In this book, Thomas Joiner puts forward his theory of why people die by suicide. It can be summarized with three vital factors: thwarted belongingness, perceived burdensomeness and the ability for self-harm. He believes that the need to belong is the most powerful of these, and in a poignant example, he quotes from one man's suicide note: "'I'm going to walk to the bridge. If one person smiles at me on the way, I will not jump.'" (120)

His evidence is impressive and the approach practical. It is easy to see how people's lives could be saved using his research and ideas. He tells of his own father who committed suicide, which provides a very personal driving force for his work. It is a shame that it is clunky to read, with unnecessary repetition. I also feel that some assertions are not clearly justified, and that Joiner is trying to fit absolutely everything into his theoretical framework, making for awkwardness and even incredulity on occasion. Most of this, I am sure, is due to a lack of clarity of expression.

Joiner takes the reader through current knowledge (and lack thereof) of suicide, devotes a chapter to acquired self-injury and its importance in suicide risk, and explains the desire for death. He defines suicide, and provides statistics. He discusses the role of genetics, neurobiology and mental illness, and then devotes a chapter on what to do about suicide, that is, risk assessment, crisis intervention, treatment and prevention. Lastly, he discusses the future of suicide prevention and research.

There is no doubting that Thomas Joiner has written an important and vital book, that clarifies the tragic and bewildering area of suicide. He clearly has a compassionate view of everyone involved, whether they are the suicidal person or the people who care for them, and understands how difficult it can be for those left behind to comprehend why or how their loved one could have taken their own life.

Including his own personal story provides a much needed humane element to a book about a very difficult and traumatic subject. He makes the point that the responses from people that helped the most after his father's death were those where compassion was to the forefront. Those who tried to pretend nothing had happened (by not saying anything about his loss) or who avoided him altogether, were, unsurprisingly, the least helpful, even hurtful.

He sets out his theory and the evidence for it generally in a  thorough and convincing manner, cementing in the reader's mind the three main factors, stated above, for suicide risk. A little less repetition would have made for a more readable book. Coming across statistics and facts again and again, as if they were being presented for the first time, was unfortunately jarring.

There were some points that concerned me. Consider the following: 'All that is needed for Gayle to engage in serious suicidal behavior if she chooses is a quick change in her feelings of connection and effectiveness.' (24) Is suicide a choice, as this sentence suggests? Another comment about deconstructionists and their view of reality and meaning seems fatuous, more like the author wanted to get something off his chest rather than make a valid point.

I am not convinced by the author's argument on the ambivalence of the suicidal person, and feel he is trying too hard to fit this into his theoretical framework. He says:

People who die by suicide not only desire it but also have developed the capacity to enact lethal self-injury; nevertheless, even in people who have developed this capacity to the extreme, they retain some fear of suicide because it flies in the face of the extremely powerful push for self-preservation. This fear produces the wish to be rescued. (53)

  I actually agree more with Edwin Shneidman's way of describing it as quoted by Joiner, that suicidal persons are ambivalent about life and death, and 'wish to die and they simultaneously wish to be rescued' (emphasis in original). Does every suicidal person want death or is it a desire for temporary oblivion, or for the pain to go away? Those who change their minds as they jump, are they responding only to the instinct for survival, or are there other possibilities?

  Joiner's example of an executioner is more unsatisfactory, because he describes it so poorly. He writes that Menninger's explanation that the man suicided because he felt guilty over his occupation is not really correct, because there is a low suicide rate amongst those who feel 'guilt, emotional pain, or hopelessness'.

By contrast, an explanation emphasizing the acquired capability to enact self-injury fits the executioner, who had ample time to habituate to pain and death… Why don't all executioners die by suicide, then? For the same reason all racecar drivers don't. They can stare down death. They could enact it, but the vast majority do not want to. (55)

  What the author should have written here is that the executioner's habituation to death was a strong risk factor for suicide, but that other risk factors must obviously have also been present. Joiner is too dismissive of guilt as a risk factor and the comparison of an executioner with a racing car driver I find inappropriate and unfortunate, both morally and psychologically.  

This is a book full of important information, but there has not been adequate attention to its presentation. A more thorough editing, attention to detail and fluency of the writing and presentation of ideas would have solved this problem.

© 2007 Sue Bond

Sue Bond has degrees in medicine and literature and a Master of Arts in Creative Writing. Reviews for online and print publications. She lives in Queensland, Australia.

Categories: Depression, Psychology