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Why do so few humans kill themselves? (theviewfromhellyes.wordpress.com)
238 points by networked on July 26, 2016 | hide | past | web | favorite | 217 comments



While interesting, this article seems to ignore the possibility that most people simply have a very strong desire to live. It assumes that if someone is suffering, and death would end that suffering, then suicide makes sense, and something weird must be going on to make people keep going.

But this really doesn't make sense. The entire concept of suffering exists merely to keep us alive. We experience pain and despair and sadness not because it's some inherent part of being conscious, but because those sensations help us to avoid things which are detrimental to survival. When push comes to shove, the drive to survive is what's fundamental, and that will (usually) override the desire to avoid suffering.

As intelligent, conscious beings, we have the capability to understand when survival is no longer possible, making suffering a waste. Thus we can, sometimes, override our desire to live in the face of terminal illness. But what's weird is not the fact that we don't constantly kill ourselves at the first sign of trouble, what's weird is the fact that we do sometimes kill ourselves when things look completely hopeless. You might as well try to stay alive, after all.


In addition to a desire to live, not everyone views suffering as the worst possible thing.

If I had to be in serious pain every day but could keep doing many things I would rather keep living with the pain. The loss in experience is worse than any level of pain.

For the obvious counterpoint: I say that from experience not naivete. I've had a nerve in my hand accidentally sliced lengthwise (for a significant length) by a surgeon. The pain was so excruciating they had to put me under before I had a heart attack (heart rate+blood pressure both went off the charts, 290bpm)

However, before that happened I was much more interested in what was going on and how unique this level of pain was. It was fascinating. Prior to that I didn't really know how much pain it was possible to feel.

Anyway the point is, not everyone is afraid of pain and suffering. Especially not to the point that suicide would even be considered.


15 years ago I may have said something similar.

I'm going to try to shed a little light on how chronic pain and disability is a bit different than acute.

I've lived with chronic pain for over 10 years. As a registered person with disabilities, college resources helped me get by - but these did not exist in the real world for someone like me.

It prevented me from working in my field of study and preference and severely limited my freedom and willingness to take risks. I encouraged friends and peers to chase my dreams; they have succeeded where I could not.

On the spectrum of pain and disability I'm relatively lucky. My condition cannot kill me. At worst, it can only prevent me from doing what I want and deny my dreams. I have managed, and am somewhere in the top 20%. My old friends are in the top 5%. I burn my life doing irrelevant work because my employer has a good benefits package that has my back if I take a turn for the worse.

Now, with age, my body and mind is starting to deteriorate, and with it the dream of figuring a way to truly overcome my challenges rather than just get by.

I have it pretty good.

Anyway, I'm off to an experimental treatment where they'll stab me 20-30 times with a needle. Unfortunately my condition causes hypersensitivity. Acute pain doesn't really matter though. They claim to have improvement in 70% of patients but the published, controlled, literature is less encouraging. This is the best outlook and most hope I've had in years.

Maybe if I keep calm, remain positive, and make myself more susceptible to placebo I can get my life back. Or maybe I'll just be one of the lucky ones.


You nailed it.

Chronic pain can be really, really, debilitating.

Think about what you are going to do in a few hours. Maybe you'll hop on public transit to meetup with someone. Or maybe bike somewhere. Or take a shower. Or make a sandwich. Or make love.

Now imagine if you had a really bad joint (ankle, knee) or back. Suddenly, taking public transit has additional complexities, like does the station have a lot of stairs and a lengthy distance to the train? Will I be able to get a seat? Or if I'm biking, is my commute going to flare up my joint/back? If I take a shower, I can't stand too long lest a joint start to get painful. Besides, I have to 'save' my pain threshold for situations that are a bit less controlled like walking to the bank or returning an item.

Whereas most people can spend 100% concentration on their surroundings, I have to expend mental energy thinking "Where's the next seat? How long am I standing up for? Am I causing damage to myself?" When science and medicine can't do much, and quality of life drops dramatically, it's hard not to think about alternatives.

Death is permanent but it does have one advantage: it's silent. There's no more pain.


Chronic pain is very easily treatable.

In the US you only got the problem that the usually subscribed extended-release pain killer only works 2/3 of the period, but everywhere else this is a solved problem with its 4-6 hours cycle.


You're quite naive. My wife maxes out on prescription pain killers that her (really quite good) pain doc gives her. It means laying in bed doesn't cause constant pain, but everything else (including showering or sitting in a chair) is unbearable after a short time.

We know so much less about the human body than we think we do. When giving birth to our first son, she was given the maximum dose epideral and was told she wouldn't be able to walk for a few days because of intense numbness. Not only did she walk to the bathroom shortly after giving birth, but it didn't even lessen the pain.

Not everybody responds to and gets the benefits of modern medicine as we'd like. I'm grateful that medicine does work on me and my children though.


Good luck to you!


> If I had to be in serious pain every day but could keep doing many things I would rather keep living with the pain.

Scratch that: ~~~No, you (most probably) wouldn't.~~~

EDIT: this post is about severe chronic pain. Think cancer, or a serious toothache which lasts for years. And it's not meant to discuss the specific situation of the parent! I'm talking in general. I also agree that not 100% patients with severe chronic pain will consider suicide, however the percentage of people considering suicide in such group is much higher than in the rest of the population.

You may believe so right now, but that's totally irrelevant: just as you were unable to imagine "how much pain it was possible to feel" before your experience, you are unable to imagine what a serious, chronic pain can do to you.

Chronic pain is a lot like depression: there's no relief, no hope, nothing you can do to ever feel any better. Assuming that you'd be able to do anything - and that doing that would even make you happy - is... well, very improbable, to say the least.

> Anyway the point is, not everyone is afraid of pain and suffering. Especially not to the point that suicide would even be considered.

Sure, it's easy to be brave in the face of the unknown. It's a lot harder to be brave once you see what "chronic pain" really means. And there is no notion of being brave (or not) once it actually happens to you - there's only despair and suffering. Really, only that. Nothing else, at all.

We have a lot of pain management methods at our disposal now and, in many cases, it's possible to reduce the symptoms and make the patient feel "well enough". Without such help, however, it's only a matter of time before (most of) the patient considers suicide - no matter how brave and "suffering accepting" he was before.


>I also agree that not 100% patients with severe chronic pain will consider suicide, however the percentage of people considering suicide in such group is much higher than in the rest of the population. You may believe so right now, but that's totally irrelevant

It doesn't matter if the "the percentage of people considering suicide in such group is much higher than in the rest of the population" if that percentage is still small within such a group.

E.g. if 1% kills themselves in the general population, while 2% or even 5% kill themselves in such a group, that's still 95%, an overwhelming majority, that do not.

In which case, what the parent thinks now is not "totally irrelevant" but mostly correct.

>And there is no notion of being brave (or not) once it actually happens to you - there's only despair and suffering. Really, only that. Nothing else, at all.

I've seen people with chronic pain (including long-term fatal cases) that are not just "despair and suffering". Including people who have dreams and follow them (creative work etc) despite the pain.


We're talking about considering suicide! Going through with it is a completely different matter, due to very many factors, some outlined in the OP, another sometimes being physically unable to do it...

> I've seen people with chronic pain (including long-term fatal cases) that are not just "despair and suffering". Including people who have dreams and follow them (creative work etc) despite the pain.

Without any kind of pain management? With severe, chronic pain?

Well, what I witnessed may have been outliers, but once you hear a person you care for begging to "please, just make it stop" every time she was able to actually articulate some words instead of screaming in pain... that leaves a mark.

What I'm saying is that there is - possibly very different for different people - a threshold of (pain-intensity times pain-time-length) above which everyone will be considering suicide. That the people you know are below such threshold doesn't mean it's not there. Having seen people way above it I really can't accept people telling me that they'd rather "live with the pain". What they mean is they'd rather live with bearable pain, which is OK; however, there is such a thing as an unbearable pain and I don't believe there is anyone who'd like to live with it.


>Well, what I witnessed may have been outliers, but once you hear a person you care for begging to "please, just make it stop" every time she was able to actually articulate some words instead of screaming in pain... that leaves a mark.

You seem to conflate chronic pain with "living in total agony", like some terminal patient.

People here are not talking about that. Maybe do some reading about what "chronic pain" means medically? It's not just a single thing like the one you described.


His example is dramatic. But it's not as far off as you might think. Have you ever had a migraine? "Chronic migraine" is a thing, and it's truely awful.


I've torn the ligaments in my ankle and I've been in chronic pain every day for the last 12 years. Honestly, it doesn't bother me. (I mean, it hurts a lot and given the choice to be alive AND have it gone, I would prefer it gone, but, meh)

It bothers people around me that I limp though. Oh well.

I gave the example of acute pain because that was more challenging to me than the chronic.


Interesting. This is a complex issue.

I have those types of issues too. Most of us do once we get old enough.

They don't really bother me. Like yours, I can overcome them. Almost everyone does.

I suspect if either of us had trained all our lives to be, and wanted to be professional runners, it would bother us greatly.


I heavily dislike such absolute statements, especially if they are unfounded.

It is merely your opinion that he wouldn't keep going with chronic pain, he has a different opinion.

There's no way for us to verify yours or his claim.


Sorry, but that patients with chronic pain are much more likely to consider suicide is an easily googlable fact. That chronic pain links with depression, which further reduces probability of "would rather keep living" is, too.

Also, the "(most probably)" part of that sentence in my previous comment is there specifically to show that I'm not making absolute statements...


The fact that given a population of people more of them will consider suicide with chronic pain does not mean ALL people will. Some of us won't.


True, of course. I edited my post above.


Out of curiosity - was the pain fixed when you woke back up? Because brief, intense pain like that is one thing, but experiencing pain all day, everyday is a very different beast. Even if it's a tenth of the pain that you felt, that kind of thing really wears on you, especially after years and years and no help from doctors.


This, I think, is relevant to the idea that suicide is very strongly tied to exhaustion and hopelessness.

Pain and grief, even when they are absolutely horrible, don't appear to be strongly correlated with suicide. Inescapable problems, even when they are not so severe, absolutely do.

Broadly, people seem to turn to suicide either when their circumstances seem unimprovable (chronic pain, inescapable debt, irreparable loss) or when they lose the ability to imagine recovery (acute depression, various forms of psychosis). I think that when considering suicide, experiences like "I've been in that much pain" are basically irrelevant - the operant part is the permanence, not the severity.


I strongly agree! I think part of the reason I (and probably many others) don't see pain as something that would lead to suicide is because I would (and do) simply accept it as a fact and I no longer see it as a problem.

Kind of like being short, or not as smart as the next guy. It's just the way it is. No point worrying about it.

However, if you viewed it as a serious problem and when is it going to be fixed and then... never... yeah, that would be very different.


Notably, a lot of the people I know who report depression-inducing pain have distracting, breakthrough pain.

Even with chronic pain, it's probably not the end of the world when it's "an ache in my knee when I move in this direction" or even "a mild ache in my knee always". But if it's "at random, frequent times, my back hurts too badly to stand or function", that's super hard to ignore or get used to, and I can see being incredibly upset by it. Cluster headaches come to mind as following this sporadic + devastating pattern, and indeed they do cause a fair bit of suicide.

"Can't escape it" and "can't get used to it" are an ugly combination.


Oh and to answer the direct question, I was given strict orders from the doctor to not go off of serious pain meds (something schedule 2, I don't remember what) for 2 weeks out of the heart attack danger. I took them for about a week before forgetting about it.

It was down to just like broken bone painful then so I decided to just deal with it so I could learn how to tolerate severe pain (I was 14 at the time), I figured it would be a useful skill. My parents were a little shocked that I decided to deal with it. I passed the time reading c++ books.

The pain did make me take a lot of breaks and sleep to bring my willpower back.

I still feel it now, but it's more like the feeling of a minor cut on your finger.

Honestly, I think I have the opposite problem. Pain hasn't been sufficient for me to avoid injury. I probably could have avoided many issues if I listened to it a little.


I've also torn three ligaments (complete separation) in my ankle and they hurt more than 1/10th of that every day. Honestly I really don't care about the pain. It bothers people around me much more that I limp severely than it bothers me that I hurt. It's not something I care to think about because when I do then I feel self-pity.


One additional note from my side: if you're able to think about anything else than the pain without the painkillers, then my post above does not relate to you at all.


Chronic pain is an entirely different beast from acute pain.


Totally agreed. I woke up once with severe arthralgia throughout my entire body, went to the ER and was asked to rate my pain level. Despite being the worst pain I've ever felt (woke up in tears due to the weight of the blanket on my toes), I answered a 7/10. Acute pain – not really a big deal.

Unfortunately, whatever caused the arthralgia was (and still is) a complete mystery, and by day 5 of having top pediatricians explaining "nothing is out of the ordinary" I pragmatically, unemotionally contemplated suicide for the first time in my life. Somehow the ailment completely disappeared over the following weeks and hasn't returned, but it's quite something to feel that pain will truly and honestly never stop. It's not even that your brain goes into panic mode. It's a different mode of existence altogether – I can't even imagine people suffering through years of pain even 1/100th of the intensity of what I had.


I watched my father live with the pain caused by ankylosing spondylitis [0] for decades before he died. I myself live with the pain of psoriatic arthritis[1], and occasional uveitis [2], both related conditions I knew I was genetically predisposed to (HLA-B27 [3]).

It isn't easy. The pharmacological therapies I know would be most effective are too expensive. And so I have to choose how to avoid suffering from my pain, every day. I choose work, music, my family, antidepressant and anti-anxiety medication, and participating in communities (like this one) where I may find peers.

[0]: https://en.m.wikipedia.org/wiki/Ankylosing_spondylitis [1]: https://en.m.wikipedia.org/wiki/Psoriatic_arthritis [2]: https://en.m.wikipedia.org/wiki/Anterior_uveitis [3]: https://en.m.wikipedia.org/wiki/HLA-B27


I think we humans for some reason have ridiculously wide pain gauge. I can only theorize that we've got super pain sensitivity along with super brain.

Humans are very often disabled by pain alone, with neligible body damage. That's clearly evolutionary disadvantageous. Makes torture possible, etc.

Relevant xkcd: http://xkcd.com/883/


It's so you can taste ridiculously hot peppers ;)


For some reason I easily tolerate very spicy food but I have huge fear of pain.


I get myself into interesting positions quite often by arguing this exact thing. Suffering is a bit of information about the state of your body/mind etc. I can imagine the best life possible, with the most contribution to society, being a huge source of pain and suffering.

Generally speaking, of course, that's not a safe bet. Suffering tends to be associated with damage and psychological stress, which are rarely good things. I'd take 8/10 pain every day for the next 40 years though over something like dimentia or advanced alzheimers.

That said, I'd also take pain over severe depression. That shit sucks.


Or it's possible we're talking about differing amount of pain or different ways we experience pain.

My back gave out once and for about a week nearly every movement was excruciating. Getting out of bed was a 10 minute ordeal. Trying to sit down on the toilet or stand up was excruciating. Trying to sit down anywhere or lie back down on the a bed sent daggers of pain through my back. Turning in a chair or in the bed was just as bad. If a doctor had said "the rest of your life will be like this" I would have seriously considered ending it.

I've also had bad experience with bungled root canal and a resulting toothache that required 600-800mg of ibuprofen every 2.5 hours for 4 weeks while I waited for an appointment with the dentist to fix it. If the ibuprofen had not worked and had to live with that pain I would have unquestionably ended it.

Had a fingernail pulled out by a doctor once with no pain killers (well, he tried 3 injections of whatever over about 20 minutes but couldn't get the area around the nail to go numb). There's a reason denailing was used as torture. It causes extreme pain.

Whether others experience similar amounts of pain or I'm just a whimp I have no idea but of course I only have my experience to go on and I have a hard time believing if people experienced the same amount of pain every day they could truly live with it.


There is a big difference between pain you can reasonably expect to go away and pain you cannot reasonably expect to go away.

Suicidal ideation is due to the latter, not the former.


Sounds like the importance of pleasure and enjoyment is greater than the importance of pain and suffering.

I wonder if you could model the "suicide critical point" as the point at which the importance of pain is greater than the importance of pleasure.

Somebody suffering and in pain but hopeful is not likely to commit suicide. Someone with a good, stable life and/or future but fixated on negative aspects or thinkings may be more inclined for suicide.


> However, before that happened I was much more interested in what was going on and how unique this level of pain was

your post brought back a memory of mine. i crushed my finger once while doing something mechanical. the bone was crushed into pieces.

it hurt so bad i started laughing. i had to be driven to the hospital because i couldn't even see straight.

that level of pain is something else, for sure. it hurts so bad, but you can detach yourself from it, somehow.


It seems very likely that this is a context issue or typical mind fallacy.

The View From Hell is written by an anti-natalist and, if I recall, 'nonpracticing suicide'. This, I think, is someone who has a radically different baseline for "desire to live" than a lot of the people responding to it.

And, on the flip side, a statement like "the drive to survive is what's fundamental" might well sound completely bizarre to the writer. The idea that despair and sadness are about avoiding things detrimental to survival is at best situationally true, as evidenced by all the times when people find those feelings themselves detrimental to survival.

But aside from all of that, I think this doesn't invalidate the basic claim that a lot of the things stopping somewhat-suicidal people are not the desire to live. At the point where someone is considering suicide, their "life drive" wiring is obviously not a whole answer - so it remains relevant to look at the large number of suicide ideators who are held back by fear, or motivation issues, or other indirect reservations.


I agree with your point at the end. The question of what keeps many suicidal people alive is quite interesting, and no doubt complex. I just feel like the introductory question of "Why do so few humans kill themselves?" is backwards: the basic strangeness of human suicide is why we do it at all. Beyond that, there is then the interesting sub-question of why some people feel a desire to do it, but refrain.


This is a fair summary. I suspect that the author might disagree about how strange the basic urge to suicide is, but I completely agree that the really interesting category is "internally suicidal but not acting on it".


> But what's weird is not the fact that we don't constantly kill ourselves at the first sign of trouble, what's weird is the fact that we do sometimes kill ourselves when things look completely hopeless.

I think hope plays a big part. We don't kill ourselves because we have hope. If we are suffering and have no hope, that's a recipe for suicide.


Being extremely depressed actually reduces short term risks of suicide because planning shuts down. It's the middle ground where things are bad, but people can still think that has the highest risks.*

*Excluding hospital assisted suicide where someone OD's on pain medication under end of life pain.


But "no hope" is not equivalent to "extremely depressed".

Think of people who commit suicide over inescapable scandals, chronic pain, or terminal illness. Extremely depressed comes with 'no hope', but that's cancelled out by 'decreased agency' (which is one theory for why antidepressants carry suicide risk). Not every form of hopelessness shares that loss of agency.


> While interesting, this article seems to ignore the possibility that most people simply have a very strong desire to live.

Alternatively: People can have goals related to the actual outside state of the world, rather than their own internal state. If you can only conceptualize goals in terms of your own internal state, then sure, you might kill yourself to avoid pain, or wirehead yourself at the first opportunity.

But if your actual goals are out there in the world, then it's essentially as you say above. Dying reduces your influence on the world. If you're not alive, it's much harder to steer the world to your desired state. Survival is a convergent instrumental goal, for people as much as for AIs.


Human evolution is very much a work in progress. Many things that hurt survival are around because other things are more important.

Evaluate these 50,000 options as pass fail. Change a few randomly, shuffle with another set. Repeat.

Sure, it works for minor things eventually. But, in the short term only the most major things have noticeable impact.


very strong desire to live.

Meh, I just fear hurting the ones I love.


So... a very store desire to live (so that you don't hurt the ones you love).


I guess the title caught me off guard. Suicide rates are low as compared to what, does any other animal on earth kill itself?

with regards to people I would not place on it on the desire to live, I figure it because there are so many distractions in life


It is said that pain is a fact, a by-product of life and the human condition. But suffering is a choice. Many simply choose not to suffer with their pain.


What a terrifying sentiment. I'm astonished at how attracted people are to theories where problems are necessarily the fault of the person experiencing them. Hey, if you're suffering, there's an easy solution: just choose not to! Gee, why didn't I ever think of that.


I think I took something different from it than others are.

Many people choose not to suffer, because "suicide is an option". Or pills. Or therapy. Or, the lucky ones, they can switch it off.

Depression (noted in another comment) further limits the ways by which one can control the suffering brought on by pain. I know this well. Many of us do.


The strong will to live inherent in most humans means that suicide is typically not a choice people can make. That's kind of my whole point: the fact that anybody can ever make this choice is remarkable. But to take the possibility of suicide and thereby declare that suffering is a choice makes no sense to me. It may be for some, but not for most.


You did see that I listed other options, right?


Does it matter? There are plenty of people suffering from problems that can't be fixed by pills or therapy and who are not mentally capable of suicide. Suffering may be a choice for some, but it is not a choice for many.


I give up; you've checked out of the conversation and I don't believe I'm effectively choosing the words to match my feelings. Sorry if I caused any angst.


is it really that astonishing? it means that you're in complete control of your experience. quite a powerful statement. this isn't a blame game, no one's pointing fingers at anyone and saying, 'gee just think more positively man" or whatever. it's a personal strategy for managing one's own suffering, and a quite powerful one at that.


Pointing fingers and telling people to think more positively is a really common reaction to depression. I think that's why I reacted so strongly to it: it sounds so much like a common counterproductive refrain.


Agree, it is a definite common reaction, and completely counterproductive.


A depressed mind doesn't work like that.

For a depressed person, their brain is constantly torturing them, and the depressed point of view seems much more real. "You can choose to pretend you're happy like the rest, but you know how life really goes."


I think you missed the point, the way to "not suffer" is death.

In general every morning we make a decision on whether the expected future happiness is going to outweigh the expected future suffering. When that fails (and it does) we find reasons of duty to keep going, for the people we love etc. You're right, depressed people have a skewed vision of the future and it destroys their expectations of happiness.


I don't think that's obvious - spdustin could be speaking from a buddhist point of view: suffering is caused by desire, not pain. You can choose to remove desire and suffering from the mind through meditation.


> The entire concept of suffering exists merely to keep us alive. We experience pain and despair and sadness not because it's some inherent part of being conscious, but because those sensations help us to avoid things which are detrimental to survival.

Emotions are often themselves detrimental to survival. They are there to make sure you survive and reproduce, not that you survive without issue.


Exactly. Our bodies go through great lengths reconstructing damaged flesh, holding together with the help of something as primitive as stitching, getting disinfected with something as common as ammonia that changes our perceptions of our bodies making survival a second nature and a habit to us.


I agree with most of the assumptions. They are assumptions, though. We don't really know what makes us feel and act the way we do.


> what's weird is the fact that we do sometimes kill ourselves when things look completely hopeless.

The hope is always there, just change the purpose.

Instead of a life without suffering one expects to end the pain.

That is the final hope that the suicidal people embrace.


For most of us, committing suicide is unimaginable.

Sometimes people find themselves in situations where the unimaginable is a better option than whatever it is they're facing. The act is equally horrific, but preferable to the alternative.

> At least 200 people are believed to have fallen or jumped to their deaths [from the World Trade Centre on 9/11] while other estimates say the number is half of that or fewer.

[...]

> The New York City medical examiner's office said it does not classify the people who fell to their deaths on September 11 as "jumpers": "A 'jumper' is somebody who goes to the office in the morning knowing that they will commit suicide. These people were forced out by the smoke and flames or blown out."

https://en.wikipedia.org/wiki/The_Falling_Man


I don't think the WTC jumpers are quite the same. They were faced with certain death or near certain death, and they naturally chose the latter. Falls from a great height are survivable, very very rarely. I see this an example of the human drive to survive: when faced with death, we'll try anything that offers any sort of hope, even just a slight delay.


> when faced with death, we'll try anything that offers any sort of hope, even just a slight delay

Many people opt-out of aggressive cancer treatments that may add months on to their lives, and increasingly euthanasia is a (legal) alternative to letting medical conditions run their course.

There are situations where ending things early can be one of the valid choices made available to you.

http://www.goodreads.com/quotes/200381-the-so-called-psychot...


That's true, but I think there's a big difference between a long-standing condition and a brief crisis. I love the quote you linked to and I think it does a great job at giving people some perspective on what suicidal people are thinking. I just think the analogy falls apart once you start digging into it. Jumping out of the towers was a last-ditch attempt to survive, not just a better way to die.


> Jumping out of the towers was a last-ditch attempt to survive

I'm not sure how it's possible to come to that conclusion.

(And to be clear: I wasn't originally trying to suggest that everyone that fell from the WTC made a decision to jump. I think it's probably fair to say almost everyone that fell was simply trying to get away from the smoke by leaning out of windows, etc. )


I'm not sure how it's not. Certain death in the smoke and fire versus a slim chance of survival if you jump, seems like the rational choice in horrible circumstances.


I don't think it was about survival chance. Death by heat sufficient to kill you would surely be extremely painful. Death by fall impact from high enough would at least be quick. As either option was clearly fatal, jumping wasn't a deliberate choice for death and hence wasn't suicide.


Maybe we should just add lithium to the water supply, although that would drive conspiracy theorists crazy!

http://www.ncbi.nlm.nih.gov/pubmed/1699579

"Using data for 27 Texas counties from 1978-1987, it is shown that the incidence rates of suicide, homicide, and rape are significantly higher in counties whose drinking water supplies contain little or no lithium than in counties with water lithium levels ranging from 70-170 micrograms/L; the differences remain statistically significant (p less than 0.01) after corrections for population density."

Edit: on a second thought, it wouldn't drive them crazy, it would literally calm them!

Edit 2: I'm not proposing adding therapy-level doses of lithium to the water, just equalizing it to the water in other regions.


You'd be literally adding chemicals to change people's brain chemistry to the water. The conspiracy theorists would be pretty justified I'd say. I think this is the sort of thing you should really decide for yourself individually.


We already remove chemicals from the water that change people's brain chemistry (e.g., lead). Adding something entirely helpful doesn't seem that different from removing something entirely harmful.


It does seem entirely different. In one case we're removing a toxin, something that doesn't need to be in water at all. In the other case we're adding something that isn't normally in the water in order to benefit a few people. We do this with fluoride in many places already, but I think this takes it to a far different level by affecting your brain chemistry.

You're giving many people who really don't need it a mood stabilizer, if it's enough to affect those who are at risk of suicide, it's surely still having an influence in the minds of those who don't need it. Why should the entire population have this alteration performed when only a few will benefit. Seems better to go and seek out those few. Personally I'd take the increased suicide risk.

Point is, people will disagree about this, the optimal solution is to just let people who want it add it or take it as a supplement in their own homes.


Lithium might be an essential micronutrient, so it may simply be treating a common problem. Much like how milk is fortified with Vitamin D.

PS: There is little (ed: zero) evidence that Lithium is and the human body puts effort into removing it. But, it's also common in the environment and may have positive impacts at low levels so it's more debatable than you might think.


Perhaps, but if it's having a mental effect of notable size it still causes me concern. If you're happy with your current behaviors I don't see why you'd want it. Wouldn't it be better for individuals to just opt to take it themselves, encourage usage of those already existing environmental sources, etc?


Iodine is added to table salt for the same effect. Although I am no fan of too many additives, I do approve this practice. I wonder if it would be feasible to institute today...

https://en.wikipedia.org/wiki/Iodised_salt


Iodised salt is easy to opt out of though, many salts come without it still. Your municipal tap water is much harder to opt out of. Which is why I'd suggest you simply allow people to add this themselves if they'd like.


My close experience with depression (not myself) is that it can takes years for someone to accept the thought of being depressed, and even more time to seek help.

Sadly, there's too much prejudice and taboo over mental health in our society. People treat it as a badge of shame, not a disease.


one of the signs of depression is poor self maintenance, people get into a rut where they stop showering, cleaning etc.

They wont always seek help.


We don't know that lithium is entirely helpful.


What about all those cancer causing chemicals we allow companies to dump into the water or fluoride? I guess the conspiracy theorists are already onto fluoride.


> I guess the conspiracy theorists are already onto fluoride.

They are. I hope however that we can agree that they are in fact conspiracy theorists.


Why would you hope that? What do you gain by polarizing an entire group of people based on something as inconsequential as fluoride? Are you unable to brush your own teeth and would suffer great harm if they stopped profiting from companies who pay to dump their fluoride waste into our water supply?

Crazy ideas only get crazier when you don't calmly address them with education and instead find some weird necessity to ostracize those with differing viewpoints.


also vaccines..


Hmm, vaccines are in a slightly different camp as they are most effective when everyone uses them. I will say that the anti-anti-vaccine crowd does much more harm than good by spreading pro-vaccine propaganda. Believe it or not, not every vaccine created has been effective and harmless and by generalizing your hate speeches (on both sides) instead of educating you only cause people to make emotional decisions rather than rational decisions.


I made that argument in a prior thread and people were really, really against it. Despite the abundance of evidence, from that study and the Japanese one [1]. I think Zinc would make a good addition too re: suicide [2]. There are two other large scale studies like this for lithium, both confirming the findings. One from Greece [3] and one from Argentina (can't find it...) [1]: http://www.ncbi.nlm.nih.gov/pubmed/19407280 [2]: http://www.jad-journal.com/article/S0165-0327(13)00626-5/abs... [3]: http://www.ncbi.nlm.nih.gov/pubmed/24072668


It's fine if you want to medicate yourself with lithium, but it's not acceptable to forcibly medicate everyone else.

The studies you linked to show an interesting correlation between lithium in water supplies and reduced suicide levels, but you can't judge the net benefit on a single metric alone. Lithium is not without side effects, and it's unreasonable to suggest that the vast majority of the population that is otherwise healthy be subjected to those side effects for the incremental benefit of a select few. The magnitude of these side effects may be relatively small in the levels we're talking about, but the net effect is likely not negligible when applied to entire populations over the course of their lifetimes.


Lithium is an element, not just a medication. The element is used to medicate people with bipolar, in huge dosages. You and I both consume lithium every day. We may consume slightly more or less than others. The ones who consume slightly more kill themselves significantly less, with no side effects. Lithium the medication is in 100-1000x the dosages, hence the side effects. If it is bad in high (but naturally occurring, and much lower than the medication) doses, we should filter it out.


> Lithium is an element, not just a medication.

It doesn't matter if you call it an element or a medication, it has non-negligible medical effects and side effects. If it had no relevant effects, we wouldn't be discussing it here.

> The ones who consume slightly more kill themselves significantly less, with no side effects.

"No side effects" is an impossible claim to make. The studies we do have show a correlation between lithium in the water supply and suicidal frequency in the population. The side effects have not been studied.

For some hard evidence: Lithium in drinking water is correlated with changes of thyroid function: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114818/

Lithium most certainly does have side effects that are dose- and time-dependent. The side effects may be minimal at low concentrations, but when applied to a population over the course of a lifetime, they would certainly add up. Especially for those who are most susceptible to the negative effects.

It's also not hard to imagine that lithium's suicide rate reduction effects (which are purely correlation at this point, FWIW) are due to it's tendency to mellow people out. The cognitive dulling of even small amounts of lithium orotate in healthy (non-bipolar and non-suicidal) people are palpable. Would you still advocate for lithium in the water if it reduced the average intelligence of the population by, say, 1%? I'm picking hypothetical numbers here, but the reality is that there are certainly downsides to mass-medicating people with small doses of lithium.


In that study, the water the people were drinking was up to 20x what was on the high end of the other study. If you are drinking water that is 20-100x higher in lithium, that is more like taking the lithium pills than it is like getting it from water. Further to that, the study proved nothing statistically significant... So if 20x higher lithium concentration causes no statistically significant downsides, what could the harm of being on the upper bound of what is typical in areas that are not lithium mines be?


To add to this, I think there are many people who just plain wouldn't like do this. Even if they're unhappy or depressed they'd rather not have that feeling taken away by a mood stabilizer.

I'm not going to argue with the fact that it results in "better" outcomes in some people's minds, but personally I'd rather accept an increased suicide risk. I'm sure I could take any number of mind-altering substances every day and I'd feel great, but that doesn't mean it's something I want to do.


Then we should also think about whether governments in areas where lithium is naturally higher have an obligation to remove it from their citizens' water.


Iodine is added to table salt in a lot of countries in the world. Why is preventing "physical" diseases ok, but mental diseases not?


You can still buy many kinds of salt without iodine, it's easy to opt out.

Additionally, when you talk about mental "diseases", things get a lot more iffy. We have a terrible understanding of the brain, our diagnoses for those diseases are literally check lists, without any proper tests, many people would rather have their natural mental performance than a modified version of it, which is what something like this would force you into whether you like it or not.


Per my sibling comment, are you saying water fluoridation wasn't kosher either? It's similarly "forced medication".

https://news.ycombinator.com/item?id=12167455


While you're at it, you might as well add magnesium, potassium, sulfate, phosphate, iodide, L-selenomethionine, copper, manganese, chromium, molybdenum, orthosilicic acid, and ascorbate, too.

While you can't make people exercise and eat their vegetables, they will usually drink the tap water.

But you then have to provide a way for people to opt out without any de facto penalty, which is the problem. So this would so something more suited for a dedicated drinking water system in an apartment building or complex. The mineralized water on tap goes to sinks, drinking fountains, and refrigerators, and regular old municipal water to sinks, toilets, showers, and laundry machines.


Iodine is already added, to salt.


Do take varying diets and local culture in consideration when you push for such stuff. Lithium is almost certainly harmless, but adding zinc to the water will probably cause health problems for some people.

It may be a case of doing it, and warning people not to eat too much of it. But you need actual research to discover that.


Are these available as supplements and, if so, is it safe to take them?


This may not apply to you, but I must mention it: Anyone suffering from suicidal ideation should seek professional help. These aren't the kinds of things you want to try to self-medicate away.

That said, there is a form of lithium that is available over the counter: Lithium Orotate. The amount of elemental lithium per dose is lower than you'll find in prescription lithium carbonate treatment, but you wouldn't want to attempt to self-medicate in to the prescription range anyway. Lithium has a notoriously narrow therapeutic window, and it would be too easy to dose yourself into the toxic range.

I've tried lithium orotoate myself out of curiosity for circadian rhythm modification. Although the dose is lower than that of prescription lithium, the effects and side effects were still palpable. Personally, I found no positive benefits but substantial cognitive slowing and general feelings of malaise. It's also worth noting that lithium is moderately toxic to the kidneys over time.

Having tried low-dose lithium orotate myself, I would never advocate for any amount of supplemental lithium in water supplies. Let's leave the medication to those who need it, rather than forcing it upon the entire population.


> I would never advocate for any amount of supplemental lithium in water supplies.

Would you remove the lithium from other water supplies?


Not meaningfully. I think PragmaticPulp captured it well. You can increase the amount of lithium you consume, but mostly what lithium does is improve B12 metabolism. Regardless of suicidal ideation status, taking B12 and improving diet/sleep would be better than taking lithium. B12 is consistently and significantly lower in those with clinical bipolar than controls, so it is the real problem. Superdosing lithium ensures an ideal environment for B12 metabolism, hence the benefits.


It's available as a prescription in the US. A psychiatrist can prescribe it. There are other drugs that have less side effects that can be tried first though. I wouldn't take it without doctor supervision as it's very easy to reach toxic levels in your blood. Even while on it with a doctor you need blood work regularly. It is one thing that did finally start to help me after about 10 years of dealing with bipolar 2 (which included symptoms of not wanting to live).

https://www.crazymeds.us/pmwiki/pmwiki.php/Meds/Lithium


Ludicrous. Let people decide that for themselves. I can't believe anyone is seriously suggesting force medicating us because it seems to be correlated (note, correlation, not necessarily causation) with a drop of suicide, homicide and rape. We don't even know how lithium would cause such a thing and its exact effect on the psyche.

I have been following the field of psychology and psychiatry closely and let me tell you, they are not only far from understanding and curing the causes of mental disorders, they are also prescribing very harmful medication based on biased research funded by pharma. What you are arguing for is very dangerous.

And even if it was shown to be beneficial beyond doubt, why not make these supplements available in another form, cheaply and conveniently? State mandated force medication is not only infantilizing to the extreme, it also violates essential liberties of the people.


You're already medicated. Fluorine is added to water, and iodine to salt.


Your point being? I am opposed to that too. I just think it should be people's own decision to medicate themselves however they see fit. At least with the salt you can buy whatever salt you please,with or without iodine. The water supply, on the other hand, cannot be chosen.


You can buy whatever water you choose to drink, done pretty frequently around the world.


Ethically, what's the difference between that and water fluoridation? Atomic number?

In both cases, you're forcing a chemical on people that the evidence says would be to their benefit, but with a Knightian ("unknown unknown") risk of really hurting them.


The point of dumping lithium would be explicitly behavioral modification which is a different kind of thing entirely to the effects of fluoride in the water.


Lithium can cause severe problems for those who have hypothyroidism (a significant portion of women). For these people, the lack of thyroid hormone would likely worsen their depression.


How about a compromise: make some form of lithium available OTC, without any patents involved?


Or perhaps people should start taking more cod-liver oil, like people did in the old days.


You realize there are seriously negative side effects to lithium, right? Kidney disease, extremely bad for nursing babies, etc


> One of the most amazing things about suicide is that over the past 80 years or so in the United States, suicide rates have been extremely flat. The fact that suicide rates have not changed in response to changes in medical technology and other ways of life is astounding.

This may be true in the US, but in Greenland it seems like suicide rates have changed in response to changing ways of life:

http://www.npr.org/sections/goatsandsoda/2016/04/21/47484792...


An obvious question is whether suicide rates are unchanged, or simply flat because we have opposed changes obscuring the data.

There's a bit of variance in the US numbers, and I wonder how means reduction, a decline in chronic pain/terminal illness, and various way of life changes compare. I'd be surprised if none of those things were relevant, but less surprised if they didn't add up to a clear trend.


There's this AMAZING scifi story, which I read in 'Writers of The Future' (great series, named after the eminent L Ron. H.). It imagines a future where after a certain age, everyone has a chip planted in them, which makes it possible to kill oneself 'on demand', painlessly, so to speak. It 'naturally selects' away all those who are uhh, more instably minded, and selects for the very very 'stable' minded. I believe the story was about how boring, unimaginative the society had gotten because natural selection had optimized for stability. Great read! You should read it if you haven't. The writer's of the future series is a collection of amazing stories also, and what finally tipped me into the Sciences, despite the somewhat uhh interesting Scientology connection. Anyone remember the name of the story?

This was inspired by @antiquark's comment: >>Probably has something to do with the theory of natural selection.


Remember that it's technically a valid evolutionary strategy to live to, say, 25, have a few kids, then off yourself. Suicide before reproduction is all that would be selected against.


Depends on how much your children need you actually. I've read somewhere that part of the reason women lose ability to bear children past around 40 is so they can take care of their grand children because that is usually more important at that point from an evolutionary point of view.

It might have been a mere speculation but it kind of makes sense.

Rather than take the time to bare and raise one child, that time is better spent taking care of your 6 grand children.


I dislike these kinds of explanations because they seem like ex post facto rationalizations. An explanation that could have gone both ways explains nothing:

* Women stop having children after 40 because it's more important to raise the children you already have. * Women don't stop having children after 40 because bearing more offspring increases your chances of survival.

Your explanation barely makes sense even on its own merits. Surely, if nature wanted us to have N children and then take care of them, it would have set a cutoff on N, rather than on the time. What if someone has no children before 40? Is it to their evolutionary advantage to care for the children they didn't have?

Or, if your explanation were true, why would women not spend ten years gestating and given birth to a healthy 10-year old? It's illogical to design a system that can pop out one baby every nine months and then say "okay now that you've had anywhere from zero to thirty children, it would be best if you stopped and took care of them.


> It's illogical to design a system that can pop out one baby every nine months

To design? Are you a creationist?

Assuming you're just confused, evolution doesn't "design" life. It's just a "whatever works" process.

For example, angler fish have a lure that resembles prey for their prey. This has been selected by the eyes of their prey. It's not that the prey wanted their predator to fool them, it's just that angler fish with bad lures starved and died off.

In the case of humans, if what your parent comment suggests is true, then it would just be that some women had some sort of defect where they couldn't give birth after some point and that turned out to give their grandchildren an advantage over the grandchildren of women without the defect. Over a long period of time, more and more descendants with defective reproduction genetics would survive compared to those without and so it becomes prevalent.

That's how evolution works.


No, that's how you explain things after the fact. If women could bear children until they died, we'd explain it by saying "well that's obviously because it's more advantageous to have more children". Again, something that can equally well explain why something happened and didn't happen doesn't have any explanatory power.

Put it another way, if I asked you "would you think that evolution would select for women bearing children until their 40s, or until they died?", you wouldn't be able to answer, because there's no predictive power in the explanation. Contrast this with "the sun rises every day because the earth revolves around itself", which allows you to predict whether the sun will rise or not tomorrow.


> that's how you explain things after the fact

I agree, that's what I said "if what your parent comment suggests is true"

In fact, said parent comment said "It might have been a mere speculation but it kind of makes sense"

I agree with you that there is no predictive power in explaining things that way (indeed, what I said is speculation, hence why I worded it in the conditional), but that was not what I was responding to. I was only responding to the "design" part of your comment.

That being said, evolution does make predictions which have been confirmed. Notably Darwin's long-nosed moth. Here's a list of more predictions[1]

[1] http://chem.tufts.edu/AnswersInScience/evo_science.html


You seem to have fixated on one word in my comment and are arguing against creationism. I'm not saying that evolution makes no predictions, I'm saying that saying "oh yes, everything is the way it is because it confers an evolutionary advantage" is a mostly wrong, largely useless answer.


> You seem to have fixated on one word in my comment and are arguing against creationism.

Well, I would argue that the vibe of your whole comment was coherent in that sense: you talked about what nature wanted, about design and about what kind of stuff would make sense while looking at it from a architect perspective.

It's a very odd way to look at it if you have no creationist conception of it all to be honest.

As for your point that not everything has an evolutionary advantage, I agree. Deafness and blindness exist after all.

But I don't really see your point as far as proposing hypotheses to account for certain prevalent traits, which, in my opinion, is what the original content was about (the grandmother hypothesis).


> Your explanation barely makes sense even on its own merits. Surely, if nature wanted us to have N children and then take care of them, it would have set a cutoff on N

To talk about what nature "wants" is probably not very helpful. I can't speak for the idea that menopause exists because it is useful for old women nurture their grandchildren, but tendencies like it exist simply because they are helpful enough in an evolutionary sense.

I mean, why should we want to have sex without reproducing? If nature "wanted" us to have children, why not make that coincide exactly with our sex drive? It's because no one designs these things or thinks of logical solutions. Having a sex drive regardless of individually wanting to have children works to a genetically beneficial end either way.

> Is it to their evolutionary advantage to care for the children they didn't have?

Their evolutionary advantage? How can an individual gain an evolutionary advantage in itself? When I'm dead, I'm dead. Nothing can be an advantage or a disadvantage to me as an individual at that point. The process of evolution stretches across generations and concerns things that do sustain for several generations, like genes.

Why would a spider want to mate if it almost always gets eaten immediately after doing so? How is it to their individual advantage to be eaten? Why would bees be born without reproductive capabilities? It's because these are genetically beneficial traits, not because the individuals themselves will gain from it.


> I can't speak for the idea that menopause exists because it is useful for old women nurture their grandchildren

Exactly. The most we can say is "it's generally useful so it tends to happen". However, evolutionary biologists tend to paint their explanations with a certainty that just isn't there, and can look at any old random thing and say "well, this is obviously because X!".

"Evolution made spiders eat their mates because it makes sense that they would want to preserve energy". Yes, but it also makes sense that the mates would stick around to feed the offspring, otherwise all species would kill the males after mating. We aren't as sure about why things are the way they are as evobio would have us believe, and not to mention evobio explanations for human psychology, which are usually completely ludicrous.

In general, the process for explaining things using evolutionary biology seems to be:

* Look at behaviour.

* Find one advantage, however small, of said behaviour, regardless of disadvantages.

* Say "well obviously this behaviour evolved like this because of that advantage".

* Publish.


I actually partially agree with you but for a slightly different reason. It seems like an unfalsifiable claim that rests solely on intuition and the notion that you can: "well just think about it, it all makes sense!"


That's exactly my point as well, though. It's completely unfalsifiable, and everything gets explained the same way.


Evolution can't force anything, and just because it's possible for a woman to not have any children, 40,000 years ago most women who could did.


We should design an ultralongitudinal study where we select for child-rearing volume and see what result we get /s



That's a valid evolutionary strategy assuming your kids will be fine once you off yourself. If that plan lessens the chances of your children's survival to child-bearing age themselves, it would be selected against.


In a tribal society, the chances of them being fine would be greater than in the classic nuclear family. So it depends on a lot of other factors.

I'm not 100% sure how to interpret evolutionary minutiae in human society past the basic agrarian level. Factor isolation becomes quite difficult. E.O. Wilson effects come into play.

If I may, the Stoics thought suicide a perfectly acceptable reaction to being "checkmated" in life - if there was a significantly unresolvable ethical dilemma, fall on your sword. The Stoics were the principal competitors to the Church early on, which led to proscriptions against suicide ( some say ).


Right, though that doesn't mean that there is anything selecting for suicide either. It's an uncontrolled variable.

Some species to kill of one parent to provide the offspring with energy. Maybe with more mass extinction events you'd start finding species that die of natural causes when population growth becomes too large.


> Suicide before reproduction is all that would be selected against.

Not necessarily true either. If your suicide is beneficial to your siblings, for example, it won't be selected against (assuming they have the trait as well, but it hasn't expressed itself for them).


If this strategy had proven valid, we would die around 30.


>The fact that suicide rates have not changed in response to changes in medical technology and other ways of life is astounding.

Because depression is a disease, its not just feeling blue because something happened to you and as such it probably has has the same distribution since the early days of humanity. Its a disease with no good treatments so we can expect the same mortality rate.

I think handwringing over people having easier lives but still killing themselves is fairly meaningless, and frankly, more than a little shaming. Depression affects people almost randomly. Wealthy people with easy lives kill themselves just as readily as poor people with harder lives. You can't will yourself out of depression because things are easy for you. The disease, unfortunately, doesn't work that way.

I have major depression. Its not caused by some negative life events or my parents not loving me or anything like that. Its clearly something I was born with or rapidly developed when I was just a child. I think its dangerous to talk about depression as not being a disease of the brain and as something that emerges from negative life events. Those things can certainly make it worse, but depression is a disease like any other, not a mood.


I love how far philosophy has come. This is very science based and yet my first reaction to the article's title was Cmd+F..."Camus". As Camus would say it seems obvious that we realize life is stupid and we should just kill ourselves but—something I didn't realize when I suffered with depression was—that when you realize everything is stupid and meaningless you find this deep appreciation or what I call "the game." You find a competition with "meaninglessness" and even suffering. And I love that game. I think people learn to love life; they find meaning in life and so they keep going.


> virtually all adults have the intellectual wherewithal to take their own lives

Do they? It's one thing to say 'i dont want to live' or "i wish i was dead", and another to actually go through the processes to do that. Suicide killers for example, need a strong metaphysical motive and promise of reward to do that.

I often wonder if a man stranded alone in an island , without any societal pressures would ever consider suicide.


> Do they? It's one thing to say 'i dont want to live' or "i wish i was dead", and another to actually go through the processes to do that

I think everyone has the capability, just as they have to murder. That they have not found circumstance such that they can conceive of it taking place doesn't mean they can't. People discover surprising (for good and ill) things about themselves when pushed to their limits and beyond.

> I often wonder if a man stranded alone in an island , without any societal pressures would ever consider suicide.

Whilst they'd be free of debt collectors, divorce, job loss, shame and the various other factors that may increase suicide, they'd also have new factors. For instance perhaps the island has no, or inadequate food and water. If you had a revolver and the prospect of starving to death considering surely suicide may be considered?

What of disease or serious injury?


> Suicide killers for example, need a strong metaphysical motive and promise of reward to do that.

There are many examples of suicide bombings without religious motivation and with non-religious perpetrators.


How do other primates behave in this regard? I'd expect various coping mechanisms exist to reduce stress becoming so high that the individual contemplates suicide as a solution, i.e. I'd expect it to be more common the individual experiences cognitive dissonance, followed by denial, withdrawal, misdirection, etc. to avoid having to directly deal with the stress inducing information/situation. Suicide requires planning, so it's a very cognitive process, where many of our coping mechanisms are more automated (even if learned, typically that's at a very young age).


According to the link, around 1 in 100 people commit suicide. It could be argued that this is a rather high number. Certainly any other diseases that achieved this would receive significant attention.

What is interesting however, is how suicide rates haven't changed with other things like medical improvements and improvements to quality of life.


I think you're vastly overestimating how much people care.

http://www.cdc.gov/nchs/fastats/deaths.htm

Check out, Chronic lower respiratory diseases at nearly 4x suicide. Can't remember hearing a thing about that in the news.


You probably have heard of campaigns to reduce smoking. These diseases (e.g., COPD and the related emphysema/chronic bronchitis) are strongly linked to smoking.

In the mid 90s, I remember seeing some anti-smoking campaigns that used people with tracheotomies (see ref 1); these folks almost definitely had lower respiratory disease.

Your point is well-taken - we hardly spoke about addiction as a medical health problem until recently.

[1] https://www.youtube.com/watch?v=L7bHdo2DJHY - this is only part of one of the ads I recall


It's also a killer of younger people. I'd bet suicide accounts for more life-years lost.


>significant attention

I think people are aware of it but it's a bit depressing to talk about given that solutions aren't easy. I can see it getting more coverage as other causes become less common in young people. It's the #1 cause for ages 15-45 in Australia for example (that's just the country that came up on random googling) http://www.aihw.gov.au/deaths/leading-causes-of-death/

I think it's more cheerful to give attention to making society happier and healthier which should have a knock on effect on the suicide rate.


Easy answer: because we want to believe life is precious and that you only live once.

Mental health is taboo.

I'm not trying to say that we should let people die, but the living standard has really skyrocketed, meanwhile we still have behaviors and systems that do damage to mental health, and we still disregard those problems.


I think actually it's because we fear death. Even if you're an atheist and know that when you die nothing will happen besides you disappearing, you still don't want to do it. Even people who commit suicide often would rather if they didn't have to use that option.

The worst thing about war in my opinion is not just that people die, but that people live in constant fear of death.


> Even if you're an atheist

I really don't understand this sentiment. Surely belief in an afterlife is a far greater motivator to off yourself than not? It's only religions that threaten you with eternal suffering if you do that would act as a special deterrent (easily eliminating all religions that don't have a concept of hell). Especially if you consider that some of those even go out of their way to make exceptions for certain forms of murder-suicide ("suicide attacks").


You're presuming to speak for others.

I don't fear death at all.

I fear dying slowly and in pain.


A mistake and an insight.

The idea that white men have the highest suicide rate is misleading - they have the highest rate of success, which is very likely because they are the most likely to own guns, which are far and away the most effective and effortless way to commit suicide. Effortlessness is important, because depression makes planning so difficult. FWIW I'd really appreciate it if we could not turn this into a debate about gun control.

The insight, of course, is that Elliot Smith didn't have a drug problem, he was looking for a drug solution. This is an incredibly accurate description of addiction. The saying in AA is "If alcohol didn't do anything for me, I'd never have let it do anything to me". Drugs and alcohol are a solution to the underlying problem, one in which we simply can't feel ok the way others can. Of course, they are a solution with horrible side effects, and one that eventually stops working. Many members of AA describe getting sober because the drugs and alcohol weren't working anymore, only to become suicidal and realize that the drugs and alcohol were only symptoms of a much deeper problem.


> which is very likely because they are the most likely to own guns

America is not the world


I think the data were taken among Americans (they included Native Americans). You're right though, and looking at data from other countries with stronger gun restrictions would be an interesting way to check this hypothesis.


In England you can use the Office for National Statistics data sets. These are good quality, and they're very clear about what is or isn't counted as a death by suicide.

http://www.ons.gov.uk/peoplepopulationandcommunity/birthsdea...

You can also use the Public Health England "Fingertips" datasets which breaksdown the data a bit more.

Here's the main Fingertips site: http://fingertips.phe.org.uk/

And here's the Fingertips mental health stuff: http://fingertips.phe.org.uk/profile-group/mental-health

And here's the Fingertips suicide stuff: http://fingertips.phe.org.uk/profile-group/mental-health/pro...

Currently the ratio of deaths by suicide for men:women is something like 4:1 or 3:1, and we think that's because (as you've said) men tend to use more lethal methods. (Although we've seen a really worrying increase in lethality of method in women in the UK).

Go careful when comparing the UK stats with the US. I think we count different things. For example: a death that would be counted as a suicide in someone over the age of 15 is not counted as a suicide in someone under the age of 15. I don't think the US does that.


The relationship between depression and suicide with age is just correlation not causation, so it's silly to draw a line there and assume they are connected -- especially since we know depressed people have a higher suicide rate than people without depression.

I think this post is an attempt to make an obvious question seem like it has deep or non-obvious answers; but in reality I think the answers are pretty obvious. Most people don't kill themselves because they don't want to. It's that simple. It's like asking "Why don't more humans become ballet dancers?" Some try and fail but most just don't want to.

If the question is really; why don't more people want to kill themselves, then the answer is going to vary person by person and be difficult if not impossible to answer globally. Bob might not have any thoughts of suicide at all but Alice might think about it but want to see her nephew grow up and not inflict that pain on her parents.

Truly answering that question would involve a really comprehensive study of a lot of different groups to even attempt to answer it.


The paper does not draw a causation, nor does the article. The paper asks a question, and the article tries to think along the lines of the question and asks some more.

----

> I think the answers are pretty obvious. Most people don't kill themselves because they don't want to.

That is a simple conclusion, indeed; and it's not wrong either. The article tries to reason how that conclusion came to be. People who have had suicidal thoughts but didn't go through with it did ultimately not want to do it, but before that decision they did want to, by definition of 'suicidal people'.

The article – inspired by the paper – opens with the premise that 'pain' and 'human cognition' alone should make a human want to 'give up' upon the slightest inconvenience, and then goes on to try and come up with other factors — like your Alice wanting to see her nephew grow up or not wanting to inflict pain on her parents — that prevent 'pain and brain' from having their way uncontested.


> The paper does not draw a causation, nor does the article.

It does draw a conclusion:

  > Indeed, there appears to be a slight elevated risk
  > of suicide in people taking some antidepressants,
  > especially young people. But the effect is tiny. 
  > And some people do think antidepressants relieve 
  > suffering. If depression caused suicide, treating
  > depression should reduce suicide rates, but of
  > course it hasn’t. This could be due to the
  > ineffectiveness of treatment, however.
If depression caused suicide, treating depressing should reduce suicide rates ... BUT ... that assumes we identify and 'rectify' all depression, and that the only cause of suicide is depression, and that the only metric of success for treatment of depression is a reduction in suicide (across the board) ... and if you adopt those three positions then the numbers start to make sense.

'But of course' this isn't the whole story.


Exactly. Treating the symptoms does not mean treating the cause and might even enhance it.


That is not causation, is it?


I think your comment has blurred some distinctions that the post takes care to pull apart. Every human inevitably suffers and has reason to commit suicide, so why don't they all want to? Many more people want to commit suicide than do commit suicide, so why is that?

The reasons that you posited for Alice not killing herself were among many mentioned in the post.


I think the post is very interesting, and not completely obvious.

It's not as much about people deciding whether or not to commit suicide; it is, that all of the benefits of intelligence also come with one potentially huge evolutionary problem, suicide. Given that any natural variance in likelihood to commit suicide should be very heavily selected for or against, what adaptations might we have that were picked up to decrease it's likelihood?

The idea in the post is that some mental illnesses may be connected to these adaptations.


tl;dr, the article mostly discusses Soper’s hypothesis that "mental illnesses" such as depression evolved as defences against suicide rather than being the cause.

So I guess rather than thinking the job's crap, I'll just have a jolly skydiving trip with no chute you get depressed instead. There might be something there - I've always been a bit puzzled by the evolutionary function of depression.


I'm not sure there needs to be an evolutionary function for everything. Some things are just "dewclaws".


Martin Hart: So... what's the point of getting' outta bed in the morning?

Rustin Cohle: I tell myself I bear witness. But the real answer is that it's obviously my programming. And I lack the constitution for suicide.

--True Detective


Time is a flat circle.

rolls up a booger between his thumb and index finger


the highest suicide rate is among people 85 years or older. With the advancement of healthcare people are living longer. So the rate of suicide amongst younger demographics most likely has declined slightly


Interesting. I've often contemplated about it. I don't think I want to live past 80. I mean unless there would be a medical revolution where you can retain youth or slow down aging significantly.


The idea that products around teeth, glasses, hearing and so on are so much better than 20 years ago and even if they just progress linearly I have two or three more rounds of these improvements really calms me when thinking about mortality.


I think most people don't want to be a personal or financial burden to those they love when they reach that age.


Get back to us when you turn 80. :)

People's experience change their perspective. What's important to you now will change. What you're able to appreciate changes.


I actually used to have that limit set to 60, but then when I thought about it, I probably would still have some physical strength at 60 and still wouldn't want to die. But at 80 I can't imagine myself being other than a total wreck.


My grandfather is 89. He can't walk very far, he gets tired very easily, and he has arrhythmia - yet he is still very strong, and very active. Most days, he gets up at 5, works in the garden, or the woodworking shop, or on property maintenance, finishes up by noon, and watches television until evening. This has been more or less his routine for the past 13 years.

If you remain active through your life, I think you're much more likely to stay active as you're older. I intend to retire by 40, but I don't intend to be idle.


60 is the new 40 :)


OK, now that I see the stat he's calling "low", 1.4%. I actually disagree. That's a pretty high number that we could probably get to go down further. Assuming that one person out of every graduating high school class is going to kill his/her-self would seem to me to be a fairly morbid assumption. But this appears to be the case.

I think the responsibility for the weight (or perhaps, levity) of the philosophical observations made in this article fall back only on the writer himself, and his own attitude(s) towards suicide.


He did the math wrong. The source he links shows about 10 deaths per 100,000 which is .01%. He's high by 2 orders of magnitude.

Edited to add: The highest by-country rate using the statistics he cites is Guyana at 44 per 100,000, which is .044%: https://en.wikipedia.org/wiki/List_of_countries_by_suicide_r...


> That's a pretty high number that we could probably get to go down further

Why? At what cost? For what benefit?


*she


This question is much more interesting when you realize that modern neuroscience is (slowly) going more and more into area that there is no free will in humans.

What is a reason to live if they are not your decisions driving it? Skipping over all (judical etc) consequences, if this is true, then life has no sense and it's more/less ok to end it - what's funny, suicide would also not be your (as in free will) decision... Meaning this is a time bomb programmed into any thinking brain (and any AI as, what's double funny, this logic also applies to any AI).

Dodge that homo sapiens :)

https://en.wikipedia.org/wiki/Neuroscience_of_free_will

https://www.amazon.com/Free-Will-Sam-Harris/dp/1451683405


> This question is much more interesting where you realize that modern neuroscience is (slowly) going more and more into area that there is no free will in humans.

Science inherently approaches the universe in a way which leaves no room for materially meaningful "free will"; only strict material determination and randomness.


I don't think the scientific method is inherently materialistic - it's just that our most validated theories about how the world work are materialist.


DNA is a self-optimizing program for its own survival. After millions of years of optimization, ones will to live is quite powerful.

The twist is that the optimization mechanism relies on mistakes in copying itself. One outcome of a copy mistake could be a weakened will to live in certain negative life circumstances.


Evolution goes deeper than your rationalizations. Our brains descended from a long line of successful matings that obviously waited long enough to fuck before checking out. Possibly the fucking potential keeps us keepin' on in the lower level of our subconscious. It may also be hard wired preservation (the fear of pain), basic pleasure, caring of others, the illusion of god(s) or some imagined purpose of life, but I would guess mostly the fucking potential drives it all, at least for the younger. There's just a lot of good things to distract us from wanting death. But again, it goes deeper than our rationalizations so its going to be hard to say exactly without in depth scientific studies on the matter.


I had a strange mental illness period a few years ago. In my opinion, Dr Peter Breggin and others with similar believes are right. To some people, like slow metabolizers, these psychiatric drugs, are the cause of suicide and other irrational behavior. The author says "Indeed, there appears to be a slight elevated risk of suicide in people taking some antidepressants, especially young people. But the effect is tiny". I think the word "tiny" is the problem here. The effect is not "tiny". It is simply misunderstood or ignored.


  >Close to 100% of humans could suicide, and yet ‘only’ about 1.4% do
Very bad and misleading wording. 1.4% here is of total number of deaths, not total number of people. Also, both numbers seem untrue. Wiki says[1] "approximately 0.5% to 1.4% of people die by suicide".

1. https://en.wikipedia.org/wiki/Suicide#Epidemiology


As I mentioned elsewhere, this math is wrong. it's 10 to 44 people per 100,000, which is .01 to .04%, 2 orders of magnitude lower than 1%.

https://en.wikipedia.org/wiki/List_of_countries_by_suicide_r...


What's the difference? Everyone dies, right?


I find this a bit over the top/strange to contemplate

Maybe because I have known people who successfully committed suicide - it turns out people who survive almost always are thankful/happy they did. In fact, it turns out if you interview people who jump from building and manage to survive, as they fall, they are thinking they wish they hadn't done that...


What if not being depressed is the beneficial adaptation? It would not surprise me if many depressed people have a more accurate view of the world and their place in it. When someone's expectations do not match reality it's not normally considered intelligent, but positivity seems unrealistic, common and beneficial to survival.


>What if not being depressed is the beneficial adaptation? It would not surprise me if many depressed people have a more accurate view of the world and their place in it

It's funny that you should mention that...

https://en.m.wikipedia.org/wiki/Depressive_realism


I got really scared for a while because I was both suicidal (the idea itself gave me an endorphin rush to think about) and my energy levels were fairly normal / I wasn't showing other symptoms of being depressed. Depression as a mechanism for preventing suicide sounds plausible.


Reminds me of this quote:

> If there wasn't the possibility of killing myself, I would have killed myself!


Altruism. You believe in the human race -- perhaps despite being majorly screwed by some individuals. You just no longer believe in yourself.

I'm about there, myself.

P.S. When I wrote this, I missed the "few" in the title.


pain, suffering, happiness, evil, good are all synthetic constructs developed by evolution that optimize the feedback loop in which a system of molecules is suck in.


I guess it might make sense to compare to suicide rates in non-human animals (e.g. dolphins which can just stop breathing to kill themselves)


i think the author misses the data point of actuall doing it, is not easy. He keeps repeating, everyone has the ability to kill themselves, but is this true? I think most people, even if pain is at 100% and desire to do it is at 100% the knife/gun/etc just won't go. So re-think the whole thing from the point that VERY FEW humans have the ability to do it.


this is overly simplistic. melancholic depression is roughly 3/4 of all cases, the rest is from bipolar disorder, which makes it more likely to for people to kill themselves. how does this theory explain postpartum depression in females?


When its over its over forever. No point rushing.


You don't seem to understand much about evolution, or life. Claiming that evolution is a random, unguided "whatever works" process is mere ignorance. To everyone who has ever looked around (or listened around, or sensed around) even for one moment, it is beyond obvious that not only evolution works "by design", but that this design is supremely personal and the ultimate in creativity. So the implied negative connotations in your "creationist" label are misplaced.


We detached this subthread from https://news.ycombinator.com/item?id=12165775 and marked it off-topic.


Evolution is about selecting mutations that provide the species with survival and reproductive advantages. Since said mutations are indeed totally random, it does also introduce a certain level of randomness to evolution itself.


Ok, so there's a "designer" out there engineering rapists, murderers, limbless people, mentally handicapped people? Why the hell did the designer create maggots that feed on people's nose tissues[1]?

More to the point: what's the design goal? To quote EY [2]:

> But when you look at all the apparent purposefulness in Nature, rather than picking and choosing your examples, you start to notice things that don't fit the Judeo-Christian concept of one benevolent God. Foxes seem well-designed to catch rabbits. Rabbits seem well-designed to evade foxes. Was the Creator having trouble making up Its mind?

> When I design a toaster oven, I don't design one part that tries to get electricity to the coils and a second part that tries to prevent electricity from getting to the coils. It would be a waste of effort. Who designed the ecosystem, with its predators and prey, viruses and bacteria? Even the cactus plant, which you might think well-designed to provide water fruit to desert animals, is covered with inconvenient spines.

I don't deny that if there is a "designer", then he gets a lot of points for creativity.

I mean, it takes a lot of "creativity" to design an 8 limbed baby [3], twins sharing the same body [4] or a child with a skull that won't stop growing [5]. Sure, it's very "creative" and even personal I guess (I mean, when you get ostracized for having an "elephant face" it sure appears to be very meant and taken very personally). So I guess you're right in at least one metaphorical sense.

[1] http://www.liveleak.com/view?i=2c8_1249503802

[2] http://lesswrong.com/lw/kr/an_alien_god/

[3] https://www.youtube.com/watch?v=XM82Hs0LEpc

[4] https://www.youtube.com/watch?v=K57IcN9DWXo

[5] https://www.youtube.com/watch?v=JW2SWfoPD5c


Probably has something to do with the theory of natural selection.


Well in society artificial selection seems to have much more influence on us.


Society is natural.


Government, laws, science, technology, management? Do all those things appear in nature without our initiative? They seem to be made by humans.

I don't really know. Ultimately you can argue that everything happening in the universe is natural, but I would make a difference between things created by intelligent creatures and the things that appears with natural selection. That doesn't involve intelligent design.


Many other species have different forms of complex societies.


It's always strange to see someone wondering whether skin pigmentation has something to do with something completely unrelated like mental health or suicide rate, when so many other factors with demonstrably more impact come into play (social, economic, etc).


Yes it's not like skin pigmentation correlates with anything at all. The author is surely suggesting that skin color is the cause and that's just silly.


The relevant question is "Why so many humans kill themselves?". Because asking the other way around implies suicide is natural, which is a ratter extraordinary claim.


The article approaches it from the perspective of "what preventative measures does the human body and mind use against suicide." In this context "so few" is probably the right wording, given a 98.6% reduction compared to no prevention (according to the numbers from the article).


Perhaps. But it is also pedagogically valuable to ask "Why don't more people commit suicide?" We might learn something about the mental defence mechanism the brain employs.


Pedagogy /can/ go off the rails if it places other goals above the elimination of human killing. I know this is self-evident, however there are many hidden killers out there so consider this a billboard.


There's no ethical reason to oppose suicide, in general. Many cultures valorized it in certain situations.


The question as posed is an interesting one, as it sits on the boundary of where the "lizard brain" and executive thought process meet. The instinct to survive is very strong, even when the rational brain thinks (rightly or wrongly) that it's a hopeless situation.

Understanding how and why people cross that line may be a way to identify people at risk and intervene.




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