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In a first-person account, “David Kent” writes that during his time on an inpatient psychiatry ward, he noticed that the aides seemed more interested in playing volleyball with each other than in paying attention to him. This upset “Kent” – an aide was supposed to be watching him; he was, after all, on suicide watch status. “Kent” stated, “His game was more important than my life.” To retaliate in anger, “Kent” began to look around the grounds for a garden hose to use to hang himself. Not finding any, he gave up, but then “stumbled on a piece of worn and weathered rope lying in the grass.” “Kent” writes, “Joy! Fear! And the beginnings of a consuming anger that could emerge now that a mode of expressing it had been found. I would show them! I sat … in plain sight … and tied a hangman’s knot in the rope … It was all decided now. No other alternative presented itself nor did I seek one. The only way I could punish them and avenge myself and disturb their holy routine and show them I meant business and escape any punishment they might wish to visit on me and mock and hate and spit on them all – the only way – was to hang myself.”
“Kent” threw the noose over a tree limb and used the rope to abrade his neck so that it was reddened a little. What spurred his impulsive wish to die, it should be emphasised, amounted to revenge (“I would show them!”). This seems to support the view that suicidal behaviour may be mostly about revenge.
But “Kent” did not die, and by his own report, did not intend or make a genuine suicide attempt. This was because he was acting – “Kent” was the cultural anthropologist David K. Reynolds, who had arranged to be admitted to inpatient psychiatry so as to study it, unbeknownst to staff (this is all described in the 1976 book Suicide: Inside and Out by Reynolds and Norman L. Farberow). These kinds of studies have been done before and since, the most well-known instance probably being David Rosenhan’s “On Being Sane in Insane Places.”
The reporting of “Kent’s” experience is, I believe, problematic and even pernicious, because it is written as if it were genuine when it is no such thing (indeed Reynolds claimed, implausible, to have experienced serious depression in his enacting of “Kent”). In the writing, shopworn ideas about suicide influence the script that is made up for “Kent” – the spurned individual vows revenge and “shows others” through suicidal behaviour, impulsive suicidal behaviour no less (another myth confronted elsewhere in this book). A mistaken view of suicidal behaviour is adopted, enacted, and then the fact that it was enacted is taken as evidence for the truth of the view in the first place. This is an unfortunate way to test knowledge claims, and though it arises in many areas of scholarship, it seems to attach itself particularly to claims about suicidal behaviour.
Like many myths and misunderstandings, the view that suicide is an act of aggression or hostility toward others contains a grain of truth (together with much chaff). First the grain of truth: Marked anger and vengefulness can represent a risk factor for suicidal behaviour. In fact, it is included in the American Association of Suicidology’s mnemonic for suicide warning signs – IS PATH WARM?
“I” is for ideation (as in suicidal ideation);
“S” is for substance abuse;
“P” is for purposelessness;
“A” is for anxiety and agitation (including being unable to sleep);
“T” is for “trapped” (as in feeling trapped);
“H” is for hopelessness;
“W” is for withdrawal;
“A” is for anger;
“R” is for recklessness; and
“M” is for mood fluctuations.
So “A” – well, the second “A” – is for anger, and the guidelines supporting mnemonic expand the phrase to “rage, uncontrolled anger, and seeking revenge.” This is indeed a documented risk factor for suicidal behaviour, but it operates like most such risk factors do – the vast majority of those who have the risk do not display the outcome, and many of those who have the outcome do not possess the risk factor. There are a lot of angry people, and very few of them die by suicide; and, of all the people who die by suicide, the majority are not angry.
Why, one might reasonably ask, is it a risk factor, then? Assume, for purposes of illustration, that rage and revenge-seeking characterise 30 percent of those who die by suicide, whereas they characterise 20 percent of others. Given a large enough sample, this represents a significant difference, and thus a risk factor is born.
Also, there are plausible neurobiological reasons to view aggression as a risk factor for suicidal behaviour. One of the most well studied involves 5-hydroxyindoleacetic acid (5-HIAA), which is the major metabolite of serotonin (an important neurochemical involved in the regulation of things like sleep and appetite); that is, when the body breaks down serotonin, one of the main things it breaks it down into is 5-HIAA. Studies have found that low levels of 5-HIAA in the spinal fluid characterise people who have engaged in violent acts like arson and murder, and more to the present point, people who have engaged in suicidal behaviour. Studies here also shown that low levels of 5-HIAA in suicide attempters are predictive of subsequent attempts, a finding that hints at but is not fully demonstrative of a causal role for aggression-related biomarkers in suicidal behaviour.
Here is why aggression is implicated in suicidal behaviour. People who have been through regular experiences of pain and provocation – and this would include episodes of aggression – habituate to the idea of injury in general, including self-injury in particular. It is not, then, that aggressive people die by suicide; rather, it is those who have developed the capability for aggression who are at risk for suicidal behaviour, and only when they have the additional risks of feeling they do not belong and that they burden others. The distinction between aggression per se and the potential for aggression may seem obscure, but it is not – consider NASCAR drivers, NFL football players, some military and police personnel, and even physicians. Few are violent in the sense of committing illegal assaults, but all have a kind of fearlessness about injury – and thus an increased capacity to sustain and tolerate it – due to their professional experience. Physicians are of special interest in this regard, because they have many protections against death by suicide (e.g., access to good health care), and yet they die by suicide at high rates. This may be at least partly due to the fact that they see pain and injury regularly, are thereby inured to it, and thus have the ready capacity to enact their own deaths should they desire to do so. I would make this prediction about any profession that involves a lot of pain and injury: The fearlessness needed to enact suicide is there in these individuals and will result in higher suicide rates unless the risk is offset by lower desire for suicide.
The desire for suicide involves feeling alienated as well as that one is a burden on loved ones. The “suicide is revenge” view makes the mistake of focusing on a secondary motive for suicide and elevating it to a primary position. The idea “I’m going to get revenge” is primary when it comes to harming others. This idea does not lead to suicide, however, unless it is layered over the more fundamental ideas of “I do not belong” and perhaps especially “my death will be worth more than my life to my loved ones.” In suicide, the primary calculation involves burdensomeness and alienation; in some small proportion of suicides, a secondary overlay can involve thoughts like “and this will show all of them, to boot.” But it is crucial to recall that this overlay does not usually occur in suicide, and when it does occur, it nonetheless remains secondary to the bedrock motives of burdensomeness and alienation.
So there is a grain of truth to the myth that suicide is about revenge on others, but this grain of truth has been perverted into the view that suicide is primarily about revenge. It is not, despite the misleading pronouncements of people like Freud – for instance, from his Totem and Taboo, “We find that impulses to suicide in a neurotic turn out regularly to be self-punishments for wishes for someone else’s death” – or Harry Stack Sullivan – for instance, from his Conceptions of Modern Psychiatry, “[Suicide] is merely a question, then, of when a derogatory and hostile attitude, ordinarily directed toward the outer world, is directed with full force toward the self.” These men and others have promulgated the view, trite in my opinion, that suicide amounts to aggression turned inward.
These kinds of pronouncements reverberate still, and their cultural permeation is impressive. Charles Robert Jenkins was a U.S. soldier based in the Demilitarised Zone (DMZ) between South Korea and North Korea in the 1960s. One night, drunk, scared, confused, and cold, he deserted, and walked across the DMZ, which led to his forty-year imprisonment in North Korea. In his 2008 memoir, The Reluctant Communist, Jenkins reported that his experiences spurred deep hate in him, and he attributed his suicide attempt while imprisoned to “hate turned inward.” Jenkins grew up in impoverished circumstances in the rural U.S. South, did not finish high school, and spent forty years in the wasteland that is North Korea, and still, the idea that suicide is aggression turned inward has gotten through to him.
As another example, consider this statement from the 1989 book American Suicide, which describes the treatment of the bodies of those who died by suicide up through the 1800s: “The practice of burying suicides under crossroads under a pile of stones or with stakes through their hearts comes from ancient fears, no doubt based on the unarticulated understanding that suicide is often an act of anger aimed at those left behind” [italics added; I would add too that this practice occurred unless the decedent was a priest, which strikes me as a little hypocritical].
No doubt? To hold “aggression turned inward” as a general principle requires an obvious lack of actual contact with those who go on to die by suicide, as well as with their families. This certainly describes Freud, and to a lesser degree, Sullivan. It also requires a lack of rigour to view “aggression turned inward” as explanatory without satisfactorily addressing why so many people turn aggression outward instead, and why relatively few people with depression turn their aggression inward enough for it to become lethal. Finally, and crucially, it fails to explain why so many people who die by suicide take steps to make their deaths easier on loved ones.
Dante stated, “Omne superfluum Deo et Naturae displiceat” (“Everything superfluous is displeasing to God and Nature”). Although I think he was mistaken about the souls of those who die by suicide contending with thorns and such for eternity, I think Dante is right about parsimony. “Aggression turned inward” is displeasing because, among other reasons, there are simpler and more compelling explanations available.
Consider any crowd of people, such as those who have gathered for a lecture, a sermon, or a sports event. Some proportion of them, by chance alone, will be angry and vengeful sorts. To use this face to describe the entire crowd is an obvious error in reasoning. As we have seen, the crowd of people who die by suicide are somewhat more likely than others to have anger issues – and so of course many of them express this in death. The key point, however, and one that gets lost all too easily in uninformed discourses about suicide, is that most do not. In any given activity, whether it is writing a letter to a newspaper editor or disciplining one’s children, the angry personalities will express their anger. Suicide is no different – angry personalities sometimes express their anger in their choice of place and method of suicide.
In fact, this was the premise for one of Arthur Conan Doyle’s Sherlock Holmes stories, “The Problem of Thor Bridge.” In the story, a woman has died from a gunshot wound to her head; her body is at the foot of a bridge, and no firearm is found at the scene … but one is found in the closet of the woman’s main romantic rival. The rival is arrested for murder, but is later freed after Holmes deduces that the dead woman framed the hated rival by placing a duplicate gun in the rival’s closet and using another, identical gun to shoot herself – a gun to which a stone was tied by a string, with the stone suspended above the water. The woman shot herself, releasing the gun from her hand, which was pulled into the water by the weight of the stone.
In this case, reality mirrors fiction – this same method of suicide was reported in a case study in the American Journal of Forensic Medicine & Pathology in 1998. There are people who arrange their deaths by suicide so as to implicate others in their deaths – aggressive indeed. One wonders if this has ever succeeded – is anyone on death row, or already executed, for someone’s suicide?
Suicides staged as homicides are, to the best of our knowledge, exceedingly rare. A more common though still rare scenario is a situation in which the death is not staged as a homicide but is arranged to express anger or maximise negative impact on those left behind. Lee Whittlesey’s Death in Yellowstone tells of a park employee who was fired from her job. She was later found dead from a self-inflicted gunshot wound in front of the house of the person she blamed for the end of her job. I was told, as another example, of a situation in which a young man was distraught over the dissolution of a relationship with his girlfriend. He went where she lived, entered the picket fence that surrounded the snow-filled front yard, and shot himself in the head. Blood-drenched snow as a painful and indelible image for the girl and her family, who believed, understandably, that this was an act of aggression and revenge.
Of course, cases like this also stand out in newspapers and other media. One case like this will generate considerable media attention; the deaths of another eighty-five individuals, on average, who also died by suicide in the United States on that same day generate little attention. This leaves the public with the idea that these kinds of angry and vengeful suicides are representative, when they are not.
Even those whose choice of suicide method may seem vengeful or mean-spirited may have harboured more benign motives. Consider, for instance, those who have died by self-inflicted gunshot wounds while driving in their cars. Studies in the American Journal of Forensic Medicine & Pathology document at least four such cases, often on interstate highways. It is plausible to view the behaviour of intentionally dying in a moving vehicle at relatively high speed as an aggressive act, given the risk to those in other vehicles. However, in these cases, no other vehicles were involved. These death scenes are often viewed, at least initially, as single-vehicle fatal accidents, and one wonders whether the decedents had imagined that their relatives would find their deaths by accident easier to cope with than their deaths by suicide.
As another example of the difficulty in assigning motives to those who have died by suicide, consider the death of a student at Grinnell College in Iowa. The young man disappeared in September, 2006, and authorities discovered from his computer that he had been researching ways to die by suicide. But they could not locate his body. Six months later, they found him at the bottom of a country club swimming pool that had been covered for the winter. Approximately two weeks after the pool had been covered for the winter, the man had slipped under the pool cover and drowned himself.
Given that he had been researching ways to die, and given the forethought that his method of death entails, one wonders whether he considered the fact that his body would not be discovered any time soon, and perhaps viewed this as a way to forestall and allay relatives’ grief. He was almost certainly mistaken in the view that this would help his family members cope, but it nevertheless could have been on his mind. It is hard to view this young man’s choice of method as involving anger and revenge against others.
Death by suicide invariably involves planning, but it also involves emotional crisis, which interferes with logic and planning. The result is often a train of thought and behaviour that includes serious lapses in logic and judgement, and these lapses can produce pernicious consequences that the suicidal person does not intend. The young man who died in the Iowa swimming pool may have intended to die and to ease the shock of his death by not having his body discovered for months. He was in a suicidal crisis, and so he could not see that this would not help his relatives at all.
Just as there are people who arrange their deaths in ways they mistakenly believe will ease the shock, there are individuals whose death scenes clearly are not meant to b shocking, but are. The write David Foster Wallace died in 2008 by hanging at his home. His wife, the only other person who lived at the residence, discovered him sometimes later. Was this a malicious, vengeful thing that Wallace did to his wife? All of the evidence indicates otherwise. Wallace’s happiest years in a life full of emotional struggle were due to his marriage. Wallace’s suicide, including its method and setting, had nothing to do with his wife; it had to do, rather, with Wallace’s intense major depressive disorder, which had gotten out of control after a change in his medication regimen. One might retort, “If Wallace had been in a different state of mind, he might have been more considerate of his wife.” But of course this misses the essential point – if Wallace had been in a different state of mind, he would not have died in the first place.
There are other cases that are clearer still. In his 1971 The Savage God – an influential literary exploration of suicide – A. Alvarez described the death by suicide of a distinguished scholar as follows: “One afternoon he put all his papers in order, paid every bill to the last cent, wrote farewell letters to all his friends, saying he was sorry, put out food and milk for his cat, packed an overnight case and carefully locked his apartment. Down in the street, he mailed the letters … and then took a taxi downtown. He checked into a scruffy hotel and took a room on an upper floor” (p. 154). He jumped to his death, and did so, incidentally, in the same sprinting and vaulting way as Hart Crane. In this case, the scholar ran across the room and hurled himself through the glass of the unopened window. His actions toward himself were of course aggressive, but his actions toward others had a considerate, not an aggressive, character.
Alvarez described another case that does not fit the view that suicide is aggressive (p. 84). In the 1700s in England, where as elsewhere garish spectacle was the norm for public entertainment, a man offered to die by suicide in public in exchange for money from each spectator for his poverty-stricken family. This anecdote clearly illustrates how some hold the mistaken idea that their deaths will help, not hurt their loved ones, contradicting the notion that suicide is inherently aggressive.
It is common for those who die by suicide to take steps to lessen the impact of their death scenes on loved ones. People will often notify 911 of a death without mentioning that they are referring to their own imminent death. They do this as a way to immediately involve emergency personnel who will serve as a buffer between the death scene and the family. Others leave instructions in notes that are meant to help the survivors, both with regard to the death scene and to more long-term matters like finances and raising children. Some choose remote or anonymous locations of death (e.g., a forest), perhaps with the idea of buffering family from suicide’s immediate aftermath.
I view my dad’s death by suicide in this way. He died by self-inflicted knife wound to the heart early one summer morning, well before sunrise, in the back of his van, which he had parked in the lot of an office park around a mile from his home. Two mornings later, people who worked at the office park understood something was wrong and called police, who discovered my dad’s body. His death was agonising to my family and me, but his choice of method did not strike us as vengeful. To say it was sad that he died alone and in pain in the dark in a parking lot is to massively understate things; to say that his choice of method was aggressive is to massively misunderstand things.
When angry, one is more likely to attribute angry motives to others. For instance, angry people are more likely than others to perceive hostility in pictures of faces, regardless of whether the faces are angry, neutral, or even happy (Knyazev et al., 2008). I think a main contributor to the myth that suicide is fundamentally about anger is the anger of survivors. Survivors of a loved one’s suicide are often very angry themselves (and of course experience other emotions too, especially devastating sadness). Questions like, “How could he have done this to us?” are common and understandable. I certainly wrestled with the question myself in the years following my dad’s death. Angry survivors sometimes attribute anger to the lost loved one’s act, when really the act was motivated by a perception of deep disconnection from others and perhaps especially by the view that one’s death will be a net benefit to others, including loved ones. Suicide is not primarily about anger or revenge; it is sadder than that, in that those who die by suicide have concluded that they are bereft and that their deaths will be a service to others.