Too high a price to pay?

In a June 2011 story, “New perspectives on suicide prevention,” I wrote about the three elements of the  “interpersonal theory of suicide,” advanced by Thomas Joiner PhD of the University of Florida. As I reported at the time:

This theory holds that a suicide is the result of three factors:  

·         a perceived sense of burdensomeness—that one has become ineffective or burdensome in the eyes of loved ones;

·         a perception that one is isolated and no longer “belongs” or is needed;

·         and an acquired capability to hurt oneself.

… Joiner says that it is the third factor—capability—that makes his framework different from its predecessors. Capability [to commit self-harm] requires two things: the know-how to cause one's death and an odd but real “fearlessness” that enables one to use it, despite the pain involved. 

…. He notes that while many individuals may experience profound feelings of burdensomeness and isolation, leading to thoughts of suicide or a wish for death, few act on their feelings.

Among those who do act—it is the third factor, capability—the combination of “know how” and “fearlessness”—that makes the deadly difference in what Joiner calls “the perfect storm” of a suicide attempt—when the perceptions of burdensomeness and isolation merge with the capability to act.  When capability is lacking, a suicide cannot happen and a would-be victim lives to see another and, we hope, brighter day.

Adam Lanza committed suicide last Friday. When his “perfect storm” arrived, the capability to act was ready-made through exposure, training, and access to powerful, high-capacity firearms and ammunition legally owned by his mother. Had he ended just his own life, or ended his own and his mother’s life in a murder-suicide on Friday, this story would have been just one more among thousands nationwide, an occasion of grief limited to a family or a small circle of acquaintances.

Absent his awful and fateful trip to Sandy Hook Elementary School, Adam Lanza was just one more young man struggling with a significant behavioral disorder, and his mother just one more parent who, despite significant financial means, struggled for years with questions:  What was wrong with her son? What should she do?  When? According to the some reports, she was preparing to involuntarily commit her son for psychiatric treatment, an action that some believe may have triggered his rampage.

No one could have predicted the scope of Friday’s shocking tragedy. But any parent or spouse who cares for a loved one with a serious mental health disorder (or a history of trauma from childhood or the battlefield) can understand statistics that show their loved one faces an increased risk for suicide. According to the National Suicide Prevention Program, those who struggle with serious mental illnesses are 12-13 times more likely to attempt or commit suicide than the general population. And note that while suicide involves violence, the violence is directed against the self, not against others. As has been noted, the mentally ill are far, far more likely to be the victims of violence (even their own) then they are to perpetrate it on others.

Even without a mental health diagnosis, people who have suffered numerous traumatic childhood events (measured by Adverse Childhood Event or “ACE scores”) also face a significantly higher suicide risk, as members of Congress learned in a December 5 Capitol Hill briefing. Those with ACE scores of 4 or more—roughly 1 in 6 Americans—are about 12 times more likely to attempt or commit suicide than the general population. Those with ACE scores of 6 or higher face an exponentially higher risk—30 to 51 times greater than the general population. (Sadly, high ACE scores, unlike serious mental illness, do correlate with a higher likelihood of perpetrating violence toward others.)

Figures like these show what parents, citizens, and legislators must know, or are certainly learning, about the predictability of at least one kind of deadly violence—suicide—for vulnerable people in our society. In light of these figures, anyone that allows the lethal capability of guns to coexist with a vulnerable loved one cannot escape the fact that this capability only multiplies the potential occurrence and lethality of harm.

As Americans, we've grown comfortable with the fact that gun ownership is an expression of freedom. We also accept the fact that, like other freedoms, the right to bear arms comes at the price of risk, a price that is highest for those who exercise the right carelessly or foolishly. We’ve always been content to pay that price, willing to trade a bit more risk for the chance to own a wider variety of more powerful weapons. Had the price of Nancy Lanza’s freedom to own such arms been limited to her son’s suicide, or even a murder-suicide involving both of them last Friday, the few Americans who noticed could have said that she and her son paid the price for what proved, in retrospect, a foolish personal decision.

But, only moments after Adam Lanza set foot in Sandy Hook Elementary School, armed to the teeth, Americans realized that we too had been foolish. And this time, 20 young children would pay the price for it.