I see you’re wearing your fat clothes: suicide isn’t about what you think it is

One December night a couple years ago I came home from a pleasant evening spent wandering the Christmas market on the Champs Elysées with some friends to find a call from my mother.  My father’s heart had stopped in the emergency room–twice.  By an amazing stroke of luck, his cardiologist had been passing through at the time, and he had resuscitated him.  They pumped on his chest, they shocked him–lots of times.  Now he was on a ventilator (a machine that breathes for you) in the intensive care unit, and it wasn’t clear whether he would survive the night.

I got on the phone with the airline, threw some clothes in a suitcase, and the next morning I was on the first plane out of Paris.  After crossing the Atlantic, and then North America, and then switching planes for the last leg from San Francisco to our home town in Oregon, I finally landed in Portland.  I grabbed a rental car and sped to the hospital.

I got to my father’s room.  He had survived the night.  He was doing well, all things considered.  The breathing machine had been removed.  The number of IV tubes, monitors, and other beeping and buzzing things that he was attached to was not enormous, given the circumstances.  He was still hoarse from the tube that had been in his throat as he greeted me in his own special way:

I see you’re wearing your fat clothes.

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(Your “fat clothes” are the clothes that a person whose weight tends to go up and down wears when their weight is up.)

This didn’t feel anywhere near as bad as it must sound.  In fact, my reaction was: Okey-dokey–looks like he’s doing fine!  And, I actually wasn’t anywhere close to as fat as I usually am, so it seemed like a win, as far as I was concerned.  It might not actually be the case that every cloud has a silver lining, but you can at least try to ignore the fucking cloud, right?

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I’m guessing that you laughed at my story.  Possibly you’re crying, remembering your own parents criticizing your weight, or your choice of clothes, or your choice of boyfriend, career, or political party–if so, I apologize.  In either case, my story probably made an impression.  Why?  Because it is so entirely different from what one would expect.

It’s differences that make things interesting.  I say that not as a statement about the value of diversity (although diversity is valuable) or about the value of surrounding oneself with dissenting opinions (although dissenting opinions are valuable), but as an assertion about why we are interested in things, and in particular, about why we read what we read.  Presumably you don’t pick up the newspaper in the morning to see what was the same yesterday as the day before–you pick it up to see what was different yesterday from what usually happens.  Roger Schank (famous artificial intelligence guy once upon a time, not-quite-so-famous Trump University guy more recently) has a whole theory about this being the reason that time seems to go by faster as we get older–the more we’ve already experienced, the fewer new things there are to notice, and so we just don’t notice time going by the way that we did when we were younger.  The excellent book They say/I say is based entirely on the notion that academic writing—you could generalize it to what the authors call persuasive writing, in which you try to convince the reader of your particular take on something—is most convincingly done by starting out showing how the position that you’re going to take runs counter to positions that have been taken previously.  Americans think that the French are rude, but they’re actually hyper-polite–you just have to know the differences between American etiquette and French etiquette to recognize it.  Paris is always portrayed as the city where everyone strolls leisurely in a state of Zen-like relaxation, but Monday through Friday, we’re all just rushing to work as fast as we can and hoping that nobody gums up the works by throwing themselves on the train tracks.  “French people are so nice” is not an interesting topic.  “Americans think that French people are rude, but they’re actually very polite”–that’s a bit more interesting.  Why?  Because of the contrast between what you thought was true, and what’s going to be asserted.

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Something that everyone knows is true: suicide is the coward’s way out.  I went looking for pictures to illustrate this statement with on Google Images, and they are legion.  Among the memes, posters, and tweets that I found were sentiments communicated by the following:

• Albert Camus, second-youngest winner of the Nobel Prize for Literature
• Seneca (not sure whether the Elder or the Younger–ironic, if the latter)
• Some sort of fuzzy baby bird
• Some entertainer I’ve never heard of
• A pretty girl
• A handsome guy
• A guru

However: despite the fact that “everyone knows” that suicide is for cowards, this turns out to be bullshit.  In fact, the distribution of suicide in society (in American society, at any rate) is not random: people with positions in life that we typically think of as requiring extra amounts of courage—police, military people and military veterans, prisoners, murderers–are more likely than the average person to kill themselves.  Lemme run a list of occupations with elevated suicide rates by you (lemme and to run something by someone explained below in the English notes):

• Military veterans
• Police
• Prisoners (an atypical study in that it includes data from 12 countries)
• Among prisoners, people convicted of murder or manslaughter have higher rates of suicide than others
• Sex workers (not sure why this paper gets cited a lot when people write about suicide rates in sex workers, but it does–my literature search kept leading me back to it.  Google Scholar shows that it’s been cited 373 times.  For comparison: my most heavily-cited article has been cited 275 times.)
• Physicians

Think about this: the instinct to preserve your life is pretty much the strongest instinct that any living thing has.  It takes a tremendous amount of courage to go against it.  Over and over, when you look at the statistics from the studies that I listed above, what you see is the following: people who are a lot tougher than you and me are at a higher risk for suicide than you are.  It’s not a game for cowards–it’s really and truly a game for people who can look death right in the eye, and step forward, against every living being’s strongest instinct.

Thomas Joiner’s book Why people die by suicide explores this issue and its implications in depth.  He makes the point that killing oneself requires overcoming what may be the strongest drive in human beings: self-preservation.  (You don’t buy it?  Pick up a razor and see if you can slit your wrists.  No, not your wrists–just a little cut someplace where it won’t do you any damage.  Did you do it?  I thought not.)  His theory is that self-harm is essentially a learned behavior—that you must, in essence, be trained, or train yourself, to have the capacity to kill yourself.  You must be fearless, and you must be able to tolerate pain.  See that photo of a Japanese army officer about to kill himself?  See that diagonal straight line to the left of the photograph?  It’s a rifle.  After the officer opens himself up with his sword, that guy shoots him in the head to put him out of his misery.  (Back in the day, after you cut yourself open, one of your samurai buddies took your head off with a sword.)  Yes, I spared you the next picture in the series.  If you want to see it, follow the link.

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So, why do people kill themselves?  I don’t claim to know.  I’ll give you a quote from the Harvard University Press notes on Joiner’s book:

Among the many people who have considered, attempted, or died by suicide, he finds three factors that mark those most at risk of death: the feeling of being a burden on loved ones; the sense of isolation; and, chillingly, the learned ability to hurt oneself.

http://www.hup.harvard.edu/catalog.php?isbn=9780674025493

(You might notice that I’m not crediting the sources of any of the “suicide is for cowards” memes that I included earlier in this post–from my point of view, the authors are welcome to shove the lack of a citation up their butts.)

If you know someone who killed themselves, the two questions that you’ve been asking yourself ever since are probably:

• Why did they do it?
• Could I have prevented it?

With respect to the first question: probably nobody knows but the person themself.  With respect to the second question: probably not.  We can’t know what could have happened, right?  But, I can tell you this: psychiatrists, psychologists, and licensed clinical social workers spend years learning how to prevent suicide, but they definitely cannot always do it.  I don’t know how you could expect yourself to do any better than a trained psychiatrist.

You might be able to do something about somebody else’s suicide, though.  For psychiatric disorders, language plays a central role in diagnosis. Applying language technology in this domain could potentially have an enormous impact.

Seulement voilà–the thing is–if you want to use computers to do things with language, then you need language data with which to train and evaluate the computer.  Until recently, if you wanted to get your hands on actual data, here’s what was available: you could obtain a set of suicide notes collected and annotated by my colleague John Pestian at Cincinnati Children’s Hospital Medical Center (and me and a bunch of other people). That data has been revealing, and we’ve learnt things about suicide from that data that we didn’t know.  But, that data was hard to come by.  Putting that data set together took years (if you can read French, you can find a paper here on some of the issues), and if you want to get your hands on it, you need to go through some hoops to demonstrate that you have a legitimate research interest, that you will not be posting people’s suicide notes on Facebook or Pinterest, and so on.

Social media has completely changed the landscape of the availability of linguistic data, including linguistic data related to depression and suicide.  In fact, the past couple years have seen an explosion of work on the linguistic characteristics of mental states associated with mental illness, including suicidality.  But, you can’t just grab it–just because people post their lives on social media doesn’t mean that it’s OK for you to use that stuff for your own purposes.  Ethical questions abound, and that’s just as true for the tweets, posts, or whatever of the psychiatrically healthy controls as it is for those with mental illness, suicidal behavior, or whatever.  And that’s where you come in.

OurDataHelps.org is a group that collects social media data, particularly linguistic data, for use in doing research like the stuff that I’ve described here with the goal of suicide prevention.  They want your data if you have ever flirted with suicide, but they want your data if you haven’t, too–you always need something to compare to, and people like me need data from non-suicidal people to compare to the data from suicidal people.  That could be you!  Check it out: OurDataHelps.org.

Not that you care about my point of view, but: I support people’s right to kill themselves. As the famous suicidologist Ed Shneidman put it in an interview with my colleague John Pestian: you ask me how many suicides I want?  I want zero.  But, I support the right to do it.  

This is a pretty prevalent attitude amongst suicide researchers.  My goal here is to give the person a chance to be shown that they have some options that they might not know they have–but, in truth, my motivation is less to prevent your death than it is to spare the people that you would leave behind the pain of losing you.  Ultimately, you have the right to end your life, if you choose to do so.  But: you probably won’t do it unless you believe that the lives of your loved ones will be improved by your death.  It won’t be, and it’s actually for them that I do the work that I do in this area.

English notes (no French notes today)

• lemme: an informal way of writing the informal pronunciation of “let me.”  Don’t use this in work- or school-related emails, but it’s totally fine in casual written communication.
• to run something by someone: to get someone’s input or permission.  I’m going to run my abstracts by Pierre and see what comments he has.

In fact, there are a bazillion expressions with run and a preposition.  (You might remember that bazillion is a word that means a large, but unspecified, number.)  Off the top of my head: