Effect Measure

A tragedy in Massachusetts is highlighting the terrible strain the housing crisis is taking on millions of former homeowners who are losing their homes:

The housing crunch has caused anguish and anxiety for millions of Americans. For Carlene Balderrama, a 53-year-old wife and mother, the pressure was apparently too much to bear.

Police say that Balderrama shot herself Tuesday afternoon 90 minutes before her foreclosed home on Duffy Drive was scheduled to be sold at auction. Chief Raymond O’Berg said that Balderrama faxed a letter to her mortgage company at 2:30 p.m., telling them that “by the time they foreclosed on the house today she’d be dead.”

The mortgage company notified police, who found her body at 3:30 p.m. The auction had been scheduled to start at 5 p.m. Balderrama used her husband’s high-powered rifle, O’Berg said.

She left a note for her family saying they should “take the [life] insurance money and pay for the house,” O’Berg said. (Boston Globe)

In recent conversations with public health officials involved in surveillance of violent deaths, they report that increasingly they are seeing under the data field that describes “Circumstance” a specific notation of “Foreclosure.” This is anecdotal information so we don’t know if this is an absolute increase in suicides caused by the stress of the mortgage crisis or just a more a better specification of what previously was merely described as “Financial circumstances.” But the case is an opportunity for me to make some observations.

First, it has long been recognized that there is a relationship between economic stresses in the society as a whole and suicide. While some powerful and sophisticated econometric models have been used to demonstrate this (I am thinking of Harvey Brenner’s work many decades ago) it really isn’t at all surprising. One can reasonably posit in this case that were it not for the mortgage crisis this woman would be alive today. Said another way, those who committed the subprime mortgage negligence killed this woman, and to the extent they broke laws in the process, they are guilty of criminally negligent homicide.

Second, suicide is often seen in our society as evidence of mental illness. My colleagues in the mental health professions seem incapable of seeing it any other way, no matter the circumstance. It is inconceivable to them suicide can ever be a rational act. But whether you are a farmer in India losing his farm or this woman in Massachusetts losing her home, the rationality seems quite clear. She believed, on rational grounds, that if she killed herself her husband and son would be better off because her insurance money would save the house for them. There’s nothing irrational about that. We don’t say soldiers are irrational for sacrificing themselves in battle for the sake of their country or their family. Why should we say this woman is crazy for doing the same thing?

Third, whether you agree with my second point or not, the presence of a gun in the household undoubtedly made it much easier for her to kill herself. Maybe she would have found another way, but suicide rates are particularly high among police officers and health care personnel and the main reason is not because they are crazier than everyone else but because they have the means at hand (guns and drugs) to carry it out effectively. Many suicides are indeed tragedies that are not rational and could and should be prevented. The best examples are the impulsive suicides of young people despondent or distraught over something they would otherwise get over or could be treated (an infatuation gone wrong, bullying at school, bipolar disorder). For many public health professionals, the main problem with guns is not homicide but suicide. If you make a suicide gesture with a gun it will almost always succeed. Access to guns is one of the main enablers of suicide.

Whatever your views on these matters, we all would agree this is a horrible tragedy. Unfortunately it is also an emblematic one.

Comments

#1 tony
July 25, 2008

Thoughtful post covering this tragedy from several angles. Thank you. Are there really insurance policies that will pay a suicide? That strikes me as irrational.
#2 Grackle
July 25, 2008

Almost any prescription drug can be used to commit suicide. Should we require that pharmacies issue only a 3-day supply at a time rather than the usual 30-day supply?

In Japan, they have suicide crazes. The most recent I’ve heard of was a formula for producing hydrogen sulfide from ordinary (well, for Japan) household products. The gas can easily produced by chemicals found in a high school science lab. It seems to be favored because it is so much quicker than burning charcoal in a closed room.

The UK used to use coal gas for home heating and cooking. When someone put their head in the oven, it was the carbon monoxide that killed them. Switching to North Sea natural gas ended the impulsive suicides, which dropped the overall suicide rate by a third, leveling out to a constant.

Removing one more easy means of quick death won’t necessarily do any good. Check your own kitchen for suicide weapons. Look around your city for tall buildings, bridges, and towers. And all the stretches of road conveying high speed traffic.

Two of my coworkers killed themselves. One used a gun to murder his wife first before shooting himself in the head. The driver for him was breast cancer — his own. The other cut his throat open with a kitchen knife. The driver was family problems.
#3 Tom in Iowa
July 25, 2008

Tragic – and probably more common that we realize. Some studies should be undertaken. Sadly for this woman most life insurance doesn’t pay for suicide, so she may have not been able to do what she hoped.
#4 Rhiannon
July 25, 2008

Killing yourself for a house is not a rational act. It’s a sign a serious defect in stress coping skills. Financial instability sucks. Losing a house sucks. Rational people ride it out and don’t kill themselves. People bounce back from far worse all the time.

Read the article. Her husband was employed. They have a big enough house that there’s no way they couldn’t scrape together the money to rent a habitable apartment. However, she hid the state of the family’s finances from her husband who was unaware of the foreclosure. Her suicide is a tragedy, but saying the mortgage industry killed her is ridiculous. There were much bigger proximal causes.
#5 revere
July 25, 2008

Rhiannon: I suppose it depends on some judgements. Let’s try to unpack the issues here:

i. Do you believe it is ever a rational act to commit suicide? Is suicde, in itself, a sign of mental illness in all cases? How about sacrificing your life for others, whether the sacrifice was effective or not? If the answer to this is “no” then we have nothing to discuss. We just differ.

ii. Assuming the answer to (i) is “sometimes,” you believe this is not an instance that is rational because she had other options? Or because her behavior showed signs of pathology prior to her suicide? That’s a long distance diagnosis and I don’t know if it is correct or not. Neither do you. But we are each entitled to express an opinion. I was making a observation in general more than her specific case.

iii. Regarding whether the mortgage industry killed her: I was taking a liberty here to make a point, but legally speaking, using “but-for” as the causation condition the legal situation was certainly a sufficient cause. The place where we could argue is whether it was a proximal cause. I doubt any jury would hold them liable even though the facts are clear — but for the actions of the subprime lenders she’d be alive today — since in our society that action is not considered sufficiently close to the act to hold them liab. So legally speaking you are likely correct. Factually speaking, I am correct. That she may or may not have been mentally ill is not an excuse for negligence. If someone is walking at the edge of a cliff and you negligently bump them over, you are liable.
#6 Edmund
July 25, 2008

Grackle said:
“Switching to North Sea natural gas ended the impulsive suicides, which dropped the overall suicide rate by a third…”

But then Grackle said:
“Removing one more easy means of quick death won’t necessarily do any good.”

Grackle, it seems likely that access to “easy means of quick death” contributes to impulsive suicides. Removing such means will likely reduce suicide rates.

I’m not arguing that we need to remove guns from households, but I expect that having access to a gun affects the likelihood of a suicide happening. Suicidal people are often looking for quick and effective ways that don’t require much thinking or planning.

Grackle said: “Almost any prescription drug can be used to commit suicide. Should we require that pharmacies issue only a 3-day supply at a time rather than the usual 30-day supply?”

You must consider that although overdosing on pretty much anything (including water) can lead to death, most prescription (and OTC) drugs are not desirable suicide methods. A person in suicidal misery doesn’t want to prolong their misery by ingesting something that might kill them in an agonizing and drawn out way, if it kills them at all (it might just leave them crippled for life).
#7 revere
July 25, 2008

Edmund is quite correct. The thing about guns as a means of suicide is their extreme lethality. If you want to kill yourself no one can stop you. But it’s the impulsive acts that are the preventable ones. If you take a bottle of tylenol or even sleeping pills, many of these acts aren’t successful. If you use a gun you’ll succeed.
#8 amk
July 25, 2008

Tanta, a weblogger at Calculated Risk, looks at the story and finds the facts aren’t that clear. For example, the story says the husband was unaware of the foreclosure, but Tanta looked at public records and found “John Balderrama did, however, file for Chapter 13 bankruptcy three times from 2004 to 2006″, listing the mortgage as his debt. Yet it’s claimed that Carlene handled the finances and John was unaware of the state of things.
#9 iRobot
July 26, 2008

this is a local story for me. AMK, I thought the same thing, there is no way the husband didnt know about the pending foreclosure. He attempted to file bankruptcy that would have allowed him to keep his house.
#10 harold
July 26, 2008

I must disagree very, very strongly with the suggestion that suicide over a home foreclosure can ever be veiwed as “rational”.

Millions of people go through bankruptcy or get foreclosure. These events cause extreme transient stress, but can obviously be moved past.

This act clearly caused shock and suffering for the family and friends of this woman.

This argument is not really relevant –

Do you believe it is ever a rational act to commit suicide? Is suicde, in itself, a sign of mental illness in all cases? How about sacrificing your life for others, whether the sacrifice was effective or not? If the answer to this is “no” then we have nothing to discuss. We just differ.

Self-sacrifice in a combat or disaster situation is usually lauded by our society. Suicide in the circumstance of a terminal, symptomatic illness, although controversial, is often viewed with sympathy. In this case, the woman killed herself, at least according to what is presented here, because her house was foreclosed on. There is no “self-sacrifice” or “hopeless physical illness” controversy here.

Yes, this act was a symptom of and result of mental illness exacerbated by emotional and financial stress. Yes, people who are about to commit violent acts, including suicide, because of a treatable mental health condition, should be restrained and treated, at least initially. I am an extremely strong defender of individual rights, at least as much as any “libertarian”, but respect for rights must take into account human conditions that reduce capacity for autonomy and create a need for active help from others, even if it is not or cannot be overtly requested, such as early childhood, active untreated mental illness, severe intoxication, etc. To deny mental illness is inhumane.

Although I don’t wish to defend the engineers of the mortgage-backed security crisis, to suggest that they are guilty of “negligent homicide” is quite a stretch. Economic activities are necessary in any society. Even skillful and honest economic and financial activity can produce losses for someone. At any given time, many people suffer from or are predisposed to depression or other mental illness. Any financial activity carries some risk of causing a vulnerable person to suffer an economic loss, and thus, at least hypothetically, carries some risk of provoking suicidal behavior.
#11 Chris
July 26, 2008

Sometimes suicide may be an act of defiance. Since the woman in the story faxed a letter to the mortgage company, and had a plan for her family to keep the house through insurance money, this may well have been a rational (reasoned) defiant act.

I see no evidence culpability on the part of the mortgage company. The article did not state this was a subprime mortgage. Since circumstances change, this may have been a sound mortgage when issued. Even if the mortgage company did violate some rules in issuing it, they aren’t responsible. In addition to the “but for” analysis of causation, their act must have been proximate. It seems probable that there were many intervening acts between the issuance of the note and the suicide. The responsibility lies with the suicidal lady – no need to blame anyone else.

In some ways,the use of a gun was commendable – many other methods commonly employed endanger others, such as driving into abutments, generating poison gas or “suicide by cop.” I hope she employed a suitable backstop. My sympathies are with the people who had to clean up the mess.
#12 paiwan
July 26, 2008

“I am an extremely strong defender of individual rights, at least as much as any “libertarian”, but respect for rights must take into account human conditions that reduce capacity for autonomy and create a need for active help from others, even if it is not or cannot be overtly requested, such as early childhood, active untreated mental illness, severe intoxication, etc. To deny mental illness is inhumane.”
————————————————————

Very good post!

An important topic concerning ethical dimension in public health.
#13 Doug Alder
July 26, 2008

Tony – to answer your question, most life insurance policies contain a clause that nullifies payments in the event of suicide during the first 3 to 5 years of the contract. If death by suicide occurs during that term then the insurance company is only obligated to return the payments made (at least that’s how it works here in Canada.)

I have a firm belief that suicide can be a rational act under many different circumstances. Imagine if you will that the US continues down its path towards totalitarianism and a future president for life decides a group of people (defining the group is irrelevant), of which you are one is undesirable. Said president then decides to lock you away in that day’s equivalent of Gitmo for life, no trial, no way out, no hope for a new president to take office and release you. Would you not consider taking one’s own life under those circumstances, in order to both relieve your suffering and to deny the state the satisfaction of torturing you, to be a rational act? I certainly would. The abhorring of suicide in our culture is a mixture of many things, empathy for the distress it causes for the surviving friends and family, one’s own fear of death and not least, millenniums of religious indoctrination intended to control individuals.
#14 revere
July 26, 2008

harold: Your attitude is a common one among mental health professionals and suicide prevention advocates: there is no such thing as a “rational” reason to commit suicide other than hopeless terminal illness (and many deny it even in that case). The fact that a society “lauds” certain kinds of self-sacrifice should be no argument for you as society is only lauding a mental illness. In this case, the woman believed, rightly or wrongly, that her death would save her family from penury because of her life insurance. That’s a rational reason although you may believe there were other options. There is a spectrum of suicidal behaviors and to label all of them cases of mental illness I believe to be over medicalizing them. The strongest arguments for vigorous suicide prevention relate not to the subject but to the terrible effects it can have on survivors. This is a real public health and medical issue but it isn’t a matter of the mental health of the suicide victim but of the survivors. No one is denying mental illness, as you imply. But we are raising a legitimate question about suicide: is it always a sign of mental illness? You seem to think so. We disagree.

The “negligent homicide” observation was just that, an observation about causality and the serious consequences of what is often thought of as a non-violent crime (assuming there is financial culpability here). It is separate from the other issue and I didn’t mean to be taken literally, as I have explained above.

Chris’s idea that using a gun to kill oneself is “laudable” because it doesn’t endanger others is kind of silly, IMO. Of course things that you do that endanger others are worse than the same things that don’t. But guns do endanger others, just by having them in the house. The data support that.
#15 Chris
July 26, 2008

Please cite your statistics, Revere. “But guns do endanger others, just by having them in the house. The data support that.” John Lott has shown otherwise, and he publishes his raw data so others may examine it. Are you just repeating the long discredited CDC studies that have refused to open their own data?
#16 revere
July 26, 2008

Chris: Case level data are not avilable (as far as I know) because of privacy issues, but otherwise I believe CDC data are open. I am counting suicides and accidental deaths. Lott’s data (as I recall) is highly controverted and about homicides.
#17 MoM
July 26, 2008

Not the first time. During the depression, a number of bankrupt farmers “bought the farm” by their untimely passing.
#18 Rich Puchalsky
July 27, 2008

I can’t believe that someone cited John Lott. Chris, are you really Mary Rosh?

At ant rate, back to revere’s: “In this case, the woman believed, rightly or wrongly, that her death would save her family from penury because of her life insurance. That’s a rational reason [...]”

Whether or not you’d consider that rational, it can’t be rational if in fact her insurance wouldn’t pay.

Life insurance (according to wikianswers, but hey) generally seems to have a period of some years after you take out the policy during which they won’t pay out for suicide. After that, they usually will, on the grounds that someone who took out a policy and then became depressed later shouldn’t be penalized. If society viewed this kind of suicide as a rational act rather than an act caused by mental illness, then insurance companies would stop paying out at any time — then, paradoxically, it would become irrational again. Better to consider it always irrational, as protection for the large majority of suicides, I’d think.
#19 revere
July 27, 2008

Rich:

Whether or not you’d consider that rational, it can’t be rational if in fact her insurance wouldn’t pay.

I don’t see why. If I am mistaken about a legal clause in my insurance and act rationally on my mistake, that seems to me like it is still rational. Mistaken, but rational. If I act rationally and logically but have irrational premises, then you could argue that a logical act can still be irrational. But I wouldn’t say that is the case here.
#20 Ana
July 29, 2008

Unsurprisingly, suicide statistics attribute causes of a personal kind, and so it has been shown that stressful life events – financial troubles, illness, job loss, a death in the family, divorce, addiction, and so on … lead to, and thus explain, suicide.

Is the decision to take one s life “rational” or “irrational”? This question can t be answered, and shouldn t be asked.

It only appeals to post hoc rationalizations (“gee like if I duh had aids and debts and my mom had cancer I d kill myself too” I ve even heard: “if i looked like her I d shoot meself in a minute” or of course the opposite: “wow I can t believe it all she had to do was dump the m*-f*”, etc. ) which might also be called glee or pious excuse making, alleviating guilt, etc.

Mind you, moving homes for a nomad is a joyful event, and divorce is often a reason to party, addiction sometimes prolongs life, etc, so, it all depends.

Does society sometimes, or regularly, unjustly put burdens on ppl that they cannot bear? Certainly. Despair is not often internally generated.

Long view. That doesn t mean that suicide prevention is useless or that foreclosures in the US are to be hailed or considered -a fact of life-, poor dopes getting what they deserve, etc.
#21 M. Randolph Kruger
July 29, 2008

You dont need training for a bottle of Tylenol to kill yourself. Sleeping pills were the big time choice for poisoning. I cant decide which you are blaming for cause here Revere… guns or economics. If its guns then forget it. I would say that the UK has almost the exact same numbers as we do pro rata and their method is self poison there. Once its in, not much you can do apparently and thats even with their UHC in place. Liquid drain cleaners too.

http://cebmh.warne.ox.ac.uk/csr/reslongterm.html

Method

The cohort of DSH patients was identified through the Oxford Monitoring System, by means of which data is collected on all DSH patients presenting to the general hospital in Oxford. The main cohort of patients was identified during the 20-year period between January 1st 1978 and December 31st 1997. Follow up was until the end of 2000, a mean follow-up period of 11.3 years (minimum 3 years, maximum 23 years). For the part of the study concerned with suicidal intent (assessed with the Beck Suicide Intent Scale) patients who presented during the 5�year period between 1st January 1993 and 31st December 1997 were included.

The patients were aged 15 years and over. Information on death or survival was collected through national mortality registers for England and Wales, Scotland and Northern Ireland. Expected numbers of deaths were calculated from national mortality statistics. The original sample included 12,666 patients. Follow up was possible for 11,583. Approximately two-thirds (N = 6961) were female and two-thirds were aged under 35 years of age. The method of DSH was self-poisoning in 85% of cases.

Thats a lot of dead people in a population of 60 million and change.

Their housing bubble is starting to burst as well but for different reasons and some that are alike. Either way guns are getting a bad rap here as some sort of facilitator of death. I read some of the above reference materials and quite a few decided to take the leap…literally. So do buildings kill people because they are tall? Some stepped into oncoming traffic, quite a few by hanging themselves. So its not the weapons Revere. It does make a statement though about suicides in the US and their causes.

Lot of that happened in the 1929 Crash.
#22 revere
July 29, 2008

Randy: National data:

UK suicide rates per 100,000: males = 10.8; females = 3.3; total = 7.0;
US: males = 17.9; females = 4.2; total = 11.0
Source: http://www.who.int/mental_health/prevention/suicide/country_reports/en/index.html

It is a fact that guns are much more successful means of suicide. Females attempt suicide much more often than males but many males succeed because of the more lethal means. These are facts known to everyone who studies suicide.
#23 paiwan
July 29, 2008

“Mind you, moving homes for a nomad is a joyful event, and divorce is often a reason to party, addiction sometimes prolongs life, etc, so, it all depends.”

Ana: Can I say that the curse in life sometimes or most likely would have the chance to turn into blessing? Is that what you mean?

“Is the decision to take one s life “rational” or “irrational”? This question can t be answered, and shouldn t be asked.”

It seems answered to my doubtness about this question. But why people or friends of suicided person always feel guilty?
#24 M. Randolph Kruger
July 30, 2008

My point is that whether you attempt it or not, if you are hell ben ton doing it then guns are the least of my worry about it. A lot of suicide by police that goes on too.

Girls may not be as successful because they might not know how to operate a handgun. They dont have access to them in the UK (only the criminals have them) but the still manage to hang and poison themselves with a reverse success rate there of the males. Interesting though that it does reverse without weapons available there to poison and hanging.
#25 pauls lane
July 31, 2008

right MRK…hanging, posion, slitting one’s wrists are pretty damn lethal if done properly…perhaps the reason females don’t choose guns is because of the mess they know it will leave…men tend not think that way…I for one have been accused many times of not thinking of the mess I am going to make when doing something, first by my mother and now by my wife…I try not to leave a mess but I fail a lot…so this woman kills herself by gun therefore I should not have a gun…if she had killed herself by hanging, I should not have a rope, belt, sheet, or blanket, if she had killed herself by slitting her wrists I should not have a knife or razor or any sharp thin object capable of cutting, slicing or dicing…

and of course it was the high-powered rifle’s fault that this woman killed herself, not her of course, but the rifle..this rifle had the audacity to be available to this woman…this rifle may have been her husband’s hunting rifle..my hunting rifles are cleaned, oiled, greased, and lovingly stored away when not in use…I guess this rifle just happened to be lying about the house….
#26 caia
October 3, 2008

It’s happened again… or almost. A 90-year-old woman has shot herself twice when deputies arrived to evict her from her home. She’s in critical condition.
#27 Werner
September 17, 2009

Governments everywhere are peddling the “mental illness” line. If a person becomes so fed up with being bullied by corporations whether they are mortgage holders or student loan lenders then sometimes suicide seems the only way out. Maybe it is. There is only so much garbage one person can take. People don’t become suicidal on a whim at least in most cases. There are limits to endurance. the comparison to soldiers is a good one. Dying for the glory of state is somehow “okay” but dying for yourself is a “sickness”.