Suicide can't be beaten

August 28, 1999


Any way you read it, suicide is a sad and sensitive topic. Whether it is the death of a celebrity like Ernest Hemingway or Sylvia Plath, a relative, a dear friend or of someone you barely know, it is a tragedy.

Of late the issue of suicide has been gaining more and more attention. Forcing the issue into the face of the American public, Jack Kevorkian, otherwise known as "Doctor Death," claims to have helped more than 130 people kill themselves. For one of these assisted suicides, he now stands convicted of second-degree murder.

Another genre - mass suicides - became big news with Jim Jones and his 900 followers in Jonestown in 1978. More recently it was the Heaven's Gate followers in California, who killed themselves believing that their deaths would get them on board the Hale Bop comet for a ride into the future. Then it was the 52 Solar Temple members who died in a series of suicides in Canada and in Switzerland. Now forecasters are warning of an upsurge in suicides around the western world as the millennium approaches.

Perhaps it is this growing paranoia that recently prompted Tipper Gore, the U.S. vice-president's wife, and U.S. Surgeon General David Satcher to declare suicide "a national tragedy and a public health problem demanding national leadership." "Let's talk about the reality of suicide in our national life," said Gore. "Let's encourage all Americans to get the help they need."

All Americans? Has Tipper been tipped off about an impending national suicide? Or is she oblivious to the fact that suicide is way down on the list of causes of death. The top three - cancer, strokes and heart disease - account for more than 60 per cent of all deaths. Add pneumonia, diabetes and accidents and you've described how most of us might expect to die. The suicide rate, at 1.3 per cent, has been on the decline for years.

And what help is Tipper offering? On close examination her recommendations are about as powerless as those applied by other administrations to previous "wars," such as Reagan's war on drugs (remember "Just say No!") and Johnson's war on poverty.

"We want coaches, we want school teachers, we want hairdressers, we want people who interact with the community," said Damon Thompson, Satcher's spokesman. "It's going to take outreach, it's going to take training. It's going to take communities to realize it's got to be a priority."

What are all these people supposed to do? Ah, there's the rub! While "prevention" may be their buzz word, research suggests that it's an illusion. In reviewing 14 studies that assessed the preventive effects on suicide rates, David Lester of the Center for the Study of Suicide in New Jersey found that only half even hinted that they might be effective. Of the remaining half, six were ineffective and one seemed to increase the number of suicides. And researchers at Arizona State University looking at a youth suicide preventions methods concluded that none were useful.

Such findings are not, it seems, influencing politicians or tempering the enthusiasm of those who offer up such enterprising solutions as "suicide prevention by e-mail."

Such ideas may capture the public imagination, but the sober conclusion, as Columbia University researchers Shaffer and Craft put it, is that "the most effective (prevention) is a systematic procedure that has a high potential for institutionalization." In common language that means locking up anyone who utters a suicidal thought.

Critical psychiatrist Thomas Szasz writes that suicide "is our ultimate, fatal freedom." But that's not how Gore and Satcher see it. They believe that no one in his right mind kills himself, that suicide is a mental-health problem that can be prevented like other health problems.

"Imagine a world free of suicide" is the slogan of one enthusiastic Texas lawyer. He is on the cutting edge of a new legal specialty - suing doctors or therapists whose patients kill themselves. His logic is simple if suicide is preventable then, whenever a person suicides, someone is responsible and that person should pay.

Perhaps mental-health workers ought to have second thoughts about endorsing treatments and giving the impression that they hold the key to suicide prevention. In this instance, such a pretense could be costly.

"Suicide is an event that is a part of human nature," wrote Goethe 200 years ago. "However much may have been said and done about it in the past, every person must confront it for himself anew, and every age must come to its own terms with it."

Dying voluntarily is a choice intrinsic to human existence; sometimes impulsive, sometimes rational, rarely preventable, and always tragic.

@ Dr.Tana Dineen

by Dr. Tana Dineen, special columnist,