James H. Shore, M.D., and Betty L. Arvidson, Ph.D., organize their research findings on suicides in Pacific Northwest cities, with particular attention on Multnomah County and Portland. In this essay, they reflect on the first reported occurrence of self-harm from the Journals of Lewis and Clark in 1805, and look to data on suicides in Multnomah County over an 80-year period, from 1894 to 1974. The research not only delves into the methods used in these instances, but the more complicated and interwoven issues that drive an individual to such a conclusion, recognizing that is an issue of public health that requires both further study and greater resources for preventative treatment.