SUICIDE:PRECIPITATING FACTORS IN SUICIDE, VIEWS ON SUICIDE

<< MOOD DISORDERS:DIAGNOSIS, Further Descriptions and Subtypes, Social Factors

STRESS:Stress as a Life Event, Coping, Optimism, Health Behavior >>

Abnormal Psychology PSY404

Lesson 28

SUICIDE

No one commits suicide out of joy it is the psychological pain and agony that one wants to avoid.

Suicide has been observed throughout the history. It has been recorded among the ancient Chinese,

Greeks, and Romans. And in more recent times, suicides by such famous people as Ernest Hemingway and

Marilyn Monroe have both shocked and fascinated society.

Today suicide ranks among the top ten causes of death in Western society. According to the World

Health Organization, approximately 120,000 deaths by suicide occur each year. More than 30,000 suicides

are committed annually in the United States alone, by 12.8 out of every 100,000 inhabitants, accounting for

almost 2 percent of all deaths in the nation (McIntosh, 1991; National Center for Health Statistics, 1988). It

is also estimated that each year more than 2 million other persons throughout the world- 600,000 in the

United States- make unsuccessful attempts to kill themselves; these people are called parasuicides

(McIntosh, 1991).

What is Suicide?

One of the most influential writers on this topic defines suicide as an intentioned death- a self-

inflicted death in which one makes an intentional, direct, and conscious effort to end one's life.

Most theorists agree that the term "suicide" should be limited to deaths of this sort.

Intentioned deaths may take various forms. Consider the following three imaginary instances.

Although all of these people intended to die, their precise motives, the personal issues involved, and their

suicidal actions differed greatly.

PRECIPITATING FACTORS IN SUICIDE

i) Stressful Events and Situations

Researchers have repeatedly counted more undesirable events in the recent lives of suicide

attempters than in those of matched control subjects. In one study, suicide attempters reported twice as

many stressful events in the year before their attempt as non-suicidal depressed patients or non-depressed

psychiatric patients. An attempt may be precipitated by a single recent event or, a series of events that have

combined impact.

ii) Abusive Environment

Suicide is sometimes committed by victims of an abusive or repressive environment from which

there is little or no hope of escape. Prisoners of war, victims of the Holocaust, abused spouses, and prison

inmates have attempted to end their lives. Like those who have serious illnesses, these people may have

been in constant psychological or physical pain, felt that they could endure no more suffering, and believed

that there was no hope for improvement in their condition.

iii) Occupational Stresses

Certain jobs create ongoing feelings of tension or dissatisfaction that can precipitate suicide

attempts. Research has found particularly high suicide rates among psychiatrists and psychologists,

physicians, dentists, lawyers and unskilled laborers.

iv) Role Conflict

Another long-term stress linked to suicide is role conflict. Everyone occupies a variety of roles in

life. The role of a spouse, employee, parent and colleague are some of the few to name. These different

roles maybe in conflict with one another and they may cause considerable stress. In recent years researchers

have found that women who hold jobs outside of the home often experience role conflicts-conflicts

133

Abnormal Psychology PSY404

between their family demands and job requirements, for example, or between their social needs and

vocational goals- and that these conflicts are reflected in a higher suicide rate.

v) Mood and Thought Changes

Many suicide attempts are preceded by a shift in the person's mood and thought. Although these shifts may

not be severe enough to warrant a diagnosis of a mental disorder, they typically represent a significant

change from the person's past mood or point of view.

"No one commits suicide out of joy. Pain is what the suicidal person seeks to escape".

In the cognitive realm, many people on the verge of suicide frequently develop a sense of hopelessness- a

pessimistic belief that their present circumstances, problems, and negative will not change.

vi) Alcohol Use

Studies indicate that between 20 and 90 percent of those who commit suicide drink alcohol just

before the act (Hirschfeld & Davidson, 1988). Autopsies reveal that about one-fifth of these people are

intoxicated at the time of death.

vii) Mental Disorders

As we noted earlier, people who attempt suicide do not necessarily have a mental disorder. On the

other hand, between 30 and 70 percent of all suicide attempters do display a mental disorder.

VIEWS ON SUICIDE

i) The Psychodynamic View

Psychodynamic theorists believe that suicide usually results from a state of depression and a

process of self-directed anger. This theory was first stated by Wilhelm Stekel at a meeting in Vienna in 1910,

when he proclaimed that "no one kills himself who has not wanted to kill another or at least wished the

death of another".

Freud (1917) and Abraham (1916,1911) proposed that when people experience the real of

symbolic loss of a loved one, they come to "introject" the lost person; that is, they unconsciously

incorporate the person into their own identity and feel toward themselves as they had felt toward the other.

ii) The Biological View

Until the 1970s the belief that biological factors contribute to suicidal behavior was based primarily

on family studies. Researchers repeatedly found higher rates of suicidal behavior among the parents and

close relatives of suicidal people than among those of nonsuicidal people, suggesting that genetic, and

biological, factors were at work. Studies of twins also were consistent with this view of suicide (Lester,

1986). A study of twins born in Denmark between 1870 and 1920, for example, located nineteen identical

pairs and fifty-eight fraternal pairs in which at least one of the twins had committed suicide. In four of the

identical pairs the other twin also committed suicide (21 percent), while the other twin never committed

suicide among the fraternal pairs.

SUICIDE IN DIFFERENT AGE GROUPS

The likelihood of committing suicide generally increases with age, although individuals of all ages

may try to kill themselves. Recently particular attention has been focused on self-destruction in three age

groups- children, partly because suicide at a very young age contradicts society's perception that childhood is

an enjoyable period of discovery and growth; adolescents and young adults, because of the steady and highly

134

Abnormal Psychology PSY404

publicized rise in their suicide rate; and the elderly, because suicide is more prevalent in this age group than

any other.

Adolescents and Young Adults

Suicidal actions become much more common after the age of 14 than at any earlier age. In the

United States more than 6,000 adolescents and young adults kill themselves each year; that is, more than 13

of every 100,000 persons between the age of 15 and 24 (Center for Disease Control, 1987).

Teenagers

Approximately 3,000 teenagers commit suicide in the United States each year, and as many as

250,000 may make attempts. Moreover, in a recent Gallup Poll (1991) a full third of teenagers surveyed said

they had considered suicide, and 15 percent said they had thought about it seriously.

Some of the major warning signs of suicide in teenagers are tiredness and sleep loss, loss of

appetite, mood changes, decline in school performance, withdrawal, increased smoking, drug or

alcohol use, increased letter to friends, and giving away valued possessions

College Students

The suicide rate tends to be higher for 18-to-24 -year-old college students than for other young people in

the same age range. Again, female students are more likely to attempt suicide, but fatal suicides are more

numerous among males. Furthermore, studies suggest that as many as 20 percent of college students have

suicidal thoughts at some point in their college career (Carson & Johnson, 1985).

Rising Suicide Rate

The suicide rate for adolescents and young adults is not only high but increasing. The suicide rate for this

age group has more than doubled. Several theories, each pointing to societal changes, have been proposed

to explain why the suicide rate among adolescents and young adults has risen dramatically during the past

few decades. First, noting the overall rise in the number and proportion of adolescents and young adults in

the general population Paul Holinger and his colleagues (1991, 1988, 1987, 1984, 1982) have suggested

that the competition for jobs, college positions, and academic and athletic honors keeps

intensifying in this age group, leading increasingly to shattered dreams and frustrated ambition,

which in turn lead to suicidal thinking and behavior.

TREATMENT AND SUICIDE

Treatment of people who are suicidal falls into two major categories:

(1) Treatment after suicide has been attempted and

(2) Suicide prevention.

Today special attention is also given to relatives and friends (Carter & Brooks, 1991; Farberow,

1991) whose bereavement, guilt, and anger after a suicide fatality or attempt can be intense. Although many

people require psychotherapy or support groups to help them deal with their reaction to a loved one's

suicide, the discussion here will be limited to the treatment afforded suicidal people themselves.

I) Treatment after Suicide Attempt

After a suicide attempt, the victims' primary need is medical care. Some are left with severe injuries,

brain damage, or other medical problems. Once the physical damage is reversed, or at least stabilized, a

process of psychotherapy may begin. Unfortunately, even after trying to kill themselves, many suicidal

people fail to become involved in therapy.

135

Abnormal Psychology PSY404

II) Suicide Prevention

During the past thirty years emphasis has shifted from suicide treatment to suicide prevention. The

emphasis on suicide prevention is labeled as suicide prevention programs.

In addition, many mental health centers, hospital emergency rooms, pastoral counseling centers,

and poison control centers now include suicide prevention programs among their services.

Suicide prevention centers define suicidal people as people in crisis that is, under great stress,

unable to cope, feeling threatened or hurt, and interpreting their situations as unchangeable.

Accordingly, the centers try to help suicidal people perceive things more accurately, make better

decisions, act more constructively, and overcome their crisis. Because crises can occur at any time,

the centers have 24-hour-a-day telephone service ("hot lines") and also welcome clients to walk in

without appointments. Those who call reach a counselor, typically a paraprofessional a person

without previous professional training who provides services under the supervision of a mental

health professional (Heilig et al., 1983).

Although specific features vary from center to center, the general approach used by the Los

Angeles Suicide Prevention Center reflects the goals and techniques of many of them. During the initial

contact, the counselor has several tasks: establishing a positive relationship, understanding and clarifying the

problem, assessing suicide potential, assessing and mobilizing the caller's resources, and formulating a plan

to overcome the crisis.

The Effectiveness of Suicide Prevention

Do suicide prevention centers reduce the number of suicides in a community? Clinical researchers

do not know. It is important to note, however, that the increase in suicide rates found in some studies may

reflect society's overall increase in suicidal behavior. One investigation found that although suicide rates did

increase in certain cities with prevention centers, they increased even more in cities without such centers.

After trying to kill themselves, some suicidal people receive therapy. The goal of therapy is

to help the client achieve a non-suicidal state of mind and develop more constructive ways of

handling stress and solving problems. Various therapy systems and formats have been employed.

Over the past thirty years, emphasis has been shifted form suicide treatment to suicide prevention

because the last opportunity to keep many suicidal people alive comes before their first attempt. Suicide

prevention programs generally consist of 24-hour-a-day "hot lines" and walking centres operated by

paraprofessionals. During their initial contact with someone considered suicidal, these counsellors seek to

establish a positive relationship, to understand and clarify the problem, to assess the suicide potential, to

assess and mobilize the caller's resources, and to formulate a plan for overcoming the crisis. Although such

crisis intervention may be sufficient treatment for some suicidal people, longer-term therapy is needed for

up to 60 percent of them. Apparently, only a small percentage of suicidal people contact prevention centres.

While clinical scientists know a great deal about suicide, they do not yet fully comprehend why

people kill themselves. Furthermore, myths about suicide and suicide intervention abound, perhaps

contributing to tragedies that might otherwise be averted.

136

Table of Contents: