in Articles, Opinion

Guns and Suicide

Friends sometimes disagree with my explanation of suicidal behavior: I see it as an attempt to solve problems that seem overwhelming and interminable. Many people I’ve spoken to view suicide as an act of selfishness. Despite the difference of opinion, both viewpoints see suicide as a choice. I have encountered no one who views suicide as an accident that happens when a person is unwise enough to keep deadly devices on hand.

That, however, seems to be the position of the Associated Press. On the heels of a historic Second-Amendment decision by the U.S. Supreme Court, the AP reported that gun ownership increases the odds of suicide. The story begins:

“The Supreme Court’s landmark ruling on gun ownership last week focused on citizens’ ability to defend themselves from intruders in their homes. But research shows that surprisingly often, gun owners use the weapons on themselves.”

That opening paragraph conjures images of a landscape littered with gun owners who were unable to resist the urge to fire upon themselves. Let’s look at some actual numbers. Roughly one in 10,000 Americans commits suicide; one in 20,000 Americans commits suicide with a gun. Yes, this is a serious problem – one that I work with on a regular basis. When confronting serious problems, I find it useful to avoid hysterics. By no objective measure are gun-owners turning weapons on themselves “surprisingly often.”

In an apparent effort to cast suicide as happenstance rather than an option motivated by real-life problems, the AP offers two main pieces of evidence:

“Public-health researchers have concluded that in homes where guns are present, the likelihood that someone in the home will die from suicide or homicide is much greater.

“Studies have also shown that homes in which a suicide occurred were three to five times more likely to have a gun present than households that did not experience a suicide, even after accounting for other risk factors.”

The unnamed public-health researchers obviously proceeded from the belief that owning a gun is a risk factor for suicide. In other words, owning a gun increases your chances of intentionally killing yourself. This may be statistically true in the same sense that anyone involved in a traffic accident is likely to own a car. But the assertion betrays a fundamental misunderstanding of suicide risk factors and suicidal behavior.

Why People Kill Themselves 101

A risk factor is a characteristic that increases the odds of an unwanted outcome. My profession has extensively catalogued factors that most frequently accompany suicide. For example, half of all completed suicides are committed by white males over the age of 35. That means that being 36, white, and male are suicide risk factors. Divorce, health problems, and substance abuse increase the risk of suicide, statistically speaking.

However, no individual is a statistic. The vast majority of white males with multiple risk factors do not attempt suicide. Risk factors are marginally useful for early intervention but they are useless for predicting which people will attempt suicide. More importantly, risk factors do not cause suicide. Suicide is a problem-solving behavior.

When faced with problems that seem overwhelming, with no hope of relief or improvement, suicide can begin to seem like a reasonable option. Even attempts at suicide that seem designed to fail (overdosing on drugs is a particularly unreliable method) can provide temporary relief. Suicidal acts paradoxically relieve anxiety and emotional pain, and when things look bad enough that can be the only goal that matters. Suicidal behavior can also gain social support that was previously absent.

There are other individual and social components that contribute to the problem-solving behavior of suicide. The point is this: suicidal behavior does not result from a cosmic roll of the dice, and it certainly is not the result of owning a gun. Suicide is a complex process that develops over time as the result of problems and pain, beliefs about problems and pain, and a constellation of personality traits and social circumstances.

People tend to think long and hard about suicide before attempting it, and they tend to choose their means based on what they hope to accomplish. Those with the goal of relieving pain tend to choose less lethal means. Those with the goal of ending their problems finally and permanently tend to choose more lethal means.

Balancing Freedom and Compassion

Many (if not most) of my colleagues argue that outlawing guns would reduce the suicide rate. One scholarly article asserted, in typical academic style, that “we as a society must prevent shootings from occurring in the first place” and went on to lament that “many people feel they have broadly applicable gun rights under the Constitution” (Wintemute, 2008).

The U.S. Supreme Court is among those who “feel” that Americans have broadly applicable Constitutional rights. Even if “we as a society” were able to eliminate guns (a wispy notion since we have widely varying motives) we would not eliminate suicide because suicide is not a result of gun ownership. According to the World Health Organization, America’s suicide rate is far outpaced by countries like Japan and France where gun ownership is low. The more lethal means in those countries include hanging and poisoning. Where there is a will to solve a problem, there is a way.

There is no doubt that my colleagues who push for gun control are kind-hearted people. In a world where we must sometimes choose between freedom and security, they will err on the side of security out of compassion for their fellow man. But in so doing, they are misusing statistical risk factors and ignoring the more important forces behind suicidal behavior.

I, on the other hand, typically err on the side of freedom with a hefty measure of responsibility, and I am more interested in the function of suicide than the means.

Focusing on the function allows me to help people who are contemplating suicide. (I’m a nice guy too.) Naturally, I ask suicidal patients to temporarily surrender deadly possessions, whether they are guns, pills, poisons, or ropes. But I have dealt with more than enough suicidal patients to know that eliminating the means never eliminates the problem. As a clinician, it would be unethical of me to pretend otherwise. As a citizen, it is folly to pretend that denying freedom to everyone will help the minority who are struggling against overwhelming problems.

-IS

References
Stobbe, Mike (2008). Gun owners more often kill themselves than others. Associated Press. Downloaded July 10, 2008 from http://www.denverpost.com/ci_9747969.

Wintemute, G.J. (2008). Guns, fear, the Constitution, and the public’s health. New England Journal of Medicine, 358(14), 1421-1424.

World Health Organization (2007). Suicide Rates Per 100,000 by Country, Year and Sex. Downloaded July 10, 2008 fromhttp://www.who.int/mental_health/prevention/suicide_rates/en/index.html.