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The Mystery Of Suicide

THEY INHABIT A STRANGE pantheon of the suicidal, prowled by brilliant, troubled ghosts. Some came to grief in the nightfall of acclaimed careers, some in the withering, high-noon glare of public adulation. There are Hemingway and Plath, Monroe and Garland, dead by premeditation or by cumulative acts of self-destruction. There are Presley, Morrison, Hendrix and Joplin, all of them fatally overdosed on drugs and fame. Some are noted almost as much for the manner of their deaths as for the impact of their lives. Last summer a depression-prone White House counsel named Vincent Foster burst into unwelcome national prominence with his final act, a self-inflicted gunshot wound to the head. And last week police in Seattle found the bloodied body of Kurt Cobain, leader of the hugely popular group Nirvana, sprawled in his home. He had apparently killed himself at least a day earlier, the police said, with the shotgun they found resting against him.

Once again, the rock world was shaken by the death of one of its gifted young artists, a tragedy that seems endemic to the pop-music scene. To many it was all too predictable. "The whole thing reeks of cliche: "Pop icon commits suicide'," said Chris Dorr, a 23-year-old Seattle college student. "It makes you wonder if our icons are genetically programmed to self-destruct in their late 20s."

But Cobain's death hit hardest in Seattle. Thousands of grieving callers bombarded local radio stations, prompting the stations to broadcast crisis-hot-line numbers and organize a candlelight vigil for Sunday. Meanwhile, dozens or mourners gathered outside his house, leaving flowers and carting off mementos.

Suicides always take their own portion of mystery with them, as President Bill Clinton suggested after Foster, his close friend and aide, killed himself. For all the recent advances in the study of behavior, there's still much that doctors don't understand about the persistent phenomenon of people taking their own lives. "We can't talk with the person who committed suicide, so we can only piece together the data," says psychiatrist George Murphy, of Washington University in St. Louis. But researchers are making a determined effort to chart the process, and what they're finding, especially on the cutting edge of brain science, may help bring down the annual toll of suicide deaths.

That toll, of course, takes its full measure on those left behind. Suicides don't simply give up on life: they leave a smear of nullity behind them. Their private act of negation attacks our own often tenuous sense of a meaning in existence. It's a kind of desertion, making everyone feel a little less defended against nothingness. "The suicide does not play the game, does not observe the rules," wrote the novelist Joyce Carol Oates in a 1978 meditation on the subject. "He leaves the party too soon, and leaves the other guests painfully uncomfortable. "

In life, Cobain was often in pain. Until his death, he was scarcely known outside the youth culture. But his band, most of whose bitter-edged lyrics he wrote and sang, had become the authentic voice of the 20-plus generation. In the few years since its formation, Nirvana helped establish grunge rock as the sound and style of '90s disillusionment. Its 1991 album, "Nevermind," sold nearly 10 million copies, and one of its songs, "Smells Like Teen Spirit," has become a virtual anthem for the rebellious young.

Cobain's life. began unraveling not long after his band hit the charts, bringing him attention he couldn't seem to handle. He felt besieged by fans and critics. Between bouts of heroin abuse, he was subject to episodes of depression. Yet friends described him as gentle and caring, not really prone to the violence that surrounds much of the rock culture. Small and almost frail-looking, he wrote music that was oddly melodic despite the abrasiveness of its lyrics. But in the end, by some process still unknown, the sadness of life led him to put a shotgun to his head.

In most instances, suicide seems an enormously selfish act. One of the strongest arguments against it is the harm it can do to others, especially the shattering legacy of guilt and grief it bequeaths to the family of the deceased. Many people reacting to Cobain's death expressed concern about what it might do to his 19-month-old daughter, Frances Bean, the only issue of his troubled marriage to singer Courtney Love.

On the other hand, libertarians and others posit a "right" to suicide, especially for the elderly and the ill. Some argue that such suicides, while tragic, maybe "rational" -a proposition that Michigan's Dr. Jack Kevorkian is testing in the courts. "There's an honest debate going on, especially on the front of physician-assisted suicides," says clinical psychologist David Jobes, of Catholic University in Washington, D.C. "Should we continue to uphold the principle that suicide is never acceptable? That's the hottest evolving area in the field."

Whatever the ethics of suicide, researchers are digging closer to its roots. The 19th-century French founder of sociology, Emile Durkheim, thought the source lay in the ups and downs of society itself Modern researchers put more emphasis on genes and neurotransmitters. Nor do all agree with assertions that the primary cause is "life stress." Says Dr. David Clark, director of the Center for Suicide Research and Prevention at Chicago's Rush-Presbyterian St.Luke's Medical Center: "That's the lay public assumption and that's what drives a lot of suicide-prevention work. And it simply doesn't hold water."

Researchers know, says Clark, that there's as much suicide among the rich as there is among the poor and the middle class. They cite a wide range of potential suicide triggers, from loss of employment or loved ones to aging and physical impairment. But, in almost all cases, they agree there is an underlying psychiatric illness -primarily depression, followed by alcoholism and substance abuse. Clinically depressed people are at a 50 percent greater risk of killing themselves. But the doctors can't agree on whether suicidal depression itself is a state of mind or a result of chemical deficiency. The good news, if there can be any about suicide, is that it's a relatively rare event: 99.9 percent of Americans don't kill themselves; for better or worse, they stick to the rules-the unspoken "covenant" we all have with each other to affirm life even, perhaps, when there's little left to affirm. The figures tend to climb and fall in waves, but they've remained stable in this country since the end of World War II: at the latest count, around 30,000 people took their own lives in 1991. Gender differences have remained fairly steady as well. Females, by around 3 to 1, attempt suicide more often than males, but males, partly because they employ more violent means, are four times more likely to die. It's estimated there are 20 persons who try suicide for every person who tries successfully.

The rate for teenagers, after climbing steeply for two decades, began leveling off in the mid-1970s although it's still not dropping as experts had hoped. The only groups going against the grain are black males and the elderly, especially white men over 65-many of them perhaps victims of the loss of status and income incurred with retirement. The increase among blacks, some demographers guess, might be because suicide is part of the continuum of violence and despair that surrounds many of them. The old are getting older and healthier; their suicide rate dropped through much of the century after 1933. Yet since about 1980, the rate has begun climbing to higher levels. Yeates

Conwell, a geriatric psychiatrist at the University of Rochester, conjectures that as they live longer, people are also growing frailer, more isolated, and harder to find and rescue. The suicide rate for the elderly is higher all over the world than it is for teenagers and young adults, says Conwell. "But it is in the U.S. that we find more elderly men committing suicide."

No profile of likely suicides has emerged. However, there are some typical signs to watch for. According to Clark, for instance, in about two thirds of cases there is usually some form of suicidal communication before the actual attempt. Edwin Shneidman, emeritus professor of thanatology at UCLA, who founded the American Association of Suicidology, was also the leading developer of the "psychological autopsy," aimed, among other things, at finding such patterns. Reviewing several years' worth of postmortems, Shneidman and his colleagues at UCLA found that around 90 percent of the suicides left clear behavioral and verbal clues, such as giving away possessions.

Shneidman, although one of the pioneers in the field, has also become one of its mavericks. He objects, for instance, to the emphasis that mainstream suicide researchers place on psychiatric illness, preferring, he says, the Oxford English Dictionary to psychiatry's diagnostic manual. No one dies of depression, he says. "It's not a tenable entry on the death certificate."

As with much of psychiatry these days, the real cutting edge of suicide research is in biochemistry. In the past few years there have been some exciting advances in studies of serotonin, the ubiquitous neurotransmitter that modulates the action of other brain chemicals. A variety of violent, impulsive behaviors have been associated with low levels of serotonin. And Dr. Frederick Goodwin, head of the National Institute of Mental Health, reports that 22 of 22 autopsy studies of brains and body fluid have also connected low levels of the chemical with suicide. Since the newer antidepressant medications, like Prozac and Zoloft, are aimed specifically at boosting serotonim Goodwin says, doctors may eventulally have a selective way to treat depressions associated with suicidal behavior.

Lately, researchers studying particular types of serotonin-related suicide have discovered they tend to be the more serious attempts-those characterized by careful planning and greater medical damage. According to psychiatrist J. John Mann. head of the NIMH research center at the University of Pittsburgh School of Medicine, studies in Sweden of hospitalized depressives with low serotonin levels found that about 20 percent committed suicide within the year. In another group with normal levels, between I and 2 percent killed themselves. "That's a tenfold greater risk." says Mann. It remains unclear why sonic people have low serotonin levels. Mann believes the reasons could be genetic, developmental or environmental. Not surprisingly . he notes, men tend to have lower levels than women. "That may be one of the reasons -by two or three men complete suicides compared with women. We don't know if it has any relationship to [unsuccessful] attempts."

What researchers do know, says Mann, is that a person's serotonin level reveals "some sort of vulnerability" to suicide. "This is the biggest leap we've made in terms of identifying people at high risk, as well as offering meaningful intervention." The serotonin connection points the way not only to a potential screening technique, but to treatment. By raising serotonin levels, as the newer antidepressants do, researchers believe they can raise the threshold for acting on suicidal impulses. "It's similar to the way we're treating epilepsy today, by raising the threshold at which seizures occur," says Mann. "In the short term, our hypothesis is that antidepressants may reduce your chances of acting on suicidal thoughts. We believe the antisuicidal effects occur before the antidepressant effects kick in."

But some treatment may actually increase the risk of suicide. "When a person is profoundly depressed," says Goodwin, "what protects them is, they can't figure out how to kill themselves. Suicide requires energy, and they don't have it." With treatment, the first thing that comes back is energy and functional capacity. "When they become activated and are still depressed, that is a very dangerous period," he says, "so drugs have to be carefully monitored."

While science tries to piece together the suicide puzzle. other forces seem determined to muddle it. Goodwin is irked by such opportunistic books as the best-selling "Final Exit," a kind of how-to manual for would-be suicides, although the way the book was snatched up suggests many people saw no reason to shun such advice. He thinks, also, that the attention given to Kevorkian's suicide machine "trivializes" suicide and ignores the fact that in Western culture it is not looked on as a normal practice. Rather, he says, "people go to enormous lengths to stay alive, even under the worst possible conditions."

On the whole, we are life-affirming, but it's an affirmation that often needs boostering. "Every one ... is bound to preserve himself", wrote the 17th-century English philosopher John Locke, "and not to quit his station willfully." Locke was talking about an obligation to the Creator, but it's also a duty we owe to ourselves, our families and the society we live in.

% OF TOTAL NUMBER OF SUICIDES IN U.S. TN 1990

Firearms           61.0
Hanging &          14.5
Strangulation 
Gas Poisoning       7.5
Other Poisoning    10.0
Other               7.0

SOURCE: BUREAU OF THE CENSUS

RATES PER 100.000 IN  1970

White Male     18.0
Black Male      8.0
White Female    7.1
Black Female    2.6

DEATH RATES IN 1980

White Male     19.9
Black Male     10.3
White Female    5.9
Black Female    2.2


DEATH RATES IN 1990

White Male    22.0
Black Male    12.0
White Female   5.3
Black Female   2.3

SOURCE: BUREAU OF THE CENSUS