The undiscovered country: Can suicide be predicted?

“All 29 people who survived their suicide attempts off San Francisco’s Golden Gate Bridge have said they regretted their decision as soon as they jumped.”

https://ennyman.medium.com/a-lesson-from-29-golden-gate-suic...

Sure most suicide attempts aren’t done this way but I think statistics like this showcase how many suicides are irrational on some level. If it was rational then you’d think they wouldn’t immediately regret it (unless the regret is irrational I guess).

Some people are just generally unhappy. They have been for decades. At that point why would they want to continue? After 30 years of unhappiness one day they'll wake up happy?

Perhaps their regret is a significant contributor to their survival though.

Rationality seems like an irrelevant term here. Desire for suicide is obviously subjective and has no objective answer. I doubt spur of the moment suicides are very common, although the 'an hero' kid and the one that misunderstood their robinhood debt come to mind. Most suicide is going to be premeditated to a large degree. How certain do the specifics need to be for it to be considered rational? I think that's grey. A lot of people point to studies showing people who survive suicide attempts often say it was a mistake, but these strike me as having an enormous survivor bias embedded in them (not on the initial attempt, but on additional more successful attempts subsequently). So long as an act isn't based on strictly false premises or mind altering substances, I'm inclined to say most are "rational" if such a term can be applied.

I've never been suicidal, but I've always felt that strong anti-suicide advocates, while strongly well intentioned, might not be fully reasoning out their belief systems. I think I'd greatly prefer to go out on my own terms in old age, without need for qualifiers like pain or disability.

Recognizing the time for your conclusion is a tropey act for old characters in fiction, and implies deep wisdom. But in real life we assume anyone feeling similar has lost their mind.

I like the article for the most part. I've noticed many comments here are lacking the empathy that is so fundamentally needed in this world to help those who suffer alleviate the pain, so as a fellow struggling one I figured I could throw my words to the wind.

People more readily mentally visualize somebody without a leg, somebody with open fractures. Not so much for mind stuff, it's not concrete enough to most until it turns physical (i.e. you're a bloodstain on the floor). That's why some comments go along the lines of "I can understand suicide for physical pain but not for mental one". I would suggest that a broken self hurts more than an open fracture, and lacking certain central abilities to stabilize the self leaves you much more legless than if you lost your physical legs.

Other comments point out the endless rational vs irrational discussion. I'd ask them: when you go get a drink at a café and you're about to order a cappuccino but you ask for a latte, how do you see the whole process? You've planned something rationally (going to get that cappuccino) and made a seemingly irrational choice at the end (getting the latte). Are you rational or not?

Furthermore, by what lens do you judge when the absence of rational decision is an illness? Typically people will reply either with a utilitarian point of view or a selfish one: either you are being counter-productive to society with your guts and bloods that need to be cleaned and the lack of your presence in the consumerist world, or I take it all backwards and call you ill first because that's what agrees with my worldview ("you're sick, you can't know what's good for you").

What I have done with myself and others is to acknowledge that those bits of perhaps-irrationality are not relevant to helping things, as we all have them in different places as we live and that's okay. It's also important to acknowledge that one can be right to feel like they're backed into a corner when a lot of evidence accrues towards that. BUT, the essential part is to show methodically that (1) there are levers of action that we are steering clear of due to cognitive distortions or lack of awareness, and (2) all suicidal people are fighting to be alive much more than even they might know, as they're still around even when making aimless steps due to the crushing pain. In short, tap into what wants to live to push back against what wants to die, and show that the realm of what is possible to advance is much larger than one might think when in the fog.

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With that said, I have my own take on parts of the article itself.

> A reader of a late-nineteenth-century edition of Chambers’s Encyclopaedia would find committing suicide described as a “heinous crime,” for which the punishments included “an ignominious burial in the highway, with a stake driven through the body.” Today the National Institute of Mental Health cautions against saying that a person “committed” suicide at all; better to say that they “completed” it, to avoid the implication of an illicit or criminal act.

As if suicide wasn't still considered a vile and illegal thing. You can share your mental health struggles with a therapist just fine until you're a risk to yourself and they call people to, forcibly if needed, remove you and take you wherever they want. Your rights can be severely limited or removed entirely when a psychiatric emergency is considered - how is that any different from being treated like a criminal? Psychiatric intake can pragmatically be worse than prison intake, from someone who's seen both.

It's not seen as vile by everybody but there are still far too many people who frame the process with words of abandonment, with selfishness, with dismissal of all the inner work of the suffering through the singular use of irrationality as an absolute concept ("you're just irrational"), and so on. You're not considered as an equal to your peers when you're suicidal, and that's not something you get to argue against because that's just part of how you're defined by them. See the following paragraph for something related.

> When patients told Freud that their lives were hopeless or without purpose, he considered this an impressive display of self-awareness. “We can only wonder,” he wrote, “why a man must become ill before he can discover truth of this kind.”

That's Freud we're talking about so whatever.. but that train of thought still seems to exist quite a bit nowadays. The introspection and the ability to shatter illusions is put in the same box as the delusions that a "sick" person has, leading a lot of people with severe depression and other disorders to associate one with the other since society does it too. "My ability to dig deeper is part of why I am sick" is entirely the wrong message to send to a vulnerable person, and it is just incorrect. For it is not the power to see beyond the surface that is a problem, but the delusions one might hold or acquire about the process. CBT points it out with the terms of cognitive distortions, which is a start. It doesn't necessarily offer a wholly coherent narrative for the emergence of those distortions, nor does it offer a strong logical argument to disprove the utility of those distortions (i.e. somebody in pain could say "so what if I see everything in black and white? this is how I've managed to survive so far, so you better prove to me that what you're offering would help me survive better").

> (about Shneidman) “I am against suicide committed by other people,” he wrote, “but I want to reserve that option for myself.”

This holds meaning that most healthy people might not realize. People who commit suicide go to the last place where there is a semblance of effective control and ability to choose an option, have some agency, in a world that (objectively sometimes but not most of the time) presents no other option. Healthy people have the comfort of a grip on their existence, or at the very least the comfort of an illusion of a grip on it. Despite having their own beliefs and instabilities, they aren't mandatorily taught CBT and other such similar things - whereas it is expected of the "sick" to do more of the homework. It's like breaking your legs on a hike and then being asked to do leg workouts to keep up, when other people happen to be luckier and go without both things and wouldn't themselves be able to do the workout.

But this is a necessary thing for a person with mental illness to do nonetheless, and I'm not debating that point. What I am trying to point at however is that the world of people who are unaware of such struggles is filled with a violent hypocrisy that contributes to the reasons for very lacking mental health services and very lacking social support from peers, as it drives the ones who suffer away from everybody else. It would do well for any healthy person to acknowledge that they, too, could be cornered into helplessness if their need for control (or the illusion of it) shattered. That brings them closer to the person considered ill, and thus narrows the gap for bridges to be built - showing both kinds of people that there is a passage between the states. That's an application of empathy that would strengthen the vulnerable at no other cost. But the healthy too can have cognitive distortions and might actually fear that it weakens them.

This sort of disconnect between those who study the subject matter and those who experience is it nothing new, so it's funny to see that it surprises people who've worked on the subject for a while (as the article highlights about Brent and Shneidman)

> “One of the problems with suicide,” he said after a time, “is that the person who killed themselves takes a lot of the answers with them.”

And the people who failed are not being asked much of anything, but instead being told what to do. You'll be diagnosed this, given those meds, told to apply this and that method. Any question about mind and life are only there in order to give you a method, not to understand. Something diametrically opposed to the mind of the suffering in the first place, which seeks understanding of self and answers so much that it spirals and loses track of healthy methods to do so. Funnily enough, I think both sides are going at it kinda wrong, and we can do much better by weaving both approaches together and treading the middle line. Sometimes you need a practical tool, and sometimes you need to understand for the sake of understanding. Be both to yourself, be both to others.