Why People Die by Suicide.
Joiner, Thomas (author).
2005. 276 p. Harvard University Press, hardcover, $24.95 (0-674-01901-6).
Library call number 616.85 JOI.

Suicide isn’t something you want to rush into.

I really don’t mean to be flip in saying this, but it is one of the main points of this book by Thomas Joiner, a professor of psychology at Florida State University.

Suicide is something you work up to over the course of many years, Joiner says. It takes careful planning, preparation and conditioning; people who later take their own lives, or try to, may never realize they are taking the steps necessary to increase the likelihood that they will succeed at doing so.

Any incident that causes physical pain, intentional or not, makes the person who feels that pain more likely to attempt suicide. The likelihood of attempted suicide increases with each subsequent painful event. Joiner calls it “habituation to pain and provocation.” He explores the many ways people build up a tolerance to pain. The index lists some of them: substance abuse, violence, childhood physical and sexual abuse, tattooing and piercing, accidents, prostitution, surgery, keeping guns at home, and even being a physician. Having enough of any of these painful experiences makes it easier to withstand the pain of suicide.

Being able to commit suicide is only half of the equation, though. People must also want to kill themselves. To want to kill yourself, you must feel that you have failed in your attempts to belong to a social group, and you must feel that you have become a burden to those around you. Combine the ability to commit suicide with the desire to do so, and the likelihood of a serious suicide attempt goes up sharply.

Of the two halves of this equation, the ability to commit suicide responds much less readily to treatment than the desire to die by suicide. Joiner thus advocates that crisis intervention should focus on reducing peoples’ feelings of burdensomeness and social failure.

He has also created a technique for controlling negative thinking, which goes by the acronym ICARE. The “I” stands for identifying the negative thought. “C” stands for categorizing the particular type of distorted thinking the thought represents. “A” stands for assessing whether the thought reflects reality. “R” stands for restructuring the thought based on that assessment. “E” stands for executing the results of that restructured thinking. People can also reduce feelings of burdensomeness and isolation by keeping in touch with friends and family.

Many mental health professionals have personal reasons for entering the field. Joiner opens the book by talking about his father’s suicide. I am not a mental health professional, but I have personal reasons for taking an interest in the field. I have struggled for many years with depression and the feelings of burdensomeness and isolation Joiner cites in his book. I came close to attempting suicide once, about two-and-a-half years ago. Since then, I have worked hard to understand the reasons behind the feelings I still struggle with. I now realize many people struggle with these same feelings. Helping friends and acquaintances look for the roots of these feelings has helped me feel less burdensome and less isolated.