On suicide, and what it tells us about our social and economic policies

Society is ill-served by our narrow definition of suicide. Suicide is more widespread than our definition would like to admit – “the act of an instance of taking one’s own life voluntarily and intentionally.” This definition is confined to self-inflicted, real-time incidents, counting only those who summarily end their own lives and understates reality, allowing us to overlook the human toll the world we’ve created socially, economically, medically, educationally, and environmentally takes on many of our citizens. It also understates the recently reported escalation in suicides, notably among middle-age women. From 2000 to today, the reported suicide rate has risen 25%. If we understood and defined suicide for what it is, the escalation would be significantly higher.

Those contemplating suicide face daunting questions. Will I have the courage? How do I do it? How can it be painless and instantaneous? How do I protect my loved ones from the aftermath or my death or from guilt? Suicides generally want to spare their family the sight of suicide’s aftermath.

The decision that life is no longer worth living can be the result of clinical depression or it can be understood as a direct reflection and harsh judgment on the communities we create as human beings… the sexually abused child who turns to drugs or gorges herself on food to make herself less sexually attractive to predators, one suffering from mental health issues with no access to healthcare, the laid-off worker left behind by automation or job-migration with no understanding of how to begin again, the impulsive teenager who succumbs to peer pressure or over-prescription by his dentist or doctor and becomes addicted to opiates until he can no longer afford them and moves to heroin or fentanyl.

These slow-moving suicides-by-lifestyle are equally decisive suicides but are not counted, as they often reframe the would-be suicide as a victim rather than a self-aggressor. Suicide-by-addiction is a powerful example. At what point does someone addicted to any substance – drugs, food, alcohol, tobacco, danger / adrenaline – abandon hope of recovery and embrace the fatal outcome?

Nor do suicides-by-consignment such as death-by-cop, death-by-car, death-by-suicide-bomb make the statistics, as these events consign the execution to others. These suicides decide to end their lives but leave it to another to complete the job with the same result… the driver who swerves in front of a semi, the person who draws a gun on a policeman, the kid with no vision for any future who dons an explosive vest in the hope of being remembered as a martyr.

Much has been written about suicide-by-lifestyle without naming it as such. Our shift to outcomes-based compensation in health care will need to account for those who have given up on self-care and decided to tacitly commit suicide with drugs, food, or liquor until their lifestyle achieves their goal. These are the suicides we are reluctant to count.

We are ill-served by our limited understanding and definition of suicide, as it is a critical metric of community well-being. Religions and governments have long condemned suicide. Catholicism considers it a mortal sin and until recently it has been a crime in the U.S. In modern times, the Church has softened its stance on consignment to hell, denial of last rites and burial in consecrated ground, acknowledging humankind’s inability to fairly judge the psychic pain or mental illness that leads one to suicide.

Nor is suicide a federal crime any more, parsed legally now into self-inflicted suicide, medically assisted suicide, and euthanasia, the last of which is illegal in all states. Medically assisted suicide or “death with dignity” is provisionally legal in California, Vermont, Washington and Oregon. Suicide, as we have understood it, is no longer prosecuted…irony abounds.

But in general, our culture still disapproves of suicide, regardless of what life would be like for the individual. Experts agree that medical heroics at the beginning and end of life account for half of all healthcare costs. The advent of advance directives is changing this culture for the better and offering people more end-of-life choices.

While our moralistic view of suicide has changed over the years, if not our tracking of it, suicide is the daily choice of many including the famous, such as Graham Greene, Jack London, Edgar Allan Poe, Sylvia Plath, Virginia Woolf and Hemingway. Modern philosophical and artistic works have tried to remove the stigma of suicide, if not justify it as a personal choice. The writer Arthur Koestler and his wife who committed suicide together come to mind.

We understand suicide as a personal decision made for private reasons. What we are less understanding about reluctant to admit is that it is also a reflection of the communities we create.