Suicide

The subject covers such a wide spectrum ranging from tragic to philosophic. Suicide statistics -- 47,173 recorded in the U.S. for 2017 versus 42,773 in 2014 -- barely capture the story. One reason is the stigma surrounding suicide leads to its suspected underreporting. Widen the lens to capture so-called "deaths of despair" (primarily manifesting from alcohol and drug overdose) and the numbers soar. These phenomena, however categorized, together largely account for the longest (three-year) consecutive decline in the expected American lifespan since 1915-18 (WWI and Spanish Flu pandemic).

But this is a story about people, not statistics. There's no room here for judgment, especially as it applies to the young. Research suggests there is a significant developmental lag between the intensification of adolescent hormonal changes and the maturation of the necessary cortical coping skills i.e. the neocortex not being fully formed until mid-twenties. Add, then, the many environmental factors, whether it be poverty, family discord, exposure to abuse or neglect, bullying, or even the ubiquitous social media platforms that provide a stage from which life is reduced to a kind of comparative and competitive performance art. Unrooted lives become so easily isolated. It's little wonder vulnerable adolescents may perceive problems as overwhelming. Over six thousand young people (436, aged 10-14; 5,723, aged 15-24) took their lives in 2016.

But despair doesn't discriminate. It respects no age bracket. It may be invisible from the outside i.e no tell-tale Ervard Munch scream of anguish. Its source may seem to lack rationality, the ground zero of subjectivity.

A physician may actually be the first to engage such a life marked by existential angst. Our focus article is one such (U.K.) GP's account of those initial clinical moments in which he must assess the patient's mental health and make the appropriate referrals -- maybe minutes to judge a patient's level of risk (click: What I have learned from my suicidal patients). His twenty years of practice, his hundreds of up-front suicidal patient contacts, his coordination with trained therapists, psychologists, and psychiatrists affords him a front-row seat from which to engage, oversee, and observe these "lives of quiet desperation."

These reflections represent a captivating combination of tenderness and objectivity. He recounts the hundreds of patients who recovered their sense of worth with the help of antidepressants, counseling and community support, even as he remains haunted decades later by the memory of his last meeting with those who took the final, fatal step. His case studies raise some issues we may choose to pursue.

Why is it, for example, that suicides, especially among the young, remain a secret and are not investigated and dealt with in ways that might protect others from a similar fate? One answer, of course, is that no one, absolutely no one, can presume to understand the anguish on the part of the victim's loved ones so that, right there, might be the end of any such discussion (click: https://www.nytimes.com/2019/12/02/well/mind/the-crisis-in-youth-suicide) Yet, silence driven by some sense of shame would seem to compound the tragedy. The author (quoting another) observes, "Suicide does not necessarily constitute a criticism of the life being ended; it may belong to that life's destiny."

Perhaps the reluctance to openly discuss the matter is the residue of some religious impulse from the Middle Ages, you know, the good old days when a suicide meant the victim was summarily plopped into Dante's Seventh Circle of Hell, sandwiched somewhere between the Heretics and the Fraudsters.

The author cites one reckoning that 90% of suicides are the result of mental illness. The lay person might justifiably wonder what that actually means. Without context the term sounds so pejorative (back to the earlier stigma point), and perhaps itself inhibits one from seeking early-stage counseling.

One might even suggest that most every soul, at some point in life, has thought about it, not from any depressive tendency but out of sheer intellectual musing. In fact, Albert Camus, in his essay The Myth of Sisyphus, maintained, "There is only one really serious philosophical problem, and that is suicide." He concludes that suicide is of little use to us, as there can be no more meaning in death than in life (for a splendid nine-minute Camus overview, click: PHILOSOPHY - Albert Camus ). That then leads to the philosophical question about what makes life worth living.

We thereby enter the terrain marked on those old, old maps as, "There Be Dragons." Up for discussion: just as no two inner landscapes are exactly the same, no two suicides are identical. The outsider (even the professional) may be ill-equipped to truly appreciate the psychic or physical pain experienced by the other. A subtle, yet important, distinction then arises as to whether the act was carried from a true desire for self-annihilation or rather was driven as the only perceived way to end the pain.

Consider, then, the entirely different context in which a totally rational individual is dealing with end-stage infirmity, acute disease or otherwise possesses a genuine sense of life completion. Add the additional fact that the subject may feel nothing but gratitude for a life well lived and wishes only that this mortal coil could just shuffle off gently into the night. Call it what you will but to deny assistance for a humane exit would itself seem to represent a tragic end of a different sort.