It's almost unheard-of to find an American CEO who has voluntarily resigned on account of his company's misdeeds, let alone one who has committed suicide because of them. In Japan, 275 company directors killed themselves in a single year, 1986 (albeit for a variety of reasons).
(13) Lack of an outside source to blame for one's misery. J.F. Henry and A.F. Short present evidence that when there is an external cause of one's unhappiness, the extreme response is rage and homicide; in the absence of an external source, the extreme response tends to be depression and suicide. Thus, while marriage and children are associated with a lower suicide rate, they are also correlated with a higher homicide rate.
Henry and Short also suggest that, as economic quality-of-life improves, homicide should decrease and suicide increase. Long-time suicide researcher David Lester found such a correlation when comparing 43 countries; and also when comparing American states.
However, national data are contradictory: it's easy to find countries with low suicide and low homicide rates (e.g. Great Britain and Greece); or high rates of both (e.g. Finland and Hungary). Furthermore, recent multi-national increases in suicide rates are roughly matched by similar increases in homicide.
In addition, there are high rates of both suicide and homicide in prison. Most jail (short-term) and prison (longer-term) suicide rates have been reported between 50 and 200 per 100,000 per year, while the age-matched male rate in the general population was around 25. Jail suicide is more frequent than prison suicide.
Still, the Henry-Short hypothesis can be used to explain some counter-intuitive facts, such as the low suicide rate among Nazi concentration camp inmates, among African-Americans, and during wartime; though, as Erwin Stengel observed, "It is a melancholy thought that marriage and the family should be such effective substitutes for conditions of war..."
(14) Other. Most suicides have multiple causes.
Consider, for example, an existentialist with a serious illness who is devastated by a recent divorce and consequently suffering from "clinical major depression". He has a prescription for anti-depressant medication which makes him feel well enough to go out of the house. He goes to a bar, gets drunk, comes back and shoots himself with a loaded gun he kept in the bedroom.
None of his neighbors responds to the noise and he bleeds to death. What "caused" his death: physical illness, philosophy, divorce, depression, medication, alcohol, availability of a gun, or social isolation? Or, perhaps, none of the above: from a slightly different perspective, none of these factors caused the suicide; rather it is the pain associated with them (along with the unwillingness to bear it) that precipitates suicide.
"Reasons" cited for suicide change with the times. Dr. Forbes Winslow wrote in 1840 that the increase in suicide was due to socialism, and particularly, Tom Paine's Age of Reason. Additional causes he cited were "atmospheric moisture" and masturbation, "a certain secret vice which, we are afraid, is practised to an enormous extent in our public schools." He recommended cold showers and laxatives.
The Question Of Intent In Suicide Attempts
"The survivor of a suicide attempt act is regarded by the public as either having bungled his suicide or not being sincere in his suicide attempt intention. He is looked upon with sympathy mixed with slight contempt, as unsuccessful in an heroic undertaking. It is taken for granted that the sole aim of the genuine attempt is self destruction, and therefore the dead are successful and the survivors unsuccessful.", Erwin Stengel.
People who carry out acts lumped together as "suicide attempts" actually have a variety of motives, and combining various intents masks important differences. According to Louis Dublin, a respected statistician, almost a third fully intend to kill themselves; fewer than half of these succeed. Those that fail generally do so because of unexpected rescue, or, more often, mistakes in planning or knowledge. These people tend to use generally-lethal methods (guns, hanging, drowning, jumping) and are disproportionately older and male.
Another third clearly do not want to die. Their suicide attempt, more aptly called a "suicidal gesture", is a cry for help or attention. They're trying to change their circumstances or to influence important people in their lives, usually parents, spouse, or lover. They make every effort to be saved, often scheduling the attempt to coincide with the expected return of a would-be rescuer.
Of course, rescuers are sometimes delayed--or uninterested. Forensic texts provide some charming examples. In one case a woman took an overdose of barbiturates and pinned a note to herself saying, "If you love me, wake me up." Her husband came home around 10 p.m., saw the note, tossed it into the trash, and went out to a bar. When he returned early next morning, she was dead. The official cause of death was suicide. Criminal charges of homicide were considered, but not filed.
These suicide "attempters" are more likely to be younger and female, and use less lethal means than the first group, most frequently drug overdoses and wrist cutting. Note that a "failed" suicide attempt in this group is one in which the person dies, which is the opposite of failure in the previous group.
The last third are people tossing the dice. They are in such emotional pain, rage, or frustration that they don't much care if they live or die, as long as the pain stops. They tend to be impulsive, not plan carefully (if at all), and leave their survival to chance. In another study, of 500 suicide attempts, only 4% were described as "well-planned", but only 7% turned out to be more-or-less harmless.
The relationship between the seriousness of someone's intent to kill herself and the lethality of the attempt is controversial. While it would seem intuitively plausible that the more seriously one intended to die the more lethal the resulting suicide attempt would be, numerous studies have reached contradictory conclusions: some have found an association, others have not.
The debate is more than academic. If the connection between serious intent and lethality of attempt is real, it implies that suicide prevention strategies that focus on decreasing the availability of lethal methods (e.g. gun-control laws) will fail, because people wanting to die will simply switch to other, similarly lethal, methods such as hanging.
If, on the other hand, there is no good correlation between intent and lethality, then a decrease in the availability of lethal methods will be effective in decreasing suicides, because serious (but not fully rational) attempters will tend to switch to methods of lesser lethality.
Other evidence suggests a third possibility, that impulsivity or depression might have the best correlation with use of lethal methods; and that these in turn, are associated with neuro-chemical imbalance.
Suicide In The Elderly And Other Groups
Statistics
The elderly (defined as those over 65 years old) have, historically and currently, the highest suicide rates in most, but certainly not all, countries of the world.
The death rate in adolescent suicide attempts is roughly 2%; among men over 45 years old, R. W. Maris found 88% of first-time attempts are fatal. Other estimates are lower, but still on the order of 25-50%, though psychiatrist Herbert Hendin, questioning these numbers, points out that there seem to be many more elderly survivors of suicide attempts than there are suicide deaths in this age group.
Despite recent decreases in old-age suicide frequency and increases in youth suicide, the suicide rate for the elderly in the U.S. is still more than 50% higher than that of 15-24 year-olds.
26 percent of the population is over 50 years old; 39% of suicides are from this group, a rate 1.5 times the national average. White males over 50 years old are about 10 percent of the population, but 33 percent of the suicides in the U.S. Elderly white males have a suicide rate 5 times the national average.
Among people over 65 years old (12% of the population), the suicide rate was about 22 per 100,000 (21% of suicides) in 1986, or almost twice the national average. The actual rate for the elderly is probably a good deal higher, since, "Many deaths from suicide are never investigated and are reported mistakenly as accidents or deaths from natural causes, particularly when the victim was old."
The annual suicide rate for elderly women (6.7/100,000) is lower than that for middle-aged women (7.9/100,000), and about one sixth that of elderly men (around 40/100,000); however the rate for women is relatively under-reported, since they tend to use methods (e.g. overdose) that leave room for other verdicts. Since American men most often use guns, these deaths are harder to attribute to "natural causes".
Nevertheless, the fact that American male suicide rates peak in old age while female rates are at their maximum during middle age is difficult to explain. The unpleasant realities of old age, increasingly poor health, death of a husband or wife, relegation to a nursing home, fall more frequently on women than men, due to the former's greater longevity.
On the other hand, women are generally better than men at maintaining social and family contacts. And men, due to the higher status and more competitive nature of their activities (e.g., business, sports, war) lose more social standing to the infirmities of old age than do women, who generally have lower rank and thus less distance to fall.
Reasons for these high rates seem to include:
(1) social isolation and loneliness, especially among widowers.
(2) physical isolation: because many old people live alone, a suicide attempt may not be discovered soon enough to survive it.
(3) the accumulation of losses, such as friends, physical and mental abilities, social status, and health.
(4) the elderly use more lethal methods than do younger people.
(5) old people are less likely to survive any given level of injury than are younger, healthier, ones.
Some specific reasons were identified among elderly suicides from the Miami area. The single most-cited cause was "physical health concerns", which were more frequent than the next two reasons ("depression" and "unknown") combined.
Such health concerns are not necessarily accurate. In one study of 248 suicides, more people (8) killed themselves in the mistaken belief that they had cancer than the number of suicides who, in fact, had terminal cancer.
The real rates are probably a good deal higher than the official ones. This is because many drug overdoses have no witnesses, no wounds, and look like a natural death. Since serious pre-existing illness is common in the elderly, such deaths are particularly likely to be misdiagnosed as "natural." In one study, 15,000 autopsies in apparently-natural deaths were reviewed. 764 (5.1%) bodies contained enough poison to account for death.
About half of the elderly who commit suicide are "depressed", but depression is common amongst old people. Both psychiatric and physical illness are more common in elderly suicides than in younger ones, whose deaths are more often precipitated by relationship, school, job, or jail problems. Between 60 and 85 percent of elderly suicides had significant health problems and in four out of every five cases this was a contributing factor to their decision. On the other hand, non-suicidal elderly had similar rates of physical illness as the suicidal.
Does depression affect willingness to accept treatment for other medical problems? In one study, depressed patients were less inclined than non-depressed ones to want medical treatment when the likelihood for improvement in some physical disease was good, but there was no difference between the two groups when the prognosis was poor. It seems that both groups were equally realistic about a poor prognosis, but that the lower quality-of-life and hopes-for-the-future among depressed patients decreased their willingness to seek or accept help when the probability of improvement was good.
This is consistent with other data. For example, a survey of elderly (60-100 years-old) visitors to senior centers in Indiana found that depression, low self-esteem, and loneliness were not associated with a decision to end their lives if faced with terminal, or debilitating chronic, illness. Again, both the depressed and non-depressed elderly were similarly pragmatic about their options under these circumstances.
However, when the severity of the depression is taken into account, differences appear. Elderly patients who were hospitalized for major depression were asked, before and after anti-depressant medication, whether they wanted life-sustaining treatment for their current physical health problems and for two hypothetical physical illnesses.
In the relatively "mild" to "moderate" cases, remission of their depression did not increase their willingness to accept medical intervention; however in the most severely depressed people, it did. This suggests that people in the midst of severe depression should probably not make life-and-death decisions, because their views are likely to change after anti-depressant treatment.
Poverty is not a good suicide predictor. Sweden and Denmark both have high per-capita income as well as comprehensive social welfare for the aged. They also both have high suicide rates among the elderly, as well as in the general population. Greece and Mexico, which have a far lower (economic) standard-of-living than Sweden and Denmark, have particularly low rates, though higher in the elderly than in the general population. Interestingly, during times of economic prosperity, the elderly suicide rate goes down while the suicide rate of younger adults goes up in the U.S.
A final observation: suicide notes left by the elderly tend to show a desire to end their suffering, rather than dwell on interpersonal relationships, introspection, or punishing themselves or others, which are common themes in younger suicides.
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from suicide and attempted suicide by geo stone.