WhyPeopleDieBy

Suicide
ThomasJoiner,Ph.D.
DistinguishedResearchProfessor&
TheBright
TheBrightBurtonProfessor
DepartmentofPsychology
FloridaStateUniversity
joiner@psy.fsu.edu
joiner@psy.fsu.edu

OnFebruary1,
2003,the
spaceshuttle
Columbia
disintegrated
asitflewover
asitflewover
thewestern
United
States

finally
showering
downover
EastTexas
andLouisiana
andLouisiana
inthousands
ofpieces,
killingall
sevencrew
members.

Thecausewasa
dense,dry,
brownishorange
pieceoffoam
weighingabout1.7
pounds,19inches
longand11inches
wide.Thefoamhit
Columbiasleft
wingtraveling545
mph,causingwhat
investigatorsnow
knowwasa
significantbreachin
significantbreachin
thewing.

Oneofthemembersofthepanel
investigatingtheaccidentsaidThe
excitementthatonlyexistswhenthere
isdangerwaskindofgone
isdangerwaskindofgoneeven
thoughthedangerwasnotgone.Key
NASAadministratorsdecidedagainst
gettinginflightsatelliteimagesofthe
flightsatelliteimagesofthe
leftwing,inpartbecausetheirsense
ofdangeraboutfoamstrikeshas
erodedovertheyears,
erodedovertheyears,duetorepeated
experiencewiththem
experiencewiththem.

RelevancetoSuicide
Akeypointofmytheoryisthatwhenpeople
getusedtodangerousbehavior
getusedtodangerousbehaviorwhenthey
losetheexcitementthatonlyexistswhen
thereisdangerinthewordsoftheaccident
investigatorthegroundworkfor
thegroundworkfor
catastropheislaiddown.JustasNASA
administratorsbecameinuredtoaveryreal
danger,tothepointofnolongereven
worryingaboutfoamstrikes,sotoo,Iwill
argue,dopotentiallysuicidalpeoplelose
thedangersignalsandalarmbellsthat
shouldaccompanyself
shouldaccompanyselfinjury.

TheAcquiredAbilityforSuicide
Whenselfinjuryandotherdangerous
injuryandotherdangerous
experiencesbecomeunthreatening
andmundane
whenpeopleworkup
totheactofdeathbysuicidebygetting
usedtoitsthreatanddanger
usedtoitsthreatanddangerthatis
whenwemightlosethem.Thatis
whentheyhavedeveloped
whentheyhavedevelopedthe
acquiredabilitytoenactlethalself
acquiredabilitytoenactlethalself
injury.

AGoodTheory
AGoodTheory
Popper:Internallycoherent

followslawsoflogic
incrementalsurvivorof
survivorof
deductivetests
deductivetests.
Parsimony:OccamsrazorDante:
OmnesuperfluumDeoetNaturae
displiceat(Everythingsuperfluous
(Everythingsuperfluous
isdispleasingtoGodandNature).
isdispleasingtoGodandNature).

AGoodTheory
AGoodTheory

Also,explainsthe
heretofore
unexplained.
unexplained.

Why.?
.dofemalephysiciansand

prostituteshavehighratesofsuicide?
prostituteshavehighratesofsuicide?
.dosuicideratesdecreaseintimes
.dosuicideratesdecreaseintimes
ofnationalcrisisandincreasewhena
cityssportsteamdashesexpectations?
cityssportsteamdashesexpectations?
.havesocietiesacrosshistoryand
acrossculturesanctionedritual
acrossculturesanctionedritual
suicide?

How.?
.tounderstandmasssuicidesin
.tounderstandmasssuicidesin

cults?

How.?

.tounderstandsuicide
.tounderstandsuicide

terrorism?

TallOrderforaComprehensive
TheoryofSuicide
TheoryofSuicide

Notonlymustthe
theoryilluminatethese
andotherquestions,it
mustalsobecompatible
withthesefacts:
withthesefacts:

Facts
Suiciderateshighestinolder

people
andinmen(exceptinChina)
andinmen(exceptinChina)
andinCaucasianpeopleinthe
andinCaucasianpeopleinthe
U.S.
Suicideisassociatedwithimpulsivity,
yetveryfewdieonawhim.
yetveryfewdieonawhim.
Suicideismoreassociatedwith
anorexiathanwithbulimia.
anorexiathanwithbulimia.

MoreFacts
Deathbysuicideis

relativelyrare
relativelyrare80perday
dieinU.S.,comparedto
1,900perdayfromheart
1,900perdayfromheart
disease.

MoreFacts
Deathbysuicideiscostly.

$10billionannuallyintheU.S.in
lostwagesalone$350,000per
deathperyear.
Thisdoesnotincludeothercosts:
Lawsuits,insurancesettlements,
investigations,effectsonsurvivors
productivity,etc.
productivity,etc.

SketchoftheTheory
ThoseWho
DesireSuicide

Perceived
Burdensomeness
ThoseWhoAre
CapableofSuicide

Thwarted
Belongingness
Belongingness

SeriousAttemptorDeathbySuicide

TheAcquiredCapabilitytoEnact
LethalSelf
LethalSelfInjury
ItseemsratherabsurdtosaythatCatoslew

himselfthroughweakness.Nonebutastrongman
cansurmountthemostpowerfulinstinctof
nature Voltaire.
Accrueswithrepeatedandescalating
Accrueswithrepeatedandescalating
experiencesinvolvingpainandprovocation,
suchas
Pastsuicidalbehavior,butnotonlythat
Repeatedinjuries(e.g.,childhoodphysicalabuse).
Repeatedwitnessingofpain,violence,orinjury(cf.
physicians).
Anyrepeatedexposuretopainandprovocation.
Anyrepeatedexposuretopainandprovocation.

TheAcquiredCapabilitytoEnact
LethalSelfInjury:Habituation
Injury:Habituation
Habituation:

Response
decrement
dueto
repeated
stimulation.

TheAcquiredCapabilitytoEnact
LethalSelf
LethalSelfInjury
Habituationcanoccurvicariously

(i.e.,throughobservation).
Thefactthatwehavespecific
emotionalreactionstoseeingpain
inflictedonotherpeoplemayresult
fromthesimplesimulationproduced
[inthecingulatecortex].
[inthecingulatecortex].

TheAcquiredCapabilitytoEnact
LethalSelf
LethalSelfInjury
theexperienceofother
peoplespain,ashandledbythe
brainsdedicatedstructures,to
someextentoverlapswiththat
ofonesownpain.
PascalBoyer,2001.
PascalBoyer,2001.

TheAcquiredCapabilitytoEnact
LethalSelf
LethalSelfInjury
Withrepeatedexposure,one

habituatesthetabooand
thetabooand
prohibitedqualityofsuicidal
behaviordiminishes,andsomay
thefearandpainassociatedwith
selfharm.
Relatedly,opponentprocessesmay
Relatedly,opponent
beinvolved.

TheAcquiredCapabilitytoEnact
LethalSelf
LethalSelfInjury
Briefly,opponentprocesstheory

(Solomon,1980)predictsthat,with
repetition,theeffectsofa
provocativestimulusdiminish.
habituationinotherwords.
habituationinotherwords.
BUT.

TheAcquiredCapabilitytoEnact
LethalSelf
LethalSelfInjury
Opponentprocesstheory

alsopredictsthat,with
repetition,theopposite
effect,oropponentprocess,
becomesamplifiedand
strengthened.
strengthened.
Exampleofskydiving.
Exampleofskydiving.

TheAcquiredCapabilitytoEnact
LethalSelf
LethalSelfInjury
Theopponentprocessfor
suicidalpeoplemaybethatthey
becomemorecompetentand
fearless,andmayeven
experienceincreasing
reinforcement,withrepeated
practiceatsuicidalbehavior.
practiceatsuicidalbehavior.

EmpiricalEvidence
EmpiricalEvidence
Lethalityofmethodandseriousnessof

intentincreasewithattempts.
intentincreasewithattempts.
Peoplewhohaveexperiencedorwitnessed
violenceorinjuryhavehigherratesof
suicideprostitutes,self
prostitutes,selfinjectingdrug
abusers,peoplelivinginhigh
abusers,peoplelivinginhighcrimeareas,
physicians.
Thosewithahistoryofsuicideattempthave
higherpaintolerancethanothers.
higherpaintolerancethanothers.

WhyIJumped
WhyIJumpedbyTinaZahn
Inthemidstofarecurrent,verysevere

(attimesnearcatatonic)postpartum
catatonic)postpartum
depression,Zahndecidedtojumpoffa
bridgenearGreenBay,Wisconsin.
bridgenearGreenBay,Wisconsin.
Shefledrelativesinhercar,whocalled
police.Policeclockedherat120mph.
police.Policeclockedherat120mph.
Still,sheisambivalent,somesignsof
whichshowupinthefollowingvideo.
whichshowupinthefollowingvideo.

AnecdotalEvidence:Cobain
AnecdotalEvidence:Cobain
Cobainwastemperamentallyfearful
Cobainwastemperamentallyfearful

afraidofneedles,afraidofheights,
and,crucially,afraidofguns.Through
repeatedexposure,apersoninitially
afraidofneedles,heights,andguns
laterbecameadailyself
laterbecameadailyselfinjectingdrug
user,someonewhoclimbedand
dangledfrom30footscalingduring
concerts,andsomeonewhoenjoyed
concerts,andsomeonewhoenjoyed
shootingguns.

AnecdotalEvidence:Cobain
AnecdotalEvidence:Cobain
Regardingguns,Cobaininitiallyfeltthat

theywerebarbaricandwantednothingto
dowiththemlaterheagreedtogowithhis
friendtoshootgunsbutwouldnotgetout
ofthecaronlaterexcursions,hegotoutof
thecarbutwouldnottouchthegunsandon
stilllatertrips,heagreedtolethisfriend
showhimhowtoaimandfire.Hediedby
selfinflictedgunshotwoundin1994atthe
inflictedgunshotwoundin1994atthe
ageof27.

AnecdotalEvidence:Meriwether
Lewis(ofLewis&Clarkfame)
Lewis(ofLewis&Clarkfame)

FromStephenAmbrosesbiographyof
Lewis,UndauntedCourage
UndauntedCourage:
Lewispacedforseveralhours(agitation),as
Lewispacedforseveralhours(agitation),as
otherscouldhearhimallnightasthefloorboards
creaked.
Twoselfinflictedgunshotwounds,neitherfatal.
inflictedgunshotwounds,neitherfatal.
Servantsfoundhimbusilycuttinghimselffrom
Servantsfoundhimbusilycuttinghimselffrom
headtofoot.
Lewissaidtoservants,Iamnocoward,butIam
Lewissaidtoservants,Iamnocoward,butIam
strong,itissohardtodie.Hediedafewhours
strong,itissohardtodie.Hediedafewhours
later.

SuicideinAnorexiaNervosa
SuicideinAnorexiaNervosa
Mortalityisextremelyhighinanorexic

women(SMR=~60).
women(SMR=~60).
Itisanunderappreciatedfactthat,
appreciatedfactthat,
shouldananorexicpatientdie
prematurely,thecauseofdeathismore
likelytobesuicidethancomplications
arisingfromcompromisednutritional
arisingfromcompromisednutritional
status.

SuicideinAnorexiaNervosa
SuicideinAnorexiaNervosa
Thereareatleasttwopossible

accountsofthehighassociation
betweenANandsuicide.Inoneview,
anorexicwomendiebysuicideathigh
ratesbecausetheyareunableto
surviverelativelylowlethality
attemptsand/ortheymaybelesslikely
toberescuedafteranattemptdueto
theirsociallyisolatedstatus.
theirsociallyisolatedstatus.

SuicideinAnorexiaNervosa
SuicideinAnorexiaNervosa
Inanotherview,informedbymy

theoryofsuicidalbehavior,anorexic
womendiebysuicideathighrates
becausetheirhistoriesofself
becausetheirhistoriesofself
starvationhabituatethemtopainand
inurethemtofearofdeath,andthey
thereforemakehighlethalityattempts
withhighintent
todie.

SuicideinAnorexiaNervosa
SuicideinAnorexiaNervosa
Wepittedthesetwoaccountsagainst

eachother,inastudyof239women
withAN,followedover~15years.
withAN,followedover~15years.
9diedbysuicide,theleadingcauseof
deathamongthesample.
deathamongthesample.
Ofthese9,weretheymostlyhighly
lethalmethodsornot?
lethalmethodsornot?

SuicideinAnorexiaNervosa
SuicideinAnorexiaNervosa
Theleastlethalmethod:Ingestionof12
lethalmethod:Ingestionof12

oz.ofahouseholdcleaningproduct,
alongwithanunknownamountofa
powerfulsedativeandalcohol(BAC=
0.16%).Causeofdeathwasgastric
hemorrhagingduetohydrochloricacid
inthecleaningproduct.
MightBitrixhavepreventedthis?
MightBitrixhavepreventedthis?

EDPB

NonEDPB

.73**

Numberof
Attempts

.46**

Provocative
Behaviors

.66**

Lethality
.78**

.98**

.73**

ANRversus
ANBP

.20* (.40*)

Extreme
Suicidal
Behavior

.98**

Intent

.90**

Premeditation
.33**

Violent
Attempt

ThoseWho
DesireSuicide

Perceived
Burdensomeness
ThoseWhoAre
CapableofSuicide

Thwarted
Belongingness
Belongingness

SeriousAttemptorDeathbySuicide

ConstituentsoftheDesirefor
Death
PerceivedBurdensomeness
PerceivedBurdensomeness
ThwartedBelongingness
ThwartedBelongingness

PerceivedBurdensomeness
PerceivedBurdensomeness

Essentialcalculation:

Mydeathisworthmore
thanmylifetomyloved
ones/family/society.
ones/family/society.

PerceivedBurdensomeness:
EmpiricalEvidence
EmpiricalEvidence
Fivestudiestodatehavedirectly

testedthisviewallsupportit.
Forexample,wetrainedraterstoevaluateactual
trainedraterstoevaluateactual
suicidenotesregardingthefollowingdimensions:
perceivedburdensomenesshopelessnessand
generalizedemotionalpain.Unknowntotheraters,
halfofthenoteswerefrompeoplewhodiedby
suicide,andhalfwerefrompeoplewhoattempted
suicideandsurvived.Thenotesfromthosewhodied
bysuicidecontainedmoreperceivedburdensomeness
thannotesfromattemptersnoeffectswerefound
regardinghopelessnessandemotionalpain.
Joineretal.(2002).Perceivedburdensomenessandsuicidality:Two
studiesonthesuicidenotesofthoseattemptingandthosecompleting
suicide. JournalofSocial&ClinicalPsychology,21,531545
JournalofSocial&ClinicalPsychology

PerceivedBurdensomeness:Self
PerceivedBurdensomeness:Self
SacrificeAcrossSpecies
SacrificeAcrossSpecies
Fireants.
Peaaphids.
Lions.
Spiders
.evenapalmtree.
.evenapalmtree.

StrengtheningBelongingness
StrengtheningBelongingness
NewCDCvision:Promoteconnectedness
Thedegreetowhichapersonorgroupis
Thedegreetowhichapersonorgroupis
sociallyclose,interrelated,orsharesresources
withotherpersonsorgroups
Betweenindividuals
Betweenindividuals/familiesandcommunity
organizations
Amongcommunityorganizationsandsocial
Amongcommunityorganizationsandsocial
institutions

ThoseWho
DesireSuicide

Perceived
Burdensomeness
ThoseWhoAre
CapableofSuicide

Thwarted
Belongingness
Belongingness

SeriousAttemptorDeathbySuicide

ConstituentsoftheDesirefor
Death
PerceivedBurdensomeness
PerceivedBurdensomeness
ThwartedBelongingness
ThwartedBelongingness

ThwartedBelongingness:
EmpiricalEvidence
EmpiricalEvidence
HoyerandLund(1993)studiednearly

amillionwomeninNorwayoverthe
courseofa15yearfollow
yearfollowup,over
1,000diedbysuicide.Theyreported
thatwomenwithsixormorechildren
hadonefifththeriskofdeathby
fifththeriskofdeathby
suicideascomparedtootherwomen.
Hoyer,G.,&Lund,E.(1993).Suicideamongwomenrelatedtonumberof
childreninmarriage. ArchivesofGeneralPsychiatry,50,134137..
ArchivesofGeneralPsychiatry

ThwartedBelongingness:
EmpiricalEvidence
EmpiricalEvidence
Twinsdiebysuicideatlowerrates

thanothersdespitehavingslightly
higherratesofmentaldisorders.
Tomassinietal.(2003).Riskofsuicideintwins:51yearfollowup.
BritishMedicalJournal,327,373374.

ThwartedBelongingness:
EmpiricalEvidence
EmpiricalEvidence
Thecamaraderieandsenseof
belongingnessfrombeingafan
ofsportsteamscanbe
considerable,especiallyunder
conditionsofsuccess
conditionsofsuccess

ThwartedBelongingness:
EmpiricalEvidence
EmpiricalEvidence
asmanywhohavelivedin

universitytownscanobservefor
themselveswhentheuniversitywinsa
nationalchampionship,say,in
football,sayin1993or1999.
football,sayin1993or1999.

ThwartedBelongingness:
EmpiricalEvidence
EmpiricalEvidence
Itisinterestingtoconsider,then,

whetherteamssuccessaffects
suicidalityfromthepresent
perspective,itmight,inthat
increasedbelongingnessshouldbe
associatedwithlowersuicidality.
associatedwithlowersuicidality.

ThwartedBelongingness:
EmpiricalEvidence
EmpiricalEvidence
Severalstudieshavedocumented

thisassociation.
Joiner,T.,VanOrden,K.,&Hollar,D.(2006).OnBuckeyes,Gators,
theMiracleonIce,andSuperBowlSunday:PullingTogetherIs
AssociatedWithLowerSuicideRates. JournalofSocial&Clinical
Psychology.
Fernquist,R.M.(2000).Anaggregateanalysisofprofessionalsports,
suicide,andhomiciderates:30U.S.metropolitanareas,1971
suicide,andhomiciderates:30U.S.metropolitanareas,19711990.
Aggression&ViolentBehavior
Aggression&ViolentBehavior,5,329341.
Steels,M.D.(1994).Deliberateselfpoisoning
Steels,M.D.(1994).DeliberateselfpoisoningNottinghamForest
FootballClubandF.A.Cupdefeat.
FootballClubandF.A.Cupdefeat.IrishJournalofPsychological
Medicine, 11,7678.
Trovato,F.(1998).TheStanleyCupofHockeyandsuicideinQuebec,
19511992. SocialForces,77
77,105126.

ThwartedBelongingness:
PoorRedSoxFans
PoorRedSoxFans

ThwartedBelongingness:
PoorRedSoxFans(Well,
PoorRedSoxFans(Well,Until
2004and2007)
2004and2007)

ThwartedBelongingness:
PoorCubsFans
PoorCubsFans

 MiracleonIce,

February22,1980
February22,1980

NumberofDailySuicides

100

90

80

70

60

1972

1976
Missing

1984

1980
1978

1982

February22(19721989)
February22(19721989)

1988
1986

Missing

D
i
s
t
a
l

F
a
c
t
o
r
s

ThoseWho
DesireSuicide

Perceived
Burdensomeness
ThoseWhoAre
CapableofSuicide

Thwarted
Belongingness
Belongingness

SeriousAttemptorDeathby
Suicide

Prevention/Treatment
Implications
Implications
Themodelslogicisthat

preventionofacquiredability
ORofburdensomenessORof
thwartedbelongingnesswill
preventserioussuicidality.
preventserioussuicidality.
Belongingnessmaybethemost
malleableandmostpowerful.
malleableandmostpowerful.

Prevention/Treatment
Implications
Implications

CBT>

burdensomenessand
lowbelonging.
lowbelonging.

Availableatplaceslikeamazon.com
Availableatplaceslikeamazon.com

Thebookgoeswellbeyondthistalk.
Thebookgoeswellbeyondthistalk.
9/11,WorldTradeCenter
9/11,WorldTradeCenter
Suicideininsectsandspiders(weird

buttrue)
Howdeathmergeswithlifeinthe
Howdeathmergeswithlifeinthe
mindsofsuicidalpeople
mindsofsuicidalpeople
Lyingaboutsuicide
Lyingaboutsuicide
Whywescrambletopreventdeathsby
lightningstrikebutdolesstoprevent
deathbysuicide
deathbysuicide

Thebookgoeswellbeyondthistalk
Thebookgoeswellbeyondthistalk
WhatItoldmyyoungsonsabouthow

suiciderunsinourfamily
suiciderunsinourfamily
Theroleofserotoninsystemgenes
Theroleofserotonin
andotherserotonin
andotherserotoninsystemparameters
insuicidalbehavior
insuicidalbehavior
Whywomenwithanorexianervosa
andborderlinepersonalitydisorderare
sovulnerabletodeathbysuicide
sovulnerabletodeathbysuicide

Thankyouforyourattention
Thankyouforyourattention

joiner@psy.fsu.edu
joiner@psy.fsu.edu