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Suicide in America
美國自殺事件
An awful hole
令人發指地無底洞
Why more Americans are killing themselves
為何越來越多美國人自殺
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.
亞特蘭大的一位商人覺得，壓抑苦悶和劇烈頭痛一樣，這種痛苦休息幾天都無法消失：“你只想堅持下去。”雖然他努力變“man”一點，但卻沒有想辦法解決問題，反而想藏起來。他解釋道，“所有的一切讓人筋疲力盡，很想放棄。”
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殺；幸運的是，他的嘗試都是徒勞的。然而，美國可沒有那么幸運，因為自殺率攀升。自殺率從2005年10萬人中的11%增加到2012年的13%。在你讀這篇文章的時間里，6位美國人將會自殺，而且十分鐘之后會有一個人自殺成功。
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.
據美國自殺協會研究，2012年，在美國自殺人數超過4萬，多于死于車禍的人數。自殺多發在五月的星期一。懷俄明州和蒙大拿州的自殺人數最多，原因或許是槍支的普及（開槍自殺比吃藥來的快）。全國范圍而言，開槍成功自殺的事件占到所有自殺事件的一半。
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.
究竟是什么原因讓人自殺？毫無疑問，那些苦悶壓抑的人正是自殺高危人群。日子不好過也會促使人自殺。大蕭條時期，自殺率攀升至10萬人19%，創歷史新高。近期金融危機之后，自殺人數也增多。羅切斯特大學醫學中心精神病專家葉芝·康威爾表示，“甚至就業難”也會讓人們陷入煩惱中。
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.
一般說來，如果75歲以上的人孤苦伶仃、罹患疾病，則很可能自殺。然而，如今，自殺高危人群則是中年人。2012年，美國45-54歲的自殺率是10萬人20%—成為美國國內年齡段之最。而55-64歲則是18%，65歲以上的則是15%。人到中年，壓力大；因為人到中年才幡然醒悟，年少夢想永無實現之日。
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.
有自殺企圖的女性人數是男性的四倍，但是男性自殺成功率確實女性的四倍之多。男性傾向更加暴力的自殺方式：大部分用槍（不到33%的女性也用槍）。女性或許更加善于尋求幫助；總體來說，女性服用抗抑郁劑的幾率是男性的2.5倍。白人自殺的幾率是非洲裔美國的3倍。黑人用槍自殺的幾率是被謀殺的五分之一（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.
退役軍人尤其傾向自殺。48個州的數據顯示，每年10萬名退伍軍人中有30名自殺——其自殺率遠高于平民。許多老兵很難從戰爭創傷中恢復過來，也很難適應退伍生活。一項由參加伊拉克和阿富汗戰爭的美國退伍老兵（一個倡導性組織）發起的調查發現，31%的老兵考慮過自殺。國會正在考慮一項法案，改革退伍軍人事務部處理此類問題的方式。
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.
激進分子稱政府沒有采取措施防止自殺。今年，聯邦僅撥款4000萬美元投入到自殺預防項目中，美國自殺預防基金會的Christine Moutier對此表示不滿。款項不包括政府在精神疾病以及其他疾病的撥款。
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.
抗抑郁劑等療法往往效果顯著。超過20項研究表明，若抗抑郁劑更易購買，那么選擇輕生的人會減少。例如，1991-1996年之間，瑞典人服用的抗抑郁劑用量超過240%，自殺率下降19%。但是，很難證明這是一個偶然。而且其他研究表明服用某種抗抑郁劑讓年輕人更加想輕生。
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.
令人吃驚的是，讓自殺變得更困難也是防止自殺的有效方法之一。美國藥劑師依然在兜售液體止痛藥，如此一來，人們只需一個動作就可以吃下一大堆止痛藥。此舉絕非明智。1998年，英國人使用罩板包裝，這樣一來，人們必須一個一個擠壓藥片，之后的11年間，因過量服用對乙酰氨基酚（泰諾的主要成分）致死的人數下降了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%.
考慮自殺的人可以通過咨詢他人，打消自殺念頭。獨自一人行為療法或者家庭集體行為療法讓困惑者說出自己的心情。丹麥，一項由65000名（1992年-2010年考慮過自殺的）人參加的調查顯示，在一個“安全、保密的”場所暢所欲言，十場談話下來，有過自殺想法的人數減少了逾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.
美國3個州認為，并不是所有的自殺都應該阻止。在俄勒岡州、華盛頓和佛蒙特州，“尊嚴死”法律允許身患絕癥而心智健全的居民尋求處方藥物安樂死。諸如此類的法律對于無助的自殺事件來說毫無意義：在俄勒岡州，1999年到2010年35-64歲之間自殺的人數增加了49%，該期間全國范圍自殺人數增加了28%。俄勒岡州自1997年便通過了“尊嚴死”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.
那么剩下的人該怎么辦呢？研究顯示，一場自殺，關聯了與死者相關的6個人的命運。自1988年以來，500萬美國人因自殺而失去了另一半。喬治亞州的咨詢師克里斯蒂·辛普森深知很難啟齒自己愛的人跳樓自殺，她的母親要她告訴朋友，自己的姐姐是死于一場車禍。
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.”
辛普森女士堅信，她補充道，“我父母絕口不提。七年后，母親安然離世”“我從中認識到已經發生的事情令人羞恥，而且作為家人，我們很失敗。”譯者：黃柳
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