Suicide Prevention in Schools as Viewed through the Interpersonal-Psychological Theory of Suicidal Behavior

I have proposed a new theory of suicidal behavior--the interpersonal-psychological theory of suicidal behavior (Joiner, 2005)--which attempts to answer the question "Why do people die by suicide?" In this commentary, I briefly describe the theory, and then argue that the theory's constructs may allow a new level of focus and specificity for suicide prevention in general and for school-based suicide prevention in particular. In so doing, I discuss my colleagues' findings and concepts from this special series and suggest some avenues for future research. The Interpersonal-Psychological Theory of Suicidal Behavior Why do people die by suicide? The theory's answer is, in a phrase, "because they can, and because they want to." But what differentiates those who can from those who cannot die by suicide? Among those who want to die by suicide, what exactly are the ingredients of the desire for death? In answer to the first question of who can die by suicide, the theory is influenced by the fact that humans (as well as other organisms) are not wired for self-destruction. On the contrary, evolution has imbedded self-preservation within us as a deep and powerful force. In this context, the theory asserts that lethal self-injury is associated with so much fear and/or pain that few people are capable of the act, including even most of those who desire death. According to the theory, the only ones who are capable of death by suicide are those who have been through enough past pain and provocation (especially involving intentional self-injury, but not limited to it) to have habituated to the fear and pain of self-injury--habituated so much that the self-preservation urge can be overcome. In varying degrees, any experience that produces substantial pain and/or fear may further this habituation process, including injury, accidents, violence (either as victim, perpetrator, or witness), and daredevil behaviors, to list just a few examples. These habituation experiences produce the capacity to enact lethal self-injury, a construct that is central to the theory. A crucial point of the theory, however, is that capacity does not necessarily entail desire. For instance, those who become expert in the martial arts have the capacity to inflict physical harm upon others, but except in self-defense situations, they do not desire to do so, and so do not. Similarly, there are many people who have become fearless and inured to pain to the degree that they have the capacity to inflict lethal self-harm, but they do not desire to do so, and so do not. Along with capacity, desire also is required. What, then, constitutes suicidal desire? The theory's answer is the sustained co-occurrence of two interpersonally relevant states of mind: perceived burdensomeness and failed belongingness. Perceived burdensomeness is the view that one's existence burdens family, friends, and/or society. This view produces the idea that "my death will be worth more than my life to family, friends, society, etc."--a view, it is important to emphasize, that represents a potentially fatal misperception. Failed belongingness is the experience that one is alienated from others and not an integral part of a family, circle of friends, or other valued groups. When people simultaneously experience perceived burdensomeness and failed belongingness, the theory asserts that the desire for death develops because of the perception that there is nothing left to live for. To summarize, why do people die by suicide? The three factors just noted are proposed as answers to this question. Who can? Those who, through habituation, have acquired the capability to enact lethal self-injury. Who wants to? Those who perceive that they are a burden on loved ones and that they do not belong to a valued group or relationship. Who dies by suicide? Those who both can and want to. A full review of the evidence that bears on this theory is beyond the scope of this commentary, but abundant anecdotal and empirical evidence supports it. …