In a book published in February 2024 by NYU Press entitled The Varieties of Suicidal Experience: A Unification, I described a young mother facing imminent death from cancer. Two professors and proponents of physician-assisted suicide opined of the young mother, “… She will fight, struggle, hang on as long as possible… for [her], it’s not about autonomy or avoiding suffering. For her, it’s about being the mother of those kids until every last breath is taken… Sadly… ironically… her dying legacy may be more difficult for her family because she struggled so mightily.”

I object.

Consider the sentiment of that last sentence, namely, “She suffered greatly.” Compare it to another that puts it into the context in which it belongs, specifically, the family context, the interpersonal context: “She suffered greatly for us.” About this revised sentence, I wrote “A mere two words open new worlds of meaning, shifting the family’s viewpoint from ‘that was grievous’ to align with the young mother’s, ‘that was hard, even at times regrettably so, but I did it for you, and I would do it again.’ Is the latter not brave and moving? What about it is sad or ironic?”.

Inherent to human nature is its gregariousness, its strands of devotion, care, loyalty—what the novelist and Nobel Laureate William Faulkner characterized as “… the old universal truths lacking which any story is ephemeral and doomed—love and honor and pity and pride and compassion and sacrifice.” Conceptualizations of human nature that overlook its deep sociality are thereby impoverished. Similarly degraded are viewpoints that refract these virtues back onto the self, excising their vital interpersonal character; notice, for example, the change in Faulkner’s “old universal truths” when they are rendered recursively—not love, but self-love; not pity, but self-pity; and not compassion, but self-compassion. Doomed and ephemeral indeed.

I realize of course that notions like self-compassion and self-forgiveness are popular and fashionable. What I struggle to understand is why that matters—for once upon a time, so were bell-bottoms popular and fashionable, to take one of a sea of possible examples. Put differently—self-awareness being one of the quite few tolerable recursions—I am aware that, in addition to being old, I sound and in many ways am old-fashioned, unapologetically so. And true to form, I insist that Faulkner, as was his wont, was right about eternal human verities—ones that do not come and go, bell-bottom-like—and it is revealing that most of them were interpersonal in emphasis, as were much of the sentiment and ethos conveyed, for example, in the American Founding Documents and elsewhere in works of significance and even genius.

Social connection is our daily bread, and in its absence, we do not thrive. What else is our daily bread? Our daily bread for one thing. For another, sleep; for a third, physical movement; and for a fourth, interactions with the natural world, including sunlight, flora, and fauna. All just as they have been for time immemorial, the vast of majority of which knew nothing—rather mercifully—of anything else, certainly to include TikTok, Starbucks, Burger King commercials (“… like a king… you rule…”), and the like. If all those ancestrally relevant things such as nutrition, sleep, sunlight, and physical activity are what is meant by phrases such as self-care, then I am enthusiastically in favor. I fear, however, that that is regularly not what is meant by such phrases, that what is really intended are self-regarding things like self-affirmation, things that would inspire boredom and puzzlement in American heroes as varied as Sojourner Truth, Neil Armstrong, and Zora Neale Hurston, the kinds of people who had far, far too much to do to have time left over to gaze into a mirror and say things like “I love me” and “I am my best ally,” the kinds of people who may even burst out laughing at the idea, not because self-affirmations are inherently laughable in each and every case—I suspect they are helpful for some people and I am all for whatever helps, especially for people who are suffering—but, revealingly, they would never have even occurred to minds like those possessed by Hurston, Armstrong, and Sojourner Truth.

Having laid the foundational context of essential aspects of our very nature, I turn now to consider the papers in this special issue in light of them. Hamilton et al. (2024) found evidence of an association between social media use and subjectively and objectively assessed sleep parameters. In this, they are not alone; among others, my colleagues and I have documented associations between screen time—especially excessive screen time (e.g., ≥ 10 h per day)—and an array of negative psychological effects, especially in young children, particularly in young girls (e.g., Robertson et al., 2022; Twenge et al., 2018). This line of research, controversial and contentious (for reasons that I do not fully understand), has led me to suspect that it is not necessarily what kids are doing while on social media (though this may well have some relevance, again especially for girls ages 11 and younger using social media for many hours per day), but rather what they are not doing while on social media (e.g., moving around, with friends, outside in contact with nature and sunlight, sleeping enough). Hamilton et al. provide some support for this view, specifically regarding sleep, and one key and welcome virtue of their work is the inclusion of objectively-assessed sleep parameters.

Jeon et al. (2024) reported on network associations over time between parameters of suicidality as well as opiate use, (other) substance use, alcohol use, and depression. There were several associations of potential interest that should be followed up on in future research, but here, I focus on one particular result: The fact that parameters of suicidality cohered more over recent years. It is interesting to reflect upon why this may be. One reason may boil down to what is essentially a statistical by-product of the fact that as a relatively low base-rate syndrome rises in prevalence over time—as suicidality has (in the USA, not in the rest of the world, importantly)—its symptoms gain more variance and thus are freer to correlate. Perhaps, but another explanation is more substantive, namely, that pernicious things like suicidality parameters, depression, and even some forms of substance abuse, may to some degree leverage and scaffold one another over time. In my view at least, the last quarter century of the American sociocultural experience and landscape accords with this possibility. Jeon et al.’s findings, interestingly, occurred roughly during the same timeframe of the rise in social media use, as studied by Hamilton et al.

Further to my remarks above regarding the pitfalls of excessive self-regard, Preston et al. (2024) focused on two forms of narcissism—grandiose narcissism and vulnerable narcissism—and showed both forms were generally problematic in samples such as firearm owners and active duty military service members. In these two samples (but not as clearly in a third sample of those with a prior history of suicidality), both aspects of narcissism potentiated the association between depression and suicidal ideation. My group too has found that the combination of depression and narcissism can be more untoward than either taken in isolation (Joiner et al., 2008). More specifically, in our study, we found that the combination of narcissistic tendencies and depression tended to eventuate in paranoia, the basic idea being that an inflated self-concept, combined with disappointment and depression, leads to a discrepancy between internal and external realities, and, in turn, a state of “threatened egotism” (Baumeister et al., 1996). This state forces a decision between either accepting the disappointment and lowering one’s self-concept (not likely for an individual with narcissistic traits) or dismissing the appraisal and maintaining one’s self-concept. According to Baumeister et al., maintenance of inflated self-concept, together with refusal of disappointment, is associated with certain outwardly-directed negative emotions and attitudes (e.g., suspicion, anger). These kinds of negative emotions and attitudes may well be alienating others, either directly or indirectly, and this is relevant to suicide risk and is consistent with the findings of Preston and colleagues.

Harkening back to my earlier considerations of what preoccupied our ancestors and what should therefore continue to preoccupy us to this day, I neglected to mention a key issue: Safety. Means safety is a lynchpin in suicide prevention—one of the few, incidentally, on which we all can seem to agree—and the study by Rogers et al. provides still more data on its importance. In fact, of the prompt-level predictors of concurrent suicidal ideation (SI), physical distance to suicide method rose above most others in its association with SI. The one exception was interesting too; specifically, rumination about suicidality displayed a very large association with SI. On the one hand, one may suggest that this is not surprising, given that if one is ruminating about suicide then of course one is ideating about it. On the other hand, the totality of work on suicide-specific rumination suggests that it is not quite as simple as this, and that suicide-specific rumination may be an important leverage point in the management, treatment, and prevention of suicidality.

Foo et al. (2024) studied an intervention that also leveraged safety in general and means safety in particular, and supplemented them with acceptance- and emotion-based skill strategies as well as psychoeducational information. The population of focus was adolescents and young adults with symptoms of psychosis, a somewhat under-researched group regarding suicidality despite their being an above-average group with regard to suicide risk. The acceptance and feasibility data, as well as the case illustration these authors included, are encouraging and point the way to continued development and testing. One future study of interest might include a dismantling aspect—that is, would the larger intervention outperform one of its components taken in isolation? In light of the results of Rogers et al. noted above, if the larger intervention proved more effective than means safety alone, that would be impressive and convincing.

These five papers represent a diverse sampling of ideas and approaches to the question of suicidality and its prevention. This is as it should be, in that ours is a young field, a young science, and it is not yet at all clear that this idea or that one, or that this approach or that one, deserves primacy (with the exception of means safety and safety planning). Until our field matures, and that will take decades, let all flowers bloom. Despite the diversity in concepts and methods, there are, I believe, commonalities to the experience of severe suicidality specifically and the human experience more generally. In the lines above, I have attempted to draw out some of those commonalities, a focus on which may serve as a North Star in our field’s efforts to prevent the catastrophes that deaths by suicide represent day in and day out.