Man is the only animal who has to be encouraged to live.

If there is blame, it belongs to the culture of western civilization itself, a culture that does not value the heart of a man or his needs, a culture that isolates men from each other, that sends a man out into the world without the emotional tools to handle feelings of rejection, failure, fear, loneliness and doubt.

Blame a culture where a man's identity, who he is, is defined by what he does for work and if he has no work, that culture tells him he is nothing.

Blame a culture that requires a man to go it alone, stand on his own two feet, be independent.

Blame a culture that left Dan flapping in the breeze because the unspoken cultural rule is that if you ask for help then you are no longer independent and that means you aren't really a man.

February 13, 2005

Social Isolation, Guns and a 'Culture of Suicide'

By FOX BUTTERFIELD

STEVENSVILLE, Mont. -- Patrick Spaulding, 17, was the star of his basketball team, an honor student and one of the most popular boys in his class at Stevensville High School here in western Montana.

Bill Tipps, 83, was devoted to his wife of 62 years, Louise, who had developed diabetes and who he feared would need to have her leg amputated.

Ron Malensek, 42, owned several small businesses, collected guns and called his wife "Princess."

All three died of a single gunshot wound to the head in this valley below the snow-covered Bitterroot Mountains. All three pulled the trigger themselves.

Death by gunfire is typically thought of as an urban plague, fueled by crime, poverty and drugs.

But rural America also has such an affliction. "Americans in small towns and rural areas are just as likely to die from gunfire as Americans in major cities," said Charles Branas, an assistant professor of epidemiology at the University of Pennsylvania School of Medicine. "The difference is in who does the shooting."

No matter the method, suicides occur at a higher rate in rural areas than in cities or suburbs, with the rate rising steadily the more rural the community. With homicides, the trend works in reverse, with higher rates in more urban areas.

Researchers have long known the statistics, but new research illuminates the substantial role of firearms in suicide.

When Professor Branas examined data from the federal Centers for Disease Control and Prevention, he found that the risk of dying by gunshot was the same in rural and urban areas from 1989 to 1999, findings that were published in The American Journal of Public Health. He has also concluded that in the most rural counties, the incidence of suicide with guns is greater than the incidence of murder with guns in major cities.

Many of the cases in Stevensville and in other rural areas have common threads, professors and epidemiologists say.

People who see themselves as rugged frontiersmen are often reluctant to reach out for help, particularly for mental health treatment. If they do, they may see a physician instead of a psychiatrist or another trained mental health expert.

Suicide risk factors like depression, economic worries and alcohol use are, of course, prevalent in urban areas, said Dr. Alex Crosby, an epidemiologist in the National Center for Injury Prevention and Control at the Centers for Disease Control. But they are heightened in rural areas by social isolation, lack of mental health care and the easy availability of guns.

"People say, 'How could people living in such beautiful places commit suicide?' " said Nels Sanddal, a psychologist in Bozeman, Mont., and president of the Critical Illness and Trauma Foundation, which works to prevent suicides. "We have a culture of suicide."

Surprise Over Statistics

As far back as 1890, soon after Montana became a state, statistics from the Census Bureau showed that it had the highest suicide rate in the nation, Mr. Sanddal said.

"When you have seen other people exercise it as an option in a difficult situation, it becomes easier for you to exercise it as an option," he said. "So now suicide is condoned or tolerated in Montana, even if people don't talk about it."

Stevensville is in Ravalli County, which has a suicide rate more than twice the national average. Since 1990, the county has had 103 suicides, more than three quarters of which involved a firearm. By comparison, there have been just 13 homicides in the county, whose population has swelled 44 percent in that time, to 36,000 people.

The youngest to commit suicide in the county was 13 and the oldest was 92. Reflecting a national pattern, suicides rise sharply with age among men in the county.

The editor of The Ravalli Republic, the local daily newspaper, said that it is against the paper's policy to report on suicides and that he was unaware of a sizable number of incidents in the county.

When asked about the high suicide figures, Sheriff Chris Hoffman said, "This shocks me," even though he is also the coroner and signs all death certificates. Since the 1890's, Sheriff Hoffman's family has raised cattle in the Bitterroot area, which Lewis and Clark traversed in 1805 and described as the most difficult part of their journey.

"People here are not aware of all the suicides," he said. "It's not something people here talk about."

Professor Branas said he encountered similar surprise when he conducted field studies in rural counties in Iowa, Ohio and Pennsylvania.

Most families of those who committed suicide around Stevensville in the last year declined to be interviewed. But relatives and friends of several people who died in previous years agreed, often reluctantly, to talk.

Mary Lee Rush, whose son committed suicide at 29 and who lives in Grantsdale, an unincorporated town in Ravalli County, said: "People here are very rural. They do for themselves. They won't go for help."

Suicide, she said, "is an acceptable way of dying if you feel desolate or you can't handle things anymore."

A Young Life Ended

Patrick Spaulding, a 6-foot-4-inch senior, was the leading scorer on his high school basketball team and had set a school record with 28 rebounds in a single game. "He lived for basketball," said his mother, Paulette Spaulding, who lives in the family house with her husband about five miles outside Stevensville. Patrick was consistently on the honor roll.

On a Friday night in January 1997, Patrick went out and drank a few beers, his friends said, and on the way home apparently fell asleep at the wheel, entangling his pickup truck in barbed wire. A sheriff's deputy gave Patrick a citation for illegal possession of alcohol.

"Under school rules, that would have meant he would be suspended from the team for the rest of the season," his mother said. "He was such a perfectionist, always harder on himself than on anyone else, he felt he had let his family and teammates down." He did not discuss the situation with his parents. The next morning, the day of a big game, alone in his bedroom, Patrick shot himself.

"Teenagers don't live for tomorrow, they live for today," Mrs. Spaulding said.

At Stevensville High School, the guidance counselor, Linda Mullan, was concerned about how other students would respond to Patrick's death and was worried about the possibility of copycats. Many students own guns and hunt, often starting in junior high school. "Guns and hunting are a rite of passage in Montana," Ms. Mullan said.

Two seniors in the same class as Patrick were so distraught by his death that they turned down appointments to the Air Force Academy, preferring to concentrate on trying to heal the wounds of grief among their classmates and prevent any further tragedy, Ms. Mullan said.

A few families of those who have taken their own lives have begun organizing themselves to better understand what happened. Pat Kendall, whose son, Josh, shot himself in the Blue Mountains in 2000, when he was 23, has opened a resource center with a lending library in a small house in Missoula, at the northern end of the valley. She has also helped get the Missoula County Health Department to start a suicide prevention program, the first of its kind in the area.

What Mrs. Kendall has come to believe is that her son probably had bipolar disorder. When he finally went to a doctor, not long before he killed himself, the doctor, who was not a trained psychiatrist, prescribed the antidepressant Prozac. But Prozac can make mood swings worse for some people with bipolar disorder. Mrs. Kendall believes that in a region with few mental health resources, Josh's problem was mistaken for depression.

'A Mercy Killing'

Bill Tipps and his wife, Louise, moved to Stevensville from a suburb of Las Vegas to be close to their adult son, Dennis Tipps, who was the high school football coach and onetime police chief.

Dennis Tipps found a site for a home for his parents nearby in an area of small farms and new houses. One of his sons, Dennis Jr., a contractor, built them a simple ranch-style home.

But Bill Tipps grew depressed. "My dad hated the cold and the winter," Dennis Tipps said.

He was also becoming increasingly concerned about the health of his wife, who was 80. She had undergone several heart surgeries, and the local doctor said her toes might have to be amputated because of diabetes.

Dennis Tipps now surmises that when the doctor pointed with a sweeping gesture to Louise Tipps's foot, and then her knee and hip, Bill Tipps assumed the doctor was suggesting that his wife's leg would also have to be taken off.

His father hated doctors and would not seek their advice, Dennis Tipps said. So his father never clarified his wife's prognosis or sought help for his apparent depression.

His father "never displayed his emotions," Dennis Tipps said. "He kept everything inside, and he was very stubborn. He wouldn't change his mind."

One morning in September 1999, at 8:05 a.m., Bill Tipps called his son at his home.

"I just shot and killed your mother so they can't take her leg off," said the elder Mr. Tipps, who was 83. "Now I'm going to shoot myself."

Dennis Tipps jumped in his truck, and as he approached his parents' house, he heard what he thought was his engine backfiring. It was his father shooting himself.

"In my dad's mind, this was a mercy killing," Dennis Tipps said. "He would never leave her side. He thought he was doing the right thing, but he overreacted."

'He Just Quit'

Debbie Miller describes the gentle side of her husband, Ron Malensek. "He called me Princess and treated me like a princess," she said.

But Mr. Malensek had been diagnosed with depression as a child, she said.

In early 2000, he called all his friends, told them goodbye and then tried to commit suicide by overdosing on pills. He survived, and she urged him to see a doctor, who prescribed Prozac.

In the summer of 2003, Mr. Malensek stopped taking the medication.

Mr. Malensek had always worked seven days a week at various jobs: he had owned two bars, a gas station and a bingo parlor, and then had a business installing rain gutters. That summer, he started neglecting customers who called for estimates, Ms. Miller said. He became angry and could not sleep, and he had no energy, she said. It was as if "he just quit," said Ms. Miller, a speech therapist at Stevensville High School.

On Aug. 5 last year, they went to a favorite bar, the Rustic Hut, in the town of Florence. It was the anniversary of his father's death.

When Ms. Miller left to go home, her husband stayed at the bar. Then he walked out back, retrieved a handgun that he had stashed there earlier, and shot himself.

After his death, Ms. Miller discovered that he had not shared other pressures with her.

"It turned out there were a lot of financial issues I didn't know about," she said. Bill collectors bombarded her and repossessed his pickup truck. She had to sell his business.

She also learned that he was a "gun freak," she said. "I'm still finding guns he had stashed all over the house."

Ms. Miller does not know the statistics about rural suicides, but she knows enough. Her father and her first husband also killed themselves.

Individualism bad for preventing suicide

By TOM MORTON
Star-Tribune staff writer Saturday, May 20, 2006

The trait that best describes the Wyoming attitude toward life contributes to a lot of death.

"Rugged independence — it has a kind of romance about it, but it's not good for suicide prevention," David Litts told participants of the first Wyoming Suicide Prevention Conference. The conference, which ends today at the Ramkota Hotel, is sponsored by the Wyoming Department of Health and the State Suicide Prevention Task Force.

The state's Republican and Libertarian brand of politics attracts people who want to live away from other people, and not have other people telling them what to do, said Litts, associate director of the Suicide Prevention Resource Center.

Although the center is in the suburban Washington, D.C., area, Litts grew up in a small farming community in Michigan and has a first-hand understanding of rural life with its own cultural characteristics.

Culture has a huge influence on suicide, and is independent of mental illness issues such as schizophrenia and anxiety disorders, he said.

In 1933, the suicide rate in the United States was 17 per 100,000, Litts said.

By 1945, the rate dropped to under 10 per 100,000 even though no significant new treatments were employed, he said.

The obvious cultural changes were the emergence from the Great Depression and World War II, when millions of young men were in small units and their lives depended on each other, Litts said.

The post-war rate rose to about 13 per 100,000 in the late 1970s, and hovered about 11 per 100,000 since then.

The Rocky Mountain region had a rate of about 17 per 100,000, and Wyoming's rate is the worst in the nation at nearly 22 per 100,000.

States with dominant Republican politics, mostly in the West, have suicide rates higher than the rest of the nation, Litts said.

People living in Western states and especially Wyoming also share the desires of anonymity, privacy, keeping family problems in the family, a tripling of the divorce rate in rural areas compared to most urban areas from 1970 to 1990, the view that suicide is viewed as a failure of the individual and the family, denial that self-inflicted deaths area a problem and a conspiracy of silence that protects the family and the victim's good name, he said.

Other individual and family factors contributing to the high suicide rate include previous suicide attempts, access to firearms, exposure to suicide, the stigma associated with mental health problems and suicide, and economic instability, Litts said.

On a societal level, the agricultural sector has declined, global markets are beyond local control, failure of the family farm causes a public loss of face, loss of a lifestyle, loss of a reason for living and alcohol misuse, Litts said.

Veterans are disproportionately from rural areas and returning vets don't receive the support and care they need, he said.

However, Wyoming and Western cultures have some factors that can counteract the suicide problems caused by the "rugged independence" mentality, Litts said.

Small communities often have strong ties through churches and religious beliefs that discourage suicide and support preservation, he said.

By way of comparison, predominantly Catholic Latin America has suicide rate in the single digits per 100,000 population compared to rates in the high 20s and 30s in countries that were part of the atheistic Soviet Union, Litts said.

"Emphasize those biblical values of 'being your brother's keeper' and 'bearing one another's burdens,'" he said.

Besides the potential of religious beliefs, small communities have their own cultural heritages, school ties, adults who know what other adults' children are doing, he said.

Litts urged the conference participants to form local suicide prevention coalitions, conduct public awareness campaigns, help local survivors — those who have lost family members to suicide — form support groups, improve relations with the media, encourage gun safety programs, and form support groups for those who have survived their own suicide attempts.

While people living in rural areas may not have a sense of shared responsibility because of their isolation, they often are good at "collective competence" in joining together to confront a crisis, Litts said.

Hot Springs County has a crisis in that it has the No. 1 suicide rate in the state, which has the No. 1 suicide rate in the nation, said Sheriff Lou Falgoust,

He and Marilyn Braaton of the Worland-based Washakie Mental Health are trying to form a suicide prevention coalition, they said.

"Our citizens are independent and often don't seek help," Falgoust said.

Braaton knows a lot of people who belong to congregations or other social groups, but many don't, she said. "Choosing to be private because a stumbling block in being able to get help."

County residents still carry the stigma that mental illness and suicide are taboo subjects, Braaton said.

"There is a lot of help available, but (not) the willingness to get help," she said.

When an individual loses his or her memory, they cannot recognize other people, they become seriously disoriented, and they don't know right from wrong. Sometimes they hurt themselves. Something similar happens when a people become colonized. They can't remember who they are because they are a people without a common history.
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Colonization is the greatest health risk to indigenous peoples as individuals and communities. It produces the anomie -- the absence of values and sense of group purpose and identity -- that underlies the deadly automobile accidents triggered by alcohol abuse. It creates the conditions of inappropriate diet which lead to an epidemic of degenerative diseases, and the moral anarchy that leads to child abuse and spousal abuse. Becoming colonized was the worst thing that could happen five centuries ago, and being colonized is the worst thing that can happen now.

Report cites mental health care disparities

American Indians and Alaska Natives face significant disparities in mental health care that are directly linked to colonization and destructive federal policies, Surgeon General David Satcher reported on Sunday.

From disease introduced by Europeans to allotment of tribal lands to stamping out of language and culture, negative treatment of Native Americans has resulted in high poverty rates, volatile family structure and lower levels of educational achievement, said Satcher. These, and other problems, are linked to "potentially negative mental health consequences," he added.

"[T]here is good reason to suspect that the history of oppression, discrimination, and removal from traditional lands experienced by Native people has contributed to their current lack of educational and economic opportunities and their significant representation among populations with high need for mental health care," writes Satcher.

"As evidenced through history and current socioeconomic realities, American Indian and Alaska Native nations have withstood the consequences of colonialism and of subsequent subjugation," he concludes.

Contained in a 217-page report called "Mental Health: Culture, Race and Ethnicity," the findings on the state of mental health of Indian Country come as no surprise to many. Tribal leaders and health experts continue today to complain of inadequate and underfunded health care on and off reservations.

For the rest of America, the report provides a comprehensive and historical review of the health problems facing Native Americans. It is based on years of medical research and studies of American Indians and Alaska Natives.

But the report points out the need to conduct more research to get a better picture of mental health struggles. No large scale studies of disorders among Native adults have ever been conducted, Satcher says, although two studies have examined some Indian youth.

One study, for instance, found that Indian children in the Northern Plains ages 13 to 17 were much more likely to be diagnosed with attention-deficit / hyperactivity disorder (AD/HD) and substance abuse or substance dependence disorders than their counterparts.

No studies have been done on Alaska Native children.

The mental health of the homeless, veterans and incarcerated Native Americans are noted as particular concerns. Despite making up less than 1 percent of the United States population, Native Americans are 8 percent of the homeless population and make up 4 percent of the criminal justice system.

Additionally, Natives with alcohol and drug problems and foster children are singled out as "high need."

Senate hearing addresses Native youth suicide
Thursday, June 16, 2005

Dr. Richard Carmona, the U.S. Surgeon General, confirmed Native American youth commit suicide, or attempt to, at extremely high rates. The rate among Native youth ages 15-24 is more than three times higher than the national average, he said. In some parts of the Indian Country, particularly the Great Plains, it is even much higher.

"The reality is, that in many of our tribal communities, suicide is not an individual clinical condition but also a community clinical condition," he testified.

Explaining why the great disparity exists is difficult, Carmona and Dr. Charles Grim, the director of the Indian Health Service, said. Additional research is needed to understand why more Native youth take their lives or have suicidal thoughts, they told the committee.

But Sen. John McCain (R-Arizona), the chairman of the committee, suggested that historical mistreatment of Native peoples is likely to blame. He noted that other suicide risk factors — mental illness, substance abuse and poverty — exist in non-Indian communities yet they don't suffer from such high rates.

"I don't know how you can draw any other conclusion that it has something to do with the history of Native Americans and their exploitation and placement in American society, which leads to greater despair," he said.

Sen. Gordon Smith (R-Oregon), who lost a son to suicide, agreed that environment likely contributes to suicide among Native youth. Along with addressing mental health issues, he said the federal government has responsibility to improve education and other opportunities in Indian Country.

"It is possible, maybe even probable, that the rate is higher among Native Americans because of the environmental factors in which they live," he argued.

Joseph B. Stone, a member of the Blackfeet Nation and licensed psychologist, embraced the theory advanced by McCain. He said that preliminary research shows that "historical trauma" or "post-Colonial stress" impacts how Native people deal with problems.

"It seems to have to do with capacity of children to regulate their arousal and the ability of families and family members impacted by the chronic stress over the course of generations to help those children regulate their arousal," he testified.

Native Americans suffer from historical trauma

Native American history meets the 1948 Geneva Convention's definition of genocide, defined as the intent to destroy a national, ethnic, racial or religious group

Monday, August 01, 2005
by Edna Steinman

The treatment given to American Indians as the United States pushed its boundaries westward has resulted in an ongoing emotional condition that a Native American social worker-researcher calls "historical trauma."

Maria Yellow Horse Brave Heart, research associate professor in the Graduate School of Social Work at the University of Denver, described her work at the 2005 Native American Family Camp, held July 19-23 at the University of Redlands. The annual event is sponsored by the United Methodist Church's Native American International Caucus.

Historical trauma has a layering effect and is the "cumulative emotional and psychological wounding over the life span and across generations, emanating from massive group trauma," she said.

Historical or intergenerational trauma is similar to that suffered by the Jewish people as a result of the Holocaust, the Japanese Americans interned in California at the beginning of World War II and African Americans suffering the aftermath of slavery, she said.

Native American history meets the 1948 Geneva Convention's definition of genocide, Brave Heart said, defining genocide as the intent to destroy a national, ethnic, racial or religious group. She said research has shown the U.S. government never intended the long-term survival of Native Americans.

During the Civil War period, Congress passed a resolution stopping negotiation of treaties with Indian tribes and decided to establish two reservations, one east and one west of the Mississippi River. Involvement in the Civil War kept Congress from implementing this plan.

Brave Heart cited the government-run Indian boarding schools as a major factor in the historical trauma. Congressional documents outlined the boarding school policy of forced separation of Indian children from the tribal communities. Gender roles and family relationships were impaired at the boarding schools, where the focus was on the European tradition of male-female relationships and not the Indian tradition of holding women and children sacred. The boarding schools compounded the trauma with a loss of parenting skills, a loss of the child's identification with the parents and other complex processes, she said.

Children of boarding school survivors passed the trauma on to their descendants, but not on purpose and not consciously, said the professor.

Type II diabetes was common among Native American people, fostered both by the overcrowded, deficient conditions in boarding schools and by trauma-caused stress hormones that wear out the body.

Historical trauma generates such responses as survivor guilt, depression, low self-esteem, psychic numbing, anger, victim identity, death identity, thoughts of suicide, preoccupation with trauma, and physical symptoms, Brave Heart said.

A Painful Remembrance

by Mary Annette Pember
Nov 29, 2007, 12:30

Toledo maintains that Indian people today are suffering the aftershocks of colonization that have resulted in an internalized oppression. She points out that some recent generations of native people have willingly sent their children to government and Christian boarding schools, where they have experienced similar abuses.

She notes that boarding schools effectively taught Native peoples to view themselves as a sub-class within White American society. "The curriculum was designed to make us into servants and, therefore, economically powerless," she adds.

This process indoctrinated Indians to believe that abandoning their traditional ways for a life of servitude was the best they could hope for; therefore sending one's child to boarding school was providing the child a chance for survival.

Toledo describes the shame and the disowning of individual and cultural reality as an example of the direct fallout from the "boarding school bomb."

She and her colleagues are convinced that without the internalized oppression experienced at the schools, Native communities would not have such high levels of violence now.

"A definition or result of internalized oppression is 'shame and the disowning of our individual and cultural reality,'" Toledo says. She notes that prior to the boarding schools, traditional native cultures did not have significant histories of violence especially against women and children.

"Native people must reclaim their traditional ways of family and discipline and 'decolonize' our minds to overcome these problems," Toledo says.

What drew you to focus on death and grieving in your work?

I grew up in East L.A. surrounded by my loving traditional Mexican family. My mom was Indian. Henry Standing Bear is my blood great-grandfather and Luther Standing Bear is his brother. Both went to Carlisle Indian School in Pennsylvania, which hauled them 2,000 miles away from South Dakota with the expressed intent of educating the Indian out of the Indian. My uncle and many Indian children died there. When I started clinical practice, I worked with primarily poor people and developed an interest in loss. If you're Indian, you're born into loss.

What does that mean, to be born into loss?

We're the survivors of people who were conquered and colonized. Those are loss experiences, to be the survivors of an American holocaust, to be the survivor of genocide. There were the boarding schools from the 1890s to the 1970s. We see the rise of alcoholism in the Indian community in the 1930s and 1940s, when that first generation goes away and comes back. When you look at Indian people demographically, there's a lot of accidental death, suicide, a lot of alcoholism and violence.

[Bill Reid] speaks of the young: [the records of] failure, apathy, lives lived at the minimum level of achievement and interest,...wandering confused and undirected from meaningless episode to meaningless episode. And always the consuming, dominating, corrosive anger often repressed with the aid of booze and drugs, and a lifestyle precariously designed so that yesterday exists only in fantasy, and there is nothing beyond tomorrow. Or to remember is to realize how it used to be or at least how one imagines it used to be. And to think is to know that tomorrow holds no promise of that fabulous education that was going to make one a doctor or a lawyer or a professional of some kind. It holds no promise even of a job or an adequate home in a stable community, of a family to continue a tradition going back to myth time. It just holds more of the dreary same.

Japan's economic deterioration is damaging a lot more than balance sheets and bank statements. Extreme stress and mental instability are at record highs. About 425,000 people were treated for stress-related mental disorders last year. In 1998, when the economy started tanking, suicides jumped 25% to more than 30,000 and haven't declined. Suicides directly attributed to employment, personal debt and the economy now number 8,500 annually, up fourfold from a decade ago. Because of population changes, the mortality rate per 100,000 people has eased slightly.

Mental health professionals say the actual number of stress-related illnesses may be much higher because psychological difficulties are often ignored or swept under the tatami mat in Japan, where depression is still viewed as a character flaw and treatment is inadequate.

"There's a very dark cloud hanging over Japanese society as more and more people lose their psychological signposts," said Dr. Yoshitomo Takahashi, a researcher with the Tokyo Institute of Psychiatry. "Mental illness still carries a lot of shame, so most people are referred only at the terminal stage. This makes our job very difficult."

Countries around the world have for decades lived with high unemployment and the social, economic and political costs it engenders. But in Japan, workers saw a job as an entitlement, and for years that was the case until Japan's economy faltered.

Companies began pruning payrolls, and the pain now is jolting the core of Japanese society: breadwinners in their 40s and 50s. This generation sacrificed almost everything for the company and now feels betrayed, isolated and worthless at being let go.

"Japan is suddenly waking up from a 56-year dream," said Hirotake Araya, general manager of Tokyo Shoko Research, a private data-collection company. "The end of lifetime employment is very difficult to accept, particularly for middle-aged people."

Research on the brains of suicides show a massive imbalance of seratonin. 90 percent of suicides fit the standard criteria for severe clinical depression. More Americans die of suicide each year (over 30,000) than are killed by drunk drivers. In retrospect, through talking with many people in Danny's life, it became obvious to us that he was suffering from severe depression. In my opinion, this is a brain problem that gets hardwired in by social, cultural and environmental dysfunctions.

I've learned that someone in the United States kills him- or herself every 17 minutes, for a total of 85 a day, almost 31,000 a year. I've learned that you who are reading this story are more likely to kill yourself than be killed by someone else, that the suicide rate for young people has tripled in the past four decades, that the relentless suicide toll of young men alone dwarfs the number of deaths from the Vietnam War and AIDS combined.

Western civilization has a long tradition of viewing self-destruction as a moral and mental failing. "No man may inflict death upon himself at will, merely to escape from temporal difficulties," St. Augustine wrote in "The City of God." Soon civil and ecclesiastical authorities branded it a sin and a crime. Corpses of suicides were publicly displayed, property confiscated, exorcisms performed. Sermons promised eternal damnation. Some clerics recommended hanging those who attempted suicide. Back then, the devil caused suicide. One hundred years ago, it was society. More recently, it was the unconscious mind. Today it is mental illness.

"Suicide is a complex malaise," [Edwin Shneidman, father of "suicidology"] says. "Sociologists have shown that suicide rates vary with factors like war and unemployment; psychoanalysts argue that it is rage toward a loved one that is directed inward; psychiatrists see it as a biochemical imbalance. No one approach holds the answer: It's all that and much more."

While not opposed to drug therapies, Shneidman thinks the so-called biologicalization of suicide is simplistic. It treats the symptoms, not the disorder. It's fine to look inward at arcing synapses, but don't ignore the external connections: religion, family, work. If a healthy person is hurt when these connections fray, is this unraveling any less devastating for someone with a mental illness? And how does biology explain that suicide hits hardest those whom society shows the least respect: young black men, teenagers, gays and lesbians, Native Americans, elderly white men?

"Suicide is not a disease," Shneidman says. "It is not like a stomachache or a headache or some special physiological state. Each suicide is sui generis. Its reasons, like the mind itself, cannot be categorized. Clinical labels are specious, and to build a profession on them is to put a skyscraper on sandy soil."

The good news is that official interest in suicide prevention is cyclical, and after nearly 20 years of barely being noticed, the death count is again capturing national attention. Three years ago, the U.S. Senate and the House passed resolutions recognizing suicide as a national problem. The Centers for Disease Control is in the midst of funding a three-year study in the Western United States, where suicide rates are the highest in the country, and in California, the Legislature is considering a $3-million bill (SB 620) that would inaugurate a suicide prevention strategy with a special focus on young people. And last month, U.S. Surgeon General David Satcher announced a national campaign that would enlist doctors, the clergy, teachers and insurance companies in the fight.

That's all encouraging. As Jamison, author of "Night Falls Fast," says: "What we do about suicide and mental illness tells us about who we are as a country...."

The bad news is that America is still as queasy about suicide as it is about abortion, euthanasia and other issues where life, death and choice intersect. We put it in a box and we bury it with shame. And as long as we do, experts say, we will likely have an epidemic.

Let's begin by calling these school shootings exactly what they are: suicides. With the exception of the two boys in Jonesboro, Ark., there was no attempt or even intent to escape. They either kill themselves (Columbine), expect to be killed or give themselves up, with life imprisonment awaiting them.

These "suicides" are accompanied by the desire to kill as many others as possible on the way out. This pattern of suicide could be called "the Samson syndrome."