The Suicide Paradox (Rebroadcast )

There are more than twice as many suicides as murders in the U. S., but suicide attracts far less scrutiny. Freakonomics Radio digs through the numbers and finds all kinds of surprises.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:01Stephen J. Dubner?

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• 2:28Stephen J. Dubner?

  Hey, podcast listeners. I'm Stephen Dubner, and this is Freakonomics Radio. Today, we are playing an episode from our archives, an important episode called "The Suicide Paradox." We first put this out in 2011. Now, five years later, suicide rates in the US have risen to their highest in 30 years, with suicide a particularly pressing problem in the military. We'll be back next week with a new episode. Here now is "The Suicide Paradox."

• 3:00Speaker 01

  There won't be a word for college or professor, but I can say "chi au kasai pau aisi chi kapiga ka ka kai bai." And that just means, "My name is pau aisi." That's my Pirahá name, and I make a lot of marks on paper.

• 3:15Stephen J. Dubner?

  Dan Everett is a college professor, a linguist. Off and on for the past 30 years, he's lived with a tribe in the Amazon called the Pirahá.

• 3:24Speaker 01

  I originally went to the Pirahá as a missionary to translate the Bible into their language, but over the course of many years, they wound up converting me, and I became a scientist instead and studied their culture and its effects on their language.

• 3:42Stephen J. Dubner?

  The Pirahá live in huts, sleep on the ground, hunt with bows and arrows. But what really caught Everett's attention is that they are relentlessly happy, really happy.

• 3:55Speaker 01

  This happiness and this contentment is really had a lot to do with me abandoning my religious goals and my religion altogether, because they seem to have it a lot more together than most religious people I knew.

• 4:09Stephen J. Dubner?

  But this isn't just another story about some faraway tribe that's really happy, even though they don't have all the stuff that we have. It's a story about something that happened during Everett's early days with the tribe. He and his wife and their three young kids had just finished dinner. Everett gathered about 30 pitahah in his hut to preach to them.

• 4:30Speaker 01

  I was still a very fervent Christian missionary, and I wanted to tell them how God had changed my life. So I told them a story about my stepmother and how she had committed suicide because she was so depressed and so lost. For the word depressed, I used the word sad. So she was very sad. She was crying. She felt lost. And she shot herself in the head, and she died. And this had a large spiritual impact on me. And I later became a missionary and came to the pitahah because of all of this experience triggered by her suicide. And I told this story as tenderly as I could and tried to communicate that it had a huge impact on me.

• 5:15Speaker 01

  And when I was finished, everyone burst out laughing.

• 5:35Speaker 02

  From WNYC Studios, this is Freakonomics Radio, the podcast that explores the hidden side of everything. Here's your host, Stephen Dubner.

• 5:50Stephen J. Dubner?

  All right. So Dan Everett was sharing this sad, intimate story about his stepmother's suicide with the pitahah.

• 5:57Speaker 01

  When I asked them, you know, why are you laughing? They said, she killed herself. That's really funny to us. We don't kill ourselves. You mean, you people, you white people, shoot yourselves in the head? We shoot animals. We kill animals. We don't kill ourselves. They just found it absolutely inexplicable and without precedent in their own experience that someone would kill themselves.

• 6:18Stephen J. Dubner?

  In the 30 years that Everett has been studying the Pirahua, there have been zero suicides. Now, it's not that suicide doesn't happen in the Amazon. For other tribes, it's a problem.

• 6:29Speaker 01

  And as I've told this story, some people have suggested that, well, it's because they don't have the stresses of modern life. But that's just not true. There's almost 100% endemic malaria among the people. They're sick a lot. Their children die at probably 75%. 75% of the children dying before they reach the age of five or six. These are astounding pressures.

• 6:52Stephen J. Dubner?

  A group of people that laughs at suicide? It doesn't sound much like the US, does it? Suicide's not a laughing matter here, and it's not so rare either. Now, compared to the rest of the world, our suicide rate puts us right about in the middle. But here's what's interesting. The US is famous for a relatively high murder rate. It's double, triple, even five times higher than most other developed countries. So if I said to you, what's more common in the US, homicide or suicide, what would you say? Listen to Steve Levitt, my Freakonomics friend and co-author, an economist at the University of Chicago. He's been studying crime for years.

• 7:35Speaker 03

  Homicides per 100,000 have fallen from something like 10 to something like 5 over the 15 years I've been at crime. So essentially homicide has fallen in half.

• 7:46Stephen J. Dubner?

  Wow. So let's say it's roughly 5 per 100,000 people now. Do you have any idea what the suicide rate is?

• 7:53Speaker 03

  That's about twice as high. It'd surprise you because it doesn't usually make the newspaper when someone commits suicide, but it always makes the newspaper when someone commits a homicide. But twice as many suicides as homicide.

• 8:04Stephen J. Dubner?

  It is surprising, isn't it? The preliminary numbers for 2009, the most recent year for which we have data, show there were roughly 36,500 suicides in the US and roughly 16,500 homicides. That's well over twice as many suicides. So why don't we hear more about it? Partly because, as Levitt says, most suicides don't make the news, whereas murders do.

• 8:29Speaker 04

  Breaking news tonight out of Jackson, where police are on the scene of an apparent murder and apparent double homicide. This latest murder. Charged with murder. He attempted murder.

• 8:38Speaker 05

  First degree murder.

• 8:41Stephen J. Dubner?

  But also, there are different types of tragedy. Murder represents a fractured promise within our social contract, and it's got an obvious villain. Suicide represents, well, what does it represent? It's hard to say. It carries such a strong taboo that most of us just don't discuss it much. The result is that there are far more questions about suicide than answers, like, do we do enough to prevent it? How do you prevent it? And the biggest question of all, why do people commit suicide? Steve Levitt has one more question.

• 9:19Speaker 03

  I always think to myself, why do more people commit suicide? If you think about the poorest people in the world, surviving on less than a dollar a day, having to walk three miles to get water and carry 70-pound packs of water back just to survive. And those people do everything they can to stay alive, whereas I think if I were in that situation, wouldn't I just kill myself?

• 9:46Stephen J. Dubner?

  And what does that say to you about human nature, that people in situations way, way, way, way, way, way worse off than you don't kill themselves in large number?

• 9:59Speaker 03

  My guess is that evolution has built into us an unbelievable desire to stay alive, which, which looked at from a modern perspective, doesn't actually make that much sense.

• 10:10Stephen J. Dubner?

  So how should we make sense of suicide? If you personally have been affected by suicide, if you've lost a friend or a family member, it may be hard to even think about making sense of it. But at the risk of shining a light into a darkness that's usually left undisturbed, let's give it a try. The first thing we need is a virgil of some sort to guide us, someone who's been thinking about suicide and death for a long, long time.

• 10:40Speaker 06

  I was born in 1942. I lived in London for 22 years of my life. And for the first three years of my life, my mother told me we slept in an air raid shelter every night.

• 10:52Stephen J. Dubner?

  David Lester is a professor of psychology at Richard Stockton College of New Jersey, about 20 minutes from Atlantic City.

• 10:59Speaker 06

  The classic bomb that came over was called a buzz bomb. As long as it was buzzing, that meant the engine was going. Once it stopped buzzing, it meant it would drop. And maybe hit your house.

• 11:12Speaker 06

  My mother says that even as a toddler, I was very concerned about them. And actually, she said that I would hear them before the air raid warnings went off. And I would warn everybody, a buzz bomb, and I would rush into the air raid shelter. 10 years ago, I remembered this picture of this little toddler who's very worried about buzz bombs and hiding from them, probably without a mature concept of death. But obviously, perhaps laying the seeds of some interest that manifested itself later in life. I've become a thanatologist in general and a suicidologist in particular.

• 11:47Stephen J. Dubner?

  Lester is president-elect of the American Association of Suicidology and the Eminence Grease of Suicide Studies. He's also alarmingly prolific. He's written more than 2,500 papers, notes, and books, about half of which are on suicide. So people expect him to know things that he says are not yet known.

• 12:09Speaker 06

  First of all, I'm expected to know the answers to questions, such as why people kill themselves. And myself and my friends, we often, when we're relaxing, admit that we really don't have a good idea of why people kill themselves.

• 12:28Stephen J. Dubner?

  So what do we know about suicide? As you drill down into the numbers, one thing that strikes you are the massive disparities, the difference in suicide rates by gender, by race and age, by location, by method, and many other variables. In the US, for instance, men are about four times as likely to kill themselves as women.

• 12:50Speaker 06

  Yes, about three to four, yes.

• 12:53Stephen J. Dubner?

  About 56% of men use a gun, compared to just 30% of women.

• 12:57Speaker 06

  Yes, men tend to use what we would call more active methods.

• 13:00Stephen J. Dubner?

  That helps explain the gender gap, since suicide by gun is usually successful. The primary method for women is technically called poisoning, usually some kind of overdose.

• 13:10Speaker 06

  The easy access to medications these days makes medications an important method.

• 13:15Stephen J. Dubner?

  For men and women, being unmarried, widowed, or divorced increases the risk. The most typical American suicide is a man 75 or older. But in that age bracket, where a lot of people are dying from a lot of things, suicide isn't even a top 10 cause of death. For people from ages 25 to 34, suicide is the second-leading cause of death, and it's in the top five for all Americans from ages 15 to 54. In terms of timing, suicide peaks on Mondays.

• 13:52Speaker 06

  There is a Blue Monday effect.

• 13:53Stephen J. Dubner?

  But not, as many people suspect, around Christmas and New Year's.

• 13:58Speaker 06

  People do not kill themselves more on national holidays.

• 14:01Stephen J. Dubner?

  There is a seasonal spike, but it's not in the long, dark days of winter.

• 14:06Speaker 06

  In fact, suicide rates peak in the spring in most countries. It's as if you expect things are going to be better, and when they turn out not to be better, you're more likely to be depressed in a suicidal way.

• 14:19Stephen J. Dubner?

  David Lester is willing to entertain any theory, to examine any pattern. Interestingly, he's found that suicide and homicide are often perfectly out of sync with each other. Homicide spikes not on Mondays, but on the weekends, and on national holidays, and during the summer and winter. Homicide is also much more common in cities than in rural areas. For suicide, it's the opposite.

• 14:46Speaker 07

  The American suicide belt's comprised of about 10 western states. It's a sort of wide longitudinal swath, running from Idaho and Montana down to Arizona and New Mexico.

• 14:59Stephen J. Dubner?

  That's Matt Ray, a sociologist at Temple who studies--well, here, I want him to say it, not me.

• 15:06Speaker 07

  To sum up what I do in a word would be to say that I study losers. And I am interested in those who lose, out on societal gains and out on opportunities. And it's another way of saying I'm interested in inequalities and stratification.

• 15:23Stephen J. Dubner?

  Ray found what he has taken to calling the suicide belt.

• 15:28Speaker 07

  So, yes, the Intermountain West is a place that is disproportionately populated by middle-aged and aging white men, single, unattached, often unemployed, with access to guns. This may turn out to be a very powerful explanation and explain a lot of the variants that we observe. It's backed up by the fact that the one state that is on par with what we see in the suicide belt is Alaska.

• 15:57Stephen J. Dubner?

  All right, so now you can get a picture of the American who's most likely to kill himself, an older, white male who owns a gun, probably unmarried, maybe unemployed, living somewhere out west, probably in a rural area. Now, don't you want to know where aren't people killing themselves?

• 16:17Speaker 08

  Okay, so I'm standing in front of the Lincoln Memorial.

• 16:21Stephen J. Dubner?

  Washington DC, our nation's capital. It's got the lowest suicide rate of any American city, just six per 100,000 people. We sent Vera Lynn Williams there to ask strangers a couple of strange questions.

• 16:35Speaker 08

  Do you know anyone that committed suicide?

• 16:37Stephen J. Dubner?

  Personally, no.

• 16:38Speaker 08

  No. Do you know anyone that died of homicide? Yes.

• 16:43Speaker 09

  Yes, I do.

• 16:44Speaker 10

  I've got a son that's been murdered. I've got cousins that's been murdered. I've probably been to a hundred wakes in the past year, but I can't tell you one person that I know that's committed suicide.

• 16:56Stephen J. Dubner?

  Now, as we told you earlier, there are more than twice as many suicides each year in the US as there are homicides. There are just three places where the homicide rate is higher than the suicide rate: Louisiana, Maryland, and the District of Columbia. It's not a coincidence that these are also places with large African-American populations. African-Americans are only about half as likely to kill themselves as whites. When it comes to murder, meanwhile, African-Americans are nearly six times more likely than whites to die.

• 17:30Speaker 11

  In our community, it's different. We have low rates of suicide and high rates of homicide.

• 17:36Speaker 08

  Why do you think that is?

• 17:38Speaker 11

  I think a lot of those homicides are probably suicides.

• 17:41Stephen J. Dubner?

  Donna Barnes works at the Suicide Prevention Center at Howard University.

• 17:45Speaker 11

  It's very easy, when you're stressed and you don't want to live anymore, to put yourself in harm's way, and somebody will take you out. And many times, we will externalize our frustration, meaning that we're going to take it out on other people. And then you might have more folks, maybe from the dominant culture, who internalize your frustration and take it out on themselves. We have been socialized to believe that a lot of our disadvantages are based on our surroundings, racism, discrimination, and all of that. So it's really easy for us, when we become frustrated and we look at what's going on

• 18:30Speaker 11

  around us, to take it out on the environment and other people rather than ourselves.

• 18:35Stephen J. Dubner?

  I asked David Lester if he had an explanation for the black-white suicide gap.

• 18:40Speaker 06

  If you're white and in psychological pain, what can you blame it on? It's like, other people are doing well, why aren't you doing well? Other people are happy, why aren't you happy? So maybe that, in part, accounts for the higher suicide rate in whites as compared to African-Americans, is because whites have fewer external causes to blame their misery for.

• 19:02Stephen J. Dubner?

  I find this idea fascinating. As Lester is quick to point out, it is little more than an idea, it's pretty much impossible to prove. The fact is, we usually don't know much about what's going through a person's mind as they consider suicide. But when your life is miserable, when it seems beyond redemption or repair, where do you put the blame? You can blame other people, you can blame yourself. What if you could blame a song?

• 19:42Stephen J. Dubner?

  Coming up, places where suicide is epidemic and how it gets that way.

• 20:13Stephen J. Dubner?

  As we said earlier, there are about 36,500 suicides a year in the US. That's an average of 100 a day. Now, the vast, vast majority of them, you never hear about. They don't make the news. That's not an accident. For decades, sociologists have been studying the media's impact on suicide rates. And some say they've proven that a widely-publicized suicide, when described in a certain way, can lead to copycat suicides, a suicide contagion. Here's reporter Sean Cole.

• 20:47Speaker 12

  All right, so we're going to have to go all the way back to 1774, when this novel came out.

• 20:52Speaker 13

  "The Sorrows of Young Verta," by Johann Wolfgang von Goethe. "May 4th. How happy I am that I am gone. My dear friend..."

• 21:02Speaker 12

  For those of you who have never read it-- I had never read it. "The Sorrows of Young Verta" was written mostly as a series of fictional letters by a young dilettante artist named Verta. He travels to the countryside, falls in love with a girl who's already engaged, despairs, and then borrows two pistols from her fiancee.

• 21:18Speaker 13

  "They are loaded. The clock strikes 12. I say, amen. Charlotte, Charlotte. Farewell, farewell."

• 21:29Speaker 12

  Sorry to spoil the ending. Now, this book was really popular when it came out. Scholars talk about legions of men in Europe dressing like the character, in blue swallow-tail coats and canary-yellow pants. And while this next part is probably apocryphal, the story goes that--

• 21:43Speaker 14

  Many people who read the book killed themselves by the same method, and sometimes they even killed themselves with the book open to the page where he was described as killing himself.

• 21:54Speaker 12

  David Phillips is a sociology professor at UC San Diego and the father of imitative suicide research in America. In 1974, exactly 200 years after "Verta" was published, he released a seminal paper called "The Influence of Suggestion on Suicide: Substantive and Theoretical Implications of the Verta Effect."

• 22:14Speaker 14

  My students and I were the first to provide modern, large-scale evidence that there is, in fact, such a thing as copycat suicide. And we called this, I called it, the Verda Effect.

• 22:25Speaker 12

  Now, Verda is a work of fiction, but the Verda Effect focuses more on true stories about suicide. The theory goes that whenever the media runs with a big, sensational suicide story, especially if the victim is famous, you can expect a bump in suicide rates. Phillips and Company gathered 20 years of suicide data, 1948 to 1967, from the National Center for Health Statistics. Then they combed through back issues of three major newspapers and honed in on front-page suicide reports. The actress Carol Landis, Dan Burrows, who ran the KKK in New York, one of the most famous stars in Hollywood history. ...is dead at 36. Marilyn Monroe was found dead in bed. Under circumstances- Of course, this was back before all the conspiracy theories about how she died.

• 23:08Speaker 12

  Anyway, in 27 out of 33 cases like this, suicide rates were higher than expected for about two months following the story. So, for example, Marilyn Monroe died on August 5, 1962. For the rest of that August, US suicide rates were 10% higher than normal.

• 23:24Speaker 14

  How do we know that there's a 10% increase in August of 62? We're comparing the number of suicides in August of 62 with the number of suicides in August of 1961 and the number of suicides in August of 1963.

• 23:38Speaker 12

  So those other Augusts are the controls?

• 23:41Speaker 14

  That's right.

• 23:42Speaker 12

  In some cases, the bump was a lot smaller, but it's not so much the size, says Phillips, as the consistency. And it wasn't just suicides that went up after these media reports.

• 23:51Speaker 14

  You also get a spike in single-car crashes after suicide stories.

• 23:56Speaker 12

  Huh.

• 23:57Speaker 14

  And you see that the driver in the single-car crash is unusually similar to the person described in the suicide story. So if the person described in the suicide story is unusually young, then the spike in single-car crashes just afterwards has drivers who are unusually young.

• 24:16Speaker 12

  So to close that loop...

• 24:18Speaker 14

  They're not accidents. They're people who are committing suicide. Right. So all of these things together make it very difficult to think of an alternative explanation.

• 24:27Speaker 12

  But this is not to say people kill themselves because they read a big splashy suicide story in the paper.

• 24:32Speaker 15

  It's not really about the causes of suicides. It's about the trigger of suicides.

• 24:38Speaker 12

  This is Thomas Niederkröten dollar, an assistant professor at the Medical University of Vienna in Austria. About 10 years after that original study, the Wörther effect hit Vienna in a big way.

• 24:49Speaker 15

  There was a tremendous increase of subway suicides and suicide attempts on the Viennese subway in the early 1980s.

• 24:58Speaker 12

  In 1983, there was just one jumper in the Viennese subway, and that person lived. The next year, there were seven suicides by subway in Vienna, and the big Austrian papers ran graphic stories about them. In 1985, 13 jumpers, 10 deaths, more splashy articles. At the peak, in 1987, there were 11 successful suicide attempts in the Viennese subway and 11 unsuccessful, though granted, three of those were the same guy. Finally, the Austrian Association of Suicide Prevention told the press to tone it down. They issued a whole series of recommendations. Don't include the word suicide in the headline. Don't print pictures of grieving relatives.

• 25:35Speaker 15

  But you should also mention helplines, helping opportunities for people in crisis.

• 25:41Speaker 12

  Amazingly, the Austrian media listened. The stories were less graphic, and they stopped running so many of them.

• 25:47Speaker 15

  And at the same time, the number of suicides and suicide attempts on the Viennese subway decreased by nearly 80%. And, and this is really stunning, the numbers remained relatively low in all the years up until today.

• 26:03Speaker 14

  Yeah, I thought that was a pretty study.

• 26:05Speaker 12

  This is David Phillips again. He says he's actually not so comfortable telling the media what to do. He thinks freedom of the press should be inviolate. But both the World Health Organization and the AP Managing Editors Association asked for his advice. So he basically told them, think of a suicide story as a kind of commercial. If you make the product attractive, people will want it. But if you say-

• 26:26Speaker 14

  By the way, when a person kills himself, let's say by shooting, he looks terrible afterwards. Or when a person poisons himself, often fouls the bed sheets and things like this. If you talk about the- Pain and the disfigurement, then I thought that would make it less likely that people would be copying the suicides.

• 26:45Speaker 12

  And there may even be a trend growing in the other direction. Thomas Niederkröntaller and his team in Austria did their own study, looking at nearly 500 newspaper articles from the first half of 2005. He says not only did they find more evidence for the Verta effect, but they saw suicide rates go down when the media wrote about someone who found an alternative solution to his or her problems.

• 27:06Speaker 15

  So this may be exactly the opposite side of the same thing. And we called this effect the Papageno effect.

• 27:16Speaker 12

  Papageno is another fictional character from Mozart's opera The Magic Flute. Like Verta, he's in suicidal crisis over a girl, his beloved Papagena. But just as he's about to hang himself, three young boys rush the stage and tell him not to do it. They say-

• 27:31Speaker 15

  Papageno, use your magic bells and Papagena will come back. And psychologically speaking, we can say, this is what we believe that actually those newspaper or press articles do. They remind people what they can do other than commit suicide.

• 27:53Speaker 07

  Now, I should say that I'm pretty agnostic about this.

• 27:57Speaker 12

  This is Matt Ray again, the Temple University sociologist from earlier in the show.

• 28:01Speaker 07

  My sense is that what this literature misses are all of the times that high-profile suicides occur that don't spark contagion. The one that comes to mind is Kurt Cobain.

• 28:15Speaker 16

  Kurt Cobain's body was found inside a garage apartment adjacent to his Seattle home. Dead of an apparently self-inflicted shotgun wound, police say a suicide note was nearby.

• 28:28Speaker 07

  So everyone was expecting a rash of shotgun-induced, you know, blow-your-head-off suicides in the wake of Cobain's death. They did not materialize. And so the question is-

• 28:41Speaker 15

  Why was it so?

• 28:43Speaker 12

  Thomas Niederkröntaller.

• 28:44Speaker 15

  There were some specifics about Kurt Cobain's suicide. In particular, Cobain's spouse-

• 28:52Speaker 12

  Courtney Love, yeah.

• 28:54Speaker 15

  Yeah, Courtney Love. She was broadcast in the media immediately after his suicide-

• 28:59Speaker 17

  I'm really sorry, you guys. I don't know what I could have done.

• 29:06Speaker 15

  And she told to the audience, this was really the wrong thing to do. And there is one study, actually from the US, which showed that reports that use negative definitions of suicide, such as suicide is something that is stupid, that you should not do, that those reports are 99% less likely to identify a copycat phenomenon than other reports.

• 29:35Speaker 12

  So, listen, suicide is something that is stupid, that you should not do. After all, I am the media. And this whole show is basically one big suicide article. And as I said to Matt Ray, I've been wondering what type of article it is.

• 29:49Speaker 07

  Are you guys trying to figure out how to report on this story without sparking suicides?

• 29:53Speaker 12

  Well, it is an odd little meta problem, isn't it? I mean, I'm doing a story about whether what I'm doing a story about could possibly cause a suicide contagion.

• 30:04Speaker 07

  Yes, I'm well acquainted with that dilemma.

• 30:09Stephen J. Dubner?

  But what about a song?

• 30:18Stephen J. Dubner?

  David Lester, the psychology professor, tells us about the time...

• 30:23Speaker 06

  In the 1930s, two Hungarians wrote a song called "Gloomy Sunday" that was thought to precipitate a wave of suicides across Europe.

• 30:30Stephen J. Dubner?

  Freakonomics Radio producer Susie Lechtenberg went to Hungary.

• 30:45Speaker 18

  Rezov Sorez's piano still sits, rather benignly, in the restaurant in Budapest where he used to play his most famous song.

• 31:02Speaker 18

  The person in the song is thinking about suicide. He or she wants to be reunited with a lover who's just died. Today, it sounds a bit melodramatic, but as many as 200 people might have killed themselves after listening to this song.

• 31:16Speaker 19

  Yes, yes, yes, yes, yes.

• 31:19Speaker 18

  Because they heard the song.

• 31:20Speaker 19

  Yeah, but it was just the trigger.

• 31:22Speaker 18

  "It was just the trigger," Hungarian psychiatrist Zoltán Reimer says, "but it had to be stopped." The Budapest police enforced a "Gloomy Sunday" ban, and the BBC...

• 31:32Speaker 06

  The BBC banned that song until 2002.

• 31:38Speaker 18

  These days, the owner of the restaurant where Suresh used to play still gets requests. He's not afraid to play it, but he feels certain...

• 31:45Speaker 19

  Absolut.

• 31:46Speaker 18

  ...that this was a suicidal song. It should come as no surprise, then...

• 31:50Speaker 19

  Rezo Suresh, completed suicide, he was around 70.

• 31:54Speaker 18

  In 1968, Rezo Suresh, Gloomy Sunday's composer, jumped to his death from the window of his small apartment in Budapest.

• 32:13Speaker 18

  Unfortunately, this Hungarian suicide story isn't unique to this one man or this one song. Suicide has been epidemic in this country. For most of the last century, Hungary's had the highest suicide rate in the world. Right now, it's more than double the suicide rate in the United States. So what is it about this place? Why are so many people killing themselves here?

• 32:35Speaker 20

  Oh, my husband. My husband was very handsome, great-looking, very intelligent.

• 32:44Speaker 18

  Sylvia and Leventi Latomerski met at a concert. He was a neurologist, she worked in finance. He was cool, she says. They fell in love, married, had a daughter, but they didn't have a fairy tale ending. Leventi's family had a history of mental illness. It was something he was afraid was in his blood.

• 33:01Speaker 20

  Before we married, we were sitting at the kitchen table, and he told me that...

• 33:09Speaker 20

  If it ever happens to him that he gets ill and he will need treatment with drugs, then he will refuse the drugs. And if he will never take drugs, he prefers taking because drugs, psychiatric drugs, will change personality and he wants to remain himself all the time.

• 33:32Speaker 18

  Levente's mental state deteriorated. He was hospitalized.

• 33:36Speaker 20

  A few years after, it happened to him exactly what he described.

• 33:42Speaker 18

  When he had a few moments alone, when doctors and nurses left his room, Levente Lata Mersky hanged himself.

• 33:49Speaker 20

  My own suicide, I was able to completely ignore. But my husband is somehow still with us.

• 33:59Speaker 18

  My own suicide was something I was able to completely ignore. Sylvia tried to kill herself years before she and Levente met, but she says she didn't want to die. It was a cry for help more than anything else.

• 34:12Speaker 20

  I took a bunch of pills but made sure that it won't kill me.

• 34:18Speaker 18

  Everyone in Hungary knows someone like Sylvia, like Levente. The World Health Organization says in 2008, about 2,400 people committed suicide here. To put that number in context, around the same time in Greece, a country that's roughly the same size, there were 394 suicides.

• 34:38Speaker 19

  Yes, my name is Zoltan Reimer.

• 34:41Speaker 18

  I met Dr. Zoltan Reimer in his smoke-filled office in Budapest. He's a professor of psychiatry at Semmelweis University, and he says there are two main reasons the suicide rate is so high.

• 34:52Speaker 19

  The prevalence of bipolar disorder. We have found the lifetime prevalence of bipolar disorder in Hungary is 5%.

• 35:01Speaker 18

  The worldwide rate of bipolar disorder is about half that.

• 35:06Speaker 19

  The risk of suicide is much higher among patients with bipolar disorder. It can be one factor, but it is just one factor. Alcohol. Alcohol plays a very important role in suicide.

• 35:22Speaker 18

  And Hungary has the third-highest alcohol consumption rate in the world.

• 35:30Speaker 18

  This country is about the size of Indiana. From the window of a train, the Hungarian Great Plains look like it, too. In the southwest, there's a small town called Kiszkunhalás.

• 35:39Speaker 21

  It's a nice little town.

• 35:41Speaker 18

  That's psychiatrist Katalin Zanto.

• 35:43Speaker 21

  So, there is a little lace museum there, and there are these women making beautiful laces. On the other hand, when, if you walk around, then you see drunken people outside the pubs. If you visit the local hospital, in the psychiatric ward, there, the circumstances were very, very poor.

• 36:11Speaker 22

  My name is Dr. Agnes Ratsnagy, and I am the leader of this psychiatric department of the Kiszkunhalás hospital.

• 36:24Speaker 18

  Until 2005, Kiszkunhalás was the epicenter of suicide in Hungary. Suicide in this town was double the national rate. As one cultural critic put it, "Living here was like living on psychic death row."

• 36:41Speaker 22

  I was in a family, it was a big family, and there were more than 10 suicides in the family.

• 36:47Speaker 18

  In 2001, Dr. Agnes Ratsnagy and a colleague began 100 psychological autopsies, meaning they interviewed families in depth after a loved one had committed suicide.

• 37:00Speaker 22

  In 67, there was mood disorder, and 60, alcohol. And of course, there were overlaps as well, but this number is huge.

• 37:11Speaker 18

  This was part of a study that ran for five years in Kiszkunhalás. Dr. Katalin Zanto and colleagues trained 28 of the town's 30 general practitioners in suicide prevention. They set up a suicide hotline and made low-cost antidepressants available to residents. Then they compared their results to a neighboring town, a control group, and it worked.

• 37:30Speaker 21

  Yeah, there were like 34 less suicides than, during this five years than in the previous five years.

• 37:40Speaker 18

  Overall, the suicide rate in the region decreased 16%. The suicide rate for women decreased 34%. This shouldn't be that surprising. Research by academics in the United States, like Jens Ludwig, has shown that antidepressants do lower the suicide rate. But here's the thing. Even though the suicide prevention program in Kischkunhalis was a success, this model just hasn't caught on anywhere else in Hungary. The country still has one of the highest suicide rates in the world. So, why?

• 38:14Speaker 23

  Well, we can see a part of the bridge, the Margaret Bridge.

• 38:23Speaker 18

  Back in Budapest, everywhere you walk, there are musicians playing classical music in the streets. The Margaret Bridge stretches over the Danube, which is the lifeblood of this city. It's stunning. But it's also the place where many Hungarians have jumped to their death. I met psychiatrist Bela Buda on the banks of the river.

• 38:41Speaker 23

  I am 73. I was born and lived in Budapest in all my life.

• 38:51Speaker 18

  He looks exactly how you want someone named Buda to look. Grayed, rotund. I've been told he speaks 17 languages. He says it's just 12.

• 39:01Speaker 23

  Les sanglots longues de violon.

• 39:03Speaker 18

  Baudelaire in French.

• 39:05Speaker 23

  Bless mon coeur.

• 39:06Speaker 18

  Goethe in German.

• 39:07Speaker 23

  Der Hunde schenam mon at mai.

• 39:10Speaker 18

  Carducci in Italian.

• 39:11Speaker 23

  Ante porre sempre nella vita il serio.

• 39:16Speaker 18

  Buda has tried to solve the problem of suicide his entire career. He started the first suicide hotline in the country. He worked in psychiatric wards when the suicide rate was soaring. But he says this problem is hard to solve because a lot of people here don't see anything wrong with suicide.

• 39:33Speaker 23

  The Hungarian general opinion is very favorable towards suicide. If somebody commits suicide, then it is commented as a brave act, as somebody had the courage to end the suffering. For instance, this old man who hanged himself are praised in the community that he was brave enough to free the family from the burden of his existence.

• 40:22Stephen J. Dubner?

  Coming up, is it your responsibility to try to stop a stranger from killing himself? And what do you call someone who considers suicide a rational act?

• 40:52Stephen J. Dubner?

  Next year, the Golden Gate Bridge will celebrate its 75th anniversary.

• 41:03Stephen J. Dubner?

  You'll hear all kinds of tributes to it, all kinds of facts and figures. One number you probably won't hear, at least in the official proclamations, is the suicide toll. Since the Golden Gate Bridge opened, more than 1,400 people have killed themselves by jumping off it. There is another place that now attracts more suicides each year: the Aioke Gahara Forest in Japan. But historically, the Golden Gate is still the world's number-one suicide spot. Last year alone, 32 people jumped and died. Now, it should be said that every weekday, about 5,000 people walk across the bridge

• 41:43Stephen J. Dubner?

  and don't jump, and 100,000 cars cross it every day, cars with drivers like-- here, I'm gonna let him pronounce his name.

• 41:51Speaker 24

  My name is Panthak Po Maha Supap Po.

• 41:55Stephen J. Dubner?

  You see?

• 41:56Speaker 24

  That's 17 letters altogether.

• 41:58Stephen J. Dubner?

  He moved here from Thailand in 1968, and he drove a cab in San Francisco for 15 years.

• 42:05Speaker 24

  One night, I pick up the guy, like, I think, down nearby Tenderline, and he want to go Golden Gate Bridge, go through 11 o'clock at night. I say, "Okay." So I drove on Franklin Street. He say, "You wouldn't ask me why I go Golden Gate Bridge at this late?" I said, "No." "I guess, if you wanna tell me, I guess I would listen to it." And he say, "I'm gonna go and jump off the Golden Gate Bridge." I say, "Okay." You're not gonna stop me? I said, why should I? You know? And so I get out to the Golden Gate Bridge. I think the fare was like $7 or something that time.

• 42:50Speaker 24

  And he looked his wallet, he found a $10, right? So he gave it to me, another $10. So I turned around, I told him, I said, I don't think you need any change. He said, well, I guess you're right, I don't need any change. I said, okay. So I let him off at the, on the side of the bridge. So once he get off, I turn around the cab, I call my dispatcher, I told him, why don't you call the patrol over there? And he did. Maybe, I don't know, maybe I was too, too cool to him. I don't know what happened, if he's really gonna jump.

• 43:32Stephen J. Dubner?

  Now, we don't know if this man did, in fact, jump off the Golden Gate Bridge that night. If he did, he almost certainly died, since only 2% of jumpers survive. We also have no idea what was going through his head that night. Did he have a fight with someone? He lose his job? Maybe just have one drink too many? Here's David Lester again.

• 43:53Speaker 06

  I'm expected to know the answers to questions, such as why people kill themselves.

• 43:58Stephen J. Dubner?

  If you unpack that why in why people kill themselves, there are all kinds of other things we don't know about suicide either. For instance, the percentage of people who seek help or get help before committing suicide, we don't know. Or even how many people who commit suicide are mentally ill. Lester says there's so much disagreement on this question that estimates range from 5% to 94%. And then, there's the mystery of the suicidal impulse.

• 44:30Speaker 06

  And I just found a case, which I'm using in an article I'm writing, where the time between the impulse and the act was something like five seconds.

• 44:43Stephen J. Dubner?

  Think about that. Five seconds.

• 44:47Speaker 06

  The man was walking over a bridge and suddenly the thought came to him.

• 44:50Stephen J. Dubner?

  One.

• 44:51Speaker 06

  You know, he was in some, I think, financial distress.

• 44:54Stephen J. Dubner?

  Two.

• 44:54Speaker 06

  But he hadn't thought about suicide before.

• 44:56Stephen J. Dubner?

  Three.

• 44:57Speaker 06

  And he said, "I ought to kill myself."

• 44:59Stephen J. Dubner?

  Four.

• 45:00Speaker 06

  And he immediately jumped off the bridge.

• 45:02Stephen J. Dubner?

  Five.

• 45:04Speaker 06

  And he was saved. And that's the shortest interval I've come across.

• 45:09Stephen J. Dubner?

  One academic study looked at attempted suicides in Houston among 15 to 34-year-olds. It found that in 70% of the cases, the time between deciding to commit suicide and taking action was under an hour. 70% of the cases. For about a quarter of the people involved, the time gap was five minutes or less. It's pretty stunning. People are making a permanent decision to end their lives on the spur of the moment. How are you supposed to stop that? Remember this guy? Pan sak po ma ha su pa po. He didn't try to stop his taxi passenger from jumping. You're not going to stop me? I said, "Why should I?" You know?

• 45:50Stephen J. Dubner?

  "Why should I?" Sounds pretty cold-hearted, doesn't it? Or does it? Your life belongs to you. It's a crime to take someone else's life, but not yours, at least not a crime in practice. So should we consider the suicidal impulse a rational choice? I know what you're thinking. Only an economist would say something like that. An economist like Dan Hamermes at the University of Texas. He once wrote a paper called "An Economic Theory of Suicide."

• 46:23Speaker 25

  Well, I think there's an epigraph to the paper, which I can't quote exactly. It's by Arthur Schopenhauer. "When the value of a man's life is less than..." No, you can read it. I don't have it with me now. Why don't you read it?

• 46:34Stephen J. Dubner?

  "As soon as the terrors of life reach the point at which they outweigh the terrors of death, a man will put an end to his life."

• 46:42Speaker 25

  Exactly. Well, that's just an economic statement. You're weighing the benefits on one side of the equation, the costs of the other. If the costs exceed the benefits, you chop off the investment.

• 46:52Stephen J. Dubner?

  Back in the spring of 1972, Dan Hamermes was hunting around for a research topic. And he thought of a poem he'd read back in high school.

• 47:00Speaker 25

  The poem is "Richard Corey" by Edwin Arlington Robinson, written in the last decade of the 19th century. Whenever Richard Corey went downtown, we people on the pavement looked at him. He was a gentleman from soul to ground.

• 47:13Stephen J. Dubner?

  There was something about the poem that nagged him.

• 47:16Speaker 25

  And he was rich, yes, richer than the king, and admirably schooled in every grace. In fine, we thought that he was everything to make us wish that we were in his place. So on we worked and waited for the light and went without the meat and cursed the bread. And Richard Corey, one calm summer night, went home and put a bullet in his head.

• 47:38Stephen J. Dubner?

  That's it, the last part. It didn't make sense to him.

• 47:43Speaker 25

  I was always very bothered by the notion that suicide's a problem of rich people. And that always struck me as an economist of being very stupid, since I believe rich people are generally going to be happier, utility's higher, income goes up, you should be less lucky to kill yourself. So that was one of the thoughts running through my mind that spring afternoon in 1972.

• 48:01Stephen J. Dubner?

  So Dan Hamermes did what economists do. He wrote a model to determine the conditions under which suicide might be considered a rational choice. He came up with three predictions. Suicide, one, rises with age, two, falls as income increases, and three, falls if your desire to live is high. It's nothing so radical, but at the time, no one had tried anything like this. Then Hamermes plugged some suicide data from the World Health Organization into his model. His predictions were right. He also calculated the opportunity cost of a suicide. A 50-year-old person and a 70-year-old person have different expectations

• 48:46Stephen J. Dubner?

  of future happiness, income, and so on. So the price of suicide is higher for the 50-year-old. But whether it makes economic sense for either person to commit suicide depends on what economists call the utility function, how much you value your life. So it all goes back to the Schopenhauer quote at the beginning of Hamermes's paper. "As soon as the terrors of life reach the point at which they outweigh the terrors of death, a man will put an end to his life." Hammermesh may have been the first economist to wrestle with suicide in this way, but he was hardly the first to intellectualize it.

• 49:23Speaker 05

  Plato, Aristotle, the Greek and Roman Stoics, the early Church Fathers, and on up to Durkheim and Freud.

• 49:33Stephen J. Dubner?

  Margaret Batten--

• 49:34Speaker 05

  Sometimes called Peggy.

• 49:35Stephen J. Dubner?

  --is a professor of philosophy at the University of Utah. Plato, she says, argued that suicide was wrong in some cases, not wrong in others. Aristotle thought it was cowardly, an offense to society.

• 49:50Speaker 05

  Stoics, on the other hand, thought that suicide was the act of the wise man. This is not done in desperation, or agitation, or depression, or any of the things that we ordinarily associate with that term, but it's the reflective, responsible act of the genuinely wise man.

• 50:14Stephen J. Dubner?

  For the Stoics, suicide was a procedure. People who wanted to commit suicide would plead their case before magistrates to get permission. The magistrates kept a supply of hemlock on hand.

• 50:27Speaker 26

  Whoever no longer wishes to live shall state his reasons to the Senate, and after having received permission, shall abandon life. If your existence is hateful to you, die. If you are overwhelmed by fate, drink the hemlock. If you are bowed with grief, abandon life. Let the unhappy man recount his misfortune, let the magistrate supply him with the remedy, and his wretchedness will come to an end.

• 50:58Stephen J. Dubner?

  But going forward in history, this was hardly the mainstream view. Christianity held that suicide is a sin. Dante set aside one ring of his Inferno for suicides. Fast forward about 700 years, and we're still firm in our moral stance. We can't really consider suicide a rational choice, can we?

• 51:22Speaker 27

  We would wake up to the sound of her typing at an astonishing speed on her Smith Corona typewriter.

• 51:30Stephen J. Dubner?

  Margaret Heilbrun is talking about her mom. Carolyn Heilbrun was a Virginia Woolf scholar at Columbia. She wrote mystery novels on the side. She was famous for making grand pronouncements, for saying outlandish things.

• 51:44Speaker 27

  A partner of mine enjoyed drinking Stolichnaya vodka, so she took to having it on hand, but she insisted on calling it Solzenitsyn vodka. And she knew it wasn't, but she just, you know, "I'll go get the Solzenitsyn." So it was the same with her once she started saying that she would kill herself when she reached a certain age. But it was another of those sort of pronouncements. And one thought, oh, well, mommy's prone to pronouncements.

• 52:22Stephen J. Dubner?

  Carolyn Heilbrun had decided that by the time she turned 70, she would have accomplished what she could accomplish. She would have had enough of life, and she'd end it. Her family, her husband and her three grown kids, they weren't quite sure what to make of this. It was a relief when her 70th birthday came and went without a suicide. Apparently, she had changed her mind. She even wrote a book called The Last Gift of Time: Life Beyond 60. Her daughter says she took a lot of pleasure in life, even the small things.

• 52:54Speaker 27

  She loved gifts, and it was quite easy to please her with a gift. And she'd made some sort of remark about she wanted to start listening to sextets, I think she said, "No longer string quartets. No longer string quartets. I want quintets and sextets." And I was at Borders Bookstore and found "Could It Have Been a Sextet?" by Elgar. And this was on Tuesday, the 7th of October. And I pulled out my cellphone to call her, and her voicemail came on. And I thought, no, I don't really feel like talking to her right now.

• 53:37Speaker 27

  I was gonna call and say, oh, you don't really want Elgar, do you? You really want me to buy you Elgar?

• 53:46Speaker 27

  And I hung up before she picked up. And I never spoke to her again.

• 54:03Stephen J. Dubner?

  Carolyn Heilbrun waited until she was 77. And then she did kill herself on October 9th, 2003. She wasn't sick. She wasn't depressed. But she did feel she'd come to the end of her writing life. And that was that.

• 54:21Speaker 27

  She left a note out in the foyer that said, "The journey is over. Love to all. Carolyn."

• 54:34Stephen J. Dubner?

  Did anyone know that she was planning to kill herself now? Did your father know, for instance?

• 54:40Speaker 27

  Oh, no, he didn't know.

• 54:41Stephen J. Dubner?

  Your father, he was an economist, yes?

• 54:44Speaker 27

  Yes.

• 54:46Stephen J. Dubner?

  So economists are practiced in the art, or science, or whatever it is of what's known as rational thinking. Here is the wife of an economist, your mother, who seems to have approached suicide, or at least life and the end of life, as a rational decision. Did you see it that way, or no?

• 55:09Speaker 27

  No, I think it's... If you're mortally ill and in great pain, I can see seeking to end your life. But no, I think it was unreasonable, irrational of her. But I think she felt it entirely reasoned out and rational.

• 55:35Stephen J. Dubner?

  Well, Margaret, I'm sorry for your loss. And again, I very much appreciate your willingness to come speak to us.

• 55:42Speaker 27

  Oh, well, thank you.

• 55:52Stephen J. Dubner?

  For David Lester, the dean of suicide studies, 40-plus years of research has yielded some answers about the what of suicide, who's most likely to do it, and when, and how. But the why remains elusive. The people who do it aren't necessarily the ones you might expect. You remember the point Steve Levitt made earlier in the show? How puzzling it is that people whose lives look so hard don't kill themselves in huge numbers? Remember the Pirahua, the Amazonian tribe with their outrageous rates of infant mortality and malaria, but no suicide? Or African Americans, who trail white Americans on just about every meaningful socioeconomic

• 56:36Stephen J. Dubner?

  dimension, but commit suicide half as often? Here's what David Lester has been thinking about.

• 56:45Speaker 06

  Actually, I've done studies on the quality of life in nations and the quality of life in the different states in America. And regions with a higher quality of life have a higher suicide rate. Now, quality of life is more than wealth. The people who try and rate the quality of life use a variety of indices: health, education, culture, geography, all kinds of things. So they put more into it than just median family income or individual per capita income. And what I've argued, therefore, is it seems to be an inevitable consequence of improving the quality of life.

• 57:23Speaker 06

  If your quality of life is poor, I mean, maybe you're unemployed, you're an oppressed minority, whatever it might be, there's a civil war going on, you know why you're miserable. You know, as the quality of life in a nation gets better, and you are still depressed, well, why? Everybody else is enjoying themselves, getting good jobs, getting promotions, buying fancy cars. Why are you still miserable? So there's no external cause to blame your misery upon, which means it's more likely that you see it as some defect or stable trait in yourself, and therefore, you're going to be depressed and unhappy for the rest of your life.

• 58:05Stephen J. Dubner?

  It's so interesting. There are just so many pieces of this puzzle, as you put it, that are fascinating but confounding. I mean, what you're talking about now, when there's a higher quality of life, suicide tends to rise. Your wife, who's an economist, I wonder if she would consider then calling suicide, to some degree, a luxury good?

• 58:24Speaker 06

  Yes. Now, there's an anthropologist in the past, Raoul Narrol, who considered suicide an indication of a sick society. And so in my writings, I've argued it, no, it's an indication of a healthy society. So, you know, it is a puzzle. It is a paradox, perhaps, we should say.

• 59:04Stephen J. Dubner?

  Freakonomics Radio is produced by WNYC Studios and Dubner Productions. This episode was produced by Susie Lechtenberg and Beray Lamb and engineered by David Herman. Our staff also includes Irvic Gunja, Jake Howitt, Merritt Jacob, Christopher Wirth, Greg Rosalsky, Alison Hockenberry, Jolenta Greenberg, and Caroline English. You can find all our previous episodes at Freakonomics.com. You can also subscribe to this podcast on iTunes or wherever you get your podcasts.

• 59:56Stephen J. Dubner?

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• 1:00:28Stephen J. Dubner?

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• 1:01:37Speaker 09

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