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Fear, Risk and Rational Suicide
Other pages on this site deal with rational suicide without taking fear into account. This is done in order to simplify the issue, by determining whether suicide is a good option if only the quality of life of the individual is considered. This article addresses fear and its place in the decision process.
Anxiety or Fear?
Fear is an emotion that alerts the body to potential life threatening situations and prepares the mind and body to respond by triggering the fight, flight or freeze response. In the face of a true life-threatening event, the fear response acts as a survival mechanism that could help save ones life.
Anxiety and fear are nearly identical and produce similar symptoms. The main difference is that fear is a rational response to an actual danger, whereas anxiety is an irrational response to an imagined danger.
Our interest is specific to the fear and anxiety caused before and during an attempt to commit suicide. It may be short-lived, occurring just when taking the last step before the end, yet may be so powerful as to prevent one from exiting.
So are we talking about fear or anxiety? Is this emotion rational or irrational? It would seem that most of the time, it is rational. No method is totally reliable, so there is risk of not succeeded and perhaps suffering permanent, debilitating, and painful damage. In addition, some methods may require some amount of suffering, for an indefinite amount of time. Even with methods which have high probabilities of success, for example, jumping from a very high location, death still may not be instantaneous. These considerations are compounded by the importance of the decision to end one's life, and the fact that people who are about to exit, do not know exactly what to expect, and have nobody to assist, support or comfort them. In such situations, fear seems rational. For these reasons we use the term fear, indicating rational cause, rather than anxiety.
Fear and Risk
The fear before an attempt to commit suicide has rational reasons. These reasons include two separate risks: the risk of failure, and the risk of pain. However, the risk and the fear from that risk are two separate things. As for risks, we can attempt to include them into the normative model. This can be done with relative ease since the essence of risk involves probability.
Fear, as an emotional reaction, will be treated differently. Fear is influenced by many factors. Some are justified like the two risks, but there are also numerous other factors which may even be the cause of something closer to anxiety. We will not address these factors separately, rather we will try to address fear by evaluating the (negative) utility of its symptoms.
It is a manner of speech to say that one is "too afraid to commit suicide", or more specifically "too afraid" to take some risk. However, people who say this are not actually experiencing fear. They are either referring to anticipating real fear at the time of taking that risk, or they are referring to the risk itself being too high, i.e., the undesirable outcome is too likely. These two are actually risk and fear as described in the two paragraphs above. The phrase "fear of risk" is confusing and will not be used in the rest of this article.
Risk
We will deal with risk using a normative model of rational decision: expected utility. This requires the person making the decision to assess probabilities for the risks and assess values for the possible outcomes.
As before, we are considering subjective probabilities, i.e. the probabilities as assessed by the decision-maker. It may be that the "real" probability of a certain risk has been researched and published somewhere, or it may be that the "real" probability can never be calculated. Either way, we are concerned with the final decision-maker's assessment even if it is not accurate.
The more research the decision-maker does, the more accurate these assessments will be, however, the time to do the research is also costly. At the end of the research all the decision-maker can do is to rely on his own subjective assessments. Demanding from the decision-maker to obtain the "real" probabilities in advance is not realistic. Since our goal is to help the decision-maker at this step, we must use subjective assessments in our models as well.
Risk of Failure
The first risk we address is the risk of failure. This is the probability of not succeeding to commit suicide. Let U(F) be the utility of failure, and P(F) be the probability of failure. In the article about normative models for suicide we assigned the utility of death to be 0, i.e. U(D) = 0. Also, we assumed that if one decides to exit, then death is assured. Introducing the risk of failure requires a more complicated calculation for determining the expected utility of committing suicide (S):
U(S) = P(F) * U(F) + (1 - P(F)) * U(D)
But since U(D) = 0, we get:
U(S) = P(F) * U(F)
P(F) and U(F) depend on the method of suicide which is chosen. One should choose methods which minimize the probability of failure, P(F), and minimize the damage which may be caused by failure (this actually requires making U(F) larger, i.e. more positive). Note that the possibility of permanent injury would make U(F) a very negative number, since the effect may last for the rest of your life. We could go further, and assess the probability of permanent injury, P(I), assuming failure. This would break U(F) into two separate cases.
Risk of Pain
For risk of pain, we could go through a similar process. However, it is difficult to assess the utility of pain until it is experienced personally. Furthermore, the pain is likely to be short lived. This occurs in methods such as hanging or cyanide. Some accounts of suicide with cyanide indicate that death is instantaneous, whereas other accounts claim that pain may last for several minutes. Assuming that success is assured, this would mean that U(D) is not 0, but actually a little less, because of the possible (or certain) pain involved until actual death. However, since this pain is short lived, it is likely to be dwarfed in comparison to living an unhappy life for several decades.
Insights about Risk
Apparently, this analysis does not provide much insight. One should try to choose methods for which the probability of failure is small, the probability of permanent injury is small, and when permanent injuries do occur, they should be of as little severity as possible. Also the probability and degree of pain during the process of suicide should be minimized. But all this is well known.
Another conclusion is that these risks may be significant enough to stop some from suicide. It may be that without considering these risks, the individual is better off dead. However, considering the risks may result in a very negative utility. A pro-life advocate might be inclined to say that if you did not choose to commit suicide then you did not really want to in the first place. However, it is easy to see that one may genuinely want to die, since it would be for their own good, however, the risks are too high as they may result in a failed attempt which would lead to a situation worse from the one started from. So it is perfectly reasonable for people to say they want to die, yet at the same time claim they will never attempt suicide.
Note that society is a main reason for the increase in the risks. High building and bridges are fenced as to not allow people access. Lethal medicine can only be obtained by prescription and with small amounts. Car exhaust is processed as to eliminate the possibility of suicide. These eliminate methods which might have lower risk.
Finally, note that the risk of failure can contribute much more negative utility than the risk of pain. Apparently this means that in choice of method more emphasis should be made on reliability and low chance of injury, rather than the amount and probability of pain. However, it is not obvious that people do so in practice, probably because the possibility of pain has a great effect on fear.
Fear
Now we turn to address fear. We are concerned with the panic-fear just before pulling the trigger or taking the last step before jumping. One could also talk about the fear during the process of suicide, for example, the fear after jumping until impact. However, we will not deal with this here. Both kinds of fear can be addressed within the utility model, similar to the way we previously dealt with pain : although they contribute negative utility, they are short lived, and thus in most cases are negligible compared to the utility of a long yet unhappy life. The reason why we are interested in the fear before exiting is that it may have an additional paralyzing effect which can stop the person from continuing.
As an analogy, consider the following case. A man suffering from agoraphobia, i.e., feeling anxiety about being in certain places or situations, such as being in a crowd or standing in line. Suppose that such a man is facing a decision of whether or not to go to a crowded mall.
Without taking anxiety into consideration, it would be rational to go to the mall. The man wants to go probably because he thinks it is beneficial to him.
Taking anxiety into account there are two possibilities. Either the negative utility of anxiety outweighs the utility of going to the mall, or the negative utility of anxiety does not outweigh the utility of going to the mall. According to the utility model, in the second case the man should go to the mall, and in the first case he should not.
But this analysis does not fit our intuition. Why take anxiety into account? Would a psychologist of this man recommend that the man not go to the mall because it might be rational? Probably not. The psychologist would focus on eliminating or at least reducing anxiety.
Regardless of whether going to the mall is rational or not, if the man attempts to go the mall he will be stopped by his anxiety. In trying to make a rational decision, anxiety may be what prevents persons from carrying out their otherwise rational decision. Until this is taken care of, there is no point to decide whether or not to go to the mall since irrational emotional responses would prevent it.
In contrast to the agoraphobic man, the fear before suicide has rational basis, however, it is quite probable that some of this fear is exaggerated or irrational. Fear could affect a rational decision process to the degree that one decide not to exit. However, fear may also be what prevents one from taking what may otherwise be a rational decision. In the latter case, the focus should be on reducing fear to a level which would not prevent you from exiting. Until this, there is not point to consider exiting any further.
Conclusion
When exploring the option of life, one should think about the best options to improve one's life. This may require significant effort. It might require changing your entire life style, going to therapy or taking medication.
Exploring the option of death requires much attention as well. For example, deciding on the best method and how to go about it. Reducing fear and risk are important factors to consider in your search for the best option to exit.
Pro-life advocates encourage people only to explore the possibility of life. In the utility model this means that they ask the decision maker to find ways to increase the utility of the outcome which follows continuing to live. Of course, if you neglect research on the best way to exit then the utility of that option will be lower than what can be achieved in reality. In order to proceed in making a rational decision one must explore both options with the same vigor. Only when we have determined the best options for life and death can we compare between them, and make a rational decision.
There are ways to reduce fear and risk. For example, mental health professionals can treat anxiety. Similar methods, might be helpful in reducing fear before exiting. Here are some commonly used techniques:
Cognitive Restructuring: This technique is used to help decrease the perception of danger or increase confidence in the ability to cope with the threat. The therapist identify the patient's thinking about certain situations, test the validity of those thoughts, and replace any irrational thoughts with more reality based thoughts. This technique might be appropriate when the method used is of high reliability.
Relaxation Training: This is used to help you learn how to relax mentally and physically. This can alleviate anxiety because it is very difficult for the body or mind to be simultaneously relaxed and anxious. Techniques include controlled breathing, imagery and progressive muscle relaxation.
Distraction: This is used to focus attention away from the thoughts or physical sensations that contribute to anxiety. One way this could be done is to focus your thoughts on society who is the main cause for the presence and degree of risks involved in exiting. Society, by not helping people exit, and by blocking numerous exiting routes, makes exiting more difficult and risky. Society is to blame for the difficulty of your exit. You may try to replace feelings of anxiety with feelings of defiance and anger towards society.
Medication: Mild tranquilizers, produce more relaxed and calm states. This is immediately applicable to our goals as one could use alcohol (not too much!), or some non-prescription tranquilizer.
Much further research is required to reduce fear and risk. Hopefully, this will be addressed in a future article.
