Module 6: Suicide

Suicide: Definition

An individual Act to cause his or her own death (No one else is involved)

WITH The Intention to Die

Suicide

• Suicide is one of the leading causes of death in the world o It is estimated that 700,000 people die of it each

year, with 31,000 suicides per year in the U.S. alone

• Many more unsuccessfully attempt suicide than actually succeed o Such attempts are called “parasuicides”

Suicide

• It is difficult to obtain accurate figures on suicide rates o Many “accidents” may be intentional deaths

• Suicide is not classified as a mental disorder in the DSM-IV-TR o While suicide is often linked to depression,

about half of all suicides result from other mental disorders or involve no clear mental disorder at all

What Do The Statistics Tell Us?

• Suicide is the 11th most common cause of death in the United States

• The number of suicides is underrepresented • Medical examiners will shade the fact when there is

any ambiguity as to the cause of death • Accidents are often suicides • For self-inflicted injury to be classified as suicide the

intentionality of the action must be established

What Do The Statistics Tell Us? • Suicide Rate = (Number of Suicides X 100,000),

divided by the population • Not a percentage • U.S. rate is 10.7, meaning 10 and 11 people out of

every hundred thousand commit suicide per year

• Suicide rates three times higher than those in the U.S. and Canada are found in the Russian Federation, Belarus, China, Estonia, Hungary, and Kazakhstan

How Is Suicide Studied?

• Suicide researchers face a major obstacle: their subjects are no longer alive

• Researchers use two different strategies to try to overcome this obstacle (with partial success): o Retrospective analysis o Studying people who survive their suicide

attempts

Suicide Patterns in the U.S.

• Completed suicides occur most often among white males

• White male suicide rate increases with age, but females and nonwhite males reach their peak vulnerability earlier in adult life

• Suicide remains the third leading cause of death among youth (ages 15-24)

Suicide Patterns in the U.S. • Bad economic times are usually associated with an

increase in suicide • The suicide rate is higher among people who:

• Suffer from depression or other psychiatric problems • Use alcohol while depressed • Deal with challenges and frustrations in impulsive ways • Are divorced • Lost an important relationship through death or break-up • Live in certain areas of the country

Suicide Patterns in the U.S.

• States with the Highest Suicide Rates (in order) • Wyoming • Alaska • Montana • Nevada • New Mexico

• States with the Lowest Suicide Rates (in order) • Connecticut • Massachusetts • New Jersey • New York • District of Columbia

Youth Suicide • The increase in completed suicides is greater for males,

although more suicide attempts are made by young women

• Both sexes turn to firearms and explosives as the most

common method of self destruction

• Academic pressure seems related to suicide among college students but not in a simple way

• Most of those who have gone on to commit suicide

expressed their despondency to others and made explicit comments about their intentions

Youth Suicide • The immoderate use of alcohol and other drugs occurs

more often with suicidal people (at all ages)

• The loss of a valued relationship is one of the most common triggering events for youth suicide

• Heavy metal music attracts depressed and suicidal youth – it does not cause suicide

• Teens and adolescents who frequently change their place of residence are at a higher risk for suicide

Family Characteristics Associated with Youth Suicide • The families impose rigid rules • Communication patterns are poor • Parent may establish too strong an emotional

bond with the youth (smother love) while not encouraging responsibility and independence

• Long-term patterns of dysfunction exist within the family

Suicide Among Elderly Persons

• Since 1990, the largest suicide rate has been among people 85 and older

• Elderly white men are the most vulnerable to suicide (by age 85 suicide rate is 18)

• Often choose firearms as mode of suicide • Less likely to give warning signs • More likely to plan suicide • Less likely to recover from an attempt

Suicide Among Elderly Persons

• Factors that increase the risk of suicide • White, male, over 65, living alone, residing in a rural

area of transient inner city zone • Social isolation • Depression • Physical illness • Alcohol use • Failure to cope with stresses • Loss of relationships

Suicide Among Native Americans • Suicide rate is exceptionally high at 19.3

• Compare to white males at 19.9, African American males at 9.1, white females at 4.8, and African American females at 1.5

• Tribal differences in suicide rates are large and also vary over time

• Alcohol is a major factor • More at risk in youth than in old age • Higher rate of impulsive suicide attempts and

completions

Other High Risk Groups • Vietnam War Veterans • Survivors of Natural or Man-Made Disasters • People with HIV/AIDS • Frequent and Addicted Gamblers • Targets of Schoolyard Bullies and Peer

Harassment • “Suicide by Cop” – confront a police officer to

force the officer to shoot in self-defense

Cultural Meanings of Suicide

• Suicide as Sinful • Judeo-Christian tradition • St. Augustine (5th century) objected because

• Doesn’t allow an opportunity to repent of other sins • Sixth commandment: Thou shalt not kill

• St. Thomas Aquinas (13th century) added • Only God has the power to grant life and death

• Controversy: Is martyrdom suicide? Did Jesus commit suicide?

Cultural Meanings of Suicide

• Suicide as Criminal • Most suicide laws have been erased • Insurance companies will pay some death

benefits when suicide occurs • Suicide as Weakness or Madness

• Highest rates among depressed psychotics • Survival of the fittest (and the weak commit

suicide)

Cultural Meanings of Suicide

• Suicide as “The Great Death” • Called daishi in Buddhism (China and Japan) • Seppuku, traditional Japanese suicide, is

personal disembowelment with a sword • Romans (classical period) viewed suicide as

noble and glorious • Suicide as a Rational Alternative

• Often attributed to Stoicism • Death is preferable to a miserable life

Durkheim: Four Types of Suicide • Egoistic

• Not under sufficient cultural control • Those whose talents or stations in life give them

special status (like celebrities or creative artists) • Altruistic

• Exaggerated or excessive concern for the community • Anomic

• Society as cast this person aside (like the homeless) • Fatalistic

• Society is too controlling (suicide is the only way out)

Individual Meanings of Suicide

• Suicide for Reunion • Suicide for Rest and Refuge • Suicide for Revenge • Suicide as Penalty for Failure • Suicide as a Mistake

A Psychoanalytical Approach to Suicide • Early Freudian Approach: What looks like

suicide is a symbolic murder of another person

• Later Freudian Approach: We have two instinctual drives • Life instinct, Eros • Death instinct, Thanatos

Underlying Causes of Suicide: The Biological View • Family pedigree and twin studies support the

position that biological factors contribute to suicidal behavior o For example, there are higher rates of suicide among

the parents and close relatives of those who commit suicide than among nonsuicidal people

• As always with this type of research, however, nonbiological factors and interpretations must also be considered

Underlying Causes of Suicide: The Biological View • Recent laboratory research has offered more

direct support for a biological model of suicide o Serotonin levels have been found to be low in people

who commit suicide • There is a known link between low serotonin and depression

o There is evidence, though, of low serotonin activity among suicidal subjects with no history of depression

• Serotonin activity may contribute to aggressive behavior

The Descent Toward Suicide

• A loss and/or trauma that deprives the person of emotional support

• Losing hope for a satisfying life • Sense of descending, sinking, falling slowly

into a subhuman kind of existence • Withdrawal and communication breakdown

increasingly isolates the individual

The Descent Toward Suicide • Constructing a façade as protection against

further emotional pain • Suicidal trance (restricted range of thoughts and

feelings) • Feeling trapped in a tunnel and death is the only

way out • An impression that death is somehow beckoning

the individual • A precipitating event is likely to trigger the actual

suicide attempt

Popular Myths About Suicide • Myth: A person who talks about suicide will not

actually take her own life • Myth: Only a specific class of people commit

suicide • Myth: Suicide has simple causes that are easily

established • Myth: Asking people about suicide will put that

thought into their mind and encourage suicide attempts

Popular Myths About Suicide • Myth: Only depressed people commit suicide • Myth: Only crazy or insane people commit suicide • Myth: Suicidal tendencies are inherited • Myth: When a suicidal person shows improvement,

the danger is over • Myth: People who are under a physician’s care or

who are hospitalized are not suicide risks • Myth: Suicide can be prevented only by a

psychiatrist or mental hospital

Suicide Prevention

• Take the suicidal concern seriously • Do not issue a provocation to suicide • Go easy on value judgments • Do not get carried away by the “good

reasons” the person has for suicide • Know what resources are available • Listen

Three Emerging Challenges

• Do antidepressants help in prevention or add to the risk of suicide?

• What are the best ways for a vulnerable survivor of a suicide attempt to deal with the aftermath?

• How does social media impact suicide?