In the 2018 documentary Suicide: The Ripple Effect, Kevin Hines boats through the fog where the San Francisco Bay opens up into the Pacific Ocean and looks up at the massive Golden Gate Bridge. There, he reflects on how 18 years earlier, he climbed over the railing and jumped in an attempt to end his life. “I was compelled to die,” he says. “I didn’t get on any cord or ledge to be talked back over. I was in free fall, and I remember that moment of free fall occurring — that second of free fall — and then instant regret… and the thought that it was too late.”
A 245-foot fall from the Golden Gate Bridge lasts approximately four seconds, and due to the potential for internal injuries, drowning and hypothermia, there is a 98 percent fatality rate. However, in that four-second window in which Hines changed his mind, he repositioned himself to hit the water feet-first. Then, in a twist of fate, he was spotted by the Coast Guard and able to stay afloat (with the help of a sea lion) until they could rescue him. His trauma nurse from that day says that all Hines kept repeating through wails of pain from a severe spinal cord injury was that he was sorry.
Beyond the movie, Hines was also featured in a 2003 New Yorker article entitled “Jumpers.” In it, Tad Friend wrote, “Survivors often regret their decision in midair, if not before.” Along those lines, only 36 people have survived the jump Hines attempted (more than 1,600 have perished from it), but nearly all of them have spoken publicly about their regret afterward. In that way then, the Golden Gate Bridge serves as a symbol of both tragedy and impulsivity. “Impulsivity coupled with psychological pain and hopelessness that things can and will improve is a formula for suicide,” therapist Hailey Shafir tells me. “All people are impulsive in nature, and we become more impulsive when we’re emotional, upset, stressed out and in danger.”
Research shows that impulsive tendencies can make people more likely to act on suicidal urges, and one study in particular found that impulsivity “may actually be a more significant indicator of suicide attempt than the presence of a specific suicide plan.” As such, impulsivity has been highlighted as a risk factor for chronic and acute suicide attempts by the American Association of Suicidology, American Foundation for Suicide Prevention and Substance Abuse and Mental Health Services Administration. Unfortunately, though, it’s often harder for family and friends to spot before it’s too late.
Clinically, impulsivity is described as the tendency to make fast and frequently precarious choices without thinking of future consequences. Impulsive behaviors are almost always provoked by extreme emotions that cause the amygdala to override the frontal lobes of the brain, the part that deals with executive functioning, or cognitive processes connected to memory, self-control and flexible thinking. People who have limited executive functioning have trouble focusing, following directions, managing their emotions and thinking about the future.
When someone is in such a state of psychological pain that they believe death to be the best choice, impulsivity makes it harder to slow down and consider alternatives. Further complicating matters, impulsivity can sneak up on you quickly, and manifest in different ways — e.g., people can be impulsive when they’re happy and when they’re suffering. No one is immune to its perils either because it’s deeply rooted in our survival instincts; impulsivity is essentially the primitive, universal and frequently flawed urge to seek pleasure and avoid pain at all costs.
That’s why psychologist David A. Jobes, who has studied suicide de-escalation for more than 30 years and created a therapeutic framework for assessing and treating suicidal urges known as Collaborative Assessment and Management of Suicidology, doesn’t just look for just depression and sadness when making an assessment. “If 132 Americans die today on average by suicide, about half will be depressed, the rest will be anxious, psychotic, substance abusing,” he explains. “We look for anything that creates agitation or irritable states where someone may lose control. Agitated depressions are always more worrisome than dysphoric depressions in terms of behaviors and loss of control.”
Jobes has found that the problems that tend to compel people to take their own lives usually fall into three categories: 1) relationships; 2) work/money problems; and 3) how a person feels about themselves. Shafir adds that the same goes for high-risk behaviors such as unprotected or anonymous sex, gambling and excessive spending. “The more dangerous, the higher the risk and cause for concern,” she says. She also stresses how much alcohol abuse in particular increases suicide risk, mainly because it limits executive functioning even more. “Alcohol and impulsivity is a dangerous mix,” she tells me. (To that end, agitation, too, can be aggravated by intoxication.)
Moreover, the tendency to have violent, emotional outbursts with family and friends can be indicative of dangerously low levels of impulse control as well. Studies show a correlation between impulsive suicides and aggression, an especially challenging warning sign because it could involve enduring abusive behavior. Per Patricia Celan, a medical doctor and psychiatry resident at Dalhousie University in Canada, this is especially true for people with “Cluster B” personality disorders, which notably include those who struggle with strong emotions, turbulent relationships, high-risk sexual behaviors and substance abuse.
Surprisingly, Celan is cautious to blame impulsivity for why men are three to four times more likely to die by suicide, even though they tend to exhibit more impulsive behaviors (a la substance abuse, gambling and violence). If impulsivity did account for the number of male suicide fatalities alone, men would also attempt suicide at a higher rate than women, which isn’t true. Notably, although men die by suicide at higher rates, women attempt suicide in greater numbers. “The main reason why male suicide attempts have a higher fatality rate than female suicide attempts is because men tend to use more lethal methods,” Shafir explains.
Jobes is similarly cautious about pointing to impulsivity as a catch-all warning sign, and acknowledges some debate in his field on the subject. “There are many who believe impulsivity in suicide is overrated, and that people rarely kill themselves impulsivily ‘out of the blue’ so to speak,” he tells me.
To be fair, Hines didn’t just wake up one morning in 2000 and decide to jump off the Golden Gate Bridge. He had experienced paranoid and suicidal thoughts ever since he was diagnosed as bipolar in high school. That said, a growing amount of recent research suggests that planned suicides are pretty rare. Though a person may have thought about suicide many times before, the final moment when they decide to climb over a guard rail and jump can be chalked up to impulse. Nor does a suicide note necessarily negate the impulsive nature of the act. “I’m more in the camp that contends that existing suicidal thoughts may be turned into action when people get extremely upset,” Jobes says.
It’s these extremes that Jobes and crisis interventionists like him are looking for — so they can walk people back from them. While focusing on the relationship, employment and/or self-esteem issues that lead to suicidal acts, clinicians educate individuals on what exactly is happening to their brains in these crisis states, and how to safely ride them out. Overall, the goal is to increase healthy coping skills when people have suicidal thoughts, and over time, reduce the frequency of these impulses through therapy, medication, substance abuse treatment and other interventions.
“We believe that effective care requires educating the patient as to the who, what, when, where and why of becoming suicidal so they can learn to manage crisis states while we treat the issues that make them consider suicide,” Jobes explains. “Our data shows this approach is more valuable than focusing on impulsivity and depression per se.”
“Thankfully, impulse control isn’t just an inherent trait — it’s also a skill that can be practiced, strengthened and improved,” Shafir notes. Cognitive behavioral therapy, meditation and other mindfulness practices like prayer and breathing exercises can all help us fend off the fight-or-flight mode that impulsivity thrives in. “Most people have impulses every day that they don’t act on, and so, they’ve already developed this skill in other areas of life. They just need to be able to transfer it.”
She (and Jobes and Celan) operate on the assumption that even the most psychologically distressed person has the ability to access this rational part of themselves if given enough time for the frontal lobes to re-engage — it takes about 20 minutes to come out of the fight-or-flight response that drives impulsivity, and several studies show that the longer people sit with suicidal feelings, the less likely they are to act on them.
“I strongly believe that people who commit suicide don’t actually want to die,” Shafir concludes. “They just want to end their pain and suffering and have come to believe that death is the only way out.”