Tuesday, March 4, 2008

Preventative Measures and Suicide

A fascinating article in yesterday's Washington Post on suicide, the Golden Gate Bridge, and preventative measures underway to keep people from leaping to their deaths.

The gist of the article (which explores the call for barriers to be built along the bridge to prevent such a thing) is a University of California survey which found "that nine out of 10 people prevented from jumping off the Golden Gate were still alive years later or had died of natural causes, despite the rationale that a barrier would prompt them only to "go somewhere else to end it."

This confirms Seiden's finding from 30 years ago, "that even the most elaborately planned suicide is essentially impulsive. That's the whole rationale for suicide prevention: that it is crisis-oriented, that there's an episode of vulnerability and you get them through it."

The survey and article offer up interviews with some the survivors of such an attempt, who leapt from the bridge but lived, giving us an inside look at what was going through the mind of someone making such a dramatic attempt to end their own life.

"The day Ken Baldwin decided to kill himself, he drove past his office and proceeded directly to the Golden Gate Bridge. Gazing at the Pacific Ocean over a railing only four feet high, he found the sole remaining impediment to his death was his own willpower, which turned out to be fleeting.

"I counted to 10, and I couldn't do it," Baldwin said. "And I counted to 10 again, and I vaulted over.

"And my hands were the last thing to leave, and once they left, I thought: 'This is the worst decision I've ever made in my life.'"

Most of the others surveyed mention the same theme: that almost from the moment they went over the side, there was instant regret over the decision.

While this is compelling anecdotal evidence, I would caution against some of the more sweeping statements made by the reporter Karl Vick, such as "The study is part of a growing body of scientific literature that explodes persistent myths about suicide while reinforcing a simple principle: When it is harder to kill oneself, fewer people do so."

Yes and no. While the interviews with those who survived are compelling, it seems buried in the details that each of the bridge jumpers who survived had made previous attempts at ending their lives prior to the jump.

And the fact that we're addressing a very dramatic, but still rare, method of suicide suggests that the method and personality involved need further research to understand the generalizability of their conclusion. In other words, putting up preventative fencing might deter the persons who went to the bridge from ever attempting suicide again (though some research suggests otherwise), but do similar findings apply with persons who overdose on medications and live? Or who suffer self-inflicted gunshot wounds and live? Or who attempt hangings and live?

While it's true that impulsiveness is definitely a hallmark of any suicide (particularly jumpers), and that we may be able to prevent those by erecting physical barriers, I find the idea that we can prevent other forms of suicide by simply limiting access, say, to prescription drugs or firearms, might not achieve the same desired effect. We still need to focus on broader preventative measures, such as availability of psychological counseling, support groups, ideation qualifiers, and so forth.

Still, in the case of the Golden Gate, which has recorded more than 1300 suicides since it opened in the 1930's, and has an astonishing rate of one suicide every 37 days, it's time to build the proper preventative fencing, "aesthetics" or "historical architecture" be damned.

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