pain of burdensomeness and thwarted belonging?

Joiner is comfortable providing an answer as to why it should be difficult to commit suicide, and why the first element of his model, competence, should be necessary: natural selection. He implicates specific genes and brain traits in suicidality (even distinct from the genetic contribution to mental illness). Yet he explicitly refuses to consider the possible role of natural selection in regard to the other elements of his model, or to suicide as a phenomenon.

Why should people care about whether they are burdens on other people? Why isn’t it, say, the feeling of being overburdened by others that causes suicide? And why should failure to belong be so painful as to facilitate suicide? Why not anger, or guilt, or physical pain, or even excessive social contact? Joiner makes no attempt to explain. But an adaptive model readily explains the features of Joiner’s model, in addition to clarifying Joiner’s more questionable results; indeed, the adaptive model has more explanatory power than Joiner’s model.

Failure to Consider Suicide as an Adaptive Behavior

Suicide, like filicide, seems upon first consideration to be a ludicrous act, viewed from the perspective of evolutionary biology: how can one’s genes go on if one kills oneself or one’s child? However, the act of filicide (the killing of one’s child or children) is clearly adaptive in many cases. Not only that, but it can be shown through statistical evidence that actors seem to differentiate between adaptive and non-adaptive filicides when they “decide” to commit filicide (as well as other apparently fitness-threatening homicides, like uxoricide and siblicide). What about suicide?

An act is adaptive when it increases the inclusive fitness of an actor – that is, when the act’s benefits – in terms of survival, procreation, or nepotistic distribution of resources to one’s genetic relatives – exceed the act’s costs, in the same terms.[1]

Under certain conditions, one’s expected contribution to one’s own genetic fitness (likelihood of reproduction, likelihood of the survival of one’s future offspring to reproduce, effectiveness at materially supporting one’s offspring and other relatives) may fall to virtually nothing. However, as long as one survives under these circumstances, he not only contributes nothing to his own genetic fitness, but also likely drains the resources of his genetic relatives. His continued survival is contrary to his genetic interests. Therefore, suicide, in this limited situation, must be said to be adaptive. (For my earlier thinking on this topic, see my essay, The Evolutionary Biology of Suicide: Is Suicide Adaptive?)

It would be callous and cruel to think of a sick relative as a burden who would be better off dead. And that is not the message of an inclusive fitness model – its message is merely that, in the Pleistocene era when modern humans were evolving, a heritable trait that functioned to tell a human something like “die if you’re a net burden on your genetic kin, otherwise stay alive” may have carried benefits in terms of selection. However, Joiner cannot get past the (admittedly substantial) emotional load of the adaptive model of suicide, and rejects it on what are essentially aesthetic grounds:

. . . I do not much like this adaptive suicide view; my own dad died by suicide and the idea that he was an actual burden is offensive. My view is that self-sacrifice is adaptive in some animal species. It may have been adaptive under certain conditions in the course of human evolution, but we will never really know. Most important, it does not really matter now. What matters now is that perceived burdensomeness – and, to the extent that it exists, actual burdensomeness – are remediable through perception- and skill-based psychotherapies. Death is no longer adaptive, if it ever was. [Joiner, p. 115]

This is a strange statement for a scientist. Although Joiner is writing a book called Why People Die By Suicide, he asserts that the essential “why” of his research does not matter – especially to the extent that it might be “offensive.” In this, I think he misunderstands the nature of the adaptive view. It is not to say that suicide is good or bad, or that Joiner’s dad really was a burden to Joiner or his family – simply that, in the human environment of evolutionary adaptedness, the ability and predilection to commit suicide under certain conditions may have conferred a benefit. Joiner also wrongly asserts that “we will never really know” about the adaptive theory, when he should know that the evolutionary psychology model is perfectly capable of generating testable hypotheses, and has done so in the past with robust results.

Joiner pushes the notion that it is perceived burdensomeness – not actual burdensomeness – that facilitates suicide. However, this may be more nice than true: suicidal persons’ perceptions of their own burdensomeness may in fact be highly accurate. Just before he dismisses the adaptive theory of suicide, Joiner summarizes a study supporting the view that suicides really are a burden: “when researchers interviewed the significant others of eighty-one people who had recently attempted suicide, a majority of significant others reported that their support of the patient represented a burden to them.”

The adaptive model leads to different predictions (and, in turn, possibly different risk assessments and treatment models) from Joiner’s model. For instance, in Joiner’s model, “belongingness” is all that matters. But an adaptive model would predict that some forms of belongingness would be more protective against suicide than others – specifically, contributing to the welfare of one’s genetic relatives (or, perhaps, surrogates for genetic relatives) would be more protective than other forms of belonging. Relationships with spouses and children would matter more than relationships with friends in an adaptive model, but not in Joiner’s model. Joiner does not even consider this to be a question worth researching. Similarly, in Joiner’s model, all that matters is “burdensomeness” – no matter who is burdened. An adaptive model might predict that burdensomeness on genetic relatives in particular (or their surrogates) would trigger suicidal behavior, rather than burdensomeness on non-relatives. Again, Joiner is not interested in testing this hypothesis, although it might have major implications for treatment and risk assessment. It cannot be said, with regard to the adaptive view of suicide, that “it does not matter now.”[2]

Joiner’s model, including a refusal to consider the adaptive view, seems to strain when it encounters certain data. For instance, when explaining the data that pregnant women experience a lower suicide rate than non-pregnant women – one-third the non-pregnant rate in one study – Joiner says: “I would suggest that the protective influence involved feelings of connection to the baby, as well as feeling needed by the baby and thus not a burden.” But a relationship to an unborn, unseen person who cannot respond is a strange sort of “relationship.” An adaptive explanation – pregnancy confers clear survival value compared to non-pregnancy – is less strained than a belongingness/burdensomeness model, and, in fact, provides a deeper explanation of why a pregnant woman might develop deep feelings for a non-speaking person inhabiting her body.[3]

Joiner’s model accounts for sex differences between the suicide rates of men and women in two ways: first, in terms of competence, men are more likely to be exposed to provocative stimulation (all kinds of violence and more) that break down one’s fear of death over time; second, in terms of desire for death, men are more likely to be disconnected and more likely to feel they are burdens than women. This is probably true – the first part, in particular, accords well with what I believe to be the most accurate explanation for the differences between the suicide rates of men and women – but, again, why should this be? Why should men be more prone to risky, painful, violent, or as Joiner terms it, “provocative” behavior?

The answer, again, lies in evolutionary biology. Men are not merely “socialized” to be more violent – there are good evolutionary reasons for their greater violence and risk-taking in all areas. A great deal of this is due to what Daly & Wilson term the “effective polygyny” of human beings (at least in the EEA) – that is, that the fertility variance among men is much higher than among women, with many more men than women having a high number of children, and, similarly, many more men than women having zero children. This leads to the sad phenomenon of male disposability – while a woman is “valuable,” with a certain, nearly guaranteed level of reproductive success, a man may have no reproductive success at all – but may, by engaging in risky behavior (e.g., successful killing in wars or honor battles), increase his reproductive success to well beyond what a woman might have. A human male is, sadly, invited by his genetic heritage to gamble his life on the chance of a big payoff in reproductive success.[4] What is driving differential violence in general may also drive differential suicides – even independently from the greater access to fear-reducing, provocative experiences.

More specifically, Joiner’s model does not explain why, in addition to varying between genders and across age groups, the time pattern in suicides across age groups is different between men and women. Men’s suicide rates are a linear function of age: the older the male, the higher the suicide rate. Women’s suicide rates vary with time differently, however. While in some countries, the pattern for women matches that for men, in other countries the pattern is very different. In Canada, rather than rising linearly with age, suicide among women peaks during the 35-44 age range; in the United States, the Netherlands, and Sweden, it peaks during the 45-54 age range; and in Australia, Denmark, and Poland, female suicides peak in the 55-64 age range.[5] While belonging and burdensomeness are probably implicated, the fact that these are the age ranges of menopause and post-menopause in women seems to lend support to the adaptive view as to why burdensomeness and thwarted belonging would come into play at those times.

While Joiner’s model is compelling, I think there is persuasive evidence that an adaptive model explains suicide better than Joiner’s model.[6] At the very least, such a hypothesis deserves to be considered, and should not be rejected on merely aesthetic grounds. To do so is irresponsible and unscientific. An accurate analysis of the etiology of suicide affects both assessment of the risk of suicide and treatment for the suffering that causes suicide.

Failure to Consider Unsuccessful Attempted Suicide as an Adaptive Behavior

Joiner refuses to consider whether a successful, completed suicide may be adaptive. Elsewhere, he refuses to consider data suggesting that making an apparently lethal but ultimately unsuccessful suicide attempt may be not only adaptive, but economically beneficial – provided one does not die in the attempt. In a 2003 article in the Southern Economic Journal, Dave Marcotte presented data that suicide attempters experience an increase in income after the attempt that is proportional to the lethality of the attempt. Charles Duhigg summarizes in his Slate article, provocatively subtitled “Why trying to kill yourself may be a smart business decision“:

Marcotte’s study found that after people attempt suicide and fail, their incomes increase by an average of 20.6 percent compared to peers who seriously contemplate suicide but never make an attempt. In fact, the more serious the attempt, the larger the boost — “hard-suicide” attempts, in which luck is the only reason the attempts fail, are associated with a 36.3 percent increase in income. (The presence of nonattempters as a control group suggests the suicide effort is the root cause of the boost.)

Marcotte’s data suggests that a suicide attempt, particularly an apparently lethal one, acts as a signal that the individual needs help – and, as it is a signal that entails significant cost (the risk of death), it is a particularly believable signal. This signal seems to act to make resources “cheaper” – a suicide attempter may get access to resources that he did not have access to before the attempt.

Again, Joiner is having none of it, and again, it’s for aesthetic, not scientific, reasons. Joiner’s complaints are two: the economic “viewpoint” is dangerous, in that it may encourage lethal-seeming suicide attempts; and it is callous, in that it denies the reality of the suffering experienced by the suicidal individual. Both of these “complaints” are without merit and are, I think, evidence of shoddy thinking on Joiner’s part.

As to the “danger” of the economic model, Joiner says

The danger of viewpoints like this should be pointed out. Any analysis that encourages suicidal behavior in any way – particularly in ways that romanticize or glorify it, or make it seem easy and normative – has potential negative consequences for public health.

But it is hardly the viewpoint that is dangerous – it’s the existing incentive structure in our society that encourages apparently lethal suicide attempts in people who often don’t really want to die. I have argued that if the suicide prohibition were ended, this dangerous incentive structure – the “fantasy of rescue” – would also end. (I have also proposed an outline of a model for ending the prohibition on suicide, with particular attention to ending the dangerous fantasy of rescue.) Analyses are not dangerous. Problems are dangerous; analyses identify the problems and point the way to solutions. By suggesting that the economic analysis is dangerous, Joiner is contributing to the taboo against speaking about suicide.[7]

Joiner’s idea that the economic hypothesis denies the reality of the suffering of suicide attempters is even more ridiculous. He believes that the economic idea is part of some kind of “deconstructionist” philosophy – he actually mentions Jacques Derrida by name (not kidding): “What is left for the deconstructionist, then, is a constant questioning of the very existence of reality and meaning – including the reality of emotional pain. Try telling that to a suicidal person.”

This objection makes so little sense that I had to reread the section (pp. 43-44) a couple of times before I understood it.[8] Joiner thinks that the economic model does not account for the pain suffered by those who attempt suicide. But the economic model suggests no such thing! Despite Duhigg’s unfortunate opening example in his popular reporting of the Marcotte study, the hypothesis is not that people coldly calculate that they will get a benefit from an apparently lethal suicide attempt. Rather, suffering people are motivated by that awful, extremely real suffering to do something awful – to, essentially, gamble their lives on a chance at making the suffering stop.

Culture, Language, and Occam’s Razor

One of the anomalies that Joiner believes he can explain with his theory is the fact that, while, in general, men commit suicide at a much greater rate than women, women in China commit suicide at a greater rate than men. Joiner is quick to find a cultural culprit: Confucianism. Specifically, he says that “the role of Confucianism in Chinese society and its view of the inferior position of women has been emphasized as one explanation, one that is consistent with the current emphasis on effectiveness as a buffer against suicide. (p. 157)” Social scientists, particularly white, Southern social scientists[9], are often quick to reach for a complicated but distancing cultural explanation when there is a perfectly good, but uncomfortable, solution available that might actually survive Occam’s Razor.

In the case of female suicides in China – and higher comparative rates of female suicide throughout Asia, including India (a noted hotbed of Confucianism) – the uncomfortable but obvious explanation is that lethal poisons are available in Asia, but not in the United States. Most females who commit suicide in China do so by poison, and the pattern holds true in other areas where female suicides exceed those of males, such as Bangalore, India. In the United States, many people, including females, attempt suicide by poisoning, but few succeed – lethal poisons are just not available in the United States, and in the event of a potentially lethal poisoning, medical care is not only available, but compulsory. The medical care necessary to treat a poisoning is often not available in China, especially in rural areas.

According to Joiner’s own model, females, who are exposed to less violent, provocative stimulation than men, should have less capability to commit suicide – by violent means. However, death by overdose or poisoning is not violent and is within the capabilities of many women. One need not reach for what even Joiner admits is speculation – that Chinese women, since they perform well in sport competitions (is he thinking of the Olympics?), are, as a group, encouraged to engage in athletics, leading to the development of more masculine traits, such as violence. Joiner’s explanation is, indeed, speculation, and ignores an obvious explanation that is consistent with his model. Perhaps the poison explanation is not as satisfying to Joiner as speculation about the effects of athleticism, because it fails to portray Asian people as sufficiently different from whites.[10]

Joiner indulges in even less responsible speculation when he considers language. Joiner devotes considerable time to the hypothesis that suicidal people fuse themes of life and death – that death becomes a focus for belonging and effectiveness. In contrast to the rest of his book, in which peer-reviewed studies are frequently cited as evidence for his claims, his main evidence for the “fusing of life and death themes” hypothesis is Nirvana lyrics (though he does give us a few isolated quotations of suicidal people that, if you squint the right way, seem to back up his idea).[11] I think that Joiner likes the idea that suicidal people fuse themes of life and death because it makes us seem more psychotic, and less rational in our actions.

The Ethics of Suicide and the Reality of Suffering

Though Joiner clearly has an ethical opinion (suicide is bad), he devotes no time to the question of the ethics of suicide and of forced hospitalization and the suicide prohibition in general. This is not unexpected. It is considered polite and compassionate to do “what is best” for suicidal people, and it is considered to be a serious failure of compassion to suggest that some of us might just know what is best for ourselves. To question suicide prevention on ethical grounds would be extremely foreign to Joiner’s way of thinking.

In addition, Joiner is sure that every death by suicide is preventable because treatment is available, but he fails to cite studies of treatments for suicidal misery that have a 100% long-term success rate. Instead, he proposes, in addition to the usual coercive suicide prevention techniques, public service announcements that say “keep your friends and make new ones too – it’s strong medicine.” He thinks that if more people called a friend every day, just to chat for a few minutes, there would be fewer suicides. He does not seem to apply this thinking to the suicide of his own father, however. His father, at the time of his death, was receiving what Joiner terms “reasonable treatments” (a mood stabilizer and an SSRI), but “his treatment came too late.” Joiner notes that his father sought out friends toward the end of his life, as Joiner’s patronizing public service announcement would have advised him, but “his efforts were not sufficient . . . . These things were beyond him . . . . (p. 226)”

Based on his (undefended) position that suicide is wrong, Joiner repeatedly describes websites like ASBS (an incarnation of the usenet group alt.suicide.holiday.bus.stop) as “pernicious” (God knows what he would think of my project). He wrongly and tellingly characterizes ASBS as pro-suicide – ASBS is pro-choice, as am I. He approvingly cites restrictive guidelines for news outlets regarding reporting on suicides. Joiner says he is against lying about suicide, and is in favor of removing its stigma, but he doesn’t want conversations about suicide to occur if he doesn’t approve of their content.

Joiner promises an explanatory model – he calls his book “a comprehensive theory of suicidal behavior (p. 222)” – and makes assertions based on tacit moral assumptions. I think that Joiner owes us not only an explanation of why people die by suicide, but also of why dying by suicide is wrong – and why coercive means of suicide prevention are ethically appropriate.


Notes

1. Of course, traits are heritable, not acts, but the ability and predilection to commit certain acts, and the ability to distinguish when to do so and when not to do so, may be seen as traits to the extent that they are specifically heritable. More precisely, we must say that a trait is beneficial when it increases one’s inclusive fitness. A trait may be very specific.

2. There is one sense in which it really doesn’t matter, of course, and that is the ethical sense. In fact, this is the sense in which even I have previously stated that an adaptive model makes no difference. But this is not the sense in which Joiner means it. He means that it can have no assessment or treatment consequences and that it is not an appropriate topic for scientific inquiry. As I stated above, the adaptive model has clear assessment and treatment implications. Whether the adaptive model is supported or refuted, it does matter.

3. Another set of data must be explained – a group of “initially pessimistic” teenage mothers reported low depression while pregnant, but high depression postpartum. Joiner attributes this to “the belief that connection to the baby and the baby’s father would solve ongoing problems” during the pregnancy, and to the fact that “the idea that motherhood would solve ongoing problems was not confirmed” after birth. However, the adaptive model gives a cleaner explanation: it makes evolutionary sense for the chemical changes during pregnancy to promote positivity and effectiveness, but also for the fitness prospects of the new baby to be evaluated coldly once the baby is born. This is particularly true for a young mother with no mate. This view is supported by Martin Daly and Margo Wilson’s work on infanticide.

4. See, e.g., Chapter 6, “Altercations and Honor,” in Homicide by Martin Daly and Margo Wilson. Aldine de Gruyter, New York, 1988.

5. Suicide Across the Life Span by Judith Stillion and Eugene McDowell. Taylor & Francis, Washington, D.C., 1996, p. 18.

6. I have not even mentioned the work of Denys DeCatanzaro, whose studies demonstrated a correlation between factors indicating low reproductive value and suicidal ideation. See, e.g., DeCatanzaro, D. (1991). Evolutionary limits to self-preservation. Ethology & Sociobiology, 12, 13-28; and DeCatanzaro, D. (1995). Reproductive status, family interactions, and suicidal ideation: Surveys of the general public and high-risk groups. Ethology & Sociobiology, 16, 385-394.

7. The unquestioning acceptance of the idea of suicide contagion, and of the harm to free speech and freedom of the press done in its name, are also ways in which the taboo against speaking about suicide is maintained.

8. I suspect that Joiner has limited familiarity with economic models and economic thinking, which may be why he seems even more threatened by this idea than by the idea that suicide is adaptive.

9. I don’t think this characterization and its implications are unwarranted. Joiner reports two incidents of people doing crazy things that might inure them to the pain of suicide. In one, a man Joiner specifically identifies by name, Huyn Ngoc Son, “swallowed three metal construction rods, each around seven inches long,” on a bet from drinking buddies, and had to have them surgically removed. In the other story, a man in England, whose name Joiner does not mention, drank fifteen pints of beer, had an argument, and went home to get a shotgun – which, while he was carrying it back to the bar in his pants, discharged shotgun pellets into his “groin area,” potentially rendering him infertile. Research reveals that the man’s name in the second incident was David Walker – the non-Vietnamese name was apparently not funny and foreign-sounding enough for Joiner to include in his description of the event.

10. I know that’s not warranted, but I have as much evidence for that claim as Joiner does for his claim that Chinese women are “sportier.” Also, I am an Internet crackpot, and Thomas Joiner is a goddamn principal investigator.

11. Elsewhere, Joiner reports that he did a “social word” analysis of a suicidal and a non-suicidal Faulkner character – yes, characters from literature – and found that, indeed, the suicidal character used fewer social words. “Faulkner accurately portrayed relatively poorly understood, intense, and rare psychological processes – still more indication of his literary genius.” This is a fun stunt, but the fact that Joiner thinks it belongs in a section called “Research on Social Isolation, Disconnection, and Suicidal Behavior” calls his judgment and intellectual honesty into question.

Thanks to Chip Smith for comments on this piece.

How Do You Want Your Death to Be? Finding Common Ground with Non-Suicides

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Each one of us will die. What do you want your death to be like?

What do you want to happen when you die? Do you want to live as long as possible? How long would be ideal? Do you want to die in a hospital, or at home? If you were dying of pancreatic cancer, would you want complete pain relief, even if it meant that you might die from a morphine overdose? Or would you want to live as long as possible, even if in pain? Would you want doctors to introduce a feeding tube? What if the feeding tube gave you severe, constant diarrhea? If you had lived with Alzheimer’s for a decade and could no longer recognize anyone and didn’t know where you were, and you came down with pneumonia, would you want to be treated for it and cured of the pneumonia? Or would you want to die naturally of pneumonia, even though it is a treatable condition? Do you want to continue living as long as you are conscious? As long as you are able to have meaningful interactions? As long as you are able to maintain your activities of daily living? As long as you can hold your grandchildren? As long as you are, technically, alive? Do you want the ability to control the manner of your death?

There is no right answer to any of the questions above. People’s wishes for their own deaths are idiosyncratic, and should be: people’s wishes for their lives, and definitions of a good life, are certainly diverse; why should the same not be true of death? The question is: once you have though about your own death and decided what you want, do you want to deny another person his “good death”? Or do you want people to be free to have lives, and deaths, as close to their ideals as possible?

Admitting that death is a natural part of life, and thinking about how we want our own deaths to be, is, I think, an important part of being a mature human being. However, some authors, like Thomas Joiner, think that irrational, visceral fear of death is not only healthy, but that it is pathological to lose this fear of death:

. . . the erosion of fear and the attendant ability to tolerate and engage in lethal self-injury may set into motion still other psychological processes that are important in suicidality; namely, the merging of death with themes of vitality and nurturance. Only when people have lost the usual fear and loathing of death do they become capable of construing it in terms related, ironically, to effectiveness and belongingness. Only those who desire death and have come not to fear it can believe that through death, their need to belong and to be effective will be met. [Why People Die By Suicide, by Thomas Joiner. Harvard University Press, 2005, p. 226.]

But it is far from clear that the “usual fear and loathing” of an inevitable, natural, well-understood process is healthy and in the interests of human flourishing. Such a fear prevents honest and productive reflection on one’s own death.

This is not to say that dislike of death, or a strong preference against death, is a problem. A strong preference against death might be an important value held by a person, based upon which the person may make rational decisions. But, except in terms of crude survival, an irrational “fear and loathing” of death is not warranted, nor should it be encouraged.

There are many obstacles to having a mature conversation, as citizens, about death. The irrational fear of death (as opposed to a love of life) is one of these obstacles. But there are other obstacles. One, I think, is the tendency for some in the anti-suicide community to emotional overreaction to any reference to suicide in the wider culture that is not both deadly serious and in accord with their beliefs.

For instance, this week, someone calling himself an “internet safety campaigner” for the British anti-suicide group PAPYRUS, is calling for the “removal” of a computer game called Billy Suicide, in which players try to prevent a character from committing suicide by maintaining his caffeine and antidepressant levels, among other things. (One can only imagine he hasn’t heard of Karoshi Suicide Salaryman, in which each level’s puzzle calls for the player to help a cute, energetic salaryman commit suicide.) Says the “internet safety campaigner” (in the Telegraph):

This game is completely irresponsible and the people who made the game should realise the damage that it can incur in the terms of somebody taking their (sic) own life

A “spokesperson for the Samaritans” agrees that culture-wide discussions of suicide should never, ever happen with any lightheartedness, based on a credulous acceptance of the poorly understood and controversial phenomenon of suicide contagion:

Suicide is not a light-hearted subject and is (sic) should always be taken seriously.

Certain types of suicide portrayal can act as a catalyst to influence the behaviour of people who are already vulnerable, particularly young people, and result in an overall increase in suicide and/ or an increase in uses of particular methods.

I think that, in the interest of greater cultural maturity on the issues of death and suicide, all conversations about death and suicide should be encouraged – even seemingly immature conversations, and conversations that take place via marginalized art forms like computer games. Good faith should be presumed, rather than malice. It is not pathological, but crucial that we lose our cultural fear of death.

An old family friend used to joke that, when he got so old as to be helpless, he wanted his sons to roll him out into the woods he’d hunted in for years, in his wheelchair, and hang strips of raw bacon over his ears so that the bears would eat him. This was his way, I think, of introducing the somewhat tabooed topic of death control – telling people that he didn’t want to die, helpless and intubated, in a hospital. I don’t think he was wrong to make such a remark.

A person who does not fear death is not a monster or mentally ill. He is free to pursue his values as he sees them – including, often, a love for life and a desire to avoid death. He may be courageous in the face of death or danger, able to realize that some things are more important than preserving his own life at any cost. He need not be a suicide; usually, he is probably not a suicide. He is not the slave of his genes. He is not a slave at all.

Written by Sister Y

November 13, 2008 at 9:14 pm

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.