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