Why People Die by Suicide

by Thomas E. Joiner

In the wake of a suicide, the most troubling questions are invariably the most difficult to answer: how could we have known? What could we have done? And always, unremittingly: why? Written by a clinical psychologist whose own life has been touched by suicide, this book offers the clearest account ever given of why some people choose to die. Drawing on extensive clinical and epidemiological evidence, as well as personal experience. Thomas Joiner brings a comprehensive understanding to seemingly incomprehensible behaviour. Among the many people who have considered, attempted, or died by suicide, he finds three factors that mark those most at risk of death: the feeling of being a burden on loved ones; the sense of isolation; and, chillingly, the learned ability to hurt oneself

Genres: Psychology, Nonfiction, Mental Health, Mental Illness, Counselling, Science, Philosophy

288 pages, Hardcover

First published January 15, 2005

About the author

Joiner, Thomas.
Joiner, Thomas E.
Joiner, Thomas E. Jr

Thomas Joiner is an American academic psychologist and leading expert on suicide. He is the Robert O. Lawton Professor of Psychology at Florida State University, where he operates his Laboratory for the Study of the Psychology and Neurobiology of Mood Disorders, Suicide, and Related Conditions. Joiner holds a Ph.D. from the University of Texas at Austin.

Reviews

[Claude]

A suicide book. Yes it's a subject I claim to know a lot about, and this book is written by my often enemy: a psychologist. In my personal experience I am continually disappointed by the stupidity of both psychologists and psychiatrists, and this book is no exception.
There are some interesting anecdotes in this book, which I was not aware of before, which made the book worth reading. But Thomas Joiner's annoying habit of stating things like, "In my model" and "my interpretation", is extremely annoying and devoid of any real knowledge. These are not exact quotes as I am too lazy to offer anything verbatim.
So Thomas Joiner's father died of suicide - this means nothing! This doesn't guarantee that he has any kind of understanding of a suicidal person's mind. There are plenty of idiot aspiring psychologists at university, and qualified ones working in the field, who seem to think that their vicarious mental illness experiences qualify them as some kind of expert. Nothing could be further from the truth. How many idiot psych students have I met on campus who "want to help people", often because, "their mother has schizophrenia." Just because your intentions are admirable does not mean you have the necessary skills to help people. I have observed time and time again that psychologists have an inflated sense of what their professional work achieves. A psychologist's work is - and can only ever be - a metaphysical kind of help/worth/value. And I hate it when a psychologist (or even a psychiatrist) pretends that they have some kind of influence over a patient, that is grounded in scientific inquiry, when they are no more than an 'elaborate' councillor. I would prefer to speak to a switched on councillor than a psych any day. Qualifications for the most part mean nothing, in a field that is dominated by idiots. If you don't believe me, all you need to do is meet the students at any university studying psychology, and you will find out that on average they are significantly more air-headed than other faculties.
I go on a bit, yes I do. It's just that Thomas Joiner pisses me right off with his virtually worthless suicidal model. Just because his father died by suicide, does not qualify this comedian any more than someone else. And the fact that he is a Professor of Psychology doesn't mean much either - this could still mean that his IQ is relatively low. Don't be fooled in to thinking that academic qualifications equate to knowledge, and especially intelligence, all too often (sadly) they don't.
Those who know the most about suicide are the ones who have help the knife closest to their heart, and come within the nearest proximity to death by their own accord (and lived obviously), --- not those that have trivial pieces of paper from institutions that entry requirements are mediocre.
I should say something nice about the book. The model Thomas develops might be empirically true, and congratulations to him (a hint of sarcasm there), on pointing out the obvious. Anyone with half a brain and a minuscule understanding of suicide and mental illness, innately knows most of what he has said. But this is the world we live in, I suppose, we must spell things out for the stupid. Which is what people are taught when undergoing a psych degree. Sigh.

[Gerri Alexander]

Last year my friend was diagnosed with a deadly form of ovarian cancer. She had lost her parents at 10 years old, which meant she had to quit school in 5th grade and became a maid. She eventually came to America, has a husband and several young children who depend on her.

At the same time we knew a young man who also had lost both parent by the time he was 17, but he was stong and healthy, had graduated from high school and had a house and car he'd inherited from his grandparents.

Which one is still alive today?

Thomas Joiner asked the question, why do some people kill themselves but not others? He looked at several studies of suicidal behavior to try to determine the risks. He found that people were most likely to kill themselves if they didn't feel connected to other and if they had knowledge of how to accomplish the act.

The human body is designed to work under a lot of stress. Killing yourself is actually pretty difficult and we have a natural fear of pain. Joiner found that suicidal people often "practice", by making little steps toward the act.

He also found that some people are at greater risk than others--doctors, military, police--because they are taught the skills as part of their job.

But feeling part of a group can protect them. For example marines might feel proud of being part of something and feel like others depended on them. Or a doctor might feel like his patients needed him.

The mother had many friends who she asked to pray for her, her family rallied around her providing transportation and care. The young man also had extended family who cared about him. He was supposed to be watching their animals while they were on vacation, but used their computer to get information on how to kill himself and used their car to drive where he could do it.

This was a great book to help understand why suicides happen, but by itself it won't do any good. It can inform people so they can possibly keep an eye on their loved ones, but unfortunately people may only be interested in reading it when it is really too late.

[Marti]

Not a great book. More like "I have a theory. I am going to repeat it until you believe it." But I didn't believe it.

[Mihrdāt]

زمانی که فاجعه‌ی دردناک خودکشی اتفاق می‌افتد، همراه حزن بی‌اندازه‌ی آن، ناباوری و بهتی میان نزدیکان می‌پیچد که چه شد؟! مسکوت ماندن جزئیات و دلایل رخداد این تراژدی تا همین امروز مسبب آن است که بارها جهت غلطی را -در جهت ستایش و تجلیل یا در جهت ساده‌انگاری و تقلیل آن-  برای قضاوت پیش بگیریم. اگر قرار است جان فردی که در لبه‌ی خطر قرار گرفته را نجات دهیم یا رنج بازماندگان این حادثه را التیام بخشیم نیاز است تا به خودکشی به چشم یک بیماری مرگبار که به قول ولتر «بر نیرومندترین غریزه‌ی حیاتی غلبه می‌کند» نگاه کرد، و از سازوکار و ملزومات مواجهه با آن آگاهی داشت.


توماس جوینرِ روانشناس که خودشْ خودکشی پدرش را از او گرفته از دیدگاه یک دانشمند اما در عین حال بسیار همدلانه در این کتاب خودکشی را موشکافی می‌کند.

او علاوه بر مروری بر نظریات انگشت‌شماری که در زمینه‌ی خودکشی پرداخته شده‌اند (چون دورکیم، مِنینگر، اشنایدمان، بومایستر و...) نظریه‌ی خودش را مطرح می‌کند که از دو بازوی اشتیاق به مرگ و توانایی انجام اعمال مرگ‌آور تشکیل شده. اشتیاق به مرگ -که عنصر دینامیک و پرتغییر نظریه‌ است- در نتیجه‌ی ادراک احساس باری بر دوش بودن و عدم تعلق اجتماعی شکل می‌گیرد و توانایی اجرای اعمال مرگبار هم با در معرض تجربه‌های دردناک و تحریک‌آمیز قرارگرفتن و عادت‌کردن به آنها می‌تواند شکل بگیرد که عنصر سخت و کم‌تغییری‌ست.
حجم زیادی از کتاب به تحلیل داده‌های کلان، بالینی و حتی داستان‌هایی از شاعران و خوانندگان پیرامون همین نظریه می‌پردازد و به این سوالِ معمولاً بی‌پاسخ‌مانده جواب می‌دهد که چرا با وجود عوامل خطر فراوانی که وجود دارند، میزان رخداد خودکشی پایین است.

کتاب همچنین به پژوهش‌های انجام‌شده برای روشن‌کردن نقش ژنتیک، نوروبیولوژی، خصایص شخصیتی و اختلالات روانی در پیدایش ریسک خودکشی می‌پردازد و در نهایت برای اقدامات لازم برای پیشگیری، مداخلات در شرایط بحران و درمان خودکشی توصیه‌های مفیدی برای خوانندگان متخصص دارد.


”متنفرم که او آخرین لحظاتش روی زمین را تنها پشت یک ون در پارکینگی گذراند.
متنفرم که هنگام مرگ او می‌بایست این نظر (اشتباه) را داشته باشد که از سوی عزیزانش و جهان به‌طور کلی رها شده.
متنفرم که من و مادرم و خواهرانم مجبور شدیم تحت بلاتکلیفی وحشتناک اتفاقی که برای پدرم افتاده بود قرار بگیریم؛ فقط برای کشف حقیقتی که بلاتکلیفی پیش آن آسان می‌نمود.
از تصور اینکه در آخرین لحظات هشیاری خود ممکن است خیلی دیر از تصمیم خود پشیمان شده باشد به خودم می‌لرزم.
و حسرت می‌خورم که خداحافظی نکرد.“

[Kasi Beorchia]

I read this book as a requirement in preparation for providing gatekeeper trainings for suicide prevention. This book is absolutely ground-breaking in the suicide prevention world. Though it reads like a textbook or really long research paper often, there are so many valuable insights about the importance of social connection and competence/self-efficacy in preventing suicide.

There was a particularly powerful insight at the end of the book that has stuck with me:

"Theorists and scientists who work on suicide are often asked why they have chosen their field of study. Isn't the topic morbid and depressing? My answer is probably predictable by now--there is nothing depressing about working to prevent and relieve the kind of suffering that my dad, my family, and millions of others go through. This alone is enough of a reason to study suicide."

[ehk2]

notes: meaningless comments on Derrida and Lacan; superficial treatment of sociological and psychoanalytical explanations. so discouraging to read, after chp.1

[arireadsthings]

While I agree with several parts of this book, I also found that many of Joiner’s arguments were incredibly biased and based in assumption rather than fact. For example:

-Joiner uses the example of a specific transgender woman who he believes is more likely to die by suicide because she underwent many surgeries and thus became accustomed to pain (one of his arguments for why people die by suicide). However, he completely negates the other potential causes of increased suicidality in this case, including how challenging it must be to live in a body that does not align with one’s view of themselves or how being a gender non-conforming individual in today’s society might negatively impact mental wellness.
-The author suggests that people with tattoos and piercings are more apt to die by suicide because they are more accustomed to pain. However, he fails to acknowledge other potential causes for this association (i.e. maybe those with increased psychological pain seek out hobbies that cause physical pain to act as a distraction or punishment, in the same way self-harm serves a purpose? Or maybe suicidal individuals find more joy in decorating their bodies?)
-Joiner notes that times of war or high crisis decrease calls to crisis lines, which he assumes means people are less suicidal during this time. However, there could be a number of other reasons for this, including that they are experiencing other kinds of crises or access to mental health resources during these times may be limited. He uses a quote that says, during these high crisis situations, people are, “Forgetting one’s petty difficulties”. This approach is minimizing and harmful.
-The author says higher rates of suicide in rural communities may be due to rural areas being cultures of honor (tied into his perceived belongingness argument), but he fails to consider other causes like fewer access to mental health resources and greater stigma around mental illness.
-Joiner claims that he can’t call kamikaze pilots or martyr deaths suicides because they don’t meet his criteria for thwarted belongingness or perceived burdensomeness, but this feels like he is picking and choosing arguments to support his hypothesis (which is the general feel of the whole book, honestly). Maybe if something doesn’t fit the argument, then it should be taken as evidence that the theory is not all encompassing, instead of assuming that other standards are inaccurate due to a hypothesis that has yet to be accepted as standard.

These are just a few examples of arguments that I felt were not well thought out and manipulated evidence and statistics to meet his needs. Do I believe thwarted belongingness and perceived burdensomeness play into suicide rates? Absolutely. However, I struggle to support the approach this book took in arguing the case.

[Rachel]

I read this is 2017 but I was recently reminded of this stupid book, and I despise both the book and the author so much that I decided to lower the rating from 2 to 1 out of spite.

[kate j]

probably could have been an article, not a book — important theories all the same.

[Eliz]

**warning this book is about suicide

This was published in 2005 so slightly outdated but in my search of literature to learn more about this topic, this was genuinely the most comprehensive book I could find.

Liked: the division of content through chapters, numerous approaches to explaining the topic from different angles (social, neurobiological, psychological, etc)

My take always: stronger understanding of risk factors (prior attempts, level of desire for suicide, perceived burdensome, thwarted belongingness, adverse childhood experiences, previous experience to pain and violence, etc), stronger understanding of building safety contract if someone does experience suicidal thoughts, deeper reflection on the role of serotonin and risks with certain antidepressants

What I didn’t get out of this: a stronger understanding of what throws someone into an acute crisis (agh! This is what I was most hoping to learn about to better accompany my patients)

[Kat McMullen]

This book helped me when I was left behind. This is not a book to give to someone to help them with their own struggles, but an academic analysis for someone grappling with a devastating loss and trying to understand "why" in an intellectual way. There are no easy answers, but reading this book helped me to grieve and feel less guilt-ridden about someone else's permanent choice.

[Dan]

This is a good read for anyone trying to understand suicide. Joiner takes a very personal approach as his father committed suicide. He revisits that throughout the book. He also reflects on his experience as a clinician and researcher. He presents what he thinks is a more compelling model for the causes of suicide, or at least what contributes to someone completing a suicide. From Harvard press, “he finds three factors that mark those most at risk of death: the feeling of being a burden on loved ones; the sense of isolation; and, chillingly, the learned ability to hurt oneself. “

Joiner also addresses the key areas of intervention and treatment, but it seems these are best left to the mental health professionals.

Suicide is a full-fledged epidemic in the U.S. military and increasingly looks like a national epidemic.

I have not read any other books on this topic, but I am certain you could do worse than Joiner.

[Saima Iqbal]

(3.75) a dry + repetitive fleshing out of one researcher’s clear + convincing model of suicide’s causes. helped me better contextualize the training i’ve received in suicide prevention; also reassured me that desire alone is insufficient. enjoyed the glimpse at how psychologists create/test theories. am curious abt how the scientific consensus has changed in the 20 yrs since this book’s publication + abt treatments. author is quite the fan of CBT tools. also want to learn more abt contagion effects.

[Tori]

9 - I am halfway through this book, and not sure if I will finish it. I have read a lot on this subject, and this book is really slow reading for me. A lot of it is pretty technical. The author talks about prior theories about why people commit suicide and then his own theory. I was interested in reading it as I was going through the "why's". I think this book might be better for psychologists than for S.O.S.

[Calvin Caulee]

I cannot give this book the minimum 3 stars.

This book is an example of the dangers of being a reductionist when it comes to complex phenomenon. The use of limited research and bias from the get go. It's a disjointed attempt to explain suicide on a global level using just three factors.

[Amal Jacob]

Joiner really opened my eyes to understand suicide at a demographic, scientific, and emotional depth. At a high level, he asserts two general patterns (really three, one split into two) for suicide:

1. The acquired capability to die by suicide.
2. A thwarted belongingness (2a) & perceived burdensome (2b) - similar, but distinct

I came into the book especially skeptical of (2), but came out much more convinced.

I feel that (1) is something I can easily agree with, yet never thought about until I saw it in words. The most common way to overcome that instinctual, primal desire for life is a learned “numbness” one feels to death, violence, pain, etc. For someone who experiences such adversity every day, their senses become dulled, and the numbness sinks into their mind like an anesthetic, circulating through their flesh. A tiredness, an exhaustion, that gnaws away base fears to nothing. In the same way one may not find the energy to eat or drink, overriding even their basic needs, so it is with their will to live. Like how we may build resistance to dopamine by pumping it through systemic drug abuse, we may also build resistance to the fear of death through repeated physical and mental abuse.

I have a strong suspicion even that those who meet (2) may unconsciously seek out (1). Though the author mainly focuses on the pipeline from (1) to (2), self-punishment/self-harm, reckless behavior, and general apathy to one’s own upkeep may be a common journey from (2) to (1). A desire to see someone else die, as another example. Perhaps questions probing for this particular desire for exposure to death/violence, if they don’t exist yet, may prove insightful for therapists judging for suicide risk.

I can also see (2a) and (2b) as motivating factors for suicide. Various examples and studies provided in the book support this. I don’t know that I can agree, however, with the author’s claim that both are necessary to some degree. I can easily see one who is self-sufficient or detached from society, for example, but as a result does not have a social network to feel a sense of belongingness. I feel, instinctively, that such a person can be at risk of suicide. I’d like to see more studies that directly compare and contrast the roles that both 2a and 2b play in suicidal behavior.

[Madilynn]

I read this book for my internship with the suicide hotline, and I think it was a really meaningful novel to read. I think anyone who wants to understand more about why people die by suicide would benefit from this book.

[Brooke]

I have a very love/hate relationship with Joiner’s work. This book serves as a good entry point to much of the theories he has since expanded on in later writings but other than that, I found it quite repetitive. There’s a touch of ego and bias that often shows up in Joiner’s work that I just can never quite get past.

[Mary Chase Mize]

Transformative and life changing - as a counselor and fellow human being.

[billie!]

god this was rough

[Jenn Amanda (she / her)]

4.5⭐

I enjoyed this a lot and my biggest issue is that Joiner was detailed in how some died even though he acknowledged that media outlets doing so could be harmful to those contemplating suicide.

[Gabby Applebaum]

Disclaimer: had to read this for class. However fabulous book!! Really enjoyed it and learned a lot!

[Corin]

I am only about 1/3 into this book. It is an empathetic discussion of suicide, from the point of view of a family member (Joiners's father killed himself).

Joiner begins the book by discussing his experience as a survivor. He makes a profound comment that it is not necessary to understand suicide in order to be compassionate about it. Likewise, trying to prioritize understanding suicide can interfere with one's compassion. Maybe it is true, in other words, that there is an accurate psychoanalytic response to a suicidal person, but at the same time the person really just needs compassion and willingness to listen. Not to understand the urge or event itself, necessarily, but the understanding to put listening first. (This reminds me of Victor Frankl's argument that a suicidal person may be pathological, but philosophically correct, and it is important that the clinical response not invalidate the philosophical decision because the person has shown pathological reason).

The argument then moves to how the suicidal person develops a tolerance for pain and an understanding of how the body responds to the threat of death. He points out that there is a biological instinct to live, and how in acting destructively the person is "practicing" suicide. Thus repeated suicide attempts are like research. A person makes gestures to alleviate extraordinary pain, but also because it is because part of the pain of suicide is that we are ambivalent to the very end--there is some part of us that wants to live, even at the point of very serious suicide attempts. So the way of "practicing" suicide is to see what it is like to override this most automatic of reflexes, to protect against self-harm.

I am trying to read the book for practice and policy implications. I think that there are many ways that suicide can be reduced, and it would probably not include involuntary treatment.

There is another book that has recently come out by Arthur Kleinman and others, called Reducing Suicide, which I would like to read after this one.

[Davie]

I was inspired to read this after learning that more active duty soldiers are dying by suicide than in combat. @)$*)#*!?!!?

Joiner is a researcher in the field, so he is as much an expert as there is -- although of course standard experimental designs aren't possible (pesky ethics and all that). And sadly, he has personal expertise. His father committed suicide. His research is particularly relevant to military suicides, more below.

He starts with an entertaining survey of the ideas about why people commit suicide through the ages. Many were contributed by philosopher / psychoanalyst types, who were more inspired by Grand Ideas than data. Against this background, the novelty of his ideas is striking.

What Joiner is after is a way to distinguish the subset of very depressed/distressed people who are likely to go on to attempt/succeed at suicide from the larger group who have almost identical symptomology on many dimensions. The Joiner theory of suicide is that two psychological factors are particularly key in predicting whether someone will attempt suicide: (1) perceived burdensomeness/self-efficacy and (2) perceived connectedness + one life experience factor: (3) tolerance for physical pain -- presumably very high in military personnel. Leahy's review on amazon does a good job of explaining these concepts. http://www.amazon.com/Why-People-Suic.... The book describes para-experimental data that supports these ideas with varying persuasiveness. One idea I found particularly disturbing was that many people who are eventually "successful" have a history of partial efforts/attempts that are a kind of tragic practice/rehearsal -- in contrast to the idea that early unsuccessful attempts are nonserious cries for help.

This is probably THE book to read about the topic if you want a survey of what is known from a research perspective, especially since there are many many more "my personal account" books than books like this. This book contains a bit of that, but much much more.

[Rachael]

I read this book at a watershed in my relationship with my personal history. Joiner's theories, after years of research, meta analysis, and lived experience (his father died by suicide), prove to be both simple enough to understand, logical enough to make sense, and almost heartening to those of us who live in the wake of suicide. Suicide, so often seen as selfish or inexplicable, has long been stigmatized more than almost any other cause of death which results in both a failure to help suicidal people properly and also a failure to help all the victims of a suicide: the family, the friends. What Joiner proposes is that there are three major factors in suicide: belongingness (or lack thereof), burdensomness, and tolerance to pain/self injury, and that people who commit suicide do not feel as though they belong (not that they actually don't have connections, but that they do not feel connected - much like body dysmorphic disorder or other mental illnesses, this lack of belongingness might not be obvious to others), that they are a burden to those around them, and who have inured themselves to pain and/or the idea of violence and self-injury.
This is a fairly scientific book, as Joiner pulls from both his own research and other studies done in order to support his theory, much more so than his later Myths About Suicide. This academic tone was not at all a detraction for me, but it did make his frequent references to Kurt Cobain a little jarring. I can understand wanting examples, and Cobain is arguably the most famous modern suicide, but I felt these inclusion were unnecessary. Still, this is an obviously minor drawback in an overall solid and approachable text. While Joiner doesn't deserve all the credit for the measure of peace I have found, I will give him credit for helping me re-frame some of my old conceptions.

[Sarah]

This book was required reading in a school counseling course. It was informative and well written.

If it seems that Joiner’s thesis becomes repetitive, remember that he is an academic. He may likely have written this book knowing that only individual chapters may be read at a given time, (such as in graduate school) and that his overall premise would need to be presented within each chapter.

Overall, this book not only highlights research which was poignant at the time of writing for suicide, but provides timeless instructions for living life well. Make social connections and cultivate purpose no matter your age.

Joiner’s is one academic perspective, but it is worthy of our attention in the greater discussion of crisis prevention and intervention.

[Mark]

This is the best -that is, most persuasive- book I've found on the subject. The author's thesis, buttressed by a great deal of research, has the benefit of simplicity: people kill themselves when they feel they don't belong to another person; feel they are not effective in their own lives; and have habituated themselves to the thought of death by "practicing" suicide -that is, by harming themselves or repeatedly putting themselves in harm's way or by attempting, in ever more rigorous fashion, suicide itself.

Having lost a brother to suicide, I can say that the theory perfectly fits with what I know of his death and the circumstances leading up to it.

The author -whose father killed himself- is also very good on the pain, guilt and bewilderment that survivors feel; and he's especially good on the further pain inflicted on survivors by people who, through lack of compassion or fear or moral idiocy or misplaced tact or bewilderment of their own, fail to offer a kind word when it's most needed.

[Reese]

Overall, it is a great and genuine book comprising precise definitions of key terms in suicidology and a seemingly plausible model that accounts for why people die by suicide, though the underlying mechanism is far more complex and leaves me unsatisfied. The outburst of technologies and the downfall of religiosity indeed contribute to the urgent suicide situation to date. I can not stop wondering whether having more introspection and self-awareness would make any difference.

Honestly, I might not be convinced by the justification for why Chinese women commit suicide more than men. The author argued that Chinese women hacked off a piece of themselves and prepared it as a restorative elixir for their family members. By doing so, the women are more likely to become habituated to pain and be able to enact lethal suicide. The practice is so rare that I've never heard of it as a Chinese person. If the author did more research on that account, it is easy to conclude that there are certain factors contributing to it, for example, patriarchal ideology.

[Jeniffer A]

Ever since I heard about Dr. Thomas Joiner's research background, I knew I wanted to read more of his work. Suicide has touched my life personally, and reading through this book gave me a glimpse into my friends' and my own life. He articulates many logical points but brings them together in a manner that makes suicide comprehensible.

[Eliana]

Not the best book on suicide I have read (I prefer Kay Redfield Jameson's) but he does propose a theory that is used in clinical practice. Its a quick read and pretty interesting.