“The millisecond my hands left the rail, it was an instant regret,” recalled Kevin Hines, a man who attempted suicide from the Golden Gate Bridge in 2000. “My final thought was ‘‘What the hell did I just do? I don’t want to die.’”

Hines picked the bridge for its “simplicity,” it was a four-foot barrier that a person could almost just tumble over. Because the bridge made it so easy to jump, even someone who felt deeply ambivalent, in half a second could impulsively make a choice that they would be unable to undo. You can decide not to jump as many times as you like, but if you decide to jump, it’s the last decision you’ll make.

Suicide is unforgiving like that. It doesn’t matter if one is perfectly content 99% of the time; a single moment of despair will suffice. The majority of suicides are on impulse; studies of people who have survived suicide attempts have found that the time between the decision to kill one’s self and the actual attempt is almost always an hour or less. (It is often less than five minutes.) And 90% of survivors will never ultimately kill themselves, suggesting what the New England Journal of Medicine calls the “temporary nature and fleeting sway of many suicidal crises.” It is disturbing to consider how many people’s brief time on Earth ends with that final thought: “What the hell did I just do?”

It’s very difficult to write about suicide without appearing dreary, depressing, and morbid. Nobody wants to discuss it, nobody wants to read about it. Online, articles about suicide get about as much readership as exposes of sweatshop labor and cow torture, i.e. not a hell of a lot.

But the moment you appreciate the human implications of the statistics, you realize that silence on suicide is a moral outrage. Suicides in America alone are now at 42,000 per year; the country’s suicide rate is the highest it has been in 30 years. That means people, thousands upon thousands of them, made of flesh and deeply sad, are simply popping out of existence one after another. In terms of death toll, it’s fourteen 9/11s per year!

And it’s largely needless. The impulsive nature of so many suicides means that they are preventable. Reducing the easy availability of means, and supporting people through the brief periods of time during which they are most likely to act, can be the difference between their living a full life and their plunging into eternal oblivion.

It’s very difficult to acknowledge the full implications of the evidence. “I’m walking to the bridge, If one person smiles at me on the way, I will not jump,” wrote one suicidal man before heading for the Golden Gate. Evidently nobody smiled; he jumped to his death. It might be comforting to believe that a smile wouldn’t actually have made a difference, that he would have made the same choice no matter what. But from what we know, that’s often not true. Many who contemplate suicide are looking for a way out; most do not want to die. A small act of kindness can nudge people from the ledge. (This is a good argument for remembering to smile at strangers.) That fact should be disquieting; it implies that so many tens of thousands of tragedies have been avoidable. It is heartening, however, insofar as it affirms the possibility of saving countless lives.

That makes the city of San Francisco’s longtime indifference toward Golden Gate suicides fairly outrageous. The bridge has been known as a “suicide magnet,” and dozens leap from it every year. Yet for decades, the city has been resistant to putting up a suicide net beneath the bridge. This has largely been for aesthetic reasons, as well as out of a reluctance to spend money on a problem that has little political value. After years of pressure from advocacy groups, in 2014 the city finally agreed to put up a barrier, though at the moment it’s being held up because the steel for the nets has to be American-made.

It’s no surprise that San Francisco dragged its feet, though. Judging from the amount of media attention it gets, suicide is evidently seen as a non-issue in the United States.  Partially, the reluctance has been because of that lie we tell ourselves: that people “would have found some other way.” That’s false, as we know, because the easier it is to do it, the more likely it is to be done. Sometimes it’s inevitable, more often it’s anything but.

Yet there’s also a uniquely American “free choice” aspect to the nation’s blasé treatment of suicide. “If people wish to kill themselves, that’s up to them” seems to be the dominant unspoken attitude. Nobody is forced to do it, thus nobody is responsible but the person who kills herself. (That’s surely one of the reasons that suicide hasn’t taken on a larger place in the country’s gun control debate. Half of all suicides per year are by firearm, and yet mass shootings—which are far rarer—are treated as the greater tragedy.)

The individualist position, which treats every person’s life outcomes as being entirely of their own making, represents both a deep moral callousness and a total indifference to empirical fact. We know that people are irrational, frail, and ambivalent, that they make choices they regret, that their brains lie to them about how much other people love them. Yet the “minding your own business” ethic is a core part of the national ideology. Your choices are your own, and if you don’t like the consequences, well, sucks for you. That line of libertarian-ish thinking is common even in cases where people’s choices are far less free than suicide; there is little sympathy for those devastated by economic crises, or drowning in medical bills. So it’s little surprise that suicide, which appears entirely freely-chosen, should be treated as an entirely private concern.

However, suicide is not some spontaneous product of the will. Like everything else, it’s brought about by a combination of a person’s internal wiring and their external conditions. Nobody would voluntarily choose to be incredibly, desperately sad all the time. Factors like unemployment and a lack of social support are obvious contributors; joblessness alone is thought to cause 45,000 global suicides annually. Depression alone generally doesn’t lead to suicide; on the other hand, depression combined with hopeless life conditions creates the sense of there being “no way out” that can lead a person to feel death is their only available option.

Consider how Gene Sprague felt in the last days of his life. Sprague, a gentle 34-year-old punk rocker, had suffered severe depression since his mother died during his youth. Sprague had often talked about killing himself, and when asked what he wanted to have for breakfast, would sometimes reply “death.” Sprague’s eventual suicide was therefore not especially surprising, even though it was tragic. But consider what Sprague wrote on his blog in the last entry before his death. Sprague was feeling especially low because he was broke and a job offer hadn’t come through:

I have not heard from the future employer, I have not received a plane ticket to fly to Texas to interview for that job (I was supposed to leave tomorrow), I have completely run out of money, I am out of cigarettes, I am completely out of food, my eBay auctions have not been bid on, and I think my ferret is dying.

Sprague suffered with suicidal depression for decades. But it was only when his material circumstances became unbearable that he actually took his life. In prior times, Sprague had something to cling to. He might have been broke, but at least he had some cigarettes. Or he might have run out of food, but at least his ferret was healthy. It was the “perfect storm” of minor miseries that actually pushed him toward his death. (Even then, Sprague seemed apprehensive, pacing the Golden Gate for 90 minutes before finally standing atop the railing and allowing himself to fall backwards.)

Economic misery can drive people to the brink. The rising suicide rate in America has corresponded with a rising hopelessness among many about their prospects for financial security. At the same time as the suicide rate has risen, there has been a massive rise in death from alcohol and drug use among poor, less educated whites, who have been among those with the bleakest job prospects in the 21st-century global economy. And, when it comes to suicide itself, rates have risen fastest in Native American communities, which are serially plagued by material deprivation.

The link between inequality and suicide is important. If a huge swath of people is left without any opportunity for advancement, and told that it is because of their own failure of initiative, can we be surprised at a consequent outbreak of suicides? Just listen to the testimony of one internet commenter, who described how college debt and an impossible job market had turned him fatalistic:

Two B.A.s and I can’t find a job making $7.50/hour. Even if I did, what’s the point? Spin my wheels and get further into debt because I can’t make a wage that covers the costs of life? I got degrees in English and History, graduated Spring of 2008…three months before the economic collapse. Things went from ‘you can get $12/hour with any degree’ to ‘You will not be able to work if you have a BA and we’d rather hire someone without one.’ When I was in high school I was making $1500/week. Now I have $22 in my pocket, no job, and come March 1st my debt to my roommate for rent will reach $1500. That’s not including the $30k in student loans I have, or the cost of car insurance…There’s no out, there’s no way to make it work, that I’ve found….  I made all A’s in 27 hours of class in one semester, I’m god damn motivated. I walked four miles yesterday in Louisiana heat to drop off resumes… I work hard at every fucking thing I do, and I lack no motivation whatsoever. Some people do not get this…. we don’t need platitudes and this other bullshit. We need help…. if this shit doesn’t get better soon, and some sort of avenue for self-advancement appears, I’m going to be left to assume that people just don’t want me here enough, and I’m going to leave… It’s either I get an opportunity soon, I step off the mortal coil, or I turn to robbery. If anyone has any better ideas I’m all ears, because fuck if I haven’t explored every option I know about.

At a certain point, if people have to work to live, but do not have any work, they will find that they cannot live. It’s hard to know what to tell someone like this; every reassurance is a lie. Is he ever going to pay off his debts while working minimum wage jobs? No. Is he ever going to advance beyond those jobs? Probably not, unless some massive new market for English majors suddenly opens up.

Research on the connections between unemployment and suicide has suggested that the link is strongest in countries that usually have low unemployment, meaning that people who expect to find a job but can’t are more likely to kill themselves than people who never had the expectation to begin with. Suicides are therefore partially a product of the frustrated American dream; in a country where one expects that hard work will create success, but hard work yields nothing whatsoever, one is likely to feel like a useless failure.

A serious attempt to address suicide has to start, then, with the actual conditions of people’s lives. People are lonely, they are broke, they are desperate, and words of encouragement offer nothing. Usually, attempts to address the suicide problem focus on the lack of adequate mental health care in the country. There are suicide hotlines, but little else to assure people’s long-term mental health. Psychiatric counseling is expensive and often inaccessible. Yet it may be necessary to provide more than just increased access to counseling. Giving people support is obviously helpful. But a country with annual 42,000 suicides has a systemic problem, and needs to think about where despair originates.

The ability to counsel someone like Gene Sprague or the unemployed Louisianan may be limited. Certainly, there are things you can try to tell people, theories for why it’s better to live than to die. Albert Camus has a nice argument for why we shouldn’t kill ourselves; the choice to live is the only way to rebel against the absurdity of our human condition. It’s not a helpful argument, exactly, but it’s nice. There’s always the guilt argument; suicide is a selfish act because it forces other people to feel guilty about stopping you. But as psychiatrist Scott Alexander points out, this amounts to telling the suicidal person that “If you think you’re a burden upon others while you’re alive, just think how much more of a burden you will be on them if you kill yourself.” Perhaps one can shame someone into living, but it’s certainly not optimal (besides, the suicidal have a difficult time believing they will be missed… that’s half the problem to begin with).

The only real way to eliminate American suicide may be to eliminate the viciousness of American capitalism. If people weren’t kept chasing an impossible dream, and were given basic economic security, perhaps they could find the peace and resolve necessary to keep going. At the moment, millions of people face nothing but unendurable bleakness; a less brutally competitive economy means a less brutally unendurable life.

But the first step to addressing a problem is recognizing that we have a problem to begin with. Until America treats every suicide victim as a person, one toward whom we have a responsibility of care, 40,000 people will continue to pop off into the darkness with each passing year. The country must decide whether it cares enough to act, or whether the aesthetic value of our shimmering bridges outweighs the cost of installing a net.

Illustrations by Benjamin Saucier.