Myths About Suicide

1. Myths About Suicide Thomas Joiner, Ph.D. The Robert O. Lawton Distinguished Professor of Psychology Department of Psychology Florida State University joiner@psy.fsu.edu

4. Suicide may just be the most stigmatized of human activities – it is even more stigmatized than appalling things like slavery and murder – and therefore a powerful mythology has arisen around it.

5. The stigma can be seen in many ways: Bereaved experience a change in their address books, as people they thought they could count on avoid them.

6. So let’s just do away with stigma, right?

7. Not only is it not easy, but stigma = fear + ignorance

8. Some things in nature should be feared, do deserve a healthy dose of respect

9. Fears are wired into us, and this wiring can be sensitive

10. Moreover, the lack of fear characterizes some of our most deranged and dangerous individuals.

11. Further still, in my book Why People Die By Suicide, I argued that the loss of fear – at least of physical pain, physical injury, and death – removes a barrier to suicide, and is therefore dangerous.

14. Cobain was temperamentally fearful – afraid of needles, afraid of heights, and, crucially, afraid of guns. Through repeated exposure, a person initially afraid of needles, heights, and guns later became a daily self-injecting drug user, someone who climbed and dangled from 30 foot scaling during concerts, and someone who enjoyed shooting guns.

15. Regarding guns, Cobain initially felt that they were barbaric and wanted nothing to do with them; later he agreed to go with his friend to shoot guns but would not get out of the car; on later excursions, he got out of the car but would not touch the guns; and on still later trips, he agreed to let his friend show him how to aim and fire. He died by self-inflicted gunshot wound in 1994 at the age of 27.

16. Mental disorders, which spur death by suicide, are forces of nature, and thus deserve our respect and even fear (but not our resignation).

17. Let’s Leave Fear Be • Stigma = fear + ignorance

18. Decreasing Ignorance via Dismantling of Myths • Many myths about suicide are so ingrained that we may not be able to reduce ignorance until we undo these myths.

19. Categories of Myths • Myths about the suicidal mind • Myths about suicidal behavior • Myths about the nature of suicide

20. Myths About the Suicidal Mind • MYTH: Suicide is primarily about • Cowardice – MYTH!!! • Weakness – MYTH!!! • Revenge – MYTH!!! • Selfishness – MYTH!!! • Self-Control – MYTH!!! • Impulsivity – MYTH!!!

21. Myths About Suicidal Behavior • MYTH: Suicide is primarily characterized by • Note leaving – MYTH!!! • “Slow” forms of suicide (e.g., smoking) – MYTH!!! • “Rational” suicide – MYTH!!! • A cry for help – MYTH!!! • Complete resolve and intent to die – MYTH!!!

22. Myths About the Nature of Suicide • MYTH: Suicide is • Limited to humans – MYTH!!! • Not seen in young children – MYTH!!! • Caused by things like breast augmentation – MYTH!!! • More common in winter – MYTH!!!

23. Myths About the Suicidal Mind • MYTH: Suicide is primarily about • Cowardice – MYTH!!! • Weakness – MYTH!!! • Revenge – MYTH!!! • Selfishness – MYTH!!! • Self-Control – MYTH!!! • Impulsivity – MYTH!!!

24. Sketch of the Theory Those Who Desire Suicide Perceived Burdensomeness Those Who Are Capable of Suicide Serious Attempt or Death by Suicide Thwarted Belongingness

25. Suicide Requires Fearlessness; Cowardice Will Prevent It • Death by any means – including suicide – is fearsome and daunting. We are self-preserving creatures, wired in our cells and souls to fear death. • Even intently and deeply suicidal people are subject to this fear, as we will see.

26. Suicide Requires Fearlessness; Cowardice Will Prevent It • The fearlessness is specifically about physical pain, physical injury, and death, and this fearlessness is distinct from concepts like courage, bravery, and heroism.

27. Why I Jumped by Tina Zahn • In the midst of a recurrent, very severe (at times near-catatonic) postpartum depression, Zahn decided to jump off a bridge near Green Bay, Wisconsin. • She fled relatives in her car, who called police. Police clocked her at 120 mph. • Still, she is ambivalent, some signs of which show up in the following video.

28. The Documentary The Bridge • Photographer saves someone who is pondering jumping from the Golden Gate Bridge. • Here too, behavioral indicators of ambivalence.

29. Incident at Train Tracks • Person balks at the last moment, thus saving her life.

30. Meriwether Lewis (of Lewis & Clark fame) From Stephen Ambrose’s biography of Lewis, Undaunted Courage: Lewis paced for several hours (agitation), as others could hear him all night as the floorboards creaked. Two self-inflicted gunshot wounds, neither fatal. Servants found him “busily cutting himself from head to foot.” Lewis said to servants, “I am no coward, but I am strong, it is so hard to die.” He died a few hours later.

31. Hesitation Wounds What are they? Virtually everyone who dies by self-inflicted knife wound has hesitation wounds around the site of the lethal injury. Why do even intently suicidal people hesitate (and some are saved during hesitation)? They hesitate because they feel fear.

32. Suicide in Anorexia Nervosa Mortality is extremely high in anorexic women (SMR = ~60). It is an under-appreciated fact that, should an anorexic patient die prematurely, the cause of death is more likely to be suicide than complications arising from compromised nutritional status.

33. Suicide in Anorexia Nervosa There are at least two possible accounts of the high association between AN and suicide. In one view, anorexic women die by suicide at high rates because they are unable to survive relatively low lethality attempts and/or they may be less likely to be rescued after an attempt due to their socially isolated status.

34. Suicide in Anorexia Nervosa In another view, informed by my theory of suicidal behavior, anorexic women die by suicide at high rates because their histories of self-starvation habituate them to pain and inure them to fear of death, and they therefore make high lethality attempts with high intent-to-die.

35. Suicide in Anorexia Nervosa We pitted these two accounts against each other, in a study of 239 women with AN, followed over ~15 years. 9 died by suicide, the leading cause of death among the sample. Of these 9, were they mostly highly lethal methods or not?

36. Suicide in Anorexia Nervosa The least lethal method: Ingestion of 12 oz. of a household cleaning product, along with an unknown amount of a powerful sedative and alcohol (BAC = 0.16%). Cause of death was gastric hemorrhaging due to hydrochloric acid in the cleaning product. 911 (intently suicidal feel fear too). Might Bitrix have prevented this?

37. Myths About the Suicidal Mind • MYTH: Suicide is primarily about • Cowardice – MYTH!!! • Weakness – MYTH!!! • Revenge – MYTH!!! • Selfishness – MYTH!!! • Self-Control – MYTH!!! • Impulsivity – MYTH!!!

38. Myths About the Suicidal Mind • The Impulsivity Myth • Three instructive incidents • Christine Chubbuck • David Foster Wallace • Skydiving incident

39. Christine Chubbuck • MYTH: She died by suicide impulsively, on live TV, while reporting the local news.

40. Christine Chubbuck • TRUTH: She died by suicide on live TV, while reporting the local news, after a very long process of planning and deliberation.

41. Christine Chubbuck • Suicide attempt four years before her death. • Frequent talk of suicide. • Asked police officer about lethality of wound site. • A week before death, bought a gun.

42. Christine Chubbuck • Days before death, she “joked” with colleague about shooting herself on the air. • Day of death, stowed gun in prop bag, and brought it to the newsdesk.

43. Christine Chubbuck • TRUTH CONTINUED: One aspect of her death contained an impulsive element, the basis on which her death has been misunderstood.

44. David Foster Wallace • Severe major depressive disorder, very well controlled for nearly 20 years by MAOI.

45. David Foster Wallace • When illness was well controlled, he did his life’s work, including Infinite Jest (all 1104 pages of it), work which in part won him a MacArthur fellowship.

46. David Foster Wallace • MYTH: He died by suicide impulsively; in a brief window of time when his wife left their house, he impulsively died by hanging.

47. David Foster Wallace • TRUTH: He made the disastrous decision to go off of MAOI, could not get illness back under control, and died by suicide over a year later.

48. Intently Suicidal People Know That Death Is Difficult to Enact • Many documented cases of people who take planful steps to prevent their bodies from reacting and saving them (e.g., binding hands before death by hanging).

49. Skydiving Incident in New York State • MYTH: Man went with friends to take pictures as the friends skydived; he impulsively jumped to his death from the plane.

50. Skydiving Incident in New York State • TRUTH: Man was not friends with others; had asked pilot if he could board and take photos the week before; had asked others their preference between jumping from a building vs. a plane.