Letters from Maine

Is the rise of suicide a medical or societal issue?


It’s hard to ignore the recent report from the Centers for Disease Control and Prevention revealing suicide rates went up by more than 30% in half of states since 1999 (“Suicide rates rising across the U.S.,” CDC Newsroom, June 7, 2018). My professional experience with suicide is limited to one former patient who died several years after aging out of my practice. His death was not a total surprise. The cornerstones of the situation he felt he couldn’t escape were well in place when he was a freshman in high school. I’m sure there was more I could have tried to do at that early stage. Although he was anxious and mildly depressed he never admitted to being suicidal.

An unhappy teen sits on the floor in a hallway at school Lisa Quarfoth/Thinkstock
Among all the print and media articles that have appeared in the wake of the CDC’s announcement and the two recent celebrity suicides, the one I found most insightful is Roxanne Roberts’ personal account written in 1996, 20 years after her father’s suicide and republished in the Washington Post June 10, 2018 (“Suicide is desperate. It is hostile. It is tragic. But mostly, it is a bloody mess”). The veteran journalist lays out the discouraging statistics about suicide on a canvas painted with the ugly details, beginning with her having to clean up the gelatinous mix of her father’s blood and brains congealed on the kitchen floor. She describes her father’s suicide as a hostile and tragic act that left in its wake unresolved questions of guilt and anger that tore apart the already fraying seams of a less-than-perfect family.

Just as in Ms. Roberts’ family, the CDC report has elicited a fresh round of finger pointing and introspection in our country at a time when it is already struggling to find a sense of its own identity. Is it too many guns? Or too few mental health professionals? Or a broken health delivery system?

Dr. Richard A. Friedman, a psychiatrist at Weill Cornell Medical College, writes in the New York Times that “suicide is a medical problem” and that we should declare war on it “as we’ve done with other public health threats like HIV and heart disease” (“Suicide Rates Are Rising. What Should We Do About It?” June 11, 2018). Although it may be contagious with outbreaks and clusters, particularly in the wake of celebrity suicides (“The Science Behind Suicide Contagion,” by Margot Sanger-Katz, The New York Times, Aug 13, 2014), I’m not so sure that suicide is a medical problem. Certainly, it can be spread by a vector, in this case the ubiquitous news media. With more exposure, suicide has become if not the norm, at least in certain subgroups a socially acceptable management option for an unhappy life. But while there are other features of suicide that tempt us to retreat into our comfort zone of the medical model, we need to face the more realistic and unsettling explanation that the increase in the suicide rate is the symptom of a sick society.

Dr. William G. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years.

Dr. William G. Wilkoff

Despite a level of electronic interconnectivity that few could have imagined 50 years ago, ironically we have become more isolated from one another. A sense of community has given way to a focus on personal development. And a reverence for commonality has been replaced by a worship of difference. The good news is that the definition of the family has broadened to include nontraditional gender relationships. But the bad news is that overall the institutions of marriage and family have become devalued. The less resilient among us are like the canaries in the mine. Being more sensitive to the isolation we see all around us, they are more likely to choose suicide as a solution.

We already are making a mistake by interpreting the apparent rise in distractible behavior as a disease that requires medication. Let’s spread a broader net as we search for answers to the alarming suicide death statistics.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Email him at pdnews@mdedge.com.

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