
Suicide Attempters’ Long-Term Survival - EndXA
https://www.hsph.harvard.edu/means-matter/means-matter/survival/
======
DoreenMichele
PSA: Most suicides occur while the person is alone. Company can be a strong
deterrent to attempting suicide.

Thanks in part to an incurable medical condition, I'm sometimes suddenly
suicidal and basically deranged. At such times, my adult sons don't leave me
alone.

They mostly try to avoid discussing it with me. They don't try to make me feel
better or act like unpaid therapists because it not only doesn't work, it's
actively counterproductive.

Their policy is to take care of me physically (food, drink, warmth), keep me
company and "do not engage Teh Crazeh."

In other words, trying to argue with me at such times about how irrational I
am amounts to adding fuel to the fire. It just makes me more upset.

I've lived with this a long time, so I'm often able to just tell them "I'm not
right and can't be trusted to be alone right now."

As my health improves, such incidents have become fewer, farther between and
shorter in duration. It happened a lot while homeless. It's been much less
common since getting back into housing.

~~~
DanBC
> Most suicides occur while the person is alone. Company can be a strong
> deterrent to attempting suicide.

This is a lot more complicated than you're making it out.

plenty of people kill themselves in front of their family. Others kill
themselves when their family are in the home. Others kill themselves in
public. Others kill themselves in hospital wards when they're on 15 minute
observations. These are not a tiny fraction of the total number of people who
kill themselves.

EDIT: I'm glad you've found something that works _for you_, but it's really
important to recognise that your experience is not usual, and that many people
would find it invalidating.

EDIT: Page 33.
[https://documents.manchester.ac.uk/display.aspx?DocID=38469](https://documents.manchester.ac.uk/display.aspx?DocID=38469)

> Living alone -- Women: 45% Men 50%

This shows that living alone is a risk factor, but it also shows that most
people who die by suicide do not live alone.

Page 55 suggests that it's external support that helps, not support by the
family:

> 149\. In 834 (43%) the patient lived alone. They were less likely to receive
> additional social support from outside the home (e.g. from a relative,
> friend or neighbour) as part of their care plan compared to those who did
> not live alone (138, 44% excluding unknowns vs. 270, 71%

~~~
ljm
There is value in moving away from those statistics and looking at the other
part of DoorenMichele’s story, which to me feels like one of compassion.

Having people around you who can support you while maintaining their own
boundaries, without getting themselves involved or colluding with that state
of mind you’re in, can be really powerful. It means you’re still being treated
like a human being who has needs beyond what they are panicking about in the
moment.

Anecdotally, I’ve been through far too many of those kinds of breakdown to
count and I was grateful when the friend I was with (who understood the
underlying causes) asked if I needed a hug, or said “I love you,” and
basically didn’t react to whatever I’d started crying about. I could be
another statistical outlier in that sense but there was always a better
alternative than engaging the conversation, and making it more real. You can
probably guess that was family related.

~~~
DanBC
> can be really powerful.

It can also be invalidating and harmful. I've met far more people for whom
it's harmful than I have who were helped by it.

It's also causing harm to those other people: a relative who attempts suicide
will increase your own risk of suicide.

I've spoken to a lot of people who had a relative who died by suicide. Many of
them had carer roles for their loved ones. Every single one of them who had
this carer role spoke about the huge amount of guilt they now feel, and about
their own significant increase in risk of death by suicide.

------
cm2012
Great summary of the suicide literature. This is why it's okay to restrain
suicidal people against their will - it's temporary madness most of the time

If your happy but very drunk friend wanted to tapdance on the edge of a tall
building, would you restrain them if necessary? Or if someone high on shrooms
was trying to drink bleach?

A suicidal mind is often one caught in the temporary throes of delusion and
irrationality, even if it comes from internal wiring going haywire instead of
external substances.

Preventing someone from killing themselves is in their best interest most of
the time for that reason. Suicidal impulses are most often fleeting relative
to normal lifespan.

~~~
stevewodil
It would be interesting to talk to these people and ask if it was the suicide
attempt itself that made them not attempt again. If you prevent the attempt
will it have the same effect?

~~~
rincebrain
I know people who have said the primary reason they don't attempt suicide
again is not that they feel life is improving or worth living, but because
each attempt further reduced their QoL and they're terrified of what another
unsuccessful attempt might yield.

------
bayesian_horse
These kinds of results also point to how much of an impact guns have on
suicide rates.

Guns make it a lot easier to attempt suicide and achieve it. In the US, guns
are often more readily available than medical treatment. If you have a gun
laying around, and you have a short bout of suicidal ideation, that can be an
unfortunate combination.

On top of that, people believe it will be less painful than other methods,
increasing the appeal.

Virtually any other method of suicide takes more effort and time. The more
time an attempt takes, the less probable the patients are to go through with
it, and the more likely the attempt is discovered in time.

~~~
chrischen
I'd be interested to read any research on how drugs impact suicide rates
(particularly if it prevents people who would have otherwise committed
suicide). As easy it is to get guns, I think drugs actually a bit easier to
obtain despite being the thing that's illegal (due to gun purchase wait
period).

~~~
Fnoord
> how drugs impact suicide rates

Define drugs. Does it include alcohol? Does the (slow) deterioration of
alcohol abuse count? If not, does the one from methamphetamine count?

Mind you, you wrote impact. Impact can be positive as well. Does medicine like
SSRIs count?

~~~
chrischen
Yes, any drug that can be considered a coping mechanism against suicide.

------
datpuz
I saw a fascinating interview with Kevin Hines, a guy who attempted suicide by
jumping off the Golden Gate Bridge, and lived. He said he immediately
regretted it after he jumped.

It seems like there is something about there being no turning back that
totally transforms one's perspective. Why, after weeks, months, or years of
planning suicide, are peoples' perspectives able to totally flip in an
instant, precisely when it's too late?

~~~
siphon22
Maybe this is one problem that VR can solve. Virtually simulated suicides?
Virtually simulated anything. You don't have to die or hurt yourself, try X in
a safe simulation first to see if you really want to go through with it.

~~~
tfha
The virtual piece of it would ruin the last second regret. The regret comes
from the realization that you've crossed through a door with no return.

Can't ever get that in VR unless somehow the subject does not realize it's
fake.

~~~
coderintherye
Would it be ethical to subject someone to a virtual suicide they thought was
real...in order to convince them to not attempt in the future? The technology
seems to be getting to a place we could create such an experience, terrifying
though it may be.

~~~
emiliobumachar
VR seems unnecessary. Just have a gun around with blank rounds.

~~~
homonculus1
At the range of direct contact to the head, the explosive force of a powder
load is deadly whether or not there's a bullet along for the ride.

~~~
emiliobumachar
Good point. How about weakened blanks?

------
yasp
What percentage of those with chronic suicidal ideation attempt suicide?

------
pcr0
Could VR suicide dissuade people from attempting suicide?

~~~
blahblahthrow
As someone who chronically ideates about suicide (but has never attempted),
things like VR rock climbing and (real life) bungee jumping have just made me
scared of jumping. But it doesn't make me not want to die, it just makes me
want to do it a better way that's less scary

~~~
bayesian_horse
I wish you the best. I don't believe there is any psychological condition
worse than wanting to die. Even excruciating physical pain at worst can drive
you to that point.

I hope you can learn from these experiences, that your will to live or at
least your survival instinct has not gone away, even during such episodes, but
was merely drowned out by an irrational mechanism.

------
Theodores
The other day a lady jumped off the bridge in a suicide attempt. A passing
tourist dived in and rescued her from the river below, someone else went out
on a paddle-board to rescue the pair of them and the air ambulance arrived
shortly thereafter to take her to the hospital.

The river is tidal and not always that deep. Luckily she didn't jump at low
tide when she could have broken her legs or ended up crippled for life. As it
happened she ended up in the mental health ward. I imagine they will put her
on drugs such as lithium and she will lose her mind. Or they might find they
have no reason to keep her in and she might discharge herself to try again.

However, if she had crippled herself then she would not be able to attempt the
same thing - jumping off the bridge. But her body would be a living reminder
constantly with her of a failed suicide attempt. There would be some impostor
syndrome going on with that, people going the extra mile for her due to her
being disabled, not through birth or accident but through a failed suicide
attempt.

Due to the nuances of a suicide attempt I am not sure that the statistics in
this article have much real meaning. Also, what comprises an attempt? A walk
into the woods where no rope gets hung from any branch is still an aborted
attempt if the intention on the first step was hanging. But actually jumping
off the bridge is past that point of no return. There is grey area in this,
the teenager taking too many pills can be put down as a 'cry for help' even if
there is a point of no return being crossed.

Survival is also a grey area, not just in terms of physical quality of life
but mental. The mental health wards of a hospital will put people on pills
that take out the high and low notes of someone's mind, turning them into a
functional zombie. Survival needs to be qualified as not needing the harsh
medication that goes with being processed by the authorities.

------
agumonkey
I had this weird and strong question the other day: how come evolution didn't
manage to wipe out suicidal gestures. Why don't we just fall into a partial
coma when our mind is overwhelmed by events. It's a bit odd.. alas evolution
is no silver bullet (sic):

~~~
DoreenMichele
It isn't necessarily _crazy_ to want your suffering to end and to believe
death is the only solution. This is why we have the _right to die_ movement.

~~~
agumonkey
I meant at the biological/neurological level, not social/moral.

~~~
DoreenMichele
The right to die movement is generally about people with terrible medical
conditions for which we have no cure.

So I don't see the distinction you are trying to make.

~~~
agumonkey
My original question was unrelated to that issue also.

------
hestipod
I am 45 and am 99% sure I won't make it to 46. This isn't some unexplained
"out of nowhere" ideation. It's a consequence of being beat down and taken
from over and over, then having to make due with less and less, rinse, repeat.
There is a breaking point. In my experience most suicidal people I come across
are so because of the same chronic loss and suffering. Pills and therapy and
hotlines don't help. They are plasters ignoring root causes. Root causes take
time and money and that's too much to ask.

I posted over a year ago in a desperate attempt to find a job that I could do
despite all my issues. I'd been fighting for that for years. Because there is
no social system where I am, not one that helps people. Culture here is about
bootstraps and anyone who doesn't pull them or have them is a mooch loser who
"deserves" what they get. I couldn't get myself anywhere better because of my
issues. So I had to try and make due in the same grind but with far less
ability and energy. One kind soul, the only one in all this time, offered such
a job and I tried to get there, things got worse for me from a few sides and I
slid back and couldn't go. I am still TRYING and hoping, but hope isn't
enough. You have to be able to act, and the ground has to stay under you and
not collapse.

We all know how difficult work and earning can be even when we are young and
healthy and love what we do, imagine doing it when in constant pain, with no
family who loves you, with no access to high quality medical care. Imagine
seeing everyone around you grind and be exhausted and not having the
opportunity and endurance they do. Not being able to go home and enjoy
something after work because it takes all your mettle just to survive a day.

I have taken to using HN to vent my feelings on this topic when it comes up,
and probably sound like a one trick pony. I am not even sure I care anymore. I
used to worry what impression I would leave. That I might upset someone or
ruin an ally with my depressive state. It all seems like it is irrelevant now
as I won't make it anyway. Years ago when I still had some shreds of
bootstraps I couldn't get any help from people or systems. I am incredibly
resentful because I believe I could have built something then to get through
this life and do some good. Now I feel most of the time like I won't make it
regardless. I feel only social support/financial security/medical access would
even possibly give me a chance..and society and family have decided I am not
"worth" that. My value has been recorded and notated. You cannot really beat a
system like that. Once you lose you means to grind and become a drain on
profits you become a thing to be disposed of rather than a person. Nobody
WANTS to be in these shoes. Nobody CHOOSES it.

Until next time...or not...

~~~
ryacko
You can join a church.

~~~
hestipod
I didn't downvote you, but that's not a solution. I am not religious and not
interested in that culture. It's a very middle American idea that church
replaces family and social support and its some haven to reach out to...it
doesn't really work like that except in the brochure.

------
wetpaws
They realize that everything is futile, including the act of suicide itself

~~~
AnIdiotOnTheNet
A multiple-suicide-attempt survivor I met once remarked that she felt a
mixture of rage and despair at "not even being able to die right". As much as
people like to believe that people don't really want to die, sometimes they
really do.

------
tomlockwood
It's also an interesting argument for stricter gun control - guns make it
incredibly easy for suicidal people to follow through on that impulse. The
amount of suicide deaths by gun in America is a testament to this.

~~~
ummonk
Why should those of us who are non-suicidal have to give up our ability to
defend ourselves because some suicidal people are gonna shoot themselves?

(I don't own any guns but this screams nanny state to me)

~~~
tomlockwood
A person and their family are 3x more likely to be shot if they have a gun in
their house, so "defence" isn't a great reason to have a gun.

~~~
AnIdiotOnTheNet
That doesn't follow. I'm probably much more likely to be electrocuted because
my house has electricity, but that doesn't mean electricity doesn't serve its
purpose.

~~~
yongjik
On the other hand, nobody argues electricity is an essential human right
because you need it to fight electrocution.

Guns might serve some purposes in some situations. It's just an incredibly
lousy tool for "defending ourselves", with negative utility on average.

~~~
briffle
Nobody argues owning a gun is an essential human right. They argue it's a
constitutional right.

~~~
homonculus1
To the contrary, the constitution doesn't grant rights. It protects essential
human rights. There's a reason arms are right up there with free speech and
privacy.

------
starpilot
In time, I will be that 1 of 10.

~~~
isatty
Hello! Do you need someone to talk to? I’m not qualified or anything though,
just your average software engineer. Ping me.

~~~
ximeng
Nice gesture but you don’t have contact details to ping in your profile

~~~
isatty
Oops. Updated. Thanks!

------
Bostonian
This could be an argument against assisted suicide, which probably has a
higher completion rate than unassisted suicide. If people want to kill
themselves, let them do so themselves. There's a good chance they won't
actually follow through.

~~~
stevewodil
It's not socially acceptable, perhaps, but most people already have access to
plenty of ways to kill themselves if they really wanted to.

Anyone with a car has a number of possibilities, one being carbon monoxide
poisoning which we understand to be pretty peaceful.

~~~
XorNot
That's the thing - suicide attempts aren't rational because they grab
whatever's at hand and pick a really painful way to do it (paracetamol
overdose is one of the worst ways to go - you get to die of liver failure over
the next week, when you're probably thinking maybe you don't want to but by
then there's literally nothing medicine can do for you).

~~~
flukus
Some, probably most suicides are quite spontaneous, but many are thought out
over a long period. People grab what's at hand because it's the best method
they know of. Suicide options are a frustratingly hard topic to google, you
get a lot of hotlines but useful information is hard to find.

