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