Who: 1-2% of modern nations
Why: factors are related to "something is wrong with your head" - depression, manic-depressive, drug/alcohol, schizo, agitation, etc. Walk into an emergency room: most people are there because something is wrong with their heads (low IQ, alcohol induced stupidity, mental illness, etc.), you will see the high risk. Now look at the doctors - they are also at high risk: under stress, lack of sleep, mood swings. Their knowledge does not protect them.
Put the whom into perspective: 1-2 % of everyone is huge. Everyone will die of "old age", baring accident or intent. Live long enough and you will die of cancer, heart failure, or other degenerate proximate cause. The ultimate cause is the same: you are old and worn out. If you treat your body poorly you will wear out faster - smoke, drink, eat garbage, don't exercise. We all know this. The fact that 1/100 to 1/50 will die by their own intent is therefore a huge number - and a number that is likely an underestimate (taking large risks, joining the army in time of war, and generally placing oneself in harms way can be an effective means of killing oneself). Look at it another way - suicide is the second leading cause of death for college students.
Suicide is a systematic and sizable problem with our society. Doctors have a fairly high level of knowledge about suicide, know the factors involved, and know how to access further information. This does not help them very much - as a group they commit suicide fairly frequently. Knowledge alone does not prevent suicide.
How can we address suicide? We must start from knowledge and move to action. Suicide is not "rare". It is prevalent, it will impact your life at some point. We all should know a little bit about suicide, as it is one of the primary causes of death - and one of the largest ones (intent: suicide or murder, accident, and decay are the possible causes). The key factors relate to mental health, a truism if there was ever was one.
We know that medication can help - lithium, anti-depressants, and cognitive therapy are known to reduce the incident of suicide, and thus early treatment is important [note: the availability and efficiency of these drugs has changed the population in universities - at one point in time those most likely to kill themselves would not be in university, as the factors contributing to suicide risk would overwhelm their lives and they would not "make the grade". This population can now better manage their problems, and can now make it into university, yet their risk remains high. Universities have not yet dealt with this "new" issue (for them).] Medication gives crutches, allowing people to hobble forward. This is not a "cure", or sufficient. But can keep people hobbling until things improve.
But in general the issue seems to be environmental - social and emotional environments are important. Stress, depression, sadness, bitterness, pain, exclusion, negativity. These are simply labels for, and symptoms of, sparse, poisoned, and broken social and emotional environments. Once you find yourself in a sparse and ugly environment you are in trouble - your "network" is diminutive, and so is your life. Joy is dead, you do not see beauty, you do not see how to solve things. You are literally unconnected. Choices, possibilities, beauty - not there. You cannot imagine a better life, you cannot image how to change things. The black knight is on the table.
It is a simple truth that the networks that define our lives are nonlinear - having 3 close friends is not 3X better than having 1, but much much more than that. Our lives become rich in more than proportion to what we have, and our lives become painful in extreme ways when we do without social connections and positive emotional experiences. One simply cannot imagine life with no meaningful connections and meaning (e.g. good social and emotional lives). We cannot understand what it will be like (and thus cannot prepare well to get through rough times) and we cannot bare it for long if we find ourselves in such a state.
Due to the requirement for social and emotional life, and the highly nonlinear nature of networks, we are at risk. We cannot plan well for loss and we cannot easily build capacity to sustain ourselves through hard time. What can we do?
The black knight is always in play, and if you lose capacity you will be cornered. We know empirically that the black knight is part of the board of our society, the black knight is ready to engage every and any of us. We have only a handful of tools open to us in pushing the black knight to the perfillary of the board - (1) recognize that suicide is common and a systematic problem in our lives, (2) take care to build up our emotional and social networks and lives, and (3) reach out to our friends and others who find themselves in sparse environments. A series of negative emotional situations can quickly make one perceive things as negative in a systematic manner, a social vacuum quickly leaves one without perspectives and help, a belief that suicide is rare leaves one feeling inadequate and ashamed of such thoughts - I'm so fucking weak and pathetic. No you are human, a human that has found yourself in an ugly situation, one that is overwhelming as we do not teach each other that emotional and social reality make up 2 out of the 3 key aspects of being human and instead we all focus on the more easily (yet not easy) measurable and taught third factor - objective truth. It is somewhat ironic that the depressed are often more capable in the objective plane, with more realistic assessment of their skill level, etc., but this is not helpful to them as they lack the fruits of the other two aspects of human reality (emotional & social). They are 2/3rds dead already, and "logically" they see suicide as the only realistic solution.
If you see your friends or children cut off, you must try to reach them. It will be hard, for they will likely not admit to having suicidal thoughts (shame), and they will not be able to see a way beyond and through the pain. The gap between their emotional and social reality and the emotional and social reality required for a bearable, let along thriving, life is too large for them to transition without help. "You don't understand", and it is true - talk to someone who made it through, and they cannot even put themselves back into the past to fully describe the lack that defined life. Before you kill yourself you are not human, you cannot imagine becoming human, you considering killing yourself as you are already dead in the ways that matter. How to we bring people back to life? We can only try to help them do it themselves, we can only hope that we catch the downward spiral before it is too late. If you do get yourself or another on medication this is just the beginning.
Primitive societies had serious issues with decay, accidents, and violence as causes of death, problems that our society has vastly reduced. If you chose to lead a physically healthy life medicine can help you immensely by getting you though emergencies, allowing you to live much longer. Basic hygiene and vaccinations has dramatically increased life span. The state has monopolized violence, reducing intragroup conflict, and the consequences of state-state warfare among competent states has become so large as to reduce intergroup conflict to an astonishing extent. So to a large extent, we have pushed off decay and accident in order to lead longer and healthier lives, and we have diminished the likelihood of someone intending to kill us. But that leaves self-intent as a large factor contributing to death, one that we have not addressed anywhere near sufficiently. It is somewhat surprising that we have largely ignored suicide - fundamentally there are not that many ways to die, so just on conceptual grounds alone one would think we would confront this more. Empirically suicide is a huge issue, an issue that points to a vastly impoverished emotional and social life.
Suicide suggests that we continue to be poor in our society - by focusing on suicide we can learn more about what it means to be human and we can improve our own and others lives. We can create wealth and beauty.
Lowdown:
Suicide is one of the key characteristics of our society, one that is not discussed and thus one that will remain prevalent. Empirically we know that 1-2% of people will kill themselves, a huge number - suicide will effect your life. A society that largely ignores 2/3rds of what it means to be a human is bound to have problems with allowing people to create fulfilling and beautiful lives. Positive social and emotional state is key in preventing suicide. "Emergency treatment" with drugs enables one to hobble onward, allowing social and emotional networks to be created, but the drugs alone are insufficient and "treatment" begins there. The good news is that the process is actually enjoyable and enriching once underway.
Reference:
Night Falls Fast: Understanding Suicide
: Suicide enlightens the human condition, every educated person should be versed in basics of suicide. This book is the best I have seen on suicide - essentially everything in this posting is directly from the author (e.g. "black knight" metaphor), was an earlier observation of mine that the author also notes (e.g. the emergency room example - which is filtered in terms of suicide here, but in general is a good example of how "brain problems" causes much pain and expense to society, ironically I was in the emergency room with someone who suffered an intense migraine attack when I first became aware of this), or was written in reaction to author (e.g. emotional + social aspects being largely ignored in our society, with the objective element of the human condition being focused on to the exclusion of these other factors). You should read this book, you should have your friends read this book, if you are a teacher you should discuss this book with your students (one tidbit you will learn: in the time it takes for one class, which you could devote to the book, 3 Americans will kill themselves - why are we not talking about this more?), if you are a parent you must read this book. If you are in a book club, read this book.
