As the country struggles to process the horrific massacre in Newtown, Conn., those of us who treat patients with mental illness must keep several facts in mind.
We know that 20,000 out of 100,000 people in the United States have a mental illness and that much of this is depression. In addition, we have learned that 5,000/100,000 people attempt suicide.
Finally, it turns out that overall, for the last 30 years, the suicide rates run around 11/100,000 people across all age ranges and 20/100,000 for young adults. This makes suicide the third-leading cause of death among young people. Yet, suicide is actually a rare event. Furthermore, the likelihood of a person committing a single homicide before committing suicide is even rarer.
As an expert in violence prevention who has been investigating these phenomena for 45 years, I view such incidents as "suicides preceded by mass murder" (mass murder defined as three or more people being killed). The problem is there is no solid evidence for this theory. Also, these kinds of suicides are even rarer and even more difficult to study with the goal of preventing these tragedies.
Of course, if people get their understanding about public health and the frequency of certain events from the media, they believe such events are not rare, but rather are quite common. These difficulties make it tricky for public psychiatrists to inform public policy and public opinion to do things that prevent these horrible events from occurring and repeating.
When an individual commits suicide and the media give that suicide a great deal of coverage, shortly afterward, there are what are called "cluster" or "copycat" or contagion suicides--this was David Phillips's seminal work back in the 1970s. The proof is so strong that the American Foundation for Suicide Prevention, the American Association of Suicidology, and the Annenberg Public Policy Center have provided Reporting on Suicide: Recommendations for the Media. These guidelines suggest that the media not give a great deal of attention to the phenomenon of suicide, and it begins with the assertion that "Suicide contagion is real."
Those of us who work with these patients know that when the media provide details about these suicides, they provide depressed, hurt individuals who express their pain through anger and violence with a blueprint for what to do with their suicidal ideation. We know that a huge dynamic in the thinking of suicidal people is often: "I'll fix you; I'll kill myself." Unfortunately, some people take this a step further and think: "I'll show you; not only will I kill myself, but I will kill a bunch of other people first. …