Beyond Blue

Beyond Blue


Suicide: Premeditated Versus Impulsive

posted by Beyond Blue

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Thanks to Beyond Blue reader Larry Parker for forwarding me the piece, “The Urge to End It All,” published in last Sunday’s New York Time magazine. It was quite timely for me because I spent the majority of my train ride home from New York discussing suicide with an Amtrak driver (my fellow passenger who would drive the train back to New York once it arrived in DC), who had been involved in 20 suicides in his 25 years of working as an engineer. 

TWENTY.

Plus his own sister who took her life in her early thirties. She was a medical doctor. “Smartest one out of all of us,” said the Amtrak guy. She overdosed on pills and he found her.

Perhaps I made the mistake of asking the train driver if he had ever hit someone. Because by the time we stopped in Philadelphia, he had described the first two in such detail that I was sure I’d be sick by the time the trained arrived in Baltimore.

“I don’t get it,” he said. “One woman was very attractive, in her twenties … she was dressed in this mini-skirt. I guess her boyfriend had just broken up with her. … I mean, it’s not like she couldn’t get another man. Especially with the sexy boots she was wearing …”

I wanted to launch into my diatribe about the disease of depression, and that (at least in my view), suicide is the result of a failed treatment, just as chemotherapy doesn’t always get all the cancer; that suicide is an act of desperation when a person runs out of hope. It’s not some horribly selfish and shameful stunt, and families of suicide victims need to be embraced not shunned, yada yada yada. But my mouth was frozen in a perfect oval shape, and no words were coming out.

He recounted the “Romeo and Juliet” tragedy–the couple on heroin who wanted to die together. They were in their twenties. She was a few months pregnant. The driver could tell from a few feet away. She faced the engineer, her boyfriend the other direction, as they held each other. Then she held up her hands as if to say “There’s nothing that you can do to save me now …” He told me that every time he passes that spot in Elizabeth, New Jersey, he thinks about it and her expression.

Scott Anderson explains how impulsive suicide–jumping off a bridge, throwing yourself in front of a train, shooting yourself with a gun–differs from other, less successful but more common, forms of suicide (overdose, carbon monoxide, cutting) in the New York Times article. And with impressive and intriguing research, he covers different approaches to suicide prevention.

Confession: his article is a fascinating read for a person like myself who has spent so much time obsessing about various methods of suicide–taking into consideration both the success rate and the risk of ending up like the woman in my psychiatric outpatient program: crippled and in even more pain than before she jumped from the five-story building.

Writes Anderson:

To turn the equation around: if the impulsive suicide attempter tends to reach for whatever means are easy or quick, is it possible that the availability of means can actually spur the act? In looking at suicide’s close cousin, murder, the answer seems obvious. If a man shoots his wife amid a heated argument, we recognize the crucial role played by the gun’s availability. We don’t automatically think, Well, if the gun hadn’t been there, he surely would have strangled her. When it comes to suicide, however, most of us make no such allowance. The very fact that someone kills himself we regard as proof of intent — and of mental illness; the actual method used, we assume, is of minor importance. 

But is it?

As it turns out, one of the most remarkable discoveries about suicide and how to reduce it occurred utterly by chance. It came about not through some breakthrough in pharmacology or the treatment of mental illness but rather through an energy-conversion scheme carried out in Britain in the 1960s and ’70s. Among those familiar with the account, it is often referred to simply as “the British coal-gas story.”

For generations, the people of Britain heated their homes and fueled their stoves with coal gas. While plentiful and cheap, coal-derived gas could also be deadly; in its unburned form, it released very high levels of carbon monoxide, and an open valve or a leak in a closed space could induce asphyxiation in a matter of minutes. This extreme toxicity also made it a preferred method of suicide. “Sticking one’s head in the oven” became so common in Britain that by the late 1950s it accounted for some 2,500 suicides a year, almost half the nation’s total.

Those numbers began dropping over the next decade as the British government embarked on a program to phase out coal gas in favor of the much cleaner natural gas. By the early 1970s, the amount of carbon monoxide running through domestic gas lines had been reduced to nearly zero. During those same years, Britain’s national suicide rate dropped by nearly a third, and it has remained close to that reduced level ever since.

How can this be? After all, if the impulse to suicide is primarily rooted in mental illness and that illness goes untreated, how does merely closing off one means of self-destruction have any lasting effect? At least a partial answer is that many of those Britons who asphyxiated themselves did so impulsively. In a moment of deep despair or rage or sadness, they turned to what was easy and quick and deadly — “the execution chamber in everyone’s kitchen,” as one psychologist described it — and that instrument allowed little time for second thoughts. Remove it, and the process slowed down; it allowed time for the dark passion to pass.

Anderson interviewed David Hemenway and others of the Injury Control Research Center at Harvard, which consists of a team of public-health officials, scientists, and statisticians, who have developed a suicide prevention program they call the Band-Aid approach. In other words, they focus on the “how” of suicides–the methods used–and brainstorm about ways to remove or complicate the possibility of using that method (like in the British coal-gas story) for the intention of suicide.

Their efforts might work for the person committing “impulsive suicide”–which, Anderson explains, is different in nature from a “premeditated” suicide (in which a person might take an overdose of pills or cut herself). And here’s the irony: the person who is typically “suicidal” (depressed, obsessions with death) might actually be SAFER than the person who acts in the heat of the moment. Because, statistically speaking, a person who shoots himself is 40 times more likely to succeed in killing himself as the guy who overdoses on pills.

Anderson explains:

As illogical as this might seem, it is a phenomenon confirmed by research. According to statistics collected by the Injury Control Research Center on nearly 4,000 suicides across the United States, those who had killed themselves with firearms — by far the most lethal common method of suicide — had a markedly lower history of depression, schizophrenia, bipolar disorder, previous suicide attempts or drug or alcohol abuse than those who died by the least lethal methods. On the flip side, those who ranked the highest for at-risk factors tended to choose those methods with low “success” rates.

What I found inspiring in Anderson’s article were the remarks made by those who failed at an impulsive suicide: how, at that moment that they were plunging from the bridge or in the half-second after they had pulled the trigger, that they realized that they didn’t want to die. They wanted to live. It’s just that they didn’t see another option out of their problem.

Writes Anderson:

One aspect of the survivors’ personalities that appears to have been left behind is whatever mind-tumble caused them to try to kill themselves in the first place. Since their attempts, none of the survivors I spoke with had experienced another impulse toward suicide. Nor had they spent much time seeing psychologists or hanging out in support groups…. 

For each, it’s almost as if their near-death experience scared them straight, propelled them back to a point of recovery beyond even their own imagining…. 

Beginning in the 1970s, Dr. David Rosen, a psychiatrist and Jungian psychoanalyst, tracked down and conducted lengthy interviews with nine people who survived leaps from the Golden Gate, as well as one who had gone off the nearby Bay Bridge.

“What was immediately apparent,” Rosen recounted, “was that none of them had truly wanted to die. They had wanted their inner pain to stop; they wanted some measure of relief; and this was the only answer they could find. They were in spiritual agony, and they sought a physical solution.”

To read more Beyond Blue, go to www.beliefnet.com/beyondblue, and to get to Group Beyond Blue, a support group at Beliefnet Community, click here.



  • Larry Parker

    This was a remarkable article.
    BTW, Elton John’s song “Someone Saved My Life Last Night” was about his own attempt to commit a “coal gas” suicide in the late 1960s.

  • Lauren

    Great article and good insights into a situation that many people go through but don’t want to talk about. I went through this in a very serious way that made me wonder how I could ever have felt so much pain without going over the edge, but it did bring me to a greater awareness of God’s love for me and the world. I have begun a new journey into a place that will hopefully benefit me and others.

  • None

    I read this article and was glad for this info into killing oneself. I have premediated at least 10 scenerios and who would find my body. I don’t want a loved one to find me, so I have plans on how to contact the proper folks. As I understand, I will most likely commit suicide on an impulse. This is truly because living is too painful. I just want to stop feeling SAD AND USELESS. I love to read the book, “My Beautiful Broken Shell.” I try hard to feel less broken but a life time of depression, even with medications and talking, I still feel broken.
    I’m glad I wrote this because maybe it’s time I let others know, so I don’t have the pity party alone.

  • Micaiah

    Great article.
    I wonder…did the Amtrak driver or Anderson ever feel suicidal in their life?
    I ask only because while the insights and research is interesting, it doesn’t bring out the feelings of the suicidal people as much as I thought it might. The impulsive vs premeditated…there’s no doubt there are both kinds, but are they necessarily connected to the method that is used? Or more likely connected to the inner workings of the victim’s mind and/or spirit?
    As someone who has dealt with numerous close friends, students and family who have attempted (and some who have succeeded) suicide and a survivor of attempts myself, methods listed here that are considered “impulsive” can definitely be premeditated and vice versa. But those that were premeditated and pulled a trigger knew exactly what was going to happen and were ready for it. Those who impulsively took pills knew what might happen and rolled the dice.
    Thanks for sharing, Therese and Larry.

  • Rochelle

    I’ve never posted, to SAD and USELESS…
    There’s so many of us that feel this way most of the time, but always remember you are not alone., and thank you for making me feel better. Sometimes the weight of the world on our shoulders is heavy on our souls. We think the easy way out is, suicide because all you feel is pain and hurt. You wait, pray, and hope it goes away… sometimes it does, sometimes it doesn’t, it lingers and it feels like forever…
    All I know is I read your post and felt your sadness, hang in there keep your chin up because your life is valued. Sending you good vibes and to all who needs them.

  • Anonymous

    I’ve shared before that one of my son’s best friends committed suicide(by hanging when they were just thirteen.. One of the profound things the minister who officiated at M’s funeral said to al of the young people there was thatM was BOT a hero, that he had CHOSEN a PERMANENTsolution to a temporary problem No one ever truly knew what the problem WAS, on the surface he had a comparatively “good” life: Athletic, popular, handsome, a two-parent and ffluent family. One of the lessons his suicide taught me is that we can never really know through observation alone how happy–or, conversely, unhappy–another individual is. Quite clearly, the observable and superficial, I might add, trappings of his life weren’t fulfilling enough to him. Tragically,M’s suicide ended up being the first of a”suicide epidemic” in our community; three others followed suit soon thereafter (They weren’t necessarily fiemds of M’s, either. Two didn’t even attend the same school!(It was a fairly large community with three middle schools and two high schools) M left no note explaining his actions, something I learned is more typical than most of us think. Even his best buddies had no idea why he was so unhappy although he had mentioned considering suicide to several of them about a week prior at a party (in OUR home!) Unfortunately, with the lack of wisdom that most thirteen year olds have, his confessors(including my son) believed they had “talked him out of it” and mentioned nothing to an adult until AFTER his father found him hanging in their pole barn one evening.

  • Warren

    Very good article!
    Regarding “Someone Saved My Life Tonight,” Elton John wrote it about being saved from marrying his girlfriend in 1969. Though he was also suicidal at the time, he credits Long John Baldry as saving his life by preventing him from marrying and abandoning his musical career, not specifically killing himself.

  • Solman

    “They were in spiritual agony, and they sought a physical solution.” according to Anderson. I would have thought that remark would have pushed one of your buttons Therese.
    As I listened to the NPR report on the article, I believe Anderson also stated that many mental health professionals were comfortable with the “post hoc rationalization” that suicide was the result of deeply-rooted mental health problems, whether seen as “impulsive” by the public or not. I have conversed with many such mental health professionals as well as preachers and other “enlightened” gurus who deflect any responsibility for their incompetence — in their treatment of a person in crisis — with post hoc rationalization.
    Life is a gift huh? Well that’s what the kids call the burning bags of poop they leave on the welcome mat: a “gift”. Does that mean the receiver needs to embrace it and hang onto it as long as possible?
    An acceptable quality of life to one may not be so acceptable to another. It’s wonderful when we can make lemonade out of lemons. Not so wonderful to be a lactose-intolerant dairy farmer whose main compensation is leftover sour milk returned (for credit) by the happy customers.
    Lastly, survivors Anderson interviewed may be reluctant to share any residual suicidal feelings because such an admission could have terrible consequences on the remaining quality of their life, especially if they’re trying to “fake it till they make it.”

  • NONE

    To Rochelle who connected with my SAD and USELESS life. Thanks for sending the good vibes, sure hope it works. Summer is my favorite season BUT here I sit, not going out. I love my gardens BUT I only see them thru windows and doors. Yes, I do go out for social or church events. My heart doesn’t feel happy and it’s breaking right now. My 3 adult children do many things with their young kids, because they say it is their family. The siblings do things together so the cousins are close. That is great; family is what life is all about. Aside from God, of course. We had a wonderful relationship but they cut me no slack now. They are always picking apart everything I say or do. There are LOTS OF PEOPLE THAT ACTUALLY LIKE ME. But I can’t just be myself around my family. I ask them if I can be included in a trip to the zoo or pool. I like spending time with grandkids………it happens only when I sit so their parents can go out. I love taking pictures of them as they are playing, it’s like seeing the world thru their young eyes. They are old enough to play games or do art projects. I bring odds and ends with construction paper. The kids just LOVE the time we just make things that they it. The parents barely look at the finished artwork AND I never see them on the frig. I asked about some and they don’t even remember seeing them. My kids lived with my depression and I know they are all prone to the same thing. Yet, they don’t take this into consideration when it comes to me. I know, I know……..I’m looking for “THE PERFECT WORLD.”
    I’m learning to “LET IT GO…………MOVE FORWARD………..AND THIS TWO SHALL PASS.” God is seeing me thru all times BUT I’M NOT SURE HE CAN CHANGE MY MIND ABOUT CHECKING OUT EARLY. I am in my 60′s so it’s not like I would be dying too young.
    Thanks again Rochelle, sorry I wrote so much, but it feels good to have others understand. And I know this group sure get the whole big picture.

  • Larry Parker

    I heard a different version of the story — what can I tell you …

  • Lynne

    I’m almost at the end of my rope, but at least I’m not hanging by it. Right now the world is crumbling around me but “I’m still standing” another Elton John song. I feel ridiculous to be falling apart like this. How can adult children of childlike adults get sucked into the abyss? My parents are fighting like they always have but now they’re getting better at it! (more vicious and petty) My older brother, who’s struggling though the 12 steps, is drinking again. He is living in our NY house because he is in the middle of an ugly divorce with his wife of 33 years. ( he signed his house over to his wife because…my theory is we’ve been programed from early on to just give in to the alfa-female and hope that makes her happy.) NEWS FLASH…it does’nt! So he feels guilty over everything…and drowns his depression. I’ve been trying to “cut” mine down to size. Also not successful. My brother has suggested my Mom go to therapy. She does’nt understand why SHE should go. She’s at least milder bi-polar and OCD and the penultimate victim. (Oh I don’t know but maybe your children might live longer) My brother has already tried the pill solution (overdose) It’s obvious to both of us that my parents are far too toxic to remain together but I’ll get Mom and my brother will get Dad and neither of us will have a life of our own because of the guilt because no one can cope with “Mommie Dearest”. Thanks for listening.

  • Anonymous

    “I heard a different version of the story”
    well, there ya go… you shoulda listened to the song.

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