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Suicide

Choosing Death Over Life

The role of intent in suicide.

Key points

  • Suicide has always been part of the human experience.
  • Although suicide is believed to be a matter of pure choice, social and psychological factors suggest this might not always be the case.
  • Motivations to suicide are typically lost to the ether.

Of the eight billion people on our tiny blue planet, sixty million will die this year. Nineteen million from cardiovascular diseases. Ten million from cancer. Almost seven million from respiratory diseases and infections. And eight hundred fifteen thousand will complete a suicide. The enormity of a number in the hundreds of thousands obscures the inference that suicide is rare, but substituting absolute numbers with the rate of occurrence helps: for every fourteen and a half people who kill themselves, one hundred thousand do not.

Attempts, however, border on common. Eighty million people will try to kill themselves this year, a rate outpacing death. Additionally, 490 million adults have, at some point in their lives, seriously considered suicide. Even so, most people never seriously think about it. Of those who have, the vast majority never make an attempt. And for every one person who completes a suicide, ninety-eight continue to live.

Suicide is often introduced, without context, as a “leading cause of death.” Alone, such declarations are misleading. Of the thirty-one causes of death tracked by the Institute for Health Metrics and Evaluation, the top fifteen account for 92.24% of all deaths. Suicide consistently ranks at or near sixteen, accounting for 1.34% of all deaths.

Though infrequent, suicide has always been part of the human experience. One of the earliest known references to it is a 4,000-year old dialogue where an Egyptian man petitions his uncooperative ba (soul) to help end his earthly existence. In it, the agitated, annoyed narrator argues that people are untrustworthy, he is hated, and a more pleasant life awaits him in the afterlife, where he will be like a god. His ba shoots down these assertions. It suggests another course: Set his ”heart’s distress” aside and pursue happiness. Nevertheless, the ba leaves the choice to the narrator.

[Author’s note: If you’re considering suicide, please call (800) 273.8255 to speak with a counselor.]

But is suicide a choice, as suggested so long ago? Or is it an act outside of someone’s control?

Modern definitions of suicide tend to rely on three factors: (1) a passive or active act of self-destruction, (2) death or injury, and (3) intent. The first two factors are unambiguous. However, questions regarding intent have long vexed suicide researchers.

Determining intent can be easy in cases of altruistic suicide where, for example, a person might give their life to save others, or in the extinct practice of jauhar, where entire communities sometimes jumped into a fire rather than endure rape, murder, mutilation, and other atrocities committed by invading armies in times of war. It can also be easy in cases of voluntary euthanasia, where a person requests their life be terminated by a doctor because of perpetual pain or illness. However, in the deaths we usually think of when we hear the word suicide, those where a person happens upon the aftermath of a loved one’s final act, intent can be much harder to determine.

The first issue is that the suicidé (a French word borrowed by anthropologists referring to the person contemplating, attempting, or committing suicide to avoid the English convention of using suicide to refer both to the act and the victim) isn’t alive to tell others what they intended. Most leave behind no note. Most notes omit explanation. Thus, motivations are lost to the ether.

However, evidence suggests some suicidés express their feelings to loved ones, who either reject the idea that the cause of the suicidé’s feelings warrant self-destruction or don’t know how to respond. Thus, a person may reach out for help and receive none.

[Author’s note: Read this guide from the Mayo Clinic to learn the signs that someone may be considering suicide and what you can do next.]

Without clear statements, the task of determining intent falls to friends, families, and official agencies. But the system used to determine a cause of death can obscure it. Many agencies use the NASH (natural, accidental, suicide, homicide) system, ruling out one possible cause before moving to the next. If a death is mistakenly ruled natural or accidental, the question of intent is never reached.

Additionally, suicide is almost universally considered a “bad death.” In some places it is worse—a crime or sin or both. Where penalties for suicide are severe, a suicidé may never reach out for help. If they die, officials and loved ones may make efforts to classify the death as anything other than a suicide. Despite these issues, researchers are confident that most deaths are categorized accurately.

A second issue is the tension between agency and patiency. Definitions of suicide require agency, if for no reason other than to distinguish them from accidents. However, current definitions include factors that partly deny a suicidé’s agency.

For example, an estimated half of all decisions to suicide take five minutes or less. In this atomic amount of time, a person can spend a lifetime ruminating, stuck in a feedback loop, overwhelmed with emotion, trying again and again to find a way past a dreadful pain only for it to hurt just a bit more each time they conclude there are no viable solutions to their current situation except one. Unfortunately, that one solution is irreversible.

If they take no action (like most people), their life continues but the story ends. Suicide narratives seldom make space for those who decide against it.

If instead…, then this scenario presents the issue of whether a person who acts on impulse has agency. According to the DSM-5, impulsivity “involves the tendency to act on a whim, displaying behavior characterized by little or no forethought, reflection, or consideration of consequences.” Impulsivity may be a trait, or someone who is usually more restrained may exhibit diminished impulse control for a variety of reasons.

Substance abuse presents the easy case against agency. Drugs and alcohol alter brain processes, often resulting in a loss of inhibitions. Trait impulsivity is harder. A person can fully consider decisions in five minutes. Also, it’s impossible to know how many times our hypothetical suicidé has considered taking their life before acting. Finally, more than half of people who attempt suicide try again—a point in favor of agency.

Even harder is when someone is affected by one of the various impulse-control disorders described by the DSM. Some lean towards agency. Others patiency. Others, both, and simultaneously. Some stem from abnormally low serotonin levels, leaning toward patiency. Some can be improved by teaching someone skills to take them out of the moment, indicating that a suicidé still has agency, even if, in the moment, they can only use that agency to step off the treadmill.

A final, confounding factor stems from culture (information acquired from teaching, imitation, and other forms of social transmission capable of affecting an individual’s behavior). Suicide rates vary by country and within countries. But, if someone raised in Barbados (0.3 per 100,000) moves to South Korea (21.2 per 100,000) or vice versa, their probability of suicide will tend toward the rate of their home. Additionally, media depictions of suicide are believed to influence imitators—to the point that the World Health Organization has published a media guide on the subject. Is agency present if the idea would never occur to someone? Is it absent if the idea came from a work of fiction?

Suicide can result from choice or from factors that take choice out of someone’s hands. English doesn’t have a word to account for gradations of agency. But it doesn’t have to. Instead of contorting the word intent, researchers should opt for definitions of suicide that include (1) the word non-accidental (to account for accidents) and (2) a sliding scale of agency (to account for the full range of cognitive possibilities).

We wish to know, in advance, who will attempt to take their life so that loved ones can shout, “Don’t do it!” But we can’t look into someone’s mind and view the threads that form the tapestry of their life. We can, however, be good friends, guarding against social isolation and hopelessness before, during, and after times of intense psychological pain. Though moving past pain takes more than just putting one’s heart’s distress aside, perhaps our voice will be one among many whispering in their ear, arguing against self-destruction. And hopefully, they will choose life over death.

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