Deconstructing 'Myths About Suicide'

Author Thomas Joiner

Author Thomas Joiner is a professor of psychology at Florida State University. He also authored Why People Die By Suicide. Ray Stanyard hide caption

itoggle caption Ray Stanyard

There are many myths about suicide: that it's an act of selfishness, that it's cowardly, that it's just a cry for help.

Psychologist Thomas Joiner has studied suicide his entire professional life — and says much of what we assume about suicide is wrong. In Myths About Suicide, Joiner explains why we have so many misconceptions about this heart-wrenching facet of human behavior.

With better understanding, Joiner says, we can do a better job of preventing suicide — and supporting those it leaves behind.

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NEAL CONAN, host:

This is TALK OF THE NATION. Im Neal Conan in Washington.

More than 30,000 Americans commit suicide every year. Many thousands more try. And we've developed a series of beliefs about what kind of people decide to kill themselves and why - that it's the coward's way out, an act of selfishness or revenge; that for some, it's just a cry for help or for others, an act of impulse.

All, as it happens, are wrong, according to Thomas Joiner, a psychologist who has studied suicide his entire professional life. And he goes on to argue that if we better understand who, how, why and when, we can do a better job to prevent suicide, or support those who it leaves behind.

If your life has been touched by suicide, what misconceptions have you encountered? What would you like others to better understand? Give us a call, 800-989-8255. Email us, talk@npr.org. And you can join the conversation on our website. Thats at npr.org. Click on TALK OF THE NATION.

Later in the program, the apparent anachronism at the entrance to high-rise apartment buildings - in defense of the doorman. But first, Thomas Joiner joins us, distinguished research professor at Florida State University. His latest book is "Myths About Suicide," and he's with us from the studios of member station WFSU in Tallahassee. Thanks very much for being with us on TALK OF THE NATION.

Professor THOMAS JOINER (Florida State University): I love the show, Neal, and I'm happy to be with you.

CONAN: Thank you. I know you've been researching suicide for a couple of decades now, but your life was personally touched on it as well. Your father took his life when you were in graduate school. And I wonder, how did that inform your studies?

Prof. JOINER: Well, beyond the shock and the misery of it, it made me want to go to war. It made me want to get revenge. The way I think about it is, this thing killed my dad, and so it's a point of honor for me to try and kill it. Now, of course, that's not possible to do, you know, directly, and so my weapon in this war is science. And I've poured myself into the science of studying the neurobiology and the psychology of suicidal behavior.

CONAN: And it's interesting the way you phrased it - this thing killed your father, not that he killed himself.

Prof. JOINER: Well, I think both are true. He did kill himself, and there's no denying that. People who kill themselves, though, are influenced in doing so by mental illnesses, and these illnesses themselves are widely misunderstood, subject to many myths. But make no mistake, they're forces of nature. They're grave. They're severe, just like heart disease, cancer and stroke. They kill a million people every year - through - suicide worldwide.

CONAN: And here's a question that I think is, I think we'll be getting a lot like this from our audience, this an email from Will(ph) in Ann Arbor. My mother took her own life when I was 13 years old. I came home from school and found her locked up in the garage with the car engine running. I tried to revive her but couldn't.

I didn't know what to think at the time. Now, 45 years later, I think suicide is the most selfish act one can commit.

Prof. JOINER: It certainly seems selfish from the outside. I understand the sentiment. But the trouble is, in trying to reason about the suicidal mind from a non-suicidal place - that's basically where most of these myths come from.

What the suicidal person is thinking at the time is actually quite different from selfishness. Their idea is along the lines of, my death will be worth more than my life to others.

Now, if you ponder that sentiment, that's not selfish at all. In fact, if anything it's the opposite. It's very selfless. Now, let me make a key point about that idea that's in the mind of suicidal people. That idea is mistaken, but the tragedy, one of hundreds of many tragedies about this event - or this phenomenon, rather - is that the suicidal person doesn't know it's mistaken. They think the idea is true, and it spurs their fatal behavior.

CONAN: That's just one of the impulses. You say there has be sort of a long-term process by which a suicidal person inures themselves to the sheer difficulty of the act.

Prof. JOINER: That's right, Neal. I mean, I think that there are two main processes that have to develop, and that have to collide, to end in this catastrophe that is suicidal behavior. One has to do with the - I think very basic insight that death is inherently fearsome and daunting. Therefore, it requires a kind of fearlessness, a fearlessness specifically about physical pain, physical injury and death, in order to enact it. So that's one process that's unfolding. It takes time to develop.

So does the other process, which has to do with: Why would people desire suicide in the first place? And I think it has to do with states of mind having to do with the idea - two ideas, actually one, that you're a burden, and one other - that's what I meant when I was referring to death being worth more than life, kinds of thoughts. The other is that you're hopelessly alienated, cut off and isolated from others. When these two processes combine, the desire for suicide spurred by alienation and burdensomeness, when all when that collides with learned fearlessness, that's when you see these catastrophes.

CONAN: And yet you think of the story, the famous writer Raymond Chandler once described how he went into a shower stall and put a gun to his head and missed three times - and then decided that probably, he didn't really want to kill himself, and went on to write some great books.

But nevertheless, it is so difficult for some people to go ahead and finish the act.

Prof. JOINER: I would respond, of course it is. Of course it is because this is such a fearsome and such a daunting thing. I mean, if you just -consider the following true-false question. True or false: Death is a fearsome prospect. Virtually all your listeners will answer that question with true.

And therefore, if you try to stare down death, it's going to be a struggle. It's going to be a fight. Our bodies are wired for survival, and even desperately suicidal people are in for quite a fight if they're going to try to enact suicide. In fact, there are many anecdotal stories just of that sort, where someone is desperately suicidal, they've truly wanted to die, and yet their bodies wouldn't let them.

CONAN: We're talking with Thomas Joiner about his new book, "Myths About Suicide." 800-989-8255. Email us, talk@npr.org. Karen's on the line from Syracuse.

KAREN (Caller): Hi, Neal. I - this is a great topic. I've tried, actively tried twice. I've been, had suicidal thoughts and feelings for, God, over 20 years now, and I've been hospitalized twice. And the last time I went in the hospital, I was so bad I basically told them: If you can't help me and you can't help me save myself, then I need to go home now because I need to finish this. I'm just done.

And I found that for me, it was a weariness. I did feel burdensome to myself and to other people, but I was just so weary of fighting this fight that I couldn't seem to win.

CONAN: And that was a fight with what?

KAREN: With depression and suicidal thoughts. I just felt like, I can't fight this anymore. You know, I'm just exhausted by it.

CONAN: Thomas Joiner, does that sound familiar?

Prof. JOINER: Absolutely. These illnesses are exhausting. They're very grave. They're forces of nature, and they do cause all sorts of reactions: weariness, emotional pain, hopelessness, and on and on and on.

The point of my work has been to try to get more specific about among all that mixture of angst and misery, what is it specifically that spurs suicidal behavior? And my answers have been burdensomeness and alienation.

CONAN: Does that sound right to you, Karen?

KAREN: I would agree with both of those. And I did have another interesting experience. A person in my family committed suicide, and I saw what it did to the rest of my family, and I felt like at that moment, it took that option away from me. And I grieved that. I grieved that I didn't feel that I could any longer even entertain that, just because I saw what it did firsthand.

CONAN: Because even though that person may have believed they were a burden on their friends and the family, when you saw the reaction to what they did, that wasn't it at all.

KAREN: Exactly, and when I saw how my family was injured by that, just so desperately hurt by that - and I grieved that this person took that away from me as an option now.

CONAN: Karen, did you get some help?

KAREN: I did. I was hospitalized for a couple of weeks, and I've worked very steadily ever since, and I'm doing great.

CONAN: Hang in there, Karen.

KAREN: Thank you so much.

CONAN: Appreciate the phone call. It's interesting. Some people say, you know, if people are determined to kill themselves, nothing's going to stop them.

Prof. JOINER: False, quite wrong. Barriers stop them, bridge barriers do. The jury is in on literature that's summarized by the phrase means restriction; in other words, restricting access to lethal means.

And bridge barriers are a great example of that. If you put up a barrier at a bridge where it's a high enough place that people would die should they jump off, what happens is that deaths, of course, at that bridge go down dramatically. But here's the key point: They don't go up at other bridges, and they don't go up using other methods.

So means restriction is an extremely important and just widely underappreciated means of suicide prevention and public health policy.

CONAN: There was a documentary done about the San Francisco - the Golden Gate Bridge there, where I think it's something - over 1,000 people have used to kill themselves. And one of the things the filmmakers did was just to film everybody who was walking across for the course of a year. And you reference this documentary several times in your book.

Prof. JOINER: Well, one of the striking things that the filmmakers observed is that they really had no idea who was who. I mean, going into that film, they had the idea that they could probably spot vulnerable people, and they found that they were mistaken about that.

And this illustrates another truth, and contradicts another myth, about suicide, and it's that these deaths, they are often hard to see coming. They can come out of the blue from people who outwardly seem like they're doing OK, seem like they're going to work, seem like they're functioning normally. But inwardly, they're in desperate misery.

And so the death seems to come out of the blue to everyone else, but if we had private access to that person's thoughts and feelings, you'd see a misery lasting for weeks, sometimes months or even longer, and you'd also see a planning process about the death itself.

CONAN: So it's not an impulsive act.

Prof. JOINER: Absolutely not. This is one of the most entrenched myths of all, that researchers will repeat it, clinicians will repeat it, but it's not true. If you ponder death, really at how fearsome it is, how daunting is, to imagine that people would just, on a whim, on the spur of the moment, be able to engage in something that dramatic and that fearsome, I just think it completely misunderstands human nature; that rather, what happens is that there's a long process building up to it.

Now again, it can seem to others to come from out of the blue, but that doesn't mean that it really did.

CONAN: Even something, as we referenced in the piece of tape in the start of the program, something as devastating as: I've been wiped out by the crash of 1929, there's nothing left for me.

Prof. JOINER: Right and well, but I would say that in events like that, there are literally millions of people who are similarly affected, but only a few, relatively speaking, attempt suicide, much less die by suicide. It's the vulnerable people who we need to be careful about.

CONAN: Thomas Joiner is with us. We're talking about the myths and the truths about suicide. More of your calls in just a moment, 800-989-8255. You can also join us by email. The address is talk@npr.org. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. Im Neal Conan in Washington.

Nine years ago, I was presented with a choice, Thomas Joiner writes in his new book. The person who presented the choice was my son Malachi(ph), 3 years old at the time. The choice was whether to lie to him or not. He said something along the lines of, I have a father, why don't you? Not all make the choice to be honest about death by suicide, sometimes with devastating consequences.

Thomas Joiner did tell his son the truth. Joiner is a psychologist who spent his career trying to understand suicide, what he considers the most stigmatized of all human behaviors. Even psychologists can have a difficult time discussing suicide frankly.

You can read more about why that's the case in an excerpt from the book "Myths About Suicide," at our website, npr.org. Click on TALK OF THE NATION.

If your life has been touched by suicide, what misconceptions have you encountered; 800-989-8255. Email us, talk@npr.org. And here's a tweet that we have from Mein Lee(ph): My godchild committed suicide. It's amazing how many people think the family should be normal after a year or so.

Prof. JOINER: Well, it's amazing how many misunderstandings the families of bereaved people have to cope with. It's endless, really, and that's one of them. This is a devastating, massive blow to families. The people, in a sense, they never really get over it. I mean, you can certainly cope. You can certainly go on. You can certainly learn to adapt. But the memory of it, the pain of it, it'll lessen - for sure - with time, but it never really goes away.

And all of that is just compounded by some of the - frankly appalling reactions that people have to the bereaved of suicide decedents. It's just such a stigmatized and misunderstood thing that the family members left behind have really, really quite a burden to carry.

CONAN: Give us some examples of what you're talking about.

Prof. JOINER: Well, I mean, you mentioned the lying aspect of it, and how I dealt with that with my son, Malachi. He's 13 now, he's doing great. In fact, he's on a field trip to New York City right now.

And you know, the lying is - I guess in a sense, it's understandable because it's such a complex topic, but my view on that was that I didn't want to have to sit, you know, across from my son and have him figure out eventually that I lied to him, not only about that he might think, but if his dad were to lie to him about something like that, what else is his dad lying about?

So I know it's hard to be truthful. I went through this myself many times. It is very hard, but it's worth it, in my judgment. You know, there are other glib things that people say in the wake of a suicide, things like it was God's will, things of that nature. They're just -just not helpful things.

Here's what is helpful: act right, just like you would if one of your friends, or someone you know, lost a loved one to heart disease or to cancer or to stroke. You do the natural things. Well, you should do the natural things with these deaths, too.

CONAN: Let's go next to Ben(ph), Ben calling us from Provo.

BEN (Caller): Thanks, Neal. I was telling your screener about my family history of suicide and, I mean, I could talk about glib remarks that people make. But the thing that comes up to me is, I don't see how your guests on the series, I guess, speak to a possible genetic background to it.

I mean, my mother was suicidal for years. She was finally told by a counselor to anchor herself to something in this world. She anchored herself to my brother and I. When my brother killed himself, it just about killed her. And then my dad killed himself. And then my sister killed herself.

And myself and my younger sister have both had suicidal thoughts at times. I only stepped back from the edge when the Army doctors at the hospital I was in told me that if I didn't eat, they would put a feeding tube in me and make my mother take them to court to take it out. And my sister has told me that she has only not done it because she knows how badly it would hurt our mom.

So I just wonder about that. Like, where is that genetic component in this?

CONAN: And Ben, we're so sorry about the situation with your family, and I know how difficult this call is, but anyway, Thomas Joiner?

Prof. JOINER: Well, I add my sympathies to yours. These illnesses are forces of nature. They take a grave toll. I would just encourage Ben, by the way, to keep fighting because despite how severe these illnesses can be, they are treatable, and it takes a fight to treat them. It takes persistence and patience, but it definitely, definitely is worth it. They're treatable and preventable in the vast majority of cases.

As to the genetic component, there's no doubt about it. The studies are clear that these behaviors run in families, and the reason that they run in families is largely because of genes.

My work has been to say, OK, there are all sorts of risk factors for suicidal behavior. There are genes. There are mental disorders. There are personality characteristics. There are early life experiences, and on and on and on. In fact, you can count up 200 such risk factors if you were inclined to.

My work has been to say: How is it that that diverse array of factors exert influence on this one behavior? And my answer has been that all of them operate via the three aspects of my model - which, again, are learned fearlessness, burdensomeness and alienation.

BEN: So people have specific genetic characteristics and environmental characteristics that would make them more susceptible to those three factors?

Prof. JOINER: I think that's a fair way of summarizing it.

BEN: OK, great.

CONAN: Ben, good luck.

BEN: Thank you.

CONAN: Appreciate it. Here's an email from Wade(ph) in St. Louis: How does the author distinguish the differences between the 9/11 World Trade Center victims who joined their hands and leaped to their death, and the typical, more-thought-out suicides that some people choose? Would you characterize those as suicides?

Prof. JOINER: Two thoughts about that. The New York City medical examiner did not. He - and I agree with this, he identified all such deaths as homicides. Those people were murdered on 9/11. That's my main view of it.

I would say, though, that my theory has the capacity to reflect - or sorry, to illuminate what you might call quasi-suicidal phenomena, things like suicide terrorism, things like what happened at the World Trade Center, things like the fact that a kind of suicidal behavior tends to exist - actually throughout nature, not just in people.

We can get into this a little bit if you like, Neal, but my model is able to shed at least some light on that, whereas I think past models struggle with that, with those kinds of quasi-suicidal, to coin the term perhaps, phenomena.

CONAN: Well, briefly, I mean, I think some people would put suicide bombers or kamikaze pilots in a different category.

Mr. JOINER: I would, too. I mean, we could leave it there. That would be easy. But people do tend to press me on this point, which I understand, and so OK, let's try to understand what is the commonality between, say, suicide terrorism and somebody who is dying by what you might call conventional death by suicide?

The main commonality - there are others - but a very important one is that they both have the same mental calculation in mind; namely, my death will be worth more than my life to others, whether it's family, in the case of suicide terrorists, I assume it's society. That that one that those really different phenomena, conventional death by suicide and suicide terrorism, that they're both underlain by the same principle of, my death will be worth than my life. To me, that points to the fundamental aspect of that calculation in all suicidal phenomena.

CONAN: Let's go next to Keith(ph), Keith with us from Nashville.

KEITH (Caller): Good afternoon, first-time caller. This is a very personal, touchy subject that has touched my life. I'm a survivor of suicide. My father committed suicide in 1992, as well as his brother.

Being the son of a pastor, growing up in Alabama, it was quite shocking to our family. But my opinion is that life can go on. You do recover. To some people, suicide comes as a surprise when it happens to a family member. To others, it is not a surprise.

For my family and I, it was not a surprise. My father had an addiction. For me, personally, I realize that there is that genetic predisposition. It's something that I watch very carefully. I realize that where my father had a prescription addiction, I wound up having alcoholism. I am in recovery. I have eight years sober in October.

But your life does get better. You know, there are so many vicious cycles that you go through after someone commits suicide. There's anger. There's sadness. There's disbelief. And then it just starts all over again.

CONAN: Well, your father was a pastor, Keith, which - that's kind of a special category.

KEITH: Yes, it was. It was a very special category. We led one life for the community. There was a totally different life behind closed doors. My father was abusive. He would...

CONAN: And how did the congregation respond?

KEITH: Actually, after it happened, everything came out in the open, and people in the congregation were aware of the addiction. They were aware of the abuse in the family. They actually - several people said, well, you know, if you were going to do nothing, why should we do anything? It was basically ignored. It wasn't discussed.

So many people don't want to discuss something. If you don't discuss it, it's not going to go away, and you can't be afraid to discuss something like that. If you're sad, if you're having a problem, if you're thinking about it, you should discuss it with someone. But so many people in that situation certainly aren't going to discuss it.

It's scientifically proven that men are more likely, when they attempt suicide, to be successful. You know, but another point that I will make is, you know, sometimes it does actually take someone's death for someone else's life to get better.

CONAN: It can cause some people to think again about their place in the world in something like that. But I sure wouldn't put it that way, Keith.

KEITH: Well, what I mean by that, in my case specifically, was my mother was no longer physically abused.

CONAN: Well -

KEITH: And - but it's a tragic thing.

CONAN: There would've been other ways to accomplish the same end that did not require somebody to die. It's...

KEITH: Absolutely correct. It was a very tragic thing. But what I want people to know is that life does go on. You will recover. You need to talk to people. You know, if you've lost someone to suicide, it's not your fault.

CONAN: Keith, thanks very much and again, we're sorry for your loss.

KEITH: Thank you.

CONAN: All right. Bye-bye. Let's see if we can go next to - this is -let's go instead to Molly(ph). Molly is with us from Kalamazoo.

MOLLY (Caller): Hi.

CONAN: Go ahead, please.

MOLLY: I lost a friend about four years ago to suicide. He was an alcoholic and he was on antidepressants. And when the two combined, it was really nasty. And he was - wonderfully sweet person all the time, except as soon as he started drinking, especially after he got put on antidepressants, he just came - became a different person. It was just really scary.

CONAN: Hmm. That's not uncommon. And how did him - his friends and family respond to his death?

MOLLY: It was actually kind of strange. He was my - he's my ex-boyfriend and he was my first love and after that, we became really close friends. And then his family and I, and his other really good friends from high school, we weren't - I can't - I don't want to use the word supportive, but we were understanding. We'd always tell who didn't know him that well because those were the ones that were really like, angry and calling him selfish. But we knew how much he'd been suffering, and how hard he had been trying and for how long. And I think everybody just kind of - his brother, I think, said it best when he said that he's happier now.

CONAN: Well, again, I'm not sure that's quite right, either. There might have been other ways to accomplish that same end.

MOLLY: Well, we definitely - I mean, he definitely tried. And believe me, if there was another - like, if there was something I could've done more, then I definitely would've done it.

CONAN: Oh, no. I'm not blaming you, Molly. I'm just saying that...

MOLLY: Oh, no, no, no, I know. I know. Sorry. I'm just saying it's - he did try a lot and it's his - I don't want to say, like - I know I'm sure it was thought out, but I don't know if it was necessarily - like it was - it seemed somewhat impulsive because it was - he didn't tell anybody, he didn't call anybody. Just one day, it was Easter, just decided to do it. And we miss him a lot, but I know we all kind of - it was his decision, and we wish there was something we could've done more, but...

CONAN: I think we can all agree with that. Molly, again, sorry for your loss. Thanks very much for the call.

MOLLY: Thank you.

CONAN: We're talking with Thomas Joiner about his new book, "Myths About Suicide." You're listening to TALK OF THE NATION from NPR News.

And I wanted to ask you - you were talking earlier about how difficult this is to do. We see a phenomenon, which I guess is - at least in terms of reading about it - relatively new: suicide by cop.

Prof. JOINER: It's a rare phenomenon where people induce police officers to shoot them, perhaps as a way to accomplish suicide. Incidentally, this is very hard on police officers who are involved in such incidents.

CONAN: Sure.

Prof. JOINER: And it - but it does speak to one aspect of my work, which is this fearlessness aspect that's required. Death is so daunting that some people are just unable to enact it and so they resort to inducing other people to kill them. I do want to make one quick comment, Neal, about antidepressant medicines.

CONAN: Yeah.

Prof. JOINER: I don't believe it's helpful to say that they kill people - quite the contrary. They save people. They're very effective treatments for mental disorders. Sure, some people have individual reactions to them just like with any medicines, but they're helpful by and large.

CONAN: Let's go to Greg(ph). And Greg's on with us from Manteca in California. Am I pronouncing that right?

GREG (Caller): Manteca.

CONAN: Manteca. Go ahead please.

GREG: Well, I attempted suicide. A couple of things. I wish could take people to the point where I was at in suicide without actually having to go attempt it. It's amazing, in a lot of cases, where you find out that people that you didn't think care, cared. My stepson-in-law, when I was in the hospital, walked up to me and said, here's a reason to live right there, and handed me a picture of my nephew.

And it does give you a fearlessness in a way, having survived it, that I fear - I don't fear a lot of the things that I used to fear. A lot of the things that used to bother me, don't bother me. One of the scary parts is the fact that we've tried to make suicide easier for people. There is a book out that tells you how to do it. It's used for assisted suicide, but that's - I went and ordered that book and followed the directions, but fortunately, it didn't work.

CONAN: I wonder, Greg, do you keep that picture around?

GREG: I do.

CONAN: Where is it; in your wallet?

GREG: It's in my wallet.

CONAN: Do you take it out from time to time?

GREG: I do, and I still talk to them from time to time. You know, it's -like I said, it's amazing because when you're at that point, you have alienated yourself from people, and you may have been alienated slightly by nature, and you tend to withdraw more and more. And you - like I said, I figured if I died, the only people who would find out was when I didn't show up for work.

CONAN: And it was so much more, as it turned out.

GREG: It was so much more. It makes a big difference. And like I said, it's - if people could realize the things around you, but you tend to blind yourself to all of the things because you're focused on your misery and what you think you're doing. And you think you're doing it for the best of reasons, that no one will miss you or that you're going to help out in a situation. And someone likened it to taking out - your relationships, and taking and throwing a hand grenade into the room. Everybody gets hurt. It's amazing. But it's - it made a big difference in my life, actually, and it's helped a lot. And if I - like I said, if I could figure out how to take people to that point without having to commit the suicide, I mean, it's amazing what's out there.

CONAN: Greg, thank you very much for the call. And we're glad that picture showed up in your life.

GREG: Thank you.

CONAN: Bye-bye.

GREG: Bye.

CONAN: We just have a few seconds left, Tom Joiner, but I think Greg's call says a lot.

Prof. JOINER: Well, it's the flip side of what I was referring to earlier. I was earlier referring to the appallingly glib things that people do. But there is a flip side to that, and it's that people really - some people, that is - really come through for you in ways that save your life.

CONAN: Thanks very much for being with us today.

Prof. JOINER: Thank you. My pleasure, Neal.

CONAN: Thomas Joiner's book is "Myths About Suicide," and he joined us from the studios of member station WFSU in Tallahassee in Florida.

Up next, James Collins joins us to argue we don't need doormen, but that's precisely what makes them so valuable. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

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Excerpt: 'Myths About Suicide'

Cover of 'Myths About Suicide'
Myths About Suicide
By Thomas Joiner
Hardcover, 304 pages
Harvard University Press
List price: $25.95

Those who have recently lost a loved one to suicide are stunned by many things following their loss, including the profound change in their address books — once trusted friends fall away after ignoring a loved one's suicide or after saying hurtful and appallingly glib things like "It was God's will." Of the many survivor anecdotes that have touched and moved me over the years, a memorable one came from a powerful Southern man who had been "comforted" by hearing that his son's death by suicide was God's will. In reaction, he thundered in his drawl: "It was NOT God's will that my precious son shot himself in the head." Good for him that he said that; I wish I had said more such things (though I said some, no doubt) in reaction to the inanities I heard after my dad's death by suicide. In Shakespeare's Hamlet, Ophelia has died, and a priest would deny her full funeral rites because she died by suicide. Her brother responds, "I tell thee, churlish priest, a minist'ring angel shall my sister be, when thou liest howling." Most people bereaved by suicide can identify with this sentiment.

A May 2007 case in Oklahoma involved the family of a young woman who had died from a gunshot wound to the head. It was not clear if the wound was self-inflicted or not, but the family felt determined to show that it was not, and to have an insurance company pay death benefits. A judge decided that the insurance company's lawyer did not adequately demonstrate the manner of death as suicide, and ordered them to pay the family (which they would have had to do anyway, as long as the death by suicide occurred more than two years after the policy was initiated. That is the standard policy, at any rate). The family's lawyer was quoted as saying, "It wasn't about the money ... This is about clearing a daughter's name of the stigma of having committed suicide."

Really? It's more about clearing a stigma than about finding the woman's actual killer?

Psychiatrists and psychologists — highly trained, doctoral level mental health professionals — sometimes whisper about or panic about or skirt around the issue of suicide, an aversion that has always puzzled me, and one that strikes me as similar to a surgeon being afraid of blood. I know about this too: I'm a clinical psychologist who specializes in the understanding and treatment of suicidal behavior. Why this profound stigma? For any stigma, the usual ingredients are fear and ignorance. If suicide is special in the degree to which it is stigmatized — and I and others believe it may be — then it is simply because the fear and ignorance are so great. Stigma about suicide should be reduced, of course, and it is a point of this book to do so, but I think it should be reduced via a decrease in ignorance, not in fear. I would prefer to leave the fear of death by suicide more or less intact. Fear can be quite healthy, and its absence can be deranged. Some of the most consistently fearless people are the most dangerous and disturbed.

Fear of injury and death, and of self-injury and self-inflicted death in particular, is natural and normal. Fear is self-preservation's substrate. In his biography of Jack London, Alex Kershaw described the author thus: "he was aware that mankind's terror has always been its most basic emotion ... it has far deeper roots than love, tracing back to the days before history, when man was just another wild, frightened savage."

The self-preservation instinct is hard-wired and strong, and, as Voltaire understood centuries ago, relevant when it comes to understanding suicidal behavior. Voltaire wrote of the death by suicide of the Roman orator Cato, "It seems rather absurd to say that Cato slew himself through weakness. None but a strong man can surmount the most powerful instinct of nature." Centuries earlier still, the Jewish historian Flavius Josephus understood this as well; he wrote that suicide "is contrary to the instincts shared by all living things." This view is found as well in Camus' The Myth of Sisyphus, in which he states, "The body's judgment is as good as the mind's, and the body shrinks from annihilation." The simple but compelling idea that occurred to Voltaire, Josephus, and Camus is that one must first grapple with one of nature's strongest forces — self-preservation — before one dies by suicide.

Based in part on this insight, I developed a new theory of suicidal behavior (in the 2005 book Why People Die by Suicide). In my view people die by suicide because they have both the ability and the desire to do so. This may seem glib or superficial, and if things were left here, it would be. What is the ability to die by suicide and in whom and how does it develop? What is the desire for suicide, what are its component parts, and in whom and how do they develop?

Self-preservation is a powerful enough instinct that few can overcome it by force of will. The few who can have developed a fearlessness of pain and death, which they acquire through a process called "habituation." Formally, habituation is defined as "a response decrement due to repeated stimulation." Less formally, it can be defined as "getting used to something." In his Memoirs from the House of the Dead, Dostoevsky wrote, "Man is a creature who can get used to anything, and I believe that is the best way of defining him."

Getting used to pain, injury, and death — becoming fearless about it — is, according to my theory, a prerequisite for serious suicidal behavior. People get used to such things by having repeatedly experienced them, often through previous self-injury, but other painful experiences serve too. A corollary to this view is that the self-preservation drive — the fear of pain, injury, and death — protects people from death by suicide (which is why this fear should remain more or less intact). This corollary is supported time and again by cases of people who report that they genuinely desired to die by suicide, but that their bodies would not allow it (e.g., people have cut at their veins for hours, only to eventually surrender to their bodies' ability to clot the wounds).

Electronically reproduced by permission of the publisher from Myths About Suicide by Thomas Joiner, Copyright 2010 by the President and Fellows of Harvard College. All rights reserved.

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