Suicide: The Coupling of Intent and Opportunity

In his latest book, Talking to Strangers: What We Should Know about the People We Don't Know, Malcolm Gladwell introduces the concept of coupling, and describes it as critical to understanding how others, not well known to us, are likely to respond  This is an unfamiliar term in the context he uses it.  He provides this definition:

“Coupling is the idea that behaviors are linked to very specific circumstances and conditions.”

Gladwell dwelled most on crime statistics in making a claim for what he refers to as coupling.  In that case, he pointed out that in our urban areas, crime tends to be concentrated in a few specific locations.  He presented data indicating that often as much as fifty percent of all crimes are committed in about three percent of the street segments.  The explanation for this effect is not well understood, but there are definitely “circumstances and conditions” that either encourage crime or facilitate its execution.  The conclusion to draw from this is that crime prevention should be focused on these high-crime areas using aggressive tactics, while treating low-crime areas much less aggressively.  That seems like an obvious approach, but police organizations often prefer to treat all areas and all persons as “likely” criminals.

Gladwell also produced data on suicides which indicated that attempts are highly affected by the types of opportunities available for the act.  To make his point he addresses the suicide of the poet Sylvia Plath in London in 1963.

“…she took towels, dishcloths, and tape and sealed the kitchen door.  She turned on the gas in her kitchen stove, placed her head inside the oven, and took her own life.”

This may seem a peculiar way to go about killing one’s self today, but in the London of that time it was by far the most common method—and it was also the most convenient.

“In the years after the First World War, many British homes began to use what was called ‘town gas’ to power their stoves and water heaters.  It was manufactured from coal and was a mixture of a variety of different compounds: hydrogen, methane, carbon dioxide, nitrogen, and, most important, the odorless and deadly carbon monoxide.  That last fact gave virtually everyone a simple means of committing suicide right inside their home.”

“In 1962, the year before Sylvia Plath took her own life, 5,588 people in England and Wales committed suicide.  Of those, 2,469—44.2 percent—did so as Sylvia Plath did.  Carbon monoxide poisoning was by then the leading cause of lethal self-harm in the United Kingdom.  Nothing else—not overdosing on pills or jumping off a bridge—came close.”

This town gas was dirty and would eventually become more expensive than a more desirable alternative: natural gas (methane) containing zero carbon monoxide.  Beginning in 1965, the British began the long conversion to the safer gas.

“After 1977, if you stuck your head in an oven and turned on the gas, the worst that could happen to you was a mild headache and a crick in the neck.”

What is of interest is the behavior of the suicide rate as this ubiquitous source of a deadly gas came and went.  After the introduction of town gas, the suicide rate increased significantly and stayed high.  This could not have gone unnoticed, but people did not seem able to make the leap to the conclusion that the ready availability of opportunity might affect the probability of occurrence.  The conventional wisdom claimed that one who wished to commit suicide would perform the act one way or another, so the readiness of a particular option would not matter.  When the gas replacement began in the 1960s, the suicide rate began to fall and stayed at a lower level.  People who would have committed suicide when a convenient method was available mostly did not move on to the next best option.  That was a rather significant finding.

Gladwell provides quotes from the criminologist, Ronald Clarke, who in 1988 asserted that Gladwell’s type of coupling was involved.

“It was widely available (in about 80 percent of British homes) and required little preparation or specialist knowledge, making it an easy choice for less mobile people and for those coming under sudden extreme stress.  It was painless, did not result in disfigurement, and did not produce a mess (which women in particular will try to avoid).…Deaths by hanging, asphyxiation, or drowning all usually demand more planning, while more courage would be needed with the more violent methods of shooting, cutting, stabbing, crashing one’s car, and jumping off high places or in front of trains or buses.”

The experts of the day did not take well to Clarke’s assertion.

“They thought it was very superficial, that these people were so upset and demoralized that it was sort of insulting to think you could deal with it by simply making it harder to commit suicide.  I got quite a bit of pushback here and there from people about that idea.”

Gladwell also supports his claim with the history and data on suicides from the Golden Gate Bridge in San Francisco.

“Since it opened in 1937, it has been the site of more than 1,500 suicides.  No other place in the world has seen as many people take their lives in that period.”

To support Gladwell’s hypothesis, and be consistent with the British data, those who would choose to jump off that bridge would be prompted to do so by the particular ambiance of the bridge itself, not necessarily a desire to die no matter how.  Fortunately, their exists data to address this issue.

“…this is exactly what seems to be the case according to a very clever bit of detective work by psychologist Richard Seiden.  Seiden followed up on 515 people who had tried to jump from the bridge from between 1937 and 1971, but had been unexpectedly restrained.  Just 25 of those 515 persisted in killing themselves some other way.  Overwhelmingly, the people who want to jump off the Golden Gate Bridge at a given moment want to jump off the Golden Gate Bridge only at that moment.”

The notion that intent and circumstances of opportunity were tightly coupled in suicides was either unknown or incomprehensible to bridge authorities.

“So when did the municipal authority that runs the bridge finally decide to install a suicide barrier?  In 2018, more than eighty years after the bridge opened.”

Gladwell is focusing on policing techniques as he developed this topic, but he cannot resist providing a brief aside on the consequences of his coupling on the favorite—and most convenient—method of suicide in the United States: handguns.

“I haven’t even mentioned the biggest example of how our inability to understand suicide costs lives: roughly 40,000 Americans commit suicide every year, half of whom do so by shooting themselves.  Handguns are the suicide method of choice in the United States.  And the problem with that, of course, is that handguns are uniquely deadly.  Handguns are America’s town gas.  What would happen if the U.S. did what the British did, and somehow eradicated its leading cause of suicide?  It’s not hard to imagine.  It would uncouple the suicidal from their chosen method.  And those few who were determined to try again would be forced to choose from far-less-deadly options, such as overdosing on pills, which is fifty-five times less likely to result in death than using a gun.  A very conservative estimate is that banning handguns would save 10,000 lives a year, just from thwarted suicides.  That’s a lot of people.”

The interested reader might find Policing and the Coupling of Crime and Place informative and interesting.