December has arrived, and winter is nearby. Daylight in the Northern Hemisphere is in increasingly short supply, but we believe the sun will stop dropping toward the horizon and provide more daylight hours after December 21, the so-called winter solstice. Many cultures that preceded the European invasion of the Americas were less certain that spring would follow winter and offered their gods various sacrifices to assure their cooperation. Then, as now, the priests or the religious institutions for which they worked, were the principal beneficiaries of the god-intended gifts, except of course in cases involving human sacrifice. The winter solstice must have inspired special dread in the young children who had misbehaved during the prior year. However, given the crowded state of our planet at the present time, we must conclude that not many children were offered up to the gods on past solstices. The gifts to the gods apparently were nonetheless sufficient to assure the annual resurrection of the sun and its associated benefits.
Many people have fear and loathing of the darkness. This has led to the assumption that suicide rates would inevitably rise as the sun fell. The winter months should produce the isolation and relative immobility that incline depressed people to seek a way out of their misery. Logic suggests that with long nights much time will be spent rehashing mistakes and reviewing missed opportunities. Old grievances will become overwhelming, and hopelessness will spur the affected individual to look for a quick and reliable way to end his or her suffering.
The Diagnostic and Statistical Manual of Mental Disorders DSM-5, the official compendium of psychiatric disorders as assembled by various authorities on human misery, identifies a recurrent, annual episode of despair linked to specific times of the year as Seasonal Affective Disorder, not coincidentally referred to as SAD. Despite the assurances of psychiatrists and psychologists who voted to make SAD a recognized (and billable) mental disorder that winter is bad and summer is good, statistics say otherwise.
Statistics were invented to keep people from fooling themselves. If every member of a community believes that a witch’s curse can kill or otherwise harm them, a lot of rope will end up being wasted hanging people. Statistical methods help avoid this improper expenditure of hemp by eliminating what human observers believe is obvious and relying upon impartial methods that get us closer to the truth.
Statistics indicate that the winter months are not the killer months. In the United States, there is an annual peak in the suicide rate, but it comes in late spring or early summer. Men are affected several times more often than women, and older men commit suicide more often than younger men or women of any age. More than half of the suicides in the United States involve self-inflicted gunshot wounds. [The Supreme Court recently ruled that states cannot impose waiting periods for the acquisition of a firearm. This ruling increases the likelihood of firearm-related suicides in individuals who are acutely or transiently depressed.]
The early twentieth century, British poet, T.S. Eliot claimed in his epic poem The Wasteland, “April is the cruellest month.” He wrote the poem after World War I when the belligerents were still reeling from the enormous carnage suffered during that war. The arrival of spring and the natural rebirth occurring outside the human sphere seemed to mock the pain and suffering that people all over Europe were still experiencing. Plants and animals proceeded with their annual activities, obviously indifferent to the deaths of hundreds of thousands on the battlefields of Europe.
His designation of April as the ‘cruellest month’ was not meant as a scientific observation, but he may have intuitively hit upon a less than obvious phenomenon. Why there is a spike in the occurrence of suicides in late spring and early summer may be related to the burst of energy and activity typical of this time of year. Severely depressed people may become more despondent when they observe the people and world around them emerging from the winter doldrums with energy and initiative that they do not share. Alternatively, there may be purely chemical reactions triggered by the seasons that make us more vulnerable to self-destructive acts.
Whatever the reason or reasons for seasonal increases in self-destructive activities, suicide must be treated as a major health issue. The depression leading to suicide routinely causes collateral damage to friends, family, and coworkers. Obviously, the most destructive situation is the one in which the suicidal person decides to target other people in his or her final act of annihilation. This puts all of us at risk and obliges all of us to be vigilant when a person exhibits abrupt changes in demeanor or behavior. We must not attribute these worrisome transformations to a ‘bad day’ or week or month. What affects each of us inevitably affects all of us.
Dr. Lechtenberg is an Easton resident who graduated from Tufts University and Tufts Medical School in Massachusetts and subsequently trained at The Mount Sinai Hospital and Columbia-Presbyterian Medical Center in Manhattan. He worked as a neurologist at several New York Hospitals, including Kings County and The Long Island College Hospital, while maintaining a private practice, teaching at SUNY Downstate Medical School, and publishing 15 books on a variety of medical topics. He worked in drug development in the U.S., as well as in England, Germany, and France.
