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