15 ms·

The undiscovered country: Can suicide be predicted?

76 points by lermontov 5y ago

underseacables 5y ago
Robert Lowell once said that if humans had access to a button that would kill us instantly and painlessly, we would all press it sooner or later. I think this explains suicide better: For most, it’s an irrational act done in the spur of the moment. What I think is more interesting is when suicide is done as a rational act with planning, and consideration for others.
- SirFatty 5y ago
  Someone can think about killing themselves for months or years before actually doing it.. are you suggesting that is irrational because there wasn't a plan or consideration of others?
  - underseacables 5y ago
    The final act itself is either rational, or irrational. I think most people commit suicide as an irrational sudden decision. They may have thought about it, they may have planned about it, but I think there’s a clear delineation between someone who says screw it, and kills themselves, versus someone who plans and commits the act with thoughtful deliberation. To make it easier to understand, perhaps you might look at this between a person who sees a train coming and decides in that moment tk step in front of the train, and someone who takes a Final Exit approach at home. The mystery is what is going through the persons mind at the moment of self execution. edit: I used the wrong word to describe a final act.
    - finnh 5y ago
      (sorry to be that guy, just a useful FYI) I think you may want "ultimate"? penultimate = second-to-last.
      - underseacables 5y ago
        Ah! Thank you, you’re absolutely correct. I changed it to “final“.
    - kar5pt 5y ago
      Living can be irrational too. There are plenty of people who are completely miserable with no hope or plan to make anything better, but still choose to live out of pure fear of death. There's always a conversation over whether suicide is rational, but no one thinks to ask if living is rational.
    - spywaregorilla 5y ago
      Rationality seems like an irrelevant term here. Desire for suicide is obviously subjective and has no objective answer. I doubt spur of the moment suicides are very common, although the 'an hero' kid and the one that misunderstood their robinhood debt come to mind. Most suicide is going to be premeditated to a large degree. How certain do the specifics need to be for it to be considered rational? I think that's grey. A lot of people point to studies showing people who survive suicide attempts often say it was a mistake, but these strike me as having an enormous survivor bias embedded in them (not on the initial attempt, but on additional more successful attempts subsequently). So long as an act isn't based on strictly false premises or mind altering substances, I'm inclined to say most are "rational" if such a term can be applied. I've never been suicidal, but I've always felt that strong anti-suicide advocates, while strongly well intentioned, might not be fully reasoning out their belief systems. I think I'd greatly prefer to go out on my own terms in old age, without need for qualifiers like pain or disability. Recognizing the time for your conclusion is a tropey act for old characters in fiction, and implies deep wisdom. But in real life we assume anyone feeling similar has lost their mind.
      - underseacables 5y ago
        Anytime there is talk of suicide in this community I’ve always remembered heartbreaking final words of Bill Zeller. Didn’t know him personally, but I would consider his act a rational one. I do think suicide can be irrational, which comes down to heat of the moment. I’ve had a few friends commit suicide, and it’s a horrible thing to endure, but I understand. A persons choice to in their life should be theirs completely, but I hope it’s one that is done with a rational thought out purpose. Not a spur of the moment thing. https://gizmodo.com/the-agonizing-last-words-of-programmer-bill-zeller-5726667 https://gizmodo.com/the-agonizing-last-words-of-programmer-b...
  - naturalauction 5y ago
    “All 29 people who survived their suicide attempts off San Francisco’s Golden Gate Bridge have said they regretted their decision as soon as they jumped.” https://ennyman.medium.com/a-lesson-from-29-golden-gate-suicide-attempts-a42f4ef3f970 https://ennyman.medium.com/a-lesson-from-29-golden-gate-suic... Sure most suicide attempts aren’t done this way but I think statistics like this showcase how many suicides are irrational on some level. If it was rational then you’d think they wouldn’t immediately regret it (unless the regret is irrational I guess).
    - AnIdiotOnTheNet 5y ago
      Perhaps their regret is a significant contributor to their survival though.
      - giantg2 5y ago
        Or perhaps they are only saying they regret it so they aren't thrown into a mental hospital. I wonder if there was a follow up on longterm survival.
        jsmith45 5y ago
        Of 515 people prevented by police from jumping off the Golden Gate Bridge between 1937 and 1971, by the end of the 70s only 6% of them had committed suicide by other means. Source: "Where are they now?" by Richard Seiden
        giantg2 5y ago
        Interesting, thanks!
      - mactrey 5y ago
        Or perhaps having the experience itself ("I survived the jump") is a significant contributor to their not regretting it. There could even be multiple mechanisms there: "turns out being that close to death is really scary," or "my survival means there is a higher power looking out for me," or "my life flashing before my eyes made me realize something about my life"...
- s1artibartfast 5y ago
  One major challenge is that careful premeditation does not necessarily mean suicide is rational. There is a big crossover between people who consider suicide and people with disorders negatively impacting their cognition and decision making.
  - aeturnum 5y ago
    > people with disorders negatively impacting their cognition and decision making. I think we should be really careful about how we think & talk about this. There are a few situations (like psychotic breaks) where people fully believe delusions that, in a short time, they will reject. We can cleanly call those experiences "irrational." On the other hand, people who experience long term depression literally experience the world differently in a way that we frequently cannot 'correct'[1]. Those people are not irrationally convinced that the world is hard to be in - they have brains for which things feel worse than for neurotypical brains. We can agree on all objectively measurable qualities of the world and their experience of that world will still be subjectively and consistently worse. The conversations from the right-to-die movement can be useful here, as chronic pain and disease offer a lens through which to understand. We have all experienced physical pain, but we have not all experienced serious depression. All I mean to say is that in the same way that someone with any chronic illness should have some choice in when and how they die, people who have chronic mental conditions should have the same right. We do not want to make the mistake of thinking that a person in a more complicated situation is compromised in some way - just that their world is more complex and we should take care to attend to the specifics of it. [1] It's not clear what way of seeing the world is 'right' but I will use correct here even with its implication that neurotypical people live in the real world.
    - s1artibartfast 5y ago
      I totally agree that it is a very tricky subject, especially regarding depression. Having some experience with it myself, I would argue that irrational pessimism is a major feature of depression. For example, people cannot accurately asses actions and activities that would in fact make them happier if they were to follow through. In this way, I think they are clearly distinct from those with terminal illness or chronic pain. I agree that people should have the right to choose death, independent of the rationality of their decision. Ultimately, people are the owner of their body and steward of their life, even if they are imperfect and irrational ones. Taking autonomy away turns individuals and their body into the property of someone else. I think there is some room for temporary holds and crisis management, but all such activities should be finite in duration.
- MeinBlutIstBlau 5y ago
  Suicide is not irrational in of itself. Facing 25-Life? Perfectly rational. Lost all your money and have no retirement? Still very rational. All you friends left you and you are completely alone to fend for yourself? Still rational. America needs to get over itself that life needs to be lived until a natural death. Not everybody wants to further deal with the excessive burdens of life. Suicide, when not done in a spur of the moment decision, can be wholly rational. Wanting to live a garbage quality if life because society thinks it's weird to just end it to not suffer is some Catholic guilt being forced on everyone.
  - tpush 5y ago
    > All you friends left you and you are completely alone to fend for yourself? Still rational. I don't think suicide is a rational response to that; I even think it's dangerous to frame it as any kind of 'rational' action to take in such a situation.
  - autoexec 5y ago
    For the most part, I agree with you, and people should be free to choose their own death at any time for any reason (rational or otherwise), but "all your friends leaving you" may be something that can be changed. At the very least new friends can almost always be found. It wouldn't seem rational to me at least to end your life over that for most people. I can respect a person's right to make that choice in any situation, but I don't have to agree with it.
- tablespoon 5y ago
  >> Robert Lowell once said that if humans had access to a button that would kill us instantly and painlessly, we would all press it sooner or later. > I think this explains suicide better: For most, it’s an irrational act done in the spur of the moment. Or it's rational, but we have some "irrational" mechanisms to prevent it that are best defeated by an impulsive act [1]. I don't actually believe that, but it's hard to argue against it under certain common sets of assumptions. [1] e.g. from a rationalist/materialist perspective: suicide is to avoid/escape pain, and it also removes the pain of guilt for doing it and the pain of missing out on all future pleasures, etc. However, evolution has formed us to reproduce, no matter how painful the struggle is and how subjectively irrational it is to endure it.
- easterncalculus 5y ago
  I'm not convinced there's anything rational in suicide by definition. Every organ, vessel, and part of your body, especially your brain, is dedicated to keeping you alive for as long as possible. If it makes you feel the need to end your life, by definition it is not working. A lot of bad things can happen to you in a lifetime, but death is the worst, without a doubt. To feel the need to inflict it upon yourself is therefore not rational at all, even if it is premeditated. What seems like one irrational spur of the moment decision is really one that in most cases had been considered well before. No one ends their own life before thinking about it beforehand.
  - dec0dedab0de 5y ago
    I'm not convinced there's anything rational in suicide by definition. Every organ, vessel, and part of your body, especially your brain, is dedicated to keeping you alive for as long as possible. I would say it's dedicated to keeping you alive long enough to raise children and help your children raise children. Which may be the same thing in practice, but more in line with how evolution works.
  - Thiez 5y ago
    That's an interesting assumption. So only acts that are in "harmony" with what your body desires are rational, and all other acts are, by your definition, irrational? So when I'm under water, swimming up to the surface, and my body is telling me to take a breath right now, that would be rational? And suppressing the urge until I reach the surface is irrational?
  - TOMDM 5y ago
    An argument from organ function only operates if you believe the process of evolution that created those organs and their "goals" are what defines human meaning. I personally believe humans derive their own meaning in life. Temporary chemical imbalances and runaway feedback loops of emotional harm can certainly lead to impairment of rational judgement concerning suicide, but that doesn't mean that if you accept the premise that humans derive their own value that there can be rational avenues to suicide. For situations like accute depression and anxiety (of which I'm intimitely familiar) are situations where I would argue ones judgement is impaired when it comes to suicide, and I don't doubt that said impairment is extrapolable to many other situations. >A lot of bad things can happen to you in a lifetime, but death is the worst, without a doubt. I think that comes down to whether you believe that A) Someone can experience a negative qualia B) Someone can rationaly predict that said living situation is now a permenant state of affairs with a high enough degree of certainty C) That death is a negative (negative only insofar as it can effect others) to neutral qualia that is still higher than and therefore preferable to an expected permenant negative qualia. I'm not of the opinion that this is something that can typically be done independently, as humans are vulnerable to a host of conditions that can impair our ability to make judgement B, and I sure as hell hope that anyone wanting to make that decision trusts the people they ask to help them make it. The protoypical example people tend to use is alzheimers victims, who are frequently (but not always) permenantly and irrecoverably (for now hopefully) distressed.
- pmoriarty 5y ago
  "Robert Lowell once said that if humans had access to a button that would kill us instantly and painlessly, we would all press it sooner or later." They'd push it even sooner if no one they cared about depended on them. A lot of people stay alive simply out of a sense of responsibility towards others.
  - agumonkey 5y ago
    I think the storage space for our notion of 'others' or 'loved ones' is one extremely potent part of our minds. I am who I love somehow, my brain goes against destroying that bond.
  - spaetzleesser 5y ago
    “They'd push it even sooner if no one they cared about depended on them. A lot of people stay alive simply out of a sense of responsibility towards others.” That would be me. I don’t want to be a burden to people.
- analog31 5y ago
  >>>> Robert Lowell once said that if humans had access to a button that would kill us instantly and painlessly, we would all press it sooner or later. In my view, firearms are close enough to this level of technology, to shed doubt on the hypothesis. I don't think everybody with a gun tries to kill themselves.
spywaregorilla 5y ago
I would tend to assume suicide is fairly predictable with high sensitivity and the data many corporations have from surveillance of customers tbh.
- anonymouse008 5y ago
  Let's just say I get really concerned about my fairly stable, committed household when I get therapy and dating app ads...
  - motohagiography 5y ago
    Given ads are necessarily both targeted and predatory, and a not a few of them are planted as part of sophisticated political campaigns and operations, someone in your house probably just triggered a link on their trapline. Ads for therapy are to stoke fears of people they may be mentally ill, and ads for dating sites are to make people feel isolated. They're just used as priming for selling you an additional something else to relieve the feelings the primers created. If I wanted you to look at my ad, I'd present something you would look away from, and have my product ad right there waiting for where you will likely look to. Look at the difference between ads in the margin of pages, vs. those inline to the content.
  - LorenPechtel 5y ago
    The targeting isn't all that good. We note the dramatic hits, we don't note the far larger number of misses. I used to get a lot of dating and foreign-matchmaking ads stemming from the fact I like chess. Never mind that I have been off the market since before there was a www.
    - spywaregorilla 5y ago
      > I used to get a lot of dating and foreign-matchmaking ads stemming from the fact I like chess. How would you know this?
      - 5y ago
Razengan 5y ago
Just allow people the basic freedom to leave the fuck out of this world if they really want to. But no, that would mean one less entity to milk for labor and money.
- AnIdiotOnTheNet 5y ago
  Yeah, it's funny how no one gives a flying fuck about your suffering and will actively encourage it for their own benefit right up until you start talking about suicide. Of course, 90% of the time that's because they see an opportunity to sell you on a new drug, religion, or ideology.
  - nicoburns 5y ago
    Yeah, this bugs me too. We shouldn't be talking about suicide prevention. We should be talking about preventing suffering.
    - axelroze 5y ago
      We can't prevent suffering. Cooperative systems like all sorts of communism don't work because people are by nature lazy and even worse greedy. Everyone maximizes their needs and minimizes their abilities. Hence we are left with competitive systems like contemporary capitalism where pressure to perform and be better than the others directly leads to suffering as inevitably there will be losers. The winners also don't fare much better as well. It is often a Pyrrhic victory. Cursed if you do. Cursed if you don't. And in the end to feel better about ourselves, we the society, tell people it is worth living so they do their stressful job for a few more decades and enjoy a few weeks of free time a week to play Candy Crush on their iPhones they are still paying via installments. But even if looked beyond politics and social organisation perfect prevention of suffering is impossible until medicine reaches some state of seamless merging with (bio)robotics. Ironically the competitive pressure might actually be the way we reach such a state of science. Ray Kurzweil is talking a bit about this in the book about the Singularity.
      - 5y ago
alpaca128 5y ago
Well that's an interesting way to fight ad blockers. Hiding the whole content.
morpheos137 5y ago
Barring cases of extreme physical pain or terminal illness or old age I can't understand the point of suicide. You are not around to enjoy the result of your consequent non-existence. Chronic severe mental illness is another possible reason but even for that I believe it can be treated in many cases with unconventional approaches like pschedelics (eg ketamine, exercise, religious experience, etc). Suffering is a natural part of life not something to be escaped on a whim.
- hashhar 5y ago
  TL; DR -- You have a chronic pain. No painkillers help. Every doctor you go to doesn't have a quick-fix. People around you keep telling you "you're imagining things", "be spiritual", "it isn't as bad as you think", "it'll go away". Nothing you try seems to help. You wake up every day feeling the pain and it keeps getting worse with no end in sight. Image living this for even a year (where this is what life looks like for some people for the last 20 years or more) and then tell me you wouldn't say no to "anything to make the pain go away". --- Hear me out. Let's say you wake up tomorrow with a bit of a headache. You take an aspirin and go about your day. You wake up tomorrow but it's still there. You visit a doctor who tells you to "take it easy" and you go about your day again. You wake up the next day and it's still not better. You begrudgingly get out of bed and go about your day. Someone tells you that you seem a bit irritable today. You then try to be aware of it and end up spending considerable mental energy trying to be "sociable". You get back home a bit exhausted. You wake up and it's worse. Your brain seems to amplify little things up to 100. You spilled some milk and you think the entire day will be like this. You feel "let's stay in today". A friend comes over, you end up exhausted trying to put on a normal face and overthink about how come it looks so easy for your friend to plan a night out today? They invite you and you accept hoping it might help. You visit the party and you feel a bit okay while in the moment. You go back home and you feel exhausted and sleep. the next day is even worse. Your brain tells you why bother getting out of bed - it's not like anything nice is going to happen to you today. you fight it and get out of bed but you can't find your slippers - you feel the day is going to be shit again but you go out anyway. Repeat previous paragraph x 1 year. Now the next day your brain convinces you there's no point in getting out today. You stay in, skip a few meals and it's night. You put on a movie and you enjoy it. Once it's over the feeling comes back. You get frustrated - you pick out some substances to help you "feel less". Maybe this feels a bit better. You repeat this for a few months. You are now so irritable and so envious of others that your personal relations start to suffer and you lash out on others. Slowly your circle shrinks. Now it's easier to not get out of bed. By now you've had the same day for the last 5 years and you can't see it getting any better. You go to a therapist. If they are good maybe you both figure out some things together that help you conquer small things - like getting multiple slippers one for each room and your brain no longer needs to panick if it can't find the slipper. But sadly most of the people aren't so lucky. You try many medications, substances but nothing seems to last. You want a quick fix but there is none to be found (unlike for physical pain). 10 years have gone by with the same morning every day - each a bit worse than the last. Now you think "This isn't going to improve I think. Nobody has answers. There are no solutions. Nothing seems to help. There is no sunshine.". Your inner voice tells you about a few other things you haven't tried yet. And that's how we lose you. So forgive me for saying this but people like you who have no empathy and are so willing to invalidate how many people feel on a daily basis don't deserve to be making decisions for others.
dbtc 5y ago
If suicide can be predicted then I would why not homicide? And then perhaps all crime.
pmoriarty 5y ago
In "Why do people die by suicide", Dr Paul Thomlinson goes over the research on predicting suicide.[1] First, he talks about a well supported model called Joiner's Model, based on research which shows that people who are most likely to commit suicide have all three of these factors: - Thwarted belongingness ("I am alone") - Perceived burdensomeness ("I am a burden") - Ability to commit suicide ("I am not afraid to die") Perceived burdensomeness has two components: Liability ("My death is worth more than my life to others") and self-hate ("I hate myself") Thwarted belongingness also has two components: Loneliness ("I feel disconnected from others") and absence of reciprocal care ("I have no one to turn to and I don't support others") And finally, capability to commit suicide is predicted by: Lowered fear of death, elevated physical pain tolerance, family history of suicide, clustering/exposure to suicidality, combat exposure, suicide attempts, childhood maltreatment And another model with the acronym "IS PATH WARM" shows that people who are most likely to commit suicide are likely to have, feel or be: - I = Ideation - S = Substance Use - P = Purposelessness - A = Anxiety - T = Trapped - H = Hopelessness - W = Withdrawal - A = Anger - R = Recklessness - M = Mood Change [1] - at about 25 minutes in to https://www.youtube.com/watch?v=Arywx88jMXw https://www.youtube.com/watch?v=Arywx88jMXw
- agumonkey 5y ago
  interesting categorization, very much so, I find there's a duality in the lonely/self-hate group. So many people who feel like that are utterly normal, they just can't connect other realities than their own judgement.
- autoexec 5y ago
  Joiner's Model seems to exclude people who are candidates for assisted suicide. They often don't feel alone, don't feel like a burden, but are terminally ill, in constant pain, feel they've lived long enough, seeing significant mental/physical decline etc. You can shoehorn them into "IS PATH WARM" under hopelessness, trapped, or anger I guess.
  - LorenPechtel 5y ago
    Yeah, it's looking at mental illness suicide. The terminally ill ones are more like the people who jump from a burning building--life has legitimately become more painful than death. That's not something a psychiatrist can change.
hashhar 5y ago
The lack of empathy in the comments is scary. No wonder the situation is so bad. Let me present a scenario which might seem more relatable since it seems people understand physical pain but have no "scale" of what mental pain could be like. You have a chronic pain (maybe one of wrists is broken in a way that there is no solution). No painkillers help. Every doctor you go to doesn't have a quick-fix. People around you keep telling you "you're imagining things", "be spiritual", "it isn't as bad as you think", "it'll go away". Nothing you try seems to help. You wake up every day feeling the pain and it keeps getting worse with no end in sight. EDIT: Missed one crucial component. The pain is so much that you cannot have normal social interactions because 80% of your energy is spent trying to cover up the pain. You feel exhausted all the time due to this and don't have the energy or the motivation to do anything. Image living this for even a year (where this is what life looks like for some people for the last 20 years or more) and then tell me you wouldn't say no to "anything to make the pain go away".
- Clubber 5y ago
  >"anything to make the pain go away" Sure, I think our rampant overdose problem and drug and alcohol over-use problem in general is a symptom of this. That's one of the reasons the war on drugs is so insidious, it punishes the people already suffering, which makes them suffer more, forcing a downward spiral that is almost impossible to get out of. All from a perceived moral failing. The US is pretty cruel to its citizens. It's not overtly, in-your-face cruel like historical regimes, but still cruel, none the less.
  - hellbannedguy 5y ago
    I have not done much traveling, but Americans seem to self-medicate more?
    - handrous 5y ago
      We take way less vacation and have far more financial uncertainty and more bills (more complexity and more to keep track of just to get by), so our background level of stress is probably higher on average than in, say, most Western European states. There may be other reasons that affect it more, but I'd fully expect that to be enough to result in more self-medication, all else being equal.
gmuslera 5y ago
Wrong science fiction reference, it should be The Minority Report. Would your prediction cause it? avoid it? It was really about to happen? If you are "testing" it, stopping the people that is about to do it would mess with the test? And not stopping them would count as unintentional murder? My objections are not about suicides, but about predictions in general and predictions that can affect human lives in particular.
one_off_comment 5y ago
I feel like the article didn't deliver on its promise. The author never got to try out the device that's supposed to predict suicide. I was most curious about that because I find myself skeptical such a thing could work.
- derbOac 5y ago
  https://psycnet.apa.org./record/2016-54856-001?doi=1 https://psycnet.apa.org./record/2016-54856-001?doi=1 Suicide is notoriously difficult to predict. That meta-analysis is one example; once you account for base rates in realistic scenarios, you can do very little better than chance. Some of this might have to do with the nature of predictors; maybe with deep learning and real-time data this might improve slightly, but I doubt it somewhat (there are significant ethical issues involved in such data regardless but that's a different issue). One of the biggest problems in this area is that suicide is such a low base rate phenomenon that it's difficult to predict for that reason alone. Not only that, but many of the predictors are relatively high base rate by comparison, so there's a very very very low signal to noise ratio. Statistically speaking, it's like finding a needle in a needlestack. I think adding to the complication is that it's not really that you want to know if someone eventually commits suicide, what you want to know is whether they do so within a certain actionable timeframe. That is, for most of the decisions such predictions are being clamored for, it doesn't really help to know that there's a 70% chance that someone will commit suicide eventually; what practitioners really want to know is "what are the odds someone will commit suicide if I make decision X right now." This is a significantly more difficult thing to study. I personally believe that the approach to suicide in developed countries is horribly misguided and probably unethical, focused too much on the act and not prevention of the state (psychological, sociological, economic) that leads to it. It's unethical to leave someone in such a personal hell that they want to exit it by killing themselves; preventing themselves from doing so, without removing them from that state, only deprives them of a means of relief.
ppod 5y ago
>It measured for what Emotra called “electrodermal hyporeactivity” by running a weak current over the skin as the sweat glands open and close. The association with suicide had been advertised by an experimental psychiatrist named Lars-Håkan Thorell, Emotra’s founder, This has regulatory approval in the EU? Why is Harpers even writing about this?
cmehdy 5y ago
I like the article for the most part. I've noticed many comments here are lacking the empathy that is so fundamentally needed in this world to help those who suffer alleviate the pain, so as a fellow struggling one I figured I could throw my words to the wind. People more readily mentally visualize somebody without a leg, somebody with open fractures. Not so much for mind stuff, it's not concrete enough to most until it turns physical (i.e. you're a bloodstain on the floor). That's why some comments go along the lines of "I can understand suicide for physical pain but not for mental one". I would suggest that a broken self hurts more than an open fracture, and lacking certain central abilities to stabilize the self leaves you much more legless than if you lost your physical legs. Other comments point out the endless rational vs irrational discussion. I'd ask them: when you go get a drink at a café and you're about to order a cappuccino but you ask for a latte, how do you see the whole process? You've planned something rationally (going to get that cappuccino) and made a seemingly irrational choice at the end (getting the latte). Are you rational or not? Furthermore, by what lens do you judge when the absence of rational decision is an illness? Typically people will reply either with a utilitarian point of view or a selfish one: either you are being counter-productive to society with your guts and bloods that need to be cleaned and the lack of your presence in the consumerist world, or I take it all backwards and call you ill first because that's what agrees with my worldview ("you're sick, you can't know what's good for you"). What I have done with myself and others is to acknowledge that those bits of perhaps-irrationality are not relevant to helping things, as we all have them in different places as we live and that's okay. It's also important to acknowledge that one can be right to feel like they're backed into a corner when a lot of evidence accrues towards that. BUT, the essential part is to show methodically that (1) there are levers of action that we are steering clear of due to cognitive distortions or lack of awareness, and (2) all suicidal people are fighting to be alive much more than even they might know, as they're still around even when making aimless steps due to the crushing pain. In short, tap into what wants to live to push back against what wants to die, and show that the realm of what is possible to advance is much larger than one might think when in the fog. ---- With that said, I have my own take on parts of the article itself. > A reader of a late-nineteenth-century edition of Chambers’s Encyclopaedia would find committing suicide described as a “heinous crime,” for which the punishments included “an ignominious burial in the highway, with a stake driven through the body.” Today the National Institute of Mental Health cautions against saying that a person “committed” suicide at all; better to say that they “completed” it, to avoid the implication of an illicit or criminal act. As if suicide wasn't still considered a vile and illegal thing. You can share your mental health struggles with a therapist just fine until you're a risk to yourself and they call people to, forcibly if needed, remove you and take you wherever they want. Your rights can be severely limited or removed entirely when a psychiatric emergency is considered - how is that any different from being treated like a criminal? Psychiatric intake can pragmatically be worse than prison intake, from someone who's seen both. It's not seen as vile by everybody but there are still far too many people who frame the process with words of abandonment, with selfishness, with dismissal of all the inner work of the suffering through the singular use of irrationality as an absolute concept ("you're just irrational"), and so on. You're not considered as an equal to your peers when you're suicidal, and that's not something you get to argue against because that's just part of how you're defined by them. See the following paragraph for something related. > When patients told Freud that their lives were hopeless or without purpose, he considered this an impressive display of self-awareness. “We can only wonder,” he wrote, “why a man must become ill before he can discover truth of this kind.” That's Freud we're talking about so whatever.. but that train of thought still seems to exist quite a bit nowadays. The introspection and the ability to shatter illusions is put in the same box as the delusions that a "sick" person has, leading a lot of people with severe depression and other disorders to associate one with the other since society does it too. "My ability to dig deeper is part of why I am sick" is entirely the wrong message to send to a vulnerable person, and it is just incorrect. For it is not the power to see beyond the surface that is a problem, but the delusions one might hold or acquire about the process. CBT points it out with the terms of cognitive distortions, which is a start. It doesn't necessarily offer a wholly coherent narrative for the emergence of those distortions, nor does it offer a strong logical argument to disprove the utility of those distortions (i.e. somebody in pain could say "so what if I see everything in black and white? this is how I've managed to survive so far, so you better prove to me that what you're offering would help me survive better"). > (about Shneidman) “I am against suicide committed by other people,” he wrote, “but I want to reserve that option for myself.” This holds meaning that most healthy people might not realize. People who commit suicide go to the last place where there is a semblance of effective control and ability to choose an option, have some agency, in a world that (objectively sometimes but not most of the time) presents no other option. Healthy people have the comfort of a grip on their existence, or at the very least the comfort of an illusion of a grip on it. Despite having their own beliefs and instabilities, they aren't mandatorily taught CBT and other such similar things - whereas it is expected of the "sick" to do more of the homework. It's like breaking your legs on a hike and then being asked to do leg workouts to keep up, when other people happen to be luckier and go without both things and wouldn't themselves be able to do the workout. But this is a necessary thing for a person with mental illness to do nonetheless, and I'm not debating that point. What I am trying to point at however is that the world of people who are unaware of such struggles is filled with a violent hypocrisy that contributes to the reasons for very lacking mental health services and very lacking social support from peers, as it drives the ones who suffer away from everybody else. It would do well for any healthy person to acknowledge that they, too, could be cornered into helplessness if their need for control (or the illusion of it) shattered. That brings them closer to the person considered ill, and thus narrows the gap for bridges to be built - showing both kinds of people that there is a passage between the states. That's an application of empathy that would strengthen the vulnerable at no other cost. But the healthy too can have cognitive distortions and might actually fear that it weakens them. This sort of disconnect between those who study the subject matter and those who experience is it nothing new, so it's funny to see that it surprises people who've worked on the subject for a while (as the article highlights about Brent and Shneidman) > “One of the problems with suicide,” he said after a time, “is that the person who killed themselves takes a lot of the answers with them.” And the people who failed are not being asked much of anything, but instead being told what to do. You'll be diagnosed this, given those meds, told to apply this and that method. Any question about mind and life are only there in order to give you a method, not to understand. Something diametrically opposed to the mind of the suffering in the first place, which seeks understanding of self and answers so much that it spirals and loses track of healthy methods to do so. Funnily enough, I think both sides are going at it kinda wrong, and we can do much better by weaving both approaches together and treading the middle line. Sometimes you need a practical tool, and sometimes you need to understand for the sake of understanding. Be both to yourself, be both to others.
3520 5y ago
In order to predict suicide you'd need real-time data of wide variety of aspects of a human being (levels of pain, hopelessness, connectedness, capability for suicide, etc) in a way that is impossible to achieve at the moment (insufficient measures and insufficient data gathering techniques).
okareaman 5y ago
As someone who has struggle with suicidal ideation his entire life, whenever the subject comes up I try to educate people by quoting author David Foster Wallace (who commited suicide) with the best explanation: “The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom Its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who leap from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’, can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling.”
- rubyfan 5y ago
  This is an amazing explanation, thank you for sharing this.
  - kingsloi 5y ago
    I agree, thank you.
- jsmith45 5y ago
  One flaw with the analogy is that a pretty significant portion of suicides (successful or attempts) are impulsive. Many people who attempt it have literally no idea they will when they wake up that morning. A 2001 University of Houston study of survivors of near lethal attempts showed that 70% of them had only decided to do it an hour or less before the attempt, and 24 percent had only spent 5 minutes before the attempt. If when attempting it, they discover that their chosen method won't work for some reason, many will just give up on killing themselves rather than looking for an alternative measure. This has been reliably seen many times. If a change is made such that one suicide method becomes unfeasible, the overall attempt rate drops. If one were committed to offing oneself it is almost impossible to stop them, as there are countless ways to do it. But the statistics are very clear that if some method is removed, alternatives are not always used. The British had an issue with people killing themselves with oven fumes, back when the ovens used coal gas which created a lot of carbon monoxide, with this accounting for about 50% of suicide deaths. When things were changed to use natural gas where this approach does not work, suicides dropped by 30%. Obviously while that means a portion ending up using some other method, many others simply never killed themselves. Of 515 people prevented by police from jumping off the Golden Gate Bridge between 1937 and 1971, by the end of the 70s only 6% of them had committed suicide by other means. Weirdly even some of the non-impulsive cases where people had planned an attempt for days or weeks just give up if their plan is foiled, rather than coming up with some alternative method. Now obviously not everybody is like this. Some people will continue to try over and over until they succeed. But the numbers suggest that those are very much a minority.
neonate 5y ago
https://archive.is/WyW6u https://archive.is/WyW6u
giantg2 5y ago
'Poté explained that the basic mechanism is comparable to the process “used in lie-detector tests, like you see in the movies.”' And yet polygraphs are known to be unreliable, to the point that they are generally not admissible in court. It would probably be better marketing if they don't imply that their product is comparable to an qn existing tech that is unreliable.
- omniglottal 5y ago
  Better marketting can and probably should include honest implications of a product's limitations.
- LorenPechtel 5y ago
  The basic problem with lie detectors is that if you know what you're doing you can trick the machine. Also, people tend to react to the sensitive questions, producing false positives. While they aren't used for it they can in certain circumstances produce results with an accuracy quite sufficient for the courtroom, and there isn't even any Fifth Amendment problems with the approach: You need things which the criminal will know but which others will not--you have to keep a bunch of details out of the press. The suspect is not asked any questions, but rather asked to read a bunch of statements about the crime--"she was wearing a red blouse", "she was wearing a green blouse", "she was wearing a white blouse", "she was wearing a blue blouse", each statement is innocent and thus will not trigger a reaction in the person who doesn't know the details. There is a 1 in 4 chance that someone will show the strongest reaction to the true statement--but what happens when you do the same thing with a bunch of details? Show the strongest reaction to the true one on 20 such 4-choice questions and now what are the odds it's a random? An innocent can't incriminate themselves because they don't know which are the sensitive answers. Note that you can't exonerate someone this way--someone who doesn't remember the details being asked about will look the same as someone who is innocent. However, if it fingers you to a sufficiently high degree of certainty guilt is assured.
  - giantg2 5y ago
    Is there case law supporting their use? To my knowledge they are not used in court due to accuracy concerns. They are typically used by police in their investigation just to rule out or confirm suspects. Edit: looks like it varies by state, but most do not allow it. https://www.brodenmickelsen.com/blog/why-polygraph-tests-are-not-admissible-in-court https://www.brodenmickelsen.com/blog/why-polygraph-tests-are...
FinanceAnon 5y ago
It's impossible to measure, but I wonder what % of suicides happens because of the culture that we live in. A lot of times when you read about someone commiting suicide it's blamed on that individual or their mental health - but is that really the root issue? How many of the suicides wouldn't happen if society was set up in a different way?
- acover 5y ago
  I think it's part of who we are. Suicides happen in tribal cultures - https://www.jstor.org/stable/658295 https://www.jstor.org/stable/658295
- xtracto 5y ago
  I think you are onto something. An example for me would be, someone committing suicide in the USA due to the perception of having to confront some incredible stressful event in the future; whereas the exact same situation in another country (with different culture) would not yield the same weight to that person. As an example, take Jeffrey Epstein suicide (let's assume thats what happen). He might have sought that exit given his possible future perspectives. Had he been in Mexico (where I live) he may have had a different (more lenient) perspective of his future.
  - deleted 5y ago
    [deleted]
- yCombLinks 5y ago
  I think the culture is extremely relevant. If you look at this map on the right: https://en.wikipedia.org/wiki/Gender_differences_in_suicide https://en.wikipedia.org/wiki/Gender_differences_in_suicide You'll see China is a significant outlier, being the only country with a higher suicide rate for women than men. All of the western nations have rates between 3.5 and 4 as many men commit suicide as women, a shockingly high difference.
- tolbish 5y ago
  This is it. It would be quite the sight to see people with real money/power (Jeff Bezos, for instance) discuss that.
leksak 5y ago
At points in my journey I've thought that the one genuinely good thing that I could maybe end up doing for others is to end my own life so that the way mental health patients are treated receives another impetus for change so that others can get the help I didn't get while desperately reaching for it.
spaetzleesser 5y ago
If there was a simple and dignified way to end my life I think I would have done it multiple times already. My whole life so far has been a struggle with feeling that I am not fitting in, with social anxiety, depression and other stuff. There have also been good times but it seems whenever I start to believe that life is good, something happens, and the happiness is taken away. The older I get the more tired I get and I really don’t feel anymore like fighting to find a place in life where I feel ok. What’s holding me up mainly is that this would probably freak out family and friends and I don’t want to be a burden to them. I also still have the hope that one day things will get better but that hope is diminishing. I just watched somebody go through a serious cancer treatment and I am 100% sure that I wouldn’t have gone through the treatment but would have ended it. I don’t want to go through the hell of treatment only to end up back in a life that’s not much fun either.
- prawn 5y ago
  What are your concerns about fitting in?
- axelroze 5y ago
  > The older I get the more tired I get and I really don’t feel anymore like fighting to find a place in life where I feel ok. Try to study philosophy, especially metaphysics, and confront any fears about life or death you might be having. It won't change your life situation (no windfall of cash) but it will change the way you see things and that can be huge.
asah 5y ago
...and assuming it is, can algorithms push people away or towards suicide? #blackmirror
cratermoon 5y ago
Two words: Means Matter https://www.hsph.harvard.edu/means-matter/ https://www.hsph.harvard.edu/means-matter/
kazinator 5y ago
> The Swedish device, which is called the EDOR and is manufactured by a company called Emotra Pick up EDOR in the self-serve warehouse: isle 19, bin 5. SKU 700.593.23. Don't forget the ALKALISK AAA batteries at the checkout.

76 points by lermontov 5y ago

Robert Lowell once said that if humans had access to a button that would kill us instantly and painlessly, we would all press it sooner or later. I think this explains suicide better: For most, it’s an irrational act done in the spur of the moment. What I think is more interesting is when suicide is done as a rational act with planning, and consideration for others.

SirFatty 5y ago
Someone can think about killing themselves for months or years before actually doing it.. are you suggesting that is irrational because there wasn't a plan or consideration of others?
- underseacables 5y ago
  The final act itself is either rational, or irrational. I think most people commit suicide as an irrational sudden decision. They may have thought about it, they may have planned about it, but I think there’s a clear delineation between someone who says screw it, and kills themselves, versus someone who plans and commits the act with thoughtful deliberation. To make it easier to understand, perhaps you might look at this between a person who sees a train coming and decides in that moment tk step in front of the train, and someone who takes a Final Exit approach at home. The mystery is what is going through the persons mind at the moment of self execution. edit: I used the wrong word to describe a final act.
  - finnh 5y ago
    (sorry to be that guy, just a useful FYI) I think you may want "ultimate"? penultimate = second-to-last.
    - underseacables 5y ago
      Ah! Thank you, you’re absolutely correct. I changed it to “final“.
  - kar5pt 5y ago
    Living can be irrational too. There are plenty of people who are completely miserable with no hope or plan to make anything better, but still choose to live out of pure fear of death. There's always a conversation over whether suicide is rational, but no one thinks to ask if living is rational.
  - spywaregorilla 5y ago
    Rationality seems like an irrelevant term here. Desire for suicide is obviously subjective and has no objective answer. I doubt spur of the moment suicides are very common, although the 'an hero' kid and the one that misunderstood their robinhood debt come to mind. Most suicide is going to be premeditated to a large degree. How certain do the specifics need to be for it to be considered rational? I think that's grey. A lot of people point to studies showing people who survive suicide attempts often say it was a mistake, but these strike me as having an enormous survivor bias embedded in them (not on the initial attempt, but on additional more successful attempts subsequently). So long as an act isn't based on strictly false premises or mind altering substances, I'm inclined to say most are "rational" if such a term can be applied. I've never been suicidal, but I've always felt that strong anti-suicide advocates, while strongly well intentioned, might not be fully reasoning out their belief systems. I think I'd greatly prefer to go out on my own terms in old age, without need for qualifiers like pain or disability. Recognizing the time for your conclusion is a tropey act for old characters in fiction, and implies deep wisdom. But in real life we assume anyone feeling similar has lost their mind.
    - underseacables 5y ago
      Anytime there is talk of suicide in this community I’ve always remembered heartbreaking final words of Bill Zeller. Didn’t know him personally, but I would consider his act a rational one. I do think suicide can be irrational, which comes down to heat of the moment. I’ve had a few friends commit suicide, and it’s a horrible thing to endure, but I understand. A persons choice to in their life should be theirs completely, but I hope it’s one that is done with a rational thought out purpose. Not a spur of the moment thing. https://gizmodo.com/the-agonizing-last-words-of-programmer-bill-zeller-5726667 https://gizmodo.com/the-agonizing-last-words-of-programmer-b...
- naturalauction 5y ago
  “All 29 people who survived their suicide attempts off San Francisco’s Golden Gate Bridge have said they regretted their decision as soon as they jumped.” https://ennyman.medium.com/a-lesson-from-29-golden-gate-suicide-attempts-a42f4ef3f970 https://ennyman.medium.com/a-lesson-from-29-golden-gate-suic... Sure most suicide attempts aren’t done this way but I think statistics like this showcase how many suicides are irrational on some level. If it was rational then you’d think they wouldn’t immediately regret it (unless the regret is irrational I guess).
  - AnIdiotOnTheNet 5y ago
    Perhaps their regret is a significant contributor to their survival though.
    - giantg2 5y ago
      Or perhaps they are only saying they regret it so they aren't thrown into a mental hospital. I wonder if there was a follow up on longterm survival.
      - jsmith45 5y ago
        Of 515 people prevented by police from jumping off the Golden Gate Bridge between 1937 and 1971, by the end of the 70s only 6% of them had committed suicide by other means. Source: "Where are they now?" by Richard Seiden
        giantg2 5y ago
        Interesting, thanks!
    - mactrey 5y ago
      Or perhaps having the experience itself ("I survived the jump") is a significant contributor to their not regretting it. There could even be multiple mechanisms there: "turns out being that close to death is really scary," or "my survival means there is a higher power looking out for me," or "my life flashing before my eyes made me realize something about my life"...
s1artibartfast 5y ago
One major challenge is that careful premeditation does not necessarily mean suicide is rational. There is a big crossover between people who consider suicide and people with disorders negatively impacting their cognition and decision making.
- aeturnum 5y ago
  > people with disorders negatively impacting their cognition and decision making. I think we should be really careful about how we think & talk about this. There are a few situations (like psychotic breaks) where people fully believe delusions that, in a short time, they will reject. We can cleanly call those experiences "irrational." On the other hand, people who experience long term depression literally experience the world differently in a way that we frequently cannot 'correct'[1]. Those people are not irrationally convinced that the world is hard to be in - they have brains for which things feel worse than for neurotypical brains. We can agree on all objectively measurable qualities of the world and their experience of that world will still be subjectively and consistently worse. The conversations from the right-to-die movement can be useful here, as chronic pain and disease offer a lens through which to understand. We have all experienced physical pain, but we have not all experienced serious depression. All I mean to say is that in the same way that someone with any chronic illness should have some choice in when and how they die, people who have chronic mental conditions should have the same right. We do not want to make the mistake of thinking that a person in a more complicated situation is compromised in some way - just that their world is more complex and we should take care to attend to the specifics of it. [1] It's not clear what way of seeing the world is 'right' but I will use correct here even with its implication that neurotypical people live in the real world.
  - s1artibartfast 5y ago
    I totally agree that it is a very tricky subject, especially regarding depression. Having some experience with it myself, I would argue that irrational pessimism is a major feature of depression. For example, people cannot accurately asses actions and activities that would in fact make them happier if they were to follow through. In this way, I think they are clearly distinct from those with terminal illness or chronic pain. I agree that people should have the right to choose death, independent of the rationality of their decision. Ultimately, people are the owner of their body and steward of their life, even if they are imperfect and irrational ones. Taking autonomy away turns individuals and their body into the property of someone else. I think there is some room for temporary holds and crisis management, but all such activities should be finite in duration.
MeinBlutIstBlau 5y ago
Suicide is not irrational in of itself. Facing 25-Life? Perfectly rational. Lost all your money and have no retirement? Still very rational. All you friends left you and you are completely alone to fend for yourself? Still rational. America needs to get over itself that life needs to be lived until a natural death. Not everybody wants to further deal with the excessive burdens of life. Suicide, when not done in a spur of the moment decision, can be wholly rational. Wanting to live a garbage quality if life because society thinks it's weird to just end it to not suffer is some Catholic guilt being forced on everyone.
- tpush 5y ago
  > All you friends left you and you are completely alone to fend for yourself? Still rational. I don't think suicide is a rational response to that; I even think it's dangerous to frame it as any kind of 'rational' action to take in such a situation.
- autoexec 5y ago
  For the most part, I agree with you, and people should be free to choose their own death at any time for any reason (rational or otherwise), but "all your friends leaving you" may be something that can be changed. At the very least new friends can almost always be found. It wouldn't seem rational to me at least to end your life over that for most people. I can respect a person's right to make that choice in any situation, but I don't have to agree with it.
tablespoon 5y ago
>> Robert Lowell once said that if humans had access to a button that would kill us instantly and painlessly, we would all press it sooner or later. > I think this explains suicide better: For most, it’s an irrational act done in the spur of the moment. Or it's rational, but we have some "irrational" mechanisms to prevent it that are best defeated by an impulsive act [1]. I don't actually believe that, but it's hard to argue against it under certain common sets of assumptions. [1] e.g. from a rationalist/materialist perspective: suicide is to avoid/escape pain, and it also removes the pain of guilt for doing it and the pain of missing out on all future pleasures, etc. However, evolution has formed us to reproduce, no matter how painful the struggle is and how subjectively irrational it is to endure it.
easterncalculus 5y ago
I'm not convinced there's anything rational in suicide by definition. Every organ, vessel, and part of your body, especially your brain, is dedicated to keeping you alive for as long as possible. If it makes you feel the need to end your life, by definition it is not working. A lot of bad things can happen to you in a lifetime, but death is the worst, without a doubt. To feel the need to inflict it upon yourself is therefore not rational at all, even if it is premeditated. What seems like one irrational spur of the moment decision is really one that in most cases had been considered well before. No one ends their own life before thinking about it beforehand.
- dec0dedab0de 5y ago
  I'm not convinced there's anything rational in suicide by definition. Every organ, vessel, and part of your body, especially your brain, is dedicated to keeping you alive for as long as possible. I would say it's dedicated to keeping you alive long enough to raise children and help your children raise children. Which may be the same thing in practice, but more in line with how evolution works.
- Thiez 5y ago
  That's an interesting assumption. So only acts that are in "harmony" with what your body desires are rational, and all other acts are, by your definition, irrational? So when I'm under water, swimming up to the surface, and my body is telling me to take a breath right now, that would be rational? And suppressing the urge until I reach the surface is irrational?
- TOMDM 5y ago
  An argument from organ function only operates if you believe the process of evolution that created those organs and their "goals" are what defines human meaning. I personally believe humans derive their own meaning in life. Temporary chemical imbalances and runaway feedback loops of emotional harm can certainly lead to impairment of rational judgement concerning suicide, but that doesn't mean that if you accept the premise that humans derive their own value that there can be rational avenues to suicide. For situations like accute depression and anxiety (of which I'm intimitely familiar) are situations where I would argue ones judgement is impaired when it comes to suicide, and I don't doubt that said impairment is extrapolable to many other situations. >A lot of bad things can happen to you in a lifetime, but death is the worst, without a doubt. I think that comes down to whether you believe that A) Someone can experience a negative qualia B) Someone can rationaly predict that said living situation is now a permenant state of affairs with a high enough degree of certainty C) That death is a negative (negative only insofar as it can effect others) to neutral qualia that is still higher than and therefore preferable to an expected permenant negative qualia. I'm not of the opinion that this is something that can typically be done independently, as humans are vulnerable to a host of conditions that can impair our ability to make judgement B, and I sure as hell hope that anyone wanting to make that decision trusts the people they ask to help them make it. The protoypical example people tend to use is alzheimers victims, who are frequently (but not always) permenantly and irrecoverably (for now hopefully) distressed.
pmoriarty 5y ago
"Robert Lowell once said that if humans had access to a button that would kill us instantly and painlessly, we would all press it sooner or later." They'd push it even sooner if no one they cared about depended on them. A lot of people stay alive simply out of a sense of responsibility towards others.
- agumonkey 5y ago
  I think the storage space for our notion of 'others' or 'loved ones' is one extremely potent part of our minds. I am who I love somehow, my brain goes against destroying that bond.
- spaetzleesser 5y ago
  “They'd push it even sooner if no one they cared about depended on them. A lot of people stay alive simply out of a sense of responsibility towards others.” That would be me. I don’t want to be a burden to people.
analog31 5y ago
>>>> Robert Lowell once said that if humans had access to a button that would kill us instantly and painlessly, we would all press it sooner or later. In my view, firearms are close enough to this level of technology, to shed doubt on the hypothesis. I don't think everybody with a gun tries to kill themselves.

spywaregorilla 5y ago

I would tend to assume suicide is fairly predictable with high sensitivity and the data many corporations have from surveillance of customers tbh.

anonymouse008 5y ago
Let's just say I get really concerned about my fairly stable, committed household when I get therapy and dating app ads...
- motohagiography 5y ago
  Given ads are necessarily both targeted and predatory, and a not a few of them are planted as part of sophisticated political campaigns and operations, someone in your house probably just triggered a link on their trapline. Ads for therapy are to stoke fears of people they may be mentally ill, and ads for dating sites are to make people feel isolated. They're just used as priming for selling you an additional something else to relieve the feelings the primers created. If I wanted you to look at my ad, I'd present something you would look away from, and have my product ad right there waiting for where you will likely look to. Look at the difference between ads in the margin of pages, vs. those inline to the content.
- LorenPechtel 5y ago
  The targeting isn't all that good. We note the dramatic hits, we don't note the far larger number of misses. I used to get a lot of dating and foreign-matchmaking ads stemming from the fact I like chess. Never mind that I have been off the market since before there was a www.
  - spywaregorilla 5y ago
    > I used to get a lot of dating and foreign-matchmaking ads stemming from the fact I like chess. How would you know this?
    - 5y ago

Razengan 5y ago

Just allow people the basic freedom to leave the fuck out of this world if they really want to. But no, that would mean one less entity to milk for labor and money.

AnIdiotOnTheNet 5y ago
Yeah, it's funny how no one gives a flying fuck about your suffering and will actively encourage it for their own benefit right up until you start talking about suicide. Of course, 90% of the time that's because they see an opportunity to sell you on a new drug, religion, or ideology.
- nicoburns 5y ago
  Yeah, this bugs me too. We shouldn't be talking about suicide prevention. We should be talking about preventing suffering.
  - axelroze 5y ago
    We can't prevent suffering. Cooperative systems like all sorts of communism don't work because people are by nature lazy and even worse greedy. Everyone maximizes their needs and minimizes their abilities. Hence we are left with competitive systems like contemporary capitalism where pressure to perform and be better than the others directly leads to suffering as inevitably there will be losers. The winners also don't fare much better as well. It is often a Pyrrhic victory. Cursed if you do. Cursed if you don't. And in the end to feel better about ourselves, we the society, tell people it is worth living so they do their stressful job for a few more decades and enjoy a few weeks of free time a week to play Candy Crush on their iPhones they are still paying via installments. But even if looked beyond politics and social organisation perfect prevention of suffering is impossible until medicine reaches some state of seamless merging with (bio)robotics. Ironically the competitive pressure might actually be the way we reach such a state of science. Ray Kurzweil is talking a bit about this in the book about the Singularity.
    - 5y ago

alpaca128 5y ago

Well that's an interesting way to fight ad blockers. Hiding the whole content.

morpheos137 5y ago

Barring cases of extreme physical pain or terminal illness or old age I can't understand the point of suicide. You are not around to enjoy the result of your consequent non-existence. Chronic severe mental illness is another possible reason but even for that I believe it can be treated in many cases with unconventional approaches like pschedelics (eg ketamine, exercise, religious experience, etc). Suffering is a natural part of life not something to be escaped on a whim.

hashhar 5y ago
TL; DR -- You have a chronic pain. No painkillers help. Every doctor you go to doesn't have a quick-fix. People around you keep telling you "you're imagining things", "be spiritual", "it isn't as bad as you think", "it'll go away". Nothing you try seems to help. You wake up every day feeling the pain and it keeps getting worse with no end in sight. Image living this for even a year (where this is what life looks like for some people for the last 20 years or more) and then tell me you wouldn't say no to "anything to make the pain go away". --- Hear me out. Let's say you wake up tomorrow with a bit of a headache. You take an aspirin and go about your day. You wake up tomorrow but it's still there. You visit a doctor who tells you to "take it easy" and you go about your day again. You wake up the next day and it's still not better. You begrudgingly get out of bed and go about your day. Someone tells you that you seem a bit irritable today. You then try to be aware of it and end up spending considerable mental energy trying to be "sociable". You get back home a bit exhausted. You wake up and it's worse. Your brain seems to amplify little things up to 100. You spilled some milk and you think the entire day will be like this. You feel "let's stay in today". A friend comes over, you end up exhausted trying to put on a normal face and overthink about how come it looks so easy for your friend to plan a night out today? They invite you and you accept hoping it might help. You visit the party and you feel a bit okay while in the moment. You go back home and you feel exhausted and sleep. the next day is even worse. Your brain tells you why bother getting out of bed - it's not like anything nice is going to happen to you today. you fight it and get out of bed but you can't find your slippers - you feel the day is going to be shit again but you go out anyway. Repeat previous paragraph x 1 year. Now the next day your brain convinces you there's no point in getting out today. You stay in, skip a few meals and it's night. You put on a movie and you enjoy it. Once it's over the feeling comes back. You get frustrated - you pick out some substances to help you "feel less". Maybe this feels a bit better. You repeat this for a few months. You are now so irritable and so envious of others that your personal relations start to suffer and you lash out on others. Slowly your circle shrinks. Now it's easier to not get out of bed. By now you've had the same day for the last 5 years and you can't see it getting any better. You go to a therapist. If they are good maybe you both figure out some things together that help you conquer small things - like getting multiple slippers one for each room and your brain no longer needs to panick if it can't find the slipper. But sadly most of the people aren't so lucky. You try many medications, substances but nothing seems to last. You want a quick fix but there is none to be found (unlike for physical pain). 10 years have gone by with the same morning every day - each a bit worse than the last. Now you think "This isn't going to improve I think. Nobody has answers. There are no solutions. Nothing seems to help. There is no sunshine.". Your inner voice tells you about a few other things you haven't tried yet. And that's how we lose you. So forgive me for saying this but people like you who have no empathy and are so willing to invalidate how many people feel on a daily basis don't deserve to be making decisions for others.

dbtc 5y ago

If suicide can be predicted then I would why not homicide? And then perhaps all crime.

pmoriarty 5y ago

In "Why do people die by suicide", Dr Paul Thomlinson goes over the research on predicting suicide.[1] First, he talks about a well supported model called Joiner's Model, based on research which shows that people who are most likely to commit suicide have all three of these factors: - Thwarted belongingness ("I am alone") - Perceived burdensomeness ("I am a burden") - Ability to commit suicide ("I am not afraid to die") Perceived burdensomeness has two components: Liability ("My death is worth more than my life to others") and self-hate ("I hate myself") Thwarted belongingness also has two components: Loneliness ("I feel disconnected from others") and absence of reciprocal care ("I have no one to turn to and I don't support others") And finally, capability to commit suicide is predicted by: Lowered fear of death, elevated physical pain tolerance, family history of suicide, clustering/exposure to suicidality, combat exposure, suicide attempts, childhood maltreatment And another model with the acronym "IS PATH WARM" shows that people who are most likely to commit suicide are likely to have, feel or be: - I = Ideation - S = Substance Use - P = Purposelessness - A = Anxiety - T = Trapped - H = Hopelessness - W = Withdrawal - A = Anger - R = Recklessness - M = Mood Change [1] - at about 25 minutes in to https://www.youtube.com/watch?v=Arywx88jMXw https://www.youtube.com/watch?v=Arywx88jMXw

agumonkey 5y ago
interesting categorization, very much so, I find there's a duality in the lonely/self-hate group. So many people who feel like that are utterly normal, they just can't connect other realities than their own judgement.
autoexec 5y ago
Joiner's Model seems to exclude people who are candidates for assisted suicide. They often don't feel alone, don't feel like a burden, but are terminally ill, in constant pain, feel they've lived long enough, seeing significant mental/physical decline etc. You can shoehorn them into "IS PATH WARM" under hopelessness, trapped, or anger I guess.
- LorenPechtel 5y ago
  Yeah, it's looking at mental illness suicide. The terminally ill ones are more like the people who jump from a burning building--life has legitimately become more painful than death. That's not something a psychiatrist can change.

hashhar 5y ago

The lack of empathy in the comments is scary. No wonder the situation is so bad. Let me present a scenario which might seem more relatable since it seems people understand physical pain but have no "scale" of what mental pain could be like. You have a chronic pain (maybe one of wrists is broken in a way that there is no solution). No painkillers help. Every doctor you go to doesn't have a quick-fix. People around you keep telling you "you're imagining things", "be spiritual", "it isn't as bad as you think", "it'll go away". Nothing you try seems to help. You wake up every day feeling the pain and it keeps getting worse with no end in sight. EDIT: Missed one crucial component. The pain is so much that you cannot have normal social interactions because 80% of your energy is spent trying to cover up the pain. You feel exhausted all the time due to this and don't have the energy or the motivation to do anything. Image living this for even a year (where this is what life looks like for some people for the last 20 years or more) and then tell me you wouldn't say no to "anything to make the pain go away".

Clubber 5y ago
>"anything to make the pain go away" Sure, I think our rampant overdose problem and drug and alcohol over-use problem in general is a symptom of this. That's one of the reasons the war on drugs is so insidious, it punishes the people already suffering, which makes them suffer more, forcing a downward spiral that is almost impossible to get out of. All from a perceived moral failing. The US is pretty cruel to its citizens. It's not overtly, in-your-face cruel like historical regimes, but still cruel, none the less.
- hellbannedguy 5y ago
  I have not done much traveling, but Americans seem to self-medicate more?
  - handrous 5y ago
    We take way less vacation and have far more financial uncertainty and more bills (more complexity and more to keep track of just to get by), so our background level of stress is probably higher on average than in, say, most Western European states. There may be other reasons that affect it more, but I'd fully expect that to be enough to result in more self-medication, all else being equal.

gmuslera 5y ago

Wrong science fiction reference, it should be The Minority Report. Would your prediction cause it? avoid it? It was really about to happen? If you are "testing" it, stopping the people that is about to do it would mess with the test? And not stopping them would count as unintentional murder? My objections are not about suicides, but about predictions in general and predictions that can affect human lives in particular.

one_off_comment 5y ago

I feel like the article didn't deliver on its promise. The author never got to try out the device that's supposed to predict suicide. I was most curious about that because I find myself skeptical such a thing could work.

derbOac 5y ago
https://psycnet.apa.org./record/2016-54856-001?doi=1 https://psycnet.apa.org./record/2016-54856-001?doi=1 Suicide is notoriously difficult to predict. That meta-analysis is one example; once you account for base rates in realistic scenarios, you can do very little better than chance. Some of this might have to do with the nature of predictors; maybe with deep learning and real-time data this might improve slightly, but I doubt it somewhat (there are significant ethical issues involved in such data regardless but that's a different issue). One of the biggest problems in this area is that suicide is such a low base rate phenomenon that it's difficult to predict for that reason alone. Not only that, but many of the predictors are relatively high base rate by comparison, so there's a very very very low signal to noise ratio. Statistically speaking, it's like finding a needle in a needlestack. I think adding to the complication is that it's not really that you want to know if someone eventually commits suicide, what you want to know is whether they do so within a certain actionable timeframe. That is, for most of the decisions such predictions are being clamored for, it doesn't really help to know that there's a 70% chance that someone will commit suicide eventually; what practitioners really want to know is "what are the odds someone will commit suicide if I make decision X right now." This is a significantly more difficult thing to study. I personally believe that the approach to suicide in developed countries is horribly misguided and probably unethical, focused too much on the act and not prevention of the state (psychological, sociological, economic) that leads to it. It's unethical to leave someone in such a personal hell that they want to exit it by killing themselves; preventing themselves from doing so, without removing them from that state, only deprives them of a means of relief.

ppod 5y ago

>It measured for what Emotra called “electrodermal hyporeactivity” by running a weak current over the skin as the sweat glands open and close. The association with suicide had been advertised by an experimental psychiatrist named Lars-Håkan Thorell, Emotra’s founder, This has regulatory approval in the EU? Why is Harpers even writing about this?

cmehdy 5y ago

I like the article for the most part. I've noticed many comments here are lacking the empathy that is so fundamentally needed in this world to help those who suffer alleviate the pain, so as a fellow struggling one I figured I could throw my words to the wind. People more readily mentally visualize somebody without a leg, somebody with open fractures. Not so much for mind stuff, it's not concrete enough to most until it turns physical (i.e. you're a bloodstain on the floor). That's why some comments go along the lines of "I can understand suicide for physical pain but not for mental one". I would suggest that a broken self hurts more than an open fracture, and lacking certain central abilities to stabilize the self leaves you much more legless than if you lost your physical legs. Other comments point out the endless rational vs irrational discussion. I'd ask them: when you go get a drink at a café and you're about to order a cappuccino but you ask for a latte, how do you see the whole process? You've planned something rationally (going to get that cappuccino) and made a seemingly irrational choice at the end (getting the latte). Are you rational or not? Furthermore, by what lens do you judge when the absence of rational decision is an illness? Typically people will reply either with a utilitarian point of view or a selfish one: either you are being counter-productive to society with your guts and bloods that need to be cleaned and the lack of your presence in the consumerist world, or I take it all backwards and call you ill first because that's what agrees with my worldview ("you're sick, you can't know what's good for you"). What I have done with myself and others is to acknowledge that those bits of perhaps-irrationality are not relevant to helping things, as we all have them in different places as we live and that's okay. It's also important to acknowledge that one can be right to feel like they're backed into a corner when a lot of evidence accrues towards that. BUT, the essential part is to show methodically that (1) there are levers of action that we are steering clear of due to cognitive distortions or lack of awareness, and (2) all suicidal people are fighting to be alive much more than even they might know, as they're still around even when making aimless steps due to the crushing pain. In short, tap into what wants to live to push back against what wants to die, and show that the realm of what is possible to advance is much larger than one might think when in the fog. ---- With that said, I have my own take on parts of the article itself. > A reader of a late-nineteenth-century edition of Chambers’s Encyclopaedia would find committing suicide described as a “heinous crime,” for which the punishments included “an ignominious burial in the highway, with a stake driven through the body.” Today the National Institute of Mental Health cautions against saying that a person “committed” suicide at all; better to say that they “completed” it, to avoid the implication of an illicit or criminal act. As if suicide wasn't still considered a vile and illegal thing. You can share your mental health struggles with a therapist just fine until you're a risk to yourself and they call people to, forcibly if needed, remove you and take you wherever they want. Your rights can be severely limited or removed entirely when a psychiatric emergency is considered - how is that any different from being treated like a criminal? Psychiatric intake can pragmatically be worse than prison intake, from someone who's seen both. It's not seen as vile by everybody but there are still far too many people who frame the process with words of abandonment, with selfishness, with dismissal of all the inner work of the suffering through the singular use of irrationality as an absolute concept ("you're just irrational"), and so on. You're not considered as an equal to your peers when you're suicidal, and that's not something you get to argue against because that's just part of how you're defined by them. See the following paragraph for something related. > When patients told Freud that their lives were hopeless or without purpose, he considered this an impressive display of self-awareness. “We can only wonder,” he wrote, “why a man must become ill before he can discover truth of this kind.” That's Freud we're talking about so whatever.. but that train of thought still seems to exist quite a bit nowadays. The introspection and the ability to shatter illusions is put in the same box as the delusions that a "sick" person has, leading a lot of people with severe depression and other disorders to associate one with the other since society does it too. "My ability to dig deeper is part of why I am sick" is entirely the wrong message to send to a vulnerable person, and it is just incorrect. For it is not the power to see beyond the surface that is a problem, but the delusions one might hold or acquire about the process. CBT points it out with the terms of cognitive distortions, which is a start. It doesn't necessarily offer a wholly coherent narrative for the emergence of those distortions, nor does it offer a strong logical argument to disprove the utility of those distortions (i.e. somebody in pain could say "so what if I see everything in black and white? this is how I've managed to survive so far, so you better prove to me that what you're offering would help me survive better"). > (about Shneidman) “I am against suicide committed by other people,” he wrote, “but I want to reserve that option for myself.” This holds meaning that most healthy people might not realize. People who commit suicide go to the last place where there is a semblance of effective control and ability to choose an option, have some agency, in a world that (objectively sometimes but not most of the time) presents no other option. Healthy people have the comfort of a grip on their existence, or at the very least the comfort of an illusion of a grip on it. Despite having their own beliefs and instabilities, they aren't mandatorily taught CBT and other such similar things - whereas it is expected of the "sick" to do more of the homework. It's like breaking your legs on a hike and then being asked to do leg workouts to keep up, when other people happen to be luckier and go without both things and wouldn't themselves be able to do the workout. But this is a necessary thing for a person with mental illness to do nonetheless, and I'm not debating that point. What I am trying to point at however is that the world of people who are unaware of such struggles is filled with a violent hypocrisy that contributes to the reasons for very lacking mental health services and very lacking social support from peers, as it drives the ones who suffer away from everybody else. It would do well for any healthy person to acknowledge that they, too, could be cornered into helplessness if their need for control (or the illusion of it) shattered. That brings them closer to the person considered ill, and thus narrows the gap for bridges to be built - showing both kinds of people that there is a passage between the states. That's an application of empathy that would strengthen the vulnerable at no other cost. But the healthy too can have cognitive distortions and might actually fear that it weakens them. This sort of disconnect between those who study the subject matter and those who experience is it nothing new, so it's funny to see that it surprises people who've worked on the subject for a while (as the article highlights about Brent and Shneidman) > “One of the problems with suicide,” he said after a time, “is that the person who killed themselves takes a lot of the answers with them.” And the people who failed are not being asked much of anything, but instead being told what to do. You'll be diagnosed this, given those meds, told to apply this and that method. Any question about mind and life are only there in order to give you a method, not to understand. Something diametrically opposed to the mind of the suffering in the first place, which seeks understanding of self and answers so much that it spirals and loses track of healthy methods to do so. Funnily enough, I think both sides are going at it kinda wrong, and we can do much better by weaving both approaches together and treading the middle line. Sometimes you need a practical tool, and sometimes you need to understand for the sake of understanding. Be both to yourself, be both to others.

3520 5y ago

In order to predict suicide you'd need real-time data of wide variety of aspects of a human being (levels of pain, hopelessness, connectedness, capability for suicide, etc) in a way that is impossible to achieve at the moment (insufficient measures and insufficient data gathering techniques).

okareaman 5y ago

As someone who has struggle with suicidal ideation his entire life, whenever the subject comes up I try to educate people by quoting author David Foster Wallace (who commited suicide) with the best explanation: “The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom Its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who leap from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’, can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling.”

rubyfan 5y ago
This is an amazing explanation, thank you for sharing this.
- kingsloi 5y ago
  I agree, thank you.
jsmith45 5y ago
One flaw with the analogy is that a pretty significant portion of suicides (successful or attempts) are impulsive. Many people who attempt it have literally no idea they will when they wake up that morning. A 2001 University of Houston study of survivors of near lethal attempts showed that 70% of them had only decided to do it an hour or less before the attempt, and 24 percent had only spent 5 minutes before the attempt. If when attempting it, they discover that their chosen method won't work for some reason, many will just give up on killing themselves rather than looking for an alternative measure. This has been reliably seen many times. If a change is made such that one suicide method becomes unfeasible, the overall attempt rate drops. If one were committed to offing oneself it is almost impossible to stop them, as there are countless ways to do it. But the statistics are very clear that if some method is removed, alternatives are not always used. The British had an issue with people killing themselves with oven fumes, back when the ovens used coal gas which created a lot of carbon monoxide, with this accounting for about 50% of suicide deaths. When things were changed to use natural gas where this approach does not work, suicides dropped by 30%. Obviously while that means a portion ending up using some other method, many others simply never killed themselves. Of 515 people prevented by police from jumping off the Golden Gate Bridge between 1937 and 1971, by the end of the 70s only 6% of them had committed suicide by other means. Weirdly even some of the non-impulsive cases where people had planned an attempt for days or weeks just give up if their plan is foiled, rather than coming up with some alternative method. Now obviously not everybody is like this. Some people will continue to try over and over until they succeed. But the numbers suggest that those are very much a minority.

neonate 5y ago

https://archive.is/WyW6u https://archive.is/WyW6u

giantg2 5y ago

'Poté explained that the basic mechanism is comparable to the process “used in lie-detector tests, like you see in the movies.”' And yet polygraphs are known to be unreliable, to the point that they are generally not admissible in court. It would probably be better marketing if they don't imply that their product is comparable to an qn existing tech that is unreliable.

omniglottal 5y ago
Better marketting can and probably should include honest implications of a product's limitations.
LorenPechtel 5y ago
The basic problem with lie detectors is that if you know what you're doing you can trick the machine. Also, people tend to react to the sensitive questions, producing false positives. While they aren't used for it they can in certain circumstances produce results with an accuracy quite sufficient for the courtroom, and there isn't even any Fifth Amendment problems with the approach: You need things which the criminal will know but which others will not--you have to keep a bunch of details out of the press. The suspect is not asked any questions, but rather asked to read a bunch of statements about the crime--"she was wearing a red blouse", "she was wearing a green blouse", "she was wearing a white blouse", "she was wearing a blue blouse", each statement is innocent and thus will not trigger a reaction in the person who doesn't know the details. There is a 1 in 4 chance that someone will show the strongest reaction to the true statement--but what happens when you do the same thing with a bunch of details? Show the strongest reaction to the true one on 20 such 4-choice questions and now what are the odds it's a random? An innocent can't incriminate themselves because they don't know which are the sensitive answers. Note that you can't exonerate someone this way--someone who doesn't remember the details being asked about will look the same as someone who is innocent. However, if it fingers you to a sufficiently high degree of certainty guilt is assured.
- giantg2 5y ago
  Is there case law supporting their use? To my knowledge they are not used in court due to accuracy concerns. They are typically used by police in their investigation just to rule out or confirm suspects. Edit: looks like it varies by state, but most do not allow it. https://www.brodenmickelsen.com/blog/why-polygraph-tests-are-not-admissible-in-court https://www.brodenmickelsen.com/blog/why-polygraph-tests-are...

FinanceAnon 5y ago

It's impossible to measure, but I wonder what % of suicides happens because of the culture that we live in. A lot of times when you read about someone commiting suicide it's blamed on that individual or their mental health - but is that really the root issue? How many of the suicides wouldn't happen if society was set up in a different way?

acover 5y ago
I think it's part of who we are. Suicides happen in tribal cultures - https://www.jstor.org/stable/658295 https://www.jstor.org/stable/658295
xtracto 5y ago
I think you are onto something. An example for me would be, someone committing suicide in the USA due to the perception of having to confront some incredible stressful event in the future; whereas the exact same situation in another country (with different culture) would not yield the same weight to that person. As an example, take Jeffrey Epstein suicide (let's assume thats what happen). He might have sought that exit given his possible future perspectives. Had he been in Mexico (where I live) he may have had a different (more lenient) perspective of his future.
- deleted 5y ago
  [deleted]
yCombLinks 5y ago
I think the culture is extremely relevant. If you look at this map on the right: https://en.wikipedia.org/wiki/Gender_differences_in_suicide https://en.wikipedia.org/wiki/Gender_differences_in_suicide You'll see China is a significant outlier, being the only country with a higher suicide rate for women than men. All of the western nations have rates between 3.5 and 4 as many men commit suicide as women, a shockingly high difference.
tolbish 5y ago
This is it. It would be quite the sight to see people with real money/power (Jeff Bezos, for instance) discuss that.

leksak 5y ago

At points in my journey I've thought that the one genuinely good thing that I could maybe end up doing for others is to end my own life so that the way mental health patients are treated receives another impetus for change so that others can get the help I didn't get while desperately reaching for it.

spaetzleesser 5y ago

If there was a simple and dignified way to end my life I think I would have done it multiple times already. My whole life so far has been a struggle with feeling that I am not fitting in, with social anxiety, depression and other stuff. There have also been good times but it seems whenever I start to believe that life is good, something happens, and the happiness is taken away. The older I get the more tired I get and I really don’t feel anymore like fighting to find a place in life where I feel ok. What’s holding me up mainly is that this would probably freak out family and friends and I don’t want to be a burden to them. I also still have the hope that one day things will get better but that hope is diminishing. I just watched somebody go through a serious cancer treatment and I am 100% sure that I wouldn’t have gone through the treatment but would have ended it. I don’t want to go through the hell of treatment only to end up back in a life that’s not much fun either.

prawn 5y ago
What are your concerns about fitting in?
axelroze 5y ago
> The older I get the more tired I get and I really don’t feel anymore like fighting to find a place in life where I feel ok. Try to study philosophy, especially metaphysics, and confront any fears about life or death you might be having. It won't change your life situation (no windfall of cash) but it will change the way you see things and that can be huge.

asah 5y ago

...and assuming it is, can algorithms push people away or towards suicide? #blackmirror

cratermoon 5y ago

Two words: Means Matter https://www.hsph.harvard.edu/means-matter/ https://www.hsph.harvard.edu/means-matter/

kazinator 5y ago

> The Swedish device, which is called the EDOR and is manufactured by a company called Emotra Pick up EDOR in the self-serve warehouse: isle 19, bin 5. SKU 700.593.23. Don't forget the ALKALISK AAA batteries at the checkout.