An Interview with Thomas Joiner, Ph.D. on Why People Commit Suicide

In this edition of the Wise Counsel Podcast, Dr. Van Nuys interviews Thomas Joiner, Ph.D., a clinical psychologist, professor of psychology and researcher of the troubling topic of suicide. Dr. Van Nuys became aware of Dr. Joiner after receiving a brochure for the annual conference of the American Association of Suicidology, which will take place in San Francisco, April 15-18, 2009, several weeks in the future at the time of this writing. Dr. Joiner will be speaking at this conference, and Dr. Van Nuys suggests that attendance there would be a good way for local mental health professionals to educate themselves on this important topic while earning continuing education credits necessary for continued licensure.

Dr. Joiner cites two motivations that drew him towards the study of suicide. As a young research psychologist, he saw career opportunity in the study of suicide, after realizing that though it was the most lethal symptom associated with major depression, it was also the least well studied aspect of that disorder. His father's suicide, which occurred in Dr. Joiner's third year of graduate school further reinforced his interest. He speaks about suicide in a very personal voice as a "foe to be defeated", and in an important way has been able to channel his grief in a professionally meaningful and societally beneficial manner.

Suicide is simultaneously a huge public health problem and also a rare event. In the USA approximately 30,000 people suicide each year. Across the world, 1,000,000 deaths a year by suicide are estimated. Suicide is highly associated with the occurrence of a variety of severe mental disorders such as Major Depression and Bipolar Disorder, Schizophrenia, Borderline Personality Disorder and Anorexia, but the fact remains that the vast majority of people who develop these disorders do not suicide (though they may frequently experience suicidal thoughts). It has not been possible to predict with great accuracy who is at risk for actual suicide and who is not, or to know how to offer protective interventions which can reduce the risk of suicide in vulnerable populations (beyond the need to treat the mental disorders which so exacerbate or create the suicidal conditions in the first place). Accordingly, Dr. Joiner's work has been focused on trying to improve our ability to predict who is at risk and to identify the best ways to prevent actual suicides from occurring.

Dr. Joiner has proposed a new theory of why people suicide which he believes is more accurate than previous formulations offered by writers like Edwin Schneidman, Ph.D. and Aaron Beck, MD. According to Schneidman's model, the key motivator which drives people to suicide is psychological pain. In Beck's understanding, the key motivator is the development of a pervasive sense of hopelessness. Dr. Joiner suggests that these are correct understandings but are also too vague to be useful for predictive purposes and not capable of offering a complete motivational picture.

Joiner proposes that there are three key motivational aspects which contribute to suicide. These are: 1) a sense of being a burden to others, 2) a profound sense of loneliness, alienation and isolation, and 3) a sense of fearlessness. All three of these motivations or preconditions must be in place before someone will attempt suicide. Psychological pain and a sense of hopelessness correspond roughly to Joiner's concepts of burdensomeness and alienation, and contribute to the content of much suicidal ideation. These are necessary but not sufficient preconditions for a suicide act, however. So long as a person remains fearful of death and the actions and consequences of the activities that will create death, the actual act of suicide is unlikely.

Joiner notes that the incidence of suicide increases linearly with age; the older you get, the more likely you are to suicide. If I (Dr. Dombeck) understand him correctly, the way he thinks about why this is so is because as people age they are also more likely to develop (based on various life experiences) the fearlessness which transforms the simple desire for death into a plan for action. Joiner talks about the heightened incidence of suicide in professions that deal daily with death and violence, such as people in the military and physicians.

Dr. Van Nuys asks Dr. Joiner whether genetics or a tendency towards "thrill seeking behavior" might play into who is at risk for suicide. Dr. Joiner reports that research has established that there is definitely a genetic contribution to suicide, but that it only can explain about 35% to 40% of the variance that goes into suicide. The research suggests that the major way that the genetic predisposition seems to express itself is by influencing how the neurotransmitter Serotonin functions within the brain.

Dr. Van Nuys asks Dr. Joiner to talk about the warning signs that suicide may be of concern. Dr. Joiner reports that the best predictive signs are often fairly clear but overlooked until hindsight provides the necessary context for interpreting them properly. People are at risk for suicide when they communicate about their desire to end their lives or to kill themselves. Other warning signs include dramatic mood changes, the combination of agitation and insomnia/sleeplessness, and the giving away of prized possessions.

The best and most effective way to prevent suicide from occurring is to treat the mental disorders that are almost certainly present and driving the situation. Generally, the best modern treatments for these various disorders will combine psychiatric medication with some empirically validated (e.g., scientifically "proven") form of psychotherapy such as cognitive behavioral therapy.

Family and friends can help a person who is considering suicide by being alert for warning signs (as mentioned above), and by patiently and persistently encouraging that person to get mental health treatment. Dr. Joiner mentions the (USA) National Suicide Prevention Lifeline (1-800-273-TALK) which makes crisis counselors available to people at risk for suicide and also concerned family and friends. Dr. Van Nuys notes that people are often at a loss for how to respond to grieving family members who have just sustained a loss due to suicide. There is something about suicide that leaves many people feeling paralyzed about how best to respond. Dr. Joiner encourages people to treat a loss by suicide just as they would any other death, which is to say, by offering support to the bereaved. The right thing to do is to show up at the funeral and offer condolences; to check in emotionally with the bereaved and offer support, and to stay in contact with the bereaved after the funeral. The wrong thing to do is to remain paralyzed.

Dr. Joiner goes over several myths associated with suicide and works to dispel them.

Suicide is not a cowardly act but rather one that takes great fearlessness to accomplish. By noting this he does not mean to romanticize suicide, but instead simply to represent it accurately.

Neither is suicide an instance of "anger turned inwards". From the suicidal person's perspective, killing one's self is frequently seen as an an altruistic act - the removal of a burden to others. Joiner does not buy into this self-perception of burdensomeness, but he does understand that this is how suicidal people tend to see their actions.

Another myth Joiner is concerned about is that antidepressant medications cause suicides. In Joiner's opinion, though there are cases where suicides have been linked to antidepressant use, this connection has been "overblown" by the media such that physicians are now increasingly afraid to prescribe antidepressants to suicidal patients. Joiner notes that the evidence is clear that antidepressant use on the whole decreases the incidence of suicides by the means of treating the mental disorders like depression that contribute to suicidal impulses.

Dr. Joiner notes that the research on suicide barriers for bridges like San Francisco's Golden Gate Bridge shows clearly that such barriers prevent suicides. There is no evidence to support the idea that suicidal people are determined to kill themselves and will simply go somewhere else to complete their suicide. In locations where barriers are in place, the overall rate of completed suicides decreases. He is strongly in support of a suicide barrier for the Golden Gate Bridge and sees as morally outrageous the argument that the barrier's construction should be delayed on account of expense or aesthetics.

In his closing remarks, Dr. Joiner hopes that listeners will offer compassion to suicidal people and their families, and that they will encourage (with patience and persistence) suicidal people to get mental health treatment for their symptoms. The combination of psychiatric medication and cognitive behavioral therapy (or other scientifically supported psychotherapy) is effective even though it can be a struggle to find the right combination of therapies to provide relief.

THOMAS JOINER grew up in Georgia, went to college at Princeton, and received his Ph.D. in Clinical Psychology from the University of Texas at Austin. He is Distinguished Research Professor and The Bright-Burton Professor in the Department of Psychology at Florida State University, Tallahassee, Florida. Dr. Joiner's work is on the psychology, neurobiology, and treatment of suicidal behavior and related conditions. Author of over 385 peer-reviewed publications, Dr. Joiner was recently awarded the Guggenheim Fellowship and the Rockefeller Foundation's Bellagio Residency Fellowship. He was elected Fellow of the American Psychological Association, and received the Young Investigator Award from the National Alliance for Research on Schizophrenia and Depression, the Shakow Award for Early Career Achievement from the Division of Clinical Psychology of the American Psychological Association, the Shneidman Award for excellence in suicide research from the American Association of Suicidology, and the Award for Distinguished Scientific Early Career Contributions from the American Psychological Association, as well as research grants from the National Institute of Mental Health and various foundations. He is editor of the American Psychological Association's Clinician's Research Digest, editor of the Journal of Social & Clinical Psychology, and incoming Editor-in-Chief of the journal Suicide & Life-Threatening Behavior, and he has authored or edited fifteen books, including Why People Die By Suicide, published in 2005 by Harvard University Press, and Myths and Misunderstandings About Suicidal Behavior, in press, also with Harvard University Press. Largely in connection with Why People Die By Suicide, he has made numerous radio, print, and television appearances, including write-ups in The Wall Street Journal, Men's Health, and The Times of London, a radio interview on the Leonard Lopate Show in New York, and two appearances on the Dr. Phil Show. He runs a part-time clinical and consulting practice specializing in suicidal behavior, including legal consultation on suits involving death by suicide. He lives in Tallahassee, Florida, with his wife and two sons.

Share:

Link: (Here's how to do it ... )

to suicide may 9th and any others of you contemplating suicide please dont. i understand that situations can be very painful and life can be rather meaningless and tedious and for some of you unbearable but unless you are quite literally the only person in the whole world who will be affected by your death do not even think about ending your life. you still have a responsibility to those left behind if not to yourself. for those of you who come from broken families or who have been isolated by friends, don't see this as an excuse for suicide because when someone dies someone knows and you don't know how it will affect the police officer, coroner, doctor or the little girl watching the special on your death. so please before you commit to something that can never be taken back and take the hope away from someone who still sees something in life, live for the rest of the world if not just for yourself.

I am suicidal. Have had these type of thoughts my whole life but they always stayed inside, subconscious in a way. now they are out. I am terribly lonely, depressed ( it comes and goes my whole life) and now for the first time I am telling people that I want to die. I am no longer afraid of the consequences of my death. I used to think I would go to hell but thats just a bunch of crap. there is no God, no hope, no truth and definately no punishment for suicide. Its all just a bunch of crap we feed ourselves to stay "positive" and keep hope alive. what is hope, its deluding yourself that life can and will improve. it wont. those are the statistics.some people by luck or whatever have a better life but some of us dont and after a while the pain just gets too much. I am 37 years old so i feel i have given it a good run. I have tried everything - psychologists, a healthy lifestyle, a good career, an over all positive life but bottom line I come home alone everyday. And i cant understand why, why am I so jinxed in love. why have i been doomed to spend my life on my own. It really sucks you know being alone, pulling into the driveway after a productive day and knowing I am going to eat alone again tonight and wake up alone again tomorrow. So i don't feel like a burden but I definately do feel hopeless, fearless, and terribly depressed. I am sorry as my sister will be devastated if I die and I will be devastated to leave her, she is everything to me, but this pain is too much. and she must please understand that I am the one living with this pain, she cant take it away, she lives on the other side of the world. no one can truly understand what it feels like to be alone day after day year after year and finally realising its never going to change. I am destined to a live alone and I am sorry whoever decided this to be my fate I am sorry but I just cant cope. I have needs to be loved to and to love in a romantic relationship dont ask me to live without it. please forgive me and offer me the way out. I am actively looking for it now, the poison that will take put me out forever. amen

Great interview with Dr Joiner. When the three motivational aspects collide you are in trouble.

I suffer from major depression, diagnosed late in life after forty years of torture. Suicide was always an option. It lead to many situations where you place youself at risk without fear of the consequences, knowing that if you didn't come through the other side it was no great loss. In fact most times you hoped for it.

Early diagnosis of mental illness may have helped me. Self medicating didn't. I would like to see some more studies on the relationship between self abuse and suicidal behaviour.

About two and a half years ago I experienced that pain in such a way that I wanted to end my life. I felt like I was a burden to my wife, children, parents, inlaws, sisters family, and myself. In the same day I lost my job, my wife kicked me out of our home, I was living in my car, and was depressed. Within a month someone stole my clothes, my computer, my cell phone and some of my possesions. I had been married for 20 years and had three great children. My counciler suggested to my wife to ask me to move out. I was 150 pounds overweight and I had sleep apena. I was getting maybe 2 hours of sleep each night and now in my car less. I was crying alot and I was falling asleep while driving in town. My parents let me stay at there home but I was so depressed all I could do was sleep, and not move because of fear of failing. I had adhd which I found out later in life. I also had mild addiction to porn on the computer. I never cheated on my wife with someone else but I did look at pictures of porn. I had lost around 15 plus jobs in my life and I left about 15 because of my uncared for mental health. I felt over medicated. I was taking lexipro, wellbutrin xl, straterra for add, and many other meds for blood. My wife while we were seperated started dating other men and inviting these men to our home. Some of these men spent the night but my wife said she never had any sex. My kids have told me otherwise. This just sent me into a downward spin. My wife went to a lawyer and I signed seperation papers because she said if I changed she would ripp them up. I think hindsite she was stringing me along just to have me sign them. I told my parents that I felt better if I was just out of everyone hair. I had stomach pain all day. I was angry that my wife would do this to me. I was codependant and I did not know this. She really did so much for our family that I took it for granted. What kept me from killing myself? I had God in my heart! I just could not let my kids experience the loss of there dad. I also relized Gods grace. How I had been always trying to earn everything in life. Love, approval, boss approval, family approval, wife approval, family approval, God approval. I found out that I cannot earn Gods love and grace. It is and was always free! I could not earn it. I found this out by going to Grace life ministries and seeing a counciler. I found some men in my church that affirmed me and me them and I could have a safe relationship with them. I put my hope and trust is God and Jesus. I started letting the Holy Spirit lead my life. I just did not let any thought go through my mind. If it was a bad thought I know where it was coming from and stopped it. I am getting better at that each day. When it was a great thought I new where that was coming from as well and I meditated on those thoughts more. I got into Gods word the bible and I wanted to read it more and more because I liked to and not because I had to. It was like I was no longer under the law. Jesus released me from that and His grace took alot of that pressure off. I was believing a lie that I was no good, and a burden, and I was alone, when all along I was in the family of Jesus Christ. No one could ever take me out of this family ever. Once I found out who I was in Jesus I was saved forever. Yes I have bad days and I have great days too! I now understand in my mind God and sin. I am not alone. I also can see the pain I experienced in others now. I guess God in me now loves to love on the hurting people like I was. How special is this gift I have been given. If you read this and know what I have felt then you too have hope too! You are very special too! Let someone show you how special you really are! I have lost over 100 pounds, have been able to go off many of my medications and now I let God live through me. He exchanged His life for mine. What a great gift it has been. Totally free!

I agree with Deb L. I find my suicidal thoughts are based in my feeling overwhelmed and hopeless. My thoughts of suicide grew as my life became overwhelming. I lived each day, wanting to kill myself, but holding off for whatever reason I could come up with, usually due to my love for my children and not wanting to scar them for life. After many years of torture, I was diagnosed as Bipolar ll (hypomanic, or depressed). One of my children (now grown) has 4 distinct and significant disabilities. I fought to secure assistance help for him all of his childhood and until recently (he is now 22). He was just diagnosed with Bipolar l (manic). I blame myself for his troubled life. This guilt is overwhelming at times. Sometimes I feel I would like to end both of our lives. I know I would never do that, but just like the suicidal thoughts I have had for all of my adult life, I know I have to keep fighting. Therapy has given my limited help, but I can not afford to go any longer, but I am consistant in taking my medication. I do have good days, but it doesn't take much for my depression to take over. I have heard people say that committing suicide is a selfish act of a coward, but they just don't know how much pain each day can bring.

My family is dealing with the recent death of son-in-law, estranged husband, father... It is very complicated; but as always, the surviving family are asking themselves "How did I miss this? What could I have said, done? How can I explain this to a 9-year old when I don't even understand it myself?"

My son-in-law meets all of your criteria. He had lot his job & his RN license because of drug abuse. He could not hold a job. He had some significant loss of mental and physical abilities due to the drug use. I'm sure he was feeling that he was a burden to his family. He had been taken to the hospital several times with suicidal behavior, but was released quickly because he had no health insurance.

He was surely feeling lonely, alienated and isolated. He had become physically abusive to his estranged wife, my daughter, and his son. They had moved into an apartment a few blocks away. He lost their home in foreclosure and wasn't able to pay child support. When he no longer had money for drugs, many of his "friends" abandoned him.

As for fearlessness, he was a big man, tall, weight-lifter. He was always pretty macho. The fear of dying compared to his psychological pain probably seemed small.

Our daughter & grandson had been held prisoner by this young man for about a year. We had no idea what was going on until they came home for Christmas on a gift-ticket. If she had only talked about their lives, we might have been able to intervene. However, she was so embarrassed that he had "tricked" her into moving 1000 miles away from family, that she never talked about this situation. She only returned after Christmas to retrieve her dog and a few personal possessions. He took his own life within 2 weeks.

I am not trying to excuse myself. I just didn't understand the situation until he was gone. I wish I had tried more to understand him.

We must all communicate better! Life is too short and too precious to have these violent deaths continue. We can't find peace until we love enough to listen and respond to the pain of our children/friends/parents.

It is indeed psychological pain which often drives a person to suicide. Several years ago I came very close to suicide, and it wasn't in order to punish anyone, or even to be less of a burden to others, but just because the psychological pain was excruciating. I felt alone, hopeless, and in agony because of a loss I'd suffered. I can't tell you how much I just wanted to end my own pain and suffering. In the end, I reached out and obtained psychotherapy, which saved my life.