31. Gambling With Your Life

I'm Matt Ray and I'm a sociologist at Temple University and I study the sociology of race and ethnicity and I study cultural sociology and I study medical sociology and sort of the sociology of health and illness.

And lately, at least, or in part of what you study, I know you've been studying suicide as well, correct? I have. To sum up what I do in a word would be to say that I study losers. And I am interested in those who lose out on societal gains and on opportunities. And it's another way of saying I'm interested in inequalities and stratification.

If you had to guess, would you say that more people in the U.S. die from homicide?

are from suicide. I mean, homicide is certainly a lot noisier in the newspaper headlines, the cop shows on TV. But the fact is, there are more than twice as many suicides every year, about 36.5,000 suicides versus about 16.5,000 homicides. And more people kill themselves in the western states than in any other part of the country.

The sociologist Matt Ray is studying the so-called suicide belt. He's also written a paper about one place out west that boasts the dubious distinction of having the highest suicide rate of any city in the country.

I was living in Las Vegas and I wanted to understand more about Las Vegas as a community. I just moved there and was struck by the exceedingly high suicide rate in Las Vegas. And so I wanted to know what's causing this and more specifically, could it be something about the place?

that actually is effectively sort of suicidogenic. You know, what's generating this high rate of suicide over such an extended period of time? Because it is far back as I could go in the statistics for decades. I was seeing this consistently high rate. So it was a puzzle, really, that more than anything else, just a curiosity that led me down this road.

Talk to me about the paper, what you found, what was particularly noteworthy and surprising to you. The suicide rate in Las Vegas is the highest of the large cities in the United States, and it's high by far. The suicide rate, and here this is sort of adjusting for age, is over the period the most recent eight years for which we have data, 18.4 per 100,000 people.

That number itself is meaningless, but the next highest number is in Florida. That's 15.9, 15.5. The national average, which is perhaps the most meaningful comparison for that same period, was 9.5. So you're talking about a suicide rate in a city. And cities in the United States typically have low suicide rates compared to rural areas. You're talking about a city that has an average suicide rate, which is twice the national average.

And the US is not among the highest countries in the world in terms of suicide rate, not among the lowest either. Although we actually do all right. But if we were looking at just Las Vegas, if all of the US were like Las Vegas, we would then be comparable to what countries in terms of suicide rate.

We would be comparable to countries like Japan, which is recognized as having a high suicide rate Austria, which is recognized as having a high suicide rate. But we wouldn't be as high as Hungary. We wouldn't be as high as Lithuania. We wouldn't be anywhere near as high as Russia. These are sort of the world leaders in suicide risk.

All right, so walk me through the paper a little bit, especially the way you tease apart different pieces of it. In other words, you looked at and wanted to tease apart the questions of whether it's people who live and stay in Las Vegas who kill themselves, whether it's people who live elsewhere and come to Las Vegas and kill themselves. If people who live in Las Vegas have a higher rate than others elsewhere, what happens when those people go elsewhere and so on? In other words, trying to separate, trying to tease out the effect of the place itself. So talk me through your

intentions and then your results there. Right, so we really were interested in this question of what happens when you expose people to Las Vegas. Is there ways in which we can determine if there's a place effect on suicide rates rather than sort of a people effect that is

People sort of bringing their suicide risk with them to Las Vegas. We wanted to see instead of something happen to people who were exposed to Las Vegas. And that's true both for residents, people who live and die in Las Vegas, and visitors that is people who live elsewhere but die in Las Vegas. Remember, we're just looking at dead people. We're just looking at death records because that's the data that we have.

And what you find then is that if I live and stay in Las Vegas, I'm going to be more likely to kill myself. If I live elsewhere and travel to Las Vegas, I will be more likely to kill myself. But if I live in Las Vegas and leave, I will be less likely to kill myself. Is that right? That's correct.

These are quite different size effects. If you, what we call the chronic exposure model, if you live and you're chronically exposed, live in Diane Vegas, you're about 60% more likely than residents elsewhere in the United States to die by suicide. For the second model that you spoke of, the visitors coming to Las Vegas compared to people who are staying home, it's about 100% increase in suicide risk.

For the residents of Las Vegas who leave, what we think of as reduced exposure model or a hiatus model, you take a break from Vegas, your risk goes down about 20 percent. It sounds like if you live in Las Vegas and there's some chance that you may be suicidal, if you are depressed and you may be suicidal. Get out of town.

So, it really does, it really will help. Well, again, the overall risk here, this is important to keep in mind when we're using this particular measure, is really small. But still, what you're saying is really interesting. You're saying that the people who are there do it more regularly than anywhere, any other city in the US, but also the people who don't live there and come there then do it more often. So, I was going to ask you, does this mean that Las Vegas is

suicide agent that it actually causes suicides or is it maybe that it's a suicide magnet but it sounds as though from what you're telling me that it's very much both is that right that's what i believe i can't answer that definitively i don't have solid evidence on all sides of this question but uh... yeah that's the explanation that

I think is most compelling, that there's a chance that suicide rates are higher in Vegas, in part because suicide rates are higher. That is, people are aware of this as a kind of more frequent option in Vegas. There's a little bit of a, perhaps, a golden gate bridge effect where people also are recognizing Las Vegas as a kind of suicide destination.

Now, I'll point out that in absolute numbers, the number of people who are doing this is really quite small. We're talking about 25 or 30 people a year who are visitors to Las Vegas, who kill themselves there. But still, that sounds like a small number, but that's still a much higher number than we see in other cities.

It's been the best part of my losing streak in an R.M.E.G. For what I can't recall. Coming up, what is it about Las Vegas that leads to such a high suicide rate? We'll also tell you why, if you live in New York, like I do, suicide isn't at the top of your worry list. Here's a hint. You might want to leave the cream cheese off your next bagel. I'm leaving Las Vegas.

From WNYC and APM American Public Media, this is Freakonomics Radio. Here's your host, Steven Dubner.

Matt Ray is a sociologist who studies, among other things, suicide. He says there are a lot of factors that contribute to Las Vegas having a suicide rate that's nearly double the national rate. For starters, it's grown quickly, really quickly, from about 127,000 people in 1960 to nearly 2 million today. And that kind of boom can make it hard to build strong government institutions. And that, says Ray, can translate into a lack of services like psychiatric counseling.

There's also a high rate of drug and alcohol use in Vegas, and of course, there's the gambling culture. But Ray says, that's not all. I'll add that there's one more feature here of Las Vegas, which I think it bears mentioning, and that is what I kind of think of as a sort of frontier culture mentality among residents, and I think even among visitors.

That Las Vegas is just this place of total license. It's the Wild West. It's an open frontier for all kinds of immorality and exploration of vice. The entire self-branding of Las Vegas as this place where that is not only

tolerated, but actually sanctions. What happens in Vegas stays in Vegas kind of mentality produces, I think, a sort of libertarian ethos of

go it alone, do it yourself, help seeking in this framework is perhaps not kind of accepted or valorize the way it is in other parts of the country. These kinds of cultural arguments are always very hard to make. They always sound deeply unscientific, but in a lot of ways I think it's exactly where

A lot of the explanatory power comes from his understanding the culture and the values underlying people's behavioral sets.

Let me ask you this, Matt. Do you feel as a scholar, you know, I mean, look, you have what sounds to be a very nice job at a very nice university and a very nice city teaching sociology at Temple in Philadelphia and you study suicide and you study as you put it losers, you know, people whose lives don't turn out the way they wanted them to turn out and then kind of need to ask themselves, what do I do about it? And some of them kill themselves.

In terms of that, do you feel that suicide is an underrated problem in our society and in any society? Underrated. Well, I think that we're kind of schizophrenic about suicide, which is that we have both devoted intellectuals and scholars and public health officials and sociologists, and especially psychiatrists and psychologists, have devoted

so much ink to thinking and talking, exploring suicide, that it's hard to say that it's under examined. We also tend to be obsessed with suicides in pop culture. I can't even begin to list the number of films, the number of TV shows whose plot points turn on suicides.

And so it's kind of a hot-button issue, but I think it's true, equally true, that most of the time we ignore the suicides that are happening in our midst. I certainly feel that's the case in Las Vegas where every year or year and a half, a reporter, an enterprising reporter at one of the Las Vegas newspapers discovers the suicide problem in Las Vegas, and we get a kind of

rash of stories. And then we go back to not thinking about it. And so to the extent that we have this kind of look but don't see relationship with suicide, it is kind of under the radar.

Why do you think we have that relationship as a sociologist or as a human being? We know it exists. It's existed throughout history. The numbers are large. I mean, you talk about how predominant suicide is in pop culture and let's say in TV shows or films. But I'll tell you, without having done any looking into this at all,

I'd bet a lot of money that murder is much more prominently featured in TV and on film than suicide, and yet murder takes fewer than half the number of lives of suicide every year.

Great point. We do seem to be far more focused on that form of violence than the lethal self-directed violence that is suicide. And I think that there's a way in which the

The need for justice that we feel when a homicide occurs motivates us to take a greater collective interest in it. A crime has occurred. The most heinous kind of crime has occurred. A life has been taken. Someone did it. That person is bad. We need to identify that person and we need to bring about some justice and some retribution.

Those ingredients are really missing. They're really missing with suicide. We see it as tragedy. We see it as loss. It's deeply saddening and depressing and grim, very, very grim. And so I think it doesn't mobilize people in the same way that homicide does, or even in some ways accidents.

Let me ask you one more question. You mentioned it, and I think we're looking into it, so I'd love to know if you have any insight. What is the story with Hungary? Why over a long period of history, why does Hungary have such a high suicide rate?

I have no idea. I would rather talk about New York. Well, give me New York then. Why New York relatively low compared to Vegas? You're absolutely right. Las Vegas has this high suicide rate. New York has the lowest. There are some urban counties in New Jersey that are lower, but the five borough area in New York has extraordinarily low suicide rates.

If you live in New York, an interesting thing is that you're more likely to die of a heart attack than elsewhere in the United States. The particular place-based risk of death for New Yorkers is not suicide. It's a myocardial infarction. This speaks to the issue of how place and health or mortality are related, which is one of the issues I'm trying to get out in the study.

In fact, the basic model for our Vegas paper was taken from a study in 1999 about the increase in heart attack risk that visitors to New York experience. People who visit New York see their risk for heart attack go up at about 6%. And residents of New York have a heart attack risk that is about 12% greater than elsewhere.

So if you should get out of New York, because if you're a New Yorker and you leave New York, Stephen, your risk of dying by heart attack will drop by about 7%. If I'm personally not a lot of risk for a heart attack, then I can probably afford the added risk of heart attack by staying in New York. If, however, I'm slightly more tending towards suicide, I got to stay out of Las Vegas.

That's exactly right. And Hungary, don't even... Cancel that flight. Do not go if you are on the fence.

Freakonomics Radio is going to Hungary and lots of other places, too. It'll all be part of an hour-long episode about suicide that airs on finer public radio stations this June, and there will be four more hours of radio, too. You'll hear from Romanian witches, Harvard dropouts, and a couple of prostitutes. Oh yeah, a bunch of economists, too.

Freakonomics Radio is a co-production of WNYC, APM, American Public Media, and Dubner Productions. Our staff includes Susie Lechtenberg, Barre Lam, Chris Neary, and Colin Campbell. Our engineer is David Herman. Subscribe to this podcast on iTunes, and you'll get the next episode in your sleep. You can find more audio at Freakonomicsradio.com. And as always, if you want to read more about the hidden side of everything, go to Freakonomics.com.

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