Suicide

There is but one truly serious philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy. --Albert Camus, The Myth of Sisyphus

Murder is understandable: People kill for money or in a moment of wild rage or because their commanding officer has ordered them to--or because, like Charles Whitman or Richard Speck, they are patently insane. But who can explain why a successful actor such as Pete Duel, getting ever better reviews in increasingly better parts, finally starring at 31 in a well-rated TV series (Alias Smith and Jones), would decide one night after watching the show to kill himself? Why would Sylvia Plath, one of the best poets of our time, be obsessed with death to the point of writing about little else and attempting suicide twice--the second time successfully? The death of an attractive, successful, relatively young person mocks the everyday concerns of the rest of us.

Overall, in the U.S., there are between 11 and 12 suicides a year per 100,000 people, a statistic that hasn't budged much in the past generation. From a world-wide point of view, it is neither high nor low; but it also doesn't mean as much as it should. We're coming to realize that a great many suicides never become part of the statistics.

Since suicide has traditionally been shameful, for three reasons--it's usually a crime, it's sometimes considered the result of hereditary mental disease and the Church calls it a mortal sin--it is frequently covered up by protective relatives. Many single-car collisions are probably suicides disguised by the victim himself. And many families have destroyed suicide notes. Where neither victim nor family hides the facts, physicians and coroners often do out of sympathy. This can take some doing, but psychologist Edwin S. Shneidman has reported two cases in which "the decedents both stabbed themselves in the heart; one was certified as an accidental death--that is, running into a sharp weapon--and the other as natural death due to heart failure."

In his account of the life and death of his son Michael, In a Darkness, James Wechsler writes:

Not long after he had been pronounced dead--"for several hours," as the doctor at Roosevelt Hospital put it--the police immediately volunteered to suppress the circumstances in which they had found him after responding to our emergency call. And a sensitive New, York Times reporter who telephoned apologetically swiftly indicated that he would not press us for crucial details if we preferred to remain silent.

The implication in much of this was that it would involve some humiliation for us to admit that Michael had taken his own life, and that his brief span on earth should not be "tarnished" by the disclosure that death was self-inflicted. Even in the numbness of those hours we were astonished at the prevalence of the view that suicide was a dishonorable or at least a disreputable matter, to be charitably covered up to protect Michael's good name and the sensibilities of his family.

Many coroners take the view that suicide, like murder, must be proved beyond a reasonable doubt; and a number of them refuse to certify any death as suicide unless there is a handwritten note. But only a minority of suicides leave notes.

Even according to officially listed cases, suicide is the 11th leading cause of death in the U. S. and the third leading cause of death among those between 15 and 19. The commonly accepted figure is about 25,000 deaths per year. But Dr. Shneidman and many other experts feel that the true figure is two to three times that high.

Furthermore, the pattern is shifting. Until recently, there was a correlation between suicide and aging: The older a man grew, the more likely that he would take his own life. Since the mid-Thirties, however, the elderly have been growing less suicidal; and, as if to make a balance, since the Fifties, the young have increasingly been taking their place on our suicide charts. In 1957, for example, only one percent of the suicides in Los Angeles County were under the age of 19; only nine percent were under 30. By 1969, the under-19 group had climbed to six percent of the total and the under-30 to 22 percent. For suicides among those between the ages of 20 and 29, the figures showed a rise of 300 percent between 1961 and 1969. National figures, though not as precise, show the same trends.

Suicide is not really a stranger to any of us. Every mind flirts with it. As Nietzsche pointed out, "The thought of suicide is a great consolation: by means of it one gets successfully through many a bad night." But far more of us than is generally realized have gone beyond sleeping on it. Less from statistics than from guesswork, experts believe that at least ten times as many Americans attempt suicide as succeed at it. Some have estimated 100 attempts for each death. A survey made in Los Angeles in 1964 led to the estimate that 5,000,000 living Americans have suicidal histories.

Nonexistent 15 years ago, a whole mental-health subspecialty, grotesquely named suicidology, has grown up and is now being taught in over 100 universities to thousands of students. The subject has its own journals and is being practiced everywhere, recruiting workers from medicine, psychiatry, social work, the ministry and what have you. More than 1000 suicide-prevention centers offering services that range from a few kind words on the phone to continuing psychiatric treatment have sprung up throughout the country. A special section within the National Institute of Mental Health is devoted to coordinating the funding of grants for the study of suicide--the clues, the causes and the means of prevention.

Helpful as this activity may be--and there are well-documented cases of the centers' saving lives--a decade and a half of work has had no effect on the suicide rate in the U. S. Predictably, some workers in the field are calling for more heroic efforts. They feel that they can no longer wait for distressed people to call their number and say, "Help!" Experts at the Los Angeles Suicide Prevention Center (the first, largest and most research oriented of all the centers) estimate that only 12 to 15 percent of the people who phone them are even seriously suicidal and that only one in five of these is in an acute emergency state. Most really suicidal people, it seems, never go near the centers.

Therefore, explains a psychiatrist at the L. A. S. P. C., "We're going to have to learn to identify the suicidal people who won't come to us for help. We'll need people in bars and barbershops and police stations who are constantly alert to presuicidal behavior, and we'll need the power to actually bring them to treatment and keep them there against their will. And before you ask me, yes, obviously there will be civil rights questions involved."

Shneidman, a founder of the L. A. center, the first head of the Federal Center for Studies of Suicide Prevention--and the man who must live with having coined the word suicidology--takes what is probably the most common public--health view of fighting suicide: "I'd do almost anything to prevent a suicide. I'd certainly feel free to put someone I thought highly lethal to himself into a dosed ward until he cooled down. Every goal is secondary to keeping him out of the coroner's office."

That position is in perfect conflict with the civil-libertarian point of view of psychiatrist Thomas S. Szasz, who wrote in the spring 1971 issue of The Antioch Review: "In regarding the desire to live as a legitimate human aspiration, but not the desire to die, the suicidologist stands Patrick Henry's famous exclamation, 'Give me liberty, or give me death!" on its head. In effect, he says, 'Give him commitment, give him electroshock, give him lobotomy, give him lifelong slavery, but do not let him choose death!' "

Szasz, a maverick in the psychiatric field, has spent years fighting the accepted practice of forcibly hospitalizing mental patients. To lock up someone as a possible danger to himself or others, he argues, is simply imprisonment without either a crime or a trial. It is also nonsensical, since many studies show that as a group, mental patients are comparatively harmless to other people. As to what they might do to themselves, that, Szasz insists, must be their own business. "Suicide," he says, "like dangerously overdrinking or overeating or not following your doctor's orders, is an unqualified human right."

He therefore condemns as deceitful the suicide-prevention-center procedure of keeping a caller on one phone while contacting the police on another. He considers it a breach of professional (continued on page 268)Suicide(continued from page 150) confidentiality when physicians and psychiatrists reveal a patient's suicidal feelings to his family and commit him involuntarily to a mental hospital. He furthermore insists that most so-called mental illnesses that lead to suicide are not medical problems at all but simply ways of behaving that others happen not to like. And, as he wrote in The Antioch Review, "By persisting in treating desires as diseases, we only end up treating man as a slave."

We seem, then, no further along in this argument than the classical philosophers: the Stoics claiming suicide as every man's right, while Aristotelians insisted it was an act against the state and God.

But it is not really difficult to divide those suicides in which society has no place from those in which it does. In the first category, society is simply given no choice in the matter. One group of people who fascinate psychologists are the successful men who, on observing an apparent decline in their physical or mental abilities, commit suicide, as if to the as they've lived, in full charge of their own destinies. The suicides of a number of physicians--a profession with an unusually high suicide rate--fall into this category. One can easily go along with Szasz in feeling that to try to prevent the suicides of such men would be to deny their right to their most deeply held values. But this is conceding very little, since the prevention of such a man's suicide is practically impossible. He seldom seeks help, gives direct hints of his intention or fails in his plan.

Dr. George E. Murphy of the Washington University School of Medicine in St. Louis reported to the 1971 Summer Institute in Suicidology that "clinical studies find that more than 90 percent of suicides are clinically ill in a psychiatric sense." Such post-mortem diagnoses are established not through séances but through attempts to reconstruct the character of the deceased by studying all available evidence and records and by interviewing those who knew him best. Surveying 134 consecutive suicides in a metropolitan area, psychiatrist Eli Robins judged 95 percent of them psychiatrically ill. Most American physicians would agree with these findings; according to The Journal of the American Medical Association, "The contemporary physician sees suicide as a manifestation of emotional illness. Rarely does he view it in a context other than that of psychiatry."

But it is hard to favor a right to suicide for someone who has been hearing God's voice telling him that he's needed in heaven, or who is convinced that only leaping from a window will spare his family further persecution by Martian secret agents, or who, for no comprehensible reason, suddenly concludes that there is no point in dressing, eating, bathing, sleeping or speaking--since he is dead already and all that remains to be done is to walk in front of a truck in order to get buried. Such psychotic states of mind are to be found in only about 15 percent of those suicides held to be psychiatrically ill. Another 25 percent are diagnosed as suffering from chronic alcoholism--a serious enough condition but one so resistant to medical cures that one is strongly tempted to agree with Szasz that it might not be a medical problem at all. To think of alcoholism as a condition that leads to suicide is actually to play with words, since in every practical sense it is a form of suicide--albeit a slow one--in itself. "The alcoholic," psychiatrist Myron Pulier has written, "is a man consciously choosing to remove himself from life through turning off a great portion of his mind. That somewhere along the line he might choose pills or a gun to turn off the rest could fall under the heading of sane, though tragic, human choice."

Similarly, another 50 percent or more of suicides have been diagnosed as suffering from "depressive illness." Depressive illness involves not only feelings of helplessness, hopelessness and worthlessness but a loss of interest in food, sex, work, friends and everything else that normally makes life worth living. It has clear physical symptoms as well: extraordinary fatigue, agonizingly disturbed sleep patterns--particularly early morning insomnia--and an inability or unwillingness to eat. It is, of all psychiatric conditions, the most likely to be associated with suicide.

But exactly what depression is--or whether it is one condition or 100--remains unknown. Many physicians, such as Dr. Ari Kiev of Cornell University Medical Center, hold that "a large proportion of depressive disorders begin as yet unknown physical changes in the nervous system." The causes of depression, they believe, are for the most part physical, and they therefore pin their hopes for cure on drug therapies of constantly evolving types.

Dr. Kiev argues, in fact, that psychotherapy is very poor treatment for anyone either threatening suicide or having attempted it. He has noted that of a series of 158 suicide attempters seen in his Cornell Program in Social Psychiatry, 91 had been in psychiatric treatment at the time of the attempt. He argues that "the model of psychotherapy which emphasizes the patient's responsibility for his difficulties tends to heighten guilt and a sense of hopelessness in suicide-prone patients."

Drugs, however, have not proved to be miracle cures for all or even most depressions, and depressions are among the most common disorders of mankind. The difficulty in dealing not only with suicide but with all aspects of depression, says Shneidman, is that "the history of paresis has mucked up the field. People in tertiary syphilis acted crazy and it turned out that there was a spirochete responsible for it. So ever since, we've been looking for the spirochete for all other mental states, and there just doesn't seem to be a spirochete making us feel that life is shitty."

Shneidman would therefore argue that suicides are psychotic and in need of medical treatment in only a few cases. But he and most other suicidologists tend to justify intervention by claiming that no man totally knows his own mind. Along with a desire to die, they believe, there is always a desire to live. Shneidman is particularly fond of Harvard psychologist Henry Murray's model of the mind as a parliament of opposing views, in clamorous dispute on every conceivable action. No matter what a man decides at any given moment, the vote might well go differently later, unless his decision is to the. The point of suicide prevention is to keep him alive until those drives Freud called the life instinct overcome--as in time they generally do--those drives that aim toward death. As long as the congress of the mind is still debating the question, suicidologists argue, it should not be allowed to adjourn permanently.

This logic adds that one can seldom do much harm in preventing a suicide, for the option to the will usually revert to the individual very quickly. The true question, a young psychiatrist recently suggested, "isn't whether we should prevent suicides but whether we can prevent them. I had a schizophrenic patient in treatment for two and a half months and I didn't get the first clue that he was suicidal. He slit his throat. It's not that easy to know, and when you do know, it's often impossible to prevent it. Thousands of people kill themselves in mental hospitals. I know of one who killed himself by hooking his strait jacket to his cot and throwing himself to the floor until he broke his neck. And one of the classical patterns of suicide is, for a patient to be discharged by the mental hospital as out of danger and then to kill himself the next day."

In any attempt to understand suicide and suicidal behavior, it is crucial to distinguish between a real attempt and a mere gesture. Many who try suicide don't have dying as their primary, purpose at all. A 30-year-old woman recently described her suicide attempt of only a few weeks earlier. After years of neurotic problems and suicidal fantasies, she had experienced a wild paranoid reaction to an antituberculosis drug. Correctly guessing the cause of the agitation (such drugs have been found to exacerbate mental disturbance), she left a "very hysterical" request with her doctor's answering service that he call her immediately. She had several drinks in an effort to calm herself, but the alcohol only disturbed her more. When the doctor had not called at one A.M., she wrote a suicide note addressed to the county medical society, accusing her doctor of prescribing the drug "despite the fact that he knew I had emotional problems and that this drug might make me suicidal." She then proceeded to take everything she could find in her medicine cabinet, including 30 or so barbiturate capsules.

"I wasn't thinking about life or death or anything like that," she says. "I was just out to get that goddamned doctor, and maybe make my ex-old man feel bad in the bargain. It was pure dumb luck that it didn't kill me. My brother has a key to the apartment and, without telling me, he'd decided to come in for the weekend from school. He called the police and an ambulance, the fire department, everybody. I was in the hospital in a coma for four days. And now...well, I'm glad to be alive, anyway. I don't think I'm suicidal anymore--at least not at the moment. Maybe I had to go through something like this to get it out of my system. But I sure don't think killing myself is the best way of getting even with that son-of-a-bitch doctor. He never did call. I'm in therapy, working on all that hostility. You know, that's what all suicide is, anger at someone you can't really attack, so you attack yourself instead...so saith my shrink."

Her shrink is, of course, taking the classic psychoanalytic view--developed by Freud and expanded by Karl Menninger in Man Against Himself--that suicide is actually a form of aggression, a drive to murder someone else that has been turned inward. Analysts can back up this theory with such case histories as "the wife who showed her disdain by taking barbiturates, permitting her husband to make love to her and then letting him wake up in bed with a corpse" or "the guy who just disappeared while on a camping trip with his wife; no note, nothing...it took them years to find his body...that showed her" or "the kid who killed himself by jumping off the roof of the restaurant where his father had breakfast every morning, just as the old man was coming out the door." It is typical for a teenaged boy who kills himself to use his father's gun while his parents are in the next room.

Children who feel unloved often think that by punishing themselves they can make their parents love them. Similarly, many grown-up suicides mean to Show a withholding parent or a faithless lover or ungrateful children "what they've done to me." People who think this way somehow ignore the fact that if the plan is successful, they won't be around to appreciate the other's remorse. But very often the assumption appears to be that, despite what they might do to themselves, they won't actually cease to exist. Freud pointed out that "in the unconscious, every one of us is convinced of his own immortality."

A great many suicidal people are so torn between the wish to the and the wish not to the that they put the choice in the hands of fate or a potential rescuer. It is often difficult to know whether or not a person who died in a suicide attempt hoped to be saved. Something of a literary battle is now raging about the death of Miss Plath, who asphyxiated herself. On one side is her friend the British poet and critic A. Alvarez, who insists that her suicide was a "'cry for help' which fatally misfired. But it was also a last desperate attempt to exorcise the death she had summoned up in her poems." Alvarez supports his argument with the fact that after getting sedatives from her doctor for her depression, she had written to a psychiatrist about entering treatment, but his letter agreeing to help her was somehow delayed and arrived after her death. Further, Alvarez points out, she had hired a new mother's helper, and if the girl had managed to enter the apartment or rouse a neighbor at the time she was scheduled to arrive, Miss Plath would undoubtedly have been saved. Next to her body was a note saying, "Please call Dr.--."

On the other side of the argument is her husband, Ted Hughes, also a poet. Hughes is certain that Miss Plath--who had been obsessed for years with the death of her father, had attempted suicide once before and wrote about the attempt in her novel The Bell Jar--intended this one to work.

In any case, her death was one of the factors that moved Alvarez to write The Savage God, the most thoughtful contemporary work on suicide since Camus's The Myth of Sisyphus. In it, he notes a sharp increase in self-inflicted death among modern artists and writers and suggests that the cause may lie in the widespread collapse of religious beliefs. While for some it is exhilarating and liberating to think of man as alone in the universe, free to create his own values out of his own mind and heart, Alvarez claims that for many, the overthrow of traditional beliefs has left a void in which life seems futile and incoherent and death absurd. Some of our best artists have tried to confront this loss of values directly in their work and, Alvarez maintains, it has killed them:

For the artist himself art is not necessarily therapeutic; he is not automatically relieved of his fantasies by expressing them. Instead, by some perverse logic of creation, the act of formal expression may make the dredged-up material more readily available to him. The result of handling it in his work may well be that he finds himself living it out. For the artist, in short, nature often imitates art. Or, to change the cliché, when an artist holds up a mirror to nature, he finds out who and what he is; but the knowledge may change him irredeemably so that he becomes that image.

Pursuing his thesis that Miss Plath's death was a mistake or a gamble, Alvarez maintains that though her art may have provoked her suicide, the act was not the inevitable result of her poetic themes: "Yet her actual suicide...adds nothing to her work and proves nothing about it. It was simply a risk she took in handling such volatile material."

When, as in the Plath case, a suicide is successful, it is, of course, impossible to determine whether or not the victim meant to accomplish it. One group of Los Angeles physicians, reporting on suicide attempts that failed, estimated that only 36 percent of the males and 27 percent of the females had really wished to die; 23 percent of the males and 19 percent of the females appeared to be leaving survival up to chance. And 25 percent of the males and 40 percent of the females appeared definitely to be expecting to be saved.

Those who expect to live or leave it to chance tend to be radically different in psychological make-up from those expecting to die. They are attempting to affect life and, usually, to communicate with specific people around them. These attempts are, in a sense, blackmail; but they are also final desperate cries for help. By taking an overdose of slow-acting barbiturates several hours before her husband returns from work, a woman is trying to tell him that she is suffering. She's telling it in as forceful a manner as she knows how.

But suicide attempts as a means of improving one's life all too frequently go wrong. Many suicidal people appear to have an almost magical conviction that some particular person (often, but not always, the one who is causing them the deepest pain) will prove to be their rescuer. Unfortunately, faith in rescuers is sometimes misplaced. Psychiatrist Robert E. Litman writes of "a husband who came home at three A.M. to find his wife unconscious, an empty sleeping-pill container in the wastepaper basket and on the table a note, 'Wake me if you love me.' He threw the note down and left. She died."

Rescuers don't always get the message, because most suicidal communications are vague. "He called me up at two in the morning," a young woman said about her ex-boyfriend. "I just couldn't find out what he wanted. He made no sense. He told me that he used to love me but that it wasn't important anymore. Weird. But he'd acted peculiarly in the past, too. That's why I broke up with him. So I told him to go to sleep. The doctor says that he'd already taken the pills. I think he expected me to rush over there." The rescuer, oblivious to the drama in which he has been cast, can easily miss his cue.

Perhaps the most important discovery of the modern study of suicide is that all suicidal communications are serious. Whether the message comes in direct statements, such as, "If you leave me, I'm going to jump out the window," or in indirect ones, such as, "My family will be better off without me," or even in nonverbal clues such as obvious attempts to wind up one's affairs or give away one's dearest possessions, it is always a call for help, and a desperate one. Despite the myth that people who threaten suicide never do it, suicidologists insist that the vast majority of suicides do, indeed, communicate their intentions to someone.

It has often been noted, however, that we all tend to look away from the suicidal person. We tell the depressive who mentions thoughts of suicide that he doesn't really mean it. And if he doesn't raise the subject, we don't, either, out of fear of putting the idea in his head. We find it easier to deny the seriousness of his calls for help than to take responsibility for answering them.

Not to answer is sometimes as damaging to the survivors as to the victim himself. The survivors often realize too late that at some level of consciousness they really had known what was coming and they can't shake the feeling that their own part in the drama was something akin to murder.

There are more mysteries than answers in the study of suicide. Suicides increase during economic depressions (in the mid-Thirties, the U. S. suicide rate was one third higher than it is now) and one need hardly ask why. But not everyone kills himself on being thrown out of work. When one investigates any individual case, he finds himself swamped with potentially relevant data.

Last year, for instance, a 42-year-old unemployed executive shot himself to death with an antique dueling pistol that had been owned by his grandfather. It was the middle of a recession and he wasn't alone. Suicide rates were rising quickly in high-unemployment areas. But he was almost a textbook case of a certain variety of suicide in America. He was in psychotherapy at the time and had previously gone through 12 years of psychoanalysis with several doctors and through three rounds with Alcoholics Anonymous. This is not at all unusual. Most suicidal people struggle desperately to control their self-destructive drives, the educated middle and upper classes often seeking medical and psychological aid.

The psychologist who had been seeing the man once a week until his death reports:

Jim was a vice-president of a very large company, and a new group had taken over, and these were people he couldn't work with. He came from a very old, once wealthy Boston family. These new men, in Jim's view, were ruthless, greedy and unethical. Firing people unconscionably--not gentlemen at all. He had no way of dealing with them. Jim wasn't paranoid; he would tell me how they were putting it to him at meetings, asking him for information they knew he couldn't have to make him look bad. He hung on for a long time, but eventually they got him fired and, you know, in a family like Jim's, you just don't get fired for any reason. It's a disgrace.

He had been living expensively and ran through his savings in no time. There were no jobs for executives at his level at that point. He ran up bills with everyone, including me, so he cut back on therapy sessions, even though I was willing to trust him for the money. He just couldn't stand owing money.

At the same time, he was having trouble with his wife. She'd given up sleeping with him and was talking about a separation. A lot of it had to do with his drinking. He claimed he wasn't an alcoholic anymore because he didn't touch the stuff till five, but from five on, he was a champion. He couldn't see why it was affecting his family, but he would come in to me slurring his words and deny that he was even slightly bombed. And after all those years of psychoanalysis--and, incidentally, with two very brilliant analysts--he was still full of rage that he couldn't let out.

But all these things were just the circumstances that were pushing him toward suicide. A lot of men lose jobs and are alcoholic and have wives who give them a hard time, but they go on living. In Jim's case, along with everything else, he was bearing a lifetime of guilt. His mother had died of an asthma attack, and he had never really straightened out in his own mind that he wasn't responsible for her death.

I knew that suicide was a possibility, but I can't say I saw it coming. He'd talk about it from time to time, but it wasn't an idée fixe. He also had healthy fantasies about new campaigns to find a job. Exactly what led him to pick up the gun, I couldn't say. He had all sorts of antidepressants and psychic energizers. I can't simply point and say, "Here's the reason." He had just become something that he couldn't tolerate being. Some people resolve that problem by embracing schizophrenia. Jim, I suspect, was establishing his identity by using his grandfather's pistol.

Jim exhibited pretty clearly the three components Menninger wrote are present in all suicides: the wish to kill (he was furious at others toward whom he couldn't discharge his anger), the wish to be killed (he felt he should rightfully be punished for his bad behavior and his failures) and the wish to die (he felt helpless and hopeless in the face of his problems).

Among Americans, the success ethic is certainly one of the strongest factors influencing such feelings. Studying in New Orleans, Dr. Warren Breed of Tulane University came to the conclusion that at least half of all American suicides are connected with failure. "They bought their obligations wholeheartedly and set out to reach them," Dr. Breed writes of failure suicides. "They wanted to succeed very much. They strove to achieve their goals--work for men and marriage for women--and thus to win the approval of those about them. In Alan Watts's terms, they took the game too seriously."

This overvaluing of society's standards seems a particularly apt description of the college suicide. In many instances in which suicide seemed related to school pressures, the post-mortem examination showed that the pressures were mostly in the student's own mind. He was doing well enough at school, but he wasn't living up to what he felt his parents expected of him. Psychologist Michael Peck, who conducted a survey of student suicides, claims, "The boys in these cases are often the sons of successful, rigid fathers who place a premium on success and masculinity. Most adolescent boys are conflicted about their sexual identity and adequacy. Strong parental demands to 'be a man' often have just the opposite effect, a weakening of the sense of identity."

One matter common to college students who have attempted or threatened suicide is that they have had far less sexual experience than their classmates. Dr. Peck's study showed that "43 percent of the suicidal students had never had sexual intercourse, as opposed to only 18 percent of the nonsuicidal students," and students who had successfully committed suicide had had the least sexual experience of all.

Most male-student victims were engaged mainly in calm, solitary pursuits. They had not been at all politically activist. They used drugs less often than other students. College administrators were fond of them. It is true that they were more emotionally disturbed than other students, but--taking it out on themselves--they caused few difficulties. When they were found dead, Peck states, the common reaction among fellow students was, "Who was he? I lived next to him for months and never got to know him."

Who he was, usually, was a boy who had bought society's demands that he must perform, fit in, function well and live up to his parents' expectations. A case often spoken of at the Los Angeles Suicide Prevention Center is that of a father who told his 19-year-old son if he couldn't cut it in this world, he might as well shoot himself. The boy dutifully acted upon the suggestion.

This question of overvaluing society's demands that one succeed would appear to be closely tied to one of the great mysteries of the American suicide phenomenon: the difference in suicidal behavior in men and women.

At every age, starting at about 15, the suicide rate for males throughout the U. S. is well over twice as high as the rate for females. On the other hand, at least three times as many women as men attempt suicide and fail at it. (One study showed eight times as many female attempters as male.) There are any number of possible explanations for the disparity. Men, for one thing, tend to use far more immediately lethal methods of attacking themselves than do women. According to U. S. Public Health Service statistics for 1969, firearms and explosives accounted for 59.2 percent of suicidal deaths among males but only 29.4 percent of those among females. However, 21.4 percent of the females killed themselves with analgesic and soporific substances (mostly barbiturates), as opposed to only 4.2 percent of the males. Taking several Seconal capsules leaves hours in which one might easily be saved. A revolver doesn't leave a second.

Since men in our society are more likely than women to own and be familiar with guns, it seems consistent enough that more suicidal men than women would choose to blow their brains out. But the drive between home and the Golden Gate Bridge is equally short for men and women, and three men leap from it for every woman who does.

It may be important that females in our society are permitted the freedom to cry, to scream, to threaten, to make dramatic gestures, to beg for help without losing their interest or desirability as people. Thus, the slit wrist, the overdose of pills, the open gas jet and all the other suicidal yet nonlethal cries for help come easily to them. Men, on the other hand, lose status when they reach for help. It has been failure that led them to despair and it is desperation that they are trying to escape. To fail, even at suicide, therefore, becomes intolerable; so instead of suicidal gestures, they kill themselves.

• • •

We will never achieve a society so perfect that every member will be free from the corrosive effects of inexpressible anger at others, feel in harmony with himself as he is, be confident and happy about the world around him and enjoy playing the game of life without taking it too seriously. To the degree that we do achieve such a society, the suicide rate will, of course, go down. But things may be going in the opposite direction: As women come more and more into the working world, the drive to succeed has added to their lives more pressures and more ways of failing in their own eyes. And in New York City, where the liberation of women has probably made more headway than anywhere else in the country, so has the female-to-male suicide ratio.

The same thing appears to be happening to blacks. Breed holds that segregation, which forced black men in the South to accept relatively low goals, played a great part in keeping down the U. S. black suicide rate, which has traditionally been only about a third as high as that of whites. Starting out with low social status, blacks had relatively little to lose. For whites, downward mobility--failure at work for men and failure in family life for women--was the common factor in the majority of suicides. But when one ceases to look at the black population as a whole, matters appear quite different.

It has been clear for some time that suicide is the third leading cause of death among college-age people. This was long thought to be a college-related phenomenon; but recent studies suggest that nonstudents have even higher suicide rates than the students. And in New York City in the 20-to-35 age range, the black suicide rate is considerably higher than that of whites. Psychoanalyst Herbert Hendin in his book Black Suicide theorizes that "a sense of despair, a feeling that life will never be satisfying, confronts many blacks at a far younger age than it does most whites. For most discontented white people the young-adult years contain the hope of a significant change for the better....The blacks who survive the dangerous years between 20 and 35," Dr. Hendin believes, "have often made some accommodation with life--a compromise that has usually had to include a scaling down of their aspirations."

If it proves to be true, as it seems to be, that suicides are lowest among populations that are not only downtrodden but without much hope for individual improvement, we might be forced to admit that suicidal tendencies are an unhappy price that we'll go on paying for freedom, affluence and hope. It is, after all, one of man's most admired qualities that he overreaches and tries for goals beyond his grasp, despite the fact that it may lead to despair.

Yet, just as it is true that not everyone who suffers is driven to suicide, it is even more obvious that not everyone who aspires to more than he can achieve kills himself. It is possible to go beyond despair and arrive at solid ground. Alvarez ends The Savage God by informing the reader that he, too, is "a failed suicide." Having gone over the edge and survived, he is able to tell us what he learned:

The despair that had led me to try to kill myself had been pure and unadulterated, like the final, unanswerable despair a child feels, with no before or after. And childishly, I had expected death not merely to end it but also to explain it. Then, when death let me down, I gradually saw that I had been using the wrong language; I had translated the thing into Americanese. Too many movies, too many novels, too many trips to the States had switched my understanding into a hopeful, alien tongue. I no longer thought of myself as unhappy; instead, I had "problems." Which is an optimistic way of putting it, since problems imply solutions, whereas unhappiness is merely a condition of life which you must live with, like the weather. Once I had accepted that there weren't ever going to be any answers, even in death, I found to my surprise that I didn't much care whether I was happy or unhappy; "problems" and "the problem of problems" no longer existed. And that in itself is already the beginning of happiness.

Another of man's most valued qualities is that he can feel what others feel and aid those who are about to collapse. It might seem that suicide reduction through restraining those about to kill themselves should not be our goal at all. Should society grant people the right to kill themselves? Perhaps it should. But since people kill themselves when miserable, exhausted, lonely, frightened, deluded, ashamed, enraged and without hope, and the pain, not death, is the enemy they need help in defeating, we should make sure that no one kills himself for a reason that need not have existed in the first place.