Friday, June 8, 2018

The Stealth Plague

Suicide Rates Continue Climbing Across The Nation:

Suicide rates rose steadily in nearly every state from 1999 to 2016, increasing 25 percent nationally, the Centers for Disease Control and Prevention reported on Thursday. In 2016, there were more than twice as many suicides as homicides.
The figures were released two days after the death of celebrity designer Kate Spade. The New York City medical examiner’s office has ruled her death a suicide.
And coming this morning on the news that Anthony Bourdain, the travel journalist and celebrity chef, ended his life via suicide in Paris. Talk about a gutting blow... as a longtime fan of "Parts Unknown", even having shown several episodes in my sociology of travel class a few years ago, I can't think of person who represented better what it meant to be alive. And yet those who are that way, who feel things down to their cores in ways most people don't, are often the most vulnerable to the suicidal impulse.
The new analysis found that nearly 45,000 Americans aged 10 or older died by their own hand in 2016. The increase varied widely by state, from a low of 6 percent in Delaware to more than 57 percent in North Dakota. The rate declined in just one state, Nevada, where it has historically been higher than average.
Social isolation, lack of mental health treatment, drug and alcohol abuse and gun ownership are among the factors that contribute to suicide.
Suicide is the tenth leading cause of death in the United States, and one of three that is increasing. The other two are Alzheimer’s disease and drug overdose, in part because of the spike in opioid deaths, said Dr. Anne Schuchat, principal deputy director of the C.D.C.
Firearms were by far the leading method, accounting for about half of suicides. That number has remained steady over recent decades, she said.
I think we're only now beginning to see the devastating effects of social isolation via new technologies such as social media, the smartphone, and the web generally. Since the internet first burst on the scene more than 25 years ago, suicide rates have been steadily increasing in all demographics (as I've charted on this blog for more than ten years). And the rates accelerated in the late 00's when social media and other wireless technologies erupted into our lives.

Leaving us with the ironic result: a population that thinks it's more "connected" than ever (friends, followers, likes, retweets, etc.) is actually more isolated than ever.
The analysis found that slightly more than half of people who had committed suicide did not have any known mental health condition. But other problems — such as the loss of a relationship, financial setbacks, substance abuse and eviction — were common precursors, both among those who had a mental health diagnosis and those who did not.
Other studies have found much higher rates of mental health disorders among people at high risk of suicide, experts noted.
“The reason most suicide decedents don’t have a known mental disorder is that they were never diagnosed, not that they didn’t have one,” said Dr. David Brent, a professor of psychiatry at the University of Pittsburgh.
The C.D.C. found that men accounted for three-quarters of all suicides, and women one-quarter. The numbers were highest among non-Hispanic whites, and among those aged 45 to 65 years old.
Previous C.D.C. reports have found rate increases of 80 percent among white, middle-aged women since 1999, and of 89 percent among Native Americans. The rates declined slightly among black men and people over age 75 during that time.
Suicide rates have waxed and waned over the country’s history and tend to reach highs in hard times. In 1932, during the Great Depression, the rate was 22 per 100,000, among the highest in modern history. The rate in the new C.D.C. data was 15.4 per 100,000.
The past three decades have presented a morbid puzzle. Rates have risen steadily in most age and ethnic groups, even as rates of psychiatric treatment and diagnosis have also greatly increased.
Again, not really a "morbid puzzle" when you read what I wrote above. It's the result of a devastating plague of social isolation that simply exacerbates other precursors to suicide (such as mental illness, substance abuse, access to guns, loss of a relationship or job, etc.).

In fact, the correlation between the "guns everywhere" laws of the mid-00's and the spike in suicide is more than anecdotal. Those states passing "open carry" laws in the last decade have seen some of the biggest spikes in suicide; those states which have passed confiscation laws (so-called "dangerous person" laws) have seen the smallest increases in suicide.

As I've noted here for over a decade, I think the biggest move towards prevention (which has to include gun restrictions, like it or not) is decreasing social isolation and bringing the behavior out of the shadows. Durkheim nailed this more than a hundred years ago: more anomie = more suicide, less anomie = less suicide. And the stigma surrounding suicide, as Goffman noted more than 50 years ago, is one of the biggest reasons why we don't do anything about it.

We simply don't talk about suicide, scrubbing it from obituaries, denying the grieving family members and friends a chance to express their devastation. And when celebrity suicides occur, such as Bourdain and Spade, people worry that "contagion" might sweep through us and lead to an increase in suicides because of it.

I've debunked contagion theory time and again on this blog and will continue to do so. Yes, there are often "upticks" in suicide when celebrity deaths occur (see also: Robin Williams, Chris Cornell, Kurt Cobain, etc.). But these aren't "causes" for the person who is already suffering from suicidal ideation, simply a road a map (via copycatting behavior). The idea that talking about suicide is going to lead to more suicide is like saying talking about cancer is going to lead to more cancer. It's silly and absurd.

The point is: we must talk about suicide. We must bring it out of the shadows and acknowledge the myriad of causes behind it. We must let those know who are suffering from suicidal ideation that there is help, there are people who are here who care, and that it's perfectly ok to talk about it. We must not be fearful that talking about it will somehow make it increase, but at the same time, don't put all the onus on the suicidal individual. Posting the suicide hotline (as I do below) is great, but it's us who must reach out to them as well.

We should, ironically, use social media, the very tool of social isolation, to spread the word and use it for something positive for a change, rather than your next self-absorbed selfie that no one really gives a shit about anyway.

Suicide is a stealth plague right now in our society. It is not an individual problem, or individual weakness. These are not moral failings in people or even crises in mental health.

This is a fucking public health epidemic, along the lines of infectious diseases, airborne allergens, drug addiction, smoking, etc. If the flu or Ebola or (fill in the blank) were killing 45,000 people a year, we'd have the national guard mobilized and billions in federal and state resources flowing to contain the problem.

Suicide is no different. And until we start treating it like a public health epidemic (hint: it's the CDC that is leading the charge) and mobilize the resources necessary to combat it, then 45,000+  men, women and children will continue to die annually, and it will only continue to increase.

[If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources.]

UPDATE: This morning's edition has a bit more information, including some really boneheaded comments from people in my field. To wit:
Some experts fear that suicide is simply becoming more acceptable. “It’s a hard idea to test, but it’s possible that a cultural script may be developing among some segments of our population,” said Julie Phillips, a sociologist at Rutgers.
Prohibitions are apparently loosening in some quarters, she said. Particularly among younger people, Dr. Phillips said, “We are seeing somewhat more tolerant attitudes toward suicide.”
In surveys, younger respondents are more likely than older ones “to believe we have the right to die under certain circumstances, like incurable disease, bankruptcy, or being tired of living,” she said.
What an irresponsible and moronic comment. There is no data suggesting such a thing as it relates to suicide, other than anecdotal evidence indicating that young people have ALWAYS been more comfortable with mortality than older people. That's nothing new, duh. Death is a foreign concept when you're young, even attractive and bright and shiny at times. It's only something that happens to older or other people. But it certainly doesn't suggest that the iGen coming along is going to be "down with" suicide or whatever Phillips is suggesting.

Plus, idiocy like this gives cover to the knuckle-dragging Social Darwinists out there who think suicide is a way to "thin the herd" and get rid of the "weakest" individuals.

I prefer instead these comments from Dr. Thomas Insel.
“In contrast to homicide and traffic safety and other public health issues, there’s no one accountable, no one whose job it is to prevent these deaths — no one who gets fired if these numbers go from 45,000 to 50,000,” Dr. Insel said.
“It’s shameful. We would never tolerate that in other areas of public health and medicine.”
Precisely. Rather than asserting the idiotic view that people are simply becoming more comfortable with suicide (which is like saying, "no man, people are down with Ebola, it's cool"), Insel drives home the point I've been making in this post and on this blog forever. 

It is a national shame. 

UPDATE II: Former White House aide, and counsel to G. W. Bush, Karl Rove has penned one of the more eloquent meditations on suicide (the death of his mother) that I've ever read. You should definitely read this

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