Research suggests more people find suicide a reasonable response to dire challenges... No recommendations about what to do and how.

The dangerous shifting cultural narratives around suicide. Julie Phillips. Washington Post, Mar 21 2019. https://www.washingtonpost.com/outlook/the-dangerous-shifting-cultural-narratives-around-suicide/2019/03/21/7277946e-4bf5-11e9-93d0-64dbcf38ba41_story.html?utm_term=.c7c37d383bb5

Research suggests more people find it a reasonable response to dire challenges.

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The data suggests that white and middle-aged Americans are the demographic groups most at risk for suicide. So in one sense, Krueger’s tragedy fits the prevailing pattern — as did the deaths last year of celebrity chef Anthony Bourdain and fashion designer Kate Spade. In general, suicide rates among whites are about three times higher than among blacks and Latinos.

Between 1999 and 2017, U.S. suicide rates increased by 45 percent for men ages 45 to 64 and by 62 percent for women in that age group. As a result, that cohort surged ahead of the 65-plus age group in absolute terms, with a suicide rate of 19.6 per 100,000 — producing, in effect, a new epidemiology of suicide.

There are many reasons for this rise, all of them important. But one underdiscussed explanation is the subtle loosening of taboos around suicide. Surveys suggest that Americans in recent years are more likely to view it as an acceptable reaction not just to terminal illness but also to life setbacks that are emotionally brutal but survivable. (That doesn’t mean these attitudes played a part in any specific recent suicide.)

Other trends have been more broadly reported. The media attention given to the deaths of high-profile people should not distract from the fact that the rising rates of suicide occur disproportionately among working-class and less-educated Americans. In 2014, the most recent year such breakdowns of data are available, men with only a high school diploma were twice as likely to die by suicide as men with a college degree. And although middle-aged men of all educational groups experienced rising suicide rates during the Great Recession, 2007 to 2010, since then rates for college-educated men have slightly declined while those for men with only a high school diploma have continued to rise.

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Yet a possible cultural component of the suicide epidemic demands close attention, too. Research suggests that Americans are becoming more tolerant and accepting of the practice. In some contexts, many Americans might find this tolerance benign — as with suicide, or even assisted suicide, in the end stages of a fatal disease (although that practice has strong critics, too).

But other attitudinal shifts may be more plainly troubling. One way to track these views is through the General Social Survey (GSS), which, since its inception in 1972, has asked a nationally representative sample of Americans about their attitudes toward suicide. In an analysis of changes in attitudes from the 1982-86 period to the 2010-16 period, Yi Tong, now a medical student at SUNY Downstate College of Medicine, and I found that the share of Americans age 18 or older who said people have the right to end their lives in the case of an incurable disease rose from 46.9 percent to 61.4 percent. The percentage who said that being “tired of living and ready to die” was a reasonable rationale for suicide jumped from 13.7 percent to 19.1 percent. And roughly 11 percent of Americans in the later period said that suicide was acceptable during a financial bankruptcy or if one had “dishonored” one’s family — up from about 7 percent, in both cases.

We know that attitudes toward suicide affect behavior. Elizabeth Luth, of Cornell’s medical school, and I examined some 30 years of data on GSS respondents (about 35 percent of whom had died since their interviews) and found that expressions of suicide acceptability were associated with subsequent death by suicide. Beliefs that suicide is acceptable under certain social circumstances (family dishonor and bankruptcy) had the strongest effects on mortality.

Reducing stigma around suicide can be positive — if it means that distressed people become more likely to seek help, for instance. But when and if the belief spreads that the act is acceptable under some conditions, even terminal illness, that may have ramifications we don’t fully understand. We need more research to figure out what messages destigmatize suicide in the good sense, opening the doors to life-saving conversations, and which ones normalize it as a response to crisis, with deadly consequences.

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