Wednesday, August 6, 2008

On the Permanence of Suicidality

Opponents of an institutional right to suicide (advocates of forced life) often defend their views by citing evidence that relatively few people who attempt suicide, but are "rescued," go on to commit suicide. One often-cited study is a 1976 study published in the Journal of the American Medical Association, which found that, of 886 patients with a "serious" suicide attempt, "only" 4% went on to kill themselves within the following five years (Rosen, The Serious Suicide Attempt: Five Year Follow Up Study of 886 Patients, 1976:235 JAMA 2105, 2105).

However, a 2004 study published in the American Journal of Psychiatry gives us some perspective on this. The findings of the newer study, "Completed Suicide After a Suicide Attempt: A 37-Year Follow-Up Study," (Am J Psychiatry 2004; 161:563–564) follows a cohort of attempted suicides (all self-poisoning attempts), as the study's title suggests, over a 37-year period. At the end of the period, 13% of the attempters has committed suicide (though that figure increases to 19% when suspicious deaths that weren't clearly suicides, but may have been, are factored in). But the most surprising result of the study is that the rate of suicide didn't substantially decrease over time. A major proportion of the suicides occurred decades after the initial attempt. The rate of suicide did not fall significantly even decades after the attempt.

It is important to consider that self-poisoning is considered by many to be a less serious method of attempting suicide than more reliably lethal means, such as jumping from heights and gunshot. The proportion of completed suicides after an attempt using these methods is unknown, but we might expect it to be significantly higher than the proportion for the attempted self-poisoners.

This evidence - that suicidality is, to a high degree, permanent, that the "urge to end it all" never goes away - conflicts meaningfully with Scott Anderson's muddle-headed but unfortunately influential July article in the New York Times, entitled "The Urge to End It All." Anderson parrots questionable statistics, like the statistic that 90% of suicides have a mental illness, which I have previously attempted to debunk. He concludes that, based on his extremely unscientific interviews with past suicide attempters, a suicide attempt magically clears up the desire to die, and if we could only rescue suicide attempters, they would all happily continue living, cured forever of the "urge to end it all."

Another important piece of data recently became available about the suicidal brain. A study published in Biological Psychiatry found that the brain of a person dead by suicide, compared to a person dead of other causes, such as a heart attack, was likely to display altered gene expression. DNA methylation, a process which generally works to impede unnecessary gene expression (for instance, to prevent a brain cell from "acting" like a kidney cell), was much more extensive in the brains of suicides (who had all been previously diagnosed with Major Depressive Disorder) than in the brains of other deceased people.

The study's leader, Dr. Michael O. Poulter, commented to Science Daily that "the nature of this chemical modification is long term and hard to reverse, and this fits with depression."

The study highlights the gaping holes in our understanding of the etiology of suicide and "depression," and lends support to the idea that suicidality is permanent - or, at least, "long term and hard to reverse."

4 comments:

  1. Do you have any views on the discipline of "suicidology"? (Sociological critique here.)

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  2. Interesting - thanks for the pointer. I'm not familiar with it. I'm automatically suspicious of it ("broader cultural contexts," "significant voices are being marginalized," "the spiritual dimension of suicidality" - vomit), but I don't really have formal views about it.

    His "narrative" or "voice" is one of the suicidality-recovery narratives, which is the only one that is allowed or acknowledged in any way. I'm surprised that he thinks it's somehow being suppressed.

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  3. I confess I didn't read the critique - I just linked to it because it was an outside account of the field.

    Google reveals no matches for "pro-choice suicidology". :-) There's an opening for you!

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  4. Ha ha - thanks Mitchell - I'm picturing the havoc I could wreak on a sociology department.

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