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On February 20, 2005, the writer Hunter S. Thompson died by suicide at his home in Woody Creek, Colorado. To many observers, the death of Thompson, the author of the American classic, Fear and Loathing in Las Vegas, and the progenitor of "Gonzo Journalism," felt like the ending of an era. One person described his passing as, "The final nail in the coffin of the Woodstock generation."
Mr. Thompson left a suicide note that was discovered by his family. It is reproduced here:
Football Season is Over
No More Games. No More Bombs. No More Walking. No More Fun. No More Swimming. 67. That is 17 years past 50. 17 more that I needed or wanted. Boring. I am always bitchy. No Fun — for anybody. 67. You are getting Greedy. Act your old age. This won't hurt.
As suicide notes go, this one is unusual in that it has a title ("Football Season is Over"). Perhaps we should be surprised to find that in the suicide note of a writer. Most people who die by suicide don't leave notes — only about a third of victims do. There is no research that I know of which suggests that professional letters are any more or less likely to leave suicide notes.
The content of the title is what is important — Mr. Thompson, a lifelong sports fan and accomplished sports handicapper, did indeed die after the conclusion of the National Football League season. Could it be that he had been hanging on, despite a crippling, suicidal depression, just to see what the next week of games would bring? On Tuesdays, he might look forward to a Thursday night game, on Friday to the Sunday contests, and Monday to that night's game. Future orientation becomes increasingly absent during a suicidal crisis — having some small thing to look forward to can make all the difference.
So, indeed, "No More Games." The "Bombs" he refers to could be the typical "bombs" or long passes of American football. Or they could refer to Mr. Thompson's erstwhile pastime of igniting propane tanks by firing into them with deer rifles. Such tanks don't just explode — they often take off into unexpected directions, creating a mad circus experience of the kind that Mr. Thompson had formerly delighted in. To think that such pranks no longer amused him points to our second consideration regarding the suicidal mind: Anhedonia.
No More Fun. I have not read a better description of what it feels like to experience anhedonia, which we clinicians lamely define as a decreased ability to experience pleasure. But to the anhedonic individual, the world can literally look gray, food might taste like ashes, a friendly hug could feel like a vise. As people age, they often experience an increase in depressive feelings. One reason for this is that their sensory acuity is decreased: Objects in the world don't look as sharp, and perhaps, not as beautiful. Flowers do not smell as sweet. Food loses its savor. Imagine if you never again could experience the pleasure of eating. For many of us, eating provides the bulk of our daily allotment of pleasure. Take that away, take away almost all pleasure, and life might quickly seem as if it is no longer worth living.
Mr. Thompson seems to suggest the presence of some physical infirmities ("No More Walking...No More Swimming") as well. Physical illness is a risk factor for suicidal behavior, often because of how it interferes with our ability to experience pleasure. Taking away our preferred activities, and life becomes, as he writes, "Boring."
He comments that he is "No Fun -- for anybody" and that he is "always bitchy." It is well known that depression in males often takes a primary presentation of irritability or grouchiness. It is further known that one fatal ingredient in a suicidal crisis is feeling like a burden to other people, feeling as if other people would be better off if you were no longer around. For most people, this conclusion is ill-formed and can be gently disputed by a clinician, thereby keeping the individual alive. But left to one's own devices, a suicidal crisis is often marked by "cognitive constriction" that makes suicide seem like the only possible solution to the present problem.
It is particularly important to notice that the act of writing the note seems to have played a role in Mr. Thompson's suicidal decision-making process. In short, he seems to be trying to talk himself (or even to taunt himself) into death by suicide: "You are getting Greedy. Act your old age." The important point here is that no one is ever 100% determined to die. There is always some part of you that wants to live. The great American suicidologist Edwin Shneidman used to say, that to understand ambivalence in suicide, one should imagine "a man cutting his throat and crying for help at the same time."
Mr. Thompson seems to try to console himself that the act of suicide "won't hurt." His choice of method, self-inflicted gunshot, is lethal in most cases. However, there is no evidence that it is painless. Very few people know that self-inflicted gunshot is fatal just 85% of the time. This is down from 93% in the 1990s. We have made tremendous advances in emergency medicine over the past few decades. We have Life Flight helicopters in the smallest towns in the country. We can keep you alive and get you to a Trauma One medical center in less than thirty minutes. But many of those survivors suffer horrific brain injuries and disfigurement and end up spending the rest of their lives in nursing homes.
In sum, we have in this short note, a useful recapitulation of many of the risk factors for suicide. We have demographic risk factors — an older, White male with a history of substance abuse problems, and access to and familiarity with firearms. There is anhedonia, physical problems, and perceived burdensomeness. There is hopelessness — the conviction that none of this will ever get better. And there is the tragically mistaken belief that death by suicide is the only solution to one's present pain.
