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Why Live: How Suicide Becomes an Epidemic
A search for the meaning behind suicide epidemics
When the suicide rate of a particular group jumps by as much as fourfold or more in a short time, they are categorized as suicide epidemics. Suicides aren’t more common where people are poorer, in wars, or have recently experienced environmental disasters; nor were they higher during the COVID-19 pandemic. On the other hand, the suicide rate tripled among middle-aged Russians after the collapse of the Soviet Union, and quintupled in white middle-aged working-class Americans in the 1970s. What is causing suicide epidemics?
In Why Live, public health researcher Helen C. Epstein travels to the remote Canadian territory of Nanavut, the region with the highest suicide rate in the world; a post-USSR Russia, where people struggle to adapt to a more capitalist society; and Micronesia, home to one of the most dramatic and sustained suicide epidemics ever identified. Consistently, she finds a sudden loss of social cohesion to be the instigating factor. When a culture based on mutual aid and community gives way to a world focused on market transactions and individualism, people start to question their most intimate attachments and their place in a changing society, leaving them to ask why live?
When the suicide rate of a particular group jumps by as much as fourfold or more in a short time, they are categorized as suicide epidemics. Suicides aren’t more common where people are poorer, in wars, or have recently experienced environmental disasters; nor were they higher during the COVID-19 pandemic. On the other hand, the suicide rate tripled among middle-aged Russians after the collapse of the Soviet Union, and quintupled in white middle-aged working-class Americans in the 1970s. What is causing suicide epidemics?
In Why Live, public health researcher Helen C. Epstein travels to the remote Canadian territory of Nanavut, the region with the highest suicide rate in the world; a post-USSR Russia, where people struggle to adapt to a more capitalist society; and Micronesia, home to one of the most dramatic and sustained suicide epidemics ever identified. Consistently, she finds a sudden loss of social cohesion to be the instigating factor. When a culture based on mutual aid and community gives way to a world focused on market transactions and individualism, people start to question their most intimate attachments and their place in a changing society, leaving them to ask why live?
176 pages, Paperback
Published September 9, 2025
5 people are currently reading
67 people want to read
About the author
Helen C. Epstein
3 books9 followersHelen C. Epstein is Visiting Professor of Global Public Health and Human Rights at Bard College. She has worked for more than 20 years as a public health consultant in Uganda and other countries for such organizations as the World Bank, UNICEF and Human Rights Watch. Her book The Invisible Cure: Why We Are Losing the Fight against AIDS in Africa was a New York Times Notable Book and Amazon’s best science book of 2007. Her articles have appeared in The New York Review of Books, The New York Times Magazine and other publications.
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Displaying 1 - 10 of 10 reviews
November 30, 2025
This book, not about copycat suicides, is instead about population-wide increases in suicide rates. Taken as examples are post-Soviet Russia, the Inuit in Alaska, and Micronesia. Epstein's thesis is that these epidemics are frequently consequences of a catastrophic, sudden transformation of a society from collectivism to individualism, characterized by capitalism especially. This may be with or without the presence of colonialism and military occupation. Regardless of its specific trappings, the shift is accompanied by a disastrous loss of cooperation, shared thinking, and the sense of your value to others. The examples she uses when she sticks to her core argument are interesting, and I think compelling.
About 2/3 into the book, she turns strictly to two subsets of American society, namely rural 21st century workers and young vets of the 2000s forever war. Some of her points hold with earlier arguments in the first chapter, to a degree, although it needed to be explored and expanded on significantly to really mesh. For one thing, it's hard to see from what is presented in the book how recent decades have been worse in terms of the free market trying to kill middle and lower class Americans than much of history. There must be additional factors beyond megacorporations replacing small businesses with Walmarts and Amazon pickup sites, because the megacorporations have grown but individualist capitalism isn't a new American phenomenon.
The vets chapter veers sharply away from everything the book has been about up until this point to focus on moral injuries (murdering a lot of innocent people in other countries for no reason, even if you're not holding the gun) and the prevalence of childhood abuse in young vets who later became suicidal. It's interesting but off topic.
She veers even further off course when she discusses art as a consistently effective form of resilience against suicide--while this is interesting, it is largely anecdotal and is strictly limited to her study of the vets, and it is also an *individualist* answer to a communal and systemic problem. Paired with the conclusion's urging that we protect what community we have left (with no real suggestions on how to do that rather than hoping the government that caused our crises will do it for us), the book shows a regrettable failure of imagination: with the cause of the damage hypothesized, the way out of the crisis seems to be "do more of what the cause of the damage taught us."
In terms of research, there's a lot here I don't know but have some questions about the credibility she extends to some of her more popular sources, such as Vivek Murthy and Jonathan Haight. I have to wonder about some of the sources I am not familiar with, given my credulousness about those I recognize; this doesn't necessarily make me strongly doubt her central thesis, just suggests that she's willing to accept most evidence that supports her argument regardless of how credible that source might or might not be.
Finally, and without getting too deeply into it, I found the glimpses of Epstein's political outlook baffling. It appears at times morally incoherent, which left me skeptical of how much I could trust her work. I'll leave aside a few notable examples, but will simply say that if I were going to conclude MY book, and I were going to say something like, "[Margaret] Thatcher and her economist kin [were] right about much," in the last paragraph of MY book, I would (a) not do that and (b) explain what the hell I meant. I'm not sure, Helen, that I will be taking cues on cultural empathy from someone who among other things refuses to explain what she means by THATCHER WAS RIGHT ABOUT MUCH.
Broadly interesting, quick and illuminating, but I am not convinced that I should trust the work and it would have benefited from being both longer and more focused.
About 2/3 into the book, she turns strictly to two subsets of American society, namely rural 21st century workers and young vets of the 2000s forever war. Some of her points hold with earlier arguments in the first chapter, to a degree, although it needed to be explored and expanded on significantly to really mesh. For one thing, it's hard to see from what is presented in the book how recent decades have been worse in terms of the free market trying to kill middle and lower class Americans than much of history. There must be additional factors beyond megacorporations replacing small businesses with Walmarts and Amazon pickup sites, because the megacorporations have grown but individualist capitalism isn't a new American phenomenon.
The vets chapter veers sharply away from everything the book has been about up until this point to focus on moral injuries (murdering a lot of innocent people in other countries for no reason, even if you're not holding the gun) and the prevalence of childhood abuse in young vets who later became suicidal. It's interesting but off topic.
She veers even further off course when she discusses art as a consistently effective form of resilience against suicide--while this is interesting, it is largely anecdotal and is strictly limited to her study of the vets, and it is also an *individualist* answer to a communal and systemic problem. Paired with the conclusion's urging that we protect what community we have left (with no real suggestions on how to do that rather than hoping the government that caused our crises will do it for us), the book shows a regrettable failure of imagination: with the cause of the damage hypothesized, the way out of the crisis seems to be "do more of what the cause of the damage taught us."
In terms of research, there's a lot here I don't know but have some questions about the credibility she extends to some of her more popular sources, such as Vivek Murthy and Jonathan Haight. I have to wonder about some of the sources I am not familiar with, given my credulousness about those I recognize; this doesn't necessarily make me strongly doubt her central thesis, just suggests that she's willing to accept most evidence that supports her argument regardless of how credible that source might or might not be.
Finally, and without getting too deeply into it, I found the glimpses of Epstein's political outlook baffling. It appears at times morally incoherent, which left me skeptical of how much I could trust her work. I'll leave aside a few notable examples, but will simply say that if I were going to conclude MY book, and I were going to say something like, "[Margaret] Thatcher and her economist kin [were] right about much," in the last paragraph of MY book, I would (a) not do that and (b) explain what the hell I meant. I'm not sure, Helen, that I will be taking cues on cultural empathy from someone who among other things refuses to explain what she means by THATCHER WAS RIGHT ABOUT MUCH.
Broadly interesting, quick and illuminating, but I am not convinced that I should trust the work and it would have benefited from being both longer and more focused.
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December 31, 2025This interesting book looks at five case studies-- the Inuit people of Nunavut, the peoples of Micronesia, the Russian people after the fall of Soviet-style communism, the working-class men in America 's rust belt, and American veterans-- to come to some conclusions about suicide epidemics, or a sudden jolt in mass mortality rate by suicide.
It concludes that suicide epidemics don't arise from the usual tragic circumstances such as war, poverty, or famine. Indeed, in the case of Micronesia, the author points out that in terms of GDP the Micronesians actually grew much wealthier, as a bonanza of American aid funds flooded the country and terminated the usual economic dependency on subsistence fishing and farming. Additionally, there were Russians who survived the horrors of WWII and persecutions only to succumb to suicide during the loss of communism.
Rather, according to the author, mass suicide occurs when there is a sudden transition in community relations from one system to the next-- specifically, from an egalitarian, kinship-based, mutual-aid type of society to a capitalist, individualist, modern wage-based one where essential relations shrink to the nuclear family. This shock transformation disrupts people's psyche and understanding of their purpose in the world, which is originally settled as their role within the community where everyone works altogether to acquire food or settle conflicts. Now the primary role is defined by wage-earning for the family, and loneliness, alienation and rejection can result if this is not satisfied. It seems that a pervasive sense of uselessness, of being a burden and annoyance to the closest loved ones, drives people to suicide. This, as far as I can understand, is the hypothesis of the book. What, then, is the solution? The author looks at the cases if the African-American people and the Jewish people, specifically, who have survived great tribulation in the form of slavery and the Holocaust respectively. She concludes that they have some coping mechanisms in common-- such as talking about their history, tight cultural links, and the consideration of survival as defiance. Furthermore, the author notes that making art is a good coping mechanism because it is a personal outlet of self-expression, as opposed to dehumanizing work.
It's a worthy read for those wondering about the conditions that can trigger suicides.
It concludes that suicide epidemics don't arise from the usual tragic circumstances such as war, poverty, or famine. Indeed, in the case of Micronesia, the author points out that in terms of GDP the Micronesians actually grew much wealthier, as a bonanza of American aid funds flooded the country and terminated the usual economic dependency on subsistence fishing and farming. Additionally, there were Russians who survived the horrors of WWII and persecutions only to succumb to suicide during the loss of communism.
Rather, according to the author, mass suicide occurs when there is a sudden transition in community relations from one system to the next-- specifically, from an egalitarian, kinship-based, mutual-aid type of society to a capitalist, individualist, modern wage-based one where essential relations shrink to the nuclear family. This shock transformation disrupts people's psyche and understanding of their purpose in the world, which is originally settled as their role within the community where everyone works altogether to acquire food or settle conflicts. Now the primary role is defined by wage-earning for the family, and loneliness, alienation and rejection can result if this is not satisfied. It seems that a pervasive sense of uselessness, of being a burden and annoyance to the closest loved ones, drives people to suicide. This, as far as I can understand, is the hypothesis of the book. What, then, is the solution? The author looks at the cases if the African-American people and the Jewish people, specifically, who have survived great tribulation in the form of slavery and the Holocaust respectively. She concludes that they have some coping mechanisms in common-- such as talking about their history, tight cultural links, and the consideration of survival as defiance. Furthermore, the author notes that making art is a good coping mechanism because it is a personal outlet of self-expression, as opposed to dehumanizing work.
It's a worthy read for those wondering about the conditions that can trigger suicides.
June 23, 2025
Good book. I enjoyed seeing some Durkheim and Tönnies and how their theories apply to suicide. Each chapter looks at a society that experienced a significant increase in suicides. The author concludes that suicide epidemics occur when a society's structure shifts from more communal to more individualist/capitalist, particularly when there isn't much of a culture of open discussion of feelings and mutual emotional support. People commit suicide when they feel alone. I didn't love the chapter on the role of art and creativity in combating suicidality, but overall I learned from this book and think it's worth a read.
June 5, 2025
Book Review: Why Live: How Suicide Becomes an Epidemic by Helen C. Epstein - A Public Health Practitioner’s Perspective
Helen C. Epstein’s Why Live is a devastating yet essential examination of suicide as a public health crisis, one that intertwines personal tragedy with systemic failure. As a public health practitioner, I found myself both intellectually challenged and emotionally shaken by Epstein’s unflinching analysis of how suicide clusters emerge, spread, and disproportionately impact marginalized groups—particularly women and youth. The book is not just a study of despair; it’s a call to reimagine mental health care through a lens of collective responsibility and structural change.
Emotional Resonance: Between Grief and Fury
Reading Why Live was an exercise in bearing witness. Epstein’s portrayal of communities ravaged by suicide “contagion” left me heartbroken, especially her accounts of young women whose suffering was dismissed as melodrama rather than treated as a medical emergency. There were moments I had to pause—her description of how patriarchal norms silence women’s pain, rendering their suicidal ideation invisible, cut too close to my experiences in maternal health advocacy. Yet amid the grief, Epstein’s spotlight on grassroots prevention efforts (like peer-support networks) kindled a fierce hope. Her work forced me to confront uncomfortable questions: How often does public health pathologize individual distress while ignoring the societal rot fueling it?
Key Insights for Public Health
-Suicide as a Social Phenomenon: Epstein dismantles the myth of suicide as purely individual pathology, showing how it spreads through communities like a disease—a framework that demands we treat it as a crisis of connection, not just chemistry.
-The Gender Paradox: While men die by suicide more often, Epstein reveals how women’s attempts are systematically undercounted and undertreated, exposing biases in both research and care.
-Structural Complicity: The book indicts systems—from austerity-starved mental health services to carceral “interventions”—that exacerbate despair. Her critique of how poverty and gendered violence fuel suicide clusters is particularly searing.
Constructive Criticism
-Intersectional Blind Spots: Epstein’s analysis of gender is robust, but deeper engagement with how racism, colonialism, and ableism shape suicide disparities would strengthen her thesis. For example, how do migrant detention or Indigenous dispossession factor into “epidemic” spread?
-From Critique to Action: While the book excels at diagnosing systemic failures, it could offer more concrete policy levers for prevention (e.g., trauma-informed school curricula, economic safety nets).
Final Thoughts
Why Live is a necessary, if harrowing, addition to public health literature. Epstein’s work refuses to let us look away from the ways society manufactures despair—and in doing so, lights a path toward healing that centers community over coercion.
Rating: ★★★★☆ (4/5) – A vital but imperfect work that demands sequel research on intersectional solutions.
Gratitude: Thank you to the publisher and Edelweiss for the review copy. In a world where mental health care remains fractured by inequality, this book is both a mirror and a map.
Helen C. Epstein’s Why Live is a devastating yet essential examination of suicide as a public health crisis, one that intertwines personal tragedy with systemic failure. As a public health practitioner, I found myself both intellectually challenged and emotionally shaken by Epstein’s unflinching analysis of how suicide clusters emerge, spread, and disproportionately impact marginalized groups—particularly women and youth. The book is not just a study of despair; it’s a call to reimagine mental health care through a lens of collective responsibility and structural change.
Emotional Resonance: Between Grief and Fury
Reading Why Live was an exercise in bearing witness. Epstein’s portrayal of communities ravaged by suicide “contagion” left me heartbroken, especially her accounts of young women whose suffering was dismissed as melodrama rather than treated as a medical emergency. There were moments I had to pause—her description of how patriarchal norms silence women’s pain, rendering their suicidal ideation invisible, cut too close to my experiences in maternal health advocacy. Yet amid the grief, Epstein’s spotlight on grassroots prevention efforts (like peer-support networks) kindled a fierce hope. Her work forced me to confront uncomfortable questions: How often does public health pathologize individual distress while ignoring the societal rot fueling it?
Key Insights for Public Health
-Suicide as a Social Phenomenon: Epstein dismantles the myth of suicide as purely individual pathology, showing how it spreads through communities like a disease—a framework that demands we treat it as a crisis of connection, not just chemistry.
-The Gender Paradox: While men die by suicide more often, Epstein reveals how women’s attempts are systematically undercounted and undertreated, exposing biases in both research and care.
-Structural Complicity: The book indicts systems—from austerity-starved mental health services to carceral “interventions”—that exacerbate despair. Her critique of how poverty and gendered violence fuel suicide clusters is particularly searing.
Constructive Criticism
-Intersectional Blind Spots: Epstein’s analysis of gender is robust, but deeper engagement with how racism, colonialism, and ableism shape suicide disparities would strengthen her thesis. For example, how do migrant detention or Indigenous dispossession factor into “epidemic” spread?
-From Critique to Action: While the book excels at diagnosing systemic failures, it could offer more concrete policy levers for prevention (e.g., trauma-informed school curricula, economic safety nets).
Final Thoughts
Why Live is a necessary, if harrowing, addition to public health literature. Epstein’s work refuses to let us look away from the ways society manufactures despair—and in doing so, lights a path toward healing that centers community over coercion.
Rating: ★★★★☆ (4/5) – A vital but imperfect work that demands sequel research on intersectional solutions.
Gratitude: Thank you to the publisher and Edelweiss for the review copy. In a world where mental health care remains fractured by inequality, this book is both a mirror and a map.
January 27, 2026
This book found me at an interesting chapter in my journey. I’m 27, and grappling with a world that feels increasingly hard to make sense of. I wonder what my next years will look like, what I want them to look like, and perhaps what they _should_ look like.
I think the title, “Why Live”, appealed to me because I’m thinking about what “truly matters”, and what happens when one loses all sense of connection to that, or fails to ever create a connection to it in the first place.
Epstein’s work made me reconsider the role the system™️ plays in shaping the contours of even our darkest, innermost states. I was not at all expecting the connection the author made between suicide epidemics and the transition of a given society from one rich in social capital, connection, and unquantifiable humanity to one characterized by commercialized, anonymous, atomizing market transactions.
The idea that a particular soullessness attends to a society which devalues those things core to our thriving — our connections with each other — and would see consequences in the form of people succumbing to the pain of existential loneliness, was very easy to engage with through the case studies the author provided. I found particular interest in the chapters on Micronesia and post-USSR Russia.
To me, the section about US veterans felt like it veered a bit off topic. The chapter on art similarly felt a bit, shall we say, chaotic? Nonetheless, it was a page turner, particularly the parts which discussed Sylvia Plath.
Part of me wished she’d spoken more to the passing references she made on the state of mental health among Black Americans. I read the referenced article from one of the times she touched on this, and I’m hungry for more!
Overall this was an engaging, thought-provoking read that put me on to multiple other references I’d like to check out soon.
I think the title, “Why Live”, appealed to me because I’m thinking about what “truly matters”, and what happens when one loses all sense of connection to that, or fails to ever create a connection to it in the first place.
Epstein’s work made me reconsider the role the system™️ plays in shaping the contours of even our darkest, innermost states. I was not at all expecting the connection the author made between suicide epidemics and the transition of a given society from one rich in social capital, connection, and unquantifiable humanity to one characterized by commercialized, anonymous, atomizing market transactions.
The idea that a particular soullessness attends to a society which devalues those things core to our thriving — our connections with each other — and would see consequences in the form of people succumbing to the pain of existential loneliness, was very easy to engage with through the case studies the author provided. I found particular interest in the chapters on Micronesia and post-USSR Russia.
To me, the section about US veterans felt like it veered a bit off topic. The chapter on art similarly felt a bit, shall we say, chaotic? Nonetheless, it was a page turner, particularly the parts which discussed Sylvia Plath.
Part of me wished she’d spoken more to the passing references she made on the state of mental health among Black Americans. I read the referenced article from one of the times she touched on this, and I’m hungry for more!
Overall this was an engaging, thought-provoking read that put me on to multiple other references I’d like to check out soon.
October 20, 2025
An act of suicide is almost always a crippling personal act. The lasting effects are, without any doubt, inevitably felt by others than the personal actor. The author of this short book focuses on only one part of the many faceted act: the public health implications. The author is a professor of Global Public Health and Human Rights at Bard College in New York state. She sees suicide at epidemic levels among the Inuit in northern Canada, residents of Micronesia, Russians after the collapse of the Soviet Union, and American military veterans and many others in heartland America. This is a useful introduction to suicide today. It can only be that very introduction since it is such a short treatment. The collected "Further Reading" can help the curious and aroused reader to learn much more. The book does, in effect, focus the reader's attention on many public policy considerations. But, there are many ways to think of suicide beyond the public health and public policy thoughts. Others can approach suicide from the social, the business and economic, the question of end-of-life medical care, and the philosophical. And there is always the question of personal autonomy. These approaches must come from other resources. This brief book remains as a valuable place to start for an introduction.
September 25, 2025
I do think this is an important book, especially coming from publisher primarily focused on policy. It take a perspective on mental health founded on cultural experience, instead of mindless sociological "data". Her argument, that suicide epidemics occur when a culture based on reciprocity is forced to become individualistic and commercialized is argued very well, and I found it compelling.
Unfortunately, I think author was constrained by the demands of her publisher. It is simply too short to really cover the scope of everything she talks about. There are chapters that end abruptly and major topics mentioned so briefly (such as the authors own suicide attempt) its almost frusterating they were brought up.
However, its an excellent argument and thought provoking work. I would recommend it to anyone.
Unfortunately, I think author was constrained by the demands of her publisher. It is simply too short to really cover the scope of everything she talks about. There are chapters that end abruptly and major topics mentioned so briefly (such as the authors own suicide attempt) its almost frusterating they were brought up.
However, its an excellent argument and thought provoking work. I would recommend it to anyone.
November 30, 2025
Started strong, finished weak.
December 17, 2025
Delightful, if brief reflection on suicide and sociology, with enlightening observations about the Inuit and Micronesia cultures, as well as war veterans. Easily accessible and engagingly written.
December 11, 2025
Finding the answer as to why suicide happens seems like a logical expectation when entering this book but obviously that can't truly be answered. However, why we see increases in suicide during specific periods in specific places becomes clear. We are lacking community in so much of the world and when community dissolves, suicide rises. This argument is made plan and strong throughout this book. I only wish it tied more to the present, though it's understandable considering research takes years to catchup.
Displaying 1 - 10 of 10 reviews