Thomas Joiner provides a robust descriptive model of suicide, but repeatedly refuses to consider the deeper "why" - the answer to which might be evolutionary adaptation in the Pleistocene.
In bathrooms at Disneyland, signs over the sinks offer what are described as "hand washing tips." The alleged "tips" are:
- Wet hands and apply soap.
- Scrub hands and rinse.
- Dry hands thoroughly using paper towels.
People find this sign amusing from an epistemological standpoint: it's not so much a set of hand washing tips as it is a (humorously unnecessary) phenomenological description of the act of hand washing. It is funny because it purports to have normative content, but fails to contain anything but description.
Similarly, Thomas Joiner's Why People Die By Suicide promises, in its title and its project, to provide an explanatory model for suicide. Joiner does provide a useful descriptive model of suicide, but he fails to live up to his title's promise of an explanation of suicide. In fact, he explicitly rejects, on what are essentially aesthetic grounds, the most promising candidate for a genuine explanatory model of suicide - that is, evolutionary psychology.
According to Joiner, three factors cause suicide: competence, or the ability to carry out a suicide; the feeling of being a burden; and social failure to belong. The first factor, competence, includes the physical ability, knowledge, and pain tolerance required to carry out a suicide, as well having lost or overcome the fear of death. The second and third factors, burdensomeness and failed belonging, join together to create the desire for death. Both the desire for death and the capability to achieve death must coexist in order for a person to commit suicide; that much is obvious. Joiner's main contributions are setting this up in a clear formulation, and positing the two specific factors that constitute the desire for death.
Importantly, while maintaining that mental illness is relevant to suicide, Joiner does not implicate mental illness in causing suicide - rather, his model explains the elevated suicide levels in people with disorders like Bipolar I and II and Borderline Personality Disorder by the fact that such disorders (a) facilitate comfort with increasingly lethal self-harm, (b) increase feelings of (and perhaps actual) burdensomeness, and (c) decrease the ability to belong.
Joiner's model is clear, helpful, and well-supported by studies. The problem with Joiner's model is that, while it describes who commits suicide and how they manage to do it, it fails to explain why those people commit suicide. Why should people care about being a burden to others? Why should people care about social belonging? Why should they care about these things, but not other things, enough that death is preferable to the pain of burdensomeness and thwarted belonging?
Joiner is comfortable providing an answer as to why it should be difficult to commit suicide, and why the first element of his model, competence, should be necessary: natural selection. He implicates specific genes and brain traits in suicidality (even distinct from the genetic contribution to mental illness). Yet he explicitly refuses to consider the possible role of natural selection in regard to the other elements of his model, or to suicide as a phenomenon.
Why should people care about whether they are burdens on other people? Why isn't it, say, the feeling of being overburdened by others that causes suicide? And why should failure to belong be so painful as to facilitate suicide? Why not anger, or guilt, or physical pain, or even excessive social contact? Joiner makes no attempt to explain. But an adaptive model readily explains the features of Joiner's model, in addition to clarifying Joiner's more questionable results; indeed, the adaptive model has more explanatory power than Joiner's model.
Failure to Consider Suicide as an Adaptive Behavior
Suicide, like filicide, seems upon first consideration to be a ludicrous act, viewed from the perspective of evolutionary biology: how can one's genes go on if one kills oneself or one's child? However, the act of filicide (the killing of one's child or children) is clearly adaptive in many cases. Not only that, but it can be shown through statistical evidence that actors seem to differentiate between adaptive and non-adaptive filicides when they "decide" to commit filicide (as well as other apparently fitness-threatening homicides, like uxoricide and siblicide). What about suicide?
An act is adaptive when it increases the inclusive fitness of an actor - that is, when the act's benefits - in terms of survival, procreation, or nepotistic distribution of resources to one's genetic relatives - exceed the act's costs, in the same terms.
Under certain conditions, one's expected contribution to one's own genetic fitness (likelihood of reproduction, likelihood of the survival of one's future offspring to reproduce, effectiveness at materially supporting one's offspring and other relatives) may fall to virtually nothing. However, as long as one survives under these circumstances, he not only contributes nothing to his own genetic fitness, but also likely drains the resources of his genetic relatives. His continued survival is contrary to his genetic interests. Therefore, suicide, in this limited situation, must be said to be adaptive. (For my earlier thinking on this topic, see my essay, The Evolutionary Biology of Suicide: Is Suicide Adaptive?)
It would be callous and cruel to think of a sick relative as a burden who would be better off dead. And that is not the message of an inclusive fitness model - its message is merely that, in the Pleistocene era when modern humans were evolving, a heritable trait that functioned to tell a human something like "die if you're a net burden on your genetic kin, otherwise stay alive" may have carried benefits in terms of selection. However, Joiner cannot get past the (admittedly substantial) emotional load of the adaptive model of suicide, and rejects it on what are essentially aesthetic grounds:
. . . I do not much like this adaptive suicide view; my own dad died by suicide and the idea that he was an actual burden is offensive. My view is that self-sacrifice is adaptive in some animal species. It may have been adaptive under certain conditions in the course of human evolution, but we will never really know. Most important, it does not really matter now. What matters now is that perceived burdensomeness - and, to the extent that it exists, actual burdensomeness - are remediable through perception- and skill-based psychotherapies. Death is no longer adaptive, if it ever was. [Joiner, p. 115]
This is a strange statement for a scientist. Although Joiner is writing a book called Why People Die By Suicide, he asserts that the essential "why" of his research does not matter - especially to the extent that it might be "offensive." In this, I think he misunderstands the nature of the adaptive view. It is not to say that suicide is good or bad, or that Joiner's dad really was a burden to Joiner or his family - simply that, in the human environment of evolutionary adaptedness, the ability and predilection to commit suicide under certain conditions may have conferred a benefit. Joiner also wrongly asserts that "we will never really know" about the adaptive theory, when he should know that the evolutionary psychology model is perfectly capable of generating testable hypotheses, and has done so in the past with robust results.
Joiner pushes the notion that it is perceived burdensomeness - not actual burdensomeness - that facilitates suicide. However, this may be more nice than true: suicidal persons' perceptions of their own burdensomeness may in fact be highly accurate. Just before he dismisses the adaptive theory of suicide, Joiner summarizes a study supporting the view that suicides really are a burden: "when researchers interviewed the significant others of eighty-one people who had recently attempted suicide, a majority of significant others reported that their support of the patient represented a burden to them."
The adaptive model leads to different predictions (and, in turn, possibly different risk assessments and treatment models) from Joiner's model. For instance, in Joiner's model, "belongingness" is all that matters. But an adaptive model would predict that some forms of belongingness would be more protective against suicide than others - specifically, contributing to the welfare of one's genetic relatives (or, perhaps, surrogates for genetic relatives) would be more protective than other forms of belonging. Relationships with spouses and children would matter more than relationships with friends in an adaptive model, but not in Joiner's model. Joiner does not even consider this to be a question worth researching. Similarly, in Joiner's model, all that matters is "burdensomeness" - no matter who is burdened. An adaptive model might predict that burdensomeness on genetic relatives in particular (or their surrogates) would trigger suicidal behavior, rather than burdensomeness on non-relatives. Again, Joiner is not interested in testing this hypothesis, although it might have major implications for treatment and risk assessment. It cannot be said, with regard to the adaptive view of suicide, that "it does not matter now."
Joiner's model, including a refusal to consider the adaptive view, seems to strain when it encounters certain data. For instance, when explaining the data that pregnant women experience a lower suicide rate than non-pregnant women - one-third the non-pregnant rate in one study - Joiner says: "I would suggest that the protective influence involved feelings of connection to the baby, as well as feeling needed by the baby and thus not a burden." But a relationship to an unborn, unseen person who cannot respond is a strange sort of "relationship." An adaptive explanation - pregnancy confers clear survival value compared to non-pregnancy - is less strained than a belongingness/burdensomeness model, and, in fact, provides a deeper explanation of why a pregnant woman might develop deep feelings for a non-speaking person inhabiting her body.
Joiner's model accounts for sex differences between the suicide rates of men and women in two ways: first, in terms of competence, men are more likely to be exposed to provocative stimulation (all kinds of violence and more) that break down one's fear of death over time; second, in terms of desire for death, men are more likely to be disconnected and more likely to feel they are burdens than women. This is probably true - the first part, in particular, accords well with what I believe to be the most accurate explanation for the differences between the suicide rates of men and women - but, again, why should this be? Why should men be more prone to risky, painful, violent, or as Joiner terms it, "provocative" behavior?
The answer, again, lies in evolutionary biology. Men are not merely "socialized" to be more violent - there are good evolutionary reasons for their greater violence and risk-taking in all areas. A great deal of this is due to what Daly & Wilson term the "effective polygyny" of human beings (at least in the EEA) - that is, that the fertility variance among men is much higher than among women, with many more men than women having a high number of children, and, similarly, many more men than women having zero children. This leads to the sad phenomenon of male disposability - while a woman is "valuable," with a certain, nearly guaranteed level of reproductive success, a man may have no reproductive success at all - but may, by engaging in risky behavior (e.g., successful killing in wars or honor battles), increase his reproductive success to well beyond what a woman might have. A human male is, sadly, invited by his genetic heritage to gamble his life on the chance of a big payoff in reproductive success. What is driving differential violence in general may also drive differential suicides - even independently from the greater access to fear-reducing, provocative experiences.
More specifically, Joiner's model does not explain why, in addition to varying between genders and across age groups, the time pattern in suicides across age groups is different between men and women. Men's suicide rates are a linear function of age: the older the male, the higher the suicide rate. Women's suicide rates vary with time differently, however. While in some countries, the pattern for women matches that for men, in other countries the pattern is very different. In Canada, rather than rising linearly with age, suicide among women peaks during the 35-44 age range; in the United States, the Netherlands, and Sweden, it peaks during the 45-54 age range; and in Australia, Denmark, and Poland, female suicides peak in the 55-64 age range. While belonging and burdensomeness are probably implicated, the fact that these are the age ranges of menopause and post-menopause in women seems to lend support to the adaptive view as to why burdensomeness and thwarted belonging would come into play at those times.
While Joiner's model is compelling, I think there is persuasive evidence that an adaptive model explains suicide better than Joiner's model. At the very least, such a hypothesis deserves to be considered, and should not be rejected on merely aesthetic grounds. To do so is irresponsible and unscientific. An accurate analysis of the etiology of suicide affects both assessment of the risk of suicide and treatment for the suffering that causes suicide.
Failure to Consider Unsuccessful Attempted Suicide as an Adaptive Behavior
Joiner refuses to consider whether a successful, completed suicide may be adaptive. Elsewhere, he refuses to consider data suggesting that making an apparently lethal but ultimately unsuccessful suicide attempt may be not only adaptive, but economically beneficial - provided one does not die in the attempt. In a 2003 article in the Southern Economic Journal, Dave Marcotte presented data that suicide attempters experience an increase in income after the attempt that is proportional to the lethality of the attempt. Charles Duhigg summarizes in his Slate article, provocatively subtitled "Why trying to kill yourself may be a smart business decision":
Marcotte's study found that after people attempt suicide and fail, their incomes increase by an average of 20.6 percent compared to peers who seriously contemplate suicide but never make an attempt. In fact, the more serious the attempt, the larger the boost — "hard-suicide" attempts, in which luck is the only reason the attempts fail, are associated with a 36.3 percent increase in income. (The presence of nonattempters as a control group suggests the suicide effort is the root cause of the boost.)
Marcotte's data suggests that a suicide attempt, particularly an apparently lethal one, acts as a signal that the individual needs help - and, as it is a signal that entails significant cost (the risk of death), it is a particularly believable signal. This signal seems to act to make resources "cheaper" - a suicide attempter may get access to resources that he did not have access to before the attempt.
Again, Joiner is having none of it, and again, it's for aesthetic, not scientific, reasons. Joiner's complaints are two: the economic "viewpoint" is dangerous, in that it may encourage lethal-seeming suicide attempts; and it is callous, in that it denies the reality of the suffering experienced by the suicidal individual. Both of these "complaints" are without merit and are, I think, evidence of shoddy thinking on Joiner's part.
As to the "danger" of the economic model, Joiner says
The danger of viewpoints like this should be pointed out. Any analysis that encourages suicidal behavior in any way - particularly in ways that romanticize or glorify it, or make it seem easy and normative - has potential negative consequences for public health.
But it is hardly the viewpoint that is dangerous - it's the existing incentive structure in our society that encourages apparently lethal suicide attempts in people who often don't really want to die. I have argued that if the suicide prohibition were ended, this dangerous incentive structure - the "fantasy of rescue" - would also end. (I have also proposed an outline of a model for ending the prohibition on suicide, with particular attention to ending the dangerous fantasy of rescue.) Analyses are not dangerous. Problems are dangerous; analyses identify the problems and point the way to solutions. By suggesting that the economic analysis is dangerous, Joiner is contributing to the taboo against speaking about suicide.
Joiner's idea that the economic hypothesis denies the reality of the suffering of suicide attempters is even more ridiculous. He believes that the economic idea is part of some kind of "deconstructionist" philosophy - he actually mentions Jacques Derrida by name (not kidding): "What is left for the deconstructionist, then, is a constant questioning of the very existence of reality and meaning - including the reality of emotional pain. Try telling that to a suicidal person."
This objection makes so little sense that I had to reread the section (pp. 43-44) a couple of times before I understood it. Joiner thinks that the economic model does not account for the pain suffered by those who attempt suicide. But the economic model suggests no such thing! Despite Duhigg's unfortunate opening example in his popular reporting of the Marcotte study, the hypothesis is not that people coldly calculate that they will get a benefit from an apparently lethal suicide attempt. Rather, suffering people are motivated by that awful, extremely real suffering to do something awful - to, essentially, gamble their lives on a chance at making the suffering stop.
Culture, Language, and Occam's Razor
One of the anomalies that Joiner believes he can explain with his theory is the fact that, while, in general, men commit suicide at a much greater rate than women, women in China commit suicide at a greater rate than men. Joiner is quick to find a cultural culprit: Confucianism. Specifically, he says that "the role of Confucianism in Chinese society and its view of the inferior position of women has been emphasized as one explanation, one that is consistent with the current emphasis on effectiveness as a buffer against suicide. (p. 157)" Social scientists, particularly white, Southern social scientists, are often quick to reach for a complicated but distancing cultural explanation when there is a perfectly good, but uncomfortable, solution available that might actually survive Occam's Razor.
In the case of female suicides in China - and higher comparative rates of female suicide throughout Asia, including India (a noted hotbed of Confucianism) - the uncomfortable but obvious explanation is that lethal poisons are available in Asia, but not in the United States. Most females who commit suicide in China do so by poison, and the pattern holds true in other areas where female suicides exceed those of males, such as Bangalore, India. In the United States, many people, including females, attempt suicide by poisoning, but few succeed - lethal poisons are just not available in the United States, and in the event of a potentially lethal poisoning, medical care is not only available, but compulsory. The medical care necessary to treat a poisoning is often not available in China, especially in rural areas.
According to Joiner's own model, females, who are exposed to less violent, provocative stimulation than men, should have less capability to commit suicide - by violent means. However, death by overdose or poisoning is not violent and is within the capabilities of many women. One need not reach for what even Joiner admits is speculation - that Chinese women, since they perform well in sport competitions (is he thinking of the Olympics?), are, as a group, encouraged to engage in athletics, leading to the development of more masculine traits, such as violence. Joiner's explanation is, indeed, speculation, and ignores an obvious explanation that is consistent with his model. Perhaps the poison explanation is not as satisfying to Joiner as speculation about the effects of athleticism, because it fails to portray Asian people as sufficiently different from whites.
Joiner indulges in even less responsible speculation when he considers language. Joiner devotes considerable time to the hypothesis that suicidal people fuse themes of life and death - that death becomes a focus for belonging and effectiveness. In contrast to the rest of his book, in which peer-reviewed studies are frequently cited as evidence for his claims, his main evidence for the "fusing of life and death themes" hypothesis is Nirvana lyrics (though he does give us a few isolated quotations of suicidal people that, if you squint the right way, seem to back up his idea). I think that Joiner likes the idea that suicidal people fuse themes of life and death because it makes us seem more psychotic, and less rational in our actions.
The Ethics of Suicide and the Reality of Suffering
Though Joiner clearly has an ethical opinion (suicide is bad), he devotes no time to the question of the ethics of suicide and of forced hospitalization and the suicide prohibition in general. This is not unexpected. It is considered polite and compassionate to do "what is best" for suicidal people, and it is considered to be a serious failure of compassion to suggest that some of us might just know what is best for ourselves. To question suicide prevention on ethical grounds would be extremely foreign to Joiner's way of thinking.
In addition, Joiner is sure that every death by suicide is preventable because treatment is available, but he fails to cite studies of treatments for suicidal misery that have a 100% long-term success rate. Instead, he proposes, in addition to the usual coercive suicide prevention techniques, public service announcements that say "keep your friends and make new ones too - it's strong medicine." He thinks that if more people called a friend every day, just to chat for a few minutes, there would be fewer suicides. He does not seem to apply this thinking to the suicide of his own father, however. His father, at the time of his death, was receiving what Joiner terms "reasonable treatments" (a mood stabilizer and an SSRI), but "his treatment came too late." Joiner notes that his father sought out friends toward the end of his life, as Joiner's patronizing public service announcement would have advised him, but "his efforts were not sufficient . . . . These things were beyond him . . . . (p. 226)"
Based on his (undefended) position that suicide is wrong, Joiner repeatedly describes websites like ASBS (an incarnation of the usenet group alt.suicide.holiday.bus.stop) as "pernicious" (God knows what he would think of my project). He wrongly and tellingly characterizes ASBS as pro-suicide - ASBS is pro-choice, as am I. He approvingly cites restrictive guidelines for news outlets regarding reporting on suicides. Joiner says he is against lying about suicide, and is in favor of removing its stigma, but he doesn't want conversations about suicide to occur if he doesn't approve of their content.
Joiner promises an explanatory model - he calls his book "a comprehensive theory of suicidal behavior (p. 222)" - and makes assertions based on tacit moral assumptions. I think that Joiner owes us not only an explanation of why people die by suicide, but also of why dying by suicide is wrong - and why coercive means of suicide prevention are ethically appropriate.
1. Of course, traits are heritable, not acts, but the ability and predilection to commit certain acts, and the ability to distinguish when to do so and when not to do so, may be seen as traits to the extent that they are specifically heritable. More precisely, we must say that a trait is beneficial when it increases one's inclusive fitness. A trait may be very specific.
2. There is one sense in which it really doesn't matter, of course, and that is the ethical sense. In fact, this is the sense in which even I have previously stated that an adaptive model makes no difference. But this is not the sense in which Joiner means it. He means that it can have no assessment or treatment consequences and that it is not an appropriate topic for scientific inquiry. As I stated above, the adaptive model has clear assessment and treatment implications. Whether the adaptive model is supported or refuted, it does matter.
3. Another set of data must be explained - a group of "initially pessimistic" teenage mothers reported low depression while pregnant, but high depression postpartum. Joiner attributes this to "the belief that connection to the baby and the baby's father would solve ongoing problems" during the pregnancy, and to the fact that "the idea that motherhood would solve ongoing problems was not confirmed" after birth. However, the adaptive model gives a cleaner explanation: it makes evolutionary sense for the chemical changes during pregnancy to promote positivity and effectiveness, but also for the fitness prospects of the new baby to be evaluated coldly once the baby is born. This is particularly true for a young mother with no mate. This view is supported by Martin Daly and Margo Wilson's work on infanticide.
4. See, e.g., Chapter 6, "Altercations and Honor," in Homicide by Martin Daly and Margo Wilson. Aldine de Gruyter, New York, 1988.
5. Suicide Across the Life Span by Judith Stillion and Eugene McDowell. Taylor & Francis, Washington, D.C., 1996, p. 18.
6. I have not even mentioned the work of Denys DeCatanzaro, whose studies demonstrated a correlation between factors indicating low reproductive value and suicidal ideation. See, e.g., DeCatanzaro, D. (1991). Evolutionary limits to self-preservation. Ethology & Sociobiology, 12, 13-28; and DeCatanzaro, D. (1995). Reproductive status, family interactions, and suicidal ideation: Surveys of the general public and high-risk groups. Ethology & Sociobiology, 16, 385-394.
7. The unquestioning acceptance of the idea of suicide contagion, and of the harm to free speech and freedom of the press done in its name, are also ways in which the taboo against speaking about suicide is maintained.
8. I suspect that Joiner has limited familiarity with economic models and economic thinking, which may be why he seems even more threatened by this idea than by the idea that suicide is adaptive.
9. I don't think this characterization and its implications are unwarranted. Joiner reports two incidents of people doing crazy things that might inure them to the pain of suicide. In one, a man Joiner specifically identifies by name, Huyn Ngoc Son, "swallowed three metal construction rods, each around seven inches long," on a bet from drinking buddies, and had to have them surgically removed. In the other story, a man in England, whose name Joiner does not mention, drank fifteen pints of beer, had an argument, and went home to get a shotgun - which, while he was carrying it back to the bar in his pants, discharged shotgun pellets into his "groin area," potentially rendering him infertile. Research reveals that the man's name in the second incident was David Walker - the non-Vietnamese name was apparently not funny and foreign-sounding enough for Joiner to include in his description of the event.
10. I know that's not warranted, but I have as much evidence for that claim as Joiner does for his claim that Chinese women are "sportier." Also, I am an Internet crackpot, and Thomas Joiner is a goddamn principal investigator.
11. Elsewhere, Joiner reports that he did a "social word" analysis of a suicidal and a non-suicidal Faulkner character - yes, characters from literature - and found that, indeed, the suicidal character used fewer social words. "Faulkner accurately portrayed relatively poorly understood, intense, and rare psychological processes - still more indication of his literary genius." This is a fun stunt, but the fact that Joiner thinks it belongs in a section called "Research on Social Isolation, Disconnection, and Suicidal Behavior" calls his judgment and intellectual honesty into question.
Thanks to Chip Smith for comments on this piece.