Is there any subject that is more challenging than suicidality? It is an enigmatic and unpredictable phenomenon— for mental health professionals as well as for others. Even experts on suicidality are uncomfortable with the expectation that we can predict when someone might choose to end his/her/their life. (This does not mean that we have not developed useful ways to help people who have suicidal thoughts[i]). When humans put an end to their lives, it produces fear and distress in others, and it can be haunting for communities. In a recent New York Times article, Jordan Kisner tells the story of how Worcester Polytechnic Institute (WPI) coped with the shock of 7 suicides in an 8 month period from July 2021 (https://www.nytimes.com/2024/01/22/magazine/worcester-polytechnic-institute-suicides.html). The article focuses on how the community responded to the multiple suicides, and, in many ways, tells a bittersweet tale of people struggling admirably to come together and do their best under tragic circumstances.
In one sense, what happened at WPI is singular and ought to be understood in terms of a particular institution at a particular moment in time. In another sense, life in America is permeated with events of violence—just think of the well-documented increase in mass murders, many of which at educational institutions (https://www.statista.com/statistics/811487/number-of-mass-shootings-in-the-us/) There is a significant difference between killing others versus killing oneself, yet we should not overlook how often mass murders, in fact, entail suicides as well as homicides. So many communities have had to adopt the motto of “X strong” in trying to come to terms with multiple deaths. There has been a documented increase in suicidality amongst young people, especially among African-American youth (https://www.apa.org/monitor/2023/07/psychologists-preventing-teen-suicide). And we can only wonder what it means for young people to live in such a society (https://www.nytimes.com/2024/01/29/upshot/teens-politics-mental-health.html).
Let us review some of the particularities of what happened at WPI from the journalist’s account. The story begins with the first suicide by a Chinese American student and the pained reaction by one of his professors, Katherine Foo. This foreshadows one of the key themes in the article: how much obligation should professors have to monitor risk and intervene with students? If professors ought to have greater obligations, given the increased risk among college students, it certainly becomes crucial for training to be provided for support (and to stop short of expecting professors to serve as competent mental health professionals).
Kisner next introduces us to the dean of arts and sciences (and professor of biology and biotechnology), Jean King, a distinguished professor, whose work focusses on stress amongst minoritized people. She emphasizes the discomfort and difficulty for our brains to be able to accommodate unpredictability, as happens with suicide. The administration’s first step was to set up an emergency task force, chaired by King, “to recommend data-backed interventions to the growing mental-health crisis on campus.” Kisner notes that WPI is a STEM-focused research university that emphasizes applying knowledge to practical problems. Moreover, she identifies the atmosphere at the university as competitive, mostly male, and with a high number of neurodivergent and introverted students who likely struggle with sustaining social bonds. The risk level at WPI for suicide is deemed as high, especially when you add the pandemic into the mix.
It is worth considering the research-driven approach that the administration at WPI endorsed. It exemplifies what Kisner labels as the school’s empiricist approach—to collect and analyze data, before moving ahead with a strategy. The work fell upon two women professors (one of whom was an assistant professor) who clearly did their best, charged with an overwhelming task. Their findings identified the issues of intense academic pressure, insufficient self-care habits among the students, lack of social connection, insufficient awareness of information about the existing health resources, and pandemic burnout. In addition, a second task force was created to oversee implementation, and an outside trauma center from Boston was invited to conduct a review of the university’s mental health practices.
Besides specific changes like hiring more counselors and increasing available training for faculty (and some other concrete suggestions), there was an emphasis on faculty taking on more responsibility—seeking to know students as whole people and incorporating discussion about their own struggles in the classroom. Not surprisingly, this caused a reaction from some faculty members who worried about incurring excessive responsibility. Moreover, as is well-documented in the article, the extra labor added to the faculty load tends to be distributed unfairly to women, trans and non-binary people, according to an independent study by Healthy Minds (https://www.bu.edu/sph/news/articles/2024/addressing-college-mental-health-cannot-fall-solely-to-the-campus-health-system/). It is sufficient for faculty to be trained to identify students in need of help and to send them to college counseling centers, rather than inviting them to contend with the students themselves. This would require that training for all faculty should be mandatory, not optional, and that staffing at counseling centers would have to grow significantly.
Well into the crisis, the recommendation from the task force on implementation included the idea of not commemorating the deaths (at that point 7 in 6 months), which they saw as potentially increasing the risk of contagion. This caused consternation amongst some students and parents, leading to a student group organizing a support walk, which garnered lots of support. Nevertheless, the community at WPI has become inspired to work together—the story of a janitor in a dining hall requesting to come to a training session about identifying students in need of help is presented as one shining example. In early 2022, WPI opened a new center for well-being and implemented a series of things like a care team that follows up about concerns raised about students the same day. While the community has clearly undergone a series of traumas, it is in the process of forging a “new vanguard: the academic institution as a wellness community.”[ii] Consistent with its identity as a tech university, WPI is also undertaking new ventures, like partnering with the UMASS medical school to create an A.I. mobile app designed to assess suicide risk among college students.
Ironically enough, the article ends with Dean Jean King expressing what amounts to being plain old wisdom: that community means coming together, acknowledging your own vulnerability to others, and conveying that you will not leave them alone. This seems less like a research-driven insight than a matter of common sense. Research can produce surprising results, and it can endorse results that we expected, thus giving us more confidence in those beliefs. It is consoling to remind ourselves, though, that human wisdom, accumulated over time, has a place and deserves to be valued and even treasured.
Understandably, the focus of the article is about how multiple suicides impacted a community and how the university has responded. Less attention was given to the suicides themselves, which is a legitimate choice. As a mental health professional, however, I wondered about these cases over and beyond some of the identifiable warning signs, like social isolation. Given the unpredictability of suicide, it is difficult to identify less immediate and less behavioral factors that predispose someone to consider suicide. However, this is a place where research can point us in a fruitful direction. For example, post-mortem suicide research on neurobiology has been productive (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3061474/).
There is also research that suggests that averse childhood experiences (ACEs) can contribute to suicide (https://www.ajpmonline.org/article/S0749-3797(17)30205-2/fulltext) and https://pubmed.ncbi.nlm.nih.gov/18439446/), as well as diathesis models of stress, that seek to link ACEs and neurobiology (https://pubmed.ncbi.nlm.nih.gov/27484207/).
It makes sense that early traumas might interfere with the development of coping mechanisms that can help to right the ship in the face of adversity. Of course, not everyone who has a history of ACEs is tempted by suicide, so there is room to tease apart those who are suicidal versus those are not. The point still stands that assessing suicidality ought to include investigation of life history with attention to ACEs.
Investigating life history and ACEs is not a magical solution for preventing suicide. It is not postulated as a smoking gun. I understand it as part of the overall assessment of risk. What seems important is not to focus exclusively on someone’s current circumstances, thus failing to take account of autobiographical memory and history. However tempting it is to prioritize immediate states of mind, exploring the past and assessing how much that is a factor are necessary components of evaluating a suicidal patient.
In conclusion, there is so much we do not know about the WPI suicides. Did any of the suicides seek help? What was that experience like for them? Was there an effort to inquire about their histories? How sad it is for anyone who tried to help (or would have like to have tried to help) to deal with these suicides. The WPI community has taken constructive steps forward as an institution; yet, the sadness remains in the voices we hear and is not likely to disappear in the near future.
[i] A good example is the Stanley-Brown Safety Planning Intervention:
https://suicidesafetyplan.com/
[ii] Some letters in response to the article question how much has changed at WPI.