Letters

In my 2015 book, “Too Much of a Good Thing,” I described four key survival traits that have enabled humans to stay alive for over 200,000 years. One of these was the hypervigilance needed to avoid getting killed—no small feat in prehistoric times, when violence caused up to a quarter of human deaths. Though it seems counterintuitive, some of the mental illnesses that can precipitate suicide derive from the related survival traits: the anxiety and phobias needed to avoid life-threatening situations, as well as the withdrawal and temporary depression that give us time to recuperate after a loss. We also need to know when to fight, when to flee, and when to be submissive if we can’t win or escape. 

Over time, however, violence has declined, and the world has gotten much safer. Unfortunately, this decline in violence is partially offset by the fact that suicide is now about twice as common as murder in the United States today. More U.S. veterans and active-duty service members die each year from suicides than the total American military deaths in Afghanistan and Iraq. Even when guns are involved, suicides outnumber murder and all other causes combined. As a result, the same hypervigilant, fear-driven survival mechanisms that helped our ancestors know, learn, and remember how to avoid getting killed now are counterproductive because of the anxiety, phobias, depression, and even suicide that they can cause. 

For individuals, the pain caused by sadness, hopelessness, and depression—inadequately treated if treated at all—is what usually leads to suicide. Suicide also can be linked to losing social contact with family and friends (egoistic suicide), to the failure to achieve desired goals (anomic suicide), and to frustration about an inability to fight the system and make things better (fatalistic suicide). Suicide is far more common among people who abuse drugs and alcohol. The alcohol and drugs probably directly contribute to the risk of suicide, but we also know that drug and alcohol abuse can be precipitated by the same emotions that precipitate suicide.

For nearly 200,000 years, our ancestors fought a veritable arms race between developing more sophisticated ways to kill and designing better defensive strategies to avoid getting killed. The good news is that the defense is winning. The bad news is that the balance has tipped to the point where our defenses against being murdered are now precipitating anxiety and depression that are killing more of us than the violence they were designed to avoid. Suicide is the 10th most common cause of death in the United States and the seventh leading cause of lost years of life. Depression is the fifth leading contributor to years lived with disability. 

Regardless of the reasons behind the statistics, we all can agree that these numbers are too high. I invite you to explore the articles inside this issue to learn about the progress being made at Columbia to understand and prevent suicide. Our researchers and experts are doing their part to turn the hypervigilance of our ancestors into research and new treatments that will reduce the number of lost years and lost lives.

With best wishes for a happy and healthy 2020,

Lee Goldman, MD
Dean

Editor's Note

Remembering a Staff Member

Avichai Assouline. Photo by Brian Winkowski.

Inside this issue you will read about “Life After Suicide,” the book Jennifer Ashton’00 wrote about her family’s recovery from a loved one’s death. Stigma helps hide many suicides, but they touch more people than many of us realize. In July, the Columbia Medicine staff endured its own experience when our editorial assistant for 2½ years, Avichai Assouline, died by suicide. He was a talented writer, a gifted filmmaker and screenwriter pursuing a master’s degree, and a valued contributor to the magazine in myriad ways. In the last three months of his life, Avi had opened up about being diagnosed with borderline personality disorder. Echoing Dr. Ashton’s rationale for writing her book, Avi decided to talk about his diagnosis to reduce the stigma associated with mental illness and suicide ideation. Avi died when living with his mental illness became unbearable, and even though his byline does not appear in this issue, his inspiration informs every word of it.

—Bonita Eaton Enochs

Remembering a Mentor

I was very saddened to read in the spring/summer edition of Columbia Medicine of the passing of Ralph James Veenema, MD. He was one of my mentors during my 1966-1970 residency at Squier Urological Clinic. He was a very meticulous surgeon with a very precise analytical mind.  When we presented surgical cases to him he would ask penetrating questions re: the reasoning behind our choices. In cancer cases, he would stress whether we were operating for “curative” or “palliative” reasons. In dissection, he abhorred blunt finger dissection and preferred precise instrument use for controlled dissection. He did not favor the classic suprapubic prostatectomy because it was not precise or controlled. He much preferred the retropubic transcapsular approach where you dissect under direct vision. He even perfected a specialized retropubic prostate retractor (named after him). After I entered private practice in Miami, Florida, I would, at times, have surgical cases where I realized I was analyzing and planning a procedure and asking myself the same questions that Dr. Veenema asked of us during these residency years. He had a great influence on me and many of his other residents. 

Ian Nisonson’62
Via emai