My depiction of death at the Bridge is information that might stop one person from jumping. The popular notion that death jumping from the Bridge is painless needs to be dispelled. The evidence is all too aparent in the Marin Coroner’s records. The San Francisco Chronicle’s web SFGATE.com also details the horror of death at the bridge. I am sorry if it is offensive to some but if the knowledge of what actually occurs stops just one person from electing to jump I belive it needs to be told.

The current literature show that about one-third of those with suicide attempts will repeat
such within one year; and 10% of these will be successful, with the risk persisting throughout the lifetime. In fact, the most important risk factor for suicide is a previous attempt.

Hines shares with Grohol his nescience of engineering: A fence can not just be raised on a suspension bridge without probable damage to the structural integrity of the bridge. This is the reason for testing of designs. Ignoring scientific facts does not further the proponents’ arguments.

It is quite appropriate that Hines talks about a “loaded gun´ in a psychiatric ward, not about leaving the window on the upper floor open. Mann et al. in their paper emphasize the prevention should include be both education of providers of care as well as restriction of means. Their “means” refer to the availability of firearms and deadly toxins. Out of 147 references only one refers to bridges and states, with the removing of an intervention “…the rate of suicide by jumping in the metropolitan area in question did not change…”

The unnecessarily graphic conclusion represents the caricaturing of a serious public heath problem, with callous disregard for the feelings of the families and friends of past victims.

Clark D. Hinderleider, M.D., Ph.D.
Secretary, Clinician-Scientists for the Public’s Weal
Instructor of Surgery, Division of Cardiothoracic Surgery
Mount Sinai School of Medicine, CUNY
Clinical Adjunct, Department of Physiology
Contributing Editor, Science Advisory Board
Member, The Learning Curve International Advisory Board
Member; Center on Science, Technology, and Space; Roosevelt Institution
Member, Union of Concerned Scientists
Member, Congressional Liaison Committee (JSCPP)

The view that people will just go some where else does not stand the test of logic. Suicide is an impetuous act – 98% of those stopped never try it again.

Suicide is a permanent solution to a temporary problem.
It is epidemic among teens that see the world as an impossible place to negotiate.

And if you can not get beyond that just think of the families that are forever ruined due to the horrible death of a loved one – the collateral damage is incalculable.

Would a sane society permit someone to leave a loaded gun in a psychiatric ward? Of course not –

The rail is too low its temptation too high and the apathy surrounding death at the Bridge to great.

Death at the Bridge is about the most horrible one could imagine. Victims usually drown in their own blood, screaming due to the pain from the loss of a limb or due to having their bones crushed at impact.

But their screams aren’t heard due as the water fills their lungs as they are washed out to sea never to be seen again.

As for the engineering concerns, one is advised by expert opinion and refers Grohol to Mr. Mulligan’s comments in the record and to the minutes of many past meetings at which this issue is discussed. The aerodynamic considerations have always been a prime consideration. It is unfortunate that Grohol chooses to discuss matters about which he has no knowledge, but this SOP for the proponents who have nothing of substance to contribute to the deliberation.

The so-called “bicycle barrier” is a separation barrier between the hundreds of thousands of people who are using the bridge for which it was built—to cross a body of water. It is a matter of public safety as it is only this which separates them from vehicular traffic. It was tested to ensure it would not compromise the structural integrity of the bridge. Once again, Grohol does not have his facts in order.

The only distraction created is by the tragic spectacle put on at the board meetings. The organizers should be ashamed. But they know that reasoned argument and scientific facts may be obscured by the blatant theatre put on by these people. One will continue to strive to make sure sense and science prevail.

Clark D. Hinderleider, M.D., Ph.D.
Secretary, Clinician-Scientists for the Public’s Weal
Instructor of Surgery, Division of Cardiothoracic Surgery
Mount Sinai School of Medicine, CUNY
Clinical Adjunct, Department of Physiology
Contributing Editor, Science Advisory Board
Member, The Learning Curve International Advisory Board
Member; Center on Science, Technology, and Space; Roosevelt Institution
Member, Union of Concerned Scientists
Member, Congressional Liaison Committee (JSCPP)

Unless San Francisco lives in an alternative universe where data and statistics from studies don’t apply, this seems to directly contradict your concerns and argument about the barrier, as quoted in the New York Times article above.

As for your continuing engineering concerns, I leave that to the engineers to answer. The fact remains that in every case where people have identified a suicide magnet (whether it was a bridge, a tower, or a building), they have successfully engineered and erected safe suicide barriers that do not endanger the engineering of the original structure. In this day and age, I have no doubt such a barrier can be safely erected on this bridge as well. (As for the Tacoma Narrows Bridge failure in 1940, while extraordinary, has little to do with this issue; it was built as a suspension bridge with no appreciation for air current dynamics where and when it was build. Engineers now have that knowledge, and have had it for the past 66 years.)

It is also telling that Hinderleider ignores what has derailed all previous attempts at a suicide barrier in the past — cost, aesthetics, and effectiveness. Notice how engineering was never a concern in the past. Not because the board didn’t appreciate that it was a concern, they just understood that if they approved a plan, the engineers would find a way to implement it safey and effectively.

Opponents of the barrier have taken a new tact — emphasize the engineering hurdle and whether such a barrier would be effective. (Cost is always a concern with any project in the public eye.) Again, you can’t prove a negative — you can’t show a barrier would be effective until it is erected. (There are creative ways to address this issue, but of course opponents are just happy to question the effectiveness without actually concerning themselves with finding ways to prove it.)

But at the heart of opposition to any suicide barrier is aesthetics. To the board that must approve any barrier, the bridge is not just a bridge, but an American icon. The landmark bridge is a tourist draw and attraction. Anything that may mar the beauty of the bridge is given short attention.

As for bridge priorities and costs, that’s also a matter of local politics, not what deserves the most attention due to the loss of human life. In October 2003, the bridge built a $5 million bicycle barrier even though no bicyclist has ever been killed. Every expenditure on bicycle and median barriers is portrayed as a “public safety issue,” while every mention of a suicide barrier becomes an “engineering issue” or “effectiveness issue.” It’s amazing how you can sway the public argument by just repeating the same phrases over and over again. It makes me wonder, though, were “effectiveness studies” done on the bicycle barrier before it was built?

This issue was last brought up in 1997, nearly a decade ago, when the board last commissioned engineering studies on a design. It appears that when the public eye is focused on this issue, the board takes a little action, commissions yet another study, and waits for the public to be distracted by something else.

This time, the public won’t be distracted. The debate and focus will not die down.

For Further Reading

Friend, T. (2003). Jumpers. The New Yorker.
http://www.newyorker.com/fact/content/?031013fa_fact

Sanders, R. (1997). Golden Gate Bridge suicide barriers can be both effective and esthetic, say student-initiated studies at UC Berkeley. UC Berkeley.
http://www.berkeley.edu/news/media/releases/97legacy/gate.html

You mention about telephones on the bridge, and there is evidence, both from the GG Bridge and elsewhere [personal communication, v.i.] that they are effective. You also cite the time factor. As one noted previously, you do not have a clear concept of engineering. The GG Bridge is suspension bridge, of whose structural integrity must be a constant in any equation. Proposals in the past have proven to render the bridge unstable. Need one remind you of the vintage film of a similar structure in Washington state which was destroyed by its instability in the wind. Do you propose to force the issue, even if the bridge is destroyed? One does not agree, nor do the hundreds of thousands who use the bridge for which it was built. An additional and complicating issue is the installation of a median barrier, a priority due to the number of people killed and injured, greatly overtaking the number of suicides.

The matter of a physical barrier should be addressed by evidence based examination not by blatant use of emotions. To frame this debate in terms of the value of a single human life is to admit that the proponents have no rational arguments and are failures in their duty to public health tenets outlined by the Surgeon General.

Clark D. Hinderleider, M.D., Ph.D.
Secretary, Clinician-Scientists for the Public’s Weal
Instructor of Surgery, Division of Cardiothoracic Surgery
Mount Sinai School of Medicine, CUNY
Clinical Adjunct, Department of Physiology
Contributing Editor, Science Advisory Board
Member, The Learning Curve International Advisory Board
Member; Center on Science, Technology, and Space; Roosevelt Institution
Member, Union of Concerned Scientists
Member, Congressional Liaison Committee (JSCPP)

References:

Chen, Y-Y, “Female Suicide in the US, “Presentation, APA Meeting, 22 May 2006.

Glatt, KM, “Effectivness of Bridge Phones,” Dutchess County Department of Mental Hygiene, March 1999

Mohr, DC, et al., “Telephone-administered psychotherapy for depression,” Archives of General Psychiatry, 62:1007, 2005

De Moore, GM, “Suicide Attempts by Firearms and by Leaping from Heights” AmericanJournal of Psychiatry, 156:1425, 1999

Suominen, K, et al., “Completed Suicide after a Suicide Attempt: A 37 Year Follow-UpStudy,” AJP, 161:562, 2004

USPHS, The Surgeon General’s Call To Action To Prevent Suicide, Washington, D.C., 2001

Evidence is important, but it shouldn’t prevent us from taking action now. I wonder if we’d have suicide hotlines today if you were the person making the decision about them in your community back in the 1960′s? “Well, there’s no evidence to support that a telephone hotline will actually help anyone, so why institute one? There’s costs, risk factors, liability issues… I mean, who needs that?!” Or telephone hotlines on bridges (of which, the Golden Gate luckily sports). We have a great deal of evidence, luckily, which shows that fences on bridges reduce the number of people who try and take their own lives.

Most bridges in most states where there is pedestrian traffic require fences of a certain height and type to prevent people from climbing over them. Sometimes this is nothing more than a modified chain-link fence. It is effective as a deterrant to the person who makes an impulsive decision (as most people who are that suicidal often are). I quote,

Similarly, the fact that suicidal crisis are very often short-lived (and, what is more, influenced by ambivalence or impulsiveness) suggests that an individual with restricted access to a given means would not put off his plans to later or turn to alternative methods [emphasis mine] (Daigle, 2005).

The problem is obvious. Some people in the area of the bridge treat it as something more than it is. Yes, it’s a beautiful bridge, and yes, you need to be certain that whatever method proposed doesn’t affect its structure. But my understanding is that we’ve been down this road before and engineering studies have already been done in the past on various forms of barriers, have they not? I mean, this is not a *new* issue, is it Clark? It’s been discussed for decades.

To the rest of the world, it just appears as foot-dragging for no legitimate reason. And I say “legitimate reason” when weighed against the price of human life.

References

Beautrais, A.L. (2001). Effectiveness pf barriers at suicide jumping sites: a case study. Aust N Z J Psychiatry, 35(5), 557. (“Removal of safety barriers led to an immediate and substantial increase in both the numbers and rate of suicide by jumping from the bridge in question.”)

Cantor, C.H. & Hill, M.A. (1990). Suicide from river bridges. Aust N Z J Psychiatry. 24(3), 377-80. (To address the argument that people will just turn to the Bay Bridge to jump, “This suggests that persons prevented from jumping from one bridge, for example by a barrier, will not automatically jump from the alternative bridge although a minority may do so.”)

Daigle, M.S. (2005). Suicide prevention through means restriction: Assessing the risk of substitution: A critical review and synthesis. Accident Analysis & Prevention, Vol 37(4), 625-632.

Gunnell, D. & Nowers, M. (1997). Suicide by jumping. Acta Psychiatrica Scandinavica, Vol 96(1), 1-6.

Lindqvist, P; Jonsson, A; Eriksson, A. (2004). Are suicides by jumping off bridges preventable? An analysis of 50 cases from Sweden. Accident Analysis & Prevention, Vol 36(4), 691-694.

Seiden, R.H. & Spence, M.C. (1982). A tale of two bridges: Comparative suicide incidence on the Golden Gate and San Francisco-Oakland Bay Bridges. Crisis: The Journal of Crisis Intervention and Suicide Prevention, Vol 3(1), 32-40.

That Grohol gives not a scintilla of evidence demonstrating the effectiveness of a physical barrier to be more than the current rate of prevention of 80% points to the deficit in his thought process. One author notes “….the lack of clear scientific evidence unequivocally proving that the construction of barriers on the [bridge] has resulted causally in an absolute reduction in the number and rate of suicides…” Grohol says that “hundreds of bridges have suicide barriers” which is just not true. A search by SPRC and SIEC identified only a very few. If Grohol has this list of sites and the associated data showing their effectiveness, he should share it with the community. If not, then he should educate himself, for which purpose one appends some references. Thence his comments would not be so foolish.

Clark D. Hinderleider, M.D., Ph.D.

Secretary, Clinician-Scientists for the Public’s Weal

Instructor of Surgery, Division of Cardiothoracic Surgery

Mount Sinai School of Medicine, CUNY

Clinical Adjunct, Department of Physiology

Contributing Editor, Science Advisory Board

Member, The Learning Curve International Advisory Board

Member; Center on Science, Technology, and Space; Roosevelt Institution

Member, Union of Concerned Scientists

Member, Congressional Liaison Committee (JSCPP)

Email: CLARKMDPH@aol.com

References
Baldessarini, RJ, “Suicide Risk and Treatments for Patients with Bipolar Disorder,” JAMA, 290:1517, 2003

Beautrais, AL, Effectiveness pf barriers at suicide jumping sites: a case study,” Aust N Z J Psychiatry,35(5): 557, 2001

Berman, A.L. (ed.), “Effectiveness of Bridge Barriers,” Suicide and Life-Threatening Behavior, 24(1):89,1994

Cantor, CH, et al., “Suicide and related behaviour from river bridges,” British Journal of Psychiatry,155:829, 1989

“Community suicide prevention: the effectiveness of bridge barriers,” Suicide Life Threat Behav, 24(1): 89, 1994 Spring

Injury Center, CDC, Prevention of and Intervention in suicide, 5 Aug 04

Joiner, T, Why People Die by Suicide, Harvard Univ Press: Cambridge, 2005

Mann, JJ, et al., “Suicide Prevention Stratégies. A systematic review,” JAMA, 294:2064, 2005

De Moore, GM, “Suicide Attempts by Firearms and by Leaping from Heights” American Journal of

Psychiatry, 156:1425, 1999

Reish, T, et al., “Securing a Suicide Hot Spot. Effects of a safety net at the Bern Muenster,” Suicide and

Life-Threatening Behavior, 35(4):460, 2005

USPHS, The Surgeon General’s Call To Action To Prevent Suicide, Washington, D.C., 2001

I don’t really think we can make the world safe from terrorists.
We can’t prevent all of the suffering, death, disease, etc. in the
world. We live for a while, then we die. At a time of our own choosing,
or some other time, death is a part of being alive.

Believing that we can control all of these things is a sure set-up for
frustration, anger, depression, etc. I don’t want to live in a world
that is suicide proof. I don’t even want to try to imagine what that
would be like.

I know who my elected supervisors are, you don’t need to tell me. Finally, it’s nice to know that you’re so sensitive in your dealings with depressed people. How comforting!