The undiscovered country: Can suicide be predicted?

“The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom Its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who leap from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’, can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling.”

Suicide is notoriously difficult to predict. That meta-analysis is one example; once you account for base rates in realistic scenarios, you can do very little better than chance.

Some of this might have to do with the nature of predictors; maybe with deep learning and real-time data this might improve slightly, but I doubt it somewhat (there are significant ethical issues involved in such data regardless but that's a different issue).

One of the biggest problems in this area is that suicide is such a low base rate phenomenon that it's difficult to predict for that reason alone. Not only that, but many of the predictors are relatively high base rate by comparison, so there's a very very very low signal to noise ratio. Statistically speaking, it's like finding a needle in a needlestack.

I think adding to the complication is that it's not really that you want to know if someone eventually commits suicide, what you want to know is whether they do so within a certain actionable timeframe. That is, for most of the decisions such predictions are being clamored for, it doesn't really help to know that there's a 70% chance that someone will commit suicide eventually; what practitioners really want to know is "what are the odds someone will commit suicide if I make decision X right now." This is a significantly more difficult thing to study.

I personally believe that the approach to suicide in developed countries is horribly misguided and probably unethical, focused too much on the act and not prevention of the state (psychological, sociological, economic) that leads to it. It's unethical to leave someone in such a personal hell that they want to exit it by killing themselves; preventing themselves from doing so, without removing them from that state, only deprives them of a means of relief.

I personally believe humans derive their own meaning in life. Temporary chemical imbalances and runaway feedback loops of emotional harm can certainly lead to impairment of rational judgement concerning suicide, but that doesn't mean that if you accept the premise that humans derive their own value that there can be rational avenues to suicide.

For situations like accute depression and anxiety (of which I'm intimitely familiar) are situations where I would argue ones judgement is impaired when it comes to suicide, and I don't doubt that said impairment is extrapolable to many other situations.

>A lot of bad things can happen to you in a lifetime, but death is the worst, without a doubt.

I think that comes down to whether you believe that

A) Someone can experience a negative qualia

B) Someone can rationaly predict that said living situation is now a permenant state of affairs with a high enough degree of certainty

C) That death is a negative (negative only insofar as it can effect others) to neutral qualia that is still higher than and therefore preferable to an expected permenant negative qualia.

I'm not of the opinion that this is something that can typically be done independently, as humans are vulnerable to a host of conditions that can impair our ability to make judgement B, and I sure as hell hope that anyone wanting to make that decision trusts the people they ask to help them make it.

The protoypical example people tend to use is alzheimers victims, who are frequently (but not always) permenantly and irrecoverably (for now hopefully) distressed.

They're not dedicated to keeping people alive. They may play a role in keeping some people alive (or not, depending on a lot of factors).

You're imagining purpose for organs and cells which just exist and sometimes function or sometimes don't.

Even if they did have some purpose (which there's no evidence for), does that mean that humans should blindly submit to whatever that purpose is?

Why shouldn't a human be able to make their own decisions instead of giving over decision-making authority to their body?