IT IS a ghastly and self-evident fact that almost everything we know about the hours and moments before suicide comes from the living. We can speculate on the motives of those who kill themselves, we can try to understand their depression and we can express sympathy to them and to those who love them, but only those who have somehow survived a suicide attempt can enlighten us further.
One such person is the writer and critic Al Alvarez who, as a young man, reacted to a failed marriage by attempting to kill himself. He refers to “the closed world of suicide” because, he says, that is how chronic depression makes you feel.
“When that kind of depression gets hold of you, you get shut off from everything. If it’s raining, it’s not raining on eight million people who live in London, it’s raining on you. Everything contributes to your depression: you stub your toe, you lose your house key, and everything is intolerable, and you seek a way out.”
Such small domestic details may seem irrelevant, but those who work with people who are chronically depressed know that they are not, and insist that it is inappropriate to suggest that people who kill themselves are selfish or egocentric. Again, we can not know what drove a man in his early thirties to stop his car on a level crossing in Berkshire late on Saturday afternoon — an act that can have been done only in the knowldege that the 5.35 train from Paddington to Plymouth was due and would be travelling at 100mph — but we can be sure that he was unaware that the violence of his death would have fatal repercussions for the train driver and seven of its passengers, says Sarah Nelson, of the Samaritans.
“It would be wrong to say that suicide is always a selfish act,” she explains. “Usually people in a suicidal state are in so much pain that they are unable to focus on anyone or anything else. It is almost a form of tunnel vision: taking their own life is the only way forward and they are not necessarily aware of the consequences of their actions, or the damage that they are doing to other people.
“They are unable to see anything objectively any more. We don’t yet know that this case was suicide, but to stop on a level crossing is an extreme solution. Everyone can probably relate in a small way to feeling so overwhelmed by sadness or happiness. If you can imagine that to the nth degree, that gives you some understanding of how people feel when they decide to end their life.” While research into suicide continues, professionals working in this field have been pleasantly surpised to note that the suicide rate has dropped in the past couple of years, both worldwide and in the UK. This follows years of a steady climb in the number of those who have succeeded in killing themselves, which has been associated with the growing divorce rate and the increasing use of alcohol and drugs. Last year the rate of suicide and unexplained deaths fell to 84 per million worldwide, the lowest since the middle of the Second World War, The Economist magazine reported. Figures from the WHO suggest that Britons are now less likely to kill themselves than Americans or other Europeans, with the exception of the Greeks, Italians and Portuguese.
So why is suicide becoming less frequent? The Samaritans believe that the biggest factor is the 1998 legislation which limited the sale of over-the-counter pain killers: these can now be sold only in packs of 24 at chemists’ and packs of 16 elsewhere, and only one pack can be bought in any single purchase. This has reduced the number of suicides by an overdose of painkillers by 25 per cent, says Nelson.
“Primarily, suicide is an impulsive act, and if people don’t have enough painkillers at home to kill themselves, they can’t use an overdose as a way out of their situation.”
Thus the method of suicide is often a matter of opportunity, rather than one of planning. Other reasons for the drop in the suicide rate relate to technological advances: the phasing out of toxic coal gas in homes and its replacement with natural gas and, more recently, the development of catalytic converters for cars. These are now fitted to four out of five vehicles, removing the possibility of their depressed owners fitting a hosepipe to the exhaust and feeding toxic carbon monoxide fumes through the window. In 1996 gas led to the suicide of 672 men; in 2002 this figure had dropped to 265.
Instead, deaths from hanging and suffocation have risen and now account for 52 per cent of suicides, as Sue Simkin, a researcher in the Centre for Suicide Research at Oxford University, confirms. “In the past men were much more likely to use ‘violent’ methods such as hanging, shooting and jumping from a height, whereas women were much more likely to take pills. Now the number of women hanging themselves has risen.
“The number of deaths from drug-related poisoning among women has fallen and this may have to do with the change in antidepressant prescriptions from the more toxic tricyclic drugs to SSRI drugs, which are not as dangerous in overdose.”
That said, the Samaritans believe that the drop in the number of suicides is too recent to present firm conclusions about its provenance, or to suggest any change in social behaviour. Sarah Nelson does not accept that there is any evidence that people are becoming happier, and points out a corresponding rise in self-harm. “This is the indicator that suggests that people will become suicidal. We may have a group of cohorts who are behaving in a progressively more self-destructive way. So although there has been a downturn over the past two years, there are risk factors that may have an effect in future.
“Suicide is the result of an individual’s decision and it’s difficult to isolate specific social factors. There is a pattern: suicidal thoughts don’t come from nowhere.
“There is a reasonable amount of evidence that excessive alcohol intake can result in suicide, because alcohol affects the brain chemistry, and the same is true of drug use. If you are systematically abusing yourself with alcholol or drugs, you are more likely to take your life.
“Those who consider suicide may be having a dreadful time in a relationship, they may be having problems with their kids. They may come home and find another problem, which becomes the proverbial straw that breaks the camel’s back. And if they have ever thought of taking their life, they try to find a way to make it happen.
“We hope that in these circumstances people will seek help, either from the Samaritans or their GP. This is particularly important as there is a stigma attached to admitting that you have these problems, and the neighbourhood network that once supported people has been eroded.”
Al Alvarez believes that he survived his suicide attempt because he was very fit. What did he learn from his experience? “The pleasure of being alive,” he replies.
