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Why People Die by Suicide | 
 enlarge | Author: Thomas Joiner
Publisher: Harvard University Press
Category: Book
List Price: $16.95
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Avg. Customer Rating:  13 reviews
Sales Rank: 53534
Media: Paperback
Edition: 1
Number Of Items: 1
Pages: 288
Shipping Weight (lbs): 0.6
Dimensions (in): 8.2 x 5.5 x 0.8
ISBN: 0674025490
Dewey Decimal Number: 616.858445
EAN: 9780674025493
ASIN: 0674025490
Publication Date: September 30, 2007
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Product Description
In the wake of a suicide, the most troubling questions are invariably the most difficult to answer: How could we have known? What could we have done? And always, unremittingly: Why? Written by a clinical psychologist whose own life has been touched by suicide, this book offers the clearest account ever given of why some people choose to die. Drawing on extensive clinical and epidemiological evidence, as well as personal experience, Thomas Joiner brings a comprehensive understanding to seemingly incomprehensible behavior. Among the many people who have considered, attempted, or died by suicide, he finds three factors that mark those most at risk of death: the feeling of being a burden on loved ones; the sense of isolation; and, chillingly, the learned ability to hurt oneself. Joiner tests his theory against diverse facts taken from clinical anecdotes, history, literature, popular culture, anthropology, epidemiology, genetics, and neurobiology--facts about suicide rates among men and women; white and African-American men; anorexics, athletes, prostitutes, and physicians; members of cults, sports fans, and citizens of nations in crisis. The result is the most coherent and persuasive explanation ever given of why and how people overcome life's strongest instinct, self-preservation. Joiner's is a work that makes sense of the bewildering array of statistics and stories surrounding suicidal behavior; at the same time, it offers insight, guidance, and essential information to clinicians, scientists, and health practitioners, and to anyone whose life has been affected by suicide. (20060130)
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| Customer Reviews: Read 8 more reviews...
Useful contribution September 29, 2008
0 out of 1 found this review helpful
Quote:
"The result is the most coherent and persuasive explanation ever given of why and how people overcome life's strongest instinct, self-preservation."
Life's strongest instinct is not self-preservation, it is reproduction by inclusive fitness mechanisms. The individual doesn't matter, it's their genes. Very important this fact is understood if a comprehensive understanding of suicide behaviour is to be achieved. Hopefully this will be made clearer in future books.
Nonetheless, a good resource for psychologists and others to gain a deeper understanding of patient risk factors.
 A unique blend of professional detachment and personal passion. September 7, 2008
1 out of 1 found this review helpful
An insightful exploration of the phenomenon of death by suicide. It will help both those who have been bereaved by suicide, and those who wish to understand why their loved one might be at risk.
Be aware, though, that the book doesn't seek to give you a detailed practical plan for intervention.
Very thought provoking, took guts to write June 16, 2007
1 out of 3 found this review helpful
It is an interesting subject to broach, much less write about. I was intrested in his observations and conclusions, and I found it very thought provoking and pretty much as I would have guessed, for the most part. Well written and something that people shy away from talking about, but very necessary, as there are too few who endores euthanasia when we totally accept it in animals, and consider it 'humane'. Why not us?? However, some people are just in a place whereby they cannot go on any longer, for whatever the reasons, and it should not be considered a 'sin' in the least, it should be understood. To me the sin is to call it that.
 A mixed bag February 24, 2007
4 out of 7 found this review helpful
Much of this book is an apology for a proposed model for suicide which is, at best, a stretch. The early secions are repetitive and and an attempt to summon evidence in support of the model. In many cases, correlations are confused with causality.
The middle section which reviews current evidence on genetics,and neurobioloby is well worth reading.
The last sections which deal with prevention and therapy are weak and
mostly a re-hash of Cognitive-Behavioral therapy tenets.
Overall, I was disappointed.
Needs More Work November 28, 2006
18 out of 23 found this review helpful
Thomas Joiner's study of suicide really belongs to a niche readership of an academic circle. The work in this important area itself exhibits a great many strengths and insights, but it also suffers from many problems that eliminate a wider readership.
Joiner asserts, essentially, that there are three ingredients that lead to suicide: lack of "belongingness"; inefficiency; and the ability to withstand pain in order to overcome the instinct for survival. Although the language of the book sometimes gets in the way of the big three concepts, Joiner forcefully argues that with all three elements suicide is far more likely in an individual, and without them, suicide is unlikely. The lack of "belongingness" -- which I found to be human contact, or alienation -- explains somewhat tautologically why some people, left out of contact with others, become desperate, fail to discern reality and lose intimacy. Inefficiency, the second element, which includes a sense of becoming a burden to others, or "I can't do anything right", also seems to provide a more rational basis for evaluating self-worth. If a person can't do anything right, what's the point of going on? The world, in their minds, would be better off without this inefficiency. The final element, overcoming pain, provides the physical mechanism for carrying out death. A person has to adjust to pain in order to do away with oneself.
Joiner explains quite a bit with his framework, but I found the book disjointed (no pun intended), repetitive to the point of my wanting to put it down or skip pages and insufficient in many crucial areas.
Perhaps the single-most troubling statement for me was, "Death is no longer adaptive, if it ever was." This reasoning leaves Joiner dismissing the evolutionary aspect of culture. Death by its very nature winnows out the least useful segments of a culture and permits a culture to adapt itself to a changing environment. Were there no death, dinosaurs would continue to rule the planet. By standing aside, improvements have a chance of being tested.
Why suicide has been conserved in society remains a very good question -- but Joiner completely dismisses the inquiry. Perhaps suicidal people, and the chemical and biological components that do conserve suicide, serve some cultural purpose one can see only by standing back. Perhaps, for example, risk takers supply a culture with soldiers, leaders, experimenters, astronauts, artists and people who have no fear of limits. Perhaps, as Joiner implies in later parts of the book, genetics through serotonin re-uptake selects those that suffer from joylessness. But perhaps genetics also provide a culture the material for greatness by permitting a person to risk death in achieving a greater good. Abraham Lincoln, for example, suffered great depressions and no doubt lacked adequate serotonin receptors. Subjectively, given the very huge burdens he bore, he easily could have killed himself before John Wilkes Booth stepped into the Presidential box at Ford's Theater.
Joiner's book conflates many important categories, but my eye went directly to the basic problem of "objectivity" versus "subjectivity." Objectively, Joiner cites many statistics about the level of suicides and what increases it or decreases it. For example, he notes that in times of crisis, suicides decrease. He theorizes that suicides decrease because people tend to have greater feelings of "belongingness." This may be true, but perhaps in times of crises, the risk takers have a more defined place. Wouldn't a person who has an inclination for suicide and a desire to become effective volunteer for dangerous assignments? If I were despondent and ready to give up, I might say "What the hell!" and volunteer for dangerous work. What would I have to lose? I wonder how many of our special forces in Iraq have genes that tend toward suicide? In other words, perhaps objectively the model for "suicidality" conflates risk taking with self-destruction.
On another level, death indeed must have an adaptive and social purpose -- at least every evolutionary study asserts this. How else would a culture improve if it failed to provide a centralized control system? Through artificial selection alone? What committee would choose those that should always survive? Perhaps suicide is just another way of nature limiting population. Certainly if overcrowding, lack of resources and desperate conditions occur, some people will check out. Who? I'm certainly not suggesting that suicide is good or bad -- only that it serves a function -- or else it would have disappeared.
Joiner briefly discusses suicide bombers and others who give up their lives for some greater cultural benefit -- still without conceding an adaptive purpose. He does not call these acts suicide. But doesn't a soldier who jumps on a hand grenade to save his comrades commit suicide? Suicide, as Joiner concedes, is the intentional taking of one's life. The courageous soldier does not lack "belongingness" or "efficiency" -- but he is in a different category than the individual who suffers depression and gives up his life out of despondency. The soldier receives posthumous appreciation because he has laid down his life for others in an efficient and beneficial way. Objectively, the cumulative effect of suicidal behavior must be adaptive. Reserving suicide for only those who are defective limits the understanding of self-inflicted death and demeans those who continually give their lives to keep a culture healthy and safe.
This failure to discuss fully the adaptive aspects of suicide leads then to Joiner's problems with subjectivity. There are many reasons, from an individual point of view, that a person would kill himself. As Joiner himself points out, elderly people suffering from terminal diseases, have a higher rate of suicide. No doubt they feel they have nothing to live for, they suffer pain and believe they should not burden their relatives. They choose to die not because they are irrational, but because they are rational. They understand that their illness uses up resources, that they can never recover and that they can give those they love a final gift. They understand that unremitting pain can end only with death. They attempt to die painlessly in the case of assisted-suicides and sometimes more painfully when they cannot obtain the assistance.
Many of the individual people Joiner discusses are simply mentally ill. Alcoholism, for example, disturbs the serotonin system, depriving drinkers of sleep and pleasure (except for brief periods). Most suicidal people, according to a number of studies, have alcohol or other drugs in their bodies when they make an attempt. Perhaps this is because alcohol and drugs reduce judgment barriers (creating more impulsivity) or because alcoholics and drug users tend also to be depressed. Ask a suicidal substance abuser why he or she wants to die and you will hear a thousand different answers -- virtually all irrational.
Most assert that they have no hope and no chance of doing anything worthwhile. They feel they are, as Joiner asserts, a burden to others. But these subjective reasons evidence depression and a skewed view of the world. As most psychiatrists will assert, the cure to depression is usually the cure to suicidal behavior. Drugs that cure depression also reduce suicides.
In my lifetime I have known four people who committed some sort of dramatic suicide. As a child, I remember my parents discussing in hushed terms a classmate that hung himself. Later, a girl I once dated argued with her boyfriend and shot herself in an attempt to keep him. The doctor father of a friend also shot himself at the end of his career. And a couple years ago a good friend argued with his wife and his parents and hung himself. However, I've known a number of elderly people who refused treatment or food or insisted (in one case) on his son feeding him an overdose of pills to end his misery. My own mother died a slow death because she refused to take care of herself at the end of her life and my younger brother died because he refused for years to admit that he had diabetes. Are some of these examples "slow suicides" or even suicides at all?
Subjectively, it is impossible to categorize every example of a controlled exit.
Finally, I take exception to Joiner's view that suicides he describes show "courage" in overcoming pain in order to kill oneself. Evolution created a strong barrier -- pain -- to insure survival of the species. "Courage" has a moral overtone to its meaning -- indicating that one who overcomes the pain is someone we should admire. In my experience and review of articles, other than those who have given their lives in battle or were terminally ill, the suicides not only lacked the courage to persevere, but utterly disregarded the feelings of those left behind. Most were narcissistic, mentally ill, irrational or felt they were "entitled" to check out. Usually they left others to address their problems because they couldn't cope any longer. In one case, a suicide left a very young child. In no cases can I recall anyone that was beyond help -- but in virtually all cases, the suicides either refused or demeaned any sort of help.
Sartre, who Joiner completely ignores, once quipped that if there were no death we would have to invent it. This holds true because the human condition requires an end to justify meaning. Whether the end is rational or not depends on exactly the problem of objectivity and subjectivity. I don't pretend to know the answer, but I do believe that Joiner needs to examine suicide from a broader perspective.
Joiner has definitely worked hard to touch on a number of areas. I think with time and a refinement of his work that his theory will improve. It needs a lot of work and a better editor, but it has potential.
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