Suicide and Predicament

Front matter

SUICIDE AND PREDICAMENT

LIFE IS A PREDICAMENT

Author:

Contents

Foreword Preface Chapter 1 Introduction 2 Predicament suicide model 3 A western option 4 Military leader suicide 5 Shame and anger suicide 6 Mental disorder suicide 7 Medicalization of suicide 8 Sociology and suicide 9 Less clear predicament suicide 10 A typology of suicide 11 A suicide pathways model 12 Rates of suicide 13 Prevention

Chronology of mentioned suicides

References

Foreword

“There is but one truly serious philosophical problem and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy.”

Albert Camus, 1942.

We have confronted the spectre of suicide throughout recorded history. It is always ready, in every dark moment, in both hemispheres of the world.

Professor Pridmore has demonstrated in this book, that in many, perhaps most cases, it is not mental illness which precedes suicide, but a predisposition plus social circumstances and acute stress. He brings all such factors together in his concept of ‘predicament’. This ‘predicament paradigm of suicide’ is the breakthrough of the early 21" century, in this troubled field. I strongly encourage medical people, psychologists and social workers, the judiciary and indeed, everybody working within the social system to pay attention.

The prediction of human behaviour is a difficult, and some would argue, not really a medical problem. Even accurate prediction of the course of a relatively simple medical condition suffered by a particular individual may be difficult, or impossible.

I quote Camus above. He also wrote that we see some people die because they judge that life is not worth living, and that paradoxically we see others get killed for the ideas or illusions that give them a reason for living. The question of the meaning of life, of course, remains unanswered — but this is by no means a question only for the medical community, as the answer lies at the heart of conditio humana.

Many now accept that social and psychological facts may play a major role when it comes to commission of the act. The two great wars left the world in turmoil with values torn to pieces- maybe as never before. This led to a 'fatherless society' in many western countries, the development of the student revolts, the hippie movement, the sexual revolution and the emancipation of women.

The price of the two great wars was high; 55 million were killed by their counterparts, and a few killed themselves. Some killed themselves to escape justice, but more out of shame and overwhelming consequent anxiety.

Today we are facing problems in a different form. International transport and migration have brought people together who do not understand each other. Some people affected by traumatic experiences make it to friendly foreign shores. But, they carry their burdens with them. With globalisation, there is no escape.

We must seek, as psychiatrists or citizens of an unquiet world, freedom and

communication between those with different opinions, as every act of discrimination (race, religion, whatever), is ultimately degrading to all mankind.

Gerhard W Schmitt

Frankfurt am Main

Germany

Preface

“If you are going from A to B you do not necessarily go in a straight line.” Margaret Thatcher (1980)

Current medical and psychological wisdom holds that all (Ernst et al.., 2004), or almost all (Bertolote et al., 2004) those who complete suicide, do so in response to a mental disorder. This book is opposed to that notion.

A typical example of contemporary advice comes from the well intentioned website (TeensHealth, 2009):

“Most teens interviewed after making a suicide attempt say that they did it because they were trying to escape from a situation that seemed impossible to deal with... And at that particular moment dying seemed like the only way out.”

An entirely reasonable statement.

“Some people who end their lives or attempt suicide might be trying to escape feelings of rejection, hurt, or loss. Others might be angry, ashamed, or guilty about something.”

Again, an entirely reasonable statement.

“What makes a person unable to see another way out of a bad situation besides ending his or her life?... The answer to those questions lies in the fact that most people who commit suicide have depression. ”

This last sentence expresses a notion to which this book is opposed.

There is no doubt that these authors are describing a mental disorder. Under the heading of ‘depression’ they write about “hormones” and “bipolar disorder”. Then comes:

“They are unaware that it is the depression — not the situation — that’s influencing them to see things in a ‘there’s no way out’...kind of way.”’

Again, a notion to which this book is opposed; sure, a mental disorder may be present, in which case, it will be argued that the mental disorder is “the situation”.

People with mental disorder are at greater risk of suicide than those without mental disorder. But it is a leap of faith, a distortion of logic, to therefore contend that therefore, all those who complete suicide have a mental disorder. This leap of faith is assisted by the WHO definition of health: “a state of complete physical, mental and social well-being”. There can be little doubt that people who suicide are distressed and are therefore not in a state of “complete...well-being”. However, an occasional measure of distress is part of the normal human experience, and to label this a mental disorder is to medicalize “the human condition”.

A ‘scientific’ mantle for the view that suicide is exclusively the result of mental disorder comes from the practice of retrospective “psychological autopsy”. In this book, space is given to the ignored opinion that this process is methodologically flawed.

iii

To demonstrate that suicide can occur in the absence of mental disorder, case studies have been examined. Cases have been chosen from the public record, so that individual privacy is not offended, and the reader can obtain further details if not convinced. Suicide has troubled every nation, every political system and every religious group of the last three millennia. 138 cases are detailed, of whom 14 suffered, or may have suffered, a mental disorder.

But more can be gained from this public record material. As all behavior is motivated, we can ask, what motivated these people without mental disorder to complete suicide? It is proposed that individuals suicide when they find themselves in predicaments (unacceptable situations from which there are limited escape options). These include the loss of honour of the defeated military leader, the shame of the prosecuted paedophile, the avoidance of pain and indignity of the terminally ill person, and the mixture of negative emotions of the bankrupt former billionaire.

A “predicament model of suicide” is presented which allows the incorporation into a single model, of the majority of what is known about the etiology of suicide. The essential element is that suicide results when the individual is in a “predicament”. A unique notion here is that mental disorder (or more precisely, the distress experienced as a result of a mental disorder) can be usefully cast as a form of (internal) predicament. Mental disorder predicament is construed as comparable to the distress which can result from environmental factors. A combination of these two is, of course, common.

The term “predicament model” has been used to draw attention to the importance of the stimulus. This is not to deny the importance of individual vulnerability. Individual vulnerability, in the medical model context, depends on genetics and life experiences. Individual vulnerability, in the sociological context, is also important, and refers to individuals who are insufficiently integrated into, or regulated by, society.

The sociology of suicide is celebrated. The mistaken idea that Durkheim found no place of psychopathology in suicide is laid to rest. The stories of the suicides of influential individuals have been transmitted through painting, sculpture, literature and music such that western culture now has a tradition of suicide as an escape option when trapped in a predicament. Suicide rates are discussed.

“A typology of suicide” is presented, based in the notion of predicaments and the observations of others. Four types of suicide are offered, into which all suicide can be categorized.

“Medicalization” is the process by which non-medical problems are re-classified as medical problems. By this process normal distress and disappointment have become synonymous with mood disorder. It is agued here, that suicide has also become medicalized, making prevention the responsibility of health professions (who have relatively little to offer in the absence of mental disorder). Further, this approach leaves without a role, the community and politicians, who have the ability to modify the values and behavior of society.

A “pathway model of suicide” is presented in which distress is the central element. This distress has three possible outcomes: it can 1) be “medicalized” (incorrectly called a mental disorder) and when suicide occurs this is (incorrectly) identified as a death attributable to mental disorder, 2) result in a mental disorder and suicide may follow as a consequence of the mental disorder, and 3) lead directly to suicide as a means of avoiding distress (egoistic/anomic or simple reaction).

The wisdom that all or almost all suicide is the result of mental disorder has spawned the prevailing suicide prevention strategy: the “high risk approach”, which focuses on identifying and treating people with mental disorder. This approach has failed to have an impact on national suicide rates anywhere in the world. This comes as no surprise, when we consider the evidence that, 1) suicide often occurs in the absence of mental disorder, and 2) treatment has never been proven to reduce the suicide risk for an individual or a group of individuals. This book provides a broader approach to suicide prevention, which will take a long time and involve cultural changes.

We have an ethical obligation to provide all possible care to people suffering mental disorder, but this is not going to reduce the suicide rate. A “population-based approach” to prevention attempts not to treat distress in particular individuals, but to reduce features of the society which underpin distress and dissatisfaction (such as unemployment, poor education and housing, and alcohol abuse). As cultural factors have a profound effect on suicidal behavior, to reduce the suicide rate, it will be necessary to change our culture (responses). Whether this is desirable and how it may be achieved will be matters for discussion. For example, shame lies at the root of a proportion of completed suicide and whether our culture can be reorganized to eradicate this emotion is yet to be determined. A prevention strategy is recommended which incorporates features from both the “high risk” and the “population based approaches”.

Should we decide to a population based approach, regular attention to annual suicide rates will do more harm than good. The person trying to lose weight who looks at the scales every day courts frustration (which increases the desire to eat); the society which is trying to reduce suicide by reshaping itself must embrace a long term project and will not benefit from slavish attention to annual suicide statistics.

Medical treatment is expensive and stigmatizing. Where suicidal thinking and behavior are not associated with mental disorder, the involvement of non-medical support people is recommended.

Finally, if we want to improve the satisfaction rating of a TV show, we don’t identify dissatisfied looking people and give them smiling classes and amphetamines, we improve the quality of the show.

Saxby Pridmore

Royal Hobart Hospital Australia

Introduction

Abstract: Suicide is conceptualized as an action which occurs in a variety of settings. The importance of personality, genetics, alcohol abuse, socioeconomic status and relationship with partner is introduced. The hegemony of mental disorder in suicide is disputed. The potency of multiple factors acting concurrently is described, giving details of twenty cases.

“Suicide is a complex behavior carried out by diverse people, under varied conditions and situations. To attempt to uncover single causal factors and implement solitary interventions is naive and simplistic.”

K S Jacob (2008)

Suicide accounts for almost 2% of the world’s death (WHO, 2005). It is time to start paying attention to the predicaments of these people, and the responses they make, rather than just keep wondering which “illness” they have, and which “treatment” they need. It will be argued that suicide is an escape option which regrettably, is frequently chosen.

Suicide is more common in people with mental disorder than people without mental disorder. But the widely made statement of the last three decades, that mental disorder is the cause of more than 98% of suicide (Bertolote et al., 2004) is fanciful. Accordingly, the “high risk” suicide prevention strategy (which states that the best approach to preventing suicide is to focus on people with mental disorder) is built on poor foundations. After decades, national suicide rates have not been (and were never going to be) even slightly influenced by the introduction of the high risk suicide prevention strategies.

All those who complete suicide, both those with and those without a mental disorder, are in predicaments (difficult situations/circumstances) and take action. A model with a broad view, which can incorporate all the available evidence, is urgently needed.

In 1996, Jeremy “Mike” Boorda, 56 years, was an Admiral in the US Navy. He joined the Navy at 16 years, and was the first person to rise through the enlisted ranks to become the Chief of Naval Operations. He served in Vietnam. Two Newsweek magazine journalists made an appointment to question him about a small brass V which he had worn on the ribbon of one of his medals. There were rumours that Boorda was not entitled to wear this decoration, a “Combat V”, because his war service had not met the necessary criteria. Boorda shot himself in the chest, where he wore his decorations, hours before the appointment.

In 1998, Wendy Hughes was 43 years of age and her husband Richard (a former computer company director) was 47 years; they lived in the Sunshine Coast hinterland, Australia. They had been married for 11 years and both had been married before. They had a long standing agreement that they would die together. Ms Hughes developed terminal cancer. She refused treatment. The couple took a one month tour of Africa, then “shopped around for a good funeral director”. They packed up their

Saxby Pridmore (Ed.) © 2010 The Author(s). Published by Bentham Science Publishers home and left their car at a garage. They booked into a luxury resort on the Sunshine Coast. They ate at an exclusive restaurant, paid their bill, went back to their room and took lethal doses of medication. They left a detailed suicide note apologising for their actions.

In 1999, Ronald Veenstra, 37 years, a married man of Mornington Peninsula, Australia, was noticed by two police officers to be sitting in his car in a car park with a hose attached to the exhaust pipe and leading into the interior of the vehicle. The windows were down and the engine was cold. In 2009, the High Court of Australia heard that Veenstra told the officers that he was in a loveless marriage and that he had thought of “doing something stupid”, but he had changed his mind and now wanted to go home and discuss matters with his wife. He had not been reported as missing and had no outstanding charges (which the officers could discover), there was no evidence of alcohol or other drug use, and he “appeared to them to be rational, cooperative and very responsible the entire time”. The officers offered to contact Veenstra’s family or a mental health professional, but he declined. The officers concluded that Veenstra was not suffering from a mental disorder and could not therefore be taken into custody and conveyed to a place for medical assessment. Veenstra did return home and have a conversation with his wife, but later that day, during her absence, he completed suicide using car exhaust fumes. The court also heard that Veenstra had withheld from the officers that arrangements had been made through his solicitor for him to be served that afternoon with papers relating to fraud charges arising out of his former employment as a financial manager of a car dealership.

In 2002, Wafa Idriss, 26 years, lived where she was born, at the al-Amari refugee camp, Ramallah, Palestine, and worked as an ambulance driver for the Red Crescent. As a young woman she had been the only asset of her family, and married her first cousin Ahmed. However, she produced only one stillborn female child and after 9 years of marriage, she was declared infertile. This was a matter of shame, and Ahmad yielded to pressure from his family to divorce his wife. Wafa may have suffered a depressive disorder as she cried inconsolably for some weeks, but there is no convincing evidence that this was more than a normal reaction. Her mother, Mabrook, said, “Wafa knew she could never marry again because a divorced woman is tainted...She was young, intelligent, and beautiful and had nothing to live for.” At a public rally, Yasser Arafat urged women to become his, “army of roses”, and that afternoon Wafa blew herself up in Jerusalem, killing one Israeli man and wounding 131 others. She was the first of the Shahida, the female Palestinian suicide bombers.

In 2003, Louis Rogers, 24 years, was living with his girlfriend, Vanessa Belino, on the 25" floor of a Philadelphia, Pennsylvania, upmarket apartment building. Ms Belino owned the apartment and was an assistant public defender. She had defended Rogers in at least two criminal cases. Rogers was upset by an argument and was witnessed to be slashing a samurai sword around. He wrecked their apartment, threw furniture off the balcony and started a fire. He then jumped down to the balcony of a 24" floor, broke into an apartment, threw furniture from the balcony and started another fire. When the police arrived, Rogers had descended to an apartment on the 23 floor. He threw a mobile phone at police and jumped from the balcony. A police-person grabbed his sleeve but he fell and died amid a demolished leather couch and armchairs, a dining table and chairs, a wooden dresser, drawers and crockery fragments. His death was attributed to anger.

Introduction Suicide and Predicament: Life is a Predicament 3

In 2008, Erin Berg, 39 years, was an Occupational Therapist and mother of 4. She was involuntarily admitted to a psychiatric ward of a Perth (Australia) hospital with severe post-natal depression, when she talked openly about ending her life. Her early life had not been easy, mother had been partially disabled by a brain aneurysm and there had been domestic violence. Ms Berg had suffered episodes of depression; she and her husband, Norman, separated but cooperated in caring for the children. Before and during hospitalization Ms Berg received support from her three sisters, all of whom were social workers. She appealed against her involuntary hospitalization and was released on a community treatment order (meaning she could live at home, but had to continue to accept treatment). Her depression had not fully resolved, but she told case workers that she had abandoned any plan to suicide. Three weeks after discharge from hospital she went to Norman’s house and asked him to take care of Elizabeth (1 year). She took a plane to Tijuana (Mexico) where she purchased a strong barbiturate, which she swallowed with whisky (as recommended by a book on euthanasia). She left a note: “No one else was involved in this, it was my choice...to euthanize myself”. She died without regaining consciousness. She was motivated by post-natal depression, which did not adequately respond to treatment.

In 2008, Choi Jin-Sil, 40 years, mother of two, hanged herself in her bathroom in Seoul. For 20 years she had been South Korea’s “cinematic sweetheart” (TIME) and had starred in 16 movies and more than a dozen soap operas. She married a baseball star in what was termed “the century’s union”. The marriage ended in 2004 and Choi had custody of the children. She entered a business relationship with Ahn Jae-Hwan, who completed suicide in September, 2008. Internet gossip commenced, claiming that Ahn had owed Choi money and her demands for repayment had led to his death. Choi denied these claims, but was known to be distressed by them. Less than a month after Ahn’s death, Choi also completed suicide. There was no history or convincing evidence of mental disorder, the suicide was attributed to public criticism and the example set by her business partner.

In 2009, Neil Puttick, 34 years, and his wife Kazumi Puttick, 44 years, jumped off a 500 foot (150 m) cliff near Belle Tout lighthouse in East Sussex (UK). They had lived in Brokerswood and had driven 150 miles (250 km) to the coast. They had two rucksacks with them, one contained the body of their deceased son, Sam, 5 years, and the other contained his favourite toys. Sam had died 2 days previously of meningitis. When Sam was 16 months of age he was made quadriplegic in a car accident. His parents gave up work and devoted their lives to caring for him. They established a website and raised money to provide him with all necessary equipment. There was no evidence of mental disorder. It is believed the couple found the prospect of living without their son to be intolerable.

In classical antiquity (van Hooff, 1990), suicide was classified as being motivated by purdor (shame), taedium vitaie (disgust/weary with/of life), inpatientia doloris (unbearable pain), dolor (grief), fides (loyalty), and furor (madness). The ancients had another category: iactatio (ostentation), which does not fit with the notion of “predicament suicide”, but this refers to the style rather than the principle “driver” of the action.

Plato (c 424-348 BCE) taught that suicide was disgraceful and that perpetrators should be placed in unmarked graves. He did, however, recognize exceptions, including, 1) when the self-killing is compelled by extreme and unavoidable misfortune, and 2) when the self-killing results from shame and having participated in grossly unjust actions (Laws LX 873c-d).

The first recorded joke about suicide appears in the Greek book, Philogelos, a collection of 265 jokes written in the ae century CE (Baldwin, 1983). It concerns a man who was trying to hang himself and struck his head in the process. He went to the doctor to get treatment for his injury, and then hung himself.

It is reasonable to suppose that, before death, people who go on to complete suicide, experience great distress; this probably includes most suicide bombers and other individuals who expect their death will be subsequently rewarded. After the death, the family and friends experience great distress. Nothing in this book should be read as diminishing the distress associated with, and caused by, suicide.

Suicide, like coughing, is a physical act. Like coughing (one thinks of the discrete cough of the gentleman’s butler coming into the boudoir), non-fatal suicidal acts may be used to draw attention to the individual. And like coughing, suicidal acts (fatal or non-fatal) may be a symptom of severe organic illness. Here, tuberculosis of the lung is like treatment resistant depression.

Suicide, like homicide, may or may not be the result of mental illness. Both may be impulsive acts (Fawcett, 2001; Woodworth and Porter, 2002; Blaustein and Fleming, 2009).

Suicide, like laughter, can have roots in many emotional experiences. Laughter can express happiness, embarrassment and even sadness; suicide can express sadness (as a feature of, or distinct from, mental disorder) and rage, in addition to the desire to avoid predicaments.

Suicide, like combing your hair, has much to do with culture and fashion. When the Japanese glam-rock star Hideto Matsumoto (34 years) completed suicide in 1998, at least 4 fans copied him. After the soccer goal-keeper for Germany Robert Enke (32 years; 2009) threw himself under a train, German Rail reported a one week four-fold increase in such deaths. Like combing your hair, if you can’t do it yourself, you may be able to get help. Should you have a terminal illness, certain doctors my offer “assisted suicide”. If you do not have a terminal illness, you may be able to provoke a police-person into killing you; this is called “suicide-by-cop” (Lindsay and Lester, 2008).

As with contemplating going to the football, or buying a house, contemplating suicide involves consideration of a range of competing options, and short-term and long-term consequences. With going or not going to the football, in the end, you decide to go or not to go. For those who live nearby the football ground, watching the game on television is a half-way position. The half-way position for suicide is a suicide-like act which does not result in death. This introduces the complex topic which goes by many terms, ‘suicide attempt’, ‘failed suicide’, ‘suicide gesture’ and ‘parasuicide’, among others, which is not the focus of this book and thus, will not be fully explored. It is important to know that even the individuals who perform such behaviour may not be clear about whether they intended to die and failed, or did not intend to die. Often people who have survived a suicide-like act report indifference; frequently

Introduction Suicide and Predicament: Life is a Predicament 5

(particularly with an overdose of medication) they report that they wanted a period of unconsciousness, a break from their predicament, and simply left the outcome of their actions (life or death) in the hands of fate.

Our probability of becoming an Olympic athlete, developing breast cancer or completing suicide is influenced by our genes. For both breast cancer and suicide, our genes account for 30-55% of our risk (Voracek and Loibl, 2007).

Personality may be defined as “the predictable responses the individual makes to the environment (or life situation)”. Personality features greatly influence the manner in which we manage any bodily conditions such as diabetes and epilepsy. In the same way, personality features greatly influence the way we manage our interpersonal relationships and other life events (Zeyrek et al., 2009). Personality features can predispose the individual to social conflict, and greatly influence the response of the individual (adaptive or maladaptive) when dealing with such conflicts. Naturally, personality features strongly influence suicide behaviour (Brent et al., 1994).

Excessive alcohol use and the use of illegal substances are closely associated with the risk of suicide (Mann et al., 2008; Schneider, 2009). This is not surprising. In addition to causing liver disease and pancreatitis, alcohol precipitates interpersonal conflict, mental disorder, and relapse in the case of people who have recovered from an episode of mental disorder. Very importantly, acute intoxication lowers inhibition (increasing impulsivity and aggression), and makes suicidal behaviour a more likely response to any conflict. Countries with high per capita consumption of alcohol are those with high rates of suicide. Nearly one quarter (24%) of US residents who complete suicide have a blood alcohol level above 0.08 mg/dl, with the highest percentage (37%) occurring among American Indians and Alaska Natives (Crosby et al., 2009). One third (34%) of Swedes who complete suicide have taken alcohol, and “many are heavily intoxicated” (Holmgren & Jones, 2010). Not yet replicated elsewhere, recent research in Croatia (Coklo et al., 2008) found the average blood alcohol in completed suicide to be 0.068 mg/dl (well over the legal driving limit) for males and 0.029 mg/dl for females. These authors also demonstrated a relationship between blood alcohol level and the choice of method, with the highest average level (0.171 mg/dl; three times the legal driving limit) being associated with the use of explosives. Alcohol use appears to be a common feature when cultures are under pressure, and has been associated with suicidal behavior among the Navajo (Grossman et al., 1991), Inuit and First Nations of Canada (Overholster et al., 1997), and Australian Aboriginal people. Alcohol and other drug use is an obvious target in the difficult struggle to reduce suicide rates, especially in communities in which rates of both alcohol consumption and suicide are high (Razvodovsky, 2009; Landberg, 2009).

As with smoking, alcohol excess and physical violence, suicide is more common in lower socio-economic groups, which raises the issue of the impact of social inequalities (Page et al., 2006; Saurel-Cubizolles et al., 2009). The exact mechanism by which lower socio-economic group membership leads to higher suicide rates is yet to be determined. There is a clear link between material disadvantage, unemployment and suicide (Yamasaki et al., 2008; Inoue et al., 2010; Cororan & Arensman, 2010). A contextual study suggests that suicidal behavior in young people living with household poverty occurs, at least in part, because in such households, the young are exposed to suicidal behavior (Bernburg, 2009). While frequent, it is harder to find examples of the suicide of individuals from the lower socioeconomic group on the public record, because their deaths are less newsworthy.

Suicide does, of course, occur in the higher socio-economic group, for example, Cleopatra (30 BC) and Amschel Rothschild (1996). Cleopatra was Queen of Egypt and Rothschild (41 years) was a very wealthy, well connected British banker.

Suicide is often associated with poor physical health. Chronic disabling conditions add a further burden to people who are dealing with other life difficulties (loneliness and debt, for example). On the other hand, poor physical health may be the primary driver, for example, in the deaths of Arthur Koestler (1905-83) and Jo Shearer (1946-2002). Koestler was a polymath author who found the burden of weakness and movement difficulties resulting from leukemia and Parkinson’s disease to be intolerable. Shearer was an accomplished Australian war correspondent who developed intractable back pain; she announced to fellow journalists she would take her life to avoid her pain.

Suicide is associated with loss of reputation. Shoichi Nagagawa (2009) a 56 year old Japanese politician died of an overdose in Tokyo, having lost his seat in the aftermath of disgraceful drunkenness at a Group of Seven meeting. Loss of reputation is dealt with in Chapter 5.

Suicide is also associated with loss of other valuables. Rene-Thierry Magon de la Villehuchet (2008) a 65 year old French aristocrat money manager living in New York died by cutting his wrists, following huge financial losses through his investments with Bernard Madoff. Major William Foxon OBE (2009) a 65 year old Englishman who had served in the French Foreign Legion and the British Army, and as head of the European Commission Monitoring Mission, also lost his life savings in investments with Bernard Madoff. One armed (he had lost an arm in military service) and fearing bankruptcy, he sat in a park near his home in Southampton, UK, and shot himself in the head. Adolf Merckle (2009) a 74 year old German billionaire was “broken” by the global financial crisis, he wrote a note and placed himself in the path of a train.