Twin_Suicide

Can Losing an Identical Twin to Suicide Doom the Survivor to the Same Fate?

Monozygotic twins share 100 percent of their DNA, but scientists are still unsure just how encoded suicidal tendencies might be in our genes

A few weeks before his own death, George Atkinson III, a former running back for the Oakland Raiders, wrote about his struggle to cope with the pain of losing his identical twin brother, Josh, to suicide. “On Christmas Eve, he went missing,” Atkinson writes on The Unsealed, a platform for open letters whose mission is to bring awareness to social issues. “We found him through the GPS in his car. Drunk and upset, he was on the verge of driving to the bridge and doing something stupid. He said he felt guilty because we pulled the plug on our mother’s life support. I told him it was our decision. I reassured him no one is blaming nobody and to snap out of it because it was in God’s hand. I calmed him down and took him home. The next day he hanged himself.”

Atkinson describes the moment he found out about his brother’s suicide as “the moment I felt like I lost everything.” Subsequently, Atkinson would be put in a psychiatric hold of his own, in the same institution as his mother, who had been a paranoid schizophrenic. “Then, I thought about my ‘why,’” Atkinson writes. “When I played football, helping my mom was my ‘why.’ She was the reason I worked so hard — I wanted to help her. Now, my daughter, who is only two years old, is my ‘why.’”

Just a few months after writing those words, Atkinson passed away. Although his cause of death has yet to be confirmed by authorities, according to the Latin Times, “speculations are rife that the 27-year-old NFL player also died by suicide.”

It’s a terrible tragedy, and if it was indeed suicide, it’s hard not to consider how much Atkinson’s being one of a set of identical twins played a part. The experience of being born an identical twin — both developed from a single egg that splits into two embryos after the fertilization process — codifies a level of kinship that’s unparalleled in nature. To be an identical twin is to share a genetic baseline and a resulting closeness that’s surely unfathomable to anyone who hasn’t experienced it themselves. 

Atkinson’s death is fortunately not a part of some well-defined trend — that is, one twin’s suicide is far from making it inevitable that the other will follow suit. “Suicide in general is a rare phenomenon in this country,” says Amy Fiske, a clinical psychologist at West Virginia University. “14.5 out of every 100,000 people die by suicide each year, so that’s a pretty rare phenomenon. So it’s not that likely that somebody’s going to die by suicide just because their twin did.” That said, there are certainly indications that a twin might be more at risk.

Twin suicides present researchers with an opportunity to examine just how much a person’s nature determines their potential for suicidal behavior. Twin studies — and particularly identical twin studies — have long provided scientists with the unique chance to try to untangle the seemingly impossible web of nature versus nurture. Since fraternal twins only share 50 percent of their DNA, but identical twins share 100 percent of the same DNA, if an observable trait — or in this case, an observable mental illness — is more common among identical twins than it is among fraternal twins, it’s a clear sign that genetic factors are at play. 

According to a report in the Indian Journal of Community Medicine, the main advantages of twin studies is that they “allow disentanglement of the shared genetic and environmental factors for the trait of interest.” “Therefore, twin studies will continue to inform mankind about the relative importance of genes and the environment on traits in ways that no other type of research ever can,” the report continues. To put it another way, identical twins are essentially the holy grail of test subjects for scientists looking to determine whether the cause of an issue is environmental or genetic.

Fiske explains that such identical twin studies can help us understand the increased likelihood of developing a particular disease — or in this case, formulating a particular behavior — based on a person’s genetic makeup. “What we refer to as ‘susceptibility genes’ tell us that there’s not one gene for suicide,” says Fiske. “There would be multiple genes that might influence propensity for depression, propensity for alcoholism — other things that might contribute to the likelihood that they might eventually choose suicide.”

Exactly how likely it is that a person will ultimately commit suicide is uncertain (only about two percent of people ever treated for depression will die by suicide, according to the Department of Health and Human Services), but Fiske says that research shows the latest estimate for the heritability of suicide attempt/completion is roughly 43 percent. “Many things that are highly heritable are somewhere in the range of 50 percent,” says Fiske. “So 40 percent is pretty high, and depression is also somewhere around high 30s to 40 percent. That begs the question: Could it be that what’s inherited is the propensity to suicide because what’s inherited is depression? We don’t know that answer yet.”

With the genetic aspect still so uncertain, the ‘nurture’ part of the equation must therefore be taken strongly into consideration. Fiske believes that one of the environmental factors that should be acknowledged with regard to suicide is the bereavement process. “There tend to be special challenges to dealing with suicide grief compared to grief when someone dies of other means, and of course, as you might imagine, the largest part of it is guilt,” says Fiske. “That’s not guilt because people did something wrong, but because you always wonder, could you have done something?”

While this question is likely to haunt anyone who has lost a loved one to suicide, for identical twins — who, again, share 100 percent of the same DNA and are thus genetically hardwired to experience life in much the same way — it can feel impossible to grapple with. “Close isn’t even the word,” says Joan Angelis, a retired personal chef whose identical twin sister, Jean, died by suicide at the age of 28. “It’s even more than being close. I felt like we were each other. Like, we had memories and… ‘Oh, remember when I did this?’ And the other one will say, ‘No, that was me that did that.’ I just truly don’t remember sometimes, because you remember things so clearly — it was yourself and, at times, myself was her.” 

As one small example, Joan can no longer remember if it was she who had a freckle on the tip of her nose when she was younger, or if it was her sister. “When we were little, my family would always tell us apart because of one of the freckle marks on the tip of our nose,” she says. “And when I look back now, I’m thinking, Was that me or Jean? The line kind of blurred who was who.”

Joan fell into a three-year depression following her sister’s suicide. The hardest thing that she had to come to terms with, she says, was not realizing that something was wrong. “The last time I saw her was on July 4th weekend in 1982,” she says — exactly one month and six days before her sister would get into a parked car in her garage, turn it on and wait for the carbon monoxide poisoning to take her. “She seemed ‘normal,’ whatever that means,” says Angelis. “I remember she said something about… I don’t know, she seemed a little down and said something like, ‘Things aren’t very good right now.’ I know she was taking some college courses, and I thought she meant not very good, like, ‘I’m getting a C and not a B, or a B and not an A.’ The slightest thought of [suicide] never entered my universe because if it did I would’ve… I…” She pauses. “There isn’t anything I wouldn’t have done.”

Angelis — now a member of Twinless Twins, an organization that helps twins who have lost their twins to deal with their loss — tells me that not realizing her sister was suicidal “will always be the hardest to deal with.” “The fact that I didn’t know, because I’ve heard other friends [who are twins] say things like, ‘Oh, I was riding in a car going to the hospital where my twin was and all of a sudden I felt this peace and I knew they died.’ Or the opposite, like, ‘All this pain and I knew that my twin… something happened and that they died.’ But I didn’t have a clue.”

Although there are, then, apparently wide variations between how much twins seem able to ‘sense’ what their twin is going through, it doesn’t undermine the unique epidemiological research tool that twin studies represent in studying genetic factors and suicidal behavior. As the book The Neurobiological Basis of Suicide states, while “suicide is a complex, multifactorial behavioral phenotype” — an observable trait — it’s also definitely familial. “A family history of suicide increases risk of suicide attempts and completed suicide,” per their report. The book notes that one 1995 study on twins found that “10 of 26 surviving [identical] twins had attempted suicide, while none of the nine surviving [fraternal] twins had a history of suicide attempts.” “This suggests that suicide attempts and completions may share a common genetic component,” they claim. 

Nancy L. Segal, who has long studied the power of nature versus nurture and conducted her own research on twin suicide, tells me that she, too, has found that the frequency of suicide attempts among twin suicide survivors was “significantly higher among [identical] twins than [fraternal] twins.” “Suicide attempts were unrelated to the closeness of the twin relationship,” writes Segal in her study. “This finding is consistent with the view that suicidal attempts may represent a genetic liability that can be triggered by extreme stress. The loss of a twin is clearly an extremely stressful event, but is unlikely to lead to suicide in the absence of an inherited predisposition.” In other words, without a family history of mental illness, even a twin who has lost their twin to suicide is unlikely to take their own life. 

For her part, Angelis tells me that after her twin sister’s suicide, she did feel a sense of impending doom — a persistent notion that suicide could potentially be her fate as well. “I just didn’t see a future that was positive,” she says. “In the beginning and for the longest time, any time that I would have an argument with my husband, the saddest thing of all when that would happen is I would think, Jean would understand. She would get it. And I don’t have that anymore.’”

She has, however, to some degree — and through her own bout with depression — come to terms with why her sister never talked about what she was going through. “[After Jean’s death], I thought I was never going to get better,” she says. “I was just wrong, but I was sure of it. And I just, I couldn’t live life in any way. I didn’t brush my teeth for three years. So I realized that if I felt like that, and if she felt like that, then why would you tell anyone who couldn’t help you, in your eyes?”

In spite of what the statistics say, though, Angelis credits her twin sister for actually saving her life. “I’m sure that my mom had depression,” she says. “She had a hard life. But it was after my sister’s suicide that I came to the realization that I kind of owe Jean my life. I’m kind of indebted to her because if she didn’t do what she did — I think we were both prone to depression — who knows how my own life would have ended up?”