New Freakonomics Radio Podcast: “The Suicide Paradox”

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Jacques-Louis David’s painting The Death of Socrates (Photo: Wally Gobetz)

If I were to ask you what’s more common in the U.S., homicide or suicide, what would you say?
Homicide is certainly a lot more prominent; it’s constantly in the headlines and in our public consciousness. But the fact is that suicide is more than twice as common as homicide. The preliminary numbers for 2009, the most recent year for which we have data, show there were roughly 36,500 suicides in the U.S. and roughly 16,500 homicides.

So why don’t we hear more about suicide? In part because it is a very different type of tragedy. Murder represents a fractured promise within our social contract, and it’s got an obvious villain. Suicide represents –- well, what does it represent? It’s hard to say. It carries such a strong taboo that most of us just don’t discuss it much. The result is that there are far more questions about suicide than answers. Like: do we do enough to prevent it? How do you prevent it? And the biggest question of all: why do people commit suicide?

Those are just a few of the questions we address in our latest Freakonomics Radio podcast, “The Suicide Paradox.” This is the third of five hour-long podcasts we’ll be releasing over the coming weeks. Some of you may have heard them on public-radio stations around the country, but now all the hours are being fed into our podcast stream. (You can download/subscribe at iTunes, get the RSS feed, listen live via the media player above, or read the transcript here.) I have to say, many of the answers we found were surprising. And the topic in toto, while obviously a difficult one, is fascinating.

David Lester, a suicidologist without peer.

You’ll hear a good deal from David Lester, a professor of psychology at Richard Stockton College of New Jersey who is considered the dean of suicide studies. He has an astonishing 2,500+ academic citations in total, more than half of which concern suicide. He is also president-elect of the American Association of Suicidology. His interest in the death goes back to his childhood in wartime England:

LESTER: The classic bomb that came over was called a buzz bomb because it was buzzing and that meant that the engine was going. Once it stopped buzzing it meant it would drop and maybe hit your house. My mother says that even as a toddler I was very concerned about them, I would listen for them. And actually she said that I would hear them before the air raid warnings went off, and I would warn everybody about a buzz bomb, and I would rush into the air raid shelter.

So, you know, as a graduate student in America, I started doing work on the fear of death and suicide without thinking of the genesis of it. And then ten years ago I remembered this picture of this little toddler who’s very worried about buzz bombs and hiding from them probably without a material concept of death, but obviously perhaps, laying the seeds of some interest that manifested itself later in life. And I’ve become a thanatologist in general, and a suicidologist in particular.

Lester may know more facts about suicide than just about anyone alive – and you’ll hear lots of them — but he is humble in the face of its causes:

LESTER: First of all, I’m expected to know the answers to questions such as why people kill themselves. And myself and my friends, we often, when we’re relaxing, admit that we really don’t have a good idea why people kill themselves.

The episode also features Steve Levitt, wondering why there aren’t more suicides than there are, and a fascinating story from the linguist Dan Everett, author of Don’t Sleep, There Are Snakes: Life and Language in the Amazonian Jungle, who tells us about the Pirahã tribe’s feelings about suicide.

An Amazonian tribe called the Piraha has all kinds of problems, but suicide is unheard of. (Photo courtesy Dan Everett)

Matt Wray

The Temple sociologist Matt Wray, whom you may remember from a podcast about the high suicide rate in Las Vegas (see his related paper here) discusses the American “suicide belt”:

WRAY: The American suicide belt is comprised of about ten western states, this sort of wide longitudinal swath running from Idaho and Montana down to Arizona and New Mexico. … So, yes the inner mountain west is a place that is disproportionately populated by middle-aged and aging white men, single, unattached, often unemployed with access to guns. This may turn out to be a very powerful explanation and explain a lot of the variance that we observe. It’s backed up by the fact that the one state that has rates that is on par with what we see in the suicide belt is Alaska. If Alaska were contiguous with the U.S. it would really have to be considered part of this western suicide belt.

Veralyn Williams

And Veralyn Williams reports on places where there’s a paucity of suicides: African-American communities. As it happens, blacks are only about half as likely to kill themselves as whites. (When it comes to murder, meanwhile, blacks are nearly six times more likely than whites to die.) There are just three places in the U.S. where the overall homicide rate is higher than the suicide rate: Louisiana, Maryland and the District of Columbia. It’s not a coincidence that these are also places with large African-American populations. Donna Barnes, who founded the National Organization for People of Color Against Suicide, tries to explain why there’s such a huge black-white suicide gap:

BARNES: Okay, it’s very easy when you are stressed and you don’t want to live anymore and put yourself in harm’s way and somebody will take you out. We get angry. We get irritable. We do things, we engage in reckless behavior more so than say, the dominant culture. And those are signs of depression. And many times we will externalize our frustration meaning that we’re going to take it out on other people. And then you might have more folks maybe from the dominant culture who internalize their frustration and take it out on themselves. We have been socialized to believe that a lot of our disadvantages are based on our surroundings — racism, discrimination and all of that. So it’s really easy, for us, when we become frustrated and we look at what’s going on around us, to take it out on the environment and other people rather than ourselves.

We also look into whether suicide is contagious. Radio veteran Sean Cole filed a fascinating piece on this topic. It includes an account of how an 18th-century Goethe novel called The Sorrows of Young Werther proved to be suicidogenic. You’ll hear from the sociologist David Phillips, whose paper “The Influence of Suggestion on Suicide: Substantive and Theoretical Implications of the Werther Effect” can be found here:

PHILLIPS: My students and I were the first to provide modern large scale evidence that there is in fact such a thing as copycat suicide. And we called this, I called it, The Werther Effect.

You’ll also hear from Thomas Niederkrotenthaler, a medical professor and founding member of the Wiener Werkstaette for Suicide Research in Austria, about a recent example of the Werther Effect in Vienna. A related Niederkrotenthaler paper, “The Role of Media Reports in Completed and Prevented Suicide: Werther v. Papageno Effects,” can be found here.

We also travel to Hungary, where suicides have always been more common than just about anyplace else on earth, and try to understand why. Freakonomics Radio producer Suzie Lechtenberg files a report that centers around a song, “Gloomy Sunday,” that’s come to be known as the “Hungarian suicide song.” It was written by Rezso Seress (who committed suicide himself); it’s been performed by everyone from Billie Holiday to Bjork. The suicide scholar David Lester has noted Hungary’s suicide problem:

LESTER: When I go to Hungary, it’s very interesting. They talk about suicide all the time. You know, they’ll be pointing out a statue and say look at that statue, oh the sculptor committed suicide. I’ve actually played to my students all the national anthems of Europe and the Hungarian national anthem was one of the most depressing national anthems. So there seems to be something about the Hungarian culture that is depressive, and suicidogenic.

In Hungary, you’ll hear from the psychiatrist Zoltan Rihmer, who is consumed with understanding Hungary’s high suicide rate, and from Ágnes Rácz Nagy, a psychiatrist in a town called Kiskunhalas, which used to be the suicide epicenter of Hungary. But in recent years, an intensive suicide-prevention plan, including the distribution of low-cost anti-depressants, helped drive the rate down.

The final segment of the suicide hour explores the question of when, or whether, suicide is a rational act. You’ll hear Freakonomics blog contributor Dan Hamermesh discuss his 1974 paper “An Economic Theory of Suicide”:

HAMERMESH: I was always very bothered by the notion that suicide’s a problem of rich people. And that always struck me as an economist as being really stupid since I believe rich people are generally going to be happier, utility is higher, income goes up, you should be less likely to kill yourself.

You’ll also hear the philosopher Margaret Battin talk about how the view of suicide as a rational act has evolved substantially over history, especially since the time of the Stoics, and Margaret Heilbrun, daughter of the Virginia Woolf scholar Carolyn Heilbrun, talking about the maddening, puzzling decision her mother made about taking her own life.

It will be interesting to see the response to this radio hour. As we started producing it, several people told me they were uneasy at the notion of even addressing a topic as loaded as suicide. I empathized with them, especially since so many people have lost a loved one to suicide. But the fact that the topic hasn’t been explored and explained in proportion to its importance only heightened my interest. I’d like to thank the many people who helped produce this episode, particularly Suzie Lechtenberg and Bourree Lam, as well as the many wise and kind people who did interviews. Although I’ve never been deeply affected by a suicide, I’ve gained a new appreciation and empathy for the many who have, and wish you all the comfort possible.


RonG

When I was in medical school, I was in a small discussion group during our psychiatry rotation. I made the argument that depression, like many other diseases, can be "terminal" and that suicide was the terminal event of the natural progression of the disease. As such, just as we give the cancer patient the right to refuse treatment and let the disease run its course, we should give the depression patient the same autonomy.

The hostility of the responses of the other medical students (and some physicians) was amazing to see. They couldn't even have a "rational" discussion on the subject.

Catherine Earp

I enjoyed this episode very much. I'm a Behavioral Health nurse. It was upsetting to me that the the journalist/DJ in this segment kept saying, "committed suicide," instead of "suicided." He even talked about how homicide is a crime but not suicide. Suicide is not a crime where I love.
Catherine, Oregon

Jon

"First of all, I’m expected to know the answers to questions such as why people kill themselves. And myself and my friends, we often, when we’re relaxing, admit that we really don’t have a good idea why people kill themselves."

There speaks a man who has never spent 10 minutes looking around himself at the world in which he lives.

Daisy Arroyo

Hello I am a 16 year old Junior at San Pasqual High School and i chose to read this as an AP Lang assignment, might i say that this is an exquisite piece of writing. These ideas of The Suicide Belt and the thoughts and reasoning behind it are just fascinating. As a lover of the psychology, I found this podcast to be extremely interesting!

David M. Marek

I was just curious re: the ratio of homicides to suicides, and still had the philip glass website
live-streaming music from "The Hours!" ; - /

Carl

What's the choir music playing during the interview with Heilbrun? A sextet by Elgar?

Kevin

Here's an interesting (although admittedly several years old) NYT article I found that explores the issue of premeditated vs impulsive suicides, and what can be done to prevent many of the impulsive ones:

http://www.nytimes.com/2008/07/06/magazine/06suicide-t.html?_r=1&pagewanted=print

Martin Miljkovic

Hi,
As much as this topic is interesting in it's darkness it also had a structural flaw being a commercial for ***you know what***. Now since you had gone to the dark side (of everything) you may wish to redeem yourselves.
Here is how:
Do a podcast on pure happiness. Reasons TO live. Do a podcast on how much all those self improvement books increase happiness for example. Do a podcast on happiness of those Amazon people you mentioned as HOW they are happy? Is joining Hare Chrishna making people happy. What happens when they leave. Is joining environmental camps societies doing that? I am just dropping here some groups from videos that I saw on youtube videos extremely happy. There are naturally others which Do a podcast on people that were once unhappy and are happy now. I am sure that there is such a group/systems out there.

This is intend to be a letter but since I just woke up and I cant find "how to ask a question" let me do jut do it this way.

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FreakListener

This podcast is well done and well-researched. There is a major omission, in my opinion. This article outlines the three things that are present in those who commit suicide: perceived burdensomeness, low belongingness/social alienation, and acquired ability to enact lethal self-injury (http://www.apa.org/science/about/psa/2009/06/sci-brief.aspx). It actually seems to be borne out by comments/interviews in this podcast. I would be have been interested in a discussion that included this.

David

Great segment but suicide is not an act, it's a feeling. I thought this point of view wasn't explored.

David

Tova Fuller MD PhD

There are problematic statements and implications of this piece. Regarding the higher rates of suicide in whites v AAs: adjusting for the fact that older white males, the gap closes considerably. In the 15 years leading up to 1995, the suicide rate for young AAs went up 233% compared to 120% for white counterparts. Furthermore, Mohler and Earls (2001) note that coroner determinations of suicide may be quite inaccurate/discrepant across race, further closing the perceived gap.

While I don't doubt environment plays a role in determining suicide rate, even a large role, let's remember that an even larger risk factor, at least in the US, is mental illness. Two solutions that are obvious to me are 1) destigmatizing the diseases that lead to suicide and 2) providing easy and universal access to mental health care.

Part of destigmatization of mental illness is seeing it as a disease with a large heritable component, just as large in some instances as cardiac disease. Do we go around talking about the environmental component of death by MI (myocardial infarction or "heart attack") as faddish? Yes. Cigarette smoking is a fad, for example. Does this prevent death by MI, discussing the sexy and infectious nature of smoking? I'm not sure. What I do know is that emphasizing the sexy and infectious nature of cigarette smoking doesn't make it less sexy. It might even be self propagating. This bothers me. Having known and lost people to suicide, I find the implication in the absence of context frustrating and almost insulting.

While it wasn't the point of the piece, destigmatization doesn't occur by implying suicide is a fad. It occurs (IMHO) recognizing that many very ill people die from their mental illness, and suicide is one of these ways. If we see suicide as the cause of death for some with terminal depression (or at least think of it in this way), we may start to motivate to march for the cure the same way we do for cancer or heart disease--even if both of these diseases has environmental components that are hypersexed in the media. I hope the experts referenced agree with this sentiment.

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Galena Alyson Canada

Here's a possible counter to the "no one else to blame" theory for the suicide paradox (why better-off folks kill themselves more).

This study concludes that more suicides occurred (in the studied area) during the Great Recession -- a manifestly external and blamable cause.

http://www.bmj.com/content/345/bmj.e5142