But part of this sense of futility may stem from a peculiar element of myopia in the way we as a society have traditionally viewed and attempted to combat suicide. Just as with homicide, researchers have long recognized a premeditation-versus-passion dichotomy in suicide. There are those who display the classic symptoms of so-called suicidal behavior, who build up to their act over time or who choose methods that require careful planning. And then there are those whose act appears born of an immediate crisis, with little or no forethought involved. Just as with homicide, those in the “passion” category of suicide are much more likely to turn to whatever means are immediately available, those that are easy and quick.
Yet even mental-health experts have tended to regard these very different types of suicide in much the same way. I was struck by this upon meeting with two doctors who are among the most often-cited experts on suicide — and specifically on suicide by jumping. Both readily acknowledged the high degree of impulsivity associated with that method, but also considered that impulsivity as simply another symptom of mental illness. “Of all the hundreds of jumping suicides I’ve looked at,” one told me, “I’ve yet to come across a case where a mentally healthy person was walking across a bridge one day and just went over the side. It just doesn’t happen. There’s almost always the presence of mental illness somewhere.” It seemed to me there was an element of circular logic here: that the act proved the intent that proved the illness.
The bigger problem with this mental-illness rubric is that it puts emphasis on the less-knowable aspect of the act, the psychological “why,” and tends to obscure any examination of the more pedestrian “how,” the basic mechanics involved. But if we want to unravel posthumously the thought processes of the lost with an eye to saving lives in the future, the “how” may be the best place to look.
To turn the equation around: if the impulsive suicide attempter tends to reach for whatever means are easy or quick, is it possible that the availability of means can actually spur the act? In looking at suicide’s close cousin, murder, the answer seems obvious. If a man shoots his wife amid a heated argument, we recognize the crucial role played by the gun’s availability. We don’t automatically think, Well, if the gun hadn’t been there, he surely would have strangled her. When it comes to suicide, however, most of us make no such allowance. The very fact that someone kills himself we regard as proof of intent — and of mental illness; the actual method used, we assume, is of minor importance.
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The offices of the Injury Control Research Center are on the third floor of the Harvard School of Public Health building in Boston. The center, directed by David Hemenway, consists of an internationally renowned team of public-health officials, social scientists and statisticians, and over the past decade they have been in the vanguard of a movement that looks at suicide prevention in a new and very different way: call it the Band-Aid approach.
“One of the differences between us and those in mental health,” Hemenway explained, “is that we focus on the ‘how’ of suicide. What are the methods used? Is there a way to mitigate them? And that’s where examples like the British coal-gas story are very instructive, because they show that if you can somehow remove or complicate a method, you have the potential of saving a tremendous number of lives.”
Animating their efforts is one of the most peculiar — in fact, downright perverse — aspects to the premeditation-versus-passion dichotomy in suicide. Put simply, those methods that require forethought or exertion on the actor’s part (taking an overdose of pills, say, or cutting your wrists), and thus most strongly suggest premeditation, happen to be the methods with the least chance of “success.” Conversely, those methods that require the least effort or planning (shooting yourself, jumping from a precipice) happen to be the deadliest. The natural inference, then, is that the person who best fits the classic definition of “being suicidal” might actually be safer than one acting in the heat of the moment — at least 40 times safer in the case of someone opting for an overdose of pills over shooting himself.
As illogical as this might seem, it is a phenomenon confirmed by research. According to statistics collected by the Injury Control Research Center on nearly 4,000 suicides across the United States, those who had killed themselves with firearms — by far the most lethal common method of suicide — had a markedly lower history of depression, schizophrenia, bipolar disorder, previous suicide attempts or drug or alcohol abuse than those who died by the least lethal methods. On the flip side, those who ranked the highest for at-risk factors tended to choose those methods with low “success” rates.
“We’re always going to have suicide,” Hemenway said, “and there’s probably not that much to be done for the ones who are determined, who succeed on their 4th or 5th or 25th try. The ones we have a good chance of saving are those who, right now, succeed on their first attempt because of the lethal methods they’ve chosen.”
Inevitably, this approach means focusing on the most common method of suicide in the United States: firearms. Even though guns account for less than 1 percent of all American suicide attempts, their extreme fatality rate — anywhere from 85 percent and 92 percent, depending on how the statistics are compiled — means that they account for 54 percent of all completions. In 2005, the last year for which statistics are available, that translated into about 17,000 deaths. Public-health officials like Hemenway can point to a mountain of research going back 40 years that shows that the incidence of firearm suicide runs in close parallel with the prevalence of firearms in a community. In a 2007 study that grouped the 15 states with the highest rate of gun ownership alongside the six states with the lowest (each group had a population of about 40 million), Hemenway and his associates found that when it came to all nonfirearm methods, the two populations committed suicide in nearly equal numbers. The more than three-times-greater prevalence of firearms in the “high gun” states, however, translated into a more than three-times-greater incidence of firearm suicides, which in turn translated into an annual suicide rate nearly double that of the “low gun” states. In the same vein, their 2004 study of seven Northeastern states found that the 3.5 times greater rate of gun suicides in Vermont than in New Jersey exactly matched the difference in gun ownership between the two states (42 percent of all households in Vermont opposed to 12 percent in New Jersey). From these and other such studies, the Injury Control Research Center has extrapolated that a 10 percent reduction in firearm ownership in the United States would translate into a 2.5 percent reduction in the overall suicide rate, or about 800 fewer deaths a year.
Beyond sheer lethality, however, what makes gun suicide attempts so resistant to traditional psychological suicide-prevention protocols is the high degree of impulsivity that often accompanies them. In a 1985 study of 30 people who had survived self-inflicted gunshot wounds, more than half reported having had suicidal thoughts for less than 24 hours, and none of the 30 had written suicide notes. This tendency toward impulsivity is especially common among young people — and not only with gun suicides. In a 2001 University of Houston study of 153 survivors of nearly lethal attempts between the ages of 13 and 34, only 13 percent reported having contemplated their act for eight hours or longer. To the contrary, 70 percent set the interval between deciding to kill themselves and acting at less than an hour, including an astonishing 24 percent who pegged the interval at less than five minutes.
The element of impulsivity in firearm suicide means that it is a method in which mechanical intervention — or “means restriction” — might work to great effect. As to how, Dr. Matthew Miller, the associate director of the Injury Control Research Center, outlined for me a number of very basic steps. Storing a gun in a lockbox, for example, slows down the decision-making process and puts that gun off-limits to everyone but the possessor of the key. Similarly, studies have shown that merely keeping a gun unloaded and storing its ammunition in a different room significantly reduces the odds of that gun being used in a suicide.
“The goal is to put more time between the person and his ability to act,” Miller said. “If he has to go down to the basement to get his ammunition or rummage around in his dresser for the key to the gun safe, you’re injecting time and effort into the equation — maybe just a couple of minutes, but in a lot of cases that may be enough.”
This is the nonsense that comes about when you see the world through a keyhole -- you miss the big picture. And when you combine that inability to see the big picture with an inherent bigotry against guns, you lose the ability to weigh costs and benefits. You are blind to the life-saving benefits of guns, and only see their less savory uses.
Suicide has been a part of human history and the human experience for far longer than guns have been around. As the article notes, guns are used in less than one percent of suicide attempts. Which means that lots of people kill themselves (or attempt to do so) in lots of other ways. Always have, and probably always will. Heck, the fact that those using guns to kill themselves achieve an 80%+ success rate that exceeds other self-extinction methods would seem to be a testament to guns' effectiveness as a killing tool. The tool can be used for good or bad purposes, according to the will of the user.
Of course, nowhere in the article was there any semblance of balance in examining the potential life-saving benefits of guns, or to state the issue differently: the cost in human lives of some of the proposed "solutions" to the suicide problem. For example, the article postulates that a 10% reduction in gun ownership might save 800 lives a year. Yet we know that guns are used defensively over two million times a year to prevent rapes, robberies, and murders. So if that 10% reduction in gun ownership results in a similar ten percent reduction in defensive gun uses, that would mean something in the neighborhood of 200,000+ additional rapes, robberies, and murders a year. That hardly seems a fair tradeoff.
Other proposed "solutions" such as making gun owners store the guns unloaded, or locked up, might help reduce suicides, but such ideas will also significantly impede defensive uses, which require immediate access to loaded guns. But when you are either ignorant, or willfully blind to the benefits of guns, it's easy to propose "solutions" that ultimately cost more human lives than they save.
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