Features

To Be or Not to Be?

More people die of suicide in King County than from traffic accidents or murder, but no one likes to talk about it. A few words about the history, meaning, and practice of suicide, from third-century Christian death cults to the Aurora Bridge.

by Brendan Kiley

samuel bosma

THE AURORA BRIDGE IS THE SECOND MOST POPULAR JUMP SITE IN THE U.S. More than 230 people have leaped from it—over the past decade, an average of one person every three months. This spring, the state will install a mile of suicide fencing on either side. If you or someone you know is considering suicide, call the King County Crisis Clinic at 461-3222 or 866-4CRISIS.

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KING COUNTY SUICIDE DEATHS by Age Group 2008

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SUICIDE METHODS in King County 2008

Last summer, a University of Washington parking-lot attendant hanged himself from the side of a campus garage while setting himself on fire. The flames burned through the cord, dropping him into the alley below, where he died of two simultaneous causes—burning and falling.

The same day somewhere else in King County, a man who'd hanged himself in his bathroom nine years earlier finally succumbed to anoxic encephalopathy and died: a time- delayed suicide. Two days after that, a 65-year-old woman took an overdose of prescription pills and drowned herself in Lake Washington. Two days after that, a 66-year-old man overdosed on sedatives, antidepressants, and alcohol in his kitchen in Kent. One week and six King County suicides later (three shootings, two hangings, and one asphyxiation by plastic bag), another Kent sexagenarian killed himself by cutting his feet and legs with a knife. He died, according to the King County medical examiner's report, of "exsanguination," the simple act of diverting a few ounces of blood from the inside of his body to the outside—an act that most people are reluctant to discuss. (That same month, another King County man exsanguinated himself by cutting his kidney dialysis catheter with scissors. The dialysis machine pumped blood out of his body and onto the floor.)

"'Tis impious, says the old Roman superstition, to divert rivers from their course," David Hume wrote in a rare (and exasperated) defense of suicide in 1755. People think that God is terribly angry at those us of who kill ourselves, he argued, because people are egotists: "The life of a man is of no greater importance to the universe than that of an oyster."

"It would be no crime in me to divert the Nile or Danube from its course," he fumed. "Where then is the crime of turning a few ounces of blood from their natural channel? Do you imagine that I repine at Providence or curse my creation, because I go out of life, and put a period to a being, which, were it to continue, would render me miserable?"

We haven't come close to answering the question.

A total of 13,339 people died in King County in 2008. (The data for 2009 hasn't been tabulated yet.) Sixteen percent of them—2,121 people—became cases for the county Medical Examiner's Office: 85 were murdered, 163 died in traffic accidents, and 210 committed suicide. Of the suicides, 93 shot themselves. (In the same year, there were 45 gun-related murders: If you're going to die by gunfire in these parts, you'll most likely be pulling the trigger.) Forty-eight hanged themselves. Twenty-nine took drugs or poison. Thirteen died from jumping, eight from asphyxia, five from cutting or stabbing, four from carbon-monoxide poisoning, three from drowning, another three from self-immolation, and four from "other."

I asked Joe Frisino—who has been investigating deaths for the Medical Examiner's Office, by his own reckoning, "for longer'n you've been alive"—what counts as "other."

"I've seen people put tape over their mouths, seen people drown themselves in a barrel of water, and some people jump into machinery," he said. "Sometimes people really want to hurt themselves or hurt the person who they think is at fault. Sometimes you see suicide notes that say, 'Well, this'll show you.' Of course, nobody shows anybody anything, because they're dead."

During his years at the Medical Examiner's Office, Frisino has become something of a scholar of suicide. "Even if a case is reported as a suicide by the police department, we go in with an open mind," he said. "We see far more deceased folks than any police officer on the beat."

He has learned that people who live on houseboats near the Aurora Bridge can recognize the sound of a body splashing into Lake Union. He has learned that the sooner he interviews a bereaved family, the more accurate the information will be, because they haven't had time to consult a lawyer or an insurance agent. And he's learned how to tell whether a hanging was a suicide or an erotic accident. "Look at the joist or whatever they've hung themselves on," he said. "If there are many notches in the wood, you've got yourself an autoerotic asphyxiation. Also, those people tend to put a towel around the rope, because if you go to work with lots of lines across your neck"—Frisino drew a forefinger across his throat and grinned—"people might ask: 'You wearing your tie a little tight these days, buddy?'"

Hanging is the most popular method of self-slaughter in the world and the second most popular in the United States, after firearms. (It's also the most common suicide method among U.S. children: Last December, a 6-year-old girl in McMinnville, Oregon, became one of the youngest suicides in American history by tying a corduroy belt around her neck and hanging herself from the top railing of a crib.)

People figured out how to weave and plait about 10,000 years ago and probably started hanging themselves shortly after. The anthology African Homicide and Suicide, a collection of studies compiled in 1960 but still considered definitive for its subject matter, reports that 90 percent of the suicides in premodern Africa were by hanging from rafters or tree branches. Among the Basoga in Uganda, the rate is as high as 96 percent, even when knives and cliffs are readily available. It's also one of the easiest methods: It takes only seven or eight pounds of tension on a cord to block the carotid artery in your neck. Meaning you can hang yourself while kneeling. Many prison "hangings" are really just prison "leanings forward."

The world's most popular jump site is said to be Mount Mihara, a volcano on an island near Tokyo where a person can leap off the rim and directly into the lava. Though the numbers are difficult to verify, over 600 people reportedly killed themselves by jumping into its crater in 1936 alone. The most popular jump site in the United States is the Golden Gate Bridge in San Francisco, a suicide magnet for people all over the country. (Reports from the University of California show that many people travel across the San Francisco-Oakland Bay Bridge to jump off the Golden Gate Bridge, though the two structures are approximately the same height. There is no record of anyone doing it the other way around.) The second most popular jump site in the United States is the Aurora Bridge, between Fremont and Queen Anne.

More than 230 people have leaped from the Aurora Bridge—the first was a shoe salesman who jumped in 1932, before the bridge was even open—and roughly 15 percent survive. In the two or three seconds it takes to fall those 164 feet, a 160-pound person can reach speeds of 55 miles per hour. One person who survived a jump in 1980 and was later profiled by the Seattle Post-Intelligencer lost two inches in height from her injuries.

Some jump into Lake Union and others jump onto the adjacent parking lot of Adobe Systems. (A few years ago, after a 15-year-old girl jumped onto the parking lot, her friends painted a big heart to mark the spot where her body fell.) On average, one person jumps off the bridge every three months. But this spring, the Washington State Department of Transportation (WSDOT) will erect more than a mile of suicide fencing on either side of the bridge. The project comes after years of debate pitting concerns about construction noise and fence aesthetics against the danger of bodies plummeting from the sky and landing on houseboats, cars, or passersby.

On a sunny, windy day in April, I stood on the bridge with WSDOT engineer Aleta Borschowa and inspector Sam Al Mallah, all of us wearing hard hats and orange safety vests, talking about the logistics of the project: how the builders will x-ray the old bridge to make sure they're not drilling into critical rebar, how they'll rig a system so they only have to shut down one sidewalk at a time, how they'll establish phone boxes allowing people in wheelchairs (who can't take the stairs to cross from the closed sidewalk to the open one) to call for a quick ride to the other end of the bridge.

"You got to think of all these things," Al Mallah says. "We'll have mesh nets beneath the bridge, so if a worker drops a wrench or something, it won't hurt anybody below."

Jamie Holter, a spokesperson for WSDOT, stood on the bridge with us, also wearing a hard hat and orange safety vest. She said the project will cost $4.6 million, down from its original, prerecession budget of $8.1 million. I mentioned a 1995 study I'd just read about the economic cost of killing oneself: The direct cost of an attempted suicide—hospital fees, autopsy and investigation costs—is $5,310. The direct cost of a completed suicide is $2,098.

"Did the state do any kind of cost-benefit analysis to figure out when the barrier would start paying for itself?" I asked.

"Uh... no," Holter answered. "I don't think the state calculated the value of a human life."

Then she told me a story.

"When I was 22, I was working as a waitress in Santa Monica. I remember walking with two bowls of French onion soup and seeing a man fall past the window—and I just dropped the bowls of soup, right there. It shocked me. He'd jumped off the roof and killed himself. I ran to the window. You think that a jumper would be like the cartoons, all splattered and gory and bloody. But he was just lying there, normal. And then this great puddle of blood began to drain out of him—I threw up right there, on the floor. It's a traumatic thing to see someone die. I'll never forget it."

When we were done talking, Borschowa, Al Mallah, and Holter took my hard hat and orange vest and drove away, leaving me to walk up and down the bridge a few times. I leaned over the edge for a while, looking at the puckers of gray-green waves below, trying to imagine jumping. For just a flash, it didn't seem so bad—a fast, exhilarating fall with nothing on the other side. No having to hike back home. No having to worry about the people I love. No rent to pay, no clothes to wash, no having to get down to the work of writing this story. No nothing.

A 2005 article in Psychiatric News says some jumpers aren't necessarily depressed or chronic suicide attempters—sometimes people are simply overwhelmed by a sudden desire to leap—and that thwarted jumpers rarely go on to kill themselves in other ways. One researcher followed the lives of 515 people who were pulled from the Golden Gate Bridge: After an average of 26 years each, 94 percent were either still living or had died of natural causes. Another study, of the Duke Ellington Bridge in Washington, D.C., showed that its suicide fence caused no increase in suicides at the Taft Bridge, which has no fence and is only one block away.

It's difficult to say why some places become suicide magnets. Hundreds have committed suicide from the Aurora Bridge, but only three suicides have jumped from the Space Needle (all in the 1970s, before suicide barriers were installed). Over 360 people are said to have jumped from the Eiffel Tower—including one possibly apocryphal young woman who landed on the roof of a car, survived, and later married the car's owner—though the rates declined after the installation of a suicide fence. The Empire State Building continues to draw people despite its guards and suicide barriers: Cameron Dabaghi, the Yale student who leaped from the Empire State Building two months ago, ignored the pleas of other people on the observation deck, took a running start to clear a safety barrier, and somehow got over a 10-foot-high spiked fence—police still aren't sure how.

In 1996, a young police officer named Kevin Grossman was called out to the Ravenna Bridge in the University District where a man was threatening to jump. Grossman had joined the Seattle Police Department only months before. "I just didn't know what to say to this guy," he recollected the other day. "He wouldn't talk, he wouldn't respond, I didn't have any experience." The man jumped and died. Officer Grossman went through the man's wallet and found an ID: His given address was the Western State mental institution.

"I thought, 'Wow,'" he said. "You can't help but blame yourself a little bit—there's got to be something else we can do to get officers out there who can even recognize the symptoms and try to help these people." He joined the Crisis Intervention Team, a group of several hundred officers who elect for special crisis training, in 1998. Seven years later, he attended the FBI negotiator school and joined the hostage-negotiation team. "The title is so sexy," he explained, "but almost all of what we do is suicide intervention"—talking to people who are, in a sense, holding themselves hostage.

Many of the strategies might seem like common sense, he says, but "conversation is a lost art." Whether he's talking to people threatening to kill hostages or threatening to kill themselves, Grossman uses active listening, empathy, and patience ("Traffic may be diverted or you inconvenience people, and that sucks, but you may end up not having to shoot someone"), and tries to help them identify something worth living for. Grossman calls that "the hook."

"People in crisis focus on the crisis," he said. "It's tunnel vision, and you try to remind them of a relationship, a kid they adore, friends, something else that's important. I had one case where a guy, a veteran going through hard times, was threatening to jump from a parking garage. I don't know how, but we somehow got on the topic of ice cream. I got him to promise me that if he got off the parking garage and got on a gurney, I'd get him a pint of Ben & Jerry's ice cream. And I'll be damned if he didn't come down and get on the gurney. And I got him a pint of ice cream."

In 2007, Detective Grossman was awarded the Seattle Police Department's Detective of the Year award.

The King County Crisis Clinic is the second oldest 24-hour crisis line in the United States. It was founded in 1964 by two married psychiatrists whose 12-year-old daughter—Jill Marie Patten—was stabbed 14 times by a letter carrier a few blocks from her home. (She survived.) As the couple looked into her attacker's past, they realized he was someone who had needed help and couldn't get it. The couple assembled a team of friends and colleagues to start a crisis hotline. Since the first call, the phones have never been off.

"We get a fair number of suicide calls," said Crisis Services director Michael Reading. In 2009, the clinic received 4,289 calls "with suicidal content" (507 of them from people under 18) and 52,158 other calls for other "emotional support." That's 20 suicidal calls for every completed suicide in King County.

The clinic has over 140 volunteers, some of whom have been there for years. The true-crime writer Ann Rule worked at the Crisis Clinic in the 1970s alongside Ted Bundy—her first book, The Stranger Beside Me, is about coming to the realization that her friend and former colleague was a serial killer.

"It's a very intense subject and a very intense job," said Gavin Turner, a soft-voiced Australian man who started at the clinic 15 months ago. "You get the whole spectrum of human experience in that phone room." If a caller begins giving verbal cues about suicide, Turner explained, the best thing to do is ask them directly whether they're thinking about killing themselves—and not to use euphemisms like "Are you thinking of taking your life?"

"Some new volunteers might question this," he said. "They wonder if they're planting the idea in someone's mind. But if you ask a direct question, you get a direct answer. And there may be some relief from the caller, like 'Finally someone is asking me.' In all the time I've been working at the clinic, I've never asked that question and had the person say no." When a caller says yes, the volunteer on the line raises his or her hand, and a mental-health professional (there are always one or two on duty) comes over to sit with the volunteer for emotional support.

The next step is to ascertain the caller's immediate safety, to determine whether they have a gun or lethal medications in the house and whether they have an immediate plan to hurt themselves. "We're not counseling on the phone," Turner said. "We're staying in the moment, dealing with what's happening now. For most people, it's a momentary impulse—sometimes they just need someone to do some active listening, to have a genuine and honest conversation, or to just to sit with them. You have to be okay with sitting in silence."

Like Detective Grossman, the volunteer tries to help the caller identify something worth living for, something short-term to keep them going through the evening. "It could be anything," Turner said. "From a relationship and the experience of being loved to the next episode of The Golden Girls. We try to remind them of the basics of self-care—did you eat today? If it's 2:00 a.m., we might suggest they have a cup of tea, turn off the light, and lie down and breathe. We ask people to make a verbal contract to stay safe this evening and ask what they're going to do at the end of the call. What's your short-term plan to get you through the next few minutes? The next few hours? And so often, at the end of a call, people say, 'Thank you so much for listening.'"

Joe Frisino, of the county Medical Examiner's Office, said that sometime in the 1980s, his office partnered with the Crisis Clinic to get the names of the 40 highest-risk people who had called the clinic but hadn't been heard from in a while. (That study would be impossible today because of privacy laws—currently, all calls to the Crisis Clinic are anonymous.) "The examiners went out to look for them," Frisino says. "And you know what? We only found one who had taken his life. We were all surprised. We thought there'd be more."

Dear Mom:

Let me tell you a few things you already know: You're ill with a disease that can't be cured and, barring a miracle, will probably end your life. Like every person who has ever had a terminal disease—like all of us who will eventually be diagnosed with terminal diseases—you will probably face a difficult moment when you think about whether to end your own life or let the disease do the ending for you.

Since you follow the news, you also know that last year, Washington State voters approved an assisted-suicide law that allows you to make that choice legally—to take some short-acting barbiturates that will help you relax while slowing your heart and your breathing and usher you, calmly, to death. Last year, 63 people in Washington State filled prescriptions for those barbiturates and 36 chose to take them.

You're also a Christian, born and raised with old-time religion and the idea that if you choose to kill yourself, God will be really unhappy with you.

And you are the person who introduced me to Hamlet, dragging me along to see it so many times as a kid that I remember traipsing around the house asking, "To be or not to be?" long before I understood that is the question. As Hamlet puts it in the first of the play's (several) suicidal speeches:

O, that this too too solid flesh would melt,
Thaw and resolve itself into a dew!
Or that the Everlasting had not fix'd
His canon 'gainst self-slaughter! O God, God,
How weary, stale, flat, and unprofitable,
Seem to me all the uses of this world!
Fie on't, ah fie! 'Tis an unweeded garden
That grows to seed...

That line about the Everlasting fixing his canon against self-slaughter seemed absurd when I first figured out what it meant. I'd never thought of suicide as a sin. It seemed more like eating the family goldfish or setting the sofa on fire—definitely a bad idea, but not something you'd wind up in hell for.

Especially since the Everlasting that Hamlet is referring to is God, who sent "His only begotten son" to earth to die on purpose and free us all from sin. Wasn't the crucifix we stared at every Sunday the image of a God who committed altruistic suicide? Wasn't that what all the fuss was about?

So, Mom, let me tell you a few things you might not already know: The Christian prohibition against suicide, as far as I can tell, isn't in the Bible. It began centuries later with a polemic St. Augustine wrote against an early Christian sect that was overly fond of martyrdom. Because Augustine didn't have much biblical evidence to muster against their suicidal tendencies, he resorted to pre-Christian philosophers (mostly Aristotle) to make his case for him. The Christian arguments against suicide are largely borrowed from pagans. And St. Thomas More—not just a theologian but a saint—makes an argument for rational, humane suicide for the terminally ill in Utopia. Granted, Utopia is fiction, not theology. But he didn't seem like he was kidding.

Despite what you might've heard about lemmings and scorpions, people are the only animals that commit suicide. The old Romans used to think that scorpions stung themselves to death when tortured with fire (and a few grainy, sadistic YouTube videos have taken them up on the challenge, setting scorpions in skillets with flammable liquids and throwing in matches). But in 1998, three French biologists found that scorpions are highly resistant to their own venom. They flail wildly when burned alive—who wouldn't?—which might look like they're trying to kill themselves, but they're not.

And lemmings jumping off cliffs? That was a stunt staged by a Disney documentary crew in 1958 that got out of hand. While filming the documentary White Wilderness in Alberta, Canada, the Disney crew wanted footage to illustrate the old story of lemmings jumping off cliffs into the Arctic Ocean—even though Alberta is landlocked and roughly one thousand miles from the Arctic Ocean. So the film crew bought some lemmings from indigenous folks, shoved them off a lakeside cliff, and filmed the result.

Ancient Greek and Roman suicides were anomalous for their violence—40 percent death by weapons, 18 percent by hanging, and 16 percent by jumping. But those suicide rates aren't verifiable, and the myth of the noble suicide as a heroic act of militant will was part of ancient cultural mythology. Cato the Younger, for example, having decided to kill himself (because he didn't want to live in a world ruled by Julius Caesar), allegedly took a bath, had supper with his friends, went to bed, read Plato's Phaedo a few times, then stabbed himself in the guts. From Plutarch's Lives:

His thrust, however, was somewhat feeble, owing to the inflammation in his hand, and so he did not at once dispatch himself, but in his death struggle fell from the couch and made a loud noise by overturning a geometrical abacus that stood near. His servants heard the noise and cried out, and his son at once ran in, together with his friends. They saw that he was smeared with blood, and that most of his bowels were protruding... the physician went to him and tried to replace his bowels, which remained uninjured, and to sew up the wound. Accordingly, when Cato recovered and became aware of this, he pushed the physician away, tore his bowels with his hands, rent the wound still more, and so died.

That is a classic noble suicide in the Western tradition—intentional, spectacular, principled. Samson was another. Robbed of his magical strength and enslaved by the Philistines, he asked God to grant him one last boost of power to shake an entire temple to the ground, taking 3,000 Philistines with him in a move that would've impressed a 9/11 hijacker. (One man's evil Philistine is another man's relative who happens to be in the wrong building at the wrong time.) In both the Old Testament (Judges 13:24) and the New Testament (Hebrews 11:32), God counts Samson among the blessed.

The Christian prohibition against suicide didn't really get going until St. Augustine and the ideological war he waged against heretical schisms, including the Donatists, a pack of fundamentalists who refused to recognize the spiritual authority of priests who'd renounced their faith during Roman persecutions. While the rest of the early Church was more forgiving to those fair-weather Christians, the Donatists called them traditors, "people who handed over" sacred scriptures to the Romans to be burned. (The word "traitor" comes from this root.)

There were too many fights, murders, and excommunications to describe here, but the Donatists had the idea that running into the arms of martyrdom was a good way to get to heaven. According to the Catholic Encyclopedia, "they were especially fond of flinging themselves from precipices" and sometimes "sought death at the hands of others, either by paying men to kill them, by threatening to kill a passerby if he would not kill them, or by their violence inducing magistrates to have them executed." St. Augustine tore into the Donatists, arguing that suicide was an unpardonable sin, and leaned on Aristotle to make his point.

In the mid 1200s, St. Thomas Aquinas argued against suicide in his Summa Theologica, leaning heavily on Augustine, more Aristotle ("The most fearsome evil of this life is death"), and the Old Testament book of Deuteronomy (which explicitly prohibits shaving but only obliquely criticizes suicide—Aquinas cites passages about how killing is God's prerogative: "I will kill and I will make live"). Aquinas mentions the Samson problem, but never resolves it.

Later thinkers dabbled in suicide—one medieval Spanish theologian argued that if you were in a shipwreck and drowned because you let someone else take an unoccupied floating board, you were just being generous, but if you gave up a board you'd already grabbed, you had committed a mortal sin—but nobody seriously questioned whether the Everlasting really had fixed his canon against self-slaughter until 1608, when priest and poet John Donne ("Death, be not proud...") wrote his Biathanatos.

In Biathanatos, Donne only lightly touches on the central problem for Christians—whether Jesus Christ was a noble suicide. Instead, Donne uses Samson as a less controversial stand-in for Christ. In his exegesis of Biathanatos, Jorge Luis Borges distills Donne's implied argument, which may have been too dangerous for anyone to explicitly make in Donne's day:

For the Christian, the life and death of Christ are the central event in the history of the world; the centuries before prepared for it, those after reflect it. Before Adam was formed from the dust of the earth, before the firmament separated the waters from the waters, the Father knew that the Son was to die on the cross and, as the theater of this future death, created the heavens and the earth. Christ died a voluntary death, Donne suggests, and this means that the elements and the terrestrial orb and the generations of mankind and Egypt and Rome and Babylon and Judah were extracted from nothingness in order to destroy him. Perhaps iron was created for the nails, and thorns for the mock crown, and blood and water for the wound. This baroque idea glimmers behind Biathanatos. The idea of a god who creates the universe in order to create his own gallows.

Biathanatos was published after Donne's death and was pretty much forgotten by everyone, save a few scholars.

I thought about you as I did this research, Mom, because if the moment comes when you have to choose between barbiturates and disease—one sabotaging your organs quickly and painlessly, the other sabotaging your organs more slowly and painfully—you shouldn't have to worry about whether you're committing a sin. Hamlet was wrong. The Everlasting did not fix his canon against self-slaughter: Augustine did, for venial reasons that have little to do with God and nothing to do with you—he was just trying to get the attention of some crazy people in North Africa.

Many of the people I talked to in the course of working on this story encouraged me not to write it. For most people, the subject is so taboo it's hard to deal with—even among people who deal with suicide for a living.

Two Jesuit scholars, one from Seattle University, flatly refused to discuss the theology of suicide with me. Jamie Holter at WSDOT had reservations about providing access to the Aurora Bridge engineers. Sue Eastgard, a youth-suicide expert, urged me to be circumspect about describing details of suicide, saying: "We can argue about freedom of speech, but there is a danger in describing horrible images that inspire some of our more disturbed kids—suicide contagion is real."

Wylie Tene, of the American Foundation of Suicide Prevention, also had some concerns about this story, particularly about how it would be illustrated. In 2007, Tene wrote a letter to The Stranger admonishing us for a joking mention of suicide in our annual regrets issue—"The Stranger has little concern that their irresponsibility may lead to copycat suicide," he wrote—so I thought I'd call Tene to ask his opinion. "An illustration of the bridge probably isn't the safest thing," he said, when I described the drawing of a woman on the Aurora Bridge. "Could the image just be of someone looking depressed, maybe crouching in a corner crying? Or maybe of the bridge with the suicide barriers in place, to give people the impression that the barriers are already up? The best image would probably be someone in a psychiatrist's office getting some help."

And Robb Miller of Compassion & Choices of Washington, who worked on the death-with-dignity campaign, asked me to withhold the names of the prescription barbiturates people take to end their lives. He also objected when I used the phrase "assisted suicide," saying that term was "loaded" and that his campaign "had put a lot of resources into" divorcing itself from the word suicide. His people prefer the term "aid in dying."

"Hell, that's just mincing words," my mom said when I told her about that conversation. "If you're going to say something, just say it." But even she urged me to be "very, very careful" while writing about Christianity and suicide. "How are you going to feel if somebody kills himself because of your article?"

There's something to that. In 1774, Johann Wolfgang von Goethe published The Sorrows of Young Werther, a romantic novel about a sensitive, lovelorn young man who shoots himself. Goethe later denounced the novel and the romantic movement in general, calling it "everything that is sick." But the damage was done: People loved it. Napoleon carried a copy of Young Werther during his invasion of Egypt. Mary Shelley wrote a scene in Frankenstein where the monster weeps as he reads it. And Wertherfieber ("Werther fever") became an 18th-century obsession, with young men imitating his clothing, his sighing romantic persona, and, allegedly, his death. As it gathered a reputation for inspiring young suicides, Young Werther was banned in Leipzig, Copenhagen, and the whole of Italy.

Academics have argued about whether popular stories—especially newspaper stories about suicides—have a "Werther effect." In the 1980s, studies in Vienna showed that when newspaper stories about people jumping in front of subway trains were made less dramatic, subway suicide attempts dropped by more than 80 percent. The overall suicide rate in Vienna dropped as well. But studies in the U.S. and elsewhere have been contradictory. "Although many of the findings suggest that media coverage on suicides may cause imitative suicidal behavior," write the authors of the Comprehensive Textbook of Suicidology, "the evidence still remains inconclusive."

In 1994, when newspapers and magazines exploded with stories about Kurt Cobain's suicide, specialists braced for the worst. Eastgard, the youth-suicide expert, was at a suicide-prevention conference on the East Coast when the news broke. "Everybody there was afraid of what was going to happen," she said. "I gave interviews for four days straight after the Cobain suicide. I lost my voice talking to the media."

Eastgard and a group of suicide-prevention specialists assembled a study to examine the King County suicide rate for a "Cobain effect." But there was none—in fact, 1994 had slightly lower suicide rates than the years before and after. (An Australian study looking at youth suicide after Cobain showed the same results.) Calls to the King County Crisis Clinic spiked, however—the coverage inspired more people to seek help. Eastgard gives much of the credit to Courtney Love.

"Whatever you think of Courtney, she did an enormous service to the community by speaking out," Eastgard said. "She was pissed at him, she swore at him, she said, 'This is not right.' It's the glamorizing, the glorifying that's problematic."

The central problem of studying suicide, say the authors of the Comprehensive Textbook of Suicidology, is the difficulty of knowing what the dead were thinking. Some people kill themselves because they're desperate or deranged. Some people kill themselves calmly and rationally, in the spirit of Seneca the Younger: "The wise man will live as long as he ought, not as long as he can." People all over the world kill themselves for all kinds of reasons—children, old people, the dirt poor, even the filthy rich.

On January 5, 2009, a German multibillionaire named Adolf Merckle who made a fortune on cement and pharmaceutical firms reclined on some train tracks near his home and was run over. Time magazine guessed that Merckle committed suicide because he "lost several hundred million euros when he got caught on the losing end of a short sale of Volkswagen shares." But who knows?

In the first chapter of The Virgin Suicides, by Jeffrey Eugenides, a young girl named Cecilia wakes up in an emergency room after slashing her wrists in a bathtub.

Dr. Armonson stitched up her wrist wounds. Within five minutes of the transfusion he declared her out of danger. Chucking her under her chin, he said, "What are you doing here, honey? You're not even old enough to know how bad life gets."

And it was then Cecilia gave orally what was to be her only form of suicide note, and a useless one at that, because she was going to live: "Obviously, doctor, you've never been a thirteen-year-old girl."

Perhaps the most committed philosopher of suicide was a 19th-century German who called himself Philipp Mainländer. He argued in his Philosophy of Redemption that everything extant yearns for nonexistence and that human beings are the shards of a God who, to overcome the monotonous agony of immortality, created a finite universe so He, too, could pass into oblivion. "Our world," Mainländer wrote, "is the means and the only means of achieving nonexistence."

On April 1, 1875, Mainländer hanged himself in his home. He used a stack of copies of Philosophy of Redemption, which had arrived the previous day, as a pedestal. He was 34 years old.

If you or someone you know is considering suicide, call 461-3222 or 866-4CRISIS.