Preface

Suicide deaths have increased astronomically since 1999. A 2016 report from the Centers for Disease Control and Prevention examining trends in suicide between 1999 and 2014 found that suicide deaths had increased for everyone in the United States, except African-American men. They increased across age groups and ethnic groups. Most startling to researchers was the increase in suicide among middle-aged white women, a group not usually considered at high risk.

It is difficult to make sense of suicide. Researchers have documented risk factors and theorized about motivations. They have developed increasingly complex taxonomies and typologies for clinicians and organizations that focus on intervention and prevention. When reviewing the literature on suicide, we found that there were some areas of agreement about risk factors, but little agreement about motivation. We were presented with a set of files of over 1200 people whose deaths were designated as suicides by the county coroner. Among those files were suicide notes, and it became our desire to learn what these case files and notes could tell us about what motivated people to kill themselves.

This book describes the findings of our research comparing suicide note writers to the larger group of people who had committed suicide within the same time frame but who had not left suicide notes. A mixed-methods approach involving both qualitative and quantitative data allowed us to delineate categories through data-driven analyses and determine which motivations were substantiated by research. We developed a unique model explaining motivations for suicide using level of chaos in an individual’s life and intent to die as anchors. This book is organized around these motivations and how identification of both risk and resilience factors can lead to more successful prevention and intervention.

Understanding motivation is an essential element of both intervention and prevention. As it turned out, though, once we had analyzed our data, we realized motivation did not tell the whole story. A demographic story existed as well. Overwhelmingly, the people who kill themselves in the United States today are white men. This was true of our sample and is true nationally. It’s also true of European countries and nations in Oceania where the population is predominantly white. We wanted to understand not only what circumstances might have motivated people to kill themselves, but also what other factors—historical, environmental or cultural—might have contributed. We also wanted to know what could be done to simplify identifying people at risk and getting the right help for them. The white men who make up the largest number of suicides are often not attempters, but prevention efforts are largely aimed at those who attempt suicide. We wanted to envision a national agenda for suicide prevention that could bring all who are at risk under a protective umbrella.

Additionally, this book includes a chapter unlike any other publication on the intersection of legal issues and suicide. Through this research a clearer picture of individuals completing suicide can be obtained, thus enhancing identification, understanding, prevention, and intervention.

Our examination of suicide ranges in time from historical material beginning around 1600 to the present day. Laws and taboos concerning suicide as well as medical and therapeutic treatments and the theories underlying current understanding of motivation were reviewed. A total of 1280 cases were analyzed for motivation, mental illness, and other patterns or trends that emerged. We also wanted to turn the question of suicide on its head and examine what we might do to create communities focused on living. Knowing the precipitating events, patterns and motivations can enhance the prevention efforts of anyone who comes into contact with a person who is potentially suicidal. We discuss blue zones, which are areas of longevity, and what those who took their lives said they needed (social support and a reason for living). We then propose a national agenda and some innovative changes that can be made to suicide prevention, as well as a simpler typology for determining whether someone needs an intervention.

This book is organized around these motivations and how identification of them can lead to more successful prevention and intervention. It consists of 10 chapters. Chapter 1, The History and Theories of Suicide, and Chapter 2, Findings, examine the history and theories of suicide and present our overall findings, including characteristics of the notes, circumstances of the suicide and a comparison of suicide note writers and people who committed suicide but did not leave notes. In Chapter 3, Suicide Motivated by Interpersonal Relationships, we provide an in-depth look at suicides motivated by relationship issues, while in Chapter 4, Escape as a Motivation for Suicide, we discuss escape from pain as a motivation for suicide. In Chapter 5, Grief and Failure, we examine less frequent motivations for suicide. In Chapter 6, The Complexity of Suicide Motivation, we present a model for understanding suicide and summarize our findings as they represent multiple and complex motivations. In Chapter 7, Severe Mental Illness, and Chapter 8, The Intersection of Suicide and Legal Issues, we discuss the role of severe mental illness and legal involvement of individuals who committed suicide. Chapter 9, Protective Factors and Resilience, and Chapter 10, Conclusions and Implications, discuss resilience and risk factors with implications for both professionals and family members.

No other volume in the field has taken our exact approach. Many volumes discuss motivation theories, and histories of suicide exist as well. Also, some sociological studies of suicide take place into account. However, this book is unique in that we used a psychological, historical, and social science lens to understand our cases and the broader questions about suicide.

The audience for this book includes students and professionals who work with, or will work with, individuals whose lives could be or have been influenced by suicide. These include psychologists, sociologists, social workers, clergy, law enforcement, policy makers, lawyers, corrections personnel, educators, nurses, and medical professionals. It is also pertinent for other disciplines to understand these patterns. This book could serve as a main text in any course with a focus on suicide. Another audience for this book is individuals whose family and friends have been touched by suicide. We have tried to present our research in keeping with scholarly criteria of objectivity and precision, while making the prose readable and informative. Our insights may help bring both understanding and solace.