Imagine that the rate of terrorism deaths in the United States had risen dramatically over the past 15 years. Imagine that this rise in deaths had been remarkably widespread, affecting almost all identifiable demographic groups. Imagine if more than 40,000 people a year died from terrorist attacks in this country, rather than a bare handful. Imagine if terrorism were one of the 10 leading causes of death in the United States.
It’s almost an impossible hypothetical; the impact would simply be too massive to really grasp. After all, though the impact of terrorist violence on the United States has been negligible since 9/11, we’ve already made massive changes to the basic functions of our system to combat it. We’ve tortured; we’ve jailed people without trial for a decade-and-a-half; we’ve undertaken a system of vast warrantless surveillance; we’ve built an immense, and immensely expensive, infrastructure for combating terrorism. All in the face of a threat that kills a negligible number of people.
Yet the conditions I outlined above accurately describe another killer, one that attracts far less attention: suicide.
The National Center for Health Statistics recently released a major study, examining the national trends in suicide. The results are grim: The age-adjusted suicide rate in the United States increased a staggering 24 percent from 1999 to 2014. Increases were seen in every age group except for those 75 and above and in every racial and gender category except for black men. The national rate rose to 13 deaths per 100,000 people in 2014. Contrast that with homicide, which killed 5.1 Americans per 100,000 in 2013. We instinctively fear the murderer hiding in the bushes, but we are at far greater risk from ourselves.
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This stark, disturbing rise in self-harm comes in the context of a world that just keeps getting safer. The violent crime rate in the United States fell dramatically for decades. Recently, the rate has fluctuated, but viewed at any kind of meaningful scale, the decline has been dramatic and meaningful. Meanwhile, modern medicine continues to reduce the fatality rates of disease and accidents, though some causes of death remain stubborn. Even car accident deaths have declined dramatically, as improving car safety technology, stricter enforcement of seatbelt laws, and a nationwide crackdown on driving under the influence have chipped away at this stubbornly high fatality rate.
But suicide operates outside of the simple functional logic of these declines. We have few meaningful options when it comes to stopping someone who is determined to kill themselves.
It’s worth remarking, however, on how little attention this trend has received, at least compared with many less important issues. This is true even when we recognize that it’s natural for people to spend less time writing and reading about bad news than about good. The relative absence of commentary is understandable when contrasted with topics like the latest Beyonce album or the Game of Thrones premiere, which are sources of joy for many. But even compared to issues like the Islamic State and climate change, from my anecdotal perspective, this dramatic rise in suicide rates has received little attention. Perhaps this is something of a “boiling frog” situation, where the slow and steady rise of a problem leaves us unable to notice it. But I suspect deeper, sadder issues are at play.
In many ways, suicide remains an unspeakable problem. Murder invites righteous indignation in those left behind; cancer, noble sorrow; death at old age, feelings of gratitude and accomplishment. But suicide subverts our easy narratives. Suicide is a crime with only a victim, no perpetrator, and thus no individual on which to place blame. Loved ones of those who commit suicide must often grapple with conflicted emotions, often feeling both pain and compassion for the one they have lost and anger that they have been made to feel this way.
Too many in our culture, meanwhile, still place the blame for suicide on its victims. It’s common, after high-profile suicides like that of actor and comedian Robin Williams, for some to argue that suicide is “the coward’s way out,” that taking one’s own life is somehow a cowardly act. Such attitudes are a flagrant failure of empathy, as well as a misunderstanding about the relationship between suicide and mental illness and addiction, both of which are strongly associated with suicide risk. Like many social problems, suicide does not have single and obvious causes but rather a concert of contributing factors working together. To blame suicide on a lack of personal character demonstrates ignorance about the nature of the problem. But such thinking contributes to the country’s persistent and deep inability to grapple with suicide in an open and healthy way.
There’s another reason, I suspect, for the relative dearth of commentary on our suicide epidemic, a disturbing one: Suicide is concentrated among those whom our society values least. Take Native Americans, for example. That racial category saw the rate for men rise by 38 percent and for women, an unthinkable 89 percent. Not coincidentally, this group suffers in comparison with natural averages in a large number of metrics that consider quality of life, with poverty and substance abuse rampant. The Native American population, sad to say, does not attract a great deal of attention in the national media, with its relatively small population and concentration in rural states, leaving the group easily forgotten by media companies concentrated in urban areas.
Or consider the declining fortunes of the white working class. In many ways, this group has suffered economically in the past several decades. With the rise of offshoring and the demise of stable careers for those lacking a college education, the white working class has seen dramatic rises in problems like unemployment and addiction. We should be clear that white Americans overall continue to enjoy significant advantages over black and Hispanic Americans in metrics like unemployment, college completion rate, and incarceration rate, which is not surprising in a country that still suffers from immense and structural white supremacy.
But this does not change the fact that white workers without college degrees have seen their overall quality of life eroded in a variety of ways that almost certainly contribute to the suicide rate. For example, as a New York Times story on the report points out, unmarried men have dramatically higher suicide rates, and divorce rates are strongly tied to income and education, with those in lower income brackets and educational levels suffering from far higher rates. Why white Americans are so much more likely to commit suicide than black, Hispanic, and Asian Americans, whose rates are less than half that of white Americans, is something of a mystery. This might paradoxically be part of the legacy of white privilege: Because white Americans have traditionally enjoyed greater affluence and cultural prestige than people of color, they might take unemployment, poverty, and their attendant indignities as harder to stomach. But this and similar explanations are necessarily speculative, and given the vast sweep of increases in suicide, we should see this problem as one affecting our entire culture across lines of difference.
While those suffering in the working class are large in number, they are not a group that captures a great deal of attention in our media, which is disproportionately attuned to the interests of the college-educated and affluent. Much of our journalist and pundit class comes from families that are middle-class, or even better off than that, and has a college education, as I do, and is likely to have personal networks that disproportionately contain people of similar backgrounds. Meanwhile, the “echo chamber” effects of social media can deepen this problem, with the concerns of poorer, more rural Americans sidelined. Terrorist attacks have tended to take place in the world’s great cities; global warming is, well, global. These problems are harder to ignore. But suicide happens in our culture’s shadows.
Suicide has geographical components, too. Sociologist Matt Wray of Temple University coined the term “suicide belt” to describe the north-south band of Western American states – Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, and Wyoming – that have unusually high suicide rates. This likely reflects the same underlying economic conditions that seem to contribute to suicide rates in general, with high rates of aging, single, unemployed men – and unusually high rates of gun ownership. Owning a gun is one of the most powerful predictors of suicide risk overall, for obvious reasons. For as much as the United States suffers from a gun murder rate far higher than most of the industrialized world, most gun deaths stem from suicide.
With so many guns and so many isolated and hopeless men, it’s little wonder that the suicide belt suffers in particular. Here, too, we can see reasons for the relative lack of discussion of our suicide problem. These Western states are far removed from the hubs of American media in New York, Washington, D.C., and Los Angeles, likely contributing to our cultural silence about this pressing issue.
Suicide is an age-old problem, one that is unlikely to be solved with any individual policy changes or technological innovations. The causes, conditions, and means of suicide are too diverse, and the problem too widespread, to imagine that we will ever prevent this problem, in the same way we’ve been able to prevent many diseases through the widespread availability of vaccination. Instead, we’ll have to chip away at it steadily, trying to rescue more and more people out of poverty and hopelessness through robust redistributive social programs and through education and awareness-raising. We’ll also need to actually invest in our mental health system, to identify those who need help and provide such help to those who seek it. To do so, we should have the national conversation we’ve put off for too long and become more comfortable discussing a topic that still retains a powerful taboo. The time is now; suicide has already cost us far too much.