The undiscovered country: Can suicide be predicted?
There are plenty of good reasons for this-shame, fear of involuntary hospitalization-but what if there were an additional reason: What if many actually weren't contemplating suicide, or were but somehow didn't know it? The Swedish device, which is called the EDOR and is manufactured by a company called Emotra, was billed as "a new and objective method for assessing suicide risk," one that "Has proven itself amply in clinical practice." It promised to tell you what you might not be in a position to intuit yourself. If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255. A reader of a late-nineteenth-century edition of Chambers's Encyclopaedia would find committing suicide described as a "Heinous crime," for which the punishments included "An ignominious burial in the highway, with a stake driven through the body." Today the National Institute of Mental Health cautions against saying that a person "Committed" suicide at all; better to say that they "Completed" it, to avoid the implication of an illicit or criminal act. Most famously, there was Émile Durkheim's 1897 Suicide, which followed from the notion that the phenomenon is "Dominantly social," and thus "Contemporaneous with some passing crisis affecting the social state." The book prefigures some of the modern studies in its tortuous classifications and its reverence for data, but it's far more useful-and in far wider use today-as a demonstration of sociological method than as a document with true and interesting things to tell us about suicide. In the 1974 anthology The Prediction of Suicide, the editors refer to a meeting hosted by the National Institute of Mental Health a few years earlier in Phoenix, at which the consensus view was that the discipline possessed a "Very flimsy basis of knowledge." The group agreed that "During previous decades the cart had been put before the horse." They argued that too much energy had gone toward suicide prevention and that "Too little effort had been made in establishing a firm empirical foundation for defining and ascertaining the causes." Thus, their work should be oriented toward determining the real risk factors, toward finding some way to predict the unpredictable. According to the Philadelphia Inquirer, the University of Pittsburgh's Endowed Chair in Suicide Studies, David Brent, had partnered with the Carnegie Mellon cognitive neuroscientist Marcel Just on a study that used fMRI brain scans to "Predict who will attempt suicide," an approach that had so far netted them a grant of almost $4 million from the National Institute of Mental Health. In the Nineties, Shneidman published a kind of manifesto warning that the discipline had "Jumped too quickly into positivistic-behavioristic empiricistic sciences," which, he believed, "Are not capable of dealing with the phenomenology of human suicide acts." Among the ideas he singled out for criticism was precisely the search for biological explanations, the way in which he'd begun to see suicide discussed "In terms of synapses, MAO inhibitors, bipolar depressions, and neurotransmitters, or any other reductionistic physical language." I read the quote to Brent, and asked what he made of it.