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If it’s not so easy, why then is it so difficult to do? Why are so few attempts actually fatal (the accepted ratio being one death for every twenty attempts)?
In March 2007, newswires carried the story that, years before, actress Halle Berry attempted suicide over a failed relationship by carbon monoxide poisoning in her car. She could not carry through with the attempt, and later commented, “I promised myself I would never be a coward again.” An irony of Berry’s comments is that she resolved never to be a coward again, meaning she would never attempt suicide again, over-looking the fact that she cowered from the act of attempting suicide itself.
Many do … and it only stands to reason in light of nature’s self-preservation imperative. Consider, for example, comments taken from a clinical case report of a woman who attempted suicide by cutting her arms. She stated, “I know now that slitting my wrists was not as poetic nor as easy as I imagined. Due to blood clotting and fainting, it is actually difficult to die from such wounds. The evening dragged on with me busy reopening the stubborn veins that insisted upon clotting up. I was patient and persistent, and cut away at myself for over an hour. The battle with my body to die was unexpected, and after waging a good fight, I passed out.” Or consider the death of Meriwether Lewis, half of the famous pair of explorers, Lewis and Clark. In his biography of Lewis, Undaunted Courage (note the title), Stephen Ambrose documents that during the night before his death by suicide, Lewis was up pacing – people could hear him as he walked back and forth on the wooden floorboards. This, incidentally, is an important detail. Agitation (a behavioural indicator of which is pacing) is an acute risk factor for suicidal behaviour, a fact to which I will return in several places through the book. After pacing all night, Lewis shot himself twice, with neither wound proving lethal at the time. Servants and others rushed in and found him “busily cutting himself from head to foot” with a razor. Lewis looked up and said, “I am no coward, but I am strong, it is so hard to die.” Lewis, an American hero, died from his injuries a few hours later.
These anecdotes, as different as they are, seem to me to contradict the idea that suicide is an easy escape, the recourse and province of cowards. People as different as Voltaire (“none but a strong man can overcome the most basic instinct of nature”) and the musician Marilyn Manson seemed to understand this contradiction. The latter, in explaining his own suicidal crisis, was quoted in May 2007 as saying, “I was clearly at the point where i was ready to give up, and it wasn’t that I didn’t have the motivation to [die by suicide], it was almost as if I couldn’t bring myself to make a conclusion … Did I want to kill myself? Yes. Did I come close to doing that? More than I’d like to think. The only thing I can say about it is, I feel like maybe I wasn’t strong enough to make that choice.”
Robert Louis Stevenson realised this fact, too, and used it in his fiction. In his novella The Suicide Club, the premise is that there is a secret yet popular London club, the function of which is essentially assisted suicide. The club arranges for the death of its members, making their deaths seem accidental – members, incidentally, who are stalwarts of the community, not cowards. The luck of the draw determines who will die each night. The popularity of the club, according to the story, is that it provides a service that members cannot perform for themselves, because suicide is too fearsome a prospect.
Of course Stevenson was writing fiction, but his premise that suicide is very difficult to do is borne out by numerous nonfiction examples. In the May 2007 issue of Atlantic Monthly, an article on homosexuality in Saudi Arabia describes the ordeal of a young man who came out to his Saudi parents after spending time in the United States. The article says the man’s father “threatened to kill himself, then decided that he couldn’t (because suicide is haram [forbidden]), then contemplated killing [his son] instead.” In this anecdote, killing another, indeed one’s son, is viewed as easier – or at least less forbidden – than killing oneself.
Florida felon John Blackwelder also viewed killing someone else as easier than killing himself. He was serving a life sentence without the possibility of parole for a series of convictions for sex crimes. Blackwelder killed his cellmate, Raymond Wigley, pleaded guilty to first-degree murder, and waived all appeals because, according to the admittedly suspect source of Blackwelder himself, he wanted to die by suicide but could not bring himself to do so. That is, killing someone else (and committing a series of sex crimes) was not beyond him, but suicide was. On May 26, 2004, Blackwelder was executed by the state of Florida for the murder of Raymond Wigley.
The life of Aileen Wuornos, a Daytona Beach prostitute who became a serial killer, illustrates a similar process. As depicted in the film Monster, based on her life, Wuornos, like Blackwelder, proved capable of killing others but claimed she could not kill herself, though she wanted to. She is quoted in the movie as saying, “People always look down their noses at hookers. Never give you a chance, because they think you took the easy way out, when no one could imagine the willpower it took to do what we do.” According to Wuornos (again, a suspect source), her willpower was so strong as to be unimaginable to most – strong enough to bear the violence and humiliation of prostitution, and strong enough to kill others – but not strong enough to kill herself.
There is at least one kernel of truth in the remarks of Wuornos and Blackwelder, and it is that killing is hard to do. This appears to be particularly true when it comes to killing a member of one’s own species, a fact that can be observed across the animal kingdom. As Dave Grossman points out in his book On Killing, within-species fights are often charmingly nonlethal. For instance, rattlesnakes do not use their venom on each other; they wrestle instead. Piranhas do not viciously bite each other, but they have a kind of swordfight with their tails. When humans fight, even with guns, a related phenomenon can occur; soldiers in battle often miss each other at rates that far exceed chance. It’s not that their aim is bad or that their weapons malfunction; they intentionally avoid inflicting injury or death on others. For example, Grossman quotes an eyewitness at the U.S. Civil War battle of Vicksburg in 1863, who said, “It seems strange that a company of men can fire volley after volley at a like number of men at not over a distance of fifteen steps and not cause a single casualty. Yet such was the facts in this case.”
John Krakauer’s 2003 nonfiction book Under the Banner of Heaven describes two brothers initially intent on killing their sister-in-law. One’s aversion to killing kicks in, but the other’s does not. As Krakauer chronicles, the two men believed they had received a direct revelation from God to perpetrate the killing. During the brutal assault, one man asked the other to get something to tie around the woman’s neck. He did so, and then, in the words of the killer, “another fascinating thing took place: as he attempted to put the cord around her neck, some unseen force pushed him away from her. He turned and looked at me and says, “Did you see that?!” I said, “Yes, I did. Apparently this is not for you to do. Give me the cord.” I wrapped it around her neck twice and tied it very tightly” (pp. 188-189). He then killed his sister-in-law and her baby.
The implication within this appalling tale is that the “unseen force” is God. This strikes me as implausible, to put it mildly. The force was the same one that rattlesnakes, piranhas, and soldiers feel: the ancient and ingrained reluctance to kill one’s own. Both brothers intended murder. That one brother was reluctant – the one in fact who received the original “revelation” – and that the other brother proceeded to commit the murders anyway shows both that the prohibition to kill is strong but that it can be overcome.
Even punishing one’s own is hard to do. Bronson Alcott, a nineteenth-century writer and educator associated with Emerson and Thoreau, made his students punish him as a punishment to them. It seemed to work – his students were averse to punishing him. If punishing one’s own is hard, it stands to reason that killing one’s own is more so. A principle of nature is that killing is hard to do, a dictate that is specific to one’s own species. The natural prohibition against killing one’s own kind surely extends to killing one’s own self.
Terrorist leaders know that killing is hard to do, which is they they assign the most technically difficult – and the most lethal – suicide attacks to the hardiest of their recruits. A 2007 study by the National Bureau of Economic Research showed that the most complex operations killing the most people were carried out by individuals who were on average five years older than other bombers and had or were pursuing advanced degrees.
The phenomenon of “hesitation wounds” in those who die by self-inflicted knife wound (often to a central organ like the heart) also illustrates the fearsome quality of killing, in this case taking one’s own life. This fear evidently affects even those who go on to overcome it. Hesitation wounds are essentially minor, nonlethal “practice” cuts that people make in the area of their body that they intend to cut lethally. As medical examiners will attest, those who die by suicide by puncturing their hearts will often have minor knife cuts on their chests – hesitation wounds – whereas those who are murdered with a knife do not (but often do have defensive wound on their hands and arms from trying to ward off the attack). This fact is considered in differentiating cause of death in cases where suicide and homicide are both possibilities. The very name “hesitation wounds” contradicts the idea that suicide is easy in any respect.
The myth that “suicide is easy” was implicated in a case in the news in June 2008. A hedge-fund scam artist, convicted of defrauding investors of $400 million and sentenced to twenty years, disappeared on the day he was supposed to report to prison. His car was found on a bridge, and the phrase “suicide is painless” (the name of the theme song from MASH) was written in the dust on the hood of his car. When this was reported, I had grave doubts about whether this man actually died by jumping from the bridge (or by any other method) – in addition to the fact that he is a convicted fraud, someone intent on suicide knows, through his or her planning and reflection, that suicide is fearsome and daunting. This is why so many shy away from it, and why it is very unlikely that someone resolved to die by suicide would write a phrase like “suicide is painless.” A fraud might, thought. Subsequent reports indicated a very high likelihood that the man faked his death, and in fact the man turned himself in to authorities in early July 2008 (claiming, not particularly convincingly, that he really had attempted to die by suicide, but by overdose).
There are, it should be noted, individuals who have no hesitation at all when it comes to causing their own deaths. An individual like this will have previously become inured to the fear and pain involved in self-injury and death through an array of painful, fear-inducing experiences. In his 1996 book Into the Wild, Jon Krakauer described several examples of people who have faced the harshness of the Alaskan wilderness. One was a man named Gene Rosellini, who lived in the forest using only technology he could make with his hands – no electricity, no central heat, not even an ax or a hatchet. If he needed to cut a log in two, he would do so with a sharp rock, even if it took him days. He lived there for years, even through the severe winters, surviving on berries, roots, and whatever game he could catch or spear. In addition to all of this, he exercised voraciously, at one point running an average of eighteen miles per day, occasionally with a bag of rocks on his back. He eventually decided on a new life goal, specifically walking around the world, but that goal was prevented by his death by suicide at age 49 by self-inflicted knife wound.
Rosellini was a hardened man, hardly the type who conforms to the “suicide is for wards” myth. His choice of self-inflicted knife wound in, I think, important in this regard. This method of suicide is fairly rare, and it is not because sharp objects are rare; rather, it is because it is more fearsome. Those who have died by suicide need to have become fearless about injury and death, else they, like the vast majority, would have backed away from it. Those like Rosellini who engage in particularly fearsome (and thus rare) methods, I would suggest, are especially fearless characters.
Rosellini could be viewed as (among other things) a kind of virtuoso of endurance, given what he put himself through. Among actual sports, the one that many see as the most grueling of all is long-distance cycling, such as is seen in the tour de France. Not only riders routinely experience crashes, but training for such races can be especially painful. Interestingly enough, as can be gleaned from Daniel Coyle’s 2005 book Lance Armstrong’s War, which also discusses cycling in general, there appears to be an association between having won the Tour de France and death by suicide. At a minimum, three of the less than sixty winners have died by suicide, and a fourth winner’s death, ruled accidental, had many signatures of being a suicide instead. Three or four of approximately sixty may not sound like a high rate, but it is far higher than the population rate in the United States, for example, where ten out of every 100,000 people die by suicide. That makes the Tour de France rate several hundred times higher. The high rate of suicide among a group of people that few would call cowards and that mot would view as among the toughest in sports casts considerable doubt on the notion that “suicide is for cowards.”
Are Holocaust victims and survivors cowards? Evidence suggests that the suicide rate in the camps themselves was astronomical, described as “the highest in human history” by one article (Barak, 2007). Rates of suicide attempts and deaths are elevated among survivors as well. This connection between Holocaust experience and suicidal behaviour does not support the “cowardice” view, but it is quite consistent with the view that past experience with injury, pain, and the like creates a familiarity and fearlessness, which, if combined with desire for death, can prove fatal.
The life and death of the poet Hart Crane offers another clear example of an individual who, through years of experience, developed a kind of fearlessness about injury, pain, and death. From approximately age 16 until his death at age 32, Crane attempted suicide at least six times. He also led a life full of physical pain and provocation (e.g., drunken, violent outbursts for which he spent time in jail in three separate countries; frequent anonymous gay sex, which given his temperament and his drinking, likely turned violent from time to time). At least two of Crane’s suicide attempts involved him being physically restrained moments before jumping off a tall structure; Crane thus had had the opportunity to get used to the idea of jumping to his death. He died at age 32 by jumping off a cruise ship into the Atlantic Ocean. Through years of frequent provocative and painful experiences, specifically including trying to jump from high places in Crane’s case, people like him have little hesitation in dying by suicide. In fact, witnesses described Crane as “vaulting” over the rail of the ship with no hesitation whatsoever. A documentary film about the Golden Gate Bridge, described below, shows people jumping to their deaths – some with visible and protracted hesitation, others with none at all.
My view is that those with no hesitation are the most fearless of all, people who have become fearless through either lengthy experience or mental preparation regarding their eventual means of death. Those who hesitate but who nevertheless proceed are somewhat less fearless, but only as compared to the “no hesitation” group, not as compared to everyone else. After all, they too have overcome the potent force of self-preservation. Another, more fearful group includes people whose hesitation is enough to save them.
Tina Zahn, who wrote the book Why I Jumped, is in this latter group. She intended to jump to her death, but was saved, and the evidence indicates that part of what saved her was her fear. Zahn was in the midst of a recurrent, very severe (at times near-catatonic) postpartum depression, during which relatives were caring for her. She bolted away from the relatives and fled in her car; the relatives called the police. The police located her car as she raced toward a bridge. They followed her and clocked her at 120 mph. To this point, she displayed considerable resolve in her desire to die – she broke away from relatives and tried to speed away from authorities.
Two accounts of what happened when she arrived at the bridge are available – one is from Zahn’s book, the other is from the police video. The two sources agree on some major details: Zahn stopped the car at the bridge’s high point, existed the car to the railing, and jumped, but was caught at the last instant and dragged back by a very brave police officer. The video reveals some other details that are not emphasised in Zahn’s book; indeed, it is possible that she is not fully aware of them. As she exited the care – after having arrived at very high speeds – she walked toward the railing, and walked rather slowly at that – no sprinting and vaulting like Hart Crane. Had she sprinted and vaulted, she would have died, as the officer would not have had time to catch her. In fact, despite her walking somewhat slowly, he still would not have had time to catch her, had she not hesitated at the railing for two or three seconds.
What is going on here? Was Zahn threatening suicide without the intention to die? Is her account in the book of a genuine desire to die a lie? I don’t think so. All the evidence suggests that she was desperately depressed and suicidal, with the serious intention to die by suicide. But even all of this is not sufficient for death; what is also needed is an ability to look death in the eye and not shudder. Zahn shuddered as she approached the bridge’s railing. She may not have been aware of her hesitation because the body can automatically take over in such circumstances – and this gave the office time to save her. If suicide were easy, Zahn would be dead now.
Eric Steel’s documentary film The Bridge depicts an incident with some similar qualities. Steel and his crew filed the Golden Gate Bridge every day for a year, using zoom lenses hundreds of yards from the bridge. In doing this, they captured on film several people jumping to their deaths; they also saved many people, as they immediately phoned the California Highway Patrol about anyone who concerned them. One such person was a young woman whom a photographer noticed as she was preparing to jump. The photographer reached over the railing, and, initially with one hand, lifted the woman back over the railing to safety. The photographer did a brave thing, but he did not have superhuman strength; the woman’s fear kicked in, and through her gestures of protest it can be seen she is helping the photographer in her own rescue.
Most everyone shudders when they try to star down death. But there are groups who are practiced at vanquishing life instincts. A 2007 report in the British Medical Journal studied sword swallowers, performers who can, among other feats, do something called “the drop.” This involves placing a sword in one’s mouth, and letting the sword plummet into one’s stomach. The report documents that these performers are remarkably healthy, but their behaviour shows that people can, through practice, do unnatural things – things that nature surely did not intend.
My students and I have studied another such group, one with serious health problems – women who suffer from anorexia nervosa (an eating disorder characterised by self starvation). Mortality is extremely high in anorexic women; they are over fifty times more vulnerable to early death than similar women who do not have the disease. Why are they at such high risk for early death? It is an underappreciated fact that, should an anorexic patient die prematurely, the cause of death is more likely to be suicide than complications arising from compromised nutritional status.
There are at least two possible accounts of the high association between anorexia and suicide. In one view – what we have termed the “fragility hypothesis” – anorexic women die by suicide at high rates because they are unable to survive attempts of relatively low lethality due to the physical fragility caused by self-starvation. Anorexic women also may be “socially fragile” – social isolation is common among anorexic people – and social isolation can make it less likely that one will be rescued following a suicide attempt.
In another view, informed by my theory of suicidal behaviour, anorexic women die by suicide at high rates because their histories of self-starvation habituate them to pain and inure them to fear of death, and they therefore make highly lethal attempts, intending to die. That is, staring down a major life instinct – hunger – has prepared them to stare down life in general.
We pitted these two accounts against each other in a study of 239 women with anorexia, followed over approximately fifteen years. During the follow-up period, the leading cause of death was suicide, consistent with the previously documented fact that early mortality in anorexia is largely due to suicide. Nine of the 239 women in the sample died by suicide. That may not sound like a large proportion, but it is staggeringly high – in a sample of 239 nonanorexic women followed for fifteen years, the expected number of suicides would be zero.
In exploring the methods by which these women died, it was clear that they tended toward extreme violence. To get a sense of this, consider the least violent of the methods used by the nine women who died by suicide: ingestion of 12 oz. of toilet bowl cleaner, along with an unknown amount of a powerful sedative and alcohol (blood alcohol content = 0.16%). The woman bed to death because the hydrochloric acid in the toilet bowl cleaner haemorrhaged her stomach. This disturbing case corroborated the view that anorexic women die not from fragility, but from a kind of unnatural steeliness, a quality derived, at least in part, from their past attempts to grapple with the self-preservation drive in the form of hunger. Had someone desired an “easy way out,” drinking hydrochloric acid seems an unlikely choice.
The view that suicide is very difficult to carry out is borne out not only by the fact that the vast majority of people shy away from it – and this includes actively suicidal people – and not only by cases of those like Hart Crane and some anorexic women who have steeled themselves against death, but also by stories of the extreme lengths that people sometimes go to bring about their own death. In September 2007 in Michigan, to take another example, a man bought the parts for a self-constructed guillotine, built it in the woods, and used it to die by suicide. A police officer who investigated the scene said, “I can’t even tell you how long it must have taken him to construct. This man obviously was very determined to end his life.”
In March 2007 in Atlanta, two men decided to die together by cutting off their arms with a circular saw. One man cut off both the other’s arms, and then one of his own. What makes this gruesome story all the more incredible – and consistent with the extreme difficulty of death by suicide – is that both men survived because their landlord found their suicide note and called police, who arrived in time to save them. A May 2007 incident affirms that not everyone survives such ordeals – a man and his mother were found dead in Los Angeles, both with extreme injuries to their neck from a circular saw, which the man had used to fatally injure both of them.
Numerous examples exist of people who try to die by one method, survive, and then immediately die by another method. It is telling, incidentally, that these examples almost always involve a highly lethal activity followed by yet another highly lethal activity; the resolve to die in these cases is hard to conceive of and flatly contradicts the view that “suicide is an easy way out.” In March 2008 in Iowa, a man killed his family and then attempted to kill himself in the garage by carbon monoxide poisoning. Probably due to ventilation in the garage, he survived. He then attempted to drown himself in a local river, but could not. Finally, he drove his car on the interstate at a very high rate of speed into an abutment, which he did not survive. Several cases have been documented in which an individual self-inflicts a gunshot wound to the head, survives, and then shoots a second, lethal shot – or, as in the case of Meriwether Lewis mentioned earlier, survives multiple gunshots, then dies by other means. In April 2007 in Alaska, a woman drove her car off a high bluff. Amazingly, she survived. As the newspaper report stated. “Police believe the woman then got out of the car and walked several yards across the ice, before throwing herself into the inlet,” where she drowned. A more harrowing case was reported in the American Journal of Forensic Medicine & Pathology in 2005. A man had tried to die by suicide by cutting himself severely. After surviving this, in the words of the article’s authors, “The man tied a rope between a fence and his neck and, while seated on the driver’s seat, accelerated the vehicle, which resulted in complete decapitation.”
This is the stuff of severe mental illness – not to mention of horror – but this is not the stuff of ease and cowardice. One might protest, along with Camus in The Myth of Sisyphus, that suicide is a confession that life’s problems are too much – that the “easy way out” view refers not to the fact that death by suicide is easy, but rather that turning away from life’s problems in this way is easy. Easier than what? Facing them, drinking them away, retiring to one’s bed, fleeing to Mexico? No, death by suicide requires staring the product of million of years of evolution in the face and not blinking; it is tragic, fearsome, agonising, and awful, but it is not easy.