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The intractable puzzle of suicide

The recent suicides of designer Kate Spade, 56, and chef Anthony Bourdain, 61, drew celebrity attention to a phenomenon that, while part of the human experience, can seem not only complex but incomprehensible.

To live life, to define each day as a gift is aspirational, of course, for we know that our days are by definition imperfect, some characterized by a welcoming contentment while others requiring a teeth-grinding effort. On occasion we pause and take notice of a soft early morning rain, the smell of newly mowed grass, the sound of a child’s voice, while accepting, however reluctantly, that the geography of our existence can be relentlessly unfair.

Embedded in the above description is the question: How is it possible that there are those among us — those who are not confronting the exigencies of either terminal illness or facing that dark corridor of debilitating old age — commit suicide? And yet we know, however abstractly, that it occurs. There are individuals who, in the fullness of their lives, purposely choose to make what must be an overwhelming decision defined by its isolation. To hear or read about it can be jarring, and we ponder the cause, knowing only that the pain or torment or hopelessness they were experiencing was beyond resolution. Robin Williams comes to mind. How was that possible?

I reflect on the reality that both Spade and Bourdain had children. How is it possible to say goodbye knowing that you leave them behind, their sense of abandonment and loss beyond description?

But consider the following facts, which continue to puzzle:

According to the Centers for Disease Control and Prevention, suicide has increased 25 percent since 1999 among people 10 or older, including all ethnicities. This has occurred despite access to new forms of treatment, such as therapy and medication. In 2016 some 45,000 people killed themselves, twice the number of homicides for that year.

More men than women take their lives, and one variable in the mix is the availability of guns. Men are far less likely to seek help than women. Plus there is the unexpected element of impulsivity.

It is uncommon for individuals to openly share suicide ideation or that they have been contemplating a plan. Nor do they demonstrate symptoms that are recognizable. And yet it is known that the rise in suicide coincides with an increase in depression and anxiety. The number of people who have open-ended prescriptions for either or both is at an historic high, and more than 15 million Americans have taken medication for treatment for five years or more, a rate that has tripled since 2000. Plus, it is likely that unsuccessful life-ending attempts are vastly underreported.

And so, we as a society are confronted with a paradox: While we acknowledge efficacious treatments are available, suicide continues to trend upward. Harvard professor of psychology Matthew Nock was quoted in the New York Times saying that the wide majority of people who die by suicide “explicitly deny suicidal thoughts or intentions in their last communications before dying.”

Benedict Carey, writing in the Times, reported that “the rise of suicide turns a dark mirror on modern American society: its racing, fractured culture; its flimsy mental health system; and the desperation so many individual souls, hidden behind the waves of smiling social-media photos and cute emoticons.”

While Carey explicitly creates a linkage between our cultural fragmentation and the increasing rate of suicide, it is seemingly impossible to drill down and find definitive causation. Perhaps life, as experienced by Spade and Bourdain, and tens of thousands of other anonymous Americans who stand briefly in that darkest of places and decide that life is no longer worth living, cannot ever be fully understood.

And so we are left with that silent individual clinging to the wrong side of the guardrail — contemplating what, we can only imagine — and then stepping forward and falling from one abyss into the next. For those who remain behind, the act can seem a bridge too far.

Chris Honoré is a Daily Tidings columnist.

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