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Tuesday, July 08, 2008

The New York Times has an article on the under-recognized (even by many prevention experts) impulse component to suicide, already well-known to everyone who's read the fascinating New Yorker article on Golden Gate Bridge jumpers I link to every time this issue comes up. The problem, in a nutshell, is this:

But part of this sense of futility may stem from a peculiar element of myopia in the way we as a society have traditionally viewed and attempted to combat suicide. Just as with homicide, researchers have long recognized a premeditation-versus-passion dichotomy in suicide. There are those who display the classic symptoms of so-called suicidal behavior, who build up to their act over time or who choose methods that require careful planning. And then there are those whose act appears born of an immediate crisis, with little or no forethought involved. Just as with homicide, those in the “passion” category of suicide are much more likely to turn to whatever means are immediately available, those that are easy and quick.

Yet even mental-health experts have tended to regard these very different types of suicide in much the same way. I was struck by this upon meeting with two doctors who are among the most often-cited experts on suicide — and specifically on suicide by jumping. Both readily acknowledged the high degree of impulsivity associated with that method, but also considered that impulsivity as simply another symptom of mental illness. “Of all the hundreds of jumping suicides I’ve looked at,” one told me, “I’ve yet to come across a case where a mentally healthy person was walking across a bridge one day and just went over the side. It just doesn’t happen. There’s almost always the presence of mental illness somewhere.” It seemed to me there was an element of circular logic here: that the act proved the intent that proved the illness.