Suicide is the tenth leading cause of death in the United States.  It’s the second leading cause of death for those 15 to 24-years-old.  In 2019, the latest year for which we have data available, 47, 511 individuals completed suicide. Suicide using firearms accounting for 23,941 of these.  The national suicide rate, again for 2019, was 13.9 per 100,000, age adjusted.  Males tend to complete suicide while females make more attempts.  This relates to method.  Men traditionally go for guns, the most efficient means, while women prefer overdoses, asphyxiation, or cutting.  But firearms trends are changing year by year.  Women are catching up.

White males consistently top suicide rankings, the 2019 rate for them being 26.1 per 100,000 and for nonwhite males 12.2.  White women’s rate was 7.0 and nonwhite is 3.4.

The latest data available from a 2017 study looking into LGBTQIA+ youth shows that 39% seriously pondered suicide while 71% reported feeling sad or hopeless for at least two weeks over the past year.  No shock there, since two out of three have revealed others have tried convincing them to change their sexual or gender identities, with youth who’ve undergone conversion therapy more likely to try suicide than those who haven’t.  71% from the study shared having suffered discrimination, while 58% of transgender and nonbinary participants admitted they were not allowed to use restrooms consistent with their gender identity.

I lifted these statistics from suicidology.org, the website for the American Association of Suicidology (AAS), the national organization that accredits hotlines and services across all states.  Interested parties can visit their website for more information, statistics, reading lists, webinars, and other tools designed to educate the public.

As a suicide-prevention counselor, I’ve been asked why persons kill themselves.  There’s no easy answer, because suicide’s a complex phenomenon, one explored by psychologists, sociologists, theologians, philosophers, and, of course, through art, music, and literature.  First things first, though: more important than understanding why is knowing what to do if you or someone else feels suicidal.  The AAS website offers information on detecting signs of suicide and how to intervene.

Also, dial 988 where I and other trained counselors are ready to help 24/7.

Why do humans kill themselves?  How do you answer such a huge question?  Or start to answer? I’m no profound thinker, but I’ve read several books presenting various theories.  The following five are classics either by popular consensus or because they have they have become so for me personally.  I’ll start with Emile Durkheim.

Suicide: A Study in Sociology by Emile Durkheim (1897)

A French philosopher, Emile Durkheim associates suicide with society, which is no surprise – he was a protégé of Auguste Comte, the father of sociology.  His taxonomy is as follows:

Egoistic Suicide

Durkheim deems egoistic suicides largely self-centered, since they occur when people lose connection with society, perceiving they’ve somehow failed to meet social codes or mores.  Social revolutions, periods when conventions upon which humanity has relied lose meaning, apply here.

Altruistic Suicide

By killing ourselves, we could save others from suffering.  Controversially for me and I strongly suspect for more than one of you, Durkheim brings up Indian sati, calling it self-sacrifice carried out by underindividuated and or excessively integrated people – hello, nineteenth-century Eurocentrism. Despite my feelings, and I do have feelings, certain cultures strongly place society above self, and that affects how members practice or perceive suicide.  Prevention often must happen at macro levels, a staggering prospect requiring nonjudgmental appraisals and conversations, appreciating multicultural values, activism led from within impacted groups, and avoiding phrases like “underindividuated” and “excessively integrated.”  Durkheim’s study describes more than prescribes, however, true to his purpose.  He talks about soldiers who throw themselves over grenades to lessen explosive blasts as well.

Anomic Suicide

These suicides relate to sudden changes that upset emotional equilibrium and radically shatter our relationship with society.  Today, we define crises as occurrences that pull us from psychological homeostasis and challenge our coping mechanisms, basically anything that cuts us off from the outside world.  Think deaths, natural disasters, and financial setbacks.  And, yes, winning the lottery can trigger anomic suicide if doing so becomes too overwhelming and thus isolating.

Fatalistic Suicide

Fatalistic suicides involve societal regulations that overly restrict individuality.  Durkheim cites suicide among slaves and childless older women for examples.  Suicide, then, represents an escape from oppression. I’ve mentioned macro-level prevention already.

Although he contributed foundational efforts, Durkheim’s theory focuses narrowly on sociological elements, eschewing psychological, biological, and idiosyncratic reasons behind suicide.  Suicide has multiple causes and facets, and my list reflects that reality.

The Suicidal Mind by Edwin Shneidman (1996)

In 1949, Edwin Shneidman was working for the Veteran’s Administration, Los Angeles, where his supervisor instructed him to write letters to two widows whose husbands had committed suicide.  Upon examining their files, Shneidman discovered that one had written a suicide note.  His curiosity sparked, over just a few weeks he gathered 700 letters, so beginning his life’s work.

Today we revere Shneidman for not only coining the term “suicidology,” but for forming the AAS and with his colleagues Norman Farberow, Robert Litman, and Mickey Heilig for inspiring expansive suicide-prevention research.  His theories have influenced my intervention style massively.

For Shneidman, suicide stems from psychological pain, what he calls “psychache.”  Thwarted or distorted psychological needs elevate suicide risk.  Suicide and mental illness overlap because mental illnesses cause perturbation, frustration, unease, upset, and pain, but self-lethality does not necessarily mean mental illness.  Psychache is very subjective mental pain that will not go away.  As a psychologist and Professor of Thanatology at UCLA, Shneidman instructed that those wishing to help must reduce suicide by alleviating pain.  Trust me, this is easier said than done, but his broad-minded approach strengthens flexibility when assessing personal attachments and how loss or the threat of loss enhances danger.

I spotlight The Suicidal Mind, because it’s Shneidman’s most accessible work.  I also suggest Definition of Suicide and Suicide as Psychache: A Clinical Approach to Self-Destructive Behavior.  He dedicates one section from Definition of Suicide to analyzing Captain Ahab’s monomania in Moby-Dick.  Ahab, he concludes, suffers from sub-intentioned suicide, an unconscious drive toward death.  Can you say Renaissance man?  Then you can say Shneidman.  That Shneidman was friends with Hershel Parker, a giant among Melville scholars, didn’t hurt, however.

The Savage God by A. Alvarez (1971)

First came Durkheim the sociologist, and then Shneidman the psychologist.  Now, A. Alvarez, a writer, poet, and literary critic, enters the discussion.  Alvarez refers to suicide as a “closed world,” and he says about his own suicide attempt: “I had entered the closed world of suicide and my life was being lived for me by forces I couldn’t control.”  He begins by considering Sylvia Plath and her suicide, and he later reveals much about his predicament and that of his parents’, both of whom attempted suicide as well. Alvarez occasionally reads like an extended Confessional poem, but more about Confessionalism when I introduce Middlebrook’s Anne Sexton.

Alvarez mixes literature, art, philosophy, psychology, sociology, religion, and other disciplines, offering a truly multi-disciplinary overview.  One passage touched me, even if the realization he describes seems more easily said than done:

When neither high purpose nor the categorical imperatives of religion will do, the only argument against suicide is life itself.  You pause and attend: the heart beats in your chest; outside, the trees are thick with new leaves, a swallow dips over them, the light moves, people are going about their business.

Night Falls Fast by Kay Redfield Jamison (1999)

A psychologist and professor of psychiatry and behavioral sciences, Kay Redfield Jamison co-directs the Mood Disorders Center at Johns Hopkins University.  James herself has bipolar disorder which greatly informs her Night Falls Fast: Understanding Suicide.  She notes that suicide rates for Americans under 40 had tripled over the 45 years before her book was published, and like Shneidman and Alvarez she casts a wide net, drawing upon history, anthropology, biochemistry, genetics, and epidemiology.

Given her own mental-health status and that she’s a psychologist, we shouldn’t be surprised that she emphasizes mood disorders and schizophrenia and their correspondences with suicide.  She shares about herself:

I was seventeen when, in the midst of my first depression, I became knowledgeable about suicide in something other than an existential, adolescent way. For much of each day during several months of my senior year in high school, I thought about when, whether, where, and how to kill myself. I learned to present to others a face at variance with my mind; ferreted out the location of two or three nearby tall buildings with unprotected stairwells; discovered the fastest flows of morning traffic; and learned how to load my father’s gun.  It was not the kind of education one expected to receive in high school.

I attended suicidology conventions during the early 2000s, and Night Falls Fast always generated deep conversations.  One contingent found Jamison’s statistics a bit alarmist, another felt she relies too heavily on medical models, but none could deny that she’s an activist coming from the heart, from a drive for helping others survive. And she succeeds.

Anne Sexton: A Biography by Diane Wood Middlebrook (1991)

The critic M.L. Rosenthal introduced the term “Confessional poetry” while reviewing Robert Lowell’s collection, Life Studies.  Confessional poets employ direct language and present images derived from private experience – emotional breakdowns, mental illness, childhood trauma, and any self-referential revealing are fair game, and overall, their output displays a true break from traditional verse up until that time.  During the 1950s and 1960s, confessionalism enjoyed huge popularity. Famous names include Robert Lowell, Sylvia Plath, John Berryman, W. D. Snodgrass, and Anne Sexton.

Middlebrook’s biography isn’t a suicidology text per se, but it’s an extremely fine narrative about an award-winning poet, mental-health patient, and eventual suicide.  I received Anne Sexton for my birthday the year it first appeared amid the controversy surrounding Middlebrook using audio recordings of therapy sessions between Sexton and her psychiatrist, Martin T. Orne.  It was Orne who urged Sexton to write poetry toward cathartic ends, and she rode it right into a Pulitzer Prize.

Remember that Edwin Shneidman began his career by examining suicide notes, even bringing “psychological autopsy” into the professional lexicon.  Biographies are important sources for understanding the suicidal mindset.  Middlebrook’s is one of the best I’ve ever read.  She’s thorough but fair, a monumental task.  Sexton lived turbulently, and lesser biographers might have made an exploitative mess of it.  Middlebrook delivers a truly compassionate recounting.

The market’s flooded with suicidology books, from the scientifically dense to popular-press releases.  Currently, I’m after my crisis-worker certification from the AAS, which requires that I read several books about crisis intervention, suicide prevention, and grief counseling.  I’m looking forward to what I call the Thomas Joiner Quartet: Why People Die by Suicide, Myths about Suicide, The Perversion of Virtue: Understanding Murder-Suicide, and The Interpersonal Theory of Suicide: Guidance for Working with Suicidal Clients.  One day, I’ll review Joiner’s oeuvre separately.  Whatever you decide to read or however you answer why people end their lives, know that you’re not the only one feeling pain.  Some may feel their subjective woes so intensely that they’re contemplating a permanent opt-out.  But we can face distress together, and together we can persevere.