6 July 2008 *New York Times* includes an article: “The Urge to End
It” by Scott Anderson.

Here are some excerpts:

“There is but one truly serious philosophical problem,” Albert Camus
wrote, “and that is suicide.” How to explain why, among the only
species capable of pondering its own demise, whose desperate attempts to
forestall mortality have spawned both armies and branches of medicine in
a perpetual search for the Fountain of Youth, there are those who, by
their own hand, would choose death over life? Our contradictory
reactions to the act speak to the conflicted hold it has on our
imaginations: revulsion mixed with fascination, scorn leavened with
pity. It is a cardinal sin — but change the packaging a little, and
suicide assumes the guise of heroism or high passion, the stuff of
literature and art.

Beyond the philosophical paradox are the bewilderingly complex dynamics
of the act itself. While a universal phenomenon, the incidence of
suicide varies so immensely across different population groups — among
nations and cultures, ages and gender, race and religion — that any
overarching theory about its root cause is rendered useless. Even
identifying those subgroups that are particularly suicide-prone is of
very limited help in addressing the issue. In the United States, for
example, both elderly men living in Western states and white male
adolescents from divorced families are at elevated risk, but since the
overwhelming majority in both these groups never attempt suicide, how
can we identify the truly at risk among them?

Then there is the most disheartening aspect of the riddle. The National
Institute of Mental Health says that 90 percent of all suicide
“completers” display some form of diagnosable mental disorder. But if
so, why have advances in the treatment of mental illness had so little
effect? In the past 40 years, whole new generations of antidepressant
drugs have been developed; crisis hotline centers have been established
in most every American city; and yet today the nation’s suicide rate (11
victims per 100,000 inhabitants) is almost precisely what it was in 1965.

Little wonder, then, that most of us have come to regard suicide with an
element of resignation, even as a particularly brutal form of social
Darwinism: perhaps through luck or medication or family intervention
some suicidal individuals can be identified and saved, but in the larger
scheme of things, there will always be those driven to take their own
lives, and there’s really not much that we can do about it. The sheer
numbers would seem to support this idea: in 2005, approximately 32,000
Americans committed suicide, or nearly twice the number of those killed
by homicide.

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.

<snip>

As it turns out, one of the most remarkable discoveries about suicide
and how to reduce it occurred utterly by chance. It came about not
through some breakthrough in pharmacology or the treatment of mental
illness but rather through an energy-conversion scheme carried out in
Britain in the 1960s and ’70s. Among those familiar with the account,
it is often referred to simply as “the British coal-gas story.”

For generations, the people of Britain heated their homes and fueled
their stoves with coal gas. While plentiful and cheap, coal-derived gas
could also be deadly; in its unburned form, it released very high levels
of carbon monoxide, and an open valve or a leak in a closed space could
induce asphyxiation in a matter of minutes. This extreme toxicity also
made it a preferred method of suicide. “Sticking one’s head in the
oven” became so common in Britain that by the late 1950s it accounted
for some 2,500 suicides a year, almost half the nation’s total.

Those numbers began dropping over the next decade as the British
government embarked on a program to phase out coal gas in favor of the
much cleaner natural gas. By the early 1970s, the amount of carbon
monoxide running through domestic gas lines had been reduced to nearly
zero. During those same years, Britain’s national suicide rate dropped
by nearly a third, and it has remained close to that reduced level ever since.

How can this be? After all, if the impulse to suicide is primarily
rooted in mental illness and that illness goes untreated, how does
merely closing off one means of self-destruction have any lasting
effect? At least a partial answer is that many of those Britons who
asphyxiated themselves did so impulsively. In a moment of deep despair
or rage or sadness, they turned to what was easy and quick and deadly —
“the execution chamber in everyone’s kitchen,” as one psychologist
described it — and that instrument allowed little time for second
thoughts. Remove it, and the process slowed down; it allowed time for
the dark passion to pass.

Quite inadvertently, the British gas conversion proved that the
incidence of suicide across an entire society could be radically
reduced, upending the conventional wisdom about suicide in the process.
Or rather it should have upended the conventional wisdom, for what is
astonishing today is how little-known the British coal-gas story is even
among mental-health professionals who deal with suicide. Last November,
I attended a youth suicide-prevention conference in New Hampshire at
which Catherine Barber, a member of the Injury Control Research Center
at the Harvard School of Public Health, gave a PowerPoint presentation
on creating physical barriers to suicide — or “means restriction,” in
public-health parlance — to a large group of mental-health officials and
school counselors. While giving a brief history of the approach, she
came to several slides describing the British gas-conversion phenomenon
and paused.

“Is everyone familiar with the British coal-gas story?” she asked. “If
so, I’ll just skip over this.”

Among the 150 or so attendees, only about a half-dozen hands went up.
Instead, most looked quite baffled.

<snip>

After three people leapt from the Ellington in a single 10-day period in
1985, a consortium of civic groups lobbied for a suicide barrier to be
erected on the span. Opponents to the plan, which included the National
Trust for Historic Preservation, countered with the same argument that
is made whenever a suicide barrier on a bridge or landmark building is
proposed: that such barriers don’t really work, that those intent on
killing themselves will merely go elsewhere. In the Ellington’s case,
opponents had the added ammunition of pointing to the equally lethal
Taft standing just yards away: if a barrier were placed on the
Ellington, it was not at all hard to see exactly where thwarted jumpers
would head.

Except the opponents were wrong. A study conducted five years after the
Ellington barrier went up showed that while suicides at the Ellington
were eliminated completely, the rate at the Taft barely changed, inching
up from 1.7 to 2 deaths per year. What’s more, over the same five-year
span, the total number of jumping suicides in Washington had decreased
by 50 percent, or the precise percentage the Ellington once accounted for.

<snip>

“At the risk of stating the obvious,” Seiden said, “people who attempt
suicide aren’t thinking clearly. They might have a Plan A, but there’s
no Plan B. They get fixated. They don’t say, ‘Well, I can’t jump, so
now I’m going to go shoot myself.’ And that fixation extends to
whatever method they’ve chosen. They decide they’re going to jump off a
particular spot on a particular bridge, or maybe they decide that when
they get there, but if they discover the bridge is closed for
renovations or the railing is higher than they thought, most of them
don’t look around for another place to do it. They just retreat.”

Seiden cited a particularly striking example of this, a young man he
interviewed over the course of his Golden Gate research. The man was
grabbed on the eastern promenade of the bridge after passers-by noticed
him pacing and growing increasingly despondent. The reason? He had
picked out a spot on the western promenade that he wanted to jump from,
but separated by six lanes of traffic, he was afraid of getting hit by a
car on his way there.

“Crazy, huh?” Seiden chuckled. “But he recognized it. When he told me
the story, we both laughed about it.”

[end excerpts]

The complete article is online at:
<http://tinyurl.com/6fbaox>.

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