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