A cross-sectional observational study by S. Todd Stolp MD and Chandler W. Stolp PhD
May 2009

©July 2007

To question what it means to be human may not sound like a public health issue.  However, suicide, as narrowly defined, is a behavior that is distinctive only to humans.  Therefore, to scrutinize what it is about humans that accounts for this uniquely human tragedy may bring us to a better understanding of the phenomenon of suicide and contribute to minimizing its occurrence in our communities.

It is clear that other creatures will engage in behavior that results in the self-imposed death of the individual.  A scorpion will sting itself, a spider may lose its life upon mating, a mammal may die defending their young against impossible odds, and higher animals may die of starvation after the loss of a mate or die as a result of self-injury upon captivity.

However, as far as science can determine, none of these examples represent actions by otherwise healthy individuals that are chosen with the specific purpose of ending the life of the individual.  So what singularly human capacities make such a decision possible?

It is generally accepted that humans enjoy intellectual powers that provide us with unique perceptions.  This includes the ability to conceive of life span, life expectancy, and mortality – most notably our own.  People understand abstract concepts like taboo behavior, popularity, ethics, and cultural norms.  We inevitably construct some sort of self-image of ourselves by measuring how we perform against the norms that regulate the societies in which we live.  Unfortunately, when our own self-assessment leads us to perceive ourselves as falling far short of our own expectations or society’s expectations, mental anguish is a frequent outcome and the mechanisms of mental illness frequently follow.  Self-awareness of the factors that influence our behavior provides the basis for widely embraced and successful forms of psychological treatment, such as Cognitive Behavioral Therapy and Dialectical Behavioral Therapy.

To maintain a healthy mental state, one must have an adequate supply of socially acceptable coping mechanisms (rational arguments, self-confidence, meaningful employment, a sense of humor, spiritual beliefs, etc…) with which to manage the negative or positive self-perceptions one encounters, to greater or lesser degrees, during life.  One theory considers that the abyss of suicide in an otherwise healthy individual represents a breakdown of these coping mechanisms relative to one’s negative self perceptions and/or world perceptions.

A recent article in the New England Journal of Medicine points out that it is possible to detect in young people when the failure of coping mechanisms begins to push a young person towards a sense of hopelessness.  There are even indications that physical, genetic factors may in some instances influence our ability to develop and exercise adequate coping skills.

Herein lays the public health message.  Prominent risk factors for suicide include Native American and White ethnicity, residence in a rural community, access to firearms, substance use disorders, male gender, sexual assault victimization and recent personal loss.  “Red flag” trigger factors include recent exposure to personal tragedy, intoxication, loss of interest in favorite pastimes, ease of access to a suicide method or legal problems.  If you or someone you know displays such behavior and admits to thoughts of suicide when you ask, call or have them call 1-800-273-TALK immediately.  For a local number to access emergency mental health care for thoughts of suicide, call your local Behavioral Health Department.

Self-perceptions are naturally distorted by our own biases.  Recognizing early when those perceptions – guided or misguided as they may be – are leading us to thoughts of hopelessness may be all the incentive we need to seek professional counseling services.  Such services can and do save lives.

©September 2007

When was the last time you took time away from work to enjoy a vacation?  While taking time off, did you relax?  It might actually be a very astute public health recommendation to advise our friends and families to “go fly a kite.”

According to a study by the International Labour Organization, Americans take fewer days off of work each year than any other industrialized country.  Twenty five percent of Americans do not receive paid vacation.  In addition, those employees in the U.S. who are provided the benefit of paid vacation days typically fail to take an average of one to two of those days per year.

Workers in Germany average 30 days of paid vacation time per year, and in France it averages 38 days.  Americans average about half that.  Even among the industrious workers of Japan, vacations are more extensive than in the U.S.

Now, it should be made clear that there is nothing wrong with dedication to work and a strong work ethic.  This is the classic parental montra.  However, it is also dangerous to accept the notion that we can maintain maximum health and benefit to our families when we forfeit every last morsel of free time in favor of work.

Research has explored the characteristics of work that contribute most significantly to work related stress.  It turns out that the occupations that generate the most anxiety on the part of employees are those jobs in which the employee has the least ability to influence their work responsibilities.  Such an insight may help explain why work within the U. S. Postal Service or in positions with repetitive mundane responsibilities are so hard on some employees.

Literature is rife with speculation about why Americans are so obsessed with work.  Economic pressures, Puritanical roots and corporate influences have all been suggested as major contributors.  However, Websters Dictionary alludes to the fact that the Latin root of the word “vacation” includes references to the cocept of “freedom.”  Restraints are equally effective, whether they be physical or self imposed and economic, and neither is conducive to good health.

Consider planning a vacation this next year.  And remember that a vacation does not have to be expensive.  Time off to go camping, or a bike trip might be just the ticket.

It is worth reminding ourselves that spending restful time with our families and friends is an important way to keep a healthy perspective on the trials of work.  Such an outlook makes for a more enjoyable life and ultimately a more productive employee.