Suicide: causes, risk factors, and prevention strategies

¶ … suicide has been of interest from the beginning of Western civilization. For philosophers, clergy and social scientists, the subject raises myriad of conceptual, theological, moral, and psychological questions, such as What makes a person's behavior suicidal? What motivates such an action? Is suicide morally permissible, or even morally required in some extraordinary circumstances? Is suicidal behavior rational? How does suicide affect those that remain? The fictional books Virgin Suicides and Norwegian Wood address some of these topics, only to find, as in real life, that each situation differs and the ones who are left must find a way to personally resolve their confusion and move on.

The definition of suicide is confusing. People have long looked at suicide in a negative fashion, although someone who dies to save others is more likely to be seen in a better light than someone who has done so to relieve mental or physical pain. Further, someone who continues to commit an act that has a high probability of leading to death, for example cigarette smoking, is not considered suicidal. Yet, a terminally ill person who asks someone else to hasten death is commiting suicide. In addition, many philosophers question whether someone has to die to actually be a suicide People speak of "attempted" suicide, where something occurs that keeps the act from being consummated (Fairbairn).

In Judaism, life is valued above almost all else. The religion not only allows, but often requires, someone to violate the laws if necessary to save a life. A person who is very ill, for instance is not permitted to follow the fasting laws on the very holy day of Yom Kippur, because fasting could cause further harm. Since life is so valuable, no one is permitted to do anything to hasten it. This includes the desire to end suffering. Jewish law completely forbids euthanasia, suicide and assisted death (Jewish Law website).

Similarly, throughout its history, the Christian church has condemned suicide as morally wrong. St. Augustine is believed to be the first to actually address this subject in depth (Amundsen), recognizing it as an extension of the fifth commandment of "Thou shalt not kill" and an unrepentable sin. This is especially true since the words "thy neighbor" are not attached as with "Thou shall not bear false witness against they neighbor. St. Thomas Aquinas further elaborated by providing three reasons for the immorality of suicide: 1) It is contrary to natural self-love, whose aim is to preserve humaankind; 2) It harms the individual's community; and 3) It violates duty to God who bestowed the gift of life (Aquinas 1271, part II, Q64, A5.)

Overall, until recently, suicide was not a topic that was discussed in the United atees. In the past several years, the subject has been aired because of changes in the laws. According to a review of the laws on the Observer Website, in 1997, in Vacco v. Quill, the Supreme Court upheld New York's prohibition of assisted suicide, but agreed to "aggressive palliative care," in which the physicians are intend only to relieve the patient's pain. Their undisclosed intent, however, may be to kill the patient by "terminal sedation." Palliative care can be morally justified even if it unintentionally shortens life. However, in the absence of exceptional proof of intent, the law cannot effectively determine whether the physician acted with the intent to relieve pain or to cause death.

Further, a competent adult has the legal right to refuse to take food and water whether administered normally or artificially. Incompetent patients may be denied nutrition and hydration if they had, when competent, expressed their desire to be so denied or, in some states, if such denial is in the best interests of the patient. In cases where the family and the physician agree that the patient should die, the issue never gets to court and the patient can be quietly starved and dehydrated to death. Yet, despite such changes in the law, suicide most remains a hidden, sometimes taboo, topic.

Unless one has actually experienced a similar mindset as someone who has commited or attempted to commit suicide, it is a very difficult concept to understand. This lack of understading is thoroughly covered by Eugenides in his novel The Virgin Suicides. In the novel, the adult narrators look back to when they were young boys and witnessed the suicides of the five Lisbon sisters -- Therese, Mary, Bonnie, Lux, and Cecilia. Thirteen-year-old Celia goes first by impaling herself. Bonnie hangs herself on a beam. Mary puts her head in the oven. Therese takes sleeping pills with gin. Lux dies in the garage. The narrators go through the story in the hope of understanding the girls' deaths. At the end of the book, the readers have the pieces of the puzzle, "but no matter how we put them together, gaps remained, oddly shaped emptiness mapped by what surrounded them, like countries we couldn't name" (246). Once again, "All wisdom ends in paradox."

Although the girls are mostly confined and locked in their house by their abusive mother, they are allowed to go to the Homecaming dance. After this time, they are once again forced to remain at home, and the boys do what they can to follow their in-home activities. Lux is seen making love on the roof, Bonnie comes to the door most mornings clutching her pillow, Mr. Lisbon loses his high school teaching job, and the house needs more and more repairs. As time goes on, the girls become increasingly pale and ghost-like. They eventually contact the boys to help them escape. When the boys go to the house to rescue the sisters, they instead witness the suicides. Many years later, their story is still unexplained. As Trip staying at a detoxification ranch, and still plagued by the deaths says:

Every second is eternal,' Trip told us, describing how as he sat in his desk the girl in front of him, for no apparent reason, had turned around and looked at him. He couldn't say she was beautiful because all he could see were her eyes. The rest of her face -- the pulpy lips, the blond sideburn fuzz, the nose with its candy-pink translucent nostrils -- registered dimly as the two blue eyes lifted him on a sea wave and held him suspended. 'She was the still point of the turning world,' he told us, quoting Eliot, whose Collected Poems he had found on the shelf of the detoxification center. For the eternity that Lux Lisbon looked at him, Trip Fontaine looked back, and the love he felt at that moment, truer than all subsequent loves because it never had to survive real life, still plagued him, even now in the desert, with his looks and health wasted.

Regardless of the reasons behind their act, Virgin Suicides is a story about five girls who are searching for a way to leave their present life behind. The Lisbon sister are expressing the belief that freedom, even with all of its inherent risks, is favorable to a restrictive security. " ... Therese was reaching out to a freer world" (171).

What can be learned from Virgin Suicides today? That it is necessary to pay more attention to the needs of youth. As noted above, in the United States and other Western cultures the idea of suicide is considered morally wrong and people do not even like using the word. In many cases, in fact, a death will be considered "an accident," because people do not want to admit it was anything else.

Suicide among adolescents and young adults nearly tripled between 1950 and 1992. Since then, the number of suicides for youths has decreased, but rates remain unacceptably high. Suicide is the third leading cause of death among young people ages 15 to 24. Adolescents and young adults often experience stress, confusion, and depression from situations occurring in their families, schools, and communities that can be overwhelming and make them consider alternative solutions. Few schools, social service agencies and communities have suicide prevention plans with screening, referral, and crisis intervention programs for youth. (Lubell, Swahn and Kegler 471).

Most youths who talk about suicide do not want to do it. They want someone to help them. If they receive this help, their lives can be improved immeasurably. The concern is for the individuals who are hurting but not listened to or those who show signs that are not recognized or ignored. These are the individuals who are most unsafe. Most experts believe that many suicides can be prevented. As in Virgin Suicides " ... The candles beseeched us. The lantern sent out its untranslatable S.O.S" (191).

Many youth, because they are young, do not realize the actual results of their decision. Frequently, when children consider suicide they are not thinking clearly. They are more concerned about receiving attention and having people cry over them than recognizing that they are ending their existence. The permanence of death is not understood. Virgin Suicides does not offer the reader much input into the actual thoughts of the girls. They are too young to truly understand the ramifications of their actions. However, they are not too young to realize that they want to find a means of escape from the unhappiness in their home. Perhaps they saw ending their lives as a better option than trying to make it on their own in the outside world -- especially since they had been secluded for most of their lives. The question: Could someone in the right position help them and change their ultimate decision?

Virgin Suicides also deals with searching for a time that perhaps was brighter, simpler, less stressful. People living in the 21st century see the 1950s as an easier time. Those living in the 1950s, along with the Cold War and the threat of nuclear war, most likely looked back to earlier decades when living on a farm or without so much technology may have been better. The "Grass is Always Greener" is not always about individuals living at the same time period. This syndrome is common. People are more concerned with the lives of those who have died (Marilyn Monroe, Elvis) than those who are living. How many books, TV shows and movies are devoted to the biography of someone who lived in the past? It is as if the viewers are trying desperately to learn something from these individuals, either to make their own lives better or to prove there is something more to life than what they have already found. Perhaps it is important to look at why people find more interest in the past than in their current lives. There may be a way to help them appreciate their present lives more than dwelling on some time they believe was better, but actually was not.

Similarly, as noted by Trip, obsession is another theme that runs through Virgin Suicides. The boys -- now men -- remain plagued over something that happened many years earlier. "Many of us continued to have dreams in which the Lisbon girls appeared to us more real than what they had been in real life" (238). What does this say about their characters? Their present-day lives? They find something that occurred so long ago more important than what is happening in their lives today. Virgin Suicides is saying that it is important for anyone who is involved with a suicide to do whatever possible to help that person; however, if all fails, then to make the best of one's own life.

Norwegian Wood by Murakami is also a flashback. The novel begins with the introductory chapter in which the 37-year-old narrator, Toru Watanabe, hears the sweet orchestral cover version of the Beatles' song "Norwegian Wood" and is reminded of his life almost 20 years earlier. The rest of the book retells the events of those times.

In high school, Naoko and Toru's are close friends. The two have great difficulty accepting the suicide of their 17-year-old best friend, Kizuki. In fact, they do not see each another for nearly a year after the funeral. They meet by chance in Tokyo, while going to college, see each other once and a while, and make love one time. After Watanabe sleeps with Naoko, he says that "her cry was the saddest sound of orgasm I had ever heard" (40). Naoko, who is emotionally unstable because of the earlier suicide, leaves Tokyo and returns to her family and then goes to live in an institution.

After Naoko leaves, Toru meets Midori, a vibrant and emotional woman who confuses him about his loyalty to Naoko and offers him a love, that he says, "stands and walks on its own, living and breathing and throbbing and shaking me to the roots of my being" (268). Toru becomes torn between his promise to help Naoko recover and his desire to begin a more fruitful relationship with Midori. He visits Naoko in the asylum and also deepens his involvement with Midori, who demands a commitment from him: "You were so nice to me when I was having my problems, but now that you're having yours, it seems there's not a thing I can do for you. You're all locked up in that little world of yours, and when I try knocking on the door, you just sort of look up for a second and go right back inside."

Naoko commits suicide, which pushes Toru into a period of searching and finally a deeper self-understanding. Toru writes: "I had learned one thing from Kizuki's death, and I believed that I had made it part of myself in the form of a philosophy: 'Death is not the opposite of life but an innate part of life'" (273).

Like Virgin Suicides, this book is about young people searching for answers. Some, like Naoko, find them in not going forward. Others, like Toru, put aside the hardships and move on. Unlike Naoko, he can be older than 20. He does not have to waiver from 18 to 19 and back to 18 again. He does choose to live, when so many others around him are choosing to die.

Similar to Virgin Suicides, Norwegian Wood relates the story of how individuals react to suicide. In the former, the boys, then men, are obsessed. They continue to look for answers to why the girls made their decisions and are almost lost in that time period. They cannot actually get on with their lives for living so much in the past. Toru, however, is able to move on. As he says to Reiko: "We were alive, she and I. And all we had to think about was continuing to be happy." The readers are not exactly sure if the two end up together for good, but for now this is what he wants, for although he says, "All I want in the world is you. I want to see you and talk. I want to begin everything from the beginning," he still admits to being dead center of this place that was no place."

Both of the books contain the mysteries inherent in life. In Virgin Suicides, the characters do not seem to gain from their search. In Norwegian Wood, Murakami makes the reader realize again and again that no one may truly understand the reasons behind events, especially not the behavior and decisions of others. However, this is all right as long as people learn more about themselves through the search that will make them happy. Murakami does not solve the mystery of loss, or life, he is just forcing the readers to recognize that these things exist.

This is a difficult lesson one learns when growing up: the knowledge that it is impossible to control everything in life, although it is so useful in an increasingly stressful and complicated world. Murakami does not provide any answers, or cliched explanations. He only demonstrates the facts and the characters' ways for coping with them. Readers must feel good not with what eventually happens between Toru and Midori, but with the fact that Toru has moved beyond the insecurities of young adulthood and can now face the greater challenges that will come in the future.

In Japan, Suicide is even more of a problem with youth than it is in the United States, because great pressure is put on students to perform in school. Even when they are in pre-school, they must be at a certain level in order to know that they will progress as they get older and have a good job. Competition is brutal.