Why People Die By Suicide by Thomas Joiner

Author:Thomas Joiner [Joiner, Thomas]
Language: eng
Format: epub
ISBN: 9780674019010
Published: 2005-09-08T12:28:54+00:00

WHAT DO WE

MEAN BY SUICIDE?

HOW IS IT

DISTRIBUTED

IN PEOPLE?

4

In the previous chapter, I asserted that those who desire suicide die by

suicide only if they can. Those who can die by suicide will die only if

they want to. But who can? Those who have acquired the capability to

enact lethal self-injury. Who wants to? Those who perceive that they are

a burden on loved ones and that they do not belong to a valued group or relationship. There are relatively large numbers of people who desire

suicide, and large numbers of those who have developed the capacity for

suicide. But there are relatively few people in the dangerous convergence

zone—those who are at greatest risk for serious suicidal behavior.

The components of the model have some interesting relation-

ships to each other. The interrelations of burdensomeness and low

belongingness have been discussed, but what of the associations be-

tween acquired ability for suicide, on the one hand, and burden-

someness and low belongingness, on the other hand? In fact, there is

evidence that social isolation may lead to increases in pain tolerance.

Researchers have shown that the pain threshold of mice increases af-

ter thirty days of isolation.1 Sensory deprivation increases the pain

threshold in people as well.2

137

138 ● WHY PEOPLE DIE BY SUICIDE

Those who desire suicide:

Those who are

Perceived burdensomeness

capable of suicide

+

Failed belongingness

Serious attempt or death by suicide

Just as isolation may lead to the ability to bear increased pain,

behaviors that increase the pain threshold may lead to isolation.

Provocative behaviors, like self-injury, can be off-putting. These be-

haviors can also lead others to perceive one as a burden. In one

study, a majority of the significant others of those who had re-

cently attempted suicide reported that their support of the patient

represented a burden to them.3 If people who engage in self-harm

are ostracized and viewed as a burden because of it, their sense of

belongingness may diminish and their sense of perceived burden-

someness may increase. In a number of ways, then, components of

the model presented here may feed each other. Any one of the com-

ponents could be viewed as an entry into a process whereby all

three components, and thus high risk for serious suicidal behavior,

escalate.

Any persuasive explanation of suicide should shed at least some

light on the existing data, including prevalence; the clustering and

“contagion” of suicide; and the associations of suicide with age, gen-

der, race, neurobiological indices, mental disorders, substance abuse,

impulsivity, and childhood adversity. The present model may also

contribute to the resolution of long-standing dilemmas in the field

of suicide research, treatment, and prevention, and explain some

What Do We Mean by Suicide? ● 139

puzzling suicide-related facts. For example, what constitutes a proper

definition of suicide itself? Are mild suicidal ideation and lethal sui-

cidal behavior located at different points along the same underly-

ing continuum, or are they categorically different phenomena? The

model may help us think about what we mean by suicide.

Definitions of Suicidal Behavior

A man is discovered dead in his car, which has veered off the road

and slammed into a tree. There are no skid marks and alcohol is in

his system, though not at levels exceeding the legal limit. Family and

friends state that he has

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