In the wake of a suicide, the most troubling questions are invariably the most difficult to answer: How could we have known? What could we have done? And always, unremittingly: Why? Written by a clinical psychologist whose own life has been touched by suicide, this book offers the clearest account ever given of why some people choose to die.

Drawing on extensive clinical and epidemiological evidence, as well as personal experience, Thomas Joiner brings a comprehensive understanding to seemingly incomprehensible behavior. Among the many people who have considered, attempted, or died by suicide, he finds three factors that mark those most at risk of death: the feeling of being a burden on loved ones; the sense of isolation; and, chillingly, the learned ability to hurt oneself. Joiner tests his theory against diverse facts taken from clinical anecdotes, history, literature, popular culture, anthropology, epidemiology, genetics, and neurobiology--facts about suicide rates among men and women; white and African-American men; anorexics, athletes, prostitutes, and physicians; members of cults, sports fans, and citizens of nations in crisis.

The result is the most coherent and persuasive explanation ever given of why and how people overcome life's strongest instinct, self-preservation. Joiner's is a work that makes sense of the bewildering array of statistics and stories surrounding suicidal behavior; at the same time, it offers insight, guidance, and essential information to clinicians, scientists, and health practitioners, and to anyone whose life has been affected by suicide.

Mr. Joiner's book is a useful guide to suicidal behavior...Mr. Joiner draws on many scientific fields--genetics, neuroscience, psychiatry, evolutionary psychology--all of which, he thinks, have something to offer the study of suicide. The major lesson of his book is the necessity of keeping the ability to commit suicide from coinciding with the desire for death...His book is a practical study, full of up-to-the-minute research.

As a survivor, I find this book to be illuminating, informative, and, most of all, healing. Joiner searches for the "why" of suicide as both a scientist and a survivor himself, and his research and insights help us to make sense of the pain and confusion that led our loved ones to end their lives.

The Florida State University psych professor, who grew up here and endured the suicide of his father not far from their Atlanta home, asserts that suicide is not simply an act but a process. Joiner describes how a person works up to suicide by overcoming the fear of death and the instinct for self-preservation. In accessible, somber prose, he also explains the conditions under which a person becomes suicidal.

It is the synergy and tension between Joiner's dual identity as suicide survivor and academic that imbues this book with both its power and a certain logical grandiosity...Joiner is to be commended for a powerful effort to integrate science and personal tragedy. In an easily digestible style, he reviews the breadth of modern suicide scholarship--biological, psychological, and social, and presents his integration clearly and forcefully.

The change in the way I now look at my dad's death comes because of [this] compelling book.

In a book both personal and scientific, Thomas Joiner gives us the deepest understanding of suicide that has yet been written. He reminds us that to go on living we need to feel that we belong to someone and that we are effective. But he adds a surprising third factor--we must not break down our fear of death. Joiner offers wise guidance not only to professionals, but to those who must live on after this kind of death in the family.

Taking one's own life goes against one of our strongest urges--the instinct of self-preservation. The deterioration of this instinct, says Thomas Joiner, should be regarded as a symptom of disease...His theory, outlined in Why People Die by Suicideis that it happens when severely depressed people acquire fearlessness. How do people become fearless? Through practice and learning, he says. This explains the bouts of self-harm or failed suicide attempts that are not cries for help so much as rehearsals for a deadly finale.

Many researchers and clinicians have tried to explain why people commit suicide. The majority of studies that have been conducted to date have examined correlates and risk factors for suicidal behavior. However, many of these risk factors are found throughout the general population, and the vast majority of people do not engage in suicidal behavior. Dr. Joiner's theory is one of the first that integrates many of these risk factors into an explanatory model. His model makes sense both intuitively and empirically. What makes Dr. Joiner's theory particularly credible is the research that he and his students have done to support his model. Additionally, he is able to use his theory to explain such diverse behaviors as the suicide attacks on 9/11 and Kurt Cobain's suicide. What makes this book particularly interesting is that it begins with a prologue detailing Dr. Joiner's personal account of loss by suicide...This book is a must-read for clinicians and researchers who are involved with suicidal patients. Dr. Joiner's model highlights the acute risk factors for serious suicidal behavior thus providing tangible targets for assessment and treatment. Additionally this volume is an excellent resource for family members who have lost a loved one to suicide...Based upon the book's combination of sound scientific research with thoughtful personal reflections and examples it is given a strong recommendation.

Drawing on extensive clinical and epidemiological evidence, as well aspersonal experience, Thomas Joiner provides the most coherent and persuasive explanation evergiven of why and how people overcome life's strongest instinct, self-preservation. He tests histheory against diverse facts about suicide rates among men and women; white and African-Americanmen; anorexics, athletes, prostitutes, and physicians; members of cults, sports fans, andcitizens of nations in crisis.

Thomas Joineris Bright-Burton Professor of Psychology at <>Florida State University.

Acknowledgments

Prologue: Losing My Dad

1. What We Know and Don't Know About Suicide

2. The Acquired Ability to Enact Lethal Self-Injury

3. The Desire for Death

4. What Do We Mean By Suicide and How Is It Distributed in People?

5. Genetics and Neurobiology of Suicidal Behavior, and the Roles of Impulsivity, Childhood Adversity, and Mental Disorders

6. Risk Assessment, Crisis Intervention, Treatment, and Prevention

7. Summary and Conclusion

Epilogue