经济学人下载:美国自杀事件 令人发指地无底洞

Suicide in America
美国自杀事件

An awful hole
令人发指地无底洞

Why more Americans are killing themselves
为何越来越多美国人自杀

BEING depressed is like having a terrible headache, says one Atlanta businessman. Except that a few days of rest do not stop the pain: “You're just expected to keep going.” Trying to “man up”, he sought little help for his condition, choosing to hide it instead. “It all gets so debilitating that you don't want to go on,” he explains.
亚特兰大的一位商人觉得，压抑苦闷和剧烈头痛一样，这种痛苦休息几天都无法消失：“你只想坚持下去。”虽然他努力变“man”一点，但却没有想办法解决问题，反而想藏起来。他解释道，“所有的一切让人筋疲力尽，很想放弃。”

He tried to kill himself more than once; fortunately, his attempts came to nothing. But the same cannot be said for a growing share of Americans. The suicide rate has risen from 11 per 100,000 people in 2005 to 13 seven years later. In the time it takes you to read this article, six Americans will try to kill themselves; in another ten minutes one will succeed.
他曾不止一次想要自杀；幸运的是，他的尝试都是徒劳的。然而，美国可没有那么幸运，因为自杀率攀升。自杀率从2005年10万人中的11%增加到2012年的13%。在你读这篇文章的时间里，6位美国人将会自杀，而且十分钟之后会有一个人自杀成功。

Over 40,000 Americans took their own lives in 2012—more than died in car crashes—says the American Association of Suicidology. Mondays in May see the most incidents. The rates are highest in Wyoming and Montana, perhaps because guns—which are more effective than pills—are so common there (see chart). Nationally, guns are used in half of all successful suicides.
据美国自杀协会研究，2012年，在美国自杀人数超过4万，多于死于车祸的人数。自杀多发在五月的星期一。怀俄明州和蒙大拿州的自杀人数最多，原因或许是枪支的普及（开枪自杀比吃药来的快）。全国范围而言，开枪成功自杀的事件占到所有自杀事件的一半。

What drives people to self-destruction? Those who suffer from depression are, unsurprisingly, most at risk. The suicide rate also rises when times are hard. During the Depression it jumped to a record 19 per 100,000. It grew after the recent financial crisis too. “Even just uncertainty over employment” makes people worry a lot, notes Yeats Conwell, a psychiatrist at the University of Rochester Medical Centre.
究竟是什么原因让人自杀？毫无疑问，那些苦闷压抑的人正是自杀高危人群。日子不好过也会促使人自杀。大萧条时期，自杀率攀升至10万人19%，创历史新高。近期金融危机之后，自杀人数也增多。罗切斯特大学医学中心精神病专家叶芝·康威尔表示，“甚至就业难”也会让人们陷入烦恼中。

The over-75s have historically been most likely to kill themselves, especially if they are lonely or ill. But now it is the middle-aged who are most at risk. In 2012 the suicide rate for Americans aged 45-54 was 20 per 100,000—the highest rate of any age group. For those aged 55-64 it was 18; for the over-65s it was 15. The middle years can be stressful, because that is when people realise that their youthful ambitions will never be fulfilled.
一般说来，如果75岁以上的人孤苦伶仃、罹患疾病，则很可能自杀。然而，如今，自杀高危人群则是中年人。2012年，美国45-54岁的自杀率是10万人20%—成为美国国内年龄段之最。而55-64岁则是18%，65岁以上的则是15%。人到中年，压力大；因为人到中年才幡然醒悟，年少梦想永无实现之日。

Women make nearly four times as many suicide attempts as men, but men succeed four times as often. Men favour bloodier methods: most use a gun, whereas less than a third of women do. Women may be better at asking for help; overall, they are two and a half times more likely than men to take anti-depressants. Whites are nearly three times as likely as African-Americans to kill themselves. Blacks are five times more likely to be murdered with a gun than to kill themselves with one; for whites it is the other way round.
有自杀企图的女性人数是男性的四倍，但是男性自杀成功率确实女性的四倍之多。男性倾向更加暴力的自杀方式：大部分用枪（不到33%的女性也用枪）。女性或许更加善于寻求帮助；总体来说，女性服用抗抑郁剂的几率是男性的2.5倍。白人自杀的几率是非洲裔美国的3倍。黑人用枪自杀的几率是被谋杀的五分之一（白人反之）。

Military veterans are especially prone to suicide. Data from 48 states suggest that 30 out of 100,000 veterans kill themselves each year—a rate far higher than among civilians. Many find it hard to overcome the trauma of combat, or to adjust to civilian life. A survey by Iraq and Afghanistan Veterans of America, an advocacy group, found that 31% of veterans had considered taking their own lives. Congress is mulling a bill to overhaul how the Department of Veterans Affairs handles the problem.
退役军人尤其倾向自杀。48个州的数据显示，每年10万名退伍军人中有30名自杀——其自杀率远高于平民。许多老兵很难从战争创伤中恢复过来，也很难适应退伍生活。一项由参加伊拉克和阿富汗战争的美国退伍老兵（一个倡导性组织）发起的调查发现，31%的老兵考虑过自杀。国会正在考虑一项法案，改革退伍军人事务部处理此类问题的方式。

Activists say the government does too little to prevent suicide. Christine Moutier of the American Foundation for Suicide Prevention complains that only $40m of federal funding will go to anti-suicide programmes this year. This does not include the billions the government spends on mental-health problems more broadly.
激进分子称政府没有采取措施防止自杀。今年，联邦仅拨款4000万美元投入到自杀预防项目中，美国自杀预防基金会的Christine Moutier对此表示不满。款项不包括政府在精神疾病以及其他疾病的拨款。

Some treatments, such as anti-depressants, are often quite effective. More than 20 studies have found that when anti-depressants are more widely available, fewer people end their own lives. For example, between 1991 and 1996 Swedes swallowed 240% more anti-depressants and the suicide rate fell 19%. But it is hard to prove a causal link. And other studies suggest that certain anti-depressants lead young people to think more about suicide.
抗抑郁剂等疗法往往效果显著。超过20项研究表明，若抗抑郁剂更易购买，那么选择轻生的人会减少。例如，1991-1996年之间，瑞典人服用的抗抑郁剂用量超过240%，自杀率下降19%。但是，很难证明这是一个偶然。而且其他研究表明服用某种抗抑郁剂让年轻人更加想轻生。

Making it slightly harder to kill yourself is also surprisingly effective. American pharmacists still sell painkillers loose in pots, enabling people to pour the whole lot down their throats in one movement. This is unwise. After Britain switched to blister packs in 1998, which require you to punch pills out one by one, deaths from overdoses of paracetamol (the active ingredient in Tylenol) dropped 44% in 11 years.
令人吃惊的是，让自杀变得更困难也是防止自杀的有效方法之一。美国药剂师依然在兜售液体止痛药，如此一来，人们只需一个动作就可以吃下一大堆止痛药。此举绝非明智。1998年，英国人使用罩板包装，这样一来，人们必须一个一个挤压药片，之后的11年间，因过量服用对乙酰氨基酚（泰诺的主要成分）致死的人数下降了44%。

Some who ponder suicide may be dissuaded by counselling. Behavioural therapies, alone or in family settings, allow sufferers to talk through their emotions and actions. A Danish study of 65,000 people who attempted suicide between 1992 and 2010 suggests that providing people with “a safe, confidential place to talk” during up to ten sessions saw repeat attempts and actual suicides drop more than 25%.
考虑自杀的人可以通过咨询他人，打消自杀念头。独自一人行为疗法或者家庭集体行为疗法让困惑者说出自己的心情。丹麦，一项由65000名（1992年-2010年考虑过自杀的）人参加的调查显示，在一个“安全、保密的”场所畅所欲言，十场谈话下来，有过自杀想法的人数减少了逾25%。

Three states have concluded that not all suicides should be prevented. In Oregon, Washington and Vermont “Death with Dignity” laws allow terminally ill, mentally competent residents to ask for prescription drugs to hasten their deaths. Such laws have no discernible effect on unassisted suicide: from 1999 to 2010 suicides among those aged 35-64 increased 49% in Oregon, which has allowed terminally ill patients to end their lives since 1997, compared with a 28% increase nationally.
美国3个州认为，并不是所有的自杀都应该阻止。在俄勒冈州、华盛顿和佛蒙特州，“尊严死”法律允许身患绝症而心智健全的居民寻求处方药物安乐死。诸如此类的法律对于无助的自杀事件来说毫无意义：在俄勒冈州，1999年到2010年35-64岁之间自杀的人数增加了49%，该期间全国范围自杀人数增加了28%。俄勒冈州自1997年便通过了“尊严死”法案。

And what of those left behind? A suicide deeply affects six people close to the deceased, research suggests. Since 1988 some 5m Americans have suffered the loss of a loved one in this way. Christy Simpson, a counsellor in Georgia, knows it can be difficult for families to discuss a loved one's suicide; her mother asked her to tell friends that her sister died in a car accident after she jumped to her death.
那么剩下的人该怎么办呢？研究显示，一场自杀，关联了与死者相关的6个人的命运。自1988年以来，500万美国人因自杀而失去了另一半。乔治亚州的咨询师克里斯蒂·辛普森深知很难启齿自己爱的人跳楼自杀，她的母亲要她告诉朋友，自己的姐姐是死于一场车祸。

Ms Simpson believes that eroding the stigma around suicide would help. “My parents could never talk about [it]. My mother went from perfect health to her grave within seven years,” she says. “The message I got was that what had happened was extremely shameful and that we had failed as a family.”
辛普森女士坚信，她补充道，“我父母绝口不提。七年后，母亲安然离世”“我从中认识到已经发生的事情令人羞耻，而且作为家人，我们很失败。”