Suicide in young people
by Chris Woodford. Last updated: June 28, 2013.
A winter night. In cold and darkness, she steals her way through the woods, her feet tracing the moon-silvered path dully, mechanically, like the wheels of a train. She follows for a mile or more, glancing occasionally at the moon, its sick white face, glimpsed through dark branches, staring full and hopelessly back like one of those kids on a cancer ward. Then, suddenly, a break in the trees, a deep cutting opening its arms to catch her, the trains thumping through... every few seconds... sudden endless carriages rushing through the windy cutting... and she's high on the giddy footbridge. And she's leaning her elbows on the criss-cross rails. And she's watching the carriages rushing, pushing under her feet. And she's wondering if she has the nerve. And she's feeling sick and bleak as the trains keep cutting through. And she stands there for an hour, wobbling between life and death, that night—the night she finally killed herself.
In the forty seconds or so that it took you to read those words...
...someone somewhere in the world has killed themselves. Read them again and someone else will die too. Quietly and hopelessly perhaps, crying themselves to sleep for the final time after punching pill after pill through the foil in the packet. Noisily and angrily, perhaps, jumping off a roof, hurling themselves under a train...
Waiting at London's Waterloo Station one afternoon a few weeks ago, I found myself wondering why the concourse was so packed with people looking angrily at their anxious watches, when a voice came over the station PA: "Due to an 'incident' on the line, all services this afternoon are subject to severe delay and disruption." And, like anyone else who's ever heard the word 'incident' spoken by a train announcer, I thought to myself: suicide. Someone who was alive this morning has become an "incident", a mess to be cleared up, an inconvenience to commuters, a "why-oh-why" story in the local paper.
And I thought to myself: why is suicide so taboo? Why does no-one ever really talk about it? It's like when rabbits die in Watership Down and the others disappear into their burrows without even mentioning it, pretending nothing has even happened. It seemed so bizarre, this conspiracy of silence. And I wondered if it was part of the problem. I wondered if, instead of telling me about the delays to the 15.47 to Portsmouth and the 16.08 to Poole, the announcer could have calmly told me a few facts about suicide instead: "British Rail apologizes for the delay to your journey this afternoon. This is due to suicide being the third biggest killer in the world today. It kills more than twice as many people as HIV/AIDS. And it kills more people than war, heart disease, strokes... and a whole variety of other global grim reapers. 160,000 people attempt suicide every year in England and Wales alone. Nearly 7000 of them succeed—roughly twice as many people as die in road accidents. Fifty years ago, suicide was mainly the preserve of elderly men; not only has there been a massive (60 per cent) increase in suicides since then, but the age position has reversed completely. Suicide now hits the youngest hardest. It's the most common cause of death for men under 35. In the United States, suicide rates in children aged 10-14 more than doubled in the period 1980-1992. One recent US study found that 10 per cent of college students had seriously considered suicide, while 7 per cent had gone so far as to draw up a suicide plan. In Britain, young males account for 80 per cent of all suicides, and while young females are much less likely to commit suicide, 4,000 'self-harm' every year—that's three an hour. Anyway, thank you for listening. We apologize for the delay to your journey and any inconvenience this may cause."
I try to get my head round those numbers: 80 per cent of suicides in Britain are young men. Or boys. There's a killer in our midst, stalking the youngest and most vulnerable. A new black death. I think of Wilfred Owen's Anthem for Doomed Youth: "What passing bells for these who die as cattle?" I try to picture several thousand dead young men piled high in a field somewhere like foot and mouth carcasses. I try to imagine the tabloid outrage if Britain's 7000 annual suicides all happened on the same day—the death toll twice as high as that on September 11th. I find myself growing angry; I wonder how the station announcer stays so calm.
Table: Suicide kills a disproportionate number of young people. This table shows the ten leading causes of death for different age ranges from <1 (left) to >65 (right) in the United States for the year 2009. Suicide is shown by green squares. For ages 10–14 and 15–24, suicide is the third most common cause of death. For ages 25–34, it becomes the second most common cause. From 35–54, it's fourth most common. The blue squares represent unintentional injury; the red squares show death by homicide. Table from Wisqars: Ten Leading Causes of Death and Injury, US Centers for Disease Control and Prevention.
Why can't society discuss and address the epidemic of suicide in young people?
Trying to understand why so many young people commit suicide is hard. But then trying to understand why anyone commits suicide isn't easy. There are a whole variety of reasons why people end their lives prematurely and often very violently. Certain people are much more likely to kill themselves than others; doctors, dentists vets, and farmers—with ready access to the tools of "self-murder"—top the list. Not surprisingly, mental illness is the most significant factor of all: many people who commit suicide suffer from an untreated illness, perhaps a mood disorder such as depression or bipolar disorder (the illness formerly known as manic depression, a roller-coaster ride of epic highs and crushing lows) or an eating disorder such as anorexia or bulimia. Brain biology plays a major role in mood disorders: cursed with badly wired brains, some people need chemical help to sort themselves out. "Negative life events" as the psychologists call them (things like lost jobs, bereavements, and the end of relationships) play a key role too; psychotherapy proves especially effective there. Together, medication and psychotherapy make a great team. Mental illnesses are often as treatable as physical problems like gallstones or broken bones.
But most people with broken bones don't die. Thousands of young men are not dying of broken bones every year. So what makes mental illnesses and suicide so different?
If the media are to be believed, there's always been something distinctly hip about dying before your time. And I don't just mean Kurt Cobain. Take a trip to the Tate and study the romantic, oil-painted portrayals of Thomas Chatterton, the self-poisoned poet, draped suggestively over a sofa, or Ophelia, Hamlet's unrequited love, floating glassy eyed between the weeds, and you'll see what I mean: romanticizing suicide is nothing new. But it's a long, long way from wallowing in the melancholy of a Tindersticks lyric to being wheeled into A&E with a blanket pulled over your head. If young people committed suicide simply because it was cool, they'd be dying in their millions. Studies have estimated that only five per cent of suicides in young people are copycat deaths. That's five per cent too many, of course, and it shows that insensitive and sensational media coverage can do more harm than good. But it also shows we have to look elsewhere for an explanation.
Photo: Suicide romanticized: Thomas Chatterton, poet and forger, is believed to have committed suicide at the age of just 17. This famous portrait painted by Henry Wallis in 1856 heightened his credibility as a romantic figure. We see nothing of the pain or despair that drove him to take his own life.
If it's not a matter of copycat killing, why are so many young people ending their lives so prematurely? There seem to be a whole raft of things that can make one young person more likely to attempt suicide than another. Alcohol and drug use are thought to play an important role; both affect your ability to reason, both can act as depressants, both can make you less inhibited and more likely to actually kill yourself if you're feeling suicidal in the first place. Young men are ten times more likely to use drugs to relieve stress. And drugs, in particular stimulants like cocaine and speed, can tip the balance in people who are already genetically hard-wired for mental illnesses such as bipolar disorder. But drugs are far from the only reason for the surge in young deaths. Puberty is also happening earlier now, bringing adolescence and depression to a younger age group ill-equipped to cope.
Photo: Alcohol abuse (and a history of alcohol or substance abuse in your family) puts you at greater risk from suicide. Alcohol abuse is also strongly connected with violence, itself one of the leading causes of death among young people. According to the World Health Organization: "Harmful drinking among young people is an increasing concern in many countries."
No man—or woman—is an island. And people don't always commit suicide purely because of the things going on inside their heads. Ever since French sociologist Emile Durkheim wrote his groundbreaking book Suicide in 1897, psychiatrists and psychologists have recognized the importance of wider social factors, both in causing suicide and in helping to prevent it. It comes as no surprise that high suicide rates often go hand-in-hand with high unemployment rates, for example. And young people from broken homes or families in which there's a high level of stress (due to parental unemployment, mental illness, or alcohol abuse, for example) are also more likely to attempt suicide, as are young people who have suffered physical or sexual abuse. Those at particular risk include young gay and bisexual men (estimated to be two to six times more likely to commit suicide than straight men) and people in prison or young offenders' institutions. Sometimes social factors can have a surprising effect. For example, suicides went up by nearly 20 per cent in the month following Princess Diana's funeral, while episodes of self-harm increased by 44 per cent. Equally, though, social factors can protect against suicide. People strongly integrated into social groups, such as devout church-goers, are much less likely to kill themselves.
So why do more young men kill themselves than young women? Again, the picture is complex. In the United States, women are two to three times more likely to attempt suicide than men, but men are four times more likely to actually kill themselves. The reason is partly due to the different types of mental illness that women and men typically suffer from and partly because men choose more violent methods of suicide that are more likely to succeed. Another crucial problem identified by researchers is that men and boys—because of social pressures to be "strong", "macho" or whatever—seem to find it much harder to ask for help when they're having a bad time.
Chart: Men tend to pick more violent suicide methods than women, which is one reason why more men kill themselves: violent suicide attempts are more likely to be successful. Data from US Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, quoted in NIMH: Suicide in the U.S.: Statistics and Prevention.
So what do we do about all this?
According to The Samaritans (a British charity that provides a sympathetic ear at the end of the phone to anyone who needs it): "There are no quick and easy solutions to the complex problems of suicide in our society today. Perhaps a starting point is to consider our response to the emotional distress that we see in the people around us." Our response means all of us. It means the World Health Organization, who have declared that it's essential for the world "to break the taboo surrounding suicide"—a major global problem that is currently slaughtering far more people than war and AIDS. It means governments providing health care that kids and young people can actually relate to; the UK government set itself the target of reducing suicides by 20 percent by 2010 and, to its credit, has come up with a comprehensive strategy for suicide prevention. It means bridging the gap between the health care that's available and the people who need it (a 1999 study by the Mental Health Foundation in London found that half the people surveyed had no idea who to contact if someone they knew needed psychiatric help). And it means us too—you and me.
Because ending the taboo of suicide means not mumbling apologetically about "incidents" or going quiet or changing the subject, but talking openly about mental illness as easily and comfortably as we talk about the common cold. A third of us will suffer from some sort of mental illness at some point in our lives. That means us, our friends, and our families. Most of us will go on to lead normal lives, because in most cases mental illness is no big deal: it is as normal, common and treatable as physical illness provided people get the help and support they need, when they need it.
I come back to the question that's been haunting me since I started working on this article: why are so many young people killing themselves? Not because "suicide is painless", as the Manics once sang—how painless is it having your stomach pumped in A&E because you screwed up an overdose?—but because for some people, sometimes, life becomes acutely and unbearably painful. Not because killing themselves was a quick and easy solution to a simple problem, but because, in most cases, they had a history of personal or family problems and untreated depression or another mental illness. People kill themselves because, at the moment when they decide to take their own life, they can see no alternative. They may or may not be ill, but they're not in their right mind either. And no-one sees it and no-one helps them in time. No-one asks them the right questions, so no-one gives them the right answers.
On average, in England, one person dies from suicide every hour. Maybe one of your friends, maybe one of mine. Maybe there's not much you or I can do to stop people dying of TB (the world's biggest killer). Maybe we can't stop people killing one another in wars. But where suicide—the black death—is concerned we can all make a difference, just by being there.
Photo: Listening: Humans naturally feel empathy with one another, presumably because there are evolutionary benefits to the species as a whole when we understand and help one another out. Most of us might consider ourselves good or reasonable listeners but, when it comes to preventing suicide, it helps to be more proactive: be prepared to ask questions at the right time, don't just sit back and wait with open ears.