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Helen C. Epstein, "Why Live: An Anatomy of Suicide Epidemics" (Columbia Global Reports, 2025)
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C
Hello and welcome to another episode on the New Books Network. I'm one of your hosts, Dr. Miranda Melcher, and I'm very pleased today to be speaking with Dr. Helen Epstein about her book titled why How Suicide Becomes an Epidemic, published by Columbia Global reports in 2025. This book helps us understand what suicide epidemics actually are, what they're caused by, and maybe as we're going to discuss how we can possibly prevent them. So this takes us into a very important and unfortunately quite topical issue as well as a historical one too. So lots for us to discuss. Helen, thank you so much for joining me on the podcast.
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D
My pleasure. Thanks so much for having me.
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C
Could you please start us off by introducing yourself a little bit and tell us why you decided to write this book.
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D
Yeah, sure. Thanks so much. I write about and teach public health at Bard College in upstate New York. And I've always been interested in epidemics of all kinds, because epidemics always tell a story. Our own individual fates are mostly unpredictable. Even if we're at high risk for, say, heart disease, for example, there's no telling if or when we'll have a heart attack. But epidemics seem to always happen for a reason. For example, people get flu in the fall when kids go back to school and are in enclosed spaces, and so on, where food likes to spread, and so on. Anyway, I'd been aware of that there were these epidemics of suicide for a long time. Epidemics being a kind of increase in the number of cases, sometimes a doubling, tripling, quadrupling, or even more of the suicide rate in a particular group of people in a fairly short space of time. So I've long been aware of suicide epidemics and then a. Or epidemics of suicide. And then a friend took her own life about eight years ago, and I was really thrown by it because I'd known she was depressed, but I really didn't expect it. And then I discovered that a number of families that she'd grown up with had also been affected by suicide. And I wondered if she was part of yet another suicide epidemic. Mental illness is always a big risk factor for suicides, apart from any epidemiological forces that might be operating. But still I wondered. It made me wonder whether there was something about my own field of public health that might shed light on. On this tragic phenomenon that individual psychological portraits, valuable as they are, haven't necessarily revealed. So that was really what led me into this.
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C
Thank you for that introduction. I think it's very helpful to understand a number of the factors that go into this kind of research and surfaces as well, the importance of the term suicide epidemic. Can you tell us more about what we need to be thinking about and understanding when we hear this term?
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D
Sure. So an epidemic in general is a spike in cases occurring in a certain population at a particular time. That's essentially all it is. And there have been suicide epidemics where there's an increase in the suicide rate within a few years, usually of, say, two, three, four fold, or even, sometimes even more, on just about every continent on Earth. It's happened often among indigenous groups like the Inuit, who live up around the Arctic Circle. That was following forced settlement and modernization in the 1960s in Russia. There was a suicide epidemic following the fall of communism in the early 1990s. In the United States, we've seen a suicide epidemic, particularly in the Rust Belt following de industrialization, which really commenced in the 1970s. And in India, there's long been a suicide epidemic among farmers with especially those that are more wrapped up in the cash crop economy as opposed to the subsistence economy and so on. And there are others as well, so they tend to. Yeah, they sort of appear. You know what's scary about that is that really this suicidal feelings could come from any one of us. That's really what an epidemic means. We're all vulnerable. It's not something intrinsic to us always. Some people are at higher risk because of mental illness or other factors. But there's also something in the air that can act on us. And that's what got me kind of alarmed.
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C
Yeah, that's definitely a concerning concept. And as well, from a research point of view, once you've decided to focus on this. I mean, that list you gave us just there of the number of different places that we can see this happening suggests kind of a immediate quandary, even beyond the sort of existential one of this could happen to anyone. Of how do you investigate something like this? I mean, it's a big topic, it's in lots of places. Can you tell us a bit about your research and writing practices that resulted in the book?
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D
Well, yeah, I guess there has been a lot of research on individual epidemics of suicide, but no one had quite pulled it together yet to see whether there were any common themes to these various epidemics around the world. And so I took, I guess, a kind of literary approach, maybe in that I plunged into the literature, the anthropological literature. There's some wonderful, amazingly good anthropological studies of these different communities, wherever they may be. And there is also sociological literature, economics literature, demographic literature, and so on. And I just read everything I could about these various affected communities to see if I could find any common themes. So then I tried to weave some stories out of all of this material to try to see what I could find, whether I could find some common themes. And that's essentially how the book got written and what it consists of.
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C
Definitely an interesting approach to take to this, but I mean, you have to do something. This is a massive scale otherwise. And just to tell listeners this book is not 800 pages, it is actually quite readable. So the method clearly has succeeded on that front. I wonder then if we can get into what you were able to weave together from looking at these different places and times, something that especially Struck me was the importance of rapid modernization in the similarities that you found across these different cases. So can you tell us about the role that these processes of modernization, especially the speed of it, might contribute to suicide epidemics?
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D
Sure, yeah. That really is the take home message, is that rapid modernization and particularly economic reforms seem to be crucial antecedents and causes of suicide epidemics, at least the ones that I was able to identify and where there was enough information to really study them. Just about every suicide epidemic I could find had been preceded by some kind of modernizing economic reform. And what such reforms do is really shift societies from ones that were formerly based on subsistence, on sharing on strong moral norms that were never written down, but that sort of valorize generosity and, and pitching in and where people were kind of raised to live for others and not for themselves. An abrupt switch. And such societies need not be necessarily indigenous societies like the Inuit living off the land in igloos and so on, but they can be just kind of, you know, stable industrialized societies as well, where people have really learned to form, have really sort of formed robust communities. But a shift from that to societies which are suddenly based on cold, hard cash transactions, where we really live for ourselves alone, and where rules are enforced not by moral code so much, but by police and courts and so on, that transition tends to be very hard on rather large numbers of people and creates a kind of feeling of stark loneliness that that transition brings about that that many people really find quite terrifying. And I think it's not hard to question why. You know, suddenly instead of finding our identities in a group, we have to find it in ourselves. And that can be really hard and painful, especially for adolescents. And young adults, by the way, are particularly prone to suicide because we have to sort of face up to the possibility that we may not easily fit into the places where we expect to fit in. We may come to see ourselves as a burden to others, which is a big, big risk factor for suicide, as others experts have shown. And that, you know, we may have to really question our identity and who we are. In pre modern communities there were of course problems. Life wasn't perfect, but everyone had a kind of role to play. Even three year old kids were valued because they could gather coconuts or help their parents. Somehow in modern societies there are a lot of people who feel needed by no one, as the anthropologist Michelle Parsons puts it. And that's perhaps the most painful feeling that we can have.
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C
Okay, so this emphasis then on the individual is a key part of this. We're talking Then about sort of capitalistic modernization, right. Where the individual is kind of the height of moral good and all sorts of other things. Right.
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D
It is about capitalism or different ways that capitalism manifests itself. So just to give one example, I have a chapter on Russia as it underwent the transition from communism to capitalism in the early 1990s. And I certainly don't mean to idealize the Soviet system or the communist system at all. It had many disastrous characteristics, but one thing about it is that it was so economically inefficient that to get by, people had to really rely on each other for what they called blat, which means a kind of system of favors. So if you wanted theater tickets or an opportunity to take a test to get your kid into school, or you wanted cucumbers in season or something like that, it was always who you know, not what you know. And people would kind of get together and share things, and nobody ever kept track of who owed what to whom. But everybody knew that they could depend on their friends for whatever it was they needed. I'm making it all sound very sort of frictionless and perfect. And of course it wasn't. But that was in the ideal scenario. That was kind of how their society, how people survived because the economy was kind of hopeless. Then they had a transition to capitalism and everything became much more efficient, but it also became much, much colder. So suddenly the person who used to get sort of steal light bulbs from his factory and give them to his friends wasn't really needed anymore. You could buy the light bulbs if you had the money that you needed. And a kind of feeling of belonging, especially for those who didn't get rich very quickly, became, which was many people. Many people actually suffered economically badly from the transition, but they also felt unneeded, un. As though they had no role in society anymore. And I think this contributed to a lot of alcoholism in particular and alcohol related suicides and just start plain suicides in that community. So that's kind of one example. Another example is what happened during a rapid fire development program initiated by the United States in this array of islands collectively known as Micronesia in the Pacific, which happened during the 1960s. The Kennedy administration decided that it wanted to help the people of Micronesia modernize. It was a very well intentioned program. And money just poured into this society for construction, for a new civil service, for hospitals, for schools and so on. And suddenly these communities that had been based on fishing and collecting breadfruit and coconuts and so on turned into a society of cash and jobs and. And so on. And this also meant that the family change had changed from one based on extended families, where everyone kind of pitched in for the group, to nuclear families, where fathers suddenly had all the control and all the money and all of the power in the family. And young men, in particular, girls, could always help out around the house, as they always do, but particularly boys were left kind of adrift, and they didn't quite know where they fit or where they belonged. And a lot of the suicides that were studied very much in depth by a wonderful pair of scholars, one Donald Rubinstein, anthropologist, and Father Francis Hessel, who was a Jesuit priest who worked in the high schools and also did a great deal of work collating all of these suicides as they happened and knew the families really well. A lot of them followed instances where a young man would ask. A young or adolescent would ask his father for $5, you know, just some money, like an allowance. And if the father turned him down, which fathers often do, they don't like being pestered. They. They would fall into this dark silence and often just retreat into themselves and. And often take the ultimate step and take their own lives. Micronesia is an especially stoic culture. So people don't express feelings easily. It's not part of their culture to do that. It's not that people don't have feelings for each other. Every human society and every human being experiences love and so on, but it's just that they don't talk about it, as many people, premodern societies and communities don't. They don't talk about it in the way modern people do. And there's. Yeah, we can talk more about that. But I guess, you know, one interesting thing, you know, that I write about in the book is the work of Erich Fromm, who was a philosopher and historian who wrote in the 1940s and 50s. And he discovered that one of the characteristics of modern society is that we have a kind of a culture of love, of love poems and birthday parties and so on. For we sort of celebrate our love for the people that we care about in a way that many traditional societies presumably never really felt the need to do. And in part, I think he shows that this culture of expressions of love evolved kind of in lockstep with the development of capitalism that, as capitalism, kind of drove us apart from each other, formalized our relationships and dehumanized them. We developed a love culture to kind of connect with and reassure ourselves of our connections to the people, you know, our romantic partners, the people in our family, our closest friends. And so on. So it's. But in societies where that culture hasn't necessarily developed, I think people who experience the often sort of harsh realities of modern capitalism from their families or from others may feel very frightened and very lost.
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C
Yeah, I could definitely understand in the examples you're giving us just how big a change it would be. Not kind of on a societal level necessarily. I mean. Yes, also that. But in an individual level, kind of, you know, what I, what my life is now in my 40s is not what I thought it would be when I was five. Right. It's that kind of speed that we're talking about that makes such a difference.
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D
I think it's a slower, it's, it's, it's, it's, it's not necessarily. I think culture is sort of imbued in all of us. So families raise their kids, for example, and let's take the example, go back to Micronesia for a minute. So families will raise their kids in a kind of non demonstrable way, you know, with, you know, you're a member of the family and so on and you know, you're with us, but you know, without necessarily celebrating their overtly their feelings for each other. Not really talking about them much. And yet the entire world is structured so that these young people, as they grow into it, especially young men, where they feel they have no place, they don't belong. It's not like the old days where a young man would go off with other young men and, you know, build canoes or go fishing or participate somehow in community life. So they find themselves kind of adrift. They may go to school, but they may not necessarily relate to it because the kinds of professions they're being prepared for, you know, not everybody takes to, takes to school and academia and so on all over the world. And they come home and they don't necessarily feel wanted or needed there either. So they don't know kind of where they belong. It's as though the culture hasn't caught up with the situation that the modern economy puts these young people into. It's not that life change is over over the course of a lifetime. It's that there's a kind of a cultural lag. We have cultural tools for dealing with and protecting ourselves from the loneliness of capitalism, the loneliness that capitalism brings. Whereas they don't have those tools yet. They don't know how, you know, parents don't know how to tell their kids, I think you're special, I think you're wonderful. You're the apple of my Eye, you know, that's just not a kind of done thing. The kind of thing that can sort of rescue a kid from despair.
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C
That idea of protecting ourselves, especially from things that feel like they don't go right, obviously is important in this context of capitalism and kind of society not having the same sorts of community bonds as it previously did. You do also, of course, talk about other risk factors in the book. So I'm wondering if we can discuss those a bit, especially the way that they can kind of compound on each other. So you discuss, for example, battlefield trauma as potentially being relevant for the risk of suicide, childhood experience of abuse as well, and the kind of combination of those things perhaps being the most potent risk. Is that right?
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D
Yeah. It seems as though repeated trauma and not necessarily terrible trauma, but a pattern of trauma in life beginning in childhood and then repeating itself in adulthood, seems to be a huge factor in suicide. So, for example, we saw staggering numbers of suicides among US Veterans, especially young men of the Iraq and Afghan wars, Really a fourfold increase in the suicide rate in a very short Spanish space of time among those young veterans between the ages of, say, 18 and 25. And part of that was just the trauma of war. Those were tough wars. But the data also suggests that not everyone who experienced war trauma became suicidal. What heightened risk for many of these young men seems to have been a combination of childhood traumas with adult trauma. And it seems like part of the mechanism of adult trauma is that it opens old wounds from childhood which kind of erupt anew. So I had interviewed scores of former suicidal veterans, and they all had horrendous most of them anyway. I mean, I guess everyone, actually, of the ones who had been really suicidal, they were no longer suicidal. When I spoke to them, by the way, they'd found some stability and peace and happiness in their lives, which was great. But they were able to talk about their experiences, and they volunteered to me without my asking. I wasn't fishing for it, but they just had, you know, all had these horrendous childhoods with lots and lots of abuse, as well as harrowing military experiences. And it was interesting because afterwards I discovered that the psychoanalyst Ronald Fairbairn, who was writing in the 1940s, saw the same thing in suicidal World War II vets that he interviewed. They all describe not just war trauma, but harrowing memories of child abuse, too. And there have also been recent statistical studies carried out by the Veterans Administration of pointing to such a similar mechanism also, that there seems to be this interaction between childhood trauma and Especially early adult trauma.
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C
It's quite an unfortunate combination. But I wonder if we can pull the thread from what you've just told us about speaking to these people who had been experiencing extreme suicidal ideation. But of course, by the time they spoke to you had survived it. What did they think most helped them get to that point?
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D
Well, it was a range of things. For some, it was the love of another person, usually a partner. And that can go an awfully long way, as discussed. And the other thing is that virtually all of them had become involved in some kind of artistic pursuit, usually one of the declamatory arts like theater or poetry. There were many memoirs that they had worked on. There was something about communicating with an audience, trying to come to grips with their own feelings and experiences and trying to transform it into something that others could grasp and that reached their hearts as well. It really seemed to help. And some of them had done some really, really interesting work. Others turned to religion, particularly Buddhism, which contains much wisdom about coping with the trials of life. And then there also seems to be some evidence that psychedelic drugs, taken particularly under medical supervision, can help kind of shake up depressive thought patterns and make people feel less suicidal. They don't always work, but there's some very promising clinical trials suggesting that they do help some people. The working class population in the United States has suffered gravely from deindustrialization, from downsizing, from offshoring, from the gigifying of the economy, from profoundly low wages. And casual work, which is very unstable, has put a lot of pressure on family life in those communities. But I have some hope in the sort of fledgling, it's very early days, but kind of fledgling revival of the. Of the union movement that could bring some of these sort of precariously employed people together to demand their rights, I think, as workers, and that that also could help bring people together. So that's also something I think, to watch.
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C
Yeah, that's very much the theme of my final question for you. What can we learn more broadly from these people you've spoken to from this research you've conducted? Any other aspects? Hope, the things that we can watch.
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D
Out for, I don't know about. I wish I could be more hopeful. I feel that we're entering some very rocky economic times and I worry a lot about that. We are starting to see, I think, this sort of inflationary effects of tariffs and cuts to government spending and the huge numbers of layoffs, for example, and the deportation of undocumented but often necessary workers who fill up our care economy and the food economy and so on. And so I worry that we're in for another rocky economic ride, at least most of us are, who are not tycoons. And we need to really take care of each other as well as ourselves, and find somehow the strength to hold our society together. And I just, I think we all need to be especially vigilant in the near future about that.
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C
Well, for listeners who want to read more about all of this to understand, potentially, as you said, Helen, what to look out for going forward, they can, of course, read the book titled why How Suicide Becomes an Epidemic, published by Columbia Global reports in 2024. 5. Helen, thank you so much for joining me on the podcast.
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D
Thanks so much, Miranda, for having me.