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Outliving the latest craze

The grimly high numbers of suicides and attempted suicides in America represent only the tip of the iceberg. In this thorough article, Amelia explains why, then contrasts the perspective of secular psychological research with the Orthodox understanding of suicide and its causes.
A new hallmark of American society is in the making. But unlike other signs of the time, this one isn't fashionable or trendy. Your friends won't be envious if you're a part of it and they're not. It won't make you popular at school, successful at work, or the idol of the country club—although it could possibly score you a tribute in the newspaper …

This wildly popular yet utterly undesirable trend is suicide, and the statistics from the Center for Disease Control and Prevention are chilling:
  • In 2006, more than 33,000 confirmed suicides occurred in the U.S. This is equivalent to 91 per day, or one every 16 minutes.1
  • Suicide is currently the second leading cause of death among American young adults, ages 25-34.1
  • In 2007, nearly 400,000 Americans were treated in emergency departments for (non-fatal) self-inflicted injuries, and nearly 166,000 were hospitalized for the same.1 According to a different source,2 emergency departments in this country treat up to 500,000 patients annually for injuries sustained in suicide attempts.
Lamentably, trends of suicidal ideation are steadily spreading to affect our nation's youth. While suicides used to be predominantly comprised of over-stressed adults, the elderly, and the terminally ill, we're now seeing that children are feeling increasingly inclined to kill themselves:
  • Suicide accounts for at least 12% of deaths of adolescents (ages 15-24) and is their third leading cause of death.1
  • For each adolescent death by suicide in 2006, there were up to 200 additional "unsuccessful" adolescent attempts.3
  • In 2007, nearly 15% of U.S. high school students reported that they had seriously considered attempting suicide during the previous year.4
In fact, the U.S. Department of Health and Human Services reports that more adolescents die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease—combined.5 Even more frighteningly, suicides among children ages 10-14 have dramatically increased since the 1990s. Among them, it's now the fourth leading cause of death.5

Worse than it looks.

Ugly as they are, the numbers above don't reveal the complete picture; they don't reflect the number of suicides quietly disguised as accidents or attributed to other causes of death.

For many reasons, survivors are often unwilling to report their loved ones' deaths as self-inflicted. Many people feel that there's a social stigma attached to suicide, one that doesn't exist for deaths that happen accidentally or naturally. Others don't want to exclude their loved one from a Christian burial, which, in some denominations, would be forbidden. For these and other similar reasons, if there exists an opportunity to avoid having an autopsy performed, many survivors choose not to identify the cause of death as suicide, preferring to report it as accidental or due to natural causes.

There's also a potential insurance-related consequence of suicide. All life-insurance policies have a limitation clause that relieves the company of its obligation to pay if the insured party commits suicide within the first two years of purchasing the policy. The reason for this clause is to protect insurance companies from adverse selection—in this case, a money-making strategy in which someone purchases life insurance already having the intent to kill himself. Of course, people who commit suicide for psychological reasons (rather than economic) likely don't care about beneficiary payments—but to their survivors, being booted from the beneficiary list only adds insult to injury. It's reason enough to avoid drawing attention to the true cause of death.

In other cases, the true cause of death can be difficult to determine. Some suicides are obvious and unmistakable, but others give rise to questions. While a doctor or medical examiner may be able to identify specific causes of death with absolute certainty—drug overdose, strangulation, bullet to the brain, and so on—the more general question of "Whodunit?" can be difficult to answer. Some people stage their own suicides as murders—for example, they might blindfold and gag themselves first, or inflict "defensive" wounds, or fashion ligature marks to suggest that they were bound before being killed in whatever manner. In situations like these, the discovery of the truth depends on evidence, which may be incomplete or ambiguous. It also depends on the skill and effort of detectives, which is vulnerable to the possibility of human error. Both decedents and their survivors are sometimes able to stage suicides to appear to be something else.

Finally, suicide as a cause of death is generally considered to be sensitive information; as such, it's legally protected. While death records are in the public domain, and while known suicides are recorded as such, it can be difficult for anyone who's not a family member (e.g., researchers) to gain access to this information. In certain states, there's also legislation to protect the privacy rights of minors, which can impact researchers' access to information on suicides involving children and teenagers. In other words, whichever suicide records actually are accurate may also be inaccessible to the public.

Some states require that hospital emergency rooms report all instances of patients seeking treatment of non-fatal injuries sustained in suicide attempts. These reports help government agencies compile statistics on suicide attempts, but they still miss part of the picture. Not all people who attempt suicide seek medical treatment for accidentally surviving. These cases also slip through the statistical cracks.

Thus, as grim as the national statistics appear to be, they reflect only a bare minimum of the suicides and suicide attempts that are actually taking place. The situation is, in fact, much messier than it looks, and there doesn't appear to be much that professionals can do to help clean things up.

What's going on?

For many people in this situation, suicide masquerades as the ultimate source of relief. As the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-TR-IV) informs clinicians, suicide stems from "an intense wish to end an excruciatingly painful emotional state...perceived...to be without end" (p. 351). This text is surrounded by a lengthy discussion of clinical depression and other mood disorders that are thought to contribute to suicidal ideation. In short, doctors believe that people commit suicide because they're too distressed to think of an alternative.

On the surface, the lives of many people who commit suicide seem to have been pleasant and fulfilling, while internally they were gnarled with misery. Evidently, having good friends, a successful marriage, a college education, a thriving career, and even going to church don't seem to make much of a difference when it comes to preventing suicide. These are the demographic characteristics that, in theory, are supposed to make people happy. However, growing numbers of people equipped with all of these resources and more are still unable to find peace from the demons, whether actual or metaphorical, who haunt them. Adolescents and children are steadily joining the ranks of adults who believe suicide to be the only escape from the pain of reality. They're relatively certain that death will bring an end to the terrifying nightmares their lives have become. This faulty conclusion leads to an irreversible mistake with irreversible consequences, both material and spiritual.

The problem with this conclusion is that it rests on an inaccurate assumption: That consciousness exists in the present life only. Suicidal thinking assumes that when physiological life ceases, so does the existence of the soul and its ability to experience pain. At the same time, it also assumes, because there's suffering in the present life, that there's no possibility of a future life without suffering. And these mistaken assumptions aren't limited to people who are suicidal. Within my own academic field, this distorted perspective has been echoed over and over among fellow colleagues and scholars. Science unambivalently maintains that when biological life ends, consciousness permanently expires.

To Christians, however, the idea is heretical and clearly untrue. The physical body dies and returns to the dust from which it was formed (Genesis 2:7), but the soul, remaining conscious and possessing all its prior faculties, immediately proceeds to its judgment (Hebrews 9:27). The Orthodox teaching is that physiological death causes the separation of body and soul, but that it's only a temporary separation, one that awaits reunion upon the Second Coming of Christ and the general resurrection—a resurrection either unto eternal life or eternal damnation.

According to scientific consensus, suicide may be an undesirable approach, but it solves the problem at hand—suffering ends when consciousness ends. According to Christian consensus, however, it solves nothing—because consciousness doesn't end. In fact, it makes the problem immeasurably and permanently worse.

So what's really going on?

We know, Christians and scientists alike, that suicide is the ultimate expression of a person's abandonment of hope. But it's not just the abandonment of secular hope in the situation improving. It's also the abandonment of a higher hope in Divine intervention and in the promise of an eternity where there is neither sickness, nor sorrow, nor sighing, but life everlasting, as one of the prayers of the Orthodox funeral service reads. Suicide doesn't mean merely giving up on life; it also means giving up on Christ. From the Orthodox perspective, suicide indicates a rejection or renunciation of faith. By definition, a person who rejects the Christian faith can't rightfully be called a Christian.

According to Orthodox theology, the belief that Jesus Christ is the Son of God and saves sinners isn't enough; evidence of that faith is also necessary. The most strikingly obvious examples of evidence of faith are the ability, the desire, and the resolve to hold onto it during difficult times. Hopelessness, which ultimately leads to suicide, is evidence of the exact opposite: The absolute lack of faith. In other words, someone who's sincerely Christian can't be hopeless, and someone who's hopeless can't sincerely be a Christian. Hopelessness is an implicit denial of Christ. Suicide is one way of making that denial explicit.

However, when researchers analyze whether Christians are any less likely to attempt suicide than non Christians, they fail to take this important detail into consideration. They only look to the demographics of people who committed suicide to see whether any called themselves Christian at one time or another; if they did, they go into the "Christian" data pile—but this is Christianity in name only. It's not Christianity in practice. As a result of this oversight, research usually claims that suicide knows no religious boundaries—that Christians kill themselves as frequently as non-Christians. But this is research coming from people who don't know much about the Christian Church, or at least not the Orthodox Church. Merely identifying with the word "Christian" doesn't mean a person necessarily is one. Ticking the box labeled "Christian" on the census doesn't mean a person wholeheartedly embraces the Christian belief system.

Scientific research, however, isn't interested in any of these details of theology or praxis. Researchers don't bother to learn what genuine faith means, nor do they measure whether the subjects of their study possessed it prior to committing suicide. They might look to one's frequency of attendance at church services, or to self-reported degrees of religiosity, but these still don't measure the extent to which a person possesses genuine faith.

Researchers, alas, are only interested in a simple yes or no to the question: Does a (nominal) connection to the word Christian make a person less likely to commit suicide? Naturally, the answer that science always yields is a resounding "no," because no one with genuine, wholehearted faith is ever included in these studies—because people with sincere faith and trust in God don't ever commit suicide. Christians who commit suicide might as well not call themselves Christians. But science isn't interested in this important caveat.

The Christian stance.

Despite differences in their dogma on salvation, most Christian denominations consider suicide to be a sin—most recognize it as murder. Not all denominations forbid it, however. Because the Orthodox and Roman Catholic Churches do forbid suicide, the denominational affiliation of a person who commits suicide is often important to researchers. They look to see whether the Church "succeeds in preventing suicide" by forbidding it; and when suicides happen contrary to Church teaching, researchers conclude that "prohibition doesn't work." The Church's commandment against suicide, however, has little to do with prohibition. It's a reflection of the reality that only God gives life and that we don't have the right to take away what we can't also give. It's also a warning that there's an impending spiritual consequence to the act. It's a commandment of morality, not sociology. In other words, it's more than an instruction; it's also an explanation for why that instruction is in place.

Judeo-Christian moral commandments are meant to keep us on the right track, spiritually speaking. This includes the commandment, Thou shalt not kill (Exodus 20:13, Deuteronomy 5:17). Suicide clearly involves the sin of murder. Unique to the Orthodox understanding of suicide, however, a second sin is also involved. This second sin is the rejection of God, which is inherent in the suicidal person's outright disregard for the moral law, his refusal of patient and prayerful endurance, his lack of belief in Divine intervention, and his failure to hope in salvation. This rejection of God is the far heavier of the two sins.

Through the saving power of our Lord and Savior Jesus Christ, our sins are forgiven, but only under certain conditions: Conditions of faith, repentance, and the mercy of the Lord (Matthew, 3:2, 4:17; John 14:6-7, Acts 17:30). A repentant Christian can be forgiven for anything, even the murder of another person—but the person who destroys himself subsequently destroys his opportunity to repent for doing so.

The same is true for the sin of losing faith and rejecting God; a person can stray from the Church and the Lord many times in his life and be forgiven upon returning. But if he never returns, or if he kills himself and is no longer able to return, he shows God that he doesn't care to be forgiven. The prodigal son was only forgiven and welcomed by his father because he repented and came back (Luke 15:11-32).

This is the real tragedy and the real reason that the Orthodox Church forbids suicide; it has nothing to do with advancing suicide research or making the national statistics more palatable.

Where do we go from here?

The Church has a great deal to say with regard to suicide; the Orthodox understanding of suicide isn't limited to the mere cry of "Don't!" It's not the great mystery that secular research makes it out to be, and there are in fact things we can do to prevent it from happening or, at a minimum, to dial down its frequency.

Suicide isn't just connected to spiritual consequences; it's also connected to spiritual causes. Researchers don't recognize these spiritual causes, however, because they're not looking for them—they're convinced that they don't exist. Science is unconcerned with the soul and its spiritual condition, because science denies the existence of the soul altogether. For this reason, research studies on suicide are devoid of any discussion of morality or the state of the soul. However, the holy fathers have been teaching us for over 2,000 years that suicide is merely the final domino to fall, following a long onslaught of spiritual mistakes.

These mistakes can be chalked up to spiritual sickness (or psychological illness, if you will). However, it's unfair to say that the Church—at least the Orthodox Church—is unable to treat spiritual sickness, when this is the very thing that she does best. The Church is a hospital for sick souls, souls in need of spiritual healing. The Church can only help, however, if the sick souls who come to her are looking to be helped. Suicidal people are already hopeless; what they need is hope, but hope can't be forced. The Church doesn't force hope, nor would she be successful if she tried.

God has offered this hope to us freely—in fact, He's promised it. But in order to receive it, we have to do our part and embrace the promise. In other words, a hopeless person must be willing to remember what hope feels like, willing to seek it, and willing to feel it. Hope comes from God, but every person—suicidal or not—has the free will to accept or reject it. Accepting the offer means making some changes—in beliefs, in thoughts, and in lifestyle; not being willing to make these changes is one of the ways in which a person can reject the hope that God offers through the Church.

When a suicidal person turns to God or the Church for hope and then rejects it, it's incorrect to claim that God and the Church have failed, or that God therefore must not exist. Christ and Christianity don't fail us, and, as the holy apostle tells us, Hope does not disappoint (Romans 5:5). We're failed only by the devil and our own imperfections. Those who seek God, if they seek sincerely, find Him. Those who seek help through the Church, if they seek it sincerely, find it too.

If we're to have any human impact on this suicide pandemic that threatens us and now also our children, we must start—and start quickly—to encourage people to treat their spiritual illnesses with spiritual medicine. Pills and counseling are clearly not enough. Going to church services is clearly not enough. Believing in God is clearly not enough, and even praying is clearly not enough. What's necessary is the Christian transformation of the soul.

[1] U.S. Centers for Disease Control and Prevention (CDC) (2007). Web-based Injury Statistics Query and Reporting System.
[2] McCaig, L. F. & Nawar, E. N. (2006). National Hospital Ambulatory Medical Care Survey: 2004 Emergency Department Summary. Advance Data from Vital and Health Statistics. Hyattsville, MD: National Center for Health Statistics, Report 372.
[3] Goldsmith, S. K., Pellmar, T. C., Kleinman, A. M., & Bunney, W. E. (Eds.) (2002). Reducing Suicide: A National Imperative. Washington D.C.: National Academy Press.
[4] Centers for Disease Control and Prevention (CDC) (2008). Youth Risk Behavior Surveillance—United States, 2007. Surveillance Summaries, June 6. MMWR 2008; 57(No. SS-4).
[5] U.S. Surgeon General, 2001: National Strategy for Suicide Prevention.