Suicide

• 1. Introduction

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  Suicide is the act of intentionally causing one's own death, and it is the 10th-leading cause of death worldwide, accounting for about 1.5% of all deaths. In 2015, it took 828,000 lives globally, up from 712,000 in 1990. Yet across that same stretch, the age-standardized death rate fell by 23.3%. The numbers pull in two directions at once. There are an estimated 10 to 20 million non-fatal attempts every year. Behind each figure sits a question this documentary will try to answer. Why does the risk cluster so unevenly across men and women, across ages, across whole regions and religions? What inside the brain and outside it pushes a person toward this act? And why has the West spent centuries arguing over whether it is a crime, a sin, or a choice? The word itself came from the Latin suicidium, defined plainly as the act of taking one's own life. It first emerged shortly before 1700, replacing older phrasings that cast the act as a form of self-murder.

• 2. The Brain Beneath

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  There is no known unifying pathophysiology for suicide, and researchers describe it instead as an interplay of behavioral, socio-economic, and psychological factors. Brain-derived neurotrophic factor, or BDNF, sits at the center of much of this work. Post-mortem studies have found reduced BDNF in the hippocampus and prefrontal cortex, in people with and without psychiatric conditions. Serotonin tells a parallel story. This neurotransmitter is believed to run low in those who die by suicide, an inference drawn partly from increased 5-HT2A receptors found after death. Investigators have also measured reduced levels of 5-hydroxyindoleacetic acid, a breakdown product of serotonin, in the cerebral spinal fluid. Direct evidence, the source cautions, is hard to obtain. Heredity adds another layer. Genetics appears to account for between 38% and 55% of suicidal behaviors. Once mental disorders are accounted for, the estimated heritability is 36% for suicidal ideation and 17% for suicide attempts. Adoption studies sharpen the picture further. A family history of suicide raises risk among biological relatives but not adopted ones, which makes imitation an unlikely explanation. A mother's history affects children more than it affects adolescents or adults.

• 3. The Weight Of A Diagnosis

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  Mental illness is present at the time of suicide between 27% and more than 90% of the time. Of those hospitalized for suicidal behavior, the lifetime risk of suicide reaches 8.6%, compared with 4% among non-suicidal people hospitalized for affective disorders. Major depressive disorder may account for half of all suicide deaths, and having a mood disorder such as bipolar disorder raises the risk twentyfold. Schizophrenia is implicated in roughly 14% of cases, personality disorders in about 8%, with borderline personality disorder the most common of those. About 5% of people with schizophrenia die of suicide. Physical illness carries its own gravity. A cancer diagnosis approximately doubles the subsequent frequency of suicide, an effect that persists after adjusting for depression and alcohol abuse. Chronic pain, traumatic brain injury, HIV, kidney failure requiring hemodialysis, and systemic lupus erythematosus all show associations. In Japan, health problems are listed as the primary justification for suicide. Among roughly 80% of those who die by suicide, the person has seen a physician within the prior year, and 45% within the prior month, a window in which contact and care might change an outcome.

• 4. Substance And Circumstance

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  Substance misuse ranks as the second most common risk factor for suicide, after major depression and bipolar disorder. Most people are under the influence of sedative-hypnotic drugs when they die by suicide, with alcoholism present in between 15% and 61% of cases. Between 3% and 35% of deaths among heroin users are attributed to suicide, roughly fourteen times the rate among non-users. Cocaine and methamphetamine misuse correlate strongly, and for cocaine the danger peaks during withdrawal. Inhalant users sit at striking risk, with around 20% attempting suicide and more than 65% considering it. Cannabis, by contrast, does not appear to independently raise the risk. Beyond chemistry lies circumstance. Socio-economic problems such as unemployment, poverty, homelessness, and discrimination may trigger suicidal thoughts. Over 200,000 farmers in India have died by suicide since 1997, partly tied to debt. In China, suicide is three times as likely in rural regions as in urban ones, a gap believed to stem partly from financial difficulty. Social isolation and a lack of support raise risk, while optimism and high social cohesion appear to offer protection. LGBTQ individuals face significantly higher risk, with family rejection, discrimination, and minority stress among the leading factors.

• 5. The Werther Effect

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  Goethe's novel The Sorrows of Young Werther ends with its protagonist killing himself, and admirers of the book went on to emulate him. That pattern gave its name to suicide contagion, the Werther effect, in which depictions of suicide can increase its occurrence. High-volume, prominent, repetitive coverage that glorifies or romanticizes the act carries the most impact. When detailed descriptions of a specific method appear, that method can be imitated by vulnerable people, a phenomenon observed in several cases after press coverage. About 15 to 40% of people leave a suicide note, and media are discouraged from reporting its contents. There is a mirror to this danger. Mozart's opera The Magic Flute gives its name to the Papageno effect, named for a character who planned to kill himself over the feared loss of a loved one until his friends intervened. Coverage of effective coping mechanisms may have a protective influence. Fictional portrayals that show alternative or negative consequences might prevent harm, and fiction can normalize mental health struggles and encourage help-seeking. Educating journalists to follow reporting guidelines can lower the risk, though getting buy-in from the media industry, especially over the long term, can be difficult.

• 6. What Has Been Proven

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  Lithium reduces the risk of suicide in mood disorders by 87% in randomized controlled trials, lowering it in bipolar disorder and major depression to nearly the level of the general population. It is thought to work by treating the underlying mood disorder and by reducing impulsivity and aggressiveness. Lithium in the water supply correlates with lower overall suicide rates, especially among men, and areas with higher concentrations also show lower rates of homicide, rape, and drug arrests. The Caring Letters model offers a quieter proof. It involved mailing short typewritten letters, sometimes as brief as two sentences, personally signed by a researcher who had spoken at length with the recipient during a suicidal crisis. The letters expressed interest without making any demands, sent monthly at first, then quarterly. A randomized controlled trial proved the intervention reduced deaths by suicide. It is inexpensive and one of very few approaches scientifically shown to work in the first years after a hospitalized attempt. Reducing access to methods matters too, whether firearms, pesticides, opioids, or barriers on bridges and subway platforms. About 60% of people with suicidal thoughts do not seek help, often citing low perceived need or a wish to handle it alone. The World Suicide Prevention Day is observed annually on the 10th of September.

• 7. Method And Geography

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  A review of 56 countries found hanging the most common method in most of them, accounting for 53% of male suicides and 39% of female suicides. Worldwide, an estimated 30% of suicides occur from pesticide poisoning, most in the developing world, ranging from 4% in Europe to more than 50% in the Pacific region. Lethality varies sharply by method: firearms 80 to 90%, drowning 65 to 80%, hanging 60 to 85%, jumping 35 to 60%, and medication overdose 1.5 to 4.0%. Up to 85% of attempts in the developed world are by drug overdose, a gap that explains why attempts so often do not become deaths. National patterns reveal the role of availability. In China, pesticide consumption is the most common method. In the United States, firearms are involved in 50% of suicides, more common in men at 56% than women at 31%. Jumping accounts for 50% of suicides in Hong Kong and 80% in Singapore. Rates per 100,000 also diverge: Australia 8.6, Canada 11.1, China 12.7, India 23.2, the United Kingdom 7.6, the United States 11.4, and South Korea 28.9. Greenland, Lithuania, Japan, and Hungary have the highest rates. Around 75% of suicides occur in the developing world, with China and India together accounting for over half the total.

• 8. Sin, Crime, And Choice

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  In ancient Athens, a person who died by suicide without the state's approval was denied a normal burial, buried alone on the city's outskirts without a marker, the hand often cut off and buried separately as the perpetrator. The Council of Arles in 452 condemned the act as the work of the Devil. A criminal ordinance issued by Louis XIV of France in 1670 had the body drawn face down through the streets and all property confiscated. The Renaissance began to shift this. John Donne's work Biathanatos offered one of the first modern defences, citing Biblical figures such as Jesus, Samson, and Saul. David Hume denied that suicide was a crime, asking in his 1777 essays, why should I prolong a miserable existence, because of some frivolous advantage which the public may perhaps receive from me. The law followed slowly. England and Wales decriminalized suicide through the Suicide Act 1961, and the Republic of Ireland in 1993. The Netherlands became the first country to legalize physician-assisted suicide and euthanasia, effective in 2002. India kept suicide illegal until 2014. The history holds darker chapters as well. In 1978, 909 members of the Peoples Temple, led by Jim Jones, died at Jonestown drinking grape Flavor Aid laced with cyanide. The 1981 Irish hunger strikes, led by Bobby Sands, ended in 10 deaths, recorded by the coroner as starvation, self-imposed.