This is an interesting article from 2013, but it’s very odd that it doesn’t mention chronic pain in connection with suicide. In fact, in this very long article, the word “pain” (or a form of it) is only mentioned 7 times. It’s like chronic pain patients don’t even exist…

http://www.newsweek.com/2013/05/22/why-suicide-has-become-epidemic-and-what-we-can-do-help-237434.html

But suicide is not an economic problem or a generational tic. It’s not a secondary concern, a sideline that will solve itself with new jobs, less access to guns, or a more tolerant society, although all would be welcome. It’s a problem with a broad base and terrible momentum, a result of seismic changes in the way we live and a corresponding shift in the way we die—not only in America but around the world.

We know, thanks to a growing body of research on suicide and the conditions that accompany it, that more and more of us are living through a time of seamless black: a period of mounting clinical depression, blossoming thoughts of oblivion and an abiding wish to get there by the nonscenic route. Every year since 1999, more Americans have killed themselves than the year before, making suicide the nation’s greatest untamed cause of death…

There are as many intentional ways to die as there are people to imagine them, and we saw more of all of them: an almost 20 percent rise in the annual suicide rate, a 30 percent jump in the sheer number of people who died, at least 400,000 casualties in a decade—about the same toll as World War II and Korea combined…

This year, America is likely to reach a grim milestone: the 40,000th death by suicide, the highest annual total on record, and one reached years ahead of what would be expected by population growth alone. We blew past an even bigger milestone revealed in November, when a study lead by Ian Rockett, an epidemiologist at West Virginia University, showed that suicide had become the leading cause of “injury death” in America…

This development evades simple explanation. The shift in suicides began long before the recession, for example, and although the changes accelerated after 2007, when the unemployment rate began to rise, no more than a quarter of those new suicides have been tied to joblessness, according to researchers…

Throughout the developed world, for example, self-harm is now the leading cause of death for people 15 to 49, surpassing all cancers and heart disease. That’s a dizzying change, a milestone that shows just how effective we are at fighting disease, and just how haunted we remain at the same time. Around the world, in 2010 self-harm took more lives than war, murder, and natural disasters combined, stealing more than 36 million years of healthy life across all ages…

And this assumes we can even rely on the official data. Many researchers believe it’s a dramatic undercount, a function of fewer autopsies and more deaths by poison and pills, where intention is hard to detect. Ian Rockett of West Virginia University thinks the true rate is at least 30 percent higher, which would make suicide three times more common than murder. Last fall the World Health Organization estimated that “global rates” of suicide are up 60 percent since World War II. And none of this includes the pestilence of suicidal behavior, the thoughts and plans that slowly eat away at people, the corrosive social cost of 25 attempts for every one official death…

We’re a gregarious species, but also a gallant one, so fond of playing the savior that we’d rather die than switch roles with the saved. In this way suicide isn’t the ultimate act of selfishness or a bid for revenge, two of the more common cultural barbs. It’s closer to mistaken heroism.

If suicide has an evolutionary component, as Joiner believes it might, this is where it manifests itself. Humans are not the only animals that commit suicide. Bumblebees kill themselves as a defense against parasites, abandoning the nest to save it. Pea aphids do something similar. They use a kind of suicide bomb that maims ladybugs, their biggest predator, to save their own kind. Higher up in the animal kingdom, male lions sacrifice themselves on the savannas: they expose their throats to attacking clans in an effort to give other family members a chance to escape. A similar instinct may still linger in our DNA, colliding uncomfortably with the frailties and banalities of modern life…

In this way, suicide isn’t about cowardice. It’s not painless or easy, like pulling the fire alarm to get out of math class. It takes “a kind of courage,” says Joiner, “a fearless endurance” that’s not laudable, but certainly not weak or impulsive. On the contrary, he says, suicide takes a slow habituation to pain, a numbness to violence. He points to that heightened suicide risk shared by athletes, doctors, prostitutes, and bulimics, among others—anybody with a history of tamping down the body’s instinct to scream, which goes a long way to unlocking the riddle of military suicides…

Smart clinicians can do it, but it’s not easy to get people into treatment. There’s the cost, for one thing, but more than that, there’s the shame and the stigma. Suicide is the rare killer that fails to inspire celebrity PSAs, 5K fun runs, and shiny new university centers for study and treatment…

The opioid war began long before 2013, and yet in this macro view of suicide, it doesn’t even warrant a mention?

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