A Strange Rush for the Exit

In a world where life appears to be getting better, why are we in the grip of a suicide epidemic?

On the World Health Organisation’s well-appointed website there is a compendious section devoted to suicide statistics. Among the welter of figures, one chart in particular stands out starkly. It is a simple linear graph showing the rate of suicide worldwide over the past 45 years. The line slopes steeply upwards, demonstrating an increase of 60 per cent over the period. The rate of increase has been steady – the line on the chart is almost straight – and the trend shows no sign of abating. Already the numbers are shockingly high and prompt uncomfortable reflections about what lies behind this contemporary death wish. For the mysterious truth is that while suicide – surely some kind of rough index of human despair – has been increasing, the indices regarding most other measures of human welfare have been steadily improving. Around the world, more people are better housed, better fed and live longer, healthier lives. There is more freedom too – many more millions live in democratic or quasi-democratic societies than did 50 years ago and yet more of us are heading, voluntarily, for the exit door. This is a strange paradox and one that presents an awkward challenge to materialism.

Here is a question: which kills more people worldwide – homicide, suicide or warfare? The surprising truth is that suicide is a much greater killer than the other two. There are now more than one million suicides a year (murders, by contrast, account for about 500,000) and some forecasts estimate this will rise to about 1.5 million by 2020. The number of deaths through warfare is – unsurprisingly – the most variable of the three but most years it doesn’t exceed the one million mark. The reality of this suicide epidemic is masked by our own cultural response. Murder and warfare – with all their drama and exciting bloodiness – grab the headlines; suicide, on the other hand, doesn’t make for great TV. We generally prefer to turn our gaze away from the bleak reality of self-murder.

The suicide rate varies significantly country by country and region by region, with some countries seeming to suffer a kind of cultural predisposition to suicide with historically high rates. So, for instance, in the Baltic states the suicide rate at around 40 per 100,000, is the highest in the world (by way of comparison the UK rate in 2005 was 6.7 per 100,000), while Russia and many countries previously part of the Soviet Union also fare badly. Japan has its own deeply embedded culture of suicide, which ensures that the country always features near the top of any list of comparative suicide rates. The suicide rate for men nearly always outstrips that for women but the age distribution varies greatly. In some countries, it is the old who are most at risk, in others the middle-aged.

But all these suicide statistics have to be treated with some circumspection. They are not always reliable and sometimes – as is the case with Africa – do not exist at all. Moreover, there are strong grounds for believing that many countries underestimate the suicide rate. Sometimes this is done deliberately, for transparently political reasons. In 1977, for instance, the German Democratic Republic decided to stop publishing suicide statistics that were becoming an embarrassment for the leadership of the self-proclaimed workers’ paradise. In Catholic countries, because of suicide’s classification as a mortal sin, the strength of the taboo almost certainly leads to suicides being under-recorded.

British suicide statistics are meticulously kept and are probably among the most reliable in the world, but even so they tell only part of the story. Motivated by compassion for families, coroners often strive to avoid a suicide verdict unless the circumstances leave absolutely no room for doubt. In the recent case of Michael Todd, the chief constable of Greater Manchester, who climbed a mountain in Snowdonia, drank a large quantity of alcohol and took sleeping pills, the coroner recorded a narrative verdict. In an apparent copycat death a few months after Mr Todd’s, another policeman, PC Anthony Mulhall, also died on Snowdon after taking sleeping tablets and alcohol. In that case the verdict was death by natural causes.

Having entered all the caveats, though, the suicide statistics remain our only guide to deciphering what is going on here. Statistics may be to truth as paint is to art – which is to say they are raw material requiring creative interpretation – but they must surely be able to tell us something. However, among suicidologists – an ugly construction, but to the point – there is no consensus about the causes of the steadily rising suicide rate.

It was the pioneering French sociologist Emile Durkheim who first gave serious thought to the underlying causes of suicide. In 1897, he published Suicide, one of the seminal works on the subject. By a close analysis of the available statistics, and by his own empirical investigations, he discovered and described rates of suicide among different groups. He found that widowed, single and divorced people were more prone to suicide and that French Protestants were more at risk than French Catholics. He went on to formulate a theory which broadly imagined four categories of suicide: egoistic, altruistic, fatalistic and anomic. Over the succeeding century, the theory was refined and became more sophisticated but Durkheim’s taxonomy of suicide has stood the test of time and still provides a useful guide. His crucial insight that a suicide should be seen not only as a unique, individual tragedy, with factors which are sui generis, but also as the outcome of certain forces – cultural, social, religious – acting on that person, is arguably the greatest contribution he made to furthering our understanding.

Informed by Durkheim’s early attempts to understand the epidemiology of suicide, and by that of many subsequent investigators, the bare statistics can be contextualised in an attempt to make sense of the experience of individual countries. Ireland is an interesting case in point. Until the early 1970s, the number of suicides in the country was very small. The graph bumps along the bottom, barely seeming to register at all. Then, in the ’70s, something significant happens. The rate starts to climb and does so, steadily, over the next 30 years, reaching a peak in 2000 at a level one – third higher than the UK’s and somewhat above the Western European average (it is now the fifth highest in the EU). Those same three decades were, of course, a period of rapid change in Ireland. From being a confessional nation, where religious observance was nearly universal, it turned into a more secular and materialistic society. Plenty of Irish people are still practising Catholics, but secularism has got a grip especially among younger people. Ireland has also become very much more prosperous. The generous Celtic Tiger has distributed largesse – albeit unevenly – around the population.

Dr John Connolly, a consultant psychiatrist who heads the Irish Association of Suicidology, candidly admits he has no satisfactory explanation for the increase but if pressed he cites the decline in religious observance, a creeping materialism and the explosive growth in alcohol consumption. He claims there is a direct correlation between alcohol consumption and the suicide rate. The link between prosperity and suicide has long been noted – it is the better-off who are more at risk. At the Oxford Centre for Suicide Research, Professor Mark Williams makes a more nuanced connection; he believes it is disparities in wealth that matter. Inequality, in his view, is a driver of suicide which is why the rate of suicide has increased so dramatically in Westernising economies like China.

Russia’s experience has something in common with Ireland’s. Until 1990 its suicide rate – though high by Western European standards – was on a gently declining trend. Then came massive upheaval as communism collapsed. Over the next five years the Russian rate shot up, then peaked and stabilised at a rate of nearly 40 suicides per 100,000 – that’s about six times higher than the UK. As in Ireland, the consumption of alcohol has increased markedly over the same period. Also as in Ireland, a hegemonic belief system – communism – was challenged and dethroned. Changing times, it seems, encourage suicide.

In Britain – it can be predicted with some certainty – the suicide rate will rise in the near future because of the recession. Looking at the statistics, the same phenomenon can be observed in previous recessions. But it is striking how stable the British suicide rate has been over the decades. It peaked in the mid 1950s at 10.7 per 100,000 then fell away, reached another peak in 1985 – nine suicides per 100,000 – and has fallen back again reaching a low of 6.7 per 100,000 in 2005. It would be higher were it not for the endeavours of mental health professionals, whose efforts to prevent suicide can claim at least some success. Attempting to save the lives of those in despair is a noble endeavour which perhaps reflects society’s instinctive abhorrence of suicide. The suicide taboo has been recorded across nearly every human society (perhaps because suicide so obviously imperils the future of any society). The literature on the subject is full of picaresque detail. In 18th century Massachusetts, a stake was driven through the heart of the suicide. In medieval France, the corpse of a suicide was dragged through the streets, head down, then hanged on a gallows. In ancient Greece, the hand by which the suicide died was severed from the corpse and disposed of separately. Dante’s Inferno demonstrates the profound Catholic strictures against suicide; he has them condemned to the seventh circle of Hell where their souls are transformed into bleeding trees constantly tormented by harpies. All these examples – and there are many more – speak of the deep upset people feel when the survival instinct, that mainspring of our animal existence, is abrogated.

We instinctively feel that suicide is wrong, and there is no denying the devastation left behind. No suicide dies happy, for suicide is surely borne of despair and despair betokens a lack of hope. Intuition suggests that the death wish is located in this spiritual realm, and a pioneering approach to the treatment of chronic depression called mindfulness-based cognitive therapy (MBCT) gives some weight to the notion.

There is a well established link between depression and suicide – most people who kill themselves are previously depressed – and in Western countries in the past 50 years there has been a huge rise in diagnosed depression. Many depressives suffer repeated attacks; the depression becomes “autonomous” and is triggered increasingly easily. They are also those most at risk of suicide. MBCT was developed by a small group of clinicians who wanted to find a cost-effective approach to prevent depressive relapse. What they have done is to harness Buddhist meditative techniques and apply them to a therapeutic setting.

Professor Williams says that results in trials have been startlingly successful. Up to half of patients have shown marked improvement and this in a notoriously intractable condition. Through simple meditative practice sufferers are encouraged to become more aware of their experience in the present moment; the mindfulness approach makes no attempt to change the content of negative thinking but rather to get the individual to change their relationship to their own thoughts and feelings. In doing so, they can be brought to the realisation that these are merely thoughts and feelings, not some objective “truth”. Patients learn to recognise and resist the downward spiral into despair.

The approach is becoming mainstream; the National Institute for Clinical Excellence now recommends MBCT and there is a network of clinicians in the NHS who have been trained in the technique. The sort of meditation that MBCT harnesses was originally central to a religious tradition that gave its adherents a comprehensive world view. But even when filleted out and put to work in a secular context it seems to be an antidote to modern ills. Professor Williams toys with the notion of a “secular spirituality” but he has also noted that some patients who undergo the therapy subsequently return to religious practice.

This is territory that might yield up clues for the increasing number of suicides worldwide. It does seem to be the case that suicide increases when the beliefs which sustain any particular society suddenly weaken or crumble away entirely. In the case of both Ireland and Russia the suicide rate rose as the fundamental assumptions which determined how these societies were organised came under challenge and were overturned. The same phenomenon can be observed in other countries experiencing rapid change. Perhaps the truth is that there is a need to believe in something (exactly what is not necessarily the point) and that if that faith is undermined some individuals experience a spiritual disorientation that leaves them more prone to suicide. This would hold good as much for the rich man suddenly reduced to penury by a stock market crash as for the cradle communist confronted by the abrupt implosion of his creed. And it might give us pause for thought as we ponder what belief sustains our own society.

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