Findings
Abstract
This chapter examines deaths that were determined to be by suicide which occurred from 2000 to 2009 in Montgomery County, Ohio or the surrounding counties. We had a copy of suicide notes for a small subset of individuals (174 or 14%) while 1106 individuals did not leave a note. The average age of the victims was 45 with a range from 11 years old to 94 years old. The vast majority (92%) were Caucasian and male (82%). The most common method used by individuals to kill themselves was firearms (51%) and a majority killed themselves at home (74%). We delineated eleven categories related to suicidal motivation and two of these categories accounted for more than 90% of the motivations for suicide; interpersonal relationships (23%), and escape (70%). This chapter contains a more detailed explanation of our methodology and our findings, as well as an examination of the similarities and differences between note writers and non-note writers.
Keywords
Suicide; motivations; suicide note; content suicide notes; suicide patterns; suicidal ideation
Mike made entries on his calendar for each day of the week preceding his suicide, starting with “maybe” on the first day, several days of “not yet” and “yet” on the day he shot himself in the head. Mike had struggled with depression for years and had twice attempted suicide by slashing his wrists. His depression began after Mike was involved in an accident in which a child was killed. It was not his fault, but he always felt guilty and began to express his desire to kill himself. One morning he left to run some errands and when he had not returned by late that evening, his wife called the police. They found him in a shower stall at his workplace with a note addressed to his son which read, “Be a better Dad than me.” He also left a note for his wife which simply said, “I love you.”
Deciphering 1280 Cases
Considerable debate has taken place about using notes that victims of suicide leave behind to help us to understand suicidal behavior, since note writers may not be comparable to non-note writers. If they are not comparable, then conclusions made about note writers, based on information obtained from their notes, could not be generalized to non-note writers. Early research comparing note writers to non-note writers yielded conflicting findings. This was likely due to small sample sizes and cultural differences since the research was conducted in a variety of countries. More recent research suggests very few differences, if any, between note writers and non-note writers.
In a 2015 study, using a comprehensive state-wide database with information available on 2936 suicide victims, 18.75% of individuals left a suicide note. When comparing demographics and circumstances of the two groups, no differences were found between note writers and non-note writers (Cerel, Moore, Brown, van de Venne, & Brown, 2015). Demographics included information such as age, gender, race, marital status, and place at the time of injury. Circumstances of their suicides included mental and physical health problems and interpersonal relationship issues. Similarly, in another study comparing 621 cases of suicide on 40 variables, note writers did not differ from non-note writers, except that note writers were more likely to live alone and make threats of suicide (Callanan & Davis, 2009).
The coroner provided us with information related to 1664 cases. Each case had basic demographic information, such as age, gender, and method of suicide included in a spreadsheet and/or an investigator’s report. We deleted 384 cases from the set the coroner provided for various reasons. In some cases we were missing a case file or critical information about the suicide or the cause of death was determined to be an accident or homicide. In other cases, the report said a note was left but we were not provided a copy of the note. We had a copy of the note for a small subset of individuals (174 or 14%) while 1106 individuals did not leave a note. (See appendices for a detailed methodology and a copy of the coding sheet we used in the study.)
Our ratio of note writers to non-note writers is comparable to what other researchers have found, but depending on the demographics of the population studied, one will find varying estimates regarding the percentage of suicide victims who leave notes. Rates range between 10 and 43% of suicide victims in the United States (Sinyor, Schaffer, Hull, Peisah, & Shulman, 2015). In a Tasmanian study, 33% of the sample left a suicide note. Researchers found that those who wrote a note were more often engaged in interpersonal conflicts but at the time of the suicide were alone. They had little medical or psychiatric care but were in psychological distress. They also tended to choose the most lethal methods for killing themselves (Haines, Williams, & Lester, 2011). Time and place are relevant as well, as percentages of note writers may be affected by literacy rates, cultural differences, and access to writing materials. Approximately 16% of all the people who committed suicide were note writers in a 1960 British study of Wales (Capstick, 1960), but in a 2006 Japanese study, 30% left notes (Kuwabara et al., 2006). Age may also be relevant; e.g., the elderly leave fewer notes than adolescents (Salib, Cawley, & Healy, 2002). In our study we had a population that spanned age groups, that had access to public education and was literate, and was diverse as to gender, race, ethnicity, and class. We had a number of people who killed themselves as a result of interpersonal conflict, but we also saw many who died to escape pain or situations.
Coroners obtain information for investigative purposes, not for research purposes (Rivlin, Fazel, Marzano, & Hawton, 2013). No standardized reporting format exists. The information collected even in one jurisdiction can vary. Some reports may be minimal, verifying the death and its suspected cause, while others contain extensive details about the weather, the condition and position of the body, and the mental, physical, and interpersonal history of the victim. These differences are due not only to investigator style, but also to the availability of information. We had basic information on almost every person. Gender was always recorded in the files or on the spreadsheet, but occasionally race or ethnicity was absent. Information that might have to be obtained from an informant, such as history of alcohol abuse, might not be included. If no mention was made of this type of information in the spreadsheet or investigator’s report, we recorded it as “unknown.” Reports were sometimes suggestive and might say, “the individual drank two bottles of wine before shooting himself,” but unless investigators specifically mentioned a history of alcohol abuse, we recorded it as “unknown.” This means that our numbers are likely underestimates of some information about our victims’ experiences, because it was simply not available. Although cases with just investigator reports offered less information than the cases with notes, they provided a clearer sense of suicide patterns because of their sheer volume. In fact, we found, consistent with other research comparing note writers to non-note writers, virtually no differences (Callanan & Davis, 2009; Cerel et al., 2015).
We used the same coding form to record information about both note writers and non-note writers. The only exception was that for note writers, an additional section is included related to the characteristics of the note (see Appendix B, Coding Information). The basic coding form was divided into four sections: demographics, previous history, characteristics of the suicide, and motivation. Demographics included information such as the day of the suicide, season, living situation, and occupation of the victim. Previous history focused on legal, financial, or interpersonal problems, physical illness, drug and alcohol abuse, and previous suicide attempts. The location of the suicide, as well as the type of trauma, was noted in the characteristics of the suicide section. Finally, a motivation for the suicide was selected out of 11 main categories. In total, we examined 116 characteristics related to note writers and 33 characteristics related to non-note writers. We were able to compare note writers to non-note writers on the latter characteristics.
Since very few demographic differences between note writers and non-note writers were found, we combined the information for non-note writers and note writers to represent overall findings. When differences were found, however, we provided information for each group separately.
The average age of our victims was 45 with a range from 11 years old to 94 years old. In 2014, people ages 45 to 64 years old and those 85 years or older had approximately the same rate of suicide (“Suicide Statistics,” 2014). The vast majority (92%) were Caucasian. These findings are virtually identical to Cerel et al.’s (2015), who found an average age of 46 years and approximately 96% of their sample was Caucasian.
In our sample, it was more common for a man to commit suicide (82%) than a woman. In 2013, 77.9% of all people who committed suicide were men. Moreover, white males accounted for 70% of all suicides (“Suicide Statistics,” 2014). More women in our sample wrote notes (20%) than men (12%). Some researchers have found the reverse pattern for note writing and gender, with men leaving more notes than women, while still others have found no differences. Cohen and Fiedler (1974) found 26% of women and 19.1% of men left notes while Cerel et al.’s (2015) results were consistent with 24% of women and 17% of men leaving notes. However, Cohen and Fiedler found no differences in the content of notes left by men and women nor were there differences in the content of notes left by men and women in our sample.
Just over 3% of our victims were identified as veterans, which appears low given the fact that a major US Air Force base is located in the vicinity so there is a high population of veterans in the area. Other researchers have found that veterans represented 19% of their sample (Cerel et al., 2015). Investigators of our cases may not have had access to veteran status, or they may not have thought it was worth noting. It is also possible that the presence of the military base was a source of support for veterans. In no case did anyone identify the impact of active duty as a major factor in his or her decision to commit suicide.
The most common methods used by individuals in our sample to kill themselves were firearms (51%) followed by asphyxiation (20%) and overdose (14%). Similarly, in 2013, the Center for Disease Control (CDC) found the most common mechanisms for suicide were firearms (51.5%), followed by asphyxia (24.5%) and poisoning (16.1%). The percentages in our study represented both note writers and non-note writers. Interestingly, Cerel et al. (2015) found overdosing and hanging to be equal among note writers while 18% of non-note writers hanged themselves and 11% used poisoning.
Most individuals in our cases killed themselves at home (74%) in their bedrooms (23.25%). Cerel et al. (2015) also found 77% of note writers and 83.15% of non-note writers killed themselves at home. When they did not kill themselves at home, they frequently were found in parks or cars. Perhaps the most unusual location was a church altar. We could identify the living situation for approximately two-thirds of the victims and they were fairly evenly split between living alone and living with a spouse, although we found that note writers were slightly more likely to live alone.
The highest percentage of suicides in our cases occurred in June (10%) with the lowest percentage (7%) in May. However, for note writers, both January and June were equally risky months. Note writers were more likely to kill themselves on Wednesday while non-note writers were more likely to kill themselves on Monday. Although the highest percentages of suicides occurred on the ninth and twentieth of the month, for note writers, the first day of the month held the highest risk.
There were virtually no differences between the percentage of note writers and non-note writers who expressed suicidal threats (19%) or ideation (14%) or had prior attempts (18%). These numbers are consistent with Cerel et al. (2015) who found approximately 19% of their sample expressed suicidal intent and 13% had a history of attempts. When added together, though, this means that half the victims had demonstrated or voiced their potential for self-harm. Often investigators noted that friends and relatives did not take the threats seriously. These family and friends may have been overcome by the chronic nature of the threats, as some individuals had threatened suicide for many years and had made numerous attempts. For others, suicide was more of an acute situation in which they were simply overcome by recent life events.
Almost a fourth (28%) of the sample had identified substance abuse issues, and 20% used substances just prior to their suicides. Callanan and Davis (2009) also found evidence of drugs or alcohol at the scene for 24% of note writers. The number dropped for non-note writers to 14%. Ten percent of our sample had been involved in some form of physically abusive situation in the past such as domestic violence, child abuse or sexual assault. However, non-note writers were more likely to have perpetrated the abuse than note writers and conversely, note writers were more likely to have been the victims of abuse than non-note writers.
Some variables existed between note writers and non-note writers that looked like they differed, but this was probably anecdotal. For example, it appears as if note writers had a greater percentage of depression (46%) than did non-note writers (37%), but since we had a note, we had more information available on note writers. Unless the investigator identified the victim’s specific mental illness, we could not record it, so the percentage of depression for non-note writers is probably a bit higher than our data indicates. Other researchers have found 40–59% of individuals who commit suicide are depressed (Callanan & Davis, 2009; Cerel et al., 2015; Sinyor et al., 2015).
Given that a large percentage of the individuals in our sample were depressed, it is not surprising that the most common motivation for suicide (70%) was to escape painful life circumstances, such as physical or psychological illness. One-third of our victims had significant physical illnesses and over half (51%) were identified as having psychological illnesses. These numbers were slightly higher for note writers. Callanan and Davis (2009) also found approximately 28% of their sample mentioned long-term health problems.
The next most common motivation for suicide in our cases was interpersonal relationships (23%). Thirty-nine percent of our cases were identified as having interpersonal problems, and this number rose to 48% for note writers. These numbers are consistent with prior research findings indicating that approximately one-third of victims have interpersonal problems with either an intimate or nonintimate partner. Cerel et al. (2015) found that approximately 26% of their sample had intimate partner problems and another 5% had relationship problems that did not involve an intimate partner.
While reading the cases, we encountered a number in which the victim killed himself or herself in front of someone else, often an intimate partner. These witnessed suicides were not cases in which someone else was simply in the home, but rather ones in which the victim intentionally committed the act in front of someone. We found that 12% of victims killed themselves in front of someone, but that note writers were less likely to kill themselves in front of someone (3%) as compared to non-note writers (13%). The act of killing oneself in front of another was itself a form of communication, and thus a note may not have seemed necessary. Many of these cases also involved drug or alcohol use; e.g., one 20-year-old man had been drinking heavily when he found a gun in the home, said “Happy Birthday” to his mother, and shot himself in front of her. These cases will be explored more in this chapter on interpersonal issues as a motivation for suicide.
Suicide Notes
Given the very few differences between note writers and non-note writers, it is likely the notes are representative of the sentiments and characteristics of both groups. Suicide notes are written for several purposes, including providing some explanation for the choice of suicide. Many notes were written for the clear purpose of reassuring survivors that the suicide was not their fault and that there was nothing they could have done to prevent it. Writers of these notes often apologized for the pain that would be caused by their loved one finding them. In cases in which no note was left, victims often took care to ensure that a family member would not be the one to find them by choosing a location such as a motel or park where a stranger would be the one to discover the body.
For the suicide note writers, this planned act of composing a final communication to others enabled them to communicate to survivors their emotional state and provided an opportunity for the individuals to justify their actions and put their affairs in order. Perhaps most importantly, many note writers attempted to mitigate the emotional burden that would be felt by survivors. Some note writers may have viewed the note as a means to have some element of control over others.
The content of the notes sometimes provided evidence that the suicide was not impulsive. These notes described the writer as having thought about suicide for days, weeks, months, or even years before carrying it out, and a substantial number described previous suicide attempts. Some notes included “to do” lists of steps leading to the suicide (e.g., “2:15-Take a shower; 3 PM-Crush pills”) and a methodical check-off of items that were completed for as long as the writer could manage. Calendars were occasionally used to mark progress toward the suicide. One man wrote the phrase “Whack bang” on the date he shot himself and “funeral” on the date he believed his services would be held.
The medium of the suicide notes sometimes provided information about the writer or sent messages about the act. Suicide notes on hotel or motel stationery usually indicated the location of the suicide, and suicide notes on business or professional association note pads spoke of the writer’s affiliations. Occasionally the medium used was simply a reflection of what was available to the writer. One young man wrote his note on a coffee filter; another spray painted his message on the floor of the barn where he killed himself; a woman wrote her message in soap on a bathroom mirror; and a father wrote the names of his children on his shirt with a magic marker. Sometimes the medium relayed its own message. With some obvious symbolism, one note was written on the reverse side of an antisuicide contract with a therapist where the writer had agreed to take various precautionary steps to counteract acute thoughts of suicide. Another was written on a Christmas card, leaving us to wonder if this was simply the only paper handy to the writer or if it was instead a statement that Christmas had been a disappointment.
Modern media were occasionally used for the final suicide communication. Some notes were generated on a computer and left beside the body, or a handwritten note was left that referred to a suicide note on an office computer. Some people announced their suicidal intentions in an e-mail or text message. Occasionally a packet containing audiotapes, videotapes, or electronic files was left at the scene or mailed to a family member or friend. We did not always have access to these “notes” but we included the ones that were in written form in the pool of people who left notes in an effort to distinguish characteristics of those who produced a final written communication and those who did not.
Some of the notes became difficult to decipher because of grammar or punctuation errors, misspellings or illegible handwriting. For individuals who had ingested substances, handwriting often became illegible as the substances took effect. The note from one person who had ingested 1.5 liters of vodka became less and less coherent until the note abruptly ended. Occasionally, parts of notes were illegible due to blood stains or spatter on the note.
The content of the notes sometimes gave us glimpses into the personality or talents of the writer. A few writers used handwriting or printing that was very precise, stylized, and even artistic. An occasional note was illustrated with drawings, usually depicting the writer’s death and a few were sprinkled with humor (3%). One 39-year-old man who struggled with substance abuse issues wrote, “My body can go to science maybe they can find a cure for cirrossiss so people can drink with impunity Ha!Ha!” Mike, the man discussed at the beginning of the chapter, apparently timed his suicide with the temperature of his beer and said, “Beer is getting warm. See ya.” Humor is not common in notes. Foster (2003) also found only 5% of notes included humor.
We created our coding sheet for the notes after we had read a sample of notes and the previous research findings of other scholars. We then met as a team to generate a draft of the coding sheet which included characteristics of the notes but also the thoughts and feelings expressed by the note writers. We included any mention of life struggles or precipitating events and instructions and advice for survivors.
We tried to be as precise in our coding of notes as we had been with the demographics. Unless the note writer specifically mentioned a feeling, we did not record it. For example, if someone talked about how depressed s/he was but did not say, “I feel so sad,” it was recorded as someone who was depressed but not as someone who was sad. We took this approach, because it was easy to read feelings into the notes and we wanted to be as objective as possible. However, this strategy likely led to underestimates of the feelings expressed and characteristics in the notes. Still, that said, our findings are consistent with other research.
Overall Structure of the Notes
We examined a total of 350 notes from 174 writers. Most individuals (68%) left one note and an additional 14% left two notes. However, one individual left 20 notes and three more left over 10 notes. Since we were examining all 350 notes, the numbers following refer to the percentage of notes, not the percentage of individuals. Approximately one-fourth (26%) of notes were dated and about two-thirds were signed. Only a small percentage typed or word-processed their notes (7%) and only two individuals mailed them. Some quoted from various sources (6%), such as literature or music, to express how they were feeling.
Most notes contained organized thoughts throughout (92%) with a clear beginning, middle, and end, even when they were under 25 words long (15%). For example, one fiercely independent 91-year-old man, who was facing declining health, wrote, “To much pain. Can’t take it no more. Love You All. God Bless.” The majority (59%) wrote notes that were relatively short (26–300 words long). Sanger and Veach (2008) found 58% of their sample provided explanations for their actions and approximately two-thirds of ours did so as well. These could be brief, “Had a good life. It’s my time to go,” or detailed. Julian, a 25-year-old, chronically depressed man, whom we also discuss in Chapter 7, Severe Mental Illness, provided a comprehensive description of the rationale, preparation and timeline for his suicide. He listed over 20 reasons why he should die but had only one reason to live. His reasons ranged from politics to his broken phone to Britney Spears. He included pages and pages of his own poetry that he said should be made available to anyone who wanted to read it. He made a list, printed mostly in capital letters on lined notebook paper,
Once individuals could justify their actions, and they were convinced suicide was the solution to their problems, they often developed thought constriction or tunnel vision (24%). Their thinking became rigid and narrow. Len, whose marriage and job had both ended, stated,
However, this is no longer a matter of choice. Death has transitioned from an enticing notion to an irresistible compulsion. I simply abhor my very being—my tortured, twisted, weird, unfulfilling existence; and so I can be no more. I just have to turn off my thoughts—I have to. This is euthanasia, pure and simple. They shoot horses, don’t they? … But instead focus on the fact that I thought about it (suicide) far more days than I didn’t and resisted on the basis of the moral implications and what it would do to the people I love … My thoughts have become completely unbearable and I can’t think of any other way to escape them.
Similar to the concept of tunnel vision is dichotomous thinking where an individual views him or herself and the world in black and white. Foster (2003) found in 12% of the notes in his sample the note writer discussed suicide as the only solution. In the notes in our sample, when dichotomous thinking was expressed (9% of notes), they often referred to the limited options individuals saw to change their life situations. One young woman’s note reflected this dualism when she said, “I love you mom & Dad. I just couldn’t take this anymore and I saw no other way out. Sorry!!!” At times, the combination of constriction and dichotomous thinking made it appear that the individual did not have control over his or her choice to commit suicide. Some individuals wrote a version of “I have no regrets only that I could not finish my life.” It was as if someone or something else had control of their destinies, that death was inevitable. Thought constriction and dichotomous thinking were identified in approximately one-fourth of the notes. However, many of the notes simply were not long enough to include this pattern. More importantly, the intent of the note was not to convey one’s pattern of thinking as much as it was to convey a message, thought, or feeling. Nevertheless, from the tone of the notes, it is clear that a vast majority of individuals saw no other way out of their situations.
Approximately two-thirds of the note writers addressed their notes to a specific person or persons, generally family members such as children (35%), parents (33%), spouses/partners (32%), siblings (13%), or other family (25%). One person wrote a note to his dog. Sometimes the note was addressed to a generic audience (18%) but for 53% of the notes, we could not determine the relationship between the note writer and the addressee and 5% had no addressee. The notes had a great variety of openings, but some similarities existed. Whether addressed to a specific person or not, many began,
“If your reading this it is probably not a good sign.”
“If you are reading this letter that means I have decided to end my life because I feel Julie is going to file for divorce in September.”
“Well if you’re reading this, then I must be dead. Kind a hard to tell since I never had a life.”
“I regret to inform you if you are reading this letter it is because I am dead.”
Content of the Notes
Great diversity appeared in the content of the notes, and although the frequency of a certain topic varied, the content about that topic was often remarkably similar. In general, the notes are divided into three sections: very frequently occurring content (over 50% of notes), frequently occurring content (approximately a third of notes), and less frequently occurring content (less than 10%). However, when constructs are related, such as love, apology, blame, and forgiveness, they are discussed together, despite the fact that they may not occur with the same frequency.
Very Frequently Occurring Content in the Notes
Love and Relationships
“Sorry I could not be more help to you but I will always love you both very very much. Please forgive me. Love Dad.”
Love for others was clearly the most predominant message in the notes (76%). Even the 91-year-old man mentioned previously expressed love for others in his 13-word suicide note. Arguably, expressing love may have been a key motivation for writing the note. We will discuss motivation for the suicide in future chapters, but motivation for writing the note is often completely independent of the reason for the suicide. The vast majority of note writers wanted their loved ones to know that they had loved them.
Expressions of love for those left behind are common in suicide notes. Foster (2003) found 60% of the notes he examined had expressions of love for those left behind. Sanger and Veach (2008) found 48.6% of the notes in their sample specifically stated “I love you.” Even though 76% of our sample expressed love for others, only 14% of note writers talked about being loved by others and 9% felt unlovable. The disparity between feeling love for others and feeling loved by others was disconcerting. The note writers were either trying to highlight that they did not feel loved or they simply forgot to mention it. Of course, many notes were written when the writer was extremely distressed because he or she had made a decision to kill himself or herself. Perhaps they thought it was too obvious to mention or simply forgot. Yet, some notes were written in the months or weeks leading up to the suicide, when they had plenty of time to consider the content. Moreover, note writers remembered to mention seemingly insignificant details in their notes (maintenance on the car). They were clearly addressing that which was important to them in the notes. However, what they did not say in the notes may be as important as what they did say. Only 14% of note writers said they felt loved by others, with 86% of note writers not mentioning feeling or being loved by others. It seems unlikely that this was simply an oversight but was rather a message they wanted to communicate.
A few note writers directly addressed not being loved but did not speculate about why they were not loved. One person said,
If I hurt anyone, which I probably didn’t, I’m sorry. It’s just that it’s my time to go now. As I sit here in this empty house I realize I am all alone. I don’t have anybody. Nobody loves me; Nobody cares about me. I love you all but you don’t love me … I came into this world naked and I will leave it naked. Forgive me, I Love You All.
Another wrote, “I really was never understood by anyone. I was always always so so alone.” Although he did not specifically mention not being loved, one man made a list of all the people to contact after his death. The list was not very long, and he reflected, “Gee, that’s a damn short list for someone who’s been on this earth 52 years, isn’t it? Kind of demonstrates the emptiness of my existence, no?”
Eleven percent indicated they were lonely which is similar to other studies (Foster, 2003; Sanger & Veach, 2008). Yet, some of these individuals isolated themselves. In his note, one middle-aged man talked about losing the love of his life in his twenties and then isolating himself from friends and family. He always declined invitations to family events, yet in his note, he thanked his cousin for all her support and extolled her virtues as a friend, parent and relative. He wrote,
I’ve been terribly lonely and each passing year has brought more pain and despaire. Loneliness is a very bad place for a loving person like me to exist. I chose not to endure anymore. Please forgive me, please understand … I only wish I had taken time to be part of and with your girls as they grew up … I have no one to do it for me so I have prearranged my own funeral.
Although his cousin had reached out numerous times, he would not return cards or calls.
Another middle-aged man, who had lost his job and become a hermit, recognized his isolation but apparently did not understand that he could change it. He stated, “I am very sorry I did not reach out for help. That was stupid!” Others discuss their intentional isolation. One 25-year-old man who had not seen his mother and sister in six years wrote,
This is hard because I know there are people who care and love me, yet I feel so alone, so isolated from the rest of the world … Now I don’t imagine to many people who will be affected by this but I sure there are a few. And to these people I am truly, truly sorry. I never meant to hurt anybody. I think that why I kept so isolated from the population, I don’t want to hurt anymore than I have to.
Another man’s journal entries detailed the months leading up to his suicide. One thing on his to-do list was to alienate himself from his friends. He intentionally started arguments with them and said things that would hurt them. He wrote,
Trying to get rid of my friends is a heart breaking yet happy time … .[talks about how he is doing this] I won’t hear from them for a while. Just a few more people to go, then my family, then I will be free. FREE!! Ditch the bitch and fuck that life, there’s no man happy that has a wife.
Although in some cases it appeared that the note writer had no support network, most had numerous people in their lives. Since the majority of note writers addressed their notes to a specific person or persons, presumably those were people they loved or for whom they felt an attachment. It is certainly possible these people did not love or express affection for the note writers. There are other explanations as to why note writers omitted expressions of love from others or feeling loved by others from the notes. Since some of the notes were very short, the writers only addressed a few basic sentiments such as their own love for others, a justification and, occasionally, instructions. The lengthier note writers may have intentionally left out feeling loved by others, but why remains unknown.
Others took responsibility for not being loved. Perhaps they were simply incapable of accepting the love. One woman who was sexually abused as a child said to her husband, “You loved me well. So well. In the end I couldn’t love myself.” Another woman knew she was loved but it was not enough. She stated, “Please make sure everyone knows it was NOT THEIR FAULT!!! I was loved and I know it. You were all there for me but I guess I needed more than any human being could be asked to give. I honestly and truly love you all.” Still others had been in a very loving situation but lost the love of family and friends, frequently due to addictions. One writer with a gambling addiction put it quite succinctly, “I also didn’t want to be such a big loser—but that isn’t the case. I am a loser, I have lost the most precious things in life. I have lost my family, I have lost my pride, I have lost my own dignity.” Even for the 14% who did feel loved by others, it was often not related to their suicides; it simply could not compensate for the pain or strife they felt. One man wrote, “I love everybody I just hate the world and the way people treat each other so I’m finished. Maybe its for the better.”
Given the emphasis on love in the notes, it was not surprising to find a focus on relationships. Although some notes thanked partners for their love and support, over a third of the notes discussed interpersonal problems (39%) or the loss of a relationship (17%). The subsequent chapters on motivational categories will explain in more detail how characteristics of the notes fit in with overall motivational patterns. Chapter 3 focuses on interpersonal relationships as a motivation for suicide. Although the concept of unrequited love as it relates to romantic relationships will be discussed in that chapter, reading the notes leaves one with a sense of overall unrequited love, not just in their relationships, but in their lives.
Apology, Blame, and Forgiveness
“I don’t think there’s really any right way to start this except by saying I’m sorry.”
Foster (2003) found 74% of his notes contained apologies or shame. However, Sanger and Veach (2008) found only 25.4% of notes contained apologies, but 33.3 asked for forgiveness. Given their professed love for others it was not surprising that many individuals felt a need to apologize for their actions. Most people did not want to hurt those they loved. Apologies were sometimes about the actual suicidal act, “If you hate me for what I’ve done. It’s understandable but know that I am so, so, so truly sorry. Just remember that I love you all and will never hurt you again,” or “Very sorry to put you through this.” Others apologized for some aspect of the act. One elderly man who was in hospice care wrote, “Sorry, I just can’t live this way any longer—I love all of you-sorry I lied about having a gun-Good bye Dad.”
Apologies were not limited to the specific act of suicide. Many note writers apologized for actions throughout their lives. One man who struggled with alcoholism wrote, “I am sorry, I know sorry doesn’t seem to have meaning anymore, but I am sorry I could not have been a better person.” Often apologies were directed toward specific persons (43%). Most of one man’s entire note was an apology directed toward his wife and children. He said, “I’m sorry for all I have done, to hurt you and the girls, and boys. Please forgive me. I love you.” Other note writers (32%) offered general apologies such as, “I’m sorry for tearing up so many lives. I’ve lost my way and don’t know what else to do. Tell everyon that a man can mess up. Life is a bitch. You live and you love and sometimes its too much.”
Apologies were often intertwined with other thoughts and feelings such as gratitude. Some focused on the inevitability of the suicide. One note writer said,
To all those who offered support & compassion to me-and those who believed in me—I am forever grateful. In truth, you have kept me alive longer than I would have been w/o your support. There was nothing more you could have done for me. I understand that you are angry for what I’ve done. I have betrayed you, let you down in the worst ways. I am deeply, deeply sorry.
For others, apologies were tied in with the justification for the act. One individual said, “I’m sorry my mind and body couldn’t take it anymore.”
Sanger and Veach (2008) found 17.4% absolved others of blame or blamed themselves. In our sample, a similar percentage absolved others from blame (20%). One 29-year-old woman who was in the midst of a divorce and had suffered from lifelong depression said,
It’s not anyone’s fault. I’ve been fucked up from the beginning. I’ve never been OK, I’ve never been good enough. I’ve never been normal … I feel disgusting. I hate myself. I don’t know how to change and I’ll never ever be OK. Or normal. Or just acceptable. It’s definitely no one’s fault. Just I’ve had all I can bear.
Another man who was having financial and marital problems said, “This is nobody’s fault but my own. I was out of control and didn’t realize what I was doing until I crashed.” Sanger and Veach (2008) found 8% of victims blamed others for their actions, similar to our findings (13%). Occasionally the blame was counterfactual, such as “If only you had …,” while other notes were very specific about to whom blame should be assigned. One 23-year-old man wrote, “I cant hold you and mom responsible all the way just 25/25 and the other 50 was my fault.”
Since many of the note writers were apologizing for their actions and absolving others from blame, it is not surprising they were also seeking forgiveness. One-third of the notes included pleas for forgiveness. One person asked survivors to forgive another person and another note indicated the writer forgave someone, but in the vast majority of cases the note writer asked forgiveness for either their past behaviors or the suicidal act. These pleas were intertwined with many of the note excerpts already presented in this chapter. Even very short notes often contained a combination of love, apologies and requests for forgiveness. One middle-aged man facing the end of his relationship wrote, “I’m so sorry please darling forgive me and don’t hate me because I still cherish the ground you walk on.”
These pleas for forgiveness were directed toward survivors and toward God. Relationships played a central role in the lives of the note writers. Many talked about not wanting to be forgotten after death. They also wanted to be fondly remembered, which would hinge on forgiveness. As with apologies, often they followed their pleas for forgiveness with justifications for their actions. Cameron, a 47-year-old man struggling with questions of sexual orientation and suffering from both physical and psychological illnesses, apologized to his sister for leaving much of the care of their mother to her and added, “Please forgive me. I wasn’t even living anymore … I’ve always (well, not always) but most of my life thought of myself as a Christian, I’ve studied and read, but maybe I’m just a Nihilist, Existentialist at heart. Maybe there is no meaning to the universe.” Those who asked God for forgiveness generally focused on the suicidal act. They sounded remarkably similar. One man who struggled with substance abuse and life-long depression wrote, “I’ve made my Rights with God and Pray He will have mercy on my soul and forgive me. I’m in his arms now.”
Also, in a few notes the writer indicated he would never forgive someone. For example, one 22-year-old man who had spent the night arguing with his girlfriend wrote this,
I know you think it was your fault but it wasn’t I loved you but you treated me like shit and I will never forgive you for that I will take the hate I have for you to my grave. I loved you like no one else and you treat me like shit. But remember one thing I love you more than anyone else. You will be my wife in my grave.
This note, and the sentiment expressed in it, will be discussed in much greater detail in the section on interpersonal relationships as a motivation for suicide.
Overall, the apologies, discussion of blame, and pleas for forgiveness expressed by the note writers seem heartfelt. These individuals believed their lifelong patterns, or simply the act of suicide itself, caused pain and they were sorry. It was possible to see, even in their last acts, that many had been caring and considerate individuals. One man left a note for authorities telling them to be careful, because the gun he had used was not on safety and should only be handled by the officer in charge. Another man, who killed himself with a gun in a motel, was waiting until the morning to kill himself so he would not wake guests. He said, “It’s about 3:15 A.M. & I’m trying to wait until 7 A.M. so I don’t wake everybody up. I know how bad I hate to be woken up. I am also very sorry for anything that has to be financially taken care of or anything else. I’m sorry.” One woman mailed a letter to her landlord asking him to come to her apartment but instructed him not to bring his son.
They also expressed their care and concern in other ways. Some note writers (22%) asked survivors to take care of another person or pet, while others (11%) said they would be “watching over” their loved ones. They were using the notes as a means to relieve others of blame. Although absolving or assigning blame may not have been the purpose of the note, for some note writers, who used precious space to add in this information, it was a critical message. It is clear that overall, many note writers were sorry, but they simply had to do this for themselves. As a 29-year-old man with multiple problems, including finances and relationship issues, said, “I am so sorry for being shallow and selfish and cowardly leaving…I know this is the easy way out but it’s the only way I know. I just can’t go through with the everyday struggles both physically and mentally.”
Escape
I’m sorry, I can’t take this mental illness any mor. I love you.
Escape was both a theme in the notes and a motivation for suicide so it will be discussed at length in Chapter 4, Escape as a Motivation for Suicide. Approximately one-fourth of notes (15%) discussed a need to escape unspecified pain. Other notes were more specific and focused on health-related problems, including mental illness (22%), physical illness (14%), medications (10%), or an acquired disability (9%). Foster (2003) also found 10% of note writers discussed physical health and/or symptoms. Not surprisingly, those who mentioned wanting to escape pain were older (50 years old) than those who did not (44 years old), and this difference was more pronounced when it came to physical pain (54 versus 44 years old). The illness or pain was often compounded by concerns about future debilitation.
James was a 50-year-old ex-Army Ranger and former Marine who injured his neck and spinal cord parachuting out of a plane. He had been through several surgeries and was taking numerous pain medications. He was depressed about his decreased mobility and had run out of pain medication. He wrote,
My spinal disorder is worring-as they told me one day it would be to painful to move or get around. I can’t work and Social Security doesn’t pay enoug to live on. Ever day is the same—just looking at a T.V. scene—watching fantasy and make believe—or seeing other people live an active-fun and fulfilling life with family and friends. Even when someone is here I feel alone and out of place…All I ever wanted was close friends and family—it wasn’t meant to be…I can’t—I don’t have it in me to ask for any help….
Those discussing a need to escape psychological pain were approximately the same age as those who did not discuss it. Many had struggled with mental illness for most of their lives and it had become unbearable. Susan, a 25-year-old woman who had struggled with anxiety and depression her whole life, wrote a note to her father and then asphyxiated herself in his garage. She told him,
I just want you to know that I love you and even through all the anger I loved you. I’m sorry I couldn’t fulfill your aspirations for me. I’m sorry I won’t be there for you when you need me as you were there for me…I just lost my way and became too afraid of my own anger, too afraid of always feeling this empty….I’m sorry that I add this burden to your life. I’m sorry I couldn’t be a stronger person. Of course, even in death I have one last favor to ask of you-[to take care of her pet]…
Like James and Susan, some individuals wrote about not wanting to become a burden in their notes (7%). While Susan felt she already had been and continued to be a burden, James did not want to become a burden. However, their concern over being a burden did not seem to be the impetus for their actions, but simply provided additional support for their decision and a confirmation that what they were doing was necessary and right. Foster (2003) also found 7% of note writers discussed being a burden to others while Sanger and Veach (2008) found 25.4% mentioned this concern.
For some individuals, their need to escape came from a combination of problems, such as the onset of depression over a cancer diagnosis. Some notes also described a need to escape an array of problems, which included illnesses, financial concerns or legal entanglement. Some talked about needing to escape their pain but did not specify its source. One woman wrote, “Dear Mom: I love you but my life means nothing to me anymore. It’s not your fault, you were the best mother in the world. But life is full of pain.” Whatever the reason, a large percentage of note writers needed to escape from something.
Instructions
I don’t want a funeral. Just put me in a hole. Cremate me and throw my ashes in a dumpster. Please. I am so sorry I ruined your life. Please find it in your heart somehow to forgive. It’s not your fault.
Instructions are common in notes. Foster (2003) found 36% of notes included instructions. Sanger and Veach (2008) found 69.6% of notes included instructions related to financial affairs (28.3%), final affairs (26.1%), and other issues. Most of our notes provided instructions for survivors (64%), although only a few of the notes (3%) were merely instructions without any other content to the note. Instructions included the disposal of the body (22%) or funeral arrangements. One woman wrote a very bitter obituary and left instructions not to change it in any way. After her name and the date it read, “She leaves behind a living hell to go be with God. I want to thank my family for helping a weak mind and body to get to this point. You took so much and gave so little. I reached out to all of you, where were you?”
Instructions about funerals were sometimes quite detailed, naming speakers, preferred readings, or the music to be played. In a few cases the writer identified specific people that he or she did not want to attend the services. Other notes had instructions regarding the allocation of property (25%) or managing affairs such as bills that needed to be paid (24%). Often these notes included bank account information and the location of particular documents. Occasionally the suicide note included a formal will or a self-written obituary.
Instructions were also left for whoever found the body. These instructions assured law enforcement that this was indeed a suicide and not a result of foul play (7%), or forbade emergency personnel to attempt to resuscitate them (7%). Some also were heartfelt requests such as, “To The Authorities Who Find Me. I beg you—do not embarrass my family (especially my Son) by putting this in the Newspapers.”
For some note writers the purpose of the instructions was simply an effort to put their affairs in order so as to ease the burden of survivors. For others, it appeared to be an attempt to maintain control over things after their deaths; e.g., one woman who was going through a bitter divorce instructed her relatives to try to take custody of her daughter away from her soon-to-be exhusband. She wrote, “Please do everything you can to have her [daughter] live with you.”
Frequently Occurring Content
God and Religion
“I leave this life with some sadness and grief, but on the other hand, I have a great curiosity to know what’s on the other side. And, I have a faith that tells me that it’s a better place and the loved ones who’ve gone before me will be here to greet me and we’ll be together and be happy. In that regard, I’m looking forward to it.”
Approximately one-third of the note writers mentioned faith, religion or God in their notes. References to God were more prevalent than to faith or religion. Most note writers hoped God would forgive them for their actions. Other individuals were angry with the hand that God had dealt them in life. One wrote,
I am so tired of hurting. I know it’s selfish and I said I never would but this whole life sucks. From being abandoned at birth UNWANTED to today. I give up. I never could figure out why God hated me so much-but he wins. I LOSE. I’m not fighting any more. Nothing to fight for. Just more and more PAIN.
Although not angry, one man, who was struggling with reconciling his homosexuality with his religious upbringing, wrote a lengthy note to his sister. In it he explained, “And then there’s the gay thing. Even though I know it’s wrong, I would rather have a relationship with a man who loved me and wanted to spend his life with me than a close walk with Christ. I guess my fate is sealed.”
A subset of the notes were letters addressed to God; e.g., one 27-year-old man who was struggling with the end of a relationship said, “Dear God, I love you so much. But I feel as if I’m all alone. I feel as if I have no one. So I had to take my own life. I want to be with you. Because you are all I have. Your the only one that truly loves me and I want to be near you. Please take me home with you. Please forgive me if I am committing a sin…See you soon!” Although his note ends as one might cheerfully sign a postcard, his sentiments show a deep and genuine desire to connect with God. The possibility of being with God and ending his aloneness was better than facing the prospect of beginning a new relationship.
A few note writers discussed God in an abstract way, often intertwining spirituality and death. One wrote, “As human beings, our highest calling should be knowledge of God. Death is an uninterrupted path to the spiritual platform. Naturally it occurs in a fleeting moment.” However, one note writer expressed the bottom line for many individuals. He said, “For everyone else—only God can judge me now.”
The Afterlife and the Morality of Suicide
“Life is not worth it. I will take my chances on the other side.”
Twenty-nine percent of note writers pondered the afterlife. Among those people, most felt something positive would happen (40%) or were uncertain (33%). A small percentage thought the afterlife would be negative (15%) or neutral (13%) for them. A few were a blend of uncertainty, but hoped for a positive result. One 24-year-old man wrote, “And as much uncertainly as I have about what will happen to me, I really do hope we are all together eventually. I will be waiting to make you smile.”
Those who anticipated a positive future often talked about reunions. In fact, overall 21% of note writers discussed reunions that would happen. Some of these reunions referred to their already deceased relatives (6%): “I’ll tell everyone that we once loved hello.” Others discussed eventual reunions with those who they were leaving behind (10%): “If Mommy is correct, and there is a heaven, I will see you there…Study hard, smile often & I will be looking down, watching over you.”
Their anticipated afterlife was often intertwined with an assessment of their lives and their views on the morality of suicide. Overall, 14% of notes discussed the morality of suicide. Paul, a 52-year-old man who had struggled with depression his whole life, was on the phone with a friend when she heard a bang and his breathing became labored. When police arrived they found a note that said, “Please try not to be too angry with me and please try not to hate my memory. On the whole, I think I was a good and moral person and in spite of the unspeakable cruelty of this act, I honestly don’t think I had a mean, inconsiderate bone in my body.”
Advice
“Be true to yourself-and those you love. Be happy in yourself and show the love to those who are close to you. Life is a very precious thing.”
This advice was written by Roger, a 41-year-old man who was depressed over his financial situation. He was about to file for bankruptcy, because he had gambled away the family savings. His wife was unaware of their financial situation. Roger’s advice was to be happy, when he clearly was not, and he recognized life as a precious thing just before he took his own.
Precipitating Events
“My life sucks. The world sucks. People suck. Today I plan on shooting myself but with my luck the gun will probably missfire life’s a bitch then you die. There are alot of factors that have effected my choice to do this the death of my girlfriend and my best friend. The deciding factor is the people upstairs they have threatened me followed me, kicked in my door and constantly harassed me. I really don’t know why…I’m disabled and I am not able to fight them on my own…But I can have no peace where I live and am not able to move so I guess this is it. Anybody that ever cared about me is dead I have no one to turn to.”
Twenty-two percent of notes mentioned precipitating events that drove the writers to commit suicide. Case after case documented a recent trauma that appeared to lead to the suicide. Usually these were significant events such as the loss of a job, a distressing medical diagnosis, an arrest or impending jail sentence, a financial crisis, or a breakup with a spouse or boyfriend/girlfriend. However, in some cases the precipitating event seemed trivial to the reader or observer. For example, a girlfriend described an argument at a bar with her boyfriend in which she chided him for drinking too much. After they went home, she left with a stated intention of returning after allowing him time to sober up and cool down. When she came back later and found that he had shot himself, it was a great surprise to her since she did not view the argument as having been serious at all.
The pattern of trivial precipitating incidents held especially true for adolescent suicides. For many teens in our sample, seemingly minor setbacks—arguments with parents or friends or punishments at school for rules violations—served as the impetus for suicide. For example, a teenager who received a traffic ticket went home and talked to his mother about his distress over the ticket. After a brief conversation, the boy seemed to calm down but he then went to his room and hanged himself. His mother was completely shocked; she had not recognized the intensity of his feelings about the incident nor how it might have interacted with other problems in his life to cause him to seek such a drastic solution.
More striking were the many people who indicated that there was not a precipitating event or acknowledged that some event was simply the last straw but not the real reason for their decision. The following notes reflect the writers’ self-awareness:
“I hope no one is disappointed in me. I am sure you will all know the story eventually, but everyone remember that this situation was the trigger, not the reason, I killed myself.”
“I decided in Sept. 2007 life was no longer worth living. I liquidated all my assets and decided to end it when they ran out. They ran out.”
“There were recent events that allowed me to reach this state of suicidal depression, but they are not to blame. The rest of my life has been nearly-suicidal depression, just waiting for something to give me a push. I’m taking advantage of the situation while it exists.”
Less Frequently Occurring Content
In addition to the preceding content, we assessed each note for any other issues the note writers deemed were important enough to put in a note, as well as emotions they expressed in the note. In general, the issues they referred to were those which contributed to their life stress and in turn led to the suicide. The most prevalent issue was some form of legal involvement, which may be one of the most underestimated risk factors for suicide.
Callanan and Davis (2009) found approximately 9% of their sample was accused of a crime or wrongdoing and approximately 12% were facing a financial crisis. Similarly, approximately 7% of Cerel et al.’s (2015) sample had a recent criminal problem and 2% had a recent noncriminal legal problem. At least 19% of our sample were entangled in criminal or civil processes, with individuals facing criminal charges ranging from child pornography to rape to sexual assault to robbery. Although at first we were not coding for arrests related to driving under the influence (DUI), we saw so many of them that we went back and began noting these cases. Also, in some cases the individual somehow involved the police in his or her suicide; e.g., a man called the police and indicated he was about to take his life. In most of these calls, no intervention could take place. It was more a notification for the police to come and pick up the body. Some individuals engaged the police in car chases or gunfire in an attempt to commit suicide-by-cop. Other individuals committed suicide in their jail cells while awaiting a hearing. In most of these cases, they did not leave a note. However, it was clear that the cause of the suicide was their legal entanglement. Finally, some legal cases involved civil issues such as custody or divorce. In many of these cases the suicide victim had been embroiled in a bitter custody dispute. In others, he simply could not face the prospect of a divorce. These cases will be examined in greater detail in the chapter on legal issues.
Although infrequent (10%), some note writers discussed work- or school-related problems. Callanan and Davis (2009) also found work issues were only mentioned in 11% of notes. Although certainly cases exist where the main impetus for suicide has been bullying in the workplace or school, for most of our cases these were simply additional stressors and not the main reason for their decision. One woman wrote,
…..It has nothing to do with you. There was nothing you could do. I was so unhappy. There was no happiness anywhere. I was so alone. 45. No husband. No man in sight. No child. No friends to hang-out with, have fun with. No money. House I never could fix up. A house where I was disrespected. A nice car. Great parents. A great niece and Aunt. A job that keeps me stressed…..I’ve made numerous mistakes on the job lately. One that might have civil consequences -----. …I battle sadness, depression and aloneness everyday….I love you both with all my heart. Thank you for being my parents….Forgive me for leaving this yucky house to be cleaned. The truth is I tried but I was too sad to finish cleaning it first….I’ll always love you. I hope I see you on the other side. Love Daughter
It was impossible to determine how frequently job loss contributed to the suicides. Clearly, the origin of the legal involvement was often the loss of a job, which led to financial stress resulting in bankruptcies, foreclosures, evictions, marital distress, and sometimes criminal behavior. Some note writers provided these details but others could only focus on their present angst.
Although infrequent, some note writers discussed the impact of an abusive relationship (5%), discrimination or oppression (5%), a recent death (2%), or body image (2%) on them. However, similar to their jobs and school, these did not appear to be the predominant cause of the suicide but more often represented one of the many stressors in their lives. One woman, who was dealing with health issues from obesity, financial distress, chronic depression, and the loss of her career wrote,
I have been very depressed for many years & this is because my family background is abusive. I experience abuse everyday & most days multiple times/day & multiple types of abuse. My death will end all of the ‘crap’ in my head. It is difficult to live with all of the memories. I have been thinking of suicide daily for several years & with me loosing my house this is the final straw.
Emotions
The predominant emotion expressed in the notes was love, but they also expressed a myriad of other emotions. Given the large percentage of note writers who were depressed, it was not surprisingly to find emotions expressed in the notes that were hallmarks of depression. Common emotions were feeling like a failure (17%), or feeling tired (12%), sad (9%), hopeless (7%), guilty (7%), or ashamed (5%). Foster (2003) found 21% of note writers discussed feeling hopeless or that life was not worth living. When adding those two feelings together, 22% of our sample expressed them. Their failures sometimes related to specific circumstances, or a relationship or endeavor, but more often the feelings of failure reflected assessments of their lives. On the back of the antisuicide contract that he had agreed upon with his therapist, one 22-year-old wrote,
I am a disappointment…I have been a failure in my own eyes my entire life. There is nothing that I excell at. There is nothing where I am the best. I have not ever completed anything of any importance. I am not a good friend. I am selfish. No one ever seems to care about me and if they do it seems self-fulfilling. That is how I treat people so that is how I should be treated in return…Why should I hang around and continue to make myself miserable? I HATE MYSELF. Fuck it I’m out.
Despite the fact that most people are just beginning to launch their lives at 22 years old and have not yet had a chance to excel, this man already felt like a failure.
Perhaps because of this sense of failure, note writers frequently indicated that life was not worth living (15%) or they were ambivalent (7%) or apathetic (2%) about their deaths. “This is not something I want to do, it’s something I have to do. Lord knows I love you girls and I don’t want to leave you, but as it has been pointed out in so many ways, by so many people I’m not good at anything as your father spent almost nine years telling me.” Another person did not discuss her failure but was clearly apathetic about her death. She wrote, “I don’t want to die but I feel dead already.”
A few note writers expressed joy (5%) or relief (3%) and some talked about the peace they would feel after they died. One 41-year-old man was separated from his wife, but when they attended their son’s wedding he asked her to come by to talk the next day. When she did she found his body and a note that read, “I’m sorry but I can’t take it anymore. I don’t want any one to feel sorry for me but I am finally at peace. I love you all.” James, the ex-Army Ranger discussed previously, wrote, “It’s hard to let go of this life—because you can see—hear—taste and feel it all. What is death—I fear it because I don’t know—what lies ahead, at least there will be no more pain—just rest and peace of mind—may I find friends—happiness or something better. I’am afraid-and alone with this feeling of hopelessness.” Similarly, others spoke of feeling free. One 57-year-old woman wrote, “I have finally found a way to finally free myself. I have felt depressed for so long—now it is time to go. I’m sorry for causing you all this inconvenience…God Bless You. You are a fine man. I don’t know how you turned out so good. Must have been prayers.”
Although we only occasionally found a note writer who expressed anger (4%), when we did, the magnitude of the anger was striking. One middle-aged woman who had worked as a nurse hanged herself in the family garage one afternoon. She left this note,
My children are grown & don’t need me. I am not in my grand children lives. I have no friends, I don’t go out, I don’t have a job because you wanted me to leave the job I liked because of insurance. I am in debt up to my ass paying for all your Drs, medicines, lawyers etc. I wish I would have left you years ago…I told you I wish I was dead-I chose the time & place. HAPPY ANNIVERSARY…DO NOT TAKE THIS OUT ON THE KIDS…I guess now you’ll get off your ass, stop drinking & smoking your weed and stop being a loser. GET A JOB. You act like an old man-try living-I wish I had….No services of any kind-Nobody was there while I was alive, I’ll be damned if they need to be there when I’m dead.
Future Studies
Although we created a very detailed list of the content and emotions we thought would be in the notes, some things we did not anticipate. When we encountered these in the cases, we recorded them so we could provide some direction for future research. In general, they related to risk factors and the note writer’s psychological state.
There is no doubt that substance use and abuse are risk factors for suicide. However, gambling was another addiction that was noted frequently and set in motion a chain of events that led to suicide. The pattern was similar to substance abusers—the addiction led to the loss of jobs, family, and control. Although the other personal and legal consequences for these addictions may have varied, the end result was the same. It is important to determine how much of a risk factor gambling is for suicide. Clearly an increased risk of suicidal behavior exists among gamblers (Moghaddam, Yoon, Dickerson, Kim, & Westermeyer, 2015). It is unclear how many suicides involve gambling, however, and how that relates to overall motivational patterns.
Many note writers were concerned that they not be forgotten and pleaded with survivors to keep their memory alive. One person wrote, “I will finally be at peace—please don’t ever forget me—I love you so very much!” A 42-year-old man who was an intravenous heroin user and suffered from chronic pain wrote, “Take care of yourself and these kids. When they get older they will forget me as I’m sure everyone else here will do to. Good luck.” Others were worried about their legacy, or how they would be remembered. Several talked about how they did not want to be remembered for seeming like a coward or as a selfish person because of their actions. Some felt they were, in fact, being cowardly and selfish. One note writer said, “I am so sorry for being shallow and selfish and cowardly leaving…I know this is the easy way out but it’s the only way I know. I just can’t go through with the everyday struggles both physically and mentally.” Another note writer detailed why his actions were not selfish or cowardly. He said,
Mom & Dad please let anyone I know read this if they want. Thank you!
Let me start by saying I’m sorry. I’m sure that doesn’t help but I don’t know what else to say. I know some of you, or all of you are probably going to be mad at me at some point. And I’m sure some people are going to say I was a coward or I’m only thinking about myself. I hope to address these feelings in this letter. Because I’m not a coward or selfish. Some of my friends know I’ve been battling these feelings for a long time. A lot of people don’t know this, but my first suicide attempt was …..but surviving did not destroy the pain in my head. Not a lot of people even know I have this pain because I do not talk about it. Maybe that is part of my problem. But as far as everyone being angry with me about this, I understand. But, #1 I am not a coward. I’ve never been fucking scared of one thing in my life. And #2 I’m not being selfish. Being selfish is what I did to Alice. I cannot live with the pain I have caused her.
We were unable to determine if or how these victims differed from the other victims, since we did not identify these factors until we completed our data collection. As with gambling, it would be interesting to determine how these concerns related to motivation. It is expected that individuals who are concerned with their legacies are more likely motivated by interpersonal reasons for the suicide.
Motivations
No recent attempts have been made at a typology of individuals who commit suicide, and none that is derived from an extensive database comparing both note writers and non-note writers, using both a qualitative and quantitative approach. After we had examined the content of the notes and files, our next step was to develop motivational categories through data-driven analyses. We then compared these to motivational systems in the literature. In the end, we delineated 11 categories and assigned each case to one. For note writers this was based on their note and the file but for non-note writers we had only the file information.
The categories included relationship issues, alienation, failure or inadequacy, guilt, escape, spiritual concerns, revenge, altruism, abuse, oppression or discrimination, and finally, bereavement. Overall, four of the categories received support and two of these categories accounted for more than 90% of the motivations for suicide. They were: Relationship (23%, killing oneself in response to a relational conflict, abandonment, or divorce) and Escape (70%, need to free oneself from psychological or physical pain, financial distress, legal problems, or other adverse life circumstances). Two other categories, Failure/inadequacy (motivations related to low self-esteem, worthlessness, self-pity, hopelessness, or self-hate), and Bereavement (suicide in response to bereavement issues) emerged as the next highest categories. However, bereavement, failure, and other motivations totaled to less than 7% of the cases.
Each of these categories has different patterns associated with the suicide; e.g., the demographics and histories of the individuals are different as are the characteristics of the suicides and the notes. The next chapters are organized around these motivations and how identification of them can lead to more successful prevention and intervention.