Grief + Mourning Suicide

Soldier Suicides on the Rise


ContentImageIt’s unclear yet whether these tough economic times are driving up the suicide rate in America. The latest Centers for Disease Control and Prevention data on suicide among the general population is from 2006. Even if we had more current data to work with, there is a lot of extrapolation necessary to make that connection. However, I think it’s certainly a possibility, given the utter desperation of so many people out of work and out of hope.

One thing we do know is that American soldiers, either still on active duty or those returning home, are facing serious mental health issues, some of which ultimately end in suicide. CNN has featured content lately about the increasing rates of soldier suicide. One story addresses the impact that multiple wars have had on enlisted and veteran personnel. Another discusses the “high risk behavior” that contributes to the rising Army suicide rate. Despite increased efforts by the Department of Defense to address the issue in the last several years, a successful coordinated effort and outcomes are still lacking.

Last year, Congress created the Joint Department of Defense Task Force on the Prevention of Suicide by Members of the Armed Forces. The findings of their report were released yesterday and concluded, in part, that:

“The years since 2002 have placed unprecedented demands on our armed forces and military families. Military operational requirements have risen significantly, and manning levels across the services remain too low to meet the ever-increasing demand,” said the report, released Tuesday. “The cumulative effects of all these factors are contributing significantly to the increase in the incidence of suicide.”

It goes on to say that:

“The Task Force also found that occasionally leadership environments (usually at the junior supervisory and sometimes at the mid-grade level) resulted in discriminatory and humiliating treatment of Service Members who responsibly sought professional services for emotional, psychological, moral, ethical, or spiritual matters, which not only deters help seeking but also reinforces the stigma.”

The NY Times recently ran a story and video about the inner workings of the suicide prevention hotline at the Department of Veteran Affairs in Canandaguia, NY. It is a powerful piece of reportage chronicling the desperate multiple life and death moments happening every day at the call center. The piece is about the struggles of the staff answering the calls and the returning men and women for whom calling the hotline may be a last resort.

While suicide statistics are kept for active-duty service members, no reliable data exists for veterans. The NY Times article reports that “…..estimates, while not universally accepted, seem alarming. According to the Centers for Disease Control and Prevention, veterans account for about one in five of the more than 30,000 suicides committed in the United States each year.”

There are more CDC suicide statistics and prevention info here.

What can be done? What should be done about this growing problem? I don’t have the answers, but here are a few thoughts. First and foremost, active-duty and returning service members need access to consistent and fully-funded mental health services. Help needs to be readily available and not tied up in bureaucratic red tape. For vets, calling a suicide prevention hotline is a temporary BandAid, not a fully developed action plan going forward. Vets suffering from PTSD and depression need to receive the same level of help found in physical rehabilitation programs at Walter Reed Army Medical Center. There need to be discussions around erasing the stigma of asking for help. Ultimately, it’s the war(s) that are to blame for soldier suicide. Yes, some of those soldiers may enter the service with pre-existing conditions that the presence of war only exacerbates, but war can never be good for the mind, the body or the soul. Eliminating the “trigger” is one step in the right direction. Obviously, there are no simple answers or solutions.

I recently saw an article in American Libraries that got me thinking as it relates to my own work. It’s about how New York Public Library’s telephone reference line, ASK NYPL, has developed a policy in handling calls from suicidal individuals and law enforcement agencies who respond to them. You can read the full article here. It inspired me to see what, if any, policy we currently have in place at my library. The outreach work I do is usually concerned with promoting the programs, services and collections of my library and enticing various demographic groups who may not be using the library to do so. One of our priorities right now is serving as “a resource during these tough economic times.” But if outreach is “reaching out”, then it seems that this may also be a way to reach people who need help, something that we are already doing every day at the library.

If you or someone you know is suicidal, please talk to someone. The National Suicide Prevention Helpline is 1-800-273-8255. If you are an active-duty member or a veteran, dial the same number and press 1 to be connected to the National Suicide Prevention Lifeline for Veterans.

Death + Technology Suicide

Overtime and Under Stress

“Maybe this spate of suicides will also serve us as a wake-up call,” he said in an interview last week. “We realize we must do a better job.” —Louis Woo, a high-ranking Foxconn executive

The NY Times has written another article about the Foxconn suicides. This follows a second pay raise by the company this past Sunday and sheds more light on the incredible number of hours many factory workers are clocking. According to the article, the first suicide, Ma Xiangqian, racked up 286 hours of work time (including 112 hours of overtime) in the month before he died—that’s three times the legal limit. And the pay? The equivalent of $1 per hour.

Now, Foxconn has instituted a new policy: stay with the company for 3 months and your monthly salary will be bumped to $300—more than double what workers were getting paid 3 weeks ago. Foxconn’s management and the companies doing business with them (namely, Apple, Dell, etc.) realize they are under a lot of public scrutiny about their labor practices. There is talk of an ongoing investigation—and I hope it is true. But the cynic in me also wonders how much of it is really a CYA campaign. I hope the former, but I suspect the latter.

All this has gotten me thinking about the sociological and cultural implications and differences between East and West when it comes to this type of death. I did a little searching for books on the subject of suicide in China specifically and in Asian society more generally. If you’d like to explore things for yourself, here are some titles you might be interested in. As always, check your local library’s collection or take advantage of interlibrary loan.

Suicide and Justice: A Chinese Perspective (Routledge Contemporary China Series). Fei Wu. 2009

Suicide: The Hidden Side of Modernity. Christian Baudelot. 2008.

Suicide in Asia: Causes and Prevention. Paul S.F. Yip. 2009

Death + Technology Suicide

Foxconn Raises Salaries

Today’s NY Times reports that Foxconn will raise employee’s salaries by 33 percent. Assembly line workers will now go from the equivalent of approximately $132 per month to $176 per month. A week earlier, company chairman Terry Gou, had promised to improve conditions at the factory and to quell the rash of suicides plaguing the company, denying there is a correlation between worker’s salaries and the suicides. According to the Times:

The company, which is based in Taiwan and employs more than 800,000 workers in China, has denied that the suicides were work-related or above the national average, saying instead that they were the result of social ills and personal problems of young, migrant workers. Foxconn said Wednesday that the decision to raise salaries was not a direct response to the suicides.

For some insight and a bit of the backstory, check out this audio clip from the folks over at Future Tense from last week. It’s about 45 seconds in.


Rash of Suicides at China’s Foxconn

Taiwanese-owned computer and electronics manufacturing giant, Foxconn, is drawing criticism for its recent spate of suicides. At present, 10 people have committed suicide within the last year—with one of those deaths occurring just hours after company Chairman Terry Gou, bowed in apology over the deaths.

Previously, we have reported on spates of suicides in posts on France Telecom and suicide hotspots like Japan’s Cliffs of Tojimbo and China’s Yangtze River Bridge. Although it’s not totally clear whether the Foxconn suicides can be attributed to copycat behavior among employees, one thing that can be fact-checked is the average number of suicides per year in China’s population as a whole.

According to 2004 World Health Organization estimates, China’s annual suicide rate is 16.9 deaths per 100,000 people. Foxconn employs approximately 800,000 employees. So, one can argue that statistically speaking, the number of recent suicides is actually less than the national average. But due to the quick succession of deaths and the fact that they all share the same employer, one has to ask what role, if any, their workplace played in their deaths. This is what investigators both in China and the U.S. are now attempting to unravel.

Death + the Law Death Ethics Suicide

Doctors Should Talk with Patients about Death

Doctors Should Talk To Patients About How They Want To Die, Says Regulator
James Meikle, The Guardian (May 20 2010)

The last month’s worth of news coverage in the UK has focused on nothing but the May elections so it was good to see an old fashioned death and dying story in the Guardian. My first take on these new guidelines, that doctors should speak with dying patients about, um, dying, was a smirk.

I do know, however, that frank and candid conversations about dying are not everyone’s forte, so I appreciate what the UK’s General Medical Council has done. As the Guardian reports,

While the guidance does not address assisted suicide, the GMC says it is still illegal and doctors have to remain within the law. However, it says there is “no absolute obligation to prolong life irrespective of the consequences for the patient, and irrespective of the patient’s views.”

This has been causing some real gnashing of teeth today. And it should. While it is absolutely true that the prolongation of life is never absolute, it’s still something which most doctors will do. Enter, then, patients and their end-of-life wishes. At a certain point during medical treatment, a patient may very well say “I’ve had enough and I want to stop all this.” Patients also expect (as well they should) that doctors will continue to treat them without giving up. The whole situation, then, can be a real bind for doctors and patients alike.

What these new guidelines want to do, it seems, is say to UK doctors that it’s ok when patients die, assuming the patient has a terminal condition and that the patient has accepted death. Negotiating the end of life is a complex task, especially when it comes to medical care, so I think that what the GMC has done is a good thing.

Here is a stripped down list of what the new guidelines entail:

• Doctors must give patients approaching the end of life the same quality of care as all other patients.

• Decisions must start from a presumption in favour of prolonging life.

• Doctors may recommend particular treatment options they believe best for patients, but must not pressurise them to accept advice.

• Patients who feel under pressure from families or carers to accept or refuse treatments must be helped to reach their own decisions.

• Doctors must not base treatment decisions involving significant risk to patients solely on constraints of money, staff or equipment.

• Doctors must respect “as far as possible” wishes of patients who do not want to know in detail about their condition or treatment.

• Doctors can withdraw from providing care if religious, moral or other personal beliefs amount to a conscientious objection to a patient’s decision to refuse treatment.

Paula-Westoby-DNR-TattooThe new guidelines also reminded me, for some odd reason, of a funny and poignant story from late 2008. A 79 year old New Zealand woman, Paula Westoby, had Do Not Resuscitate tattooed on her chest. She did this so that in the event she unexpectedly died, her wishes would be known.

This is what I call a real commitment to the End of Life.

Defying Death Suicide

TAL: Trouble Bridge Over Water

This American Life: The Bridge
originally aired May 7, 2010

Act One, Bridge Over Troubled Water

We posted last December about the Cliffs of Tojimbo in Japan, a popular tourist destination but also suicide hotspot, and the man who made it his mission to talk down and counsel would-be jumpers.

Act One of This American Life‘s episode The Bridge follows a similar situation in China, where Chen Sah patrols a four-mile long bridge thronged by thousands of pedestrians every day and averages one suicide per week. In standard This American Life fashion, the story is at once tragic, hopeful and bewildering, as reporter Mike Paterniti is embroiled in his own rescue of a jumper, a young man whom Chen then scolds and threatens to punch in the face for being a coward.

Death + Crime Death + Popular Culture Death + the Law Death Ethics Suicide

Kevorkian Revisited

Independent Minds: Dr. Jack Kevorkian (Listen to the audio)

Heard an interesting public radio broadcast this evening. It’s a series titled “Independent Minds” and tonight’s profile featured Dr. Jack Kevorkian. The show illuminates, through interviews, audio clips and sound bites, the life of the controversial “Dr. Death” and attempts to separate and dissect the man and the myth.

Want more Jack? Check out trailers for the upcoming HBO film You Don’t Know Jack, starring Al Pacino as Kevorkian. Directed by Barry Levinson, it also stars Susan Sarandon, John Goodman and Brenda Vaccaro. I don’t have cable and it could be a while before it shows up on Netflix. So if anyone catches it, by all means let us know and share your thoughts!

Death + the Law Death Ethics Suicide

UK Children Not Charged with Assisting Parents to Die

No Assisted Suicide Charge for Son of Sir Edward Downes
BBC News (March 19, 2010)

My very first post for the Death Reference Desk occurred on July 15, 2009 and it discussed the deaths of Edward and Joan Downes. The Downes’ went to the Dignitas Clinic in Switzerland to die together, their’s is a common story in the UK. Indeed, the stories about UK residents going to the Dignitas clinic remain an almost weekly occurrence.

What is new about the Downes’ case is that the Director of Public Prosecutions in the UK (Keir Starmer) has decided to not charge either of the Downes’ children with assisting their parents to die. I have discussed at length how suicide in the UK is legal but assisting a person to die is not. The Death Ref section on the Death + The Law presents these cases. Today’s legal decision is also important because it is the first time that the new guidelines drawn up by Keir Starmer have found no public interest in prosecuting a family member who clearly acted on compassionate grounds.

I am including a news clip from last July about Joan and Edward Downes. It’s interesting to note what has and hasn’t changed since then.

Death + the Law Death Ethics Suicide

2009 Oregon Death with Dignity Numbers

2009 Summary of Oregon’s Death with Dignity Act
The Oregon Public Health Division (March 2010)

Report Finds 36 Died Under Assisted Suicide Law
William Yardley, The New York Times (March 04, 2010)

Earlier this month, the state of Oregon published its annual report on who used the 1997 Death with Dignity Act. I have discussed the ins and outs of the Oregon law before but I want to highlight the following sections of the 2009 report:

• As in prior years, most participants were between 55 and 84 years of age (78.0%), white (98.3%), well-educated (48.3% had at least a baccalaureate degree), and had cancer (79.7%). Patients who died in 2009 were slightly older (median age 76 years) than in previous years (median age 70 years).

• Most patients died at home (98.3%); and most were enrolled in hospice care (91.5%) at time of death.

• In 2009, 98.7% of patients had some form of health care insurance. Compared to previous years, the number of patients who had private insurance (84.7%) was much greater than in previous years (66.8%), and the number of patients who had only Medicare or Medicaid insurance was much less (13.6% compared to 32.0%).

What is really important to note about the individuals using the Oregon law is their age, ethnicity, access to hospice care, and health insurance status. In a nutshell, the vast majority of the individuals were in the middle to upper middle social classes and hardly the lowest rung of Oregonians. This is important to point out because it demonstrates that this particular Assisted Dying law is not killing off the weak, the poor, and the uneducated.

In short, the law is not being abused.

Death + the Law Death Ethics Suicide

Living in America and Dying with Dignity in Europe

Frontline: The Suicide Tourist
PBS (March 02, 2010)

Assisted Suicide Guidelines: Family Can Still Face Prosecution
Sandra Laville, The Guardian (February 25, 2010)

Frontline, the documentary film unit for the Public Broadcasting Service in America, just premiered a really important new program. The film follows an American, Craig Ewert, as he decides to end his life at the Dignitas Clinic in Switzerland. What is unique about this storyline is that it focuses on an American going to Dignitas, which isn’t that common. To date, thirteen US citizens have ended their lives at Dignitas (as opposed to 135 Brits and 563 Germans).

The cultural, political and social issues surrounding Dignitas have been an ongoing topic in the United Kingdom, which makes the timing of Frontline’s documentary all the more uncanny. Last week, the Director of Public Prosecutions for the UK (Keir Starmer) published new guidelines for assisted suicide. Over the years, many people have wondered if “assisting” someone commit suicide included, say, going to Dignitas with the person. So much confusion has surrounded this UK law that short of actually changing it (which will eventually happen) the guidelines were published to help define whom the law can and cannot prosecute.

I have written extensively about the assisted dying debates in the UK on Death Ref (indeed, my first post was on an assisted dying case) and you can find a plethora of information in the Assisted Suicide section and the Death + the Law section.

As a final point of interest, the state of Oregon has published its 2008 Summary of Oregon’s Death with Dignity Act and you can see how people have used the law there to die.

In the end, the law will be changed in the UK and it will resemble Oregon’s law.

Death + the Law Death Ethics Suicide

Give Terry Pratchett the Freedom to Die…

Sir Terry Pratchett Calls for Euthanasia Tribunals
Maev Kennedy, The Guardian (February 02, 2010)

Terry Pratchett: My Case for a Euthanasia Tribunal
Terry Pratchett, The Guardian (February 02, 2010)

Last week, the British writer Sir Terry Pratchett (he of Discworld fame) catapulted the ongoing UK discussion on Assisted Dying back into the news. This is a persistent topic in the UK and I have written about it quite a bit on Death Ref here.

Terry Pratchett (who has been diagnosed with Alzheimer’s) is asking that a tribunal system be set up in England which then evaluates an individual’s request to die. The goal of setting up the tribunals is to make sure that any person making this request is of sound mind and not being coerced into the situation. Suicide has been legal in England since 1961 but helping another person commit suicide is against the law. So, a number of legal and political battles have dealt with the limits of what “assisting” another person means.

I have discussed these issues quite bit in the Death + The Law section.

In so many ways, this issue just keeps going and going and going. So much so, I’ve been collecting various articles for months because they appear daily and posting each one would be a full-time job.

Terry Pratchett’s request for a new UK system (or, at least, something for England… Wales and Scotland might be on their own) is another article for the group.

The problem, of course, is that all these issues and arguments are really interesting and important to discuss/think about/mull over.

But even I get Assisted Dying debate fatigue, and thinking about death is my job. The biggest dilemma, it seems to me, is that death is a human “problem” without terminus. At least in the twenty-first century West. England is certainly taking its time with any permanent changes to the law. It’s a slow process, to be sure, but it is a process. Terry Pratchett’s request will go a long ways in helping change UK law.

In the event you are a person doing research on Assisted Dying and the plethora of issues related to this topic, here are the articles that I have been recently collecting.

To wit:

The Guardian on the Dignitas clinic in Switzerland: ‘Death tourism’ leads Swiss to consider ban on assisted suicide

The Guardian on an elderly couple who committed suicide together: Couple wrote to BBC to tell of suicide decision

The Guardian on tour in the Dignitas clinic: Inside the Dignitas house

New York Times Magazine article on Brain Death and Organ Donation (which are related….): When Does Death Start?

New York Times on End of Life Care in California: Months to Live: Weighing Medical Costs of End-of-Life Care

New York Times on End of Life sedation: Months to Live: Hard Choice for a Comfortable Death: Sedation

BBC News on push in Scotland for a Terry Pratchett-like law: Most MSPs oppose end-of-life bill

Death + Popular Culture Defying Death Suicide

Death Meets Corporate Retreat in South Korea

South Koreans Experience What It’s Like to Die — and Live Again
John M. Glionna, Los Angeles Times (January 4, 2010)

For $25 a client, the Coffin Academy in Daejeon, South Korea, will help you experience what it’s like to be a corpse, including penning your own epitaph, writing final letters to loved ones and attending your own funeral — supine in the darkness of a closed coffin.

In a country with an exorbitant suicide rate, these kinds of death seminars are viewed as a means to “appreciate life by simulating death” and are particularly popular with large firms hoping to boost worker productivity. But they’ve also been criticized as “how-to manuals” for suicide, or apt to lead to suicide ideation–the opposite of the intended effect.

Interestingly, advocates aren’t only selling it as an effective vehicle for life reassessment and renewal, but as a morbid “scared straight” encounter. That’s right — don’t kill yourself, because it’s dark and scary in a confining coffin, which your employer has just required you to experience. Proponents of unsavory future lives may argue otherwise, but I’m pretty sure death is a cure for claustrophobia.

Check out the full article linked above. While unfortunately slim on follow-up — just how productive, happy, readjusted or suicidal anyway are the participants the next week, month or year? — it does provide a good overview of the seminar and descriptions of the emotional impact on participants along the way. Just a teaser… many of them are freaked the heck out.

If the South Koreans are too dour and psychologically wounded for you, perhaps an account of a three-day “death rehearsal” workshop in California will be of interest. Here they don’t just lie in their coffins, they paint them pretty colors, plus share a potluck dinner of “food that one would bring to a family in mourning.”