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Chapter Nine: Suicide

  • Only humans knowingly take their own lives
  • Suicide is one of the leading causes of death in the world
  • 1 million people die by suicide each year
  • Parasuicides: Unsuccessful suicide attempts
  • Psychological Dysfunction: A breakdown of coping skills, emotional turmoil, a distorted view of life

What is suicide?

  • Suicide: A self-inflicted death in which one makes an intentional, direct, and conscious effort to end one’s life
  • Four kinds of people who intentionally end their lives
    • Death Seeker: A person who clearly intends to end their lives at the time they attempt suicide
    • Death Initiator: A person who intends to end their life believing that the process of death is already under way and that they’re simply hastening the process
    • Suicides among the elderly
    • Suicides among the very sick
    • Death Ignorer: A person who doesn’t believe that their self-inflicted death will mean the end of their existence
    • Believe they’re trading their present lives for a better or happier existence
    • Death Darer: A person who experiences mixed feelings or ambivalence about their intent to die
    • Their risk-taking behavior doesn’t guarantee death
    • ex: Russian Roulette
  • Subintentional Deaths: When people play indirect, covert, partial, or unconscious roles in their own deaths
    • Correlation between regularly engaging in such behaviors and later attempts at suicide
    • Self-injury / Self-mutilation
  • Self-injury
    • The pain brought on seems to offer some relief from tension or other kinds of emotional suffering
    • The behavior serves as a temporary distraction from problems
    • The scars that result may document the person’s distress
    • Self-injury may help a person deal with chronic feelings of emptiness, boredom, and identity confusion

How Is Suicide Studied?

  • Retrospective Analysis: A kind of psychological autopsy in which clinicians and researchers piece together data from the suicide victim’s past
    • Past statements, conversations, and behaviors
    • Suicide notes
    • These sources of info aren’t always available or reliable
    • Hannah Baker in 13RW
  • Studying people who survive their attempts
    • There are 12 nonfatal suicide attempts for every fatal suicide
    • It may be that ppl who survive suicide attempts differ in important ways from those who don’t

Patterns and Statistics

  • Suicide rates vary from country to country
  • Countries that are largely Catholic, Jewish, or Muslim tend to have low suicide rates
  • Very religious people seem less likely to die by suicide
  • Three times as many women attempt suicide, but men die from their attempts three times more than women
    • Men tend to use more violent methods
    • Women use less violent methods
  • At least half of individuals who carry out suicide are socially isolated and have few or no close personal friends
  • Suicide rates tend to vary according to race and ethnicity

What Triggers a Suicide?

  • Suicidal acts may be connected to recent events or current conditions in a person’s life

Stressful Events and Situations

  • Combat veterans from various wars are more than twice as likely to die by suicide as nonveterans
  • Immediate Stress: Loss of loved one, loss of a job, significant financial loss, stress caused by natural disasters
  • Long-term stress
    • Social Isolation: Those without social supports are particularly vulnerable to suicidal thinking and actions
    • Serious illness
    • Believe that death is unavoidable and imminent
    • Believe that the suffering and problems caused by their illnesses are more than they can endure
    • Abusive or repressive environment
    • Believe they have little or no hope of escape
    • ex: pows, inmates of concentration camps, abused spouses and children, prison inmates
    • Occupational stress
    • Higher rates among ppl working in unskilled occupations
    • Emotional strain of jobs like psychologists, physicians, nurses, police officers, etc.

Mood and Thought Changes

  • Many suicide attempts are preceded by a change in mood
  • Increase in sadness
  • Increases in feelings of anxiety, tension, frustration, anger, or shame
  • Psychache: A feeling of psychological pain that seems intolerable to the person
  • Shifts in thinning
  • Hopelessness: A pessimistic belief that their present circumstances, problems, or mood will not change
  • Feeling of hopelessness is the single most likely indicator of suicidal intent
  • Dichotomous Thinking: Viewing problems and solutions in rigid either/or terms
    • Suicide was the only thing i could do

Alcohol and Other Drug Use

  • As many as 70 percent of the people who attempt suicide drink alcohol just before they do so
  • ¼ of ppl who die by suicide are legally intoxicated
  • The more intoxicated suicide attempters are, the more lethal their chosen suicide method

Mental Disorders

  • The vast majority of all suicide attempters have a psychological disorder
  • Severe depression, chronic alcoholism, schizophrenia
  • Treatments for depression consistently reduce the rate of suicidal thinking, attempts, and completions among patients
  • Among those who are severely depressed, the risk of suicide may increase as their mood improves and they have more energy to act on their suicidal wishes
  • Severe depression may also play a key role in suicide attempts made by those with serious physical illnesses
  • Schizophrenia
    • Popular notion: When ppl kill themselves, they’re responding to an imagined voice commanding them to do so or to a delusion that suicide is a grand and noble gesture
    • Suicides by people with disorders featuring psychosis reflect feelings of demoralization, a sense of being entrapped by their disorder, and fears of further mental deterioration
    • Suicide is the leading cause of premature death among ppl with schizophrenia

Modeling: The Contagion of Suicide

  • One suicidal act serves as a model for another
  • Social contagion effect
  • Family members and friends, celebrities, highly publicized cases, coworkers and colleagues
  • Postvention: Postsuicide programs that hold therapy sessions for recruits that had been close to the suicide victims

What Are the Underlying Causes of Suicide?

The Psychodynamic View

  • Suicide results from depression and from anger at others that is redirected toward oneself
  • When ppl experience the real or symbolic loss of a loved one, they come to introject the lost person
    • Suicide is the extreme expression of self-hatred and self-punishment
    • Relationship found between childhood losses and later suicidal behaviors
  • While most people learn to redirect their death instinct by aiming it towards others, suicidal ppl direct it toward themselves
    • Suicide rates drop in times of war when ppl are encouraged to direct their self-destructive energy against the enemy

Durkheim’s Sociocultural View

  • The probablity of suicide is determined by how attached a person is to social groups and community
  • People who have poor relationships with their society are at higher risk of killing themselves
  • Three categories of Suicide: Egoistic, Alturistic, and Anomic
  • Egoistic Suicides: Carried out by ppl over which society has little or no control
    • Not concerned with the norms or rules of society
    • Not integrated into the social fabric
  • Alturistic Suicides: Carried out by ppl who are so integrated into the social structure that they intentionally sacrifice their lives for its well-being
    • ex: soldiers who throw themselves on live grenades to save others
    • Societies that encourage people to sacrifice themselves for others and to preserve their own honor are likely to have higher suicide rates
  • Anomic Suicides: Carried out by ppl whose social environment fails to provide stable structures to support and give meaning to life
    • Anomie: A societal condition that leaves people without a sense of belonging
    • Act of a person who’s been let down by a disorganized, inadequate society
    • When societies go through periods of anomie, their suicide rates increase
    • Economic depression
    • Population change
    • Increased immigration
    • A major change in a person’s immediate surroundings can also lead to anomic suicide
    • People who suddenly inherit a great deal of money
      • Relationships with social, economic, and occupational structures are changed
    • Ppl who are sent to a prison environment
      • Removed from society
  • The final explanation probably lies in the interaction between societal and individual factors

The Interpersonal View

  • Interpersonal Theory of Suicide: People will be inclined to pursue suicide if they have perceived burdensomeness, thwarted belongingness, and a psychological capability to carry out suicide
    • Thomas Joiner
    • Perceived Burdensomeness: Believe that their existence places a heavy and permanent burden on their family, friends, and even society
    • Typically inaccurate
    • Often leads to self-hatred
    • Thwarted Belongingness: Feel isolated and alienated from others
    • Social disconnect
    • Feels enduring, unchangeable, and confining
    • People who experience both of these interpersonal perceptions are inclined to develop a desire for suicide
    • Unlikely to attempt suicide
    • Must have the psychological capability to inflict lethal harm on themselves
    • Psychological capability to carry out suicide
    • We all have a basic motive to live and preserve ourselves
    • This motive weakens for certain ppl as a result of repeated exposure to painful or frightening life experiences
      • Abuse
      • Trauma
      • Severe illness
    • May develop a heightened tolerance for pain and a fearlessness about death
    • Accounts for military suicides - military service has been linked to all these feelings

The Biological View

  • Family pedigree studies show that suicidal people have higher rates of suicide in their parents and close relatives
  • Low serotonin activity may be a predictor of suicidal acts
  • Low serotonin activity of suicidal persons corresponds to dysfunction throughout their depression-related brain circuit
  • Low serotonin activity and brain-circuit dysfunction plays a role in suicide separate from depression
  • Contributes to aggressive and impulsive behavior

Is suicide linked to age?

  • Likelihood of dying by suicide steadily increases with age through middle age, then decreases during early old age, and increases again at 75

Children

  • Suicide is infrequent among children
  • Suicide attempts by the very young are commonly preceded by other behavioral patterns
  • Linked to the loss of a loved one, family stress, abuse and victimization by parents and peers, and depression
  • Many child suicides appear to be based on a clear understanding of death and a clear wish to die
  • Suicidal thinking among children is more common than believed

Adolescents

  • Suicidal actions become much more common after the age of 13
  • Suicide has become the second leading cause of death in adolescents, after suicides
  • Half of teen suicides have been tied to clinical depression, low self-esteem, and feelings of hopelessness
  • Many teens who try to kill themselves struggle with anger and impulsiveness, have serious alcohol or drug problems, or have deficiencies in their ability to sort out and solve problems
  • Often under great stress
    • Long-term pressures
    • Relationships with parents
    • Family conflict
    • Inadequate peer relationships
    • Social isolation
    • Repeated bullying
    • Immediate stress
    • Parent’s unemployment or medical illness
    • Financial setbacks
    • Social loss
    • School
  • LGTBQ teenagers are 3 times as likely as other teens to have suicidal thoughts and to attempt suicide
  • Period of adolescence itself produces a stressful climate in which suicidal actions are more likely
  • Teen suicide attempts
    • More teenagers attempt suicide than actually kill themselves
    • Some wish to die, others want to make others understand how desperate they are, get help, or teach others a lesson
    • Up to half of teenagers who make a suicide attempt try again in the future
    • Societal factors
    • Number and proportion of teens and young adults has risen, leading to increased competition
    • Weakening ties in the family
    • Easy availability of substances and pressure to use them
    • Mass media coverage of suicides
    • Detailed descriptions may serve as models for ppl contemplating suicide
  • Multicultural issues
    • Teen suicide rates vary by race and ethnicity
    • Non-hispanic white american teens are more prone to suicide
    • Growing rates for young african and hispanic americans
    • Native americans have the highest teenage suicide rate
    • Extreme poverty
    • Limited educational and employment opportunities
    • High rate of alcohol abuse
    • Geographical isolation
    • Cluster suicides

The Elderly

  • As people grow older, they become ill, lose close friends and relative, lose control over their lives, and lose status in our society
  • ⅔ of particularly elderly individuals who die by suicide had been hospitalized for medical reasons within 2 years preceding the suicide
  • Heightened rate of vascular or respiratory illnesses among elderly people who attempted suicide
  • Suicide rate of elderly people who’ve recently lost a spouse is particularly high
  • More determined in their decision to die and give fewer warnings, so their success rate is much higher
  • Clinical depression plays an important role in 60% of suicides by the elderly
    • More elderly ppl who are suicidal should be receiving treatment for their depressive disorders
    • Treating depression in older persons helps reduce their risk of suicide markedly
  • Suicide rate among the elderly is lower in some minority groups
    • Rate among elderly native americans is low bc the aged are held in high regard
    • Low suicide rate in elderly african americans bc they’ve already overcome significant adversity

Treatment and Suicide

What Treatments Are Used After Suicide Attempts?

  • Physical damage is treated
  • Many suicidal people fail to receive systematic follow-up care
  • Some suicidal ppl refuse therapy
  • Goals of therapy: keep individuals alive, reduce their psychological pain, help them achieve a nonsuicidal state of mind, provide them with hope, guide them to develop better ways of handling stress
  • Ppl who receive therapy after their suicide attempts have a lower risk of future suicide attempts and deaths
  • Cognitive-Behavioral Therapy is particularly helpful
  • Dialectical Behavior Therapy (DBT) is being used increasingly in cases of suicidal thinking and attempts

What Is Suicide Prevention?

  • Suicide Prevention Program: A program that tries to identify people who are at risk of killing themselves and to offer them crisis intervention
  • suicide hotlines: 24-hr telephone services in which callers reach a counselor who provides services under the supervision of a mental health professional
    • Counselors are typically paraprofessionals
    • Paraprofessional: A person trained in counseling but without a formal degree
  • Crisis Intervention: A treatment approach that tries to help people in a psychological crisis to view their situation more accurately, make better decisions, act more constructively, and overcome the crisis
  • Crisis Text Line - Nonprofit crisis intervention service that offers text counseling in partnership with hotlines
  • Trevor Lifeline: A nationwide, around-the-clock hotline available for LGTBQ teenagers who are thinking about suicide
  • Technique used
    • Establish a positive relationship
    • Set a positive and comfortable tone for the discussion
    • Convey understanding, non judgment, availability
    • Understand and clarify the problem
    • Assess suicide potentional
    • Degree of stress
    • Relevant personality characteristics
    • How detailed the suicide plan is
    • Severity of symptoms
    • Coping resources available
    • Assess and mobilize the caller’s resources
    • Formulate a plan
  • Longer-term therapy is needed for most
  • Reduce the public’s access to particularly lethal and common means of suicide
    • Gun control
    • Safer medications
    • Better bridge barriers
    • Car emission controls

Do Suicide Prevention Programs Work?

  • Difficult to measure
  • Only a small number of suicidal people contact prevention centers
  • Prevention programs do seem to reduce the number of suicides among the high-risk people who call
  • Relies on accurate assessments of suicide risk
  • Public education about suicide is the ultimate form of prevention

Psychological and Biological Insights Lag Behind

  • Suicide has received much more examination from the sociocultural model than from any other
  • Sociocultural factors typically leave us unable to predict that a given person will attempt suicide