ON SUICIDE

She took another sip of gin and finished the note to Tom. "And remember, I will always love you--Helen." Below her signature she scrawled, "Don't forget to give Dick his vitamins," and her eyes welled with tears at the thought of how sorry they would be and how sad it all was. Then she pinned the note carefully to her black cocktail dress, took a handful of pills, turned on all the lights, and composed herself on the sofa. As the darkness swept over her, she was thinking: "What if he has to work late?"

TOM came home in time, and Helen became an "attempt" instead of a coroner's statistic. Did she really want to die, or was she just making a gesture? Helen does not know now, and her ambivalence is typical; experts on suicide believe that most acts aimed at self-destruction, whether or not they succeed, are really attempts to reach out for others --ill and awful ways of crying, "Help me!"

"There is only one truly serious philosophical problem," wrote Albert Camus, "and that is suicide." In other words, what is it that makes life worth living? Religion's answer to that question today is still powerful, but far more muted than it used to be. Most men take their answers from the self-evident pleasure of being alive and, even in despair, from stubborn hope and a dimly realized sense of duty to the miracle of life. Camus' own answer was that revolt against the apparent meaninglessness of existence is noble, and that to revolt is to live--suicide is submission. He did not submit; he died in an auto accident in 1960. "It is essential to die unreconciled," he had said, "and not of one's own free will."

Such admonitions have not prevented the suicide rate from rising. It is the tenth cause of death in the U.S.--in 1920 it ranked 22nd--and it is estimated that more than one in every 100 Americans now living have tried to kill themselves at one time or another. The overall rate is 10.8 suicides per 100,000. In the age group from 15 to 19, the rate is 4 per 100,000, up from 2.4 a decade ago, and is the third-ranking cause of death (after accidents and cancer). Among college students, presumably because of the stress of work and the strain of readjusting values, suicide ranks second as cause of death and is about half again as frequent as in the non-college population of the same age.

The Deadly Springtime

Citizens of other countries are doing themselves in even more frequently. According to the latest available figures, the U.S. rate was surpassed by Hungary (26.8), Austria (21.7), Czechoslovakia (21.3), Finland (19.2), West Germany (18.5), Denmark (19.1), Sweden (18.5), Switzerland (16.8), Japan (16.1) and France (15.5). England's suicide rate is a little above that of the U.S. Far below them both are the rates of Italy (5.3), Ireland (2.5) and Egypt (0.1), although such figures are often misleading.

Accuracy of reporting varies widely. Besides in those parts of the world where suicide comes under strong religious censure, there are compelling reasons for relatives, doctors and coroners to report it as an accident or a heart attack. Not necessarily for religious reasons, the same is often true in the U.S. But certain patterns can be seen.

In the U.S., Nevada has the highest suicide rate (22.5) of any state, and the West Coast the highest of any region. Nevada's high rate presumably results from the state's low population outside of Reno and Las Vegas, where gambling, drinking and divorce create a high-crisis quotient. The West Coast's rate is probably high because of the large number of people who move there after retirement and bring with them the increased suicide rale that goes with advancing years. Another factor is that the West Coast attracts the ambitious and restless who are inclined to react bitterly to failure. Some of the lowest suicide rates in the U.S. are in Mississippi and South Carolina, relatively static societies where even the poorest people tend to have roots and fixed status.

Age, marital situation and occupation are all significant factors in proneness to suicide. One is most likely to try it and fail before 35 and to succeed after 50. In most of the U.S. and the Western world, more women than men make suicide attempts, but nearly four times as many men actually kill themselves. Single people are far more likely to kill themselves than the married--but who can say if they do it because they are unmarried or are unmarried because they are depressive people who are inclined to kill themselves? Divorced males seem to have a hard time finding a reason for living: 69.4 per 100,000 of them kill themselves in the U.S., as opposed to only 18.4 of divorced women.

Artists, professional men and top executives commit suicide more than other people; two in every 100 doctors kill themselves, perhaps because of the ready availability of the means (a factor that also ups the suicide rate of policemen and soldiers). More surprising is the high rate of suicide among psychiatrists.

The fewest suicides in America and Northern Europe take place in December, the most in April and May. No one knows why April is the crudest month--perhaps because someone who is depressed to start with feels lonelier and more out of things than ever, when the rest of the world is elated by spring, perhaps because of frustrated sexual stirrings or nostalgia for happier times.

How to Destroy the World

The why of suicide is the most elusive question of all. Money problems? Poverty as such does not drive people to suicide; it is the wealthy whose fortunes collapse, like Swedish Match King Ivar Kreuger, rather than those with nothing to lose, who are more inclined to it. Poor health? Physical suffering rarely triggers self-destruction; the incidence among cancer patients is remarkably low. Love? Few really kill themselves for unrequited passion.

Why one man watches the ground rush up to meet him or tastes the steel of a pistol--while another gives a shrug, takes a drink, or develops a manageable neurosis--is an enigma that has only recently received serious examination.

The first modern work on suicide, by French Sociologist Emile Durkheim, was published in 1897, and is still a classic. Durkheim laid the blame for suicide on the interplay between individual and society. He divided suicides into three main strains: 1) Egoistic, in which the individual is too much on his own, isolated from the community; 2) Altruistic, in which the individual is too little on his own and at the mercy of society, like the Indian wives who committed suttee by throwing themselves on their husbands' funeral pyres; 3) Anomic, in which society's controls over the individual break down, or his adjustment to society is shattered, as by unemployment or another's sudden death.

Freud, on the other hand, viewed self-destruction as a purely psychological phenomenon with the same essential structure as depression. He held that it is a form of aggression against someone loved turned inward upon the self, because the self is identified with the loved one. Later, Freud formulated his famed "death instinct," into which suicide fitted neatly as death's triumph over the life instinct. Many psychoanalysts do not accept the death instinct, but most modern thinking swings between versions of Freud's psychodynamics of depression on the one hand and Durkheim's sociological factors on the other.

Most authorities today hold that suicide does not occur suddenly but is the outcome of a mixture of causes and a long, progressive "failure of adaptation." But lately, according to Dr. Stanley Yolles, director of the National Institute of Mental Health, many psychiatrists are considering the possibility of a hitherto-unnamed neurosis that predisposes its victims to suicidal tendencies: they "are just as disinclined to be ill as, for instance, tuberculosis patients; they are not free in making their decisions to die."

In a study of Scandinavia, Manhattan Psychoanalyst Dr. Herbert Hendin found some significant clues. Norwegians, who are less emotionally dependent and less repressed than their neighbors, average less than half the suicide rate of Sweden and Denmark. Dr. Hendin found Swedes bottled up emotionally, extremely ambitious, and prone to despair and self-aggression when their goals have not been achieved. In Denmark, Hendin declared, mothers control the behavior of their children by making them feel guilty; hence, suicide in Denmark, he theorized, is typically motivated by the attempt to establish guilt in a love object.

Suicide is often designed to punish or manipulate others. 'Our unconscious," Freud noted, "does not believe in its own death," and the man who seeks to end his life is no exception. The notes that suicides leave behind suggest that they rarely appreciate the fact that they will not be around to enjoy the fruits of their action. In analyzing 721 suicide notes collected by the Los Angeles county coroner's office, Psychologists Edwin S. Shneidman and Norman L. Farberow were struck by the many instructions, admonitions and lists of things to do that seemed to epitomize "the illogicality of the entire suicidal deed--thinking simultaneously and contradictorily of being absent and giving orders as though one were going to be present to enforce them."

Still, many who kill themselves have an understandable desire for extinction--Shneidman and Farberow call them "surcease" suicides. Brilliant, hard-driving lames Forrestal, the first U.S. Defense Secretary, who threw himself from a 16th-story hospital window in May of 1949, was suffering from a mental breakdown and decided that life was unendurable with his mind impaired. Novelist Virginia Woolf also killed herself (in April 1941) because she thought she was going mad. Poet Hart Crane was seriously deranged when he killed himself in April 1932, as was Ernest Hemingway when he blew his brains out with his favorite shotgun. Hemingway's suicide raises the problem of whether the tendency can be inherited (his father shot himself when the author was 29, and his sister died, apparently of an overdose of drugs, last month). Studies of identical twins indicate that there is no genetic factor, but suicide does run in some families--perhaps because of the suggestibility that occasionally produces epidemics of suicide, such as that in 18th century Germany in imitation of Goethe's sick but romantic hero, Werther. Marilyn Monroe felt that she had good cause to hate the world, and may well have unconsciously fantasied many suicides do--that in killing herself she was destroying it, as in A. E. Housman's poem:

Good creatures, do you love your lives

And have you ears for sense?

Here is a knife like other knives,

That cost me eighteen pence.

Vneed but stick it in my heart

And down will come the sky,

And earth's foundations will depart

And all you folk will die.

How to Get Through a Bad Night

Serious study of suicide has been hampered by the fear and loathing that society brings to the idea of self-destruction; an example is Mary Hemingway's initial insistence that her husband's death was accidental. Primitive tribes usually fear the suicide as a ghostly avenger. Pre-Christian Greeks tended to disapprove of it as an offense against the gods, whose property men were. But the Stoics and Epicureans, taking man as the measure of all things, condoned self-destruction as a blessed escape. Said Seneca: "Against all the injuries of life, I have the refuge of death." As Nietzsche was later to remark more pithily: "The thought of suicide gets one successfully through many a bad night."

There are seven suicides in the Bible, from Samson to Judas, and neither the Old Testament nor the New specifically forbids it, as does the Koran, which calls suicide "a much graver crime than homicide." But St. Augustine condemned it as "a detestable and damnable wickedness," perhaps to put a stop to a growing tendency of extremist Christians to seek instant sainthood via self-martyrdom. From the Middle Ages to the end of the 18th century in Europe, self-murder was stigmatized by the full force of church and state--a suicide's property was confiscated, his body was dragged through the streets and buried at a crossroads, with a stake driven through the heart (presumably to keep him from haunting the living). In Asia, by contrast, suicide as a form of renunciation has widely been considered admirable.

In the West during the 18th century, a new view gathered momentum--that a man's life was his own to do with as he pleased. Slowly, sanctions against suicide began to be lifted. In the U.S., attempted suicide is still a felony or a misdemeanor in nine states, though the laws are rarely enforced. Even the Roman Catholic Church has modified its position. It is not unusual these days to give a suicide a proper Roman Catholic funeral and a consecrated grave, on the ground "that his demented soul did not possess sufficient freedom of will for his heinous deed to constitute a mortal sin."

Reading the Signals

Even as moral condemnation of suicide is lessening, the scientific community is making greater efforts to prevent it. In Washington, the National Institute of Mental Health has just set up a national Center for the Studies of Suicide Prevention, which will launch research projects and help set up suicide-prevention staffs in hospitals and centers throughout the U.S. At present, there are nearly 60 such centers functioning or about to be established.

Head of the new Washington organization is Psychologist Shneidman who joined with Fellow Psychologist Farberow eight years ago to found the Los Angeles Suicide Prevention Center, recognized as the most thorough and modern operation of its kind. The volunteers on its staff, who have been trained by professionals, answer the agonized phone calls that flood in with sympathetic attention, assess the imminence of a suicidal act, and refer callers to institutions for help.

Most suicides, psychologists agree, really want to be rescued. The case of the man threatening to jump to death in public view may be extreme, but it is also typical. Says Farberow: "The man up there is saying, 'Look at me. See how bad I feel.' Sitting on the ledge of a building is a tremendous effort at communication." Of immediate importance in improving communication is the education of medical men to recognize the symptoms of potential suicides; two-thirds of those who attempt suicide have visited a physician. There are various warning signs, including talk; the notion that those who talk about suicide will never really do anything about it is entirely false.

Oddly enough, the fear of pain or unpleasantness in the method of killing oneself is often a potent deterrent. As Dorothy Parker wryly noted:

Razors pain you; Rivers are damp; Acids stain you; And drugs cause cramp.

Guns aren't lawful;

Nooses give;

Gas smells awful;

You might as well live.

"You might as well live" is the way men and women normally feel--whatever their present misery. "There is no conceivable human situation," says Dr. Yolles, "which is unendurable or hopeless enough to drive a healthy man to death--neither mental anguish nor concentration camp torture nor bankruptcy." Viewing the suicidal tendency as a kind of mental illness, Yolles predicts that attacking it on a national scale will lower the U.S. suicide rate in a few years.

The statistics may not reflect it so promptly; for a time, they may actually rise, for one of the effects of stepped-up education on the subject may well be a lifting of taboos, hence more truthful death certificates. But it is certain that in the future the "cry for help" will be far better heard and far more sympathetically attended to than it has ever been.

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